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Progress Seen in Managing Blacks With HIV

Progress Seen in Managing Blacks With HIV

Research has shown that the percentages of blacks who are linked to and retained in HIV care, taking antiretroviral therapy (ART), and achieving viral suppression are lower than those of other racial and ethnic groups. According to recent estimates, blacks account for 44% of the total number of people in the United States living with HIV but represent just 12% of the U.S. population. The National HIV/AIDS Strategy was developed in an effort to reduce the number of new HIV infections, increase access to care, improve health outcomes for those with HIV, and reduce HIV-related health disparities. “To achieve these goals, blacks with HIV need high levels of care and viral suppression,” says Y. Omar Whiteside, PhD. Achieving these goals calls for 85% of blacks with diagnosed HIV to be linked to care, 80% to be retained in care, and the proportion with undetectable viral loads to increase by 20% by 2015. A Large Analysis In an issue of the Morbidity & Mortality Weekly Report, Dr. Whiteside and colleagues conducted a study to provide clinicians with proxy measures to determine where the U.S. stands in achieving the goals outlined in the National HIV/AIDS Strategy. The analysis included 19 jurisdictions with complete reporting of all levels of CD4 and viral load test results. These jurisdictions represented 44% of all blacks with HIV living in the U.S. in 2010. The study found that about 75% of blacks diagnosed with HIV were linked to care, but less than half received regular care or were prescribed ART, and only about one-third had achieved viral suppression. “One of the most important findings was that...

Drug Wars in the Exam Room

As physicians, we have all been faced with patients inappropriately looking for prescriptions for controlled substances. Some are looking to abuse them and some to divert them for profit. It is often hard to distinguish when a patient truly needs these medications or when they are just “drug-seeking.” More experienced doctors have a better sense of which patients are which. Drug-seeking patients often play on our emotions because they know we generally care about patients and may have difficulty turning down a request for opioids from someone in supposed pain. For years, patients have used many ruses to access these medications. Many of them “doctor shop,” use several pharmacies, or frequent various emergency rooms, making it difficult to track their prescriptions. And it’s much harder for a doctor to turn down a request from a new patient in acute pain than from one the doctor knows well and doubts. Having so many controlled substances available and sold on the streets has led to an increase in prescription drug dependency. These patients have a hard time breaking these addictions and often can only stop with help from special rehab programs. It has led to a further resurgence of IV heroin addiction and opioid deaths in many areas. As the states have tightened controlled substance prescriptions, they have become less available for diversion and are now a gateway drug to heroin—which is cheaper than prescribed medications. I am seeing teens in my practice addicted to IV heroin, a habit that started by raiding parents’ or relatives’ medicine cabinets. It has never been more imperative for doctors to step up and do...
Managing Skin Abscesses in the MRSA Era

Managing Skin Abscesses in the MRSA Era

Abscesses are one of the most common skin conditions encountered by general practitioners and emergency physicians, and the incidence of these infections has increased in recent years. In addition, MRSA infections have become one of the most common causes of skin abscesses. “Community-associated MRSA (CA-MRSA) has also been shown to cause severe infections in non-immuno-compromised hosts,” explains David A. Talan, MD, FACEP, FIDSA. “We’re still unsure as to why CA-MRSA appears to be more virulent than other healthcare–associated strains and methicillin-susceptible Staphylo-coccus aureus. Unfortunately, the management of skin abscesses is highly variable throughout the country.” In a review article published in the New England Journal of Medicine, Dr. Talan and Adam J. Singer, MD, described helpful approaches to managing common skin abscesses that generally involve the extremities and trunk. “When possible, our recommendations were based on randomized trials,” Dr. Talan says. “However, many recommendations are based on small observational studies or expert opinion. While there may be some disagreement, the approaches we advise have been both workable and useful in our practice.” Diagnosis Skin abscesses typically appear as a swollen, red, tender, and fluctuant mass, often with surrounding cellulitis. The diagnosis of skin abscesses based on physical exams is often straightforward and proven correct by incision and drainage. Ultrasonography may be helpful for cases in which the abscess is deep, complex, or obscured by extensive cellulitis. It may also be helpful for patients treated for cellulitis in which initial antibiotic treatment fails and to ensure the adequacy of drainage. Needle aspiration is an alternative approach to diagnosing and treating abscesses. Treatments “Standard incision and drainage is the mainstay of...
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