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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...
Clinical Questions at the Point of Care

Clinical Questions at the Point of Care

Since the 1980s, studies have shown that clinicians frequently raise questions during patient encounters in all healthcare settings. These studies have suggested that although questions arise frequently, they often go unanswered. “Unanswered questions should be seen as an opportunity to improve outcomes by filling gaps in medical knowledge,” says Guilherme Del Fiol, MD, PhD. He adds that understanding clinicians’ questions is essential to guiding the design of interventions that aim to provide the right information at the right time. According to Dr. Del Fiol, there are challenges associated with maintaining current knowledge in medicine. “Several factors can come into play,” he says. “Science is continuing to expand medical knowledge, but this can make it increasingly complex to appropriately deliver healthcare. In addition, the aging population continues to grow, a phenomenon that further complicates how easily clinicians can address more difficult questions at the point of care.” No systematic reviews have been available on the clinical questions raised by clinicians in the context of patient care and decision making. A Systematic Review on Clinical Questions Dr. Del Fiol and colleagues recently conducted a systematic review of the literature on clinicians’ questions. Published in JAMA Internal Medicine, the research focused on the need for general medical knowledge that could be obtained from books, journals, specialists, and online resources. The systematic review took into account the frequency by which clinicians raised clinical questions, how often these questions were pursued and how often answers were successfully found, and the types of questions that were typically asked. They also sought to determine overriding themes and the potential effects of information seeking on clinicians’ decision...
Recognizing & Treating Caregiver Burden

Recognizing & Treating Caregiver Burden

Research has shown that unpaid family or informal caregivers provide as much as 90% of the in-home long-term care that is needed by adults. A 2009 study estimated that 65.7 million people in the United States served as unpaid family caregivers to an adult or child, two-thirds of whom provided care for an adult aged 50 or older. “The burden of caring for others is increasing because of our aging population, an increase in the number of people living with chronic disease, and a lack of formal support for caregivers,” says Ronald D. Adelman, MD. In addition to providing assistance with basic and instrumental activities of daily living and medical support, caregivers also provide emotional support and comfort. The economic burden of informal caregiving is substantial, with a recent study estimating that the cost of informal dementia caregiving was $56,290 annually per patient. Furthermore, many caregivers have little choice in taking on a caregiving role, and many report feeling ill prepared to take on these responsibilities. “Many caregivers are unaware of the toll that caregiving takes on them, making them more vulnerable to other serious health problems,” Dr. Adelman says. “In addition, caregivers often receive inadequate support from health professionals and frequently feel abandoned and unrecognized by the healthcare system.” Diagnosis & Assessment of Caregiver Burden In a recent issue of JAMA, Dr. Adelman and colleagues reviewed cohort studies and other analyses to provide strategies to diagnose, assess, and intervene for caregiver burden. Several risk factors for caregiver burden were identified, including female sex, low educational attainment, and residing with care recipients. Depression, social isolation, financial stress, a higher...
AIDS 2014

AIDS 2014

New research is being presented at AIDS 2014, the 20th International AIDS Conference, from July 20 to 25 in Melbourne, Australia. Physician’s Weekly offers its sincerest condolences to the families, friends, and colleagues of those who lost their lives while en route to AIDS 2014–as well as all the passengers and crew–on board Malaysian Airlines flight MH 17 that was shot down over Ukraine yesterday.   Meeting Highlights Can Video Games Increase Patient HIV Knowledge? HIV Testing Low Among Teens Benefits Seen With At-Home HIV Treatment PrEP Deemed Safe for Moms & Fetuses HIV Diagnosis Rates Declining News From the Meeting AIDS 2014 Ends with Calls for Uniting HIV, Global Health and Human Rights 20th International AIDS Conference Photo Gallery Now or Never: The Urgency of Closing the Treatment Gap for Children Living With HIV/AIDS  Adult Male Circumcision Also Protects Women from HIV Infection (video) Put Patient’s Health First to Improve Outcomes and Program Efficiency: Bill Clinton’s Presentation (video) Rx Switching Tied to HIV Viral Breakthrough South Korean Patients Have Nowhere to Go as World Gathers to Discuss HIV/AIDS Cancer Drug First to Wake Dormant HIV Fast-Tracking the Global HIV Reponse – Day 5 at AIDS 2014. Sir Bob Geldof Says the ‘Last Mile’ of the HIV Epidemic Must Be Funded Treating HIV Cuts National Infection Rates Men Who Have Sex With Men Getting Tx Sooner Tox-Sparing HIV Regimen Falls Short ‘Kick’ Study Excites AIDS Meeting How the Dutch Pay Tribute to the Victims of MH17 (A Photo Album) New HIV Guidelines Released by WHO A ids-Free Generation Within Reach if We Boost HIV Treatment, Says Bill Clinton Three-Drug Cocktail Has...
Updating Adult Vaccination Recommendations

Updating Adult Vaccination Recommendations

Research has shown that current vaccination rates for adults are low. “There are 14 different infectious agents for which vaccines are recommended for adults, but vaccination rates are low for a number of reasons,” says Carolyn B. Bridges, MD. “There is limited public awareness about the need for vaccines for adults besides influenza. Also, patients rely on recommendations about vaccines from their providers, but many providers don’t routinely assess vaccination status and follow with recommendations for the vaccines their patients need.” Each year, the Advisory Committee on Immuni­zation Practices (ACIP) reviews and updates its recommended immunization schedule for adults aged 19 and older. Each February, the schedule is updated on the CDC website (www.cdc.gov/vaccines). The schedule provides a brief summary of ACIP recommendations using figures and footnotes to describe which patients are recommended to receive each vaccine and a table that describes the primary contraindications and precautions for each vaccine. Strategies for Improvement A number of strategies can help incorporate adult vaccinations into clinical practice, including systems changes so that vaccines are routinely assessed and offered. Other strategies include using reminders for healthcare providers (HCPs), such as prompts in electronic health records, using protocols or standing orders for office staff, and sending reminders to patients about needed vaccines. According to Dr. Bridges, one of the most important elements in improving vaccination rates is making sure patients hear from their provider about which vaccines they need. The CDC has partnered with many organizations to update the Standards for Adult Immunization Practice. The standards are a call to action for providers to: – Assess vaccination needs among patients in every clinical...
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