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Identifying Families at High Genetic Risk of Cancer

Cancer can be defined as sporadic, familial, or hereditary. This classification can assist nurses in identifying individual family members at risk for cancer and developing a plan for cancer screening, prevention, and risk reduction. Distinguishing the type of cancer can also help determine whether genetic testing is appropriate for individuals in a particular family: Sporadic cancers (SCs) account for the majority of cancers diagnosed in the United States. SCs occur due to errors of DNA replication in genes that normally function to promote cell growth and development, and typically develop after the age of 60. Familial cancers are characterized by an increase in the number of cancers within a family; however, the pattern of cancers is not consistent with a hereditary cancer syndrome. Unaffected, close relatives are considered to be at increased risk of developing the cancers seen within the family when compared with the general population. Hereditary cancer syndromes (HCSs) are attributable to mutations in specific genes that are inherited from either parent in an autosomal dominant (AD) or recessive pattern. Only about 5% to 10% of all cancers are hereditary. Individuals who inherit a highly penetrant cancer susceptibility gene are likely to develop cancer within their lifetime. The challenge for busy healthcare providers is to identify high-risk individuals and to assure access to comprehensive risk assessment services. Identifying Hereditary Cancer Risk A three-generation pedigree of both the maternal and paternal lineage is constructed to identify HCSs. First-degree relatives (parents and siblings) share 50% of their genes; second-degree relatives (aunts, uncles, and grandparents) share 25% of their genes; and third-degree relatives (cousins) share approximately 12.5% of their genes....
Autism Checklist at 12-Months May Facilitate Treatment

Autism Checklist at 12-Months May Facilitate Treatment

A simple 24-item checklist may help physicians identify children with autism spectrum disorders (ASDs) as early as 1-year old, triggering earlier and potentially more effective treatment. The checklist can be completed by parents or caregivers in 5 minutes and scored in less than 2 minutes by medical staff. In a new pilot study published online in the Journal of Pediatrics, nearly 10,500 babies were screened by the checklist which covers three areas: social and emotional communication, receptive and expressive speech, and symbolic behavior. Of those infants, 184 failed the screen and were further evaluated and tracked. Of those 184, researchers claimed that 32 received a provisional or final diagnosis of ASDs, 56 were diagnosed with language delays (5 of which ended up being false positives), 9 were diagnosed with developmental delays, and 36 were diagnosed with “other” deficits. The remaining 46 infants were false positives. While such a program needs further evaluation and long-term follow-up, the take home message is clear: pediatricians can play a significant role in identifying children with possible ASD at a very young age, prompting earlier diagnosis and treatment—a critical factor in the management of developmental...

Guidelines for Managing Achilles Tendon Rupture

When an Achilles tendon ruptures, the forces placed on the tendon exceed its tensile limits. Patients who sustain these injuries often experience sudden pain in the affected leg, difficulty with weight-bearing, and weakness of the affected ankle. “The Achilles tendon is one of the strongest tendons in the body, and a rupture can be quite disabling,” explains Christopher P. Chiodo, MD. “The healing period after a rupture requires time away from work and limits athletic activity. Time away from work may have a financial impact on patients, and limiting activity may affect patients’ overall health and well-being.” Achilles tendon rupture is more common in men who are in their 30s and 40s, but more people are staying active as they age, meaning that these injuries can occur in older age groups. An acute Achilles tendon rupture affects 5.5 to 9.9 of every 100,000 people in North America each year. There are currently no treatment regimens that are universally agreed upon. The aims of treatment include ascertaining a timely and accurate diagnosis, achieving pain relief, restoring functional status, and returning to pre-rupture activities. “Once a timely and accurate diagnosis is made, clinicians and patients must discuss both conservative strategies (eg, casts or braces) and surgical treatment,” Dr. Chiodo says. New Evidence-Based Guidelines The American Academy of Orthopaedic Surgeons (AAOS) has released an evidence-based clinical practice guideline on the diagnosis and treatment of acute Achilles tendon rupture. Available on AAOS’s website (www.aaos.org), the goal of the guidelines is to provide assistance to providers who are qualified to treat Achilles tendon ruptures. “These recommendations give guidance on how to select treatment options...
Physician Turnover Rates Increase As Economy & Housing Market Improve

Physician Turnover Rates Increase As Economy & Housing Market Improve

Physician turnover rates appear to track with conditions in the economy and housing markets, according to the 6th annual Physician Retention Survey from the American Medical Group Association and Cejka Search. Is it as simple case of physician supply and demand? It appears that a worsening economy and drop in home sales may cause physicians to delay retirement and relocation. This may be cause for concern in 2011 as improvements in the marketplace may mean medical groups should prepare for greater turnover. Medical groups are now encouraged to offer flexible work options to retain physicians at all stages of their careers.  The consensus from the medical groups responding to the 2010 survey indicates: 51% said they do not encourage physicians to delay their retirement. 90.6% provide flexible hour incentives. 62.5% offer no call incentives. 65.6% offer reduced call incentives. Medical groups that provide flexible practice models supporting physicians’ lifestyle choices throughout their careers seem to be successfully hiring and retaining physicians. In the 2010 survey, 13% of male physicians practiced part-time and 36% of females practiced part-time, compared with 7% and 29%, respectively, in 2005. What other motivational factors might medical groups consider to retain some of their top physicians as the economy...

Updated Guidelines for Secondary Stroke Prevention

The American Heart Association/American Stroke Association (AHA/ASA) released updated guidelines to prevent subsequent stroke in survivors of ischemic strokes or transient ischemic attacks (TIAs). Specifically, the guidelines—which were published in the January 2011 issue of Stroke—include new recommendations for treating metabolic syndrome, stenting of the carotid artery, and atrial fibrillation, among other updates. The update revised previous recommendations from 2006 and reflected new evidence from recent investigations and analyses pertaining to secondary stroke prevention. This guideline is one of five “flagship” evidence based statements from the AHA/ASA, which are revised every 3 years. They are designed to assist clinicians in making important treatment decisions after stroke or TIA. Metabolic Syndrome & Stenting Updates Among the new recommendations made in the section on metabolic syndrome is that clinicians are now advised to treat individual components that are also stroke risk factors, particularly dyslipidemia and hypertension, in order to prevent a second stroke or TIA in individuals with metabolic syndrome. All patients with carotid artery stenosis and a TIA or stroke should receive optimal medical therapy, including antiplatelet therapy and statins, as well as risk factor modifications. Another important note is that the utility of screening patients for metabolic syndrome after stroke is unknown, so more research is necessary in this component of stroke management. “As the data continue to shed light on emerging therapies and technologies, the hope is that we’ll be able to decrease the burden of stroke and TIA more in the future.”  The section on carotid artery stenting (CAS) for extracranial symptomatic carotid disease was also updated because of recent large clinical trials. CAS can be used as...

Comorbidities in ADHD

Clinical management of ADHD should address multiple comorbid conditions and manage a range of adverse functional outcomes, according to findings from a UCLA research team. Investigators found that children with ADHD were more likely to have other mental health and neurodevelopmental conditions. Parents reported that 46% of children with ADHD had a learning disability vs 5% without ADHD; 27% vs 2% had a conduct disorder; 18% vs 2% anxiety;14% vs 1% depression; and 12% vs 3% speech problems. Most children with ADHD had at least one comorbid disorder, and 18% had three or more. The study recommended that therapeutic approaches be responsive to each...
Tonight’s Cocktails Shake Up Tomorrow’s Surgical Skills

Tonight’s Cocktails Shake Up Tomorrow’s Surgical Skills

No matter how experienced the surgeon, a study found that after a night of drinking, surgeons’ skills were subpar well into the following day. In the April issue of Archives of Surgery, a small study found that the skills of experienced laparoscopic surgeons remained impaired as late as 4pm the next day following a night of binge drinking. According to researchers, surgeons’ performance declined significantly from baseline with respect to the time to complete a test in a virtual reality training system, economy of diathermy use, and error scores. This may be of particular concern when it comes to laparoscopic surgery because laparoscopic techniques rely heavily on cognitive, perceptual, and visuospatial abilities—skills vulnerable to the effects of alcohol. In the study, researchers tested surgeons randomized to abstain from alcohol or to consume alcohol until subjectively intoxicated. The test was composed of 6 increasingly complex tasks that are commonly performed by laparoscopic surgeons—and the test was conducted three times throughout the day: 9am, 1pm, and 4pm. The alcohol group registered significantly worse performance on diathermy and made significantly more errors. Compared to baseline test results, surgeons who consumed alcohol made more errors at all three test times—the difference reaching statistical significance only at 1 pm. There are no rules or guidelines to govern the consumption of alcohol the night before surgical responsibilities, even though alcohol consumption has widely recognized effects on performance across multiple jobs and...
Key Points From New Alzheimer’s Guidelines

Key Points From New Alzheimer’s Guidelines

For the first time in nearly 30 years, the diagnostic criteria for Alzheimer’s disease (AD) have been updated in the April 19 online issue of Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. The guidelines provide new criteria, including mild cognitive impairment (MCI) due to AD as well as specifically differentiating what can be used in clinical practice and what is intended to remain in research settings only. The document establishes earlier stages of the disease in the hopes of spotting and possibly treating the condition much sooner than it is currently. However, despite the buzz about new scans and blood and fluid tests that claim to show early signs of AD, the guidelines specify that they are still just tools for research and do not advise physicians to modify how they evaluate and manage patients. Three working groups were convened to cover AD dementia, MCI due to AD, and preclinical AD. Among the new and maintained recommendations, the working groups established some of the following key points: The AD working group retained the core clinical criteria framework of probable AD dementia from the criteria published in 1984, which will continue to be the cornerstone of diagnosis in clinical practice. However, biomarker evidence is expected to enhance the pathophysiological specificity of the diagnosis of AD dementia. The MCI working group included the use of biomarkers, such as advanced imaging of cerebrospinal fluid markers of disease, in the research setting. The final set of criteria for MCI has four levels of certainty: • Concern regarding a chance in cognition • Impairment in one or more cognitive domains • Preservation...

A New Approach for Managing CDAD

Clostridium difficile-associated diarrhea (CDAD) can present variably as a mild diarrheal illness to severe diarrhea, colitis, and, in the most serious cases, death. Patients may experience 20 or more diarrheal episodes daily with resulting dehydration. CDAD affects more than 700,000 people in the United States annually, but the incidence may be higher because cases are often underreported, undiagnosed, or left untreated. Estimates for medical treatment and hospital stays associated with CDAD have been reportedly as high as $3.8 billion annually. Risk Factors & Recurrence of CDAD Patients typically develop CDAD from the use of broad-spectrum antibiotics that disrupt the normal gastrointestinal (GI) flora. This can allow C difficile to sporulate and proliferate. Older patients are at particularly high risk for CDAD, possibly because of a weakened immune system or the presence of underlying disease. About two-thirds of CDAD patients are 65 or older. Other risk factors associated with CDAD include (but are not limited to) prolonged hospital stays, renal impairment, recent abdominal surgery, and sharing hospital rooms with CDAD-infected patients. About 20% to 30% of patients experience CDAD recurrence following treatment. Risk factors for recurrence of CDAD include older age, concomitant antibiotics, low albumin, poor performance status, poor immune response to toxins, and fecal incontinence. In patients who have experienced up to two episodes of CDAD, risk of recurrence increases to 50% to 65%. A Welcome Treatment Addition for CDAD Metronidazole (Flagyl, Pfizer) and vancomycin (Vancocin, ViroPharma) have long been used as therapies for patients with CDAD. Vancomycin is FDA approved for this use. Metronidazole does not carry an FDA indication for treatment of CDAD but became popular after...

Striving Toward Quality Pain Management

The epidemic of untreated chronic or recurrent pain has lasted for decades, yet millions of people are still not adequately treated. One significant barrier to effective pain management is that clinicians and patients are often reluctant to talk about pain. Oftentimes, patients with pain believe their complaints aren’t taken seriously by their healthcare providers or they’re concerned about becoming addicted to certain pain medications. Many physicians also have difficulty managing pain, which can then have an impact on patient care and management. Some doctors have concerns or reservations about their ability to manage pain appropriately, the potential for substance abuse and addiction, or regulatory scrutiny. There is a significant knowledge deficit in the management of pain, especially when it comes to treatment options and the potential harms associated with available therapies. The unintended or undesirable side effects related to pain treatment can have a negative impact on patients, ranging from minor to life-threatening adverse events. Patient perceptions of side effects can also play a role. In some cases, patients may abandon their treatment due to side effects, even though these therapies have the potential to reduce pain and suffering and improve quality of life and physical function. “There is a significant knowledge in the management of pain, especially when it comes to treatment options and potential harms associated with available therapies.” Education is Critical No single treatment option for pain management is without risk, but physicians must also consider the risks involved with making decisions to not treat pain. There is a general lack of education in medical schools and during residency training on pain management. Many of the...

An Effective Intervention for Managing Depression in Primary Care

The inadequate treatment of depression in primary care settings continues to be a major public health problem despite efforts to improve care. “In primary care, most depressed patients have chronic or recurrent depression,” explains Michael S. Klinkman, MD, MS, “and many cases are further complicated by comorbid health disorders. Treatment protocols that are designed to improve the effectiveness of acute-phase care apply only to a small fraction of the depressed patients that are seen by primary care physicians [PCPs].” The DPC Intervention Dr. Klinkman and colleagues at the University of Michigan had a study published in the September/October 2010 Annals of Family Medicine in which the Depression in Primary Care (DPC) intervention was assessed. “The primary aim of the DPC project was to develop, implement, and evaluate the effectiveness and sustainability of a depression management program that could support how PCPs manage patients in both acute and chronic phases of treatment,” says Dr. Klinkman. The DPC clinical intervention included several components, including care managers who offered support at specific sites, disease monitoring and clinician feedback, patient activation and self-management assistance, and a clinical information system in which a secure email system enabled care managers, PCPs, and consultation-liaison psychiatrists to communicate efficiently to coordinate care. The DPC intervention consisted of a series of telephone calls and email exchanges between enrollees and care managers, care managers and referring physicians, and, on occasion, care managers and consultation-liaison psychiatrists (Table 1). Dr. Klinkman says “the primary goals were to increase enrollees’ self-management of depression and provide feedback to referring physicians about clinical progress and possible complications in treatment.” The intake telephone call, which required 20 to...
Reporting EHR Meaningful Use for Medicare Bonus Has Begun

Reporting EHR Meaningful Use for Medicare Bonus Has Begun

Physicians using an electronic health record (EHR) system in a “meaningful” way and who hope to qualify for the $18,000 incentive payment from Medicare this year can now report that they have met the requirements (starting Monday, April 18). This incentive is due to the economic stimulus legislation, the American Recovery and Reinvestment Act, from 2009. The first Medicare incentive checks will be cut by the Centers for Medicare and Medicaid Services (CMS) in May. Physicians can file an “attestation” report, submitting online at the CMS website. Physicians who satisfy meaningful use requirements (improving and streamlining patient care with digital technology) for the first time in either 2011 or 2012 will receive $18,000 that year. Annual payments will decrease over the next 4 years, adding up to $44,000. All incentive payments cease after 2016. Starting in 2015, physicians who fail to demonstrate meaningful use of an EHR system starting in 2015 will experience financial consequences: a 1% reduction in Medicare reimbursement. This reduction will increase to 2% in 2016, and 3% in 2017 and...
New Guidelines on Painful Diabetic Neuropathy: Summary

New Guidelines on Painful Diabetic Neuropathy: Summary

Painful diabetic neuropathy (PDN) is estimated to affect 16% of the more than 25 million people who have diabetes in this country. Unfortunately, the condition is often unreported and untreated. The American Academy of Neurology (AAN) released new guidelines on the treatment of PDN, providing physicians with evidence-based management on use of various pharmacologic agents (ie, anticonvulsants, antidepressants, and opioids) as well as nonpharmacologic treatment (ie, transcutaneous electrical nerve stimulation and magnetic field treatment). Click below for a snapshot of  the strong evidence (Level A) and moderate evidence (Level B) recommendations that were in the guidelines released by the AAN:  ...
Docs Choose Riskier Treatment for Themselves

Docs Choose Riskier Treatment for Themselves

Physicians will more likely select a treatment for themselves that is riskier and has a higher death rate but less chance of adverse complications—but they would recommend an opposite course for their patients, according to a study in the new issue of Archives of Internal Medicine. The study, conducted by researchers from Duke University and the University of Michigan, asked physicians to choose between two treatment options for cancer and the flu – one with a higher risk of death and one with a higher risk of serious, lasting complications. Of over 240 internists and family physicians responding to a survey involving a theoretical scenario involving colon cancer treatment, approximately 38% chose the treatment that carried a higher mortality rate but lower rate of adverse effects—and only 25% said they would recommend that option for a patient. Of almost 700 physicians who responded to a similar question about the avian flu, 63% chose the treatment with the higher-mortality rate and lower adverse-effect rate, while only 49% recommended the same option for a patient. In an accompanying commentary on the study, physicians with the palliative-care program at the University of Rochester, NY Medical Center state wrote: “Physicians may be more able to imagine their patients’ abilities to adapt to significant disability than the patients themselves could, but only when considering the consequences for themselves can they imagine the level of suffering that might be a byproduct of an unfavorable outcome.” The act of making a recommendation appears to change the ways the physicians think regarding medical choices, according to study researchers. Having a better understanding of the thought process that occurs...

Updated Guidelines: Primary Stroke Prevention

In the February 1, 2011 issue of Stroke, the American Heart Association/American Stroke Association (AHA/ASA) released new guidelines for the primary prevention of stroke. The guideline reviews evidence on established and emerging risk factors for stroke. A significant change in these guidelines, which update a previous statement from 2006, is that clinicians are urged to address primary prevention of both ischemic and hemorrhagic stroke because the risk factors and prevention strategies for these events largely overlap. The critical role of a healthy lifestyle in the prevention of stroke is also emphasized. Areas of particular interest include emergency department (ED) screening, aspirin use among low-risk patients, asymptomatic carotid artery stenosis, and atrial fibrillation (AF), among other updates. ED screening for stroke risk represents an entirely new recommendation. Due to a lack of resources, there has been a surge in the number of people who receive care through the ED. This setting represents a unique opportunity to capture individuals at high risk of stroke and to offer information on smoking cessation programs, referrals for alcohol/drug abuse programs, screening for hypertension, and identification of AF. Aspirin Update A notable point in the AHA/ASA scientific statement is that aspirin is not recommended for preventing a first stroke in people at low risk or in those with diabetes or diabetes plus asymptomatic peripheral artery disease. Use of aspirin to prevent cardiovascular events—including but not limited to stroke—is recommended for those at sufficiently high risk. However, it’s important to weigh the risks, primarily bleeding, associated with treatment. Managing Asymptomatic Carotid Artery Stenosis Population screening for asymptomatic carotid artery stenosis is not recommended. An area that has...

The Framework for Eliminating HAIs

Healthcare-associated infections (HAIs) are one of the leading causes of death in the United States and are becoming increasingly problematic for hospitals and healthcare facilities throughout the country. The World Health Organization has reported that approximately 1.4 million people have an HAI at any given time. Compounding the problem is that little is known about the burden of infections outside of hospitals, particularly in long-term care facilities, ambulatory surgical centers, and other outpatient settings. The emergence of HAIs caused by multidrug-resistant microorganisms is another increasing concern. As Americans continue to age and healthcare costs continue to rise, the elimination of HAIs is paramount for improving patient health and healthcare savings. “The number of people who become sick or die from HAIs is unacceptably high, and these infections cause a significant financial burden,” says Denise Cardo, MD. “As consumers are increasingly asking for transparency and accountability in healthcare, their expectations on how well these infections are managed will continue to increase. This is a unique and timely opportunity to move toward the elimination of these infections.” Inconsistent Implementation According to Dr. Cardo, tried and true preventive measures for HAIs are inconsistently implemented. “The success of prevention efforts has varied considerably from one setting to the next,” she says. “However, we have a growing body of knowledge that defines a full range of prevention interventions that can address specific HAIs when consistently applied across settings. HAIs can be eliminated by implementing a proven framework for prevention at all levels of healthcare delivery. For the infections that we know how to prevent, we must prevent them consistently and effectively. For the infections...

Conference Highlights: CROI 2011

This feature highlights some of the studies that emerged from the 2011 CROI annual conference, including the protective effects of circumcision against HIV, treatment of HIV-tuberculosis coinfection, and research on HIV-resistant T cells. » Circumcision Provides Protection Against HIV » Prompt Treatment Needed for HIV-TB Coinfection » Nurse Care Effective in HIV Management » Optimism on HIV-Resistant T Cells  Circumcision Provides Protection Against HIV The Particulars: Previous research has suggested that circumcising men may help protect them in the future from contracting the HIV virus. Findings from recent original randomized trials have suggested that circumcision reduces the risk of catching HIV by about 50%. Clinicians have expressed some concern about the effect of male circumcision on changing sexual behaviors and the adoption of more risk practices. A study was conducted to see how circumcision affects both the risk of HIV and human behavior. Data Breakdown:Researchers found that HIV incidence was 73% lower among trial participants who were circumcised and those who got circumcised later when compared with those in a control arm who did not accept circumcision. Researchers offered men in the control arm the chance to be circumcised, and 80.4% accepted. Among control participants who were circumcised, the risk of HIV was reduced 67%, compared with the men who declined the procedure. In post-trial surveillance, the study group observed no change in the number of non-marital sex partners between intervention and control patients. There was also no significant difference in condom use between the 1,321 men who got circumcised and the 372 who did not. Take Home Pearls: The benefit of male circumcision for HIV prevention appears to persist, even...

Biceps Injuries: A Look at Treatment Trends

Each year, about 10 million people seek medical attention for shoulder injuries, and another 4 million present to physicians with arm injuries. Tendinitis of the long head of the biceps (LHB) is a common inflammatory tenosynovitis, which occurs as the tendon courses along its constrained path within the bicipital groove of the humerus. It typically presents with anterior shoulder pain and is often exacerbated by overuse. In many cases, LHB tendinopathy occurs in combination with other shoulder problems, particularly rotator cuff tendon injuries. “The goal in treating any LHB tendinopathy should be to address the pain in a way that also respects the patient’s lifestyle.” Despite plenty of research into the anatomy of the LHB tendon and conditions that affect it, there is still some controversy on the most appropriate management strategies for patients with these injuries. It’s known that tendinopathy of the LHB has inflammatory, degenerative, overuse-related, and traumatic causes, but the medical literature doesn’t provide evidence to support one specific treatment approach over another; there are advantages and disadvantages to consider for each procedure. In the November 2010 Journal of the American Academy of Orthopaedic Surgeons, my colleagues and I published a review on the diagnosis and treatment of LHB tendinitis to assist physicians who manage these injuries. Determining Treatment Approaches LHB tendinitis is associated with a variety of causes and a wide range of severity. As such, patients must receive a thorough patient history and physical examination, including radiographic imaging, to determine the appropriate diagnosis and treatment for their injury. Once a diagnosis has been established, patients will require non-surgical therapies—rest, ice, NSAIDs, activity modification, and physical therapy—as first-line treatment. Selective...
Discolored Sputum Does Not Signal Antibiotics

Discolored Sputum Does Not Signal Antibiotics

Adults with acute cough/lower respiratory tract infection who present with discolored sputum appear to be prescribed antibiotics more often than those with clear/white sputum, according to a recent study; however, antibiotic prescribing was not associated with recovery or benefit. Researchers of a large international study consisting of more than 3,400 patients in 13 countries investigated whether discolored sputum and feeling unwell are associated with antibiotic prescribing and whether there are benefits from antibiotic treatment for acute cough/lower respiratory tract infection. Patients with yellow or green sputum were prescribed antibiotics more than three times as frequently as those who had clear or white sputum. Antibiotic prescribing were not associated with a greater rate or magnitude of symptoms score resolution. Patients with yellow or green sputum feeling mildly unwell reported initial symptom scores of 23.3 out of 100 (patients not prescribed antibiotics) and 21.3 (patients prescribed antibiotics). After 7 days, those not taking antibiotics recorded an average symptom score of 4.3, compared with 3.9 in those taking antibiotics. The color of sputum appears to be commonly misinterpreted by both physicians and doctors to mean that antibiotics are needed.  In a time when there is an alarming increase in resistance of bacteria that cause community-acquired infections, the overuse and misuse of antibiotics continues to be a public health...
Winners Announced in Physician’s Weekly iPad Giveaway!

Winners Announced in Physician’s Weekly iPad Giveaway!

We are pleased to announce our two winners in the Physician’s Weekly iPad Giveaway promotion, which ended March 7 and pulled in more than 3,500 entries. At this writing, an iPad is en route to Robert Massey, a Physician Assistant with Exeter Hospital Emergency Dept. in Exeter, NH — who was chosen as a second-round winner. On the opposite side of the country, our second winner, Dr. Richard Tom, hails from Hawaii — where he practices internal medicine at Kaiser Permanente Moanalua Medical Center & Clinic in Honolulu. Upon receiving his new iPad, Dr. Tom wrote to us to say: “Just wanted to let you know I received the iPad yesterday and love it. By the way, great idea offering the iPad as a giveaway. It’s ideal for reading the PW newsletters.” We couldn’t agree more! Thanks to all our readers who entered the iPad contest. For those who did not win this time around, we are planning similar promotions in the months to come so check our website regularly for announcements, subscribe to the Physicians Weekly eNewsletter, or follow us at facebook.com/physiciansweekly and twitter.com/physicianswkly. Congratulations to our...
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