Category Archives: Clinical practice

Clinical practice

PPIs increase the risk for clostridium difficile says FDA

Last month the Food and Drug administration (FDA) formally put out an alert linking the risk of proton pump inhibitors (PPI) to clostridium difficile  associated diarrhea. Though this has been known for some time it was only now that the concerns have been raised to the level of a safety alert.

The PPIs are often viewed as a safe class of drug and are often started for valid reasons but not stopped even after the original indication is gone. As the incidence of recurrent and refractory clostridium difficile  becomes an every growing problem especially in the elderly who are often on PPIs it is becoming necessary to evaluate the risks and benefits of continuing PPIs long term.

 Bottom line: Stop PPIs if there is not longer a clear reason to be taking them.

Reference:

Safety Alerts for Human Medical Products > Proton Pump Inhibitors (PPIs) – Drug Safety Communication: Clostridium Difficile-Associated Diarrhea (CDAD) Can be Associated With Stomach Acid Drugs.

Healthy living blog

I just found out that Dr Stuart Segal, a close colleague  and local family physician has been blogging too. He blogs about issues related to health that come up in his day to day practice. Being a family physician he certainly sees a broader range of health issues in his practice than I do and frequently writes commentary on frontline issues. Continue reading

Fruit and vegetable intake and overall cancer risk

This is a published 8 year study that followed over 477 thousand individuals looking for incidence of cancer. The results were interestingly that the intake of fresh fruit and vegetables make little if no difference in the rates of cancer. Interesting but not surprising findings. Remember statistically the best ways to maintain health is:

  1. Watch your weight, keep the BMI within normal range
  2. Dont smoke
  3. Get regular exercise
  4. Get treatment for hypertension and diabetes
  5. Keep up to date on vaccinations
  6. Avoid accidents

Fruit and vegetable intake and overall cancer risk… [J Natl Cancer Inst. 2010] – PubMed result.

Getting the most from your doctor- How do doctors make a diagnosis

A better understanding of how doctors make diagnoses can help the consumer get the most out of a doctor visit.

A better understanding of how doctors make diagnoses can help the consumer get the most out of a doctor visit.

By no means am I suggesting that patients need to know how to make a diagnosis but rather that a better understanding of the mechanics of the process may help avoid unnecessary waste of time and money in trying to provide care. Continue reading

Surgical wound classification

This past week we reviewed some hospital data and found ongoing confusion with regards to classifying surgical wounds. I put together a quick cheat sheet to help with wound classification.

Under classifying the wound will produce a lower severity of illness making the provider and the institution appear worse for the same outcomes

Remember as more data is being collected for hospital report cards it is imperative to have accurate wound classification. The knee jerk reaction of many providers is to under classify the surgical wound. Outcomes are being compared to these data points. Under classifying the wound will produce a lower severity of illness making the provider and the institution appear worse for the same outcomes.

So lets all get the credit we deserve by making sure we classify wounds correctly.

Classification of surgical wounds

Classification of surgical wounds