Authors


Pamela Horn, MSN

Latest:

The Dangers of ATVs

An all-terrain vehicle-ATV-is described by the American National Standards Institute as one that "travels on low pressure tires, with a seat that is straddled by the operator, and with handlebars to be used for steering."1 By this definition, an ATV is designed for interactive riding by a single operator. Drivers are able to shift their weight freely in all directions depending on the situation and terrain. According to ATV safety standards and recommendations, children younger than 6 years are never to be on an ATV of any size-alone or with someone else.


Pamela L. Moore, PhD

Latest:

Chinese Physicians More Burned Out Than US Physicians

Think you have it bad? Consider the Chinese.


Pamela Wible, MD

Latest:

How to Grow a Happy Doctor

Clinician mental health advocate Pamela Wible, MD, has drafted The 10 Commandments for Medical Educators. Your comments welcomed.


Parag Mehta, MD

Latest:

Acute Epiglottitis

A 74-year-old nursing home resident was admitted to the hospital with shortness of breath and stridor. Radiographic examination of the neck revealed the “thumb sign” of a swollen epiglottis (Figure, white arrow); the black arrow indicates the normal posterior wall of the pharynx. Acute epiglottitis was diagnosed.


Parker Brown

Latest:

Are Expensive Diabetes Drugs Worth It?

The good news is that a few diabetes drugs now show valid cardioprotective benefits; the bad news is the drugs are unaffordable for many.


Parthas Narasimhan, MD, FRCPC, FACP

Latest:

Bronchoalveolar Carcinoma in a 58-Year-Old Man

A 58-year-old man presents with exertionaldyspnea of 6 weeks’ duration, adry cough for 2 weeks, and decreasedappetite. He denies fever, chills, sputumproduction, hemoptysis, cigarette smoking,and significant weight loss. Thepatient, a retired electrician, was exposedto asbestos 20 years earlier.


Pat F. Bass III, MD, MS, MPH

Latest:

I Made a Difference...

I made a difference in a student’s life.


Patompong Ungprasert, MD

Latest:

Autosomal Dominant Polycystic Kidney Disease in a 38-Year-Old Woman

Autosomal dominant polycystic kidney disease (ADPKD) is common. Presenting symtpoms include hypertension, hematuria, proteinuria, and renal insufficiency.


Patric T.S. Ma, MD

Latest:

Primary Biliary Cirrhosis

A 50-year-old woman had a 6-month history of severe generalized itchiness and fatigability. There was no associated fever, abdominal pain, or joint pain. A cholecystectomy had been performed 20 years earlier. She had no family history of hypercholesterolemia or liver disease.


Patricia H. Martin, OMD-III

Latest:

Double Aortic Arch in an Infant With Persistent Stridor

Double aortic arch-a vascular ring anomaly in which both embryonic aortic arches persist and encircle the trachea and esophagus-is rare.


Patricia Hood, PA-C

Latest:

Erythema ab Igne in a 66-Year-Old Black Woman

This 66-year-old black woman presented with a 2-year history of a painless skin eruption. She stated that her skin had “changed overnight” while she was caring for her mother who had been hospitalized.


Patricia Martin, OMS-IV

Latest:

Bilateral Painless Swelling of the Neck in a 40-Year-Old Man

On palpation, the swelling was non-tender, soft, and mobile but did not feel fluid-filled. Here, view ultrasound findings and propose your diagnosis.


Patricia Taylor, MS, RN

Latest:

Vulvar Melanosis

During a routine examination, macular dermatitis with irregular borders was noted on the genitalia of an otherwise healthy 41-year-old woman. The right labia minora featured a 7-cm dark pigmented macular area; a similar area measuring 10 cm was observed on the left upper labia minora.


Patrick Brady, MD

Latest:

Gastrointestinal Involvement of Systemic Amyloidosis

The authors present a case of AL amyloidosis with rare GI involvement and an equally rare presenting symptom.


Patrick F. Pace, PhD

Latest:

Medication Nonadherence and the Risks of Hospitalization, Emergency Department Visits, and Death Among Medicare Part D Enrollees With Diabetes

The authors are affiliated with the University of Mississippi School of Pharmacy, in University, Miss. Dr Yang is assistant professor in the department of pharmacy administration.


Patrick Foye, MD

Latest:

Back Extension Exercises for Patients With Osteoporosis

Exercises that help strengthen themuscles that support the spinemay be especially helpful duringthe postmenopausal years. Theback extension series illustratedin Figures 1 through 5 is anexample of progressively moredifficult exercises that can beperformed several times perweek. These exercises can alsobe performed individually inconjunction with resistance andweight-bearing routines.


Patrick G. Mckinney, MD

Latest:

The 10 Most Common Prescribing Errors: Tips on Avoiding the Pitfalls

Numerous factors contribute to the medication errors that kill up to 98,000 patients each year. Unnecessarily high dosages can result in increased side effects with only a small therapeutic benefit, especially in elderly patients. Lack of patient information-such as a history of allergies or adverse drug reactions-is another cause of error and injury. Communication failures include the use of ambiguous abbreviations, misinterpretation of verbal orders, and lack of timely response to a patient's medication-related symptoms. Dosing errors are common in children because of variability in dosage expressions in drug references. Remedies for prescribing errors are described in detail here.


Patrick Harpole, MD

Latest:

AIDS-Related Psoriasis

A 29-year-old man presented with a complaint of venereal warts and a long history of mild psoriasis, which he had treated with fluocinolone. He returned 3 months later complaining of chest congestion of 10 days' duration; it had been treated with ciprofloxacin at an urgent care facility.


Patrick J. Lavin, MD

Latest:

Rebound Headache: Keys to Effective Therapy

Which of these scenarios is familiarto you? •A local pharmacist calls to say thatyour patient wants another refill for thecombination analgesic containing aspirin,caffeine, and butalbital that youprescribed last week. Pharmacy recordsindicate that this patient has received250 tablets of this medication inthe last 34 days.


Patrick M. Foye, MD

Latest:

Osteoarthritis of the Knee and Hip:

For patients with osteoarthritis, nonpharmacologic treatment can be an effective adjunct to drug therapy. Patient education is essential; both community-based and independent self-care programs are available. Weight loss can improve function and alleviate symptoms; however, it is more effective when dietary modification is accompanied by increased physical activity.


Patsy Stinchfield, RN, MS

Latest:

Podcast: Measles Shows Its Spots-Again

Measles is making a comeback . . . yet again . . . in the United States.


Paul B. Thompson, MD

Latest:

Desmoplastic Melanoma

A minute, nonpigmented, innocuous-appearing papule on the nose of a 60-year-old man did not seem cause for alarm. However, a simple, 3-mm punch biopsy saved this patient's life.


Paul C. Lee, MD

Latest:

Primary synovial sarcoma presenting as an endobronchial mass

Endobronchial primary synovialsarcoma is an extremelyrare pulmonary tumor. We reportthe case of a 58-yearoldman who presented witha right-sided endobronchialmass, which was diagnosed asprimary synovial sarcoma onthe basis of histological appearanceand immunohistochemicalstaining. To the bestof our knowledge, this is onlythe third case report of endobronchialprimary synovialsarcoma.


Paul E. Lomeo, MD

Latest:

Encephalocele

This 3-year-old child was brought to our ear, nose, and throat clinic for evaluation of the nasal mass that had developed over the previous few months, reports Dr Paul E. Lomeo of Muskegon, Mich. The youngster was known to have congenital problems, including cardiac, renal, and craniofacial anomalies. There was no identified syndrome associated with his health.


Paul E. Marik, MD

Latest:

Considering the role of NPPV, PEEP, and other interventions Managing acute severe asthma: What therapies to try, part 2 key words: Asthma, Leukotriene modifiers, Mechanical ventilation

abstract: The mainstay of therapy for acute severe asthma includes ß2-agonists, anticholinergics, and corticosteroids. Other agents, such as leukotriene modifiers and magnesium sulfate, can be used in patients who have responded poorly to conventional therapy. Noninvasive positive pressure ventilation (NPPV) should be tried before intubation in alert, cooperative patients who have not improved with aggressive medical therapy. However, NPPV should not be attempted in patients who are rapidly deteriorating or in those who are somnolent or confused. Endotracheal intubation is recommended for airway protection or for patients who present with altered mental status or circulatory shock. Patients should be admitted to the ICU if they have difficulty in talking because of breathlessness, altered mental status, a forced expiratory volume in 1 second or peak expiratory flow rate of less than 25% of predicted, or a PaCO2 greater than 40 mm Hg after aggressive treatment in the emergency department. (J Respir Dis. 2007;28(3):113-117)


Paul E. Sax, MD

Latest:

Antiretroviral Therapy

Tenofovir disoproxil fumarate is approved to treat HIV infection in combination with other antiretroviral agents. Although tenofovir is generally well tolerated, the potential for nephrotoxicity exists based on preclinical data, case reports, and observational studies.


Paul J. Lee, MD

Latest:

Preschooler With Slowly Progressing Rash on One Arm

During the past week, a rash on theright thumb and forefinger of a 4-yearoldboy has progressed to involve theentire arm.


Paul J. Leo, MD

Latest:

Matters of the Heart: Pericardial Tamponade

A 70-year-old woman with no previousmedical problems had had progressivedyspnea and generalized weaknessfor the past several days. She washypotensive (73/31 mm Hg), tachycardic(120 beats per minute), andtachypneic (28 breaths per minute);oxygen saturation (room air) via pulseoximetry was 84%.


Paul J. Raiman, MD

Latest:

Pseudomembranous Colitis

Following mechanical bowel preparation and prophylactic antibiotic therapy, a 59-year-old man underwent transanal excision of a villous adenoma of the distal rectum. Two weeks after discharge, he returned with a temperature of 38.9°C (102°F), abdominal pain, and diarrhea.


Paul Kamitsuka, MD

Latest:

Cutaneous Mycobacterium Infection

This rash, which covered a 68-year-old woman's body, was noted to have worsened during the past 2 months. A cephalosporin antibiotic had failed to clear the condition. The patient, a nursing home resident, suffered from emphysema, asthma, and heart disease. She had been receiving oxygen therapy and prednisone for 1 year.

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