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Lactic acidosis associated with metformin use in treatment of type 2 diabetes mellitus

Metformin, an antihyperglycemic, is widely used in the treatment of type 2 diabetes mellitus (DM). A rare, but important complication associated with this drug is the development of lactic acidosis: Overall mortality of lactic acidosis is approximately 50%. Certain subsets of patients taking metformin are at greater risk of developing lactic acidosis.
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Pediatrics

A prudent approach to screening for and treating tuberculosis

Screen children and adolescents for risk factors for latent TB infection and active disease, perform a tuberculin skin test if—and only if— a risk factor is present, and treat patients with a positive finding according to strategies discussed here.
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Pediatrics

Tackling back pain in a young athlete

Today's focus on intense, specialized sports training at younger ages means that children are increasingly susceptible to back injury. This overview of the diagnosis and treatment of back pain in child and adolescent athletes, includes conditions to consider in the differential.
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Obstetrics and Gynecology

A primer on breast reduction surgery

Excessively large breasts can be so painful that even the rare risk of losing her nipples and areolae won't dissuade a woman from undergoing reduction surgery. This article—by two plastic surgeons—gives you information on the pros and cons of various surgical approaches so you can educate patients about all of their options.
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Focus On: Business & Practice
Practice Management

Do pay-for-performance programs really produce quality care?

Not really, according to a study in the Journal of the American Medical Association (10/12/05). The study compared the impact of a pay-for-performance program on quality of care within two sets of physician groups within PacifiCare Health Systems.
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Practice Management

The art and science of the clean claim

Use your staff and computer technology the right way, and you can reduce costly denials and boost collections.
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Practice Management

"IN THE TRENCHES": PART 1 - Fundamentals of practice finance

You may not have been trained as a CEO, but unless you sharpen your business skills, your clinical skills may be all for naught. In the first of our 3-part series, a seasoned physician executive outlines the tools needed to manage people, profits, and policies.
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