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Autoimmune diseases are difficult to diagnose; their symptoms can be vague, vary from patient to patient, and often overlap. Moreover, there is no single diagnostic test for any one autoimmune disease. Diagnosis is most often based on a compilation of clinical information, family history and data from laboratory testing. Laboratory tests include highly sensitive but relatively nonspecific antinuclear antibody (ANA) testing and/or tests for individual antibodies that are more disease specific. This test guide discussed the approaches to testing, provides an algorithm for the primary care physician, and a convenient table of autoantibody prevalence in autoimmune diseases. In sum, 1) ANA by IFA is the gold standard as an initial test according to the American College of Rheumatology. This test is very sensitive and if positive this provides a titer and pattern. Higher titers indicate greater likelihood of disease. 2) ANA antibodies by multiplex measures specific antibodies which cause various ANA IFA patterns and helps physicians specifically pin point what specific antibodies are present. Testing for antibodies alone will miss ANA related diseases. 3) Optimal approach is to order ANA IFA with reflex to antibodies cascade panel, because it initially screens by a highly sensitive test and only if positive does it reflex for relevant antibodies in the cascade panel. Thus this combines the power of both high sensitivity and high specificity to rule in or rule out autoimmune disease.
30 million people in the United States have diabetes. Diabetes and its effects can be devastating to the patient, and costly to treat. In fact, in 2012 the direct medical cost of treating diabetes in the United States was $176 billion. CoxHealth serves a population of over 24,000 patients with diabetes. Diabetes is the leading cause of adult-onset blindness, however more than 95 percent of vision loss is preventable thanks to modern therapies. One of the most effective therapies is called a diabetic retinopathy exam (DRE). Through this exam it is possible to diagnose retinal pathologies in patients with diabetes, including blindness. For CoxHealth, the challenge was getting their patients to follow through on referrals to ophthalmologists for their annual exams. Generally speaking, only about 50 percent of at-risk diabetic patients undergo retinal evaluation largely because of the barriers of cost, inconvenience, lack of awareness, and even procrastination. For CoxHealth, their compliance rate for DRE screenings was just 32%, creating a detrimental clinical and financial impact on the organization. By partnering together, IRIS and CoxHealth are saving sight and changing the lives of thousands by providing diabetic retinopathy exams in primary care facilities.
Evolving discussions around optimal first foods for babies can often leave parents confused, hesitant and insecure in the food choices they make for their infants and toddlers. As a health professional, you are in a unique position to educate parents on the importance of nutritious complementary foods that support early growth and development. This webinar will review the emerging evidence supporting nutrient-rich protein, including beef, as a first solid food to an infant’s diet and address important nutrient requirements for nourishing the early stages of life.
Through this technical bulletin, you will learn how to evaluate patient risk of severe cutaneous adverse reactions (SCARs) to allopurinol. Allopurinol hypersensitivity syndrome is estimated to occur in 1 of 1,000 allopurinol users in the United States and is associated with marked morbidity and a mortality rate of 20% to 25%. Until recently, there was no way of predicting which patients were likely to develop allopurinol hypersensitivity syndrome. The Quest Diagnostics HLA-B*58:01 Typing assay determines the presence of the HLA-B*58:01 allele and thus identifies patients at increased risk of allopurinol-induced SCARs. The bulletin provides a user-friendly chart of allele frequency by race and ethnicity. It also reviews current guidelines: (1) American College of Rheumatology recommends HLA-B*58:01 genotyping prior to allopurinol therapy and (2) Clinical Pharmacogenetics Implementation Consortium recommends against the use of allopurinol in HLA-B*58:01 carriers and recommends alternative therapy in these patients.
Through a collaboration with AAFP, Nature Made sponsored the development of a Drug-Nutrient Interactions (DNI) and Drug-Nutrient Depletions (DND) resource tool within the official AAFP Member App. The DNI/DND applet is a point-of-care resource for Family Physicians to access DNI/DND information. Download the AAFP app to access the DNI/DND resource today.
Influenza immunization can be a complex and daunting undertaking involving activities related to reservation of vaccine, shipping and delivery, coding/reimbursement, and in-office patient education activities. Sanofi Pasteur is dedicated to helping providers achieve their immunization goals through a direct relationship this influenza season.
Heart disease is a major public health concern, and diet is believed to play an important role in mediating cardiovascular disease risk. As a family physician, you are in a unique position to educate Americans on the importance of diet and nutrition for better health. In the last several years, the evidence surrounding the role of lean beef in a heart-healthy diet has grown significantly. Lean beef, enjoyed daily as part of a healthy diet and active lifestyle, can promote heart health and keep healthy adults feeling strong. According to the latest research, lean red meat can be just as effective as other protein sources, such as chicken and fish, in lowering LDL cholesterol and reducing cardiovascular disease risk. (1) The 2015 Dietary Guidelines for Americans recommend a well-balanced diet focused on nutrient-dense foods—including lean beef—and smart portion control as part of a heart-healthy lifestyle. (1) Roussell et al. Beef in an Optimal Lean Diet study: effects on lipids, lipoproteins, and apolipoproteins. Am J Clin Nutr 2012;95:9-16.
It's likely that many of your patients may experience drug-nutrient depletions and interactions caused by common prescription drugs. Download the "Common Drug Classes, Drug-Nutrient Depletions, & Drug-Nutrient Interactions" booklet as a reference guide today.
Through this video presentation, you will learn about the clinical benefits of the first line screen test for autoimmune diseases. ANA testing by IFA microscopy is a highly sensitive test for detecting up to 150 antibodies and is the gold standard set by the American College of Rheumatology. ANA IFA testing in the correct clinical setting can lead to early diagnosis and treatment of devastating diseases.
Through this video presentation, you will learn about the clinical benefits of the first line screen test for autoimmune diseases. ANA testing by IFA microscopy is a highly sensitive test for detecting up to 150 antibodies and is the gold standard set by the American College of Rheumatology. ANA IFA testing in the correct clinical setting can lead to early diagnosis and treatment of devastating diseases. ANA IFA uses HEp-2 human tissue culture cells to detect autoantibodies directed against antigens in the cell nucleus and cytoplasm. A fluorescent microscope is used to view fluorescent-labeled ANAs. When results are positive, various fluorescent staining patterns are observed and are reported along with the titer. The patterns are associated with different autoimmune disorders. Higher titers are generally associated with greater likelihood of disease, but do not reflect disease activity. Advanced testing through a 3 tiered algorithm can be an effective way to help make an early diagnosis of the more common rheumatic diseases. Eight case studies are reviewed to educate the physician on how clinical and lab findings can be used to help make an early diagnosis.
Do you regularly get questions about low calorie sweeteners? Access quick-to-scan summaries, along with citations, of recent scientific research supporting the safety and efficacy of low calorie sweeteners in the 2017 update of this practical resource. It’s compiled for you – the busy family practice physician compliments of SPLENDA® Sweeteners.
What do physicians need to know about hospice and palliative services, goals of care conversations, advance directives and other issues that become more important as curative therapies become less effective? VITAS Healthcare, the nation’s oldest and largest hospice care provider, offers a monthly series of webinars that cover everything from the ethics of end-of-life care to the palliation of pain. Put your patient in control. Help them understand the trajectory of their disease and their options at every step along the way. VITAS can help.
We asked physician recruiters at healthcare facilities around the country who have extensive experience interviewing physicians what their ideal answers would be to the most frequently asked interview questions. From good ways to respond to “Tell me about yourself” to suggestions for the best answer for “What are you strengths and weaknesses?” Click the link get the answers to these and other regularly asked questions to help you prepare for your next interview.