November 1, 2011

Shave and punch biopsies can diagnose questionable skin lesions, including possible malignancies. Approaches include the superficial shave biopsy, saucerization excision, punch biopsy, and elliptical excision. The best biopsy method for suspected melanoma remains controversial.

A stepwise evaluation can help identify the cause of elevated transaminase levels. If initial test results are normal, a trial of lifestyle modification with observation or further testing for less common causes is appropriate. Gastroenterology referral is recommended if…

The most recent updates to the recommended adult immunization schedule include the use of the quadrivalent human papillomavirus vaccine to prevent genital warts in males; a single dose of herpes zoster vaccine for adults 60 years and older; replacing a single dose of tetanus…

The increased availability of sensitive imaging tests has improved the diagnosis of osteomyelitis. Sampling of the wound for culture and antimicrobial sensitivity is essential to direct treatment. The increased incidence of methicillin-resistant Staphylococcus aureus…

AMA Letter to Supercommittee Calls for Medical Liability Reform | CMS Launches Initiative Using a Blended Payment Model Based on the PCMH | HHS Issues Final Rule on Operation of Medicaid Recovery Audit Program | ONC Launches Web Site on Health IT and EHRs, Publishes Health IT…

Adult vaccinations are underutilized despite proven efficacy and cost-effectiveness. There are many barriers to immunization that are more prominent in adults than in children, including cost, lack of tracking systems, and competing demands.

Improving screening and treatment for depression in primary care will require better mental health care integration. Depression is common in primary care, yet screening for the condition remains low. Enhanced, coordinated financial support for the integration of mental health…

Although it does not improve overall alcohol abstinence rates, the oral formulation of the opioid antagonist naltrexone (Revia) is moderately effective in decreasing the amount and frequency of alcohol consumption in patients with alcohol dependence.

Compared with no treatment, cognitive interventions improved cognitive performance in healthy older adults and older adults with mild cognitive impairments. However, there is inadequate evidence to determine which aspects of these interventions are effective.

Photo Quiz presents readers with a clinical challenge based on a photograph or other image.

Many medical errors have been identified as systemic and addressed with interventions, such as checklists. However, a substantial number of errors that occur in diagnosis and treatment are attributed to flaws in clinical reasoning.

The American College of Physicians (ACP) has issued a clinical guideline on the use of intensive insulin therapy in hospitalized patients with or without diabetes mellitus to achieve glycemic control and improve health outcomes.

There is no single antidepressant or class of antidepressants that is most effective for the treatment of insomnia in patients with depression. The use of antidepressant medications can have a positive impact on sleep physiology, but does not seem to improve subjective ratings…

The liver releases several substances when it is injured. Two of these are enzymes called alanine transaminase (ALT) and aspartate transaminase (AST).

Osteomyelitis (OSS-tee-oh-MY-uh-LIE-tiss) is an infection in a bone. It is caused by bacteria that spread through the blood from a wound or infection somewhere else in the body. In children, it usually occurs in the arms and legs. In adults, it usually affects the feet, spine…