Friday, November 22, 2013

A Funny Thing Happened on the Way to ATP 4 - New Cholesterol Guidelines 2013

In somewhat of a surprise move, the National Hearth, Lung and Blood Institute (NHLBI) has partnered with the American Heart Association and American College of Cardiology (AHA/ACC) in order to get new Guidelines out the door.  One set, focused on Cholesterol, is essentially ATP 4 (Adult Treatment Panel 4) replacing the 12 year old ATP 3.  The links for this guideline can be found below.

Risk Calculator (Excel)

A good commentary on this subject can be found at Dr. Bilizarian's blog on Medscape.

A note, this risk calculator appears to overestimate individual risk between 75% and 150%, leading to suggest greatly increased statin use.  More to follow...

Thursday, September 26, 2013

Resources for Toxic Exposures from Environmental Hazards

Excellent case studies in Environmental Medicine can be found at the CDC Agency for Toxic Substances and Disease Registry (ATSDR):

Abstracts for articles on BPA and Phthalates in Adolescents, along with opposing editorial in August 19, 2013 Pediatrics:
BPA article abstract: Bisphenol A and Chronic Disease Risk Factors in US Children

Phthalate article abstract: Urinary Phthalates and Increased Insulin Resistance in Adolescents

Editorial: Urine Chemical Content May Be a False Measure of Environmental Exposure

Wednesday, September 25, 2013

NIH Consensus Development Conference on Diagnosing Gestational DiabetesMellitus

While the 2013 ADA recommendations support the 1 step approach to screening for Gestational Diabetes Mellitus, a subsequent NIH Consensus Conference in March 2013 supports the previous 2 step method.  You can find the statement from this conference at :

Tuesday, July 30, 2013

Diabetes Resources

Some new Diabetes resources:

The American Association of Clinical Endocrinologists has a 2013 Comprehensive Diabetes Management Algorithm.  You can access it at:
Algorithm (pretty pictures):
All including Consensus Statement:

As always, the American Diabetes Association updates their Clinical Practice Recommendation every January.  The latest set can be found at:

The University of California San Francisco maintains a Diabetes Education Online site with a wealth of resources and easy-to-understand images at:

Check these resources out!

Dr. Z

Friday, September 14, 2012

Statins in Diabetics

As discussed at lectures today, the American Diabetes Association 2012 Standards of Medical Care in Diabetes state:
  • Statin therapy should be added to lifestyle therapy, regardless of baseline lipid levels, for diabetic patients:
    • ○ with overt CVD. (A)
    • ○ without CVD who are over the age of 40 years and who have one or more other CVD risk factors. (A)
  • For patients at lower risk than those above (e.g., those without overt CVD and under the age of 40 years), statin therapy should be considered in addition to lifestyle therapy if LDL cholesterol remains >100 mg/dL or in those with multiple CVD risk factors. (E)
  • In individuals without overt CVD, the primary goal is an LDL cholesterol <100 mg/dL (2.6 mmol/L). (A)
  • In individuals with overt CVD, a lower LDL cholesterol goal of <70 mg/dL (1.8 mmol/L), using a high dose of a statin, is an option. (B) 

    For full details, see the entire set of Standards at: (Click on "Full Text" and search for Dyslipidemia)

Friday, August 17, 2012

Teaching Skills

The most commonly used method of case-based teaching is the:

One Minute Preceptor
Five Microskills for clinically based teaching*

1) Get a commitment

2) Probe for supporting evidence

3) Teach general rules

4) Reinforce what was done right

5) Correct mistakes

There are numerous examples available in the website link at the right under "videos" or "precepting". One of the best is from the "The Practical Prof" at The Alberta Rural Physician Action Plan.

* Neher JO, Gordon KCM, Meyer B, Stevens N. A five-step microskills model of clinical teaching. J Am Boar Fam Prac. 1992; 5:419-24

Friday, February 10, 2012

WHO Fracture Risk Assessment Tool

The World Health Organization Fracture Risk Assessment tool for the US is available at:

Make sure it is set to the correct country. You can also use the "Calculation Tool" menu to select specific ethnic groups.