Thursday, October 1, 2015

Errata for my presentations at 2015 AAFP FMX!

My Big Blue Friend and I would like to make you aware of some corrections, additions and explanatory materials from my presentations on Diabetes at the 2015 Family Medicine Experience!  These were sessions CME031 & 032: Diabetes Update 2015: New Trends in an Old Disease.

Slide 31: ACOG Gestational Diabetes Recommendations:
Under the heading "Start medication if" the last line should read "-2-hour 120 mg/dL"

Slide 32: Prevent Diabetes STAT
The url listed no longer works (though it did in the past and remains in the STAT program handouts).  The working URL is: here 

Slide 61: DPP-4 Inhibitors:
Additional Information: on 8-28-15, the FDA issued a Drug Safety Communication noting that rare patients using DPP-4 inhibitors had experienced severe disabling joint pain.  The onset of pain occurred from one day to several years after starting the medication.  The pain usually resolved within one month of stopping the DPP-4i medication.

If you have any further recommendations or have discovered additional errors, please send them to me at

Thank you,

Monday, July 13, 2015

2015 Clinical Guideline Resources

Resources updated to support the 2015 Guidelines discussion for new Family Medicine Residents:

Hypertension2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults
Additional Resources: 
American Family Physician: POEMsJNC 8 Report on Prevention, Evaluation and Treatment of Hypertension
AAFP: 2014 Hypertension Guideline Stands to Simplify Treatment, Says Expert

Hyperlipidemia2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
American Heart Association: CV Risk Calculator
AAFP: New Guidelines Propose Significant Shift in Cholesterol Management

Diabetes: American Diabetes Association: Standards of Medical Care in Diabetes—2015
(including the new Abridged Standards for Primary Care Providers)
American Association of Clinical Endocrinologists: AACE Comprehensive Diabetes Management Algorithm 2015
Additional Resources: 
National Diabetes Education Program2012 Diabetes Numbers at a Glance
CDC Diabetes Data & Trends

In addition, there are a number of "apps" that I think can be of use in clinic:

1) Agency for Healthcare Research & Quality: electronic Preventive Service Selector (ePSS)
2) Shots by STFM (Society or Teachers of Family Medicine)
3) American Heart Association/American College of Cardiology  ASCVD Risk Calculators (online)

Friday, October 24, 2014

Links for Computer Applications: AAFP Scientific Assembly 2014

Meaningful Use

         Stage 1

      13 required core objectives

      5 menu objectives (from list of 9)

     Total of 18 objectives  

         Stage 2

      17 core objectives

      3 menu objectives (from list of 6)

      total of 20 objectives  


EHR Selection & Implementation

        AAFP Center for Health Information Technology

        AAFP Health-IT Guides

    Selecting & Implementing an HER  

CDS Implementation Guides   

    How-to guides:

     Start with a Strong Foundation for CDS

     Assemble a CDS Implementation Team

     Plan for Successful CDS Development, Design, and Deployment 

     Roll Out Effective CDS Interventions

     Measure Effects and Refine CDS Interventions

Old Fashioned CDS System


Smartphone Apps





    Medscape Mobile App:  


        Leverage content

    Elsevier: ClinicalKey:  

    Skyscape: Omnio:  

Drug Reference



        Monthly Prescribing Reference:  

        Physician’s Drug Reference:

    Standalone or Omnio  



    Patient lists

    Aggregate patient data

    Order entry

    Charge capture  


        ePSS: electronic Preventative Services Selector


        Shots by STFM:  

        ASCVD Risk Estimator: ACC/AHA  



     Diagnosis search/differential builder


        Pregnancy wheel

     Huge range

Patient Health Apps

         Calorie counters

         Activity trackers

         Smoking Cessation:

         Patient Social Media:


         Exercise monitors



     Apple Watch: coming

         Sleep monitors


     Sleep Cycle:  


Tuesday, April 22, 2014

Journal Club Resources

A good place to find Journal Club resources is the Centre for Evidence Based Medicine at Oxford:

There you can find a step-by-step introduction to the process of EBM, including tools such as the worksheets to appropriately evaluated each type of article.

If you have any trouble using this site, or finding the correct worksheet, please contact me by email.


Dr. Z

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