Web Roundup

CONTENTS

J A N U A RY / F E B R U A RY 2 0 2 2

1 The uninvited dinner guest.

11 Posterior stroke may present as vertigo.

15 Hypersensitivity reaction after COVID-19.

29 Misdiagnosis does not equal malpractice.

FEATURES

6 Diagnosis and Staging of Chronic Obstructive

Pulmonary Disease by PCPs

Using the GOLD standards for COPD staging will identify high-risk patients, improve delivery of care, and reduce health care costs.

11 Atypical Posterior Stroke: Diagnosing Cause of Vertigo in Primary Care

The HINTS examination performed within 48 hours of symptom onset has a sensitivity of 100% and specificity of 96% for diagnosing stroke.

21 Community-Acquired Clostridioides difficile

Cases in Children on the Rise

A thorough clinical evaluation of diarrhea must rule out other causes, such as viral enteritis, parasitic infection, bacterial infection, and inflammatory bowel disease.

DEPARTMENTS

1 From the Director

Guess Who’s Coming to Dinner?

3 Web Roundup

A summary of our most recent opinion, news, and multimedia content from ClinicalAdvisor.com.

15 Dermatology Clinic

■ Red Patches Over Face, Chest, and Upper Limbs ■ Itchy Rash After COVID-19

29 Legal Advisor

Nurse Practitioner Sued for Missed Hip Fracture

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Download the app ClinicalAdvisor.com/App

EXCLUSIVE TO THE WEB AT THE WEB AT ClinicalAdvisor.com

NEWS

ClinicalAdvisor.com/News

National Nurses United Call for Permanent OSHA COVID-19 Standards

In light of Omicron, nurses are calling for a permanent OSHA standard built on current emergency temporary standards and updated scienti c knowledge of the virus.

Duloxetine Failed to Reduce Pain in Patients With Osteoarthritis

The study found no clinically relevant or statistically signi cant e ect of duloxetine on pain scores at 3 or 12 months in patients with chronic hip or knee osteoarthritis.

Black, Hispanic Patients Are Less Likely to Have Bariatric Surgery

Patients with obesity in the study who underwent bariatric surgery were more likely to be White, have a higher education level, not receive SNAP, and considered food secure.

Early Trauma Increases Risk for Substance Abuse

The authors of the study noted that early trauma could include emotional, physical and sexual abuse, neglect, mental illness, divorce and separation, and substance misuse.

Rates of HCV Treatment Declined From 2015-2020

The COVID-19 pandemic and opioid crisis created new barriers to HCV treatment, leading to the lowest annual treatment rate in 5 years.

CLINICAL CHALLENGE

ClinicalAdvisor.com/Clinical-Challenge

Brady Pregerson, MD

Generalized Weakness and Dehydration

A 63-year-old man with a history of thyroid cancer presents to the emergency department with a 4-day history of generalized weakness and loss of appetite. He has no history of recent falls and he denies any pain, heart palpitations, vomiting and/ or diarrhea, focal weakness, syncope, or other complaints. See the full case at: clinicaladvisor.com/case_january_february22

THE WAITING ROOM

Of cial Blog of The Clinical Advisor

ClinicalAdvisor.com/WaitingRoom

Jim Anderson, MPAS, PA-C, DFAAPA

Mandatory COVID-19 Vaccines Needed for Health Care Workers

Amid the vaccine debate, Jim Anderson wonders how any health care worker — PA, nurse practitioner, physician, or nurse — could square not getting vaccinated after vowing to protect and improve the health of all Americans.

MY PRACTICE

ClinicalAdvisor.com/MyPractice

April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCN, FAAN

Creating Healthy Work Environments for NPs During the COVID-19 Pandemic

The president of AANP discusses what constitutes a healthy work environment in hospitals and how to create professional and personal barriers to manage burnout.

Conference Roundup

Advances in Inflammatory Bowel Diseases (AIBD) 2021 Annual Meeting

December 5 to 7, 2021 Orlando, Florida

IMID ASSOCIATED WITH INCREASED RATES OF PSYCHIATRIC DISORDERS

Patients with childhood-onset immunemediated inflammatory diseases (IMID) have an increased prevalence of anxiety and mood disorders compared with control individuals, according to research presented at the AIBD 2021 Annual Meeting.

The investigators searched the Pubmed, PsychINFO, and Embase databases for studies regarding pediatric-onset inflammatory bowel disease (pIBD), rheumatic diseases (RD), and autoimmune liver diseases. The studies that reported prevalence rates of diagnosed psychiatric disorders and/or suicide were included in the review.

Random-effects meta-analysis was used to calculate the pooled prevalence rates of psychiatric disorders reported by 3 or more studies within the same IMID. Psychiatric disorders were grouped according to International Classification of Diseases-10th Revision. The risk for bias was assessed independently by 2 authors with use of the New-Castle Ottawa scale.

A total of 23 studies were included in the review — 13 regarding psychiatric disorders in pIBD and 10 in RD. No studies reported on psychiatric disorders in autoimmune liver diseases.

Among patients with pIBD, the prevalence rates for anxiety and mood disorders were 6% (95% CI, 4%-9%) and 4% (95% CI, 2%-8%), respectively, in register-based studies, and 33% (95% CI, 25%-41%) and 18% (95% CI, 12%26%), respectively, in studies that used psychiatric assessment.

The pooled estimates for RD were 13% (95% CI, 12%-15%) for anxiety disorders and 20% (95% CI, 15%-26%) for mood disorders. Suicide risk was increased in pIBD but not in juvenile idiopathic arthritis, the most common RD, according to analysis of single studies.

The study authors noted that only pooled estimates on emotional disorders were possible and that studies on a wider variety of psychiatric disorders are needed.

PATIENTS WITH IBD SHOULD EAT LESS PROCESSED RED MEAT

Increased frequency of processed meat consumption is associated with higher risk for mortality in patients with inflammatory bowel disease (IBD), according to research presented at the AIBD 2021 Annual Meeting.

Data from 5763 patients with IBD in the United Kingdom (UK) Biobank who were recruited from 2007 to 2010 and followed until March 13, 2021, were included in this analysis. A simplified food frequency questionnaire was used to collect baseline dietary information and deaths were ascertained from the death registry. Meat consumption of 0.1 to 0.9 times per week was used as a reference.

The mean patient age was 57.3 (SD, 7.9) years, 3028 (52.5%) were women, and 1834 and 3929 patients were diagnosed with Crohn disease (CD) and ulcerative colitis (UC), respectively. Follow-up time on average was 11.7 years, during which 590 deaths over 67,095 person-years were documented.

Compared with processed meat consumption of less than once per week, consuming processed meat more than 4 times per week was associated with an increased risk for mortality (hazard ratio [HR], 1.53; 95% CI, 1.06-2.23; P =.025). This association was observed among patients with CD (HR, 2.01; 95% CI, 1.12-3.62; P =.020) but not UC (HR, 1.27; 95% CI, 0.77-2.09; P =.346). No association was found between mortality

Patients with IMID have an increased prevalence of anxiety and mood disorders.