Waukesha Family Practice

Guidelines for use of Antiretroviral Agents

2006-02-15T14:48:00.000-08:00

NIH Guidelines for use of Antiretroviral Agents

An excellent review of Antiretroviral agents when to use them and what are the best agents to use and when is the best time to use them.

Medicare Part D

2006-02-09T17:56:00.000-08:00

I found a link to the medicare website where you can enter the names of drugs and it will show which programs will cover the certain drugs. Some pt's have been asking the Dr's what to do and it is very confusing to them which to pick. This way if they enter the meds they are on it will tell them which programs will cover the meds.

Medicare Part D

Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.

2005-11-17T08:50:00.000-08:00

Prevention of thromboembolism

A guideline by ACCP well organized and gives level of evidence for each recommendation.

Waukesha School DIstrict Calendar for 2006

2005-11-10T12:39:00.000-08:00

For those who use the Waukesha School District here is a link to the 2006 Calendar.

The Homeopathy Pharmacopoeia

2005-08-16T07:25:00.000-07:00

Homeopathy Pharmacopoeia

Published by the FDA is a listing of some information about homeopathic drugs and remedies

Pill Identifier

2005-08-16T07:12:00.000-07:00

Pill Identifier

This is a website wherein one can enter the type of med (tablet, capsule, etc.), shape, color, and/or text found on the pill and get a pictorial display of medications. I have found this useful with patients who can’t remember the name of a medicine they are taking.

Nacotic equivalents

2005-04-07T07:55:00.000-07:00

Table of Narcotic equivalents posted by Cornell University

MedlinePlus Health Information from the National Library of Medicine

2005-03-22T14:01:00.000-08:00

MedlinePlus Health Information from the National Library of Medicine A really cool site for patients to look up high qualitymedical information

2005-03-15T17:27:00.000-08:00

Wisconsin Medicaid Prior Authorization for Drugs form

The preferred drug list for Medicaid and Seniorcare is listed here. For more information about Wisconsin's drug program see the preferred drug list information page.

Prior Authorization for PPI's and NSAID's use this form and fax it to 606-221-8616 or click for complete instructions.

For an overview of issues related to physicians in Wisconsin and medicaid see the physician's page

EBM Resources

2005-02-28T13:45:00.000-08:00

Using Internet Resources to Find Point of Care Clinical Evidence:
The Clinician’s Guide to Choosing Your Database

Douglas J. Bower, M.D. dbower@mcw.edu and
Barbara Jamieson, M.L.S. bjamieso@mcw.edu or asklib@mcw.edu

MCW Clinical Resource Page - MCW’s Internet portal for links to a variety of electronic resources. MCW Volunteer Clinical Faculty (VCF) have access. A log-in is required which is automatically created with every VCF appointment.

EBM Databases that can be Accessed on the Internet Without a Subscription:

Myhq: Dr. Brian Alper’s Internet portal for links to a variety of electronic resources. Dr. Alper is the founder and Medical Director of Dynamed.

Prime Answers: This will take you the Care Provider Toolkit. Scroll down the page until you see the heading: Find the Evidence. Prime Answers is the first question box. While the Care Provider Toolkit is
similar to Clinical Resources there are differences. See if you like Prime Answers.

AAFP: American Academy of Family Physicans: This site allows access to full text articles; it is an excellent source for topics relevant to Family Medicine. FPIN reviews can be found here.

Journal of Family Practice (JFP): The Journal of Family Practice publishes InfoPoems, but requires a subscription to actually read articles or Poems. The other commercial source of InfoPOEMs is the search engine, InfoRetriever.

PubMed and PubMed Central: http://www.ncbi.nlm.nih.gov/entrez/query. Easily found by typing PubMed in a browser search box. PubMed is Medline, plus it includes several other databases. PubMed Central is an archive of life sciences literature in full text. One of the more useful features in PubMed is Clinical Queries. Clinical Queries is a fast way to do a Medline search through the use of canned search fields (filters) to help retrieve information. Clinical Queries can be narrowed to articles on: etiology, therapy, prognosis or diagnosis. Clinical Queries can also be searched for just Systematic Reviews.

Center for Disease Control: http://www.cdc.gov/ Travel medicine, immunizations, MMWR reports and patient education materials.

Shots 2005: http://www.immunizationed.org/ The Group on Immunization Education of the Society of Teachers of Family Medicine. Childhood and adult immunizations. Great Palm download!

AHRQ: http://www.ahrq.gov/clinic The Agency for Healthcare Research and Quality database provides evidence-based guidelines. All US Preventive Services Task Force (USPSTF) guidelines are found here. The Palm version of the USPSTF guidelines is very cool and free to download. It is called the Interactive Preventive Services Selector.

Bandolier: http://www.jr2.ox.ac.uk/bandolier/ Bandolier’s special focus is pain. Its parent group is the Pain Research Group based in Oxford, UK.

Clinical prediction Rules—Mount Sinai School of Medicine: http://www.mssm.edu/medicine/general-medicine/ebm/. The site includes prediction rules for cardiovascular, respiratory, endocrine/metabolic, orthopedics, infectious diseases, all cprs, nephrology, screening, and procedures. There are also therapeutic NNTs and NNSs.

MedlinePlus: www.nlm.nih.gov/medlineplus. —The patient’s version of Medline.
MedlinePlus has several databases within it such as Senior Care and toxic household products, but the main features are medical encyclopedias, dictionaries, drug information, clinical trials, interactive health tutorials and health topics from reliable sources. Primary languages are English and Spanish but over 60 other languages including Hmong and Vietnamese are included.
National Guideline Clearinghouse: http://www.guideline.gov. Excellent source for guidelines
PEDro - Physiotherapy Evidence Database: http://www.pedro.fhs.usyd.edu.au/index.html PEDro, an initiative of the Centre for Evidence-Based Physiotherapy (CEBP). PEDro is the Physiotherapy Evidence Database. It has been developed to give physiotherapists and others rapid access to bibliographic details and abstracts of randomized controlled trials in physiotherapy. Most trials on the database have been rated for quality to help to quickly discriminate between trials, which are likely to be valid and interpretable, and those, which are not.

Primary Care clinical Practice Guidelines: http://medicine.ucsf.edu/resources/guidelines/ This site will include all guidelines, evidence-based, consensus, practice parameters, protocols, as well as other resources such as primary articles, integrative studies, meta-analysis, critically appraised topics, and review articles. Compiled by Peter Sam at the UCSF School of Medicine

RXList: http://www.rxlist.com/ A drug site for both health professionals and patients, it often has some information about new drugs before Medline does. Each year has a list of the top 200 most prescribed drugs. The database uses fuzzy logic, which means that a drug name can be spelled incorrectly and there is a reasonable probability of retrieving information.

SUMSearch: http://sumsearch.uthscsa.edu/ SumSearch is a single gateway that attempts to provide references to answer clinical questions around diagnosis, aetiology, prognosis and therapy (plus physical findings, adverse treatment effects and screening/prevention) by searching only high-quality sources. SUMSearch always searches: 1. Merck Manual. 2. MEDLINE for review articles and editorials that have full texts available. 3. National Guideline Clearinghouse from the Agency for Health Care Policy and Research (AHCPR) 4. Database of Abstract of Reviews of Effectiveness (DARE) 5. MEDLINE for original research. Depending of the focus requested SUMSearch will search PubMed with the highest sensitivity filters developed by Haynes et al.

Trip (Turning Research Into Practice) Database: http://www.tripdatabase.com/ This resource, hosted by the Centre for Research Support in Wales, aims to support those working in primary care. The database has 8000 links covering resources at 28 different centers and allows both Boolean searching (AND, OR, NOT) and truncation. It allows some free searching but then requires a subscription.

UP Antimicrobial Guide: http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/table of contents.htm This site is published by the University of Pennsylvania. This database provides antimicrobial information.

Google Scholar: http://scholar.google.com/
Available since late 2004, you may want to try Google Scholar. As with any other Google search you will need to be careful to critically appraise any citations (even if they are “peer-reviewed.”)
According to the developers of Google Scholar, it “enables you to search specifically for scholarly literature, including peer-reviewed papers, theses, books, preprints, abstracts and technical reports from all broad areas of research. Use Google Scholar to find articles from a wide variety of academic publishers, professional societies, preprint repositories and universities, as well as scholarly articles available across the web.
Just as with Google Web Search, Google Scholar orders your search results by how relevant they are to your query, so the most useful references should appear at the top of the page. This relevance ranking takes into account the full text of each article as well as the article's author, the publication in which the article appeared and how often it has been cited in scholarly literature. Google Scholar also automatically analyzes and extracts citations and presents them as separate results, even if the documents they refer to are not online. This means your search results may include citations of older works and seminal articles that appear only in books or other offline publications. Google Scholar enables you to search specifically for scholarly literature, including peer-reviewed papers, theses, books, preprints, abstracts and technical reports from all broad areas of research. Use Google Scholar to find articles from a wide variety of academic publishers, professional societies, preprint repositories and universities, as well as scholarly articles available across the web.”

AMA (Public Health) Physician's Guide to Assessing and Counseling Older Drivers

2005-01-14T12:41:00.000-08:00

AMA (Public Health) Physician's Guide to Assessing and Counseling Older Drivers

This is an excellent guide in assessing and counselling older drivers. It includes how to assess function, some physician interventions as well as state by state regulations regarding driving

The Wisconsin recommendations for aging and impaired drivers has informationon driving with a disability as well as mature drivers.

Withholding and Withdrawing Life-sustaining Treatment

2004-12-14T09:27:00.000-08:00

Withholding and Withdrawing Life-sustaining Treatment

An excellent review on this very important and useful topic using the AMA's EPEC for information. Also included are patient education handouts on Artifical Fluids and nutrition and Cardiopulmonary resuscitation

Another good resource is the AMA code of ethics regarding this topic.

For more resources check out Northwestern's EPEC project or the End of Life/Palliative care Educational resource center through the Medical College of Wisconsin

Health Education Assets Library: Multimedia Repository - What We Offer: AAMC-HEAL Collaboration

2004-11-05T10:26:00.000-08:00

This is a really cool website that contains over 30,000 teaching images,videos, animations and presentations.
They are all medically related and they are all FREE.

Check it out. It's not as easy as the google image search but has a lot more full presentations, animations and video

Habitual spontaneous abortions

2004-11-04T13:02:00.000-08:00

A good evidenced based summary on Habitual Aborters

Disability issues

2004-11-01T14:54:00.000-08:00

Social Security Disability

This website has a number of useful links to help one understand social securities rules and regulations regarding disability.

An article on the Practical approach to adults with disabilities is an excellent review and gives some good guidelines for defining disability

Some good texts on the subject include Guides to the Evaluation of Permanent impairment and Disability Evaluation both by the AMA

For information about the medical aspects of worker's compensation laws in Wisconsin click here.

Also included is a sample copy of a FMLA form and form DB-450 (used for diability insurance)

GME FUNDING

2004-10-22T14:31:00.000-07:00

The AMSA report on GME funding is a good summary of the way the government funds Graduate medical education

MD Net Guide

2004-08-12T10:30:00.000-07:00

Transitioning from One EMR to another

Here is an article co-authored by our own Nate Buffington on How to transition from one emr to another. Way to go Nate!

Centre for Health Evidence -- Users' Guides to Evidence-Based Practice

2004-08-12T10:25:00.000-07:00

How to Use Articles About Health-Related Quality of Life Measurements

A web site which helps explain quality of life measurements, what they are, ans how the help your patients. A easily navigated useful review of this topic.

Home

2004-08-10T14:56:00.000-07:00

Home

Medical Teacher is the journal of the Association for Medical Education in Europe, an international association for all involved with medical and healthcare professions education. Good abstracts but you have to pay to get the full text on-line.

Handbook of Medical Informatics

2004-08-03T09:58:00.000-07:00

Handbook of Medical Informatics - Web Site

Need some information about the concepts behind medical informatics? This is a nice website to check out. It has loads of information, demos and videos as well as exercises you can do.

Powerpoint presentations on pediatrics

2004-08-03T09:26:00.000-07:00

National Capital Area Military Pediatrics Residency Educational Programs
This website has a lot of really useful lectures on a variety of pediatric topics. They have quick reviews on anything from Pediatric foot deformities to eating disorders. It is worth a look.

Kidometer

2004-07-19T09:51:00.002-07:00

Kidometer - If you haven't used it before, nice palm quick-reference for peds stuff...

Medical Algorithms

2004-07-19T09:51:00.001-07:00

Growing collection of medical algorithms

International CME

2004-07-14T12:18:00.000-07:00

Info on international CME

Geriatrics At Your Fingertips

2004-06-29T15:40:00.000-07:00

Geriatrics At Your Fingertips is a quick reference text book by the American Geriatrics Society. It goes through issues commonly encountered in the elderly. You can review issues on line or download the entire text to your PDA. The service is free but you need to get a user name and password.

Online Patient Brochures for Arthritis

2004-06-29T13:16:00.000-07:00

Online Arthritis Brochures

A link to excellent patient education brochures about arthritis by the arthritis foundation.
Most in PDF format. Has some information about alternative therapies.

Adoption Information

2004-06-17T10:28:00.000-07:00

Two very useful websites for wisconsin

1. Department of Health and Human Services website on Adoption - has links to all the laws, forms and names of adoption agencies

2. Wisconsin Adoption Information Center is a great site for patients looking for information

3. The national adoption clearinghouse has information on a national level with many resources for those looking to adopt or looking to give their children up for adoption.

Obstetric Protocols from Lancaster General Hospital

2004-06-16T09:49:00.000-07:00

Lancaster General Hospital OB Protocols is an excellent resource for OB protocols. They are designed in collaboration with OB's, FP's, peds, neonatology, perinatology. As much as possible they are evidenced based and practical. Multiple topics including

1) Induction of labor
2) Dating criteria
3) preterm labor
4) preeclampsia
5) postterm pregnancies

Areas are bookmarked so they are easy to find

Breastfeeding resources

2004-06-15T17:13:00.000-07:00

The US government has produced a number of resources to assist with breastfeeding. This website gives a number of interventions to help initiate and continue breastfeeding

Insect repellent strengths

2004-06-14T12:24:00.000-07:00

the New England Journal of Medicine did a study comparing the strengths of insect repellents. The big winner was Deep Woods Off and other DEET containing sprays. The best non- DEET repellent was Bite Blocker for kids which contains soybean oil as it's main ingredient. As always wearing long sleeved pants and shirts also offers protection as does permethrin treated clothing. REI carries all of the above products.

Medical Student Curriculum Resources Project

2004-06-09T11:51:00.000-07:00

Curriculum Resources Project

Lists a number of resources for the education of medical students. Looks at Preclinical year 3 and year 4.

Builds the curriculum around the core competencies

Obstetrical Guidelines

2004-06-09T09:31:00.000-07:00

Obstetrical Guidelines

This website has a list of obstetrical guidelines which were developed via a collaboration of Family docs, OB's, perinatologist, neonatologists and MFM docs at the University of Arkansas.

Topics include:
1) Bacterial Vaginosis
2) Preeclampsia/Eclampsia/Help Syndrome
3) Fetal Demise
4) Genetic Risk Assessment
5) GBS status
6) HIV
7) HPV and abnormal Pap
8) IUGR
9) Preterm labor and preterm ROM
10) UTI's
11) Rh Isoimmunization
12) Twins

among others

Another web site is MFM protocols from New Mexico which has a number of topics including

1) fetal fibronectin
2) non-stress testing
3) PUBS
4)Intra-uterine growth retardation
among others

Geriatrics curriculum

2004-06-09T09:17:00.000-07:00

Geriatrics curriculum on the web

POGOE is a warehouse of educational items on Geriatrics. There are a number of resources including powerpoint presentations, PDA downloads, and web based instructions on multiple topics all searchable and broken down by categories.

Obstetrical CME for nurses

2004-06-09T09:14:00.000-07:00

Nursing CEU in obstetrics

Perifax is an excellent CEU resource for nurses in Obstetrics. They provide 13 modules per year which are available in print or on-line. The cost is $41 per year per nurse if you have 5 or more signing up.

Is tramadol hydrochloride a good choice for moderate pain?

2004-06-07T07:49:00.000-07:00

We recently had a good talk on managing pediatric pain, but I have a comment on tramadol which was described as "a non-narcotic pain medication that is not habit forming" and effective for moderate pain. In fact, tramadol is a narcotic medication, just not legally classified as a scheduled narcotic medication. It probably should be. The mechanism of action is through mu-opioid receptors, withdrawal symptoms occur, it can be psychologically addictive, and it is a drug of abuse with value on the “street”. Here is a brief overview of this drugs limitations. Both oxycodone and hydrocodone may be more effective and safer for managing moderate pain, and do not have the seizure risk.

Tramadol hydrochloride:

> Pharmacokinetics: Active at mu-opioid receptors; also blocks reuptake of serotonin and norepinephrine; metabolite is 200 times more active than tramadol at opioid receptors, and is metabolized through cytochrome p450.

> Because tramadol hydrochloride is not a scheduled drug, it is often viewed as safer than oxycodone and hydrocodone for moderate pain. It is marketed as an “alternative” to narcotic medication even though the mechanism of action is similar.

> Less potent than oxycodone and hydrocodone, therefore less effective for managing moderate pain.

> Side effect profile similar to opioids

> Withdrawal symptoms occur after extended use

> As with narcotic medications psychological dependence possible

> Street value

> Seizure risk even at recommended doses

> Seizure risk compounded for any patient who is already at increased seizure risk (epilepsy; alcohol or other withdrawal; head injury; metabolic disorder; CNS infection)

> Seizure risk also increased for patients on MAO inhibitors, neuroleptics, SSRIs and tricyclic antidepressants

> Seizure risk increased if nalaxone is administered

Your thoughts?

Ultrasound in placental abruption

2004-06-04T13:58:00.000-07:00

A study of 149 consecutive patients showed:

1) Sensitivity - 24%
2) specificity - 96%

Positive sonographic findings were associated with more aggressive managment and worse neonatal outcomes

Abstract of Article

Interpreting TB skin test

2004-06-04T12:05:00.000-07:00

The CDC has a handout on Interpreting TB skin tests.

Includes how to administer ppd and what is considered positive as well as what to do with BCG immunized patients.

Birth Data from 2002

2004-06-04T11:46:00.000-07:00

From the National VItal statistics report comes the Birth Data from 2002

Highlights include
1) lowest birth rate in the country's history (13.9 per thousand)
2) Highest Cesarean section rate in the nation's history (26.1%)
3) Highest low birth weight rate in 3 decades
4) Average age at first birth is 25.1 years
5) Teen birth rate (especially among African Americans) is slowly declining

New Contraceptive Options - February 15, 2004 - American Family Physician

2004-06-04T09:39:00.000-07:00

New Contraception options

Has a good review of the newer contraception options as well as a summary table of all available options and their efficacy rates

2004 STFM lectures

2004-06-04T07:16:00.000-07:00

A link to all the handouts and lectures at this year's STFM
Some of the highlights

Preventing and Treating Obesity: Finding the Will and Way

Morale in Family Medicine Residencies: What makes it? What breaks it? Can it be restored?

Factors Influencing Reversible Contraception Use in Women Aged 35 and Over

Improviing Care for Patients with Diabetes: An Evidence-based Approach

MCW Department home page

2004-06-03T14:25:00.000-07:00

MCW Dept of Family and COmmunity Medicine has a clinical resources page that is worth a look. Links to many evidenced based websites are listed there

PHCI homepage

2004-06-03T14:07:00.000-07:00

PHCI home page please check out iCare tutorial

Prostate Cancer

2004-06-03T13:38:00.000-07:00

Prostate Cancer review from MDConsult. Reviews evidence that even normal PSA have a significantly high risk of prostate cancer

Epilespy Surgery

2004-06-03T13:20:00.000-07:00

Indications for epilepsy surgery

1) Children with Lesional localization related epilepsy
2) Catastrophic epilepsies
a) Infantile spasms
b) Sturge-Weber
c) Rasmussen's syndrome
d) Malformations of cortical development
e) perinatal infarctions
3) Failure of 2 to 3 standard antiepileptic drugs
4) Seizures in which the clinical presentation, EEG findings or MRI suggests a single focal generator
5) Intractable generalized epilepsy

Neurology clinic at CHW 414-266-2831

Obesity Clinic requirements at CHW

2004-06-03T12:58:00.000-07:00

The physician referral packet lists all the criteria to refer overweight children to their program. For more info the phone number is (414) 266-6917.