The Internet Medical Journal Friday, February 19, 1999 7:48 AM 21-October-1998 (1998;2:7)The US News and World Report (October 26th, 1998) shows itself to be clearly out of touch with whatis happening in the health care job market. Stating that becoming a primary care physician is a "hotcareer track" ignores the clear trends that physicians--even primary care physicians--are having adifficult time finding a job (see the pearl below). Also, the salaries listed for physicians aremisleading--because they fail to state that several doctor groups were excluded from the average,including resident physicians, military physicians, and federally employed physicians. The hot jobmarket in the health care field is becoming a allied health professional, such as a nurse practitioner or aphysician assistant. The income is nearly identical, but the expense in time and money in getting thedegree is much less. Do you disagree? Thoughtful responses will be published in the IMJ. Send yourarticle to the editor.Recommended reading this week is the novel A Confederacy of Dunces by John Kennedy Toole. Thisbook will fill your life with good humor and laughter. Did you know that humor and laughter really domake you healthy? The landmark book on this topic is Anatomy of an Illness As Perceived by thePatient : Reflections on Healing and Regeneration by Norman Cousins. This is a must read for everydoctor; make sure your doctor has read it! By the way, the hardcover price for these books is nearlyidentical to the paperback price, so be sure to order the hardback.With this issue, the IMJ will recommend music for readers interested in improving their health willwant to get Music for The Mozart Effect Vol 2 - Heal the Body. Research has proven the healingpowers of Mozarts music. This collection is specifically designed to help your body heal.Be sure to check out Amazon.com for online book and music browsing.Now for the pearls of the week---The 10 most effective preventive services in order: childhood vaccines; flu & pneumonia vaccines;smoking cessation; BP monitoring; ERT; Folic Acid for women of childbearing age; and newborn,cervical cancer, & cholesterol screens. Partnership for prevention , 1998.Successful exercisers in this group of older women tended to engage at least part-time in a soloexercise program; less successful were exercisers who only participated in group exercising. Perri M JConsulting Clin Psychol, 1997, 065:0278.Just over 1 out of 5 resident physicians are finding it difficult to get a job upon graduation from theirresidency program; the number of nonphysician medical providers (e.g. nurse practitioners) doubled injust 4 years from 1993 to 1997. Miller R et al. JAMA, 1998, 280:0777.To identify the early detection of melanoma, use the ABCDE rule: Assymetry, Border irregularity,Color variegation, Diameter over 6 mm, Enlargement/Elevation/Erythema. Using the ABCD rule onlywill miss some cases of melanoma. Brodell RT, Helms SE. Postgrad Med, 1998, 104:0145.A new t-PA dosing regimen was found to be better than the current standard regimen at promotingTIMI grade-3 flow. The NEW regimen is an initial 20 mg IV bolus followed by 80 mg IV over 60
minutes. Gulba DC et al. JACC, 1997, 030:1611.Raloxifene (Evista) has been shown to improve bone mineral density and lower LDL cholesterol. Itseems to be an estrogen ANTAGONIST at the breast and uterus, but an estrogen AGONIST in boneand lipid metabolism. Delmas PD et al. NEJM, 1997, 023:1641.The risk of a hemorrhagic stroke after receiving t-PA for an acute myocardial infarction was 0.95% ; ofthose, 53% died. Gurwitz JH et al. Ann Intern Med, 1998, 129:0597.Low back pain persisted for at least one year in this study of 463 patients with a new episode of lowback pain. At 3 months, 21% had reported full recovery, and at 1 year, only 35% reported completerecovery. Croft PR et al. BMJ, 02-MAY 1998, 316:1356.Patients taking nortriptyline as an aid to smoking cessation were about 5 times more likely to beabstinent at 6 months, as compared with a placebo controlled group (both groups received counseling).The placebo quit rate was 3% at 6 months. Prochazka AV et al. Arch Intern Med, 1998, 158:2035.Warfarin is underutilized among the elderly who have already had a stroke and also have atrialfibrillation. Brass LM et al. Arch Intern Med, 1998, 158:2093.PSA screening has uncertain, if any benefits. Ann Intern Med, 1998, 129:0212.If blood is present in the stool, a flex sig and barium enema is recommended. Ann Intern Med, 1998,129:0212.Even if only small polyps are found on flexible sigmoidoscopy, a full colonoscopy is recommended.Ann Intern Med, 1998, 129:0212.The D-dimer test, with a cutoff value of 500 mg/dL, has a negative predictive value of 99%. Thesensitivity is 99% and specificity is 41%. Ann Intern Med, 1998, 129:0212.Aspirin reduces the 6-month mortality and moderate/severe disability after a stroke (NNT=43).Unfractionated heparin was not shown to be helpful. Ann Intern Med, 1998, 129:0212.