临床时讯 ＞ 专家论坛
Medscape是美国专为临床医师和其他健康工作者提供医学信息的网站，2011年底其推出各种“十大（top10）”盘点，让我们看看美国初级保健医生（Primary Care Physicians）频道评出的点击率最高的10篇新闻。
CDC建议每年都要接种流感疫苗，由于人体对于流感病毒的免疫力会随着时间而逐渐减弱，所以通过上一次接种获得的免疫力也许并不能够保证今年仍然有效。文章见美国CDC官方网站（CDC Expert Commentary，September 2011）。
Ann Fam Med. 2011 Jul-Aug;9(4):299-304.
Tea and coffee consumption and MRSA nasal carriage.
Matheson EM, Mainous AG 3rd, Everett CJ, King DE.
Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
PURPOSE: Hot tea and coffee have been found to have antimicrobial properties. The purpose of this study was to determine whether the consumption of tea, coffee, or both is associated with less frequent nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA).
METHODS: We performed a secondary analysis of data from the 2003-2004 National Health and Nutrition Examination Survey to investigate the relationship between the consumption of coffee, hot tea, cold tea, and soft drinks, and MRSA nasal carriage among the noninstitutionalized population of the United States.
RESULTS: An estimated 2.5 million persons (1.4% of the population) were MRSA nasal carriers. In an adjusted logistic regression analysis controlling for age, race, sex, poverty-income ratio, current health status, hospitalization in the past 12 months, and use of antibiotics in the past month, individuals who reported consuming hot tea were one-half as likely to have MRSA nasal carriage relative to individuals who drank no hot tea (odds ratio = 0.47; 95% confidence interval, 0.31-0.71). Similarly, individuals who reported consuming coffee had about a one-half reduction in the risk of MRSA nasal carriage relative to individuals who drank no coffee (odds ratio = 0.47; 95% confidence interval, 0.24-0.93).
CONCLUSIONS: Consumption of hot tea or coffee is associated with a lower likelihood of MRSA nasal carriage. Our findings raise the possibility of a promising new method to decrease MRSA nasal carriage that is safe, inexpensive, and easily accessible.
Top10：侵袭性黑色素瘤（MM）早期识别的ABCDE方法，A即非对称（asymmetry），B即边缘不规则（border irregularity），C即颜色变化（color variability），D即直径大于6毫米（diameter greater than 6 mm），E即进展或变化（evolution or change）。
Counting Down 10 Through 1: Most-Read Medscape Articles by PCPs
10. The "Ugly Duckling" Sign: An Early Melanoma Recognition Tool For Clinicians and the Public
The key to preventing deaths due to invasive melanoma (MM) remains detecting the disease early, at a stage when surgical excision of the tumor is still curative. One clinical clue to diagnosis is the "ugly duckling" sign -- a useful indicator for MM screening with implications for healthcare workers and the lay public alike. Given certain limitations of the established ABCDE acronym for early melanoma recognition, this study suggests a new, broader way of thinking about the ugly duckling concept and its place in MM detection.
9. Tea and Coffee Consumption and MRSA Nasal Carriage
In this study, consumption of hot tea or coffee was associated with a lower likelihood of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage. The findings raise the possibility of a promising new method to decrease MRSA nasal carriage that is safe, inexpensive, and easily accessible.
8. 10 Physicians Charged in Fed Sweep of Medicare 'Fraudsters'
In September, a federal bust of Medicare fraud in 8 cities has yielded criminal charges against 91 individuals, including 10 physicians as well as nurses, physical therapists, and family counselors. The defendants allegedly billed Medicare for $295 million in false claims with the help of kickbacks, illegal pain medication prescriptions, imaginary psychotherapy sessions, and other ploys. The US Department of Justice called the bust "the highest amount of false Medicare billings in a single takedown in Strike Force history."
7. Six Biggest Gripes of Employed Doctors
The 6 biggest complaints according to this article were:
Lack of job security;
Changes in compensation;
Call schedule is too burdensome;
Lack of business control;
Lack of clinical autonomy; and
The tyranny of noncompete clauses.
This article offers a discussion where you might want to share ideas on this volatile subject
6. What's Killing Us? The 4 Deadliest Diseases
This Medscape One-on-One between Eli Adashi, MD and Tea Collins, Executive Director of The Non-Communicable Diseases (NCD) Alliance, discussed the importance of the new global initiative against four major NCDs that are responsible for 60% of deaths worldwide: cancer, diabetes, cardiovascular disease, and pulmonary disease.
5. I'm Struggling to Live on $160,000 a Year: MD Lament
Whereas most Americans would consider a $160,000 income a fortune, many physicians find it a challenge to live on that amount. Why can some manage easily while others are struggling to pay the bills?
4. Updated Influenza Vaccine Recommendations Issue
New for the 2011-2012 season is a more-permissive influenza vaccination recommendation for persons with egg allergies. The CDC Advisory Committee on Immunization Practices now recommends that people who have experienced only hives from consuming eggs can receive the trivalent inactivated vaccine intramuscularly as long as they are treated by a healthcare provider who is familiar with the potential manifestations of egg allergies and can be observed by a healthcare professional for at least 30 minutes after receiving each dose. Live-attenuated influenza vaccine should not be used in these patients. Read the full CDC commentary.
3. FDA Approves New Drug for Type 2 Diabetes
In May, the US Food and Drug Administration approved linagliptin (Tradjenta™) for improving blood glucose control in adults with type 2 diabetes, either as a stand-alone or in combination with other therapies.
2. Doctors' 5 Worst Financial Mistakes
Physicians do their best to manage their money and investments wisely, but a few common mistakes keep cropping up. Are you guilty of any of these?
1. FDA Restricts Use of Simvastatin 80 mg
In early June 2011, the US Food and Drug Administration (FDA) issued a drug safety communication on the 80-mg dose of simvastatin because of an increased risk for muscle toxicity. "Simvastatin 80 mg should not be started in new patients, including patients already taking lower doses of the drug," the agency stated.
It advised physicians to limit using the 80-mg dose unless the patient had already been taking the drug for 12 months and there is no evidence of myopathy. In addition, the FDA requested that additional changes be made to the drug's label. The label changes include the new dosing recommendations as well as warnings not to use the drug with various medications, including itraconazole (Sporanox), ketoconazole (Nizoral), posaconazole (Noxafil), erythromycin, clarithromycin, telithromycin (Ketek), HIV protease inhibitors, nefazodone, gemfibrozil, cyclosporine, and danazol. In addition, the 10-mg dose should not be exceeded in patients taking amiodarone, verapamil, and diltiazem, and the 20-mg dose should not be exceeded with amlodipine (Norvasc) and ranolazine (Ranexa).
As a result, there was concern that physicians would not be comfortable escalating to branded statins because of resistance from managed care and sometimes the necessity for prior authorization. In addition, it was thought that many patients would also be distressed by the added cost of a more expensive statin. The availability of generic atorvastatin in November should help address these issues for many patients.
For commentary on this issue see Switching From Simvastatin 80 mg: How to Shop for Statins and Simvastatin 80 mg: If You Can't Go Lower, Go Elsewhere