Atypical moles: diagnosis and management.

Atypical moles are benign pigmented lesions. Although they are benign, they exhibit some of the clinical and histologic features of malignant melanoma. They are more common in fair-skinned individuals and in those with high sun exposure. Atypical moles are characterized by size of 6 mm or more at the greatest dimension, color variegation, border irregularity, and pebbled texture. They are associated with an increased risk of melanoma, warranting enhanced surveillance, especially in patients with more than 50 moles and a family history of melanoma. Because an individual lesion is unlikely to display malignant transformation, biopsy of all atypical moles is neither clinically beneficial nor cost-effective. The ABCDE (asymmetry, border irregularity, color unevenness, diameter of 6 mm or more, evolution) mnemonic is a valuable tool for clinicians and patients to identify lesions that could be melanoma. Also, according to the "ugly duckling" concept, benign moles tend to have a similar appearance, whereas an outlier with a different appearance is more likely to be undergoing malignant change. Atypical moles with changes suggestive of malignant melanoma should be biopsied, using an excisional method, if possible.

Low back pain: an approach to diagnosis and management.

Low back pain is a common condition, responsible for significant morbidity and major occupational and economic impact on society. While most cases of low back pain spontaneously resolve, the clinician must be alert to clinical indicators or "red flags" that suggest the presence of systemic illness or imminent neurologic compromise. In the absence of such findings, diagnostic imaging generally does not contribute to management, and may be safely delayed for a trial of conservative therapy. Continued activity is associated with a favorable outcome. Nonsteroidal anti-inflammatories, acetaminophen, muscle relaxants, and tricyclic antidepressants can provide meaningful pain relief, while several nonpharmacologic measures may also contribute to symptomatic and functional improvement.

Effects of electronic prescribing on the clinical practice of a family medicine residency.

BACKGROUND AND OBJECTIVES: Electronic prescribing is one of the components of the Patient-centered Medical Home and is one of the "meaningful use" criteria to qualify electronic medical records for financial incentives. While there are many potential benefits of electronic prescribing, documentation of these is currently sparse. The purpose of this study was to measure practice improvement as a result of the implementation of electronic prescribing. METHODS: Using telephone logs, the number and nature of after-hours calls were reviewed before, immediately after, and 1 year after the initiation of electronic prescribing. Patient and provider satisfaction studies were also conducted. RESULTS: One year after the onset of electronic prescribing the overall rate of after-hours calls was reduced by 22% from baseline, significant at P< or =.05, though calls related to medications were significantly increased. Both provider and patient satisfaction with electronic prescribing was very high. CONCLUSIONS: Electronic prescribing was positively received by patients and providers and resulted in a reduction in total after-hours calls, despite a paradoxical increase in medication-related calls. Further study is warranted to document other evidence-based outcomes of electronic prescribing.