Hormone replacement therapy.

HRT should not be used for the prevention or treatment of chronic disease (eg, heart disease, osteoporosis, dementia). HRT is effective in alleviating moderate to severe menopausal symptoms. Clinicians must be aware of the risks and benefits of HRT and discuss them thoroughly with their patients. As new forms and lower doses of hormones become available, additional studies will be needed to compare therapeutic strategies adequately. Studies of younger perimenopausal and menopausal women are needed. Whatever regimen is chosen, the lowest allowable estrogen dose to relieve symptoms for the shortest time is recommended. Alternatives to hormonal therapy are being examined and some may be considered. Table 1 provides an evidence-based summary of current recommendations.

Methods for teaching physical examination skills to medical students.

BACKGROUND AND OBJECTIVES: Teaching physical examination (PE) skills is a fundamental component of medical education. However, there is little information available about how medical school faculty teach PE skills. This study surveyed PE course directors to determine how they presently teach PE skills, the methods that are perceived to be the best, and how standardized patients (SPs) are recruited and paid. METHODS: A written survey was mailed to PE course directors at US allopathic and osteopathic medical schools. RESULTS: PE course directors at 83 (58%) schools responded. Results indicate that the top three methods presently used for teaching (demonstration on an SP, practice on an SP, and practice on patients) and those perceived to be the best methods are the same but in different rank order. A significant difference was observed in the overall mean scores of the present methods versus the best methods in 8 of the 10 teaching methods; thus, instructors are not always using the best methods to teach PE. There were also differences in methods used to teach "sensitive areas" (ie, genital or breast exam). CONCLUSIONS: The highest-ranked methods for teaching PE are demonstrations and practice with SPs and practice on real patients. However, PE instructors are not always using the teaching methods they deem best.

Managing benign prostatic hyperplasia.

Medical and surgical options for the treatment of benign prostatic hyperplasia have expanded in recent years. Saw palmetto, the most widely used complementary medication, is less effective than standard medical therapy but has fewer side effects. Although non-selective alpha blockers provide rapid relief of symptoms and are relatively inexpensive, they can cause dizziness and orthostatic hypotension. These effects occur less often with tamsulosin, a more selective alpha blocker. Finasteride, a 5alpha-reductase inhibitor, slowly reduces prostatic volume but is not as effective as alpha blockers, especially in men with a smaller prostate. Dutasteride, a new 5alpha-reductase inhibitor, has recently been labeled for the treatment of benign prostatic hyperplasia. Surgery may be appropriate initial treatment in patients with severe symptoms who are not at high risk for complications. Surgery may also be indicated in patients who have failed medical therapy or have recurrent infection, hematuria, or renal insufficiency. Transurethral resection of the prostate is effective in most patients, but it carries some risk of sexual dysfunction, incontinence, and bleeding. Surgical procedures that use thermal microwave or laser energy to reduce hyperplastic prostate tissue have recently become available. In general, the newer procedures are less expensive than transurethral resection of the prostate and have fewer complications; however, the need for retreatment is somewhat greater with these less invasive techniques.