Consider this tool to reduce antibiotic-associated adverse events in patients with sepsis.

Predictive biomarker procalcitonin can aid clinical decision-making on continued antibiotic treatment in this patient population.

A "no-biopsy" approach to diagnosing celiac disease.

This noninvasive alternative to the diagnostic gold standard may cut risk and expense for adult patients.

Confidently rule out CAP in the outpatient setting.

A focus on specific signs and symptoms-without imaging-may rule out community-acquired pneumonia in outpatients.

Hemorrhoids: Diagnosis and Treatment Options.

Many Americans between 45 and 65 years of age experience hemorrhoids. Hemorrhoidal size, thrombosis, and location (i.e., proximal or distal to the dentate line) determine the extent of pain or discomfort. The history and physical examination must assess for risk factors and clinical signs indicating more concerning disease processes. Internal hemorrhoids are traditionally graded from I to IV based on the extent of prolapse. Other factors such as degree of discomfort, bleeding, comorbidities, and patient preference should help determine the order in which treatments are pursued. Medical management (e.g., stool softeners, topical over-the-counter preparations, topical nitroglycerine), dietary modifications (e.g., increased fiber and water intake), and behavioral therapies (sitz baths) are the mainstays of initial therapy. If these are unsuccessful, office-based treatment of grades I to III internal hemorrhoids with rubber band ligation is the preferred next step because it has a lower failure rate than infrared photocoagulation. Open or closed (conventional) excisional hemorrhoidectomy leads to greater surgical success rates but also incurs more pain and a prolonged recovery than office-based procedures; therefore, hemorrhoidectomy should be reserved for recurrent or higher-grade disease. Closed hemorrhoidectomy with diathermic or ultrasonic cutting devices may decrease bleeding and pain. Stapled hemorrhoidopexy elevates grade III or IV hemorrhoids to their normal anatomic position by removing a band of proximal mucosal tissue; however, this procedure has several potential postoperative complications. Hemorrhoidal artery ligation may be useful in grade II or III hemorrhoids because patients may experience less pain and recover more quickly. Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms.

Lung Cancer: Screening and Evaluation of Patients With Solitary Pulmonary Nodules.

Low-dose computed tomography (CT) scan is the only modality currently considered acceptable for lung cancer screening in high-risk populations. Screening recommendations vary. The US Preventive Services Task Force recommends annual low-dose CT scan to screen high-risk patients (ie, asymptomatic patients ages 55 to 80 years with a 30 pack-year smoking history and who currently smoke or have quit within the previous 15 years). The American Academy of Family Physicians recommends a shared decision-making discussion between the clinician and patient regarding the benefits and potential harms of screening. Medicare covers lung cancer screening to age 77 years as part of a shared decision-making visit and when offered in conjunction with smoking cessation. Approximately 320 high-risk patients who smoke need to be screened annually over 3 years to prevent 1 death from lung cancer. The false-positive rate is 96%. Solitary pulmonary nodules or masses identified on screening or incidentally on other imaging should be managed based on appearance and size and the clinical risk factors of the patient, in accordance with guidelines.

Lung Cancer: Management.

Lung cancer management that is individualized for age, comorbidities, cancer type, cancer stage, and patient preference has long been a cornerstone of management. New to this realm of individualized management are the emerging biologic therapies, immunotherapies, and targeted therapies for non-small-cell lung cancer provided by advances in genetics and molecular medicine. These techniques have led to a new field of precision medicine based on the unique molecular characteristics of a specific patient and the specific cancer. However, standard management including surgery, chemotherapy, and radiation therapy remains the most common management options for stage I through III lung cancers. Advancements in precision medicine are most relevant to patients with stage IV (ie, metastatic) lung cancers. Functional patient assessment and pulmonary function testing are keys to preoperative assessment. Early palliative care and a minimally invasive approach to surgery should be considered in patients who can tolerate surgery.

Help Desk Answers: Surgery vs conservative management for AC joint repair: How do the 2 compare?

When not considering the grade of acromioclavicular (AC) joint dislocation, both conservative and surgical management lead to positive outcomes, although surgically managed patients require more time out of work.