Fwd: Breast Cancer Assessment, Diagnosis, and Management

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Thought this was good info for all of us...Blessings,BeckyNote: forwarded message attached.

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Top Stories

The Emergence and Impact of Extensively Drug-Resistant Tuberculosis

CME/CE Atrophic Vaginitis and Estrogen Treatment

CME/CE Risk Factors, Epidemiology, and Treatment Strategies for Multidrug-Resistant Bacteria

A Complementary Approach to Pain Management

CME/CE New Guidelines Issued for Nervous System Lyme Disease

From The Editor

New from the CDC -- 5 self-directed, interactive training modules, designed to enhance clinical skills in the examination of the breast. This curriculum reviews the latest on the presentation and management of common breast problems, with an emphasis on assessment and early diagnosis. Nurses/APNs may earn 5.75 continuing education credits for participation in this series.

If you have feedback about this MedPulse newsletter, I would like to hear from you. If you have technical questions, such as "How do I print my CE certificate?," please read the CME/CE Frequently Asked Questions or use the contact support form to contact Customer Support.

Yox, RN, EdD

Editor, Medscape Nurses

Feature Articles

Featured This Week

The Emergence and Impact of Extensively Drug-Resistant Tuberculosis

The CDC issued its first federal quarantine order since 1963 for a patient with XDR-TB. Where did this disease come from and how can we treat it?

Medscape Pulmonary Medicine 2007

The CDC's Quarantine Authority: An Expert Interview With Barwick Eidex, PhD

Barwick Eidex, PhD, Associate Director for Science, Division of Global Migration and Quarantine at the CDC explains the scope and process of invoking the government's quarantine authority.

Medscape Pulmonary Medicine 2007

Test Your Knowledge/Earn CE Credit

Breast Cancer Module I: Breast Anatomy, Physiology, and Pathology

Understanding breast anatomy, physiology and pathology is essential for follow-up of abnormal findings.

CME/CE Breast Cancer Module II: Health History and Clinical Breast Examination

Assessing clinical history and performing a thorough clinical breast examination are essential to managing risk and prevent a delayed diagnosis of breast cancer.

CME/CE Breast Cancer Module III: Workup of a Palpable Mass

Assessing and documenting clinical findings that are suspicious for cancer are essential for timely and appropriate follow-up. The primary care clinician must also correlate the clinical findings with imaging findings to determine the appropriate plan of action to prevent a delayed diagnosis of breast cancer.

CME/CE Breast Cancer Module IV: Follow-up of Abnormal Imaging Findings -- Biopsy Methods

Understanding breast imaging findings is essential for correlation with clinical findings and subsequent plan of action to prevent a delay of diagnosis of breast cancer.

CME/CE Breast Cancer Module V: Risk Management

Primary care clinicians can help ensure that women receive timely and appropriate follow-up by practicing risk management strategies developed from common causes of delay of diagnosis of breast cancer.

More Continuing Education

CME/CE Atrophic Vaginitis and Estrogen Treatment

Review physiologic changes, physical findings, symptoms, and current approaches to treatment of this "new" epidemic.

CME/CE Diagnosing and Treating Interstitial Cystitis: An Interactive Case

This interactive case addresses a number of the difficulties clinicians face in diagnosing and treating patients with this challenging condition.

CME/CE Helping the Hyperactive Child: When Autism Looks Like ADHD

Many children with autism-spectrum disorders also have hyperactivity and inattention. Learn about the concurrent diagnosis of these syndromes and the latest evidence on effective pharmacotherapy.

CME/CE Risk Factors, Epidemiology, and Treatment Strategies for Multidrug-Resistant Bacteria

A review of risk factors, emerging trends, and treatment strategies for the development of multidrug-resistant bacteria to assist clinicians managing infection from the most common antimicrobial-resistant organisms.

CME/CE LDL-C -- How Low Should You Go?

Clinical trials have demonstrated that very significant reductions of LDL-C can be achieved. How low should you go? Are there other options?

CME/CE Managing Chronic Mild-to-Moderate Pain Due to Rheumatoid Arthritis: The Cardiovascular Considerations Associated With Therapeutic Options

An interactive case study highlighting cardiovascular considerations and demonstrating decision-making strategies for the treatment of mild-to-moderate RA pain using NSAIDs and COX-2 inhibitors.

A Complementary Approach to Pain Management

Clinicians face multiple challenges when patients ask for their input about CAM therapies. While some forms of CAM can be effective for relief of pain, the evidence is often not compelling.

Topics in Advanced Practice Nursing eJournal 7(1) 2007

Nursing Journal Partners

Hospitals and Philanthropy as Partners in Funding Nursing Education

Nursing education needs a new strategy for sustaining itself, and new collaborations may hold the key.

Nurs Econ 25(2) 2007

Cerebral Palsy: Introduction and Diagnosis (Part 1)

Review information needed to diagnose and explain CP, as well as to guide treatment and provide support to the child and family.

J Pediatr Health Care 21(3) 2007

Dietary and Holistic Treatment of Recurrent Calcium Oxalate Kidney Stones

Don't miss this evidence-based review of the literature on dietary modifications for reducing the risk of recurrent calcium oxalate stone disease.

Urol Nurs 27(2) 2007

Acetaminophen Toxicity

Taking too much acetaminophen can cause big problems. This drug should not be used casually.

Journal for Nurse Practitioners 3(3) 2007

Diagnosis and Treatment of Idiopathic Normal Pressure Hydrocephalus

The patient presents with progressively worsening symptoms, including gait and balance impairment, deterioration of memory and cognition, and recent urinary urgency and incontinence.

J Neurosci Nurs 39(2) 2007

Sexual Assault Nurse Examiner Program Characteristics, Barriers, and Lessons Learned

By highlighting problems, potential solutions, and lessons learned, the results of this national survey will guide future practice.

J Foren Nurs 3(1) 2007

Ask the Expert Advanced Practice Nurse

What Can Be Done About a Hand Wart That Keeps Reappearing After Removal?

I have a patient (baseball player) with a wart on his thumb. We have removed the wart several times and it returns. Is his baseball glove reinfecting him with the virus, or is it simply reoccurring?

Medscape Nurses 2007

Stories, Blogs, & Columns

Dystonia Awareness Week June 3-7, 2007

Learn more about dystonia -- a neurological condition that presents itself through involuntary movements, tremors, and bizarre postures.

Blog Showcases Humorous Videos of Med School Life

A screenwriter-turned-med student writes about healthcare, medical school, and some irreverent clips on YouTube.

Medscape Med Students 2007

Neurology

CME Restless Legs Syndrome: Impact, Recognition, and Management

Learn about RLS and its negative impact on quality of life, the relationship between RLS and psychiatric disorders, ways to improve diagnosis, and treatment approaches in this video-based Spotlight.

Mental Health/Psychiatry

Treating ADHD in Adults With Comorbid Mood Disorders: What the Evidence Shows

How does ADHD affect the symptoms of comorbid mood disorders and their prognosis? Which approaches provide the most effective management?

Medscape Psychiatry & Mental Health 2007

Antidepressants in Bipolar Depression: Data From STEP-BD: An Expert Interview With Nierenberg, MD

Does adding an antidepressant to mood stabilizer therapy hurt or help your bipolar patient? A new and comprehensive study from the NIH yields some results that may change the way you prescribe.

Medscape Psychiatry & Mental Health 2007

The Meaning of the Term "Bipolar Disorder"

What differentiates bipolar from unipolar depression? What factors are relevant when considering antidepressants?

Medscape Psychiatry & Mental Health 2007

The Effectiveness of ECT for Bipolar Disorder

How effective is ECT for bipolar depression, depression with a switch into mania, refractory mania, and maintenance? For what 2 types of patients should it be considered a first-line treatment?

Medscape Psychiatry & Mental Health 2007

Bipolar Disorder -- How Best to Treat Lactating Women: Psychiatry and Mental Health Viewpoint

Should women with bipolar disorder stay on lithium while breastfeeding? How safe is going off lithium for the mother? How safe is exposure for the infant?

Medscape Psychiatry & Mental Health 2007

Neonatal/Pediatrics

A Longitudinal Study of Adolescents with Perinatally or Transfusion Acquired HIV Infection: Sexual Knowledge, Risk Reduction Self-efficacy and Sexual Behavior

These investigators emphasize that since HIV-positive children are surviving to adolescence and beyond, messages on safer sex and risk reduction should be incorporated into routine medical settings.

AIDS Behav 11(3) 2007

Women's Health

Deep Dyspareunia and Sex Life after Laparoscopic Excision of Endometriosis

This study examines the effect of laparoscopic excision of endometriosis on deep dyspareunia and quality of sex life.

Hum Reprod 22(4) 2007

Smoking, Alcohol and Caffeine in Relation to Ovarian Age During the Reproductive Years

A look at whether smoking, alcohol and caffeine are related to four indicators of ovarian age: antral follicle count (AFC), follicle stimulating hormone (FSH), inhibin B and estradiol.

Hum Reprod 22(4) 2007

Cardiovascular Disease

Consciousness of Blood Pressure Is Rising as Details About Possible Remedies Continue to Evolve

One billion adults with diseases involving hypertension? Is that possible, and what are we, can we, should we be doing about it?

Medscape Cardiology 2007

Insulin Resistance, the Metabolic Syndrome, and Risk of Incident Cardiovascular Disease

Can insulin resistance predict cardiovascular disease independent of the metabolic syndrome?

J Am Coll Cardiol 49(21) 2007

Highlights From Other Medscape Specialties

CME Radiological Imaging in Pneumonia: Recent Innovations

Chest radiography is the most commonly used imaging tool in pneumonias because of availability and an excellent cost-benefit ratio. This review article provides the background and rationale for appropriate use of chest x-rays, CT scans, and other modalities.

Effectively Managing the Patient Not Just the Problem

A construction worker with diabetes is noncompliant in managing his foot ulcer. There's a good reason and a good solution.

Wounds 19(4) 2007

Pharmacoepidemiology of Potential Alcohol-Prescription Drug Interactions Among Primary Care Patients With Alcohol-use Disorders

Many patients are taking medications that can have moderate to severe interactions with alcohol, yet they are unaware of the risks.

J Am Pharm Assoc (Wash) 47(2) 2007

Acceptability of Male Circumcision for Prevention of HIV/AIDS in Sub-Saharan Africa: A Review

In an analysis of 13 studies from 9 African countries, investigators report that 65% of uncircumcised men were willing to become circumcised and 69% of women favored circumcision for their partners.

AIDS Behav 11(3) 2007

MedGenMed

Terminal Sedation, Euthanasia, and Causal Roles

What are the ethical pros and cons of terminal sedation in combination with termination of treatment in comparison with alternatives such as assisted suicide?

Medscape General Medicine 9(2) 2007

Use of Depleted Uranium Is a Form of Radiologic Warfare

Helen Caldicott, MD, Founder and President of the Nuclear Policy Research Institute in land, explains why "depleted uranium" might not be depleted enough.

Medscape General Medicine 9(2) 2007

Medscape Alerts

EnDura No-React Dural Patches Recalled Due to Sterility Concerns

Class 1 recall affects all dural substitute products in the line distributed since 2003.

Medscape Medical News 2007

Complete MoisturePlus Contact Lens Solution Recalled

A CDC investigation revealed a 7-fold increased risk for Ancathamoeba keratitis in users of the multipurpose contact lens solution made by Advanced Medical Optics.

Medscape Medical News 2007

Opinion Poll

What's in a Name?

Which of the following terms do you think is most useful for nonphysician healthcare workers when being referred to as a group? To vote or view results of the poll, click on the title above.

News

Test Your Knowledge/Earn CE Credit

New Guidelines Issued for Nervous System Lyme Disease

The American Academy of Neurology has issued new evidence-based treatment guidelines for nervous system Lyme disease, which endorse conventionally recommended courses of antibiotics for treatment.

Medscape Medical News 2007

Time Watching Television Linked to Glucose Control in Pediatric Type 1 Diabetes

A study showed a continuous increase in glycated hemoglobin level with every hour of watching television in children and adolescents with type 1 diabetes.

Medscape Medical News 2007

Aggressive Care Might Delay Recovery From Whiplash

The observation that intensive care early after a whiplash injury is associated with slower recovery was reproduced in an independent patient cohort.

Medscape Medical News 2007

Increased Coffee Consumption May Reduce Risk for Gout in Men

A prospective study showed that long-term coffee consumption was associated with a lower risk for incident gout in men older than 40 years.

Medscape Medical News 2007

Guidelines for Drug Dosing Regimens in Chronic Kidney Disease

A review provides various drug dosing regimens and principles for appropriately treating patients with chronic kidney disease.

Medscape Medical News 2007

Risk Factors Identified for Poor Short-Term Outcome in Acute Pediatric Asthma

An observational cohort study of children with severe asthma identified more effective risk factors to screen and evaluate interventions for high-risk children with asthma in the emergency department.

Medscape Medical News 2007

Neonatal Intensive Care Reduces Mortality in Very-Low-Birth-Weight Infants

A study showed mortality of hospital-delivered very-low-birth-weight babies was reduced in hospitals with neonatal intensive care units with high volumes and high levels of care of such patients.

Medscape Medical News 2007

General Health News

Diets High in Meat Linked With Greater Skin Cancer Risk

Diets with high amounts of meat and fat compared with those rich in vegetables and fruit appear to increase the risk of squamous cell carcinomas of the skin, according to Australian researchers.

Reuters Health Information 2007

Aerobic Activity Modestly Increases HDL Cholesterol Levels

A meta-analysis showed regular aerobic exercise increases high-density lipoprotein cholesterol levels, with exercise duration per session being the most important element of an exercise program.

Medscape Medical News 2007

Accelerated Diagnostic Protocol Effective for Transient Ischemic Attack

An emergency department (ED) accelerated diagnostic protocol for transient ischemic attack (TIA) is more efficient and less costly than traditional inpatient admission, according to a report in the May 8th ls of Emergency Medicine.

Reuters Health Information 2007

Exposure to Pesticides Linked to Risk for Parkinson's Disease

A case-control study showed an exposure-response association of pesticide exposure with Parkinson's disease, which suggests a causative role.

Medscape Medical News 2007

Vitamin D's Anti-Inflammatory Properties May Prevent Age-Related Macular Degeneration

Results of a study published in the May issue of the Archives of Ophthalmology suggest that vitamin D may protect against age-related macular degeneration (AMD).

Reuters Health Information 2007

High-Carbohydrate Diets Are Linked to Higher Blood Pressure

Carbohydrate-rich diets are associated with slightly higher blood pressure than diets rich in cis-monounsaturated fat, according to findings published in the May issue of the American Journal of Clinical Nutrition.

Reuters Health Information 2007

Dietary Fiber Intake Not Tied to Colorectal Cancer Risk

Although the potential connection between dietary fiber and colorectal cancer has long held an attraction for both medical researchers and the general public, investigators report in a new study that the results of a large prospective cohort study do not support such a link.

Reuters Health Information 2007

Vitamin A (Retinol) Effaces Wrinkles in Naturally Aged Skin

In a small randomized trial, topical retinol improved fine wrinkles associated with natural aging, most likely as a result of induction of glycosaminoglycan and increased collagen production.

Medscape Medical News 2007

Drug-Resistant Bugs on Rise Outside Hospital: Study

Drug-resistant bacteria are infecting more people in community settings such as prisons and public housing, and not just in hospitals where such "superbugs" can run rampant, researchers said on Monday.

Reuters Health Information 2007

Pediatrics

Fish Oil Supplementation Improves Motor Skills in Children With Phenylketonuria

Fish oil supplementation improves motor skills in children with phenylketonuria (PKU), according to findings published in the May issue of the Journal of Pediatrics.

Reuters Health Information 2007

Inflicted Head Trauma Worse Than Noninflicted Type for Infants

Infants who sustain head injuries due to abuse have worse outcomes than infants with head trauma due to other causes, according to a report in the May issue of Pediatrics.

Reuters Health Information 2007

Women's Health

FDA Approves Lybrel for Continuous Contraception

The FDA approves a 28-day pill pack of levonorgestrel/ethinyl estradiol 90-micrograms/20-micrograms combination tablets (Lybrel).

Medscape Medical News 2007

Calcium, Vitamin D Intake May Lower Risk for Premenopausal Breast Cancer

A study showed that women who had high intakes of calcium and vitamin D had a lower risk of developing premenopausal breast cancer, with greater protection against more aggressive tumors.

Medscape Medical News 2007

Transvaginal Sonographic Screening May Catch Ovarian Cancer Early

Transvaginal sonography (TVS) screening is associated with a reduction in ovarian cancer stage at detection and with increased case-specific survival, new research shows. However, TVS screening is not helpful in diagnosing ovarian malignancies in women with normal ovarian volumes.

Reuters Health Information 2007

Breast-Conserving Therapy Safe for Younger Breast Cancer Patients

Breast-conserving treatment is safe for women younger than 40 with breast cancer, according to a report in the May 15th issue of Cancer.

Reuters Health Information 2007

Men's Health

Erectile Dysfunction Drugs Show Promise in Treatment of Lower Urinary Tract Symptoms

In 3 studies, men receiving vardenafil, sildenafil, or tadalafil had improved symptoms compared with those receiving placebo.

Medscape Medical News 2007

Chronic Disease

Severe Hypoglycemia May Follow a Particular Pattern of Blood Glucose Fluctuation

A study showed severe hypoglycemia follows a particular blood glucose fluctuation pattern that is identifiable with routine self-monitored blood glucose readings.

Medscape Medical News 2007

Better Monitoring Could Curb Anticoagulation Problems

Patients taking anticoagulants orally for long periods have international normalized ratios (INRs) that fall outside the individual therapeutic range more than one-third of the time. This increases the likelihood of adverse events, researchers report in the May 22nd issue of the Canadian Medical Association Journal.

Reuters Health Information 2007

Salmeterol and Fluticasone Propionate Slow Decline in COPD Patients

Patients receiving the combination therapy lost less lung function during the course of the 3-year TORCH trial than did those receiving placebo.

Medscape Medical News 2007

Health and Politics

Rosiglitazone Meta-Analysis Continues to Drive Controversy in Second Week

The rosiglitazone story rumbles on this week, with some observers claiming that the meta-analysis was timed to get data into the public arena without the FDA's knowledge, thereby bringing the subject of drug safety to the fore once more. In the meantime, the one ongoing trial that everyone agrees will give definitive information on cardiovascular outcomes with rosiglitazone could be in jeopardy, as some participants desert the study due to safety concerns.

Heartwire 2007

Bush Picks New U.S. Surgeon General

President W. Bush announced on Thursday that he had picked Kentucky physician Holsinger to become the top U.S. health educator and said he would focus on reducing childhood obesity.

Reuters Health Information 2007

FDA News and Approvals

FDA Safety Changes: Keppra, Saizen, Prozac

The FDA has approved revisions to the safety labeling for levetiracetam, somatropin (recombinant DNA origin), and fluoxetine HCl.

Medscape Medical News 2007

First-Time Generic Approvals: Toprol-XL, Suprax, Lotrel

The FDA has approved generic formulations for metoprolol succinate extended-release tablets for treatment of hypertension and other conditions, cefixime oral suspension for treatment of bacterial infections, and amlodipine besylate/benazepril for treatment of hypertension.

Medscape Medical News 2007

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