Primary Care Clerkship Patient Education Handouts

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The Primary Care Clerkship (PCC) was, until April of 2009, a required 8-week interdisciplinary course for all third and fourth year medical students. For several years, students had completed a course project which involved answering a clinical question generated during patient care in their primary care clinic. In addition to summarizing the research available to answer this clinical question, students also translate this medical language into a document suitable to inform an average patient on this topic – a Patient Education Tool (PET) handout. This project has been continued in the required, 4-week, Family Medicine Clerkship, that began May of 2009. Given the time and energy invested by students in creating these handouts and the overall high quality of the final product, the course directors were eager to make these products more generally available to the public through this site. The information provided does not necessarily reflect the views of the University of Minnesota Medical School physicians and faculty. These materials are provided for informational purposes only and are in no way intended to take the place of the advice and recommendations of your personal health care provider. You use the information provided in these handouts at your own risk.

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    Bridging to Warfarin - A Patient's Guide to Low-Molecular-Weight Heparin
    (2009-08-20) Luger, Alex
    A patient's guide to bridging to warfarin. LMWH dosed once daily is as safe and effective as LMWH dosed twice daily, and is important for preventing the increased risk of clotting that occurs when first starting warfarin.
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    Which NSAID Pain Relievers Should I Use If I Have Heart Disease Risk?
    (2009-08-20) Bohman, J. Kyle
    Common pain relievers including NSAIDs, Aspirin and COX-2 inhibitors have been shown to have varying degrees of cardiac disease risk and gastritis risk. The choice between pain relievers depends on an individual’s risk factors and tolerance of side effects.
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    Diabetes: Taking Care of Yourself
    (2009-08-20) Maust, Thomas J.
    General information regarding type 2 diabetes care in a primary care setting including information regarding associated triopathy, eating habits, blood sugar information, what to expect at the doctor’s visit, and when to call the doctor.
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    Minor Head Trauma – what should I look for?
    (2009-08-20) Sibley, Ted
    If a patient has a minor head injury and a Glascow Coma Scale of 15, then there are certain identifiable risk factors that need to be evaluated for to determine the need for further imaging. These risk factors include: Loss of Consciousness, Post-Traumatic Amnesia, Seizure, Confusion, Focal Neurological Deficit, Vomiting, Headache, Skull Fracture, age over 60, or patient with a coagulopathy. If two or more of these risk factors are present, then patient will need neuroimaging. If only one risk factor is present, then it is up to the physican to determine if patient needs neuroimaging.
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    A Simple Guide to Cholesterol: What you Need to Know and do to Manage your Cholesterol
    (2009-08-20) Matter, Reed
    An estimated half of Americans have high cholesterol making its management both prevalent and important. Many patients may be unaware they have high cholesterol or of its long-term effects on health. Cholesterol does significantly increase a patient’s risk of heart disease, heart attack, and stroke. This PET is designed to give a general overview of what cholesterol is and its risk factors. It also is designed to help enable patients to better manage their cholesterol through reviewing possible lifestyle interventions and pharmacotherapy. Lifestyle changes that are recommended include eating a healthy, low fat diet, exercising at least 30 minutes every day, weight loss, and smoking cessation. Statins, nicotinic acid, fibric acid, and bile acid resins are briefly reviewed including side effects. The need to talk to your physician before starting alternative therapy is also emphasized. The alternative therapy Red Yeast Rice (RYR) extract is also reviewed. Recent research may indicate a role for RYR extract in safely reducing cholesterol in the short-term. However, many of the studies looking at RYR are of poor quality and do not look at its longterm effects. Medications that have been proven to be safe and effective such as statins are recommended for the primary pharmacological management of high cholesterol.
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    “Is Honey Better for Your Child’s Cough Due to the Common Cold than Dextromethorphan (e.g. - Robitussin)?”
    (2009-08-20) Ragusa, Peter
    Honey is generally believed to be safe outside of the infant population (it may cause botulism, a potentially fatal disease, in infants under one). Honey is also known to have antibacterial properties and is cited by the World Health Organization as a potential treatment for upper respiratory infections. In a recent study comparing honey, dextromethorphan, and no treatment, parents of children with colds rated honey the highest for relief of their child’s cough and sleep problems. As a result, the authors concluded, honey is likely a better treatment for the cough and sleep difficulty associated with childhood upper respiratory tract infections. Suggested dosing is: 2-5 years - 1/2 teaspoon, children 6-11 years - 1 teaspoon, and children 12-18 years - 2 teaspoons every 6-8 hours as needed.4 Use caution when administering honey to a child with a personal or family history of allergies as allergic reactions are known to occur with honey.
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    HPV Vaccination for Boys
    (2009-08-20) Suojanen, Mark
    Gardasil has been demonstrated to be a safe and effective vaccine to confer immunogenicity to young men but is awaiting approval by the U.S. FDA.
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    What do I need to know about Testicular Cancer?
    (2009-08-19) Savard, Elizabeth Koffel
    Screening for testicular cancer screening in men is not necessary because it is a fairly rare disease with an impressively high cure rate. It is also usually found by the patient or his sexual partner without any screening exam. However, patients must be educated on how it may present so that they do go see their physician as early as possible. Some additional information on risk factors is also included.
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    Vitamin D
    (2009-08-19) Kuffenkam, Kerry Lynn
    Since the term Vitamin D contains the word “vitamin” most people wrongly assume adequate amounts can be obtained by eating a healthy diet. But to obtain adequate amounts these diets must contain wild-caught fatty fish, Shitake mushrooms, reindeer meat, or cod liver oil. Vitamin D promotes the reabsorption of calcium and phosphorus from the intestines and the kidneys, which is needed for bone growth and normal mineralization. Vitamin D also acts as a molecular switch, activating more than 200 target genes. Vitamin D receptors exist in most tissues of the body, like the brain, colon, prostate, and breast. This explains why Vitamin D may have a role in preventing so many different diseases such as protection against rheumatoid arthritis, psoriasis, lupus, type 1 diabetes, and multiple sclerosis. The skin’s production of Vitamin D is based on distance from the equator, season of the year, time of day, air pollution, cloud cover, melanin content of the skin, use of sunblock, age, and extent of clothing covering the body. Anyone who works indoors, lives at higher latitudes, wears excessive clothing, regularly uses sunblock, is dark-skinned (melanin acts as an effective sunscreen), obese, or who avoids the sun is at risk. Vitamin D deficient patients display symptoms that are extremely common, difficult to treat, and easy for doctors to dismiss. Symptoms such as muscle weakness, a feeling of heaviness in the legs, chronic musculoskeletal pain, fatigue, and tiring easily are common. These symptoms are due to Vitamin D receptors present in the skeletal muscle and bone. As a result, patients with Vitamin D deficiency often complain of aches and pains in their joints and muscles. The vast majority of Vitamin D deficiency cases may appear normal on exam although frequent infection and autoimmune illness may be warning signs that a deficiency has been present for many years. Illnesses associated with Vitamin D deficiency are cancer, heart disease, multiple sclerosis, diabetes, autism, stroke, rheumatoid arthritis, inflammatory bowel disease, periodontal disease, macular degeneration, mental illness, depression, preeclampsia of pregnancy, rickets, osteomalacia, and osteoporosis. Treatment of Vitamin D Deficiency is Vitamin D supplementation, sunlight, and artificial ultraviolet B radiation. As little as 10 minutes of sunlight is thought to be enough to prevent Vitamin D deficiencies.
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    Antibiotic Associated Diarrhea: What is it and how do you make it better?
    (2009-08-19) KenKnight, Jonathan
    Consider using probiotics for the prevention of antibiotic-associated diarrhea in children. Evidence suggests that probiotics given for the duration of the course of antibiotics cut the risk of developing diarrhea by almost 50%.
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    Osteoarthritis of the glenohumeral joint
    (2009-08-19) Ou-Yang, David
    It is estimated that osteoarthritis of the shoulder affects over 30% of patients over the age of sixty, and it can lead to pain, crepitus, loss of motion, and loss of function. Multiple treatment options are available, both surgical and nonsurgical. The following is a patient education tool dedicated to osteoarthritis of the glenohumeral joint.
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    “What you should know about osteoporosis”
    (2009-08-19) Thomas, Christine
    A general patient education tool about the risk factors, prevention, and treatment of osteoporosis in adults.
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    Depression
    (2009-08-19) Johns, Brian
    A tri-fold leaflet patient education tool for depression awareness.
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    Doc, I got the Shingles! Now what?
    (2009-08-19) Coobs, Benjamin R.
    Shingles (herpes zoster) is a painful rash caused by a reactivation of the virus Varicella zoster. Varicella zoster also causes the infection chicken pox, and following resolution of chicken pox the virus can hide out in the nerves of your body. When a person has a weakened immune system, this virus can reproduce in this nerve and reappear as a painful blistering rash on your skin. This is generally a self-limited rash, but some complications exist including blindness if the rash involves your eye, persistent pain, and bacterial infection in areas of open lesions. Treatment usually includes pain medications and antiviral medications to control your pain, decrease the duration of the rash, and decrease the prevalence of postherpetic neuralgia. Other treatment options may include steroids, antidepressant medications, and topical treatments as directed by your physician.
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    Sciatica
    (2009-08-19) Reiner, Anne
    Low-back pain is a very common complaint encountered in the primary care setting. It is not unusual for patient’s to report pain or numbness and tingling, known as sciatica, in one leg that accompanies back pain. Only a small percentage of these are due to compression or irritation of the sciatic nerve by a lumbar disc prolapse (bulging of the cushion between the vertebrae of the spine); however, this is the most common cause of sciatica. Surgery is a necessity for a small minority of sciatica cases. Most resolve by conservative management; however, surgery may provide faster relief in acute sciatica cases and for those cases that have not resolved initially with conservative management. At this time there is no long-term data showing a surgery to be superior to conservative management.
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    Out-of-Hospital Status Epilepticus and Use of Benzodiazepines
    (2009-05-06) Yang, Tou Cher
    Benzodiazepines are considered safe and effective in treatment of status epilepticus occurring in out-of hospital settings when administered by paramedics. Status epilepticus is defined here as seizure activity for greater than five minutes. Lorazepam is the recommended agent.
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    Selecting appropriate initial pharmacotherapy for African Americans with severe, isolated hypertension.
    (2009-05-06) Saith, Sunil E.
    African American patients with isolated Stage II hypertension (e.g. no diabetes, previous heart disease) were started on amlodipine and valsartan combination therapy, or amlodipine alone, in a double-blind randomized controlled study. Blood pressure reduction was greater in the amlodipine/valsartan group than amlodipine alone, eight weeks after beginning treatment.
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    Osteoporosis: A patient’s guide to diagnosis, prevention, and treatment.
    (2009-05-06) Pepin, Scott R.
    A patient education tool describing osteoporosis, how diagnosis is made, and the prevention and treatment options. Bisphosphonate treatment is the usual pharmacological treatment. Bisphosphonates have been proven to be safe for long-term use up to 10 years; however, there is little data supporting the use beyond 5 years except in patients with a high risk for osteoporotic fracture.
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    Treatment of Acute Diarrhea in Children with Probiotics
    (2009-05-06) Rajpal, Preeti
    Probiotics can be helpful in shortening the length of acute diarrhea in children. This study investigates which probiotic preparations are effective therapies in reducing the length of acute diarrhea in children.
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    What you need to know about vitamin D
    (2009-05-06) Gaeckle, Nate
    This is a short informative 1 page summary of the importance of vitamin D, how you make it, and how much you need everyday.