Today’s Clinical Pearl: When assessing patients for anxiety disorders, it is important to rule out other medical disorders that may produce similar symptoms. These disorders include:

• Thyroid disease
• Cardiovascular disease
• COPD
• B12 deficiency
• Meniere’s disease
• Substance intoxication and withdrawal

Anxiety disorders are the most common psychiatric complaint in primary care and may affect 10%-15% of your patients. To receive the latest updates on anxiety disorders, click here to register to attend MER’s CME conference: Neuropsych Medicine for Primary Care (part of the Neurology for the Non-Neurologist series).

If you are thinking of making your next CME Conference a “CME Spa Escape”, consider these 3 amazing MER destinations:

Spa Terra at the Meritage Resort and Spa, Napa Valley, CA  – April 27-29

Experience Spa Terra located underground in the resort’s Estate Wine Cave and recognized for its four-diamond service. The spa’s relaxation lounge and twelve treatment rooms are all cocooned in the heart of the earth. With steam grottos, soaking pools, treatment alcoves, waterfalls, and radiant heating, Spa Terra provides and old world escape from the ordinary. Try the Solo Vino package which includes a body wrap with wine cave mud and a 50 minute massage. Click here for more information!

The Spa at The Grove Park Inn, Asheville, NC – May 18-20

Rejuvenate your body and soul at The Spa at The Grove Park Inn, ranked one of the top 5 spas in the country by Travel + Leisure. At this spa, mountain highs and blue skies take you to a destination of serenity. Soak in mineral pools with soothing underwater music and therapeutic waterfall pools, relax in the sauna, or savor mountain views from the spa’s spectacular outdoor whirlpool. Try the Blue Ridge Bliss package which includes a Mountain View Massage, Waterfall Body Experience, and Green Tea and Ginger Facial. Click for more information!

The Spa at Pelican Hill, Newport Beach, CA – June 22-24

Indulge in a spa treatment at the # 1 rated resort in the United States, the Resort at Pelican Hill. Inspired by the Romans, this spa is committed to creating a highly personal spa experience that relaxes, replenishes, and invigorates your body and soul. The spa features 22 treatment rooms, women’s & men’s Acqua Colonnade, relaxation lounges, fitness center, wellness classes, personal training, salon, spa cuisine and a boutique. Try a Himalayan salt soak in conjunction with a duet massage. Click here for more information!

Visit www.mer.org to register for these CME Spa Escapes.

Get ahead and get away when you attend a CME conference at these featured spring destinations:

Napa Valley

If you are a “foodie” or wine enthusiast, then this is the perfect CME meeting for you! Attend Clinical Endocrinology for Primary Care Physicians in Napa Valley and receive the latest update on Diabetes, Obesity, and other Endocrine disorders each morning. Then spend the rest of each day tasting some of the world’s finest wines, sampling farm-to-table cuisine, relaxing at the Merit age’s underground luxury spa with steam grottos, or playing a round of golf at the gorgeous Eagle Vines Golf Club, surrounded by vineyards and cherry trees. Click here for more information.

Jazz Festival, New Orleans

If you love live music (including jazz and blues) and a great atmosphere, then there is no better place to earn CME than in New Orleans during Jazz Festival.  Attend Rheumatology and Musculoskeletal Medicine for Primary Care Physicians and learn the most up-to-date management strategies for Arthritis and other Rheumatologic Disorders each morning. Then spend the afternoons and evenings listening to live music at the Jazz Festival, exploring the famous French Quarter, sampling authentic Cajun cuisine, browsing the shops by the river, and visiting the local artists at Jackson Square. Be sure to try a Hurricane at Pat O’Brien’s! Click here for more information.

Aruba

What’s not to like about the sparkling blue water, white sand, colorful reefs, and fabulous weather that awaits you in Aruba? Attend Internal Medicine for Primary Care Physicians and spend each morning learning from our expert faculty about the topics most relevant to your primary care practice. Then play at the beach, set sail on a catamaran, try your luck at the resort casino, dive to a ship wreck, visit an old fort, try dune sliding or a jeep safari tour in the afternoons and evenings. If you bring your kids, be sure to take them to the butterfly farm and natural bridge. Click here for more information.

Traveling to CME conferences can be an amazing experience or it can end up in disaster. Here are some great tips for traveling to CME conferences in 2012.

1. If you are willing to travel away from home for CME, chances are that you are interested in visiting the location that the conference is being held. Review the conference agenda carefully and make sure that it provides you with ample time to enjoy your destination.
2. Save money by choosing an airline that provides you with at least one free checked bag.
3. Seek conferences in which the organizers have extended the group rate with the hotel beyond the conference dates.
4. If traveling with children, seek hotels that have organized kids programs available while you are attending the conference.
5. When attending CME conferences at international destinations, avoid credit card fraud by ensuring that your credit card never leaves your sight. Most international restaurants and retail shops have the ability to run your card in front of you.
6. If you are traveling with a spouse or friend,  reserve both the window and the aisle seat, leaving the middle seat empty. If the flight is not full, you will have the entire row to yourselves. If the flight is full, the person sitting in the middle will be more than willing to switch seats for a window or aisle.
7. Be sure to bring your meal with you or purchase it before getting on the plane. Always purchase additional bottled water and take with you on the plane. Most airlines don’t provide adequate beverage service for the length of the flight.
8. When in the conference, make your mobile device last longer by using the one beep mode on a low setting and disabling vibrate mode. More energy is required to make your entire device buzz.
9. To stay healthy while traveling, purchase a bottle of hand sanitizer and use it after touching the airplane bathroom door handles, trays, magazines, reading lights, or air vents.
10. As clinicians, we rarely have free time outside of our families or practices but be sure to set aside time on your trip to do something just for you!

For more information on traveling to CME conferences in 2012, click here.

Ciao and welcome to your CME adventure in the city known as the world’s biggest open air museum! If Italy is one of your dream travel destinations, then don’t miss out on the opportunity to earn CME this summer in Rome. Attend CME sessions each morning and then allow yourself to be seduced by what’s known as the “Eternal City”.

Visit the ancient Roman sights like the Colosseum, the Pantheon, and the Aqueducts.

Explore the great squares and the famous Spanish steps.

Be amazed by the Trevi Fountain and Fountain of Four Rivers.

Discover the beauty of the Vitacan City and be awed by the Sistine Chapel.

Photograph Rome’s great basilicas and churches.

Grab a slice of authentic Pizza at Remo.

Glam up for a night at the opera.

For more information on CME conferences in Rome, click here.

Many primary care clinicians believe that it is there responsibility to discuss issues of weight and obesity with patients. When the time comes however, it can be uncomfortable for both the physician and patient and many physicians feel ill equipped to deal with issue related to weight loss. In addition, many physicians don’t believe that counseling patients on weight loss actually works. Although there are many resources for discussing obesity and weight loss with patients, here are some tips that may put both physicians and their patients on the road to success.

• Do your home work and take a refresher course on nutrition exercise. The University of North Carolina offers a free on-line course called Nutrition in Medicine that covers numerous topics targeted towards the practicing physician. Or, take a CME course that offers a broader update on  obesity.
• Don’t focus on spending more time discussing weight with your patients; rather, improve the quality of discussion by utilizing some of the motivational interviewing techniques which may include treating the patient like an expert, using reflection, and avoiding confrontation and judgment.
• Patients may not recognize that they are overweight or obese so ask questions to find out how the patient views them self such as “What do you think about your weight?”
• Patient motivation is key – find out a goal that the patient is passionate about and ask questions like, “How might you better be able to participate in/improve ______ if you lose 30 or 50 lbs?”
• Avoid terms that patients consider undesirable, such as “fatness,” “excess weight,” or “large size,” and stick with terms considered  more desirable, like “weight,” “BMI,” and “unhealthy body weight.”
• For patients that don’t recognize that they have a problem, focus on sharing general information about health, diet, exercise and weight.
• Have patients start with simple things like weighing themselves every day, cut back on sweetened beverages, walk or participate in some other physical activity 3 days per week for 15-20 minutes per day, park their car further from their destination, eat in more days per week, etc. Never overestimate their knowledge of simple weight loss techniques.
• Even if the patient does not appear overweight, always ask them about the types of food they are eating and how much they are exercising – focus on the patient’s behaviors and not just the weight.
• Remember that change comes slowly and encouraging your patients on a consistent basis will eventually pay off. Remember that even broaching the topic of weight can make your patients up to twice as likely to attempt to lose weight.

Receive more education and practice these techniques with your next few overwieght patients and you’ll be putting your patients on the road to success in no time!

If spending more time with family is on your mind, here are some of the greatest family destinations to consider when planning to attend your next CME conference:

Disney’s Grand Floridian Resort, Orlando, FL

What location is more perfect for family time than Orlando? Orlando offers unlimited opportunities for fun including thrill rides (be sure to check out Universal Studio’s new ride Harry Potter and the Forbidden Journey™), resorts, shows, theme parks like Disney, Sea World, and Universal Studios, fabulous shopping,  and championship golf.

Atlantis Resort, Nassau, Bahamas

Atlantis is an amazing family destination that caters to all ages, including “big kids”! Swim with the dolphins or interact with sea lions, ride the 120 foot water slide, stroll along miles of white sand beaches, snorkel the ruins at Atlantis, swim at one of 11 pools, try your luck at the casino, golf on the ocean, or unwind with blissful pampering at Mandara Spa.

The Village at Breckenridge, Breckenridge, CO

Plan your winter family fun with a ski vacation at Breckenridge. This Colorado resort boasts 300 inches of powder per year, caters to skiers and riders at every level, and offers one of the country’s best ski and snowboard schools for kids. After a fun filled day skiing or riding, relax and enjoy the dining, shopping, nightlife, and hospitality offered by this historic mountain town. When you are ready to take a break from skiing or riding, try tubing, visiting a mountain day spa, cross country skiing, snowmobiling, or snowshoeing.

Providers of high quality education like MER are currently offering CME conferences at each of these family destinations. Click here for 2012 dates and information.

If you are searching for a New Year’s CME conference but are looking for a warm alternative to Times Square,  Miami Beach may be your perfect New Year’s destination. Stay at the beachfront Eden Roc Renaissance Hotel, earn up to 11 CME credits at MER’s Internal Medicine for Primary Care Physicians conference, and then take advantage of the warm weather, beautiful beaches and amazing places to ring in the New Year. A few Miami New Years celebration options include:

Bayfront Park Amphitheater: This free even features live performances by various bands. There’s a countdown at midnight for the dropping of the Big Orange, followed by fireworks. This is a great family outing, if you’re kids are old enough to make it until midnight.

Mansion Nightclub: This is one of Mimi’s hottest nightclubs. Ticket prices include an open bar until midnight.

SET Nightclub: Tickets include a 3-hour open bar.

Fontainebleau Poolside Celebration: If you are interested in a poolside celebration, this is the place to be!

Miami Beach New Year’s Eve Party: A free fireworks celebration offered by the City of Miami at midnight.

Click here for some additional listings and be sure to purchase your tickets early!

Due to a number of factors, such the lack of significant power of the study and an unexpected increase in HDL-C in the placebo arm, the results from the AIM-High study (click here to view article)  failed to demonstrate a 25% reduction in cardiovascular events in those patients randomized to receive niacin. This study was discontinued earlier for futility, but further results have recently been released. The purpose of AIM-high was to evaluate the benefit of adding niacin to patients with a low LDL-C value with pre-existing statin therapy. There was only a 4 mg/dL difference in HDL-C between the treatment arms. Since the study was underpowered and other confounding factors existed, the value of adding niacin to effective statin therapy is unknown and the current HPS2-Thrive study, which has enrolled 25,000 patients is underway and also investigating the benefit of niacin to statin therapy. Is this study the nail in the coffin of the HDL hypothesis (the ability to modify HDL-C to reduce cardiovascular events) or is the HDL hypothesis alive and well?

As a primary care physician, here are some things to consider:

What advice are you giving patients?

Will you modify your clinical practice and how?

Do you use fish oil in patients who are at high risk of cardiovascular events?

Will you use niacin for patient who are statin intolerant or do not achieve LDL goals?

Feedback on any of these questions  is welcome!

So far this year, 210 drugs have been added to the list of drugs in short supply and many of the drugs included on the list are considered life-saving medications.  Just days ago, acknowledging that this is a growing crisis, President Obama signed and executive orders instructed the FDA to obtain better advance warning of impending supply problems but this will not prevent future shortages. How could this current crisis be affecting patients of primary care physicians?

• Your patients may experience delays in surgeries
• Your patient may not be able to receive chemotherapy drugs, treatments for allergies, hypertension, pain medication, and drugs to treat heart conditions
• Your patients may receive less effective treatments for their condition
• Many hospitals that have been forced to utilize “gray market vendors” (companies other than their normal wholesalers) to purchase drugs in short supply at mark-ups as much as 650%. These costs will ultimately be passed on to your patients
• Drugs purchased from “gray market vendors” may not have been stored properly and may cause side effects or other problems in patients
• In some cases, hand-mixed batches of liquid nutrition given via feeding tubes are replacing unavailable sterile pre-mixed liquids. These are subject to bacterial contamination and have resulted in 9 deaths to date.

Although there is little that you primary care physicians can do to affect this drug shortage, be prepared and be aware of which drugs are in short supply in hospitals and pharmacies in your area!  You may need to determine alternative regimens for your patients with chronic conditions and spend extra time teaching them new dosage instructions and potential side effects of substitute drugs.