Diagnosis, treatment of chronic sinusitis present challenges

Chronic sinusitis can make a patient's life miserable, but it's often a difficult diagnosis to parse. Its symptoms can easily mimic those of other disorders, such as allergic rhinitis, and there's a lack of consensus about its causes, diagnosis and treatment. In our cover story, Kathy Holliman summarizes the existing guidelines and asks experts what to look for to pin down the disorder, as well as ways that internists can help patients get some relief.

Communication problems between primary care physicians and hospitalists often plague outpatient and inpatient practices, partly because it's often not clear who's responsible for establishing common standards. The ideal answer, unsurprisingly, is “everyone.” Fewer balls are dropped when primary care physicians and hospitalists collaborate on a system that fits their specific circumstances. Also, Stacey Butterfield reports on ways to make that collaboration happen, including tips on improving communication from both the hospitalist and the PCP perspective.

Is calcium supplementation good, neutral or bad? Does it help build bone mineral density, or cause cardiac events? Although some studies have suggested a modest reduction in fracture risk among patients taking calcium and vitamin D supplements, recent reports have mentioned possible harms associated with increased calcium intake, including higher rates of myocardial infarction. Our story looks at both sides of the debate, including a recent update from the Institute of Medicine, and offers advice on making decisions about calcium supplementation.

Also in this issue, Jerome Groopman, FACP, and Pamela Hartzband, FACP, present the latest Mindful Medicine, their ongoing column on medical decision making. In this month's case, an internist misses a diagnosis that is literally right before his eyes. Click here to learn why this happened and how mistakes like this can be avoided in daily practice.

Last year at this time, health care reform legislation had not yet been enacted. This year, although the Patient Protection and Affordable Care Act is officially on the books, physicians face ongoing and often contentious debate about its implementation and possible revision. As always, we aim to keep you informed about developments on this front and others in health care. You can find us online, our blog, and via Twitter. Let us know what's important to you by e-mail.

Sincerely,

Jennifer Kearney-Strouse