Chemotherapy
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Community-acquired pneumonia (CAP) is a common illness that creates significant burdens upon the healthcare system. Improving the quality of medical care for patients with this illness requires an evidence-based and cost-efficient treatment approach. ⋯ The second step is to quantify severity of illness, which can help physicians determine the appropriate initial site of treatment, intensity of the diagnostic evaluation, and choice of initial antibiotic therapy. Case histories are presented to outline the clinical application of an approach that uses the Pneumonia Patient Outcomes Research Team (PORT) prediction rule for prognosis to quantify the severity of illness, and recent guidelines for the management of CAP are highlighted.
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The four major factors predisposing individuals to community-acquired pneumonia (CAP) are chronic obstructive pulmonary disease, congestive heart failure, diabetes, and a high alcohol intake. The elderly are also at increased risk of severe infection. ⋯ Of the fluoroquinolones currently available that have antipneumococcal activity, levofloxacin is well tolerated and effective. It has been approved by the Food and Drug Administration (FDA) for treatment of CAP and widespread use has shown it to be very safe.
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Octreotide is an extremely useful compound for palliative care physicians. It appears to be active in a number of different pain states and may be given by the spinal and intraventricular route. Its actions in reducing gut motility and secretions make it a valuable adjunct in the management of inoperable bowel obstruction. ⋯ Its ability to reduce gut secretions has led to its use in the treatment of fistulae. It has also been proposed as a useful drug in the management of cachexia and ascites. Most of the existing evidence is based on small numbers of case reports and further larger trials are necessary.
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The diagnosis and treatment of neuroendocrine tumors have been significantly improved during the last decades. Localization and staging of the disease by somatostatin receptor scintigraphy (Octreoscan) are now the 'gold standard' for the management of these tumors. ⋯ New long-acting formulations of the somatostatin analogs are as effective as the old regular formulations but will further improve quality of life for the patients. Tumor-targeted therapy with (111)In and (90)Y coupled to somatostatin analogs show promising results but await further studies.
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Randomized Controlled Trial Comparative Study Clinical Trial
Safety and efficacy of cefpirome in comparison with ceftazidime in Chinese patients with sepsis due to bacterial infections.
The safety and efficacy of cefpirome (CPM), a fourth-generation cephalosporin, has not yet been studied in an Asian population. ⋯ CPM is as safe and effective as ceftazidime in the treatment of sepsis due to bacterial infections in Chinese patients.