The Medical clinics of North America
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Especially in the United States, homeopathy has not become integrated into mainstream medical practice; this is partly because of the historical paucity of quality published research studies or quality educational programs. More recently, there have been better-designed studies in reputable journals, although historically most studies have been inconclusive or of poor methodology. The confusion around homeopathy in the United States exists for several reasons: 1. ⋯ According to a study published in 1995 in the Journal of the American Board of Family Practice, 69% of family practice physicians expressed interest in learning more about homeopathy. Increasing public and professional interest calls for attempts to study homeopathy in a more systematic way and to provide quality academic overview for medical practitioners. The growing number of complementary and alternative medicine centers affiliated with major teaching hospitals should provide a solid interface between evidence-based biologic medicine and many emerging complementary and alternative medicine modalities, including homeopathy.
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Med. Clin. North Am. · Nov 2001
ReviewHow should we make the admission decision in community-acquired pneumonia?
The spectrum of pneumonia patients ranges from only slightly compromised patients to patients who require life-sustaining measures. Admission decision support algorithms usually are not required for patients at either end of the spectrum. For patients presenting with intermediate severity of illness, decision support algorithms have shown that they can support clinicians in the admission decision and complement the clinicians' experience and clinical judgment with an objective tool. ⋯ Further studies are needed, however, that show the successful dissemination and clinical implementation during routine patient care. Studies are needed that assess the impact of guidelines and prediction rules on patient outcomes. As the example of the PSI shows, the development, implementation, and dissemination of admission decision support systems is not a revolutionary, but a stepwise, evolutionary process that requires many years of research.
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Med. Clin. North Am. · Nov 2001
ReviewAchieving a safe and early discharge for patients with community-acquired pneumonia.
The rationale for achieving an early discharge for patients with CAP is that reduced length of stay can result in lower costs. When hospital discharge is premature, however, use of resources after discharge from the hospital may increase. This situation could increase overall cost and worsen quality of care. ⋯ Improving efficiency of care reduces length of stay. This reduction may be accomplished by implementing clinical pathways, identifying and correcting causes of medically unnecessary hospital days, initiating early discharge planning, enlisting the services of a discharge coordinator, and organizing outpatient parenteral antibiotic treatment programs. These strategies are effective in many but not all patients, and their application should be tempered with careful clinical judgment.
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Med. Clin. North Am. · Sep 2001
Review Case ReportsDuration of deep vein thrombosis and pulmonary embolism prophylaxis after joint arthroplasty.
One of the most important complications after joint arthroplasty is the development of deep vein thrombosis. Despite effective prophylaxis modalities, studies have shown a significant incidence of thrombotic events after hospital discharge. This article reviews the literature on the incidence of deep vein thrombosis and provides recommendations for managing postoperative joint replacement patients.
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Delirium is a common postoperative complication that is associated with substantial patient morbidity and mortality. Because of the variability in its presentation, delirium has the potential to be overlooked or misdiagnosed. There are few well-designed prospective studies looking at the incidence of delirium; however, retrospective data reveal it to be highly variable. ⋯ Pharmacologic therapy, usually with haloperidol, may be indicated if patients remain agitated. Investigations have supported the premise that delirium is a potentially preventable condition. This prevention can be accomplished by maximizing the patient's medical status and conscientiously avoiding the conditions that are known to precipitate delirium.