The Medical clinics of North America
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A wide spectrum of central and peripheral nervous system abnormalities may be associated with HIV infection. These disorders may be caused by HIV infection, result as secondary complications related to immunosuppression, or be a neurotoxic effect of therapeutic agents. ⋯ Early diagnosis and therapy is critical, and may result in substantial improvement in patients' quality and quantity of life. This article reviews the approach to differential diagnosis of these neurologic disorders and presents theories of pathogenesis and current approaches to treatment.
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Despite the potential medical problems described here, the vast majority of liver transplant recipients report a remarkable improvement in the quality of their lives. Many, in fact, have normal lifestyles, in marked contrast to their disability before liver transplantation. ⋯ The liver transplant center should encourage communication and be readily accessible to the primary care physician. This team approach is responsible for measuring the survival of liver transplant recipients in decades, rather than years.
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Med. Clin. North Am. · May 1996
ReviewRisk factors for the development of chronic obstructive pulmonary disease.
Cigarette smoking clearly has been shown to be the major environmental risk factor predisposing to the development of COPD. Occupational exposures to dust and fumes, air pollution, passive smoke exposure, childhood respiratory infections, and diet may also contribute. Airway hyperresponsiveness is a risk factor for the development of decline in FEV1, but its role in the development of COPD remains uncertain. ⋯ Other genetic factors are likely involved but have not yet been identified. Elucidation of additional genetic risk factors may provide useful insights into the pathogenesis of COPD. Potential interactions between the various environmental and genetic risk factors may be extremely important in determining the variable development of COPD.
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The 1990s is truly the era of increased accountability in the practice of medicine. Through the methods of cost and quality measurement and the introduction of a manager (i.e., the MCO), society as a whole will benefit from a medical delivery system that focuses on linking the outcomes of care delivered to the processes of the care provided. Report cards serve an important tool by which information about quality and costs can be quantified and shared with the purchasers and users of the medical delivery system. ⋯ Physicians must provide high-quality care to each patient they see but must also develop the mindset and structures to manage an entire population of patients. The expectations of each of the entities with whom they interact must be understood, and physicians need to develop the skills and infrastructure to put total quality management and information technology to work to help them facilitate the delivery of high-quality care in a cost-effective manner. Everyone involved in the health care system--from purchasers to payers to consumers--shares the same goals as physicians: provide the highest-quality care and achieve the best possible outcomes in the most cost-effective manner.
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Med. Clin. North Am. · Mar 1996
ReviewPreventing complications in diabetes mellitus: the role of the primary care physician.
Many Americans, knowingly or unknowingly, are afflicted with diabetes. Because of a lack of awareness or a disbelief that aggressive treatment benefits patients on the part of both patients and physicians, diabetes, particularly NIDDM, remains underdiagnosed and undertreated despite complications that can dramatically diminish quality of life. Increasing evidence that good glycemic control forestalls if not prevents these outcomes makes it the primary care physician's imperative to diagnose diabetes before complications develop. Physicians, through targeted screening and aggressive treatment of patients in whom they diagnose this chronic disease, can markedly reduce diabetes-related morbidity and mortality.