JAMA : the journal of the American Medical Association
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Comparative Study
Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study.
Enhancing daily functioning and well-being is an increasingly advocated goal in the treatment of patients with chronic conditions. We evaluated the functioning and well-being of 9385 adults at the time of office visits to 362 physicians in three US cities, using brief surveys completed by both patients and physicians. For eight of nine common chronic medical conditions, patients with the condition showed markedly worse physical, role, and social functioning; mental health; health perceptions; and/or bodily pain compared with patients with no chronic conditions. ⋯ Hypertension had the least overall impact; heart disease and patient-reported gastrointestinal disorders had the greatest impact. Patients with multiple conditions showed greater decrements in functioning and well-being than those with only one condition. Substantial variations in functioning and well-being within each chronic condition group remain to be explained.
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Review
Calcium entry blockers in the treatment of hypertension. Current status and future prospects.
Calcium entry blockers will be increasingly used for the treatment of hypertension. The currently available calcium entry blockers are similar in antihypertensive efficacy but differ in their effects on the atrioventricular node and the degree of peripheral vasodilatory action. The new generation of dihydropyridine calcium entry blockers exhibits more specific vasodilatory actions with a less negative inotropic effect, which may affect their use in patients with congestive heart failure. ⋯ Short-term administration of calcium entry blockers preserves or improves renal function; however, their long-term effect has not been documented. Calcium entry blockers have not exhibited protection against coronary heart disease, but experimental evidence supports the continued search for cardioprotection. Calcium entry blockers are important drugs for the treatment of hypertension; the second generation may provide additional benefits because of its more specific pharmacologic actions.
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Cat-scratch disease is usually a benign, self-limited disease that causes regional lymphadenopathy. Occasionally, it may present with systemic symptoms and have a prolonged course. To date, antibiotic therapy has not been proved to be of value. ⋯ Extensive follow-up has shown no recurrence of symptoms. These cases suggest that gentamicin may be efficacious in shortening the course of cat-scratch disease. Prospective, randomized trials should be performed to confirm these results.
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Tear gas has gained widespread acceptance as a means of controlling civilian crowds and subduing barricaded criminals. The most widely used forms of tear gas have been o-chlorobenzylidenemalononitrile and omega-chloroacetophenone. Proponents of their use claim that, if used correctly, the noxious effects of exposure are transient and of no long-term consequences. ⋯ Sadly, the nature of its use renders analytic epidemiologic investigation of exposed persons difficult. In 1969, eighty countries voted to include tear gas agents among chemical weapons banned under the Geneva Protocol. There is an ongoing need for investigation into the full toxicological potential of tear gas chemicals and renewed debate on whether their use can be condoned under any circumstances.