The Journal of family practice
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Hamman's crunch of pneumomediastinum is an unusual, adventitious sound heard on auscultation of the chest. Its rarity and dramatic nature frequently result in an expensive evaluation and hospitalization. Once recognized, it can be managed on an outpatient basis with serial chest radiographs to resolution of the pneumomediastinum or pneumothorax.
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An elderly nondiabetic woman was found stuporous and unresponsive at home. In the emergency department, testing revealed that she had a serum glucose of 40 mg/dL (2.2 mmol/L). ⋯ An inspection of her medications disclosed a professional medication sample bottle labeled as containing a nonsteroidal anti-inflammatory drug (NSAID) that actually contained chlorpropamide tablets. Drugs, notably sulfonylureas, must be considered as a possible cause of unexplained severe hypoglycemia.
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Comparative Study
Factors associated with appointment keeping in a family practice residency clinic.
Failure to keep an appointment not only affects the patient's health care, but also has an impact on the effectiveness and productivity of the medical facility. This study explored patient demographic factors associated with appointment keeping. ⋯ Several identifiable factors significantly affect whether a patient will keep a clinic appointment. Our findings should be considered in program changes in appointment scheduling and follow-up methods for noncompliant patients.
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Review Comparative Study
Do antidepressant medications relieve chronic low back pain?
Antidepressant medications are commonly prescribed for patients with chronic low back pain. A literature synthesis was performed to determine whether antidepressants are more effective than placebos in decreasing pain, disability, depression, and analgesic medication use in such patients. ⋯ The literature has not demonstrated that antidepressants are superior to placebos in improving low back pain or related problems. However, further randomized controlled trials are needed to determine whether antidepressants are useful for low back pain.