The American journal of medicine
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Review
Approaches to patient education: emphasizing the long-term value of compliance and persistence.
Approximately 50% of patients with chronic disease do not obtain optimal clinical benefit from treatment because of poor compliance with medication regimens. Lack of compliance is associated with poor clinical outcomes, increased hospitalizations, lower quality of life, and higher overall healthcare costs. Although poor compliance and persistence are common across many disease states, they may be particularly poor in treatment for asymptomatic chronic diseases such as osteoporosis. ⋯ Patient satisfaction with treatment has been linked to compliance with therapy; by improving patient care through fulfilling expectations for physician visits and providing frequent feedback, the healthcare provider can dramatically improve compliance. Self-management programs focusing on day-to-day management of chronic diseases have been shown to significantly improve heath behaviors and health status. Regardless of the strategy used, attention must be directed to identifying the patients least likely to persist with treatment and to providing the education and support these patients need to adhere to osteoporosis therapy.
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Hypothermia-related cases typically occur after exposure to low ambient temperatures; however, numerous cases occur in individuals with no history of exposure to cold environment. Hypothermia is associated with such complications as acidosis, impaired myocardial function, bleeding diathesis, and decreased kidney and liver function. ⋯ The choice of rewarming therapy is based on the degree of hypothermia. The evaluation, electrocardiographic manifestations, and management of hypothermia are reviewed.
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Review Meta Analysis
The incidence of stroke after myocardial infarction: a meta-analysis.
While the risk of stroke after myocardial infarction (MI) is increased compared with the risk among those without MI, the magnitude of this risk remains unclear. Although numerous clinical trials have reported the incidence of stroke following MI, these are among selected populations. We reviewed cohort studies reporting the incidence of stroke after MI to better define the risk of ischemic stroke in an unselected population. ⋯ The public health implications of stroke among MI survivors, as well as the large number of MI survivors, underscore the need to be aware of this devastating complication. Further research is needed to determine the optimal stroke prevention strategies for MI survivors.
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Comparative Study
Does the content of primary care visits differ by the racial composition of physicians' practices?
The study compared the content of primary care visits between physicians with larger and smaller African American practices. ⋯ There are few differences in the content of office visits between physicians with larger and smaller African American practices.
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We sought to determine the risk of an allergic reaction to a cephalosporin exposure in those with prior penicillin reactions. ⋯ Patients with allergic-like events after penicillin had a markedly increased risk of events after either subsequent cephalosporins or sulfonamide antibiotics. Cross-reactivity is not an adequate explanation for this increased risk, and the risk of anaphylaxis is very low. Thus, our data indicate that cephalosporins can be considered for patients with penicillin allergy.