The American journal of medicine
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In order to assist physicians in the effective pharmacologic management of this challenging population, evidence-based pharmacologic treatment algorithms for the different stages of Alzheimer's disease have been developed. Evidence-based guidelines outlining pharmacotherapeutic strategies can be systematically implemented to optimize outcomes for patients in different stages of Alzheimer's disease. ⋯ The N-methyl-D-aspartate receptor-antagonist, memantine, may be used as monotherapy or in combination with a cholinesterase inhibitor for patients with moderate Alzheimer's disease, and as monotherapy for patients with severe Alzheimer's disease. During treatment, cognitive and functional status should be monitored over 6-month intervals, and pharmacologic therapy should ideally be continued until there are no meaningful social interactions and quality of life has irreversibly deteriorated.
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Randomized Controlled Trial Multicenter Study Comparative Study
Comparing COPD treatment: nebulizer, metered dose inhaler, and concomitant therapy.
Patients using albuterol and ipratropium for treating chronic obstructive pulmonary disease (COPD) can use either nebulizers or metered dose inhalers. This study compared the 2 methods of delivering medication and the concomitant use of both nebulizer and inhaler, with respect to health-related quality of life, patient symptoms, and efficacy. ⋯ Patients using combined nebulizer therapy morning and night with mid-day inhaler use had the most statistically significant improvements in quality of life indices. This concomitant regimen provides the additional symptom relief offered by a nebulizer with the convenience of an inhaler when patients are away from home.
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It is widely accepted that hip and spine fractures are associated with substantial morbidity, but there is growing awareness that other fractures are under-recognized. The incidence of nonspinal, nonhip fractures is higher than for hip fractures because they occur at an earlier age. Furthermore, the incidence of nonspinal, nonhip fractures exceeds that of hip fractures in men and women >80 years old. ⋯ Nonspinal, nonhip fractures are associated with low bone mineral density, thus it may be possible to identify those at risk. Because these fractures also are indicative of increased risk at other sites, those susceptible might benefit from assessments including these other fracture types. It is the clinician's responsibility to attend to and recognize that nonspinal, nonhip fractures are usually associated with osteoporosis and should be treated.
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Sarcoidosis is an idiopathic granulomatous disease that may affect any organ. The varied manifestations of the disease may prompt patients with sarcoidosis to seek care from primary care physicians and subspecialists. This article outlines the approach to the evaluation and treatment of sarcoidosis by primary care physicians.
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Randomized Controlled Trial
A randomized, controlled, trial of controlled release paroxetine in fibromyalgia.
We investigated the efficacy and tolerability of paroxetine controlled release, a selective serotonin reuptake inhibitor in fibromyalgia. ⋯ Paroxetine controlled release appears to be well-tolerated and improve the overall symptomatology in patients with fibromyalgia without current mood or anxiety disorders. However, its effect on pain measures seems to be less robust.