The American journal of medicine
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Migraine headaches are among the most common and potentially debilitating disorders encountered by primary healthcare providers. In the treatment of acute migraine and the prevention of recurrent attacks, there are prescription drugs of proven benefit. ⋯ In addition, the totality of evidence, including some, but not all, randomized trials, suggests the possibility that daily aspirin, in doses from 81 to 325 mg, may be an effective and safe treatment option for the prevention of recurrent migraine headaches. The relatively favorable side effect profile of aspirin and extremely low costs compared with other prescription drug therapies may provide additional options for primary healthcare providers in the treatment of both acute and recurrent migraine headaches.
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Health care providers are frequently faced with the challenge of caring for patients who have limited English proficiency. These patients experience challenges accessing health care and are at higher risk of receiving suboptimal health care than native English speakers. ⋯ Many providers lack the skill set and knowledge that are vital to successful collaboration with an interpreter. The objective of this article is to address a number of questions surrounding the use of health care interpreters and to provide concrete suggestions that will enable providers to best serve their patients.
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Ulcers in patients with diabetic neuropathy in their feet are quite common but should be differentiated from the distinctive but rare ulceration resulting from rat bites in these insensate feet. We describe and analyze the features of rat bites in 2 patients with diabetic neuropathy in their feet and highlight 8 clinical features that should raise suspicion and alert the clinician to this possibility. ⋯ We describe and analyze the features of rat bites in 2 patients with diabetic neuropathy in their feet and highlight 8 clinical features that should raise suspicion and alert the clinician to this possibility.
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Meta Analysis
Peripheral Vein Thrombophlebitis in the Upper Extremity: A Systematic Review of a Frequent and Important Problem.
The acceptable incidence of thrombophlebitis following intravenous cannulation is 5%, as recommended by the Intravenous Nurses Society guidelines, but publications have reported startling figures of 20% to 80%. Given the frequency of intravenous lines, this presents a potential clinical problem. We aimed to determine the predisposing patient, catheter, and health care-related factors of peripheral vein thrombophlebitis in the upper extremity. ⋯ Recognition of the predisposing factors would allow for targeted strategies to aid in the prevention of this iatrogenic infection, which may include closer monitoring of patients who are identified to be vulnerable. Based on this systematic review, we developed an algorithm to guide clinical management. Further research is warranted to validate this algorithm.
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Skin cancer affects 1 in 5 Americans, resulting in significant morbidity and mortality. Treatment costs and rates of skin cancer and melanoma continue to rise, making preventative measures increasingly important. However, there is conflicting evidence about efficacy of primary and secondary prevention strategies in decreasing incidence and improving early diagnosis. ⋯ Additional emerging evidence shows that regular skin cancer screening in high-risk populations improves early detection and decreases melanoma mortality. New technology may enhance prevention, promote accurate diagnoses, and improve management of melanoma and nonmelanoma skin cancers. Here, we place rising rates of melanoma within historical context, review costs, efficacy, and evidence for primary and secondary skin cancer prevention and examine the evolving role of novel technologies in the field.