The American journal of medicine
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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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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.
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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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Several well-controlled clinical trials have shown that prolonged antibiotic therapy has no benefit in relieving posttreatment Lyme disease symptoms. However, some insist that such symptoms are due to a persistent Borrelia burgdorferi infection requiring prolonged antibiotic therapy to resolve. This unproven view is bolstered by the results of in vitro experiments where small numbers of viable B. burgdorferi can be detected after treatment with antibiotics. The results described in the present work suggest that the presence of persisters can best be explained by classic biochemical kinetics and that there are alternative explanations for this phenomenon that appears to have no clinical significance.
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Blood pressure is a physiologic measure that reflects cardiac output and systemic vascular resistance. Classification by these components could be useful in characterizing subtypes of hypertension, which may have a role in selecting treatment strategies. However, hemodynamic phenotypes of a large, stable, outpatient population with hypertension remain unknown. ⋯ Different hemodynamic blood pressure phenotypes were identified across all hypertensive blood pressure categories. Although individual characteristics were associated with the cardiac index to systemic vascular resistance index ratio, they only weakly explained the variation.