The American journal of medicine
-
Preeclampsia involves a diffuse inflammatory state and elevated levels of troponins in patients with preeclampsia have been anecdotally reported. It is, however, unknown whether it is attributable to the preeclampsia. ⋯ Preeclampsia was not associated with a rise in troponin I levels in our study. Patients with preeclampsia and elevated troponin levels should have further cardiac investigations.
-
Anaphylaxis, an acute and potentially lethal multisystem allergic reaction, is almost unavoidable in medical practice. Physicians must be able to recognize anaphylaxis, treat it promptly and appropriately, and provide preventive recommendations. Epinephrine, which should be administered immediately, is the drug of choice for acute anaphylaxis.
-
Effective management of chronic obstructive pulmonary disease (COPD) requires successful physician-patient communication. Unfortunately, however, both parties often report problematic communication. Accommodating patients' desire for more information and an increased role in decision-making can increase their satisfaction surrounding the dialogue. ⋯ To reduce observed gaps in communication, physicians can focus on 4 topic areas: (1) communicating COPD diagnosis and test results, (2) optimizing disease education, (3) prioritizing smoking cessation, and (4) demonstrating correct inhaler use. Simple communication techniques, including consistent vocabulary, perspective display series, the 5 As of smoking cessation (ask about tobacco use, advise to quit, assess willingness to make a quit attempt, assist in quit attempt, arrange follow-up), and inhaler training, can maximize in-office efficiency. Combining these topic areas and communication techniques could result in higher levels of physician and patient satisfaction.
-
Review
Optimizing treatment of chronic obstructive pulmonary disease: an assessment of current therapies.
Bronchodilators are the mainstay of chronic obstructive pulmonary disease (COPD) therapy. Inhaled short-acting beta2-agonists generally have a more rapid onset of effect and shorter duration of action than short-acting anticholinergic agents, and are usually prescribed as "rescue" medication to relieve acute bronchospasm. For patients with persistent symptoms, maintenance therapy with inhaled long-acting beta2-agonists is preferable to short-acting beta2-agonists because long-acting beta2-agonists provide more predictable, longer-lasting improvements in lung function. ⋯ Combining different classes of bronchodilators or combining a bronchodilator with a corticosteroid provides greater improvements in lung function and symptoms than the individual agents given alone. Nonpharmacologic interventions, including pulmonary rehabilitation, oxygen therapy, and surgery, can benefit patients at various stages of disease. A treatment algorithm that combines both pharmacologic and nonpharmacologic interventions for the management of COPD is presented.