Neurologic clinics
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This review discusses a practical approach to the patient with possible fungal infection of the central nervous system (CNS). Difficulties in establishing the diagnosis come from the nonspecific clinical syndromes (subacute meningitis, meningoencephalitis, and brain abscess) and the low isolation rate of fungi from cerebrospinal fluid (CSF). Helpful diagnostic clues often come from knowledge of the patient's geographic travels, risk factors, evidence of systemic organ infection, and fungal serologic tests. Standard and new antifungal agents are evaluated and the initial and suppressive drug management of the common fungal infections is presented.
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In recent years, investigators have made significant advances in understanding the pathogenesis of bacterial meningitis, particularly with regard to understanding the cascade of biologic events that cause excessive inflammation within the central nervous system (CNS). Nevertheless, the most important event in the field of bacterial meningitis in the past decade is the dramatic decline in the incidence of Haemophilus influenzae meningitis in children as a result of the widespread use of the conjugated H. influenzae type b vaccine. ⋯ This problem has significantly complicated initial management of patients with suspected bacterial meningitis. Preliminary data show promise with new conjugated S. pneumoniae vaccines.
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This update provides an overview of the current state of expert witness testimony regarding malpractice cases. Many trials are reduced to a battle of the experts and many physicians advertise their credentials and expertise in hopes of attracting lucrative cases. This article focuses on what constitutes an expert witness, medical organizations oversight, the peer review process, and physician immunity.
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The term health care fraud describes a variety of sins committed with more frequency and sophistication by a multitude of sinners. Because physicians are among those most likely to be affected by such fraud and efforts to prevent it, they may want to be familiar with this subject. Accordingly, certain aspects of health care fraud are reviewed from a physician's perspective.
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The reasonable clinical approach to the patient who has low back pain includes a search for any of the red flags that would prompt consideration of additional diagnostic testing for serious underlying disease. The common patterns of back pain would be explored in an effort to categorize the patient's symptoms and to begin formulation of a diagnostic impression. Re-evaluation of the patient in light of his response (or lack of response) to these measures is an essential component of the clinical assessment. Finally, some consideration must be given to the various biopsychosocial factors that may affect prognosis, particularly in patients who have more chronic pain and disability-related issues.