Clinics in podiatric medicine and surgery
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Multidisciplinary pain management clinics provide the standard of care for the diagnosis, evaluation, and treatment of patients who have chronic pain. Primary care physicians are encouraged to maintain an active role in the care of patients after referral to these pain centers, often for long-term opiate therapy or complex regional pain syndrome. Insights into the role of pain management clinics after referral are discussed in this article.
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Clin Podiatr Med Surg · Jul 2008
ReviewPost-operative pain management using patient-controlled analgesia.
Patient-controlled analgesia is an effective form of postoperative pain management for select lower extremity orthopedic procedures in the in-patient setting. The goal of this article is to present an introduction to the prescription and management of patient-controlled analgesia in the acute, postoperative setting. The surgeon should have a thorough understanding of this intervention as it relates to pain control and overall patient care.
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The podiatric physician often encounters complex painful neuropathies in daily practice. Diabetic neuropathy is one form of chronic neuropathic pain dealt with on a regular basis. The goal of this article is to review the pathophysiology, diagnosis, and treatment options of this complaint. Medical and surgical interventions are discussed, with a clinical emphasis on patient selection and prevention.
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Clin Podiatr Med Surg · Jul 2007
ReviewCurrent perioperative treatment of patients with type 1 and type 2 diabetes.
Diabetes mellitus is rapidly increasing, diabetic patients are likely to undergo surgical procedures more than non-diabetic patients, the hospital stay of diabetic patients is longer, and diabetic patients have increased mortality and morbidity. The correct treatment of diabetic patients in the perioperative period is crucial to improve clinical outcomes. ⋯ Metabolic control deserves great attention because hyperglycemia is related to increased complications and worse outcomes. Insulin infusion regimens to achieve near normoglycemia must be implemented in surgical and critically ill patients.
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Clin Podiatr Med Surg · Jul 2007
ReviewSurgical management of diabetic foot infections and osteomyelitis.
Foot ulceration and subsequent infection are a major complication of diabetes mellitus. Without proper diagnosis and treatment, these infections often lead to amputation. ⋯ When conservative measures fail or when faced with limb- or life-threatening infection, surgical intervention, whether it be incision and drainage or possible amputation, is warranted. The authors review underlying pathophysiology of diabetic foot infections and an evidenced-based approach to surgical management, with additional emphasis on treatment of osteomyelitis.