The American journal of the medical sciences
-
More than 100 million U.S. adults experience chronic nonmalignant pain. Many physicians are uncomfortable managing such patients. We sought to determine the timing and intensity of training that primary care physicians receive in chronic pain treatment, and the effect of training on their comfort in managing patients. ⋯ Most primary care physicians are not comfortable treating patients with chronic nonmalignant pain. Education increases primary care physicians' comfort in managing these patients. Increased comfort was associated with the willingness of primary care physicians to take charge of managing chronic pain. In addition, physician comfort is greatest when pain management skills are taught after residency training.
-
Warfarin has been shown to decrease the rate of thromboembolic events in patients with nonvalvular atrial fibrillation, but it is frequently underprescribed. Our goal was to establish whether there have been racial disparities in the filling of warfarin prescriptions for patients with newly incident nonvalvular atrial fibrillation. ⋯ African-American patients in the Ohio Medicaid population between 1998 and 2002 were significantly less likely than white patients to fill a warfarin prescription for newly incident nonvalvular atrial fibrillation.
-
Review Case Reports
Cardiac involvement in Kugelberg-Welander disease: a case report and review.
There are few reports of cardiac involvement in patients with Kugelberg-Welander disease. We report a case of a 51-year-old man with Kugelberg-Welander disease who presented with syncope. ⋯ He was successfully treated with emergency temporary pacing followed by permanent pacemaker implantation. In this report, we review the relevant literature and argue that patients with Kugelberg-Welander disease should be evaluated regularly for cardiac disease.
-
Case Reports
Acute renal failure and nephrotic range proteinuria due to amyloidosis in an HIV-infected patient.
Amyloidosis is an uncommon cause of renal disease in HIV-positive patients. Diagnosis is challenging, treatment options are limited, and prognosis remains poor. We discuss an HIV-positive patient with acute renal failure and nephrotic range proteinuria. ⋯ It has been reported in intravenous or subcutaneous drug abusers, some of whom were HIV-positive. This case underscores the importance of tissue diagnosis to determine the cause of renal disease in HIV-positive patients. Clinical diagnosis, based on CD4 count, viral load, and degree of proteinuria, may not predict the pathological diagnosis in HIV-positive patients.
-
Despite the frequency of recurrent acute cellulitis of the lower extremities, factors associated with this infection have not been previously assessed in a case-control study among patients admitted to U.S. hospitals. ⋯ Our results suggest that increased emphasis on weight loss, smoking cessation, and improved foot hygiene in the homeless might decrease recurrences of lower extremity cellulitis.