Disease-a-month : DM
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Lung cancer is the most common fatal malignancy in both men and women, both in the United States and elsewhere in the world. Today, lung cancer is most often diagnosed on the basis of symptoms of advanced disease or when chest x-rays are taken for a variety of purposes unrelated to lung cancer detection. Unfortunately, in the United States no society or governmental agency recommends screening, even for patients with high risks, such as smokers with airflow obstruction or people with occupational exposures, including asbestos. ⋯ A new health care initiative, the National Lung Health Education Program, recommends spirometric testing for all smokers 45 years or older, as well as for patients with symptoms of lung cancer. Screening for lung cancer in such patients will find many cancers at an early stage when they are amenable to cure. Today, we have the knowledge and the technology that could change the outcome of lung cancer.
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Infectious diarrhea is an extremely common illness that affects millions of Americans annually. For most patients, the illness is a self-limited one. Its major risk is dehydration. ⋯ Several organisms have been associated with specific postinfectious syndromes that are responsible for additional morbidity and mortality. The antibiotic resistance of bacterial pathogens has been increasing, and this has a limiting effect on the empiric treatment choices available for suspected bacterial diarrhea. Careful attention to local sensitivity patterns and appropriate testing of the patient's isolate are among the important factors that lead to successful treatment decisions.
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Telemedicine has drawn increasing attention as one of the emerging service delivery vehicles running on the information highway. Until recently, the adoption of telemedicine has been discouraged by the cost of telecommunications and equipment and by the lack of infrastructure, standards, and evidence of cost-effectiveness and cultural acceptance. Although there have been attempts to reduce costs by making use of computer communication networks, they were technically limited by slow network speed and the lack of real-time audio/video compression technology. ⋯ However, there is still no proof that telemedicine is necessarily cost-effective for a broad set of applications. Each prospective application requires its own business case analysis. Within the current environment, the development of a telemedicine strategy should be based on a sound knowledge of the current and future potential of telemedicine to improve health care access and quality while containing and possibly reducing health care costs.
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The past decade has seen significant advances in the available treatments for asthma. These include longer-acting bronchodilating agents, high topical potency inhaled corticosteroids, and agents that interfere with leukotriene production or action. ⋯ Experimental therapies for the steroid-dependent patient have also been discussed. Although clinical trials to date have established many of these as effective in asthma, the results of ongoing, large, multicenter studies investigating the relative merits of these therapies, alone and in combination, will further clarify how to maximize the utility of these agents in the treatment of asthma.