The American journal of managed care
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Peyronie's disease (PD) is characterized by the formation of palpable fibrotic tissue in the tunica albuginea of the penis. It is thought to manifest in response to recurrent microtrauma during erection in those with risk factors that may include wound-healing disorders. The initial stage of PD is thought to last from 6 to 18 months, and it is characterized by an inflammatory period with pain in approximately one-third of men. ⋯ At this time, nonsurgical treatments are unreliable and have variable efficacy, and surgical treatments are reserved for those with disabling disfigurement. Moreover, surgery may result in loss of penile length and ED, and there are only a few physicians in the United States that perform such surgeries. There is a great need to increase awareness of PD in patients and general practitioners, to elucidate the pathogenesis of PD, and for the development of novel treatments for this disfiguring disease.
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Type 2 diabetes mellitus (T2DM) is a multisystem disease comprising numerous metabolic defects that contribute to the development of hyperglycemia. Although insulin resistance in the skeletal muscle and liver together with progressive beta cell failure are traditionally thought of as the core defects responsible for the development and progression of hyperglycemia, research over the past 2 decades has revealed a far more complex interaction of organs and tissues, with consequences for the fundamental understanding of the mechanisms of glucose disequilibrium and the nature of T2DM itself. ⋯ The function of the kidneys in abnormal glucose homeostasis is a striking example of this evolution in T2DM knowledge, as the role of glucose transporters in regulating plasma glucose levels and producing hyperglycemia has enhanced current understanding of T2DM. As pathophysiologic mechanisms and defects continue to be discovered, they offer an expansion of potential targets for treatment of T2DM.
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Multiple sclerosis (MS) is a chronic immune-mediated disease that potentially requires symptomatic and disease-modifying therapies. Numerous symptoms (eg, fatigue, spasticity, depression, bowel and bladder dysfunction, pain, and impaired mobility) are associated with the neurologic damage that results from MS. Several therapies (eg, modafinil, dalfampridine, baclofen, diazepam, gabapentin, opioids) are used for symptomatic treatment of disability and symptoms, but these do not improve disease outcome. ⋯ A more definitive therapy for MS should reduce relapse rate, prolong remission, limit the onset of new MS lesions, and postpone the development of long-term disability. The currently available MS disease-modifying therapies have been shown to reduce relapse rate, have beneficial effects on magnetic resonance imaging measures, and delay accumulation of disability. In addition, a number of agents are in development, but thus far no beneficial agent has been established in primary-progressive MS.
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Randomized Controlled Trial
Are benefits from diabetes self-management education sustained?
To evaluate whether outcomes from diabetes self-management education for patients with suboptimal control were sustained. ⋯ Conventional IE (but not GE) resulted in significant and sustained improvements in self-efficacy and reduced diabetes distress compared with UC, but short-term improvements in A1C, nutrition, and physical activity were not sustained. Patients may need ongoing reinforcement to achieve lasting behavioral change and glucose control.
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To assess the effect of inpatient oral nutritional supplement (ONS) use on length of stay, episode cost, and 30-day readmission probability. ⋯ Use of ONS decreases length of stay, episode cost, and 30-day readmission risk in the inpatient population.