Minnesota medicine
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Pain control at the end of life is almost always achievable regardless of the cause. Most of the principles for managing pain at the end of life are derived from cancer practice. ⋯ It determines the appropriate analgesic therapy; drug dose and route of administration; drug dosing intervals; titration of drug doses; control and prevention of analgesic side effects; and application of adjuvant, loco-regional (nonsystemic), and invasive treatments. A comprehensive approach that integrates patient preferences and management of psychosocial and spiritual/existential components of the patient's pain and suffering with physical components will improve analgesia, reduce the burden of the illness and its treatment, and improve the patient's quality of life.
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Until recently, domestic violence was considered a criminal justice or social service problem. However, physicians see victims in emergency settings and clinics with complaints and symptoms that go beyond physical injuries. ⋯ This article discusses the prevalence of domestic violence and the variety of presentations. Guidelines for screening, what to do with a positive response, when to call the police, and how to document and code are reviewed, as are issues unique to older victims of domestic violence.