Minnesota medicine
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Palliative care specialists focus on meeting the needs of patients with serious and/or life-threatening illnesses. These physicians have expertise in managing complex pain and nonpain symptoms, providing psychosocial and spiritual support to patients and their families, and communicating about complex topics and advance care planning. ⋯ At the core of this field, however, are physicians who trained as internists and are boarded by the American Board of Internal Medicine. This article discusses the central principles of palliative care and explores its growth in two areas: oncology and critical care medicine.
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Vascular malformations of the brain are a heterogeneous group of disorders involving the blood vessels of the brain. These entities are relatively rare; therefore, most primary care physicians are somewhat unfamiliar with their clinical implications and management. Vascular malformations of the brain range from the completely benign capillary telangiectasia to the potentially fatal arterio-venous malformation. This article reviews the distinct natural histories, etiologies and treatments of four major types of malformations: capillary telangiectasia, developmental venous anomaly, cavernous malformation and arteriovenous malformation.
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Growth in Medicare expenditures has forced legislators and policymakers to look for ways to slow spending and get more value for their money. This article reviews previous federal efforts to control Medicare costs as well as current ones required by the Patient Protection and Affordable Care Act. It also describes a proposal for value-based purchasing that the authors developed under contract to the Centers for Medicare and Medicaid Services. This approach uses two measurement systems-one for physicians who practice primarily in outpatient settings and one for physicians who practice primarily in the hospital.
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Obstructive sleep apnea (OSA) is a common problem that plays a role in a number of other chronic health concerns including hypertension, atrial fibrillation, diabetes, and gastroesophageal reflux disease to name a few. In this article, we discuss the relationship between OSA and these conditions as well as how OSA is diagnosed and treated.
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The change in core temperature that occurs as a result of exposure to cold air or water affects all body systems. A decrease in core temperature induces shivering, then muscle stiffness; depresses the central nervous and respiratory systems; triggers cardiac arrhythmias and vasoconstriction; and affects body [figure: see text] fluid balance. Cold water immersion presents additional considerations, including the general shock effect on the cardiac and respiratory systems and the triggering of the diving reflex when the entire body is immersed. Basic education and precautions can prevent most cases [figure: see text] of accidental hypothermia; but when they do occur, treatment should include controlled rewarming, especially if the core temperature is below 32 degrees C.