Postgraduate medicine
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Postgraduate medicine · Jan 2010
Review Historical ArticleTherapeutic hypothermia: implications for acute care practitioners.
The use of therapeutic hypothermia (TH) in acute care medicine has evolved over the past 2 centuries, and its use over the past decade has increased in emergency departments, intensive care units, and operating rooms. Therapeutic hypothermia has several potential clinical applications based on its putative mechanisms of action. It appears to improve oxygen supply to ischemic areas of the brain and decreases intracranial pressure. ⋯ Therapeutic hypothermia decreases cardiac output by 7% for each 1 degrees C decrease in core body temperature, but maintains the stroke volume and the mean arterial pressure. Despite a growing amount of data, this life-saving technique is underutilized in hospitals worldwide. The purpose of this comprehensive review is to show the evolution and the clinical use of TH as it pertains to acute care practitioners.
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Postherpetic neuralgia (PHN) is a neuropathic pain condition that can arise as a complication following herpes zoster infection, with pain often localized to the affected dermatome. Patients are initially likely to seek treatment for PHN pain from their primary care practitioner; however, adequate pain relief is difficult to achieve in many patients. Combination therapies are often used and have shown promise, but there is still limited clinical evidence in the literature to support them. This article reviews the recent literature and guidelines on PHN treatment, with a focus on combination therapies, and seeks to help primary health care practitioners select treatment strategies that provide immediate relief for patients with localized PHN pain.
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Postgraduate medicine · Jan 2010
ReviewPrimary care use of FRAX: absolute fracture risk assessment in postmenopausal women and older men.
Osteoporosis-related fractures (low-trauma or fragility fractures) cause substantial disability, health care costs, and mortality among postmenopausal women and older men. Epidemiologic studies indicate that at least half the population burden of osteoporosis-related fractures affects persons with osteopenia (low bone density), who comprise a larger segment of the population than those with osteoporosis. The public health burden of fractures will fail to decrease unless the subset of patients with low bone density who are at increased risk for fracture are identified and treated. ⋯ The current National Osteoporosis Foundation Guide recommends treating patients with FRAX 10-year risk scores of > or = 3% for hip fracture or > or = 20% for major osteoporotic fracture, to reduce their fracture risk. Additional risk factors such as frequent falls, not represented in FRAX, warrant individual clinical judgment. FRAX has the potential to demystify fracture risk assessment in primary care for patients with low bone density, directing clinical fracture prevention strategies to those who can benefit most.
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Postgraduate medicine · Jan 2010
ReviewReview of medication adherence in children and adults with ADHD.
To review the literature on the prevalence, potential causes, and consequences of medication nonadherence in adult attention-deficit/hyperactivity disorder (ADHD). ⋯ Studies have documented that medication nonadherence is common in childhood/adolescent ADHD. Further prospective studies are necessary to document the scope of the problem in adult ADHD and to examine the potential benefits of utilizing extended-release medications in adult ADHD. Studies correlating the impact of medication nonadherence on symptoms and impairments in adult ADHD are needed. Future studies should consider utilizing technology to document medication nonadherence, such as MEMS caps.
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Postgraduate medicine · Jan 2010
Developing a system to predict laboratory-confirmed chlamydial and/or gonococcal urethritis in adult male emergency department patients.
We aimed to create a system for predicting which male emergency department (ED) patients with suspected chlamydial and/or gonococcal urethritis would have laboratory-confirmed infections based on clinical factors available at the initial ED encounter. ⋯ This system of a combination of risk factors available during the clinical encounter in the ED modestly predicts which adult male patients suspected of having chlamydial and/or gonorrheal urethritis are more likely to have or not have a laboratory-confirmed infection. A prospective study is needed to create and validate a clinical prediction rule based on the results of this system.