Postgraduate medicine
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Postgraduate medicine · Sep 2013
Comparative StudyImpact of an electronic medical record system on emergency department discharge instructions for patients with hypertension.
Uncontrolled hypertension is associated with significant patient morbidity and health care costs. Many patients evaluated in the emergency department (ED) do not regularly consult health care providers and have socioeconomic barriers to receiving primary care. Hypertension screening and counseling has been advocated as a routine part of ED care. Previous work has shown poor referral rates and education for ED patients presenting with elevated blood pressure (BP). We sought to determine whether implementation of an electronic medical record (EMR) would improve these rates. ⋯ Overall, the initiation of EMR led to a decrease in outpatient referrals and acknowledgment of elevated BP rates in discharge instructions. The provision of more complete lifestyle modifications improved in the post-EMR phase.
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Postgraduate medicine · Sep 2013
Randomized Controlled Trial Multicenter StudyLower-dose diclofenac submicron particle capsules provide early and sustained acute patient pain relief in a phase 3 study.
Non-steroidal anti-inflammatory drugs are prescribed for the treatment of patients with acute pain but use of such analgesics is associated with dose-dependent adverse events (AEs). Diclofenac submicron particle capsules have been developed using SoluMatrix technology to provide analgesia at lower doses than available solid oral dosing forms. Our study evaluated the analgesic efficacy and safety of lower-dose diclofenac submicron particle capsules in patients with acute pain following elective surgery. ⋯ Lower-dose diclofenac submicron particle capsules provided effective analgesia in this phase 3 clinical study in patients with acute pain and are a potentially promising option for the treatment of patients with acute pain.
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Postgraduate medicine · Sep 2013
ReviewHerpes zoster: diagnostic, therapeutic, and preventive approaches.
Herpes zoster (Hz), which generally presents as a localized, painful cutaneous eruption, is a common clinical problem, particularly among adults ≥ 50 years of age and immunocompromised patients. The diagnosis of Hz is mainly made clinically, except in patients with atypical manifestations or certain complications, such as central nervous system involvement, in which laboratory virologic testing is required. In addition to having a higher mortality rate, immunocompromised individuals have atypical and severe clinical findings and are at greater risk for complications and recurrence of Hz. ⋯ Measures for preventing Hz include infection control through routine hand hygiene and appropriate use of isolation precautions and personal protective equipment; immunoglobulins, such as the varicella-zoster virus immunoglobulin and vaccine; and antiviral agents. The zoster vaccine has been shown to be effective in reducing the incidence of Hz and PHN. The vaccine is recommended for all individuals aged ≥ 60 years who have no contraindications, including individuals who report a previous episode of Hz.
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Postgraduate medicine · Sep 2013
Review Case ReportsAsterixis related to gabapentin intake: a case report and review.
Asterixis has been reported as a side effect of toxic and metabolic abnormalities. The current literature contains very little evidence of gabapentin-related neurotoxicity. Our observations reveal that neurotoxic side effects of gabapentin use may be seen even when dose adjustments are made for patients with mild-to-moderate renal dysfunction. Clinical vigilance for possible neurotoxic effects of gabapentin therapy in patients with renal dysfunction is warranted.
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Postgraduate medicine · Sep 2013
ReviewImpact of sodium glucose cotransporter 2 inhibitors on weight in patients with type 2 diabetes mellitus.
Most patients with type 2 diabetes mellitus (T2DM) are overweight or obese. Both T2DM and overweight/obesity are associated with increased patient risk of cardiovascular events and mortality. Despite being the recognized cornerstone of treatment, weight loss and maintenance of weight loss are difficult for patients with T2DM, particularly as treatments for T2DM may cause weight gain. ⋯ Due to the caloric loss associated with decreased glucose in urine, treatment with SGLT2 agents offers the benefit of weight loss to patients, as well as reduction in hyperglycemia. Clinical trials of SGLT2 inhibitors in patients with T2DM, ranging in length from 4 to 90 weeks, have shown patient weight reductions from baseline of up to 4.7 kg. Such weight loss may have beneficial effects on adherence to medication, glycemic control, and cardiovascular risk in patients with T2DM.