Postgraduate medicine
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Postgraduate medicine · Jul 2012
ReviewCOPD and associated comorbidities: a review of current diagnosis and treatment.
Health care utilization and costs associated with chronic obstructive pulmonary disease (COPD) continue to increase, notwithstanding evidence-based management strategies described by major respiratory societies. Cardiovascular diseases, asthma, diabetes and its precursors (obesity and metabolic syndrome), depression, cognitive impairment, and osteoporosis are examples of common comorbidities that can affect or be affected by COPD. Appropriate diagnosis and management (from a pharmacologic and nonpharmacologic perspective) of COPD and its associated comorbidities are important to ensure optimal patient care. An evolving understanding of COPD as a multimorbid disease that affects an aging population, rather than just a lung-specific disease, necessitates an integrated, tailored disease-management approach to improve prognoses and reduce costs.
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Postgraduate medicine · Jul 2012
ReviewDiabetic peripheral neuropathy and the management of diabetic peripheral neuropathic pain.
Diabetic peripheral neuropathy (DPN) affects approximately half of patients with diabetes. Neuropathic pain is a major complaint of patients with diabetic polyneuropathy. ⋯ This article provides an outline of the clinical subtypes, pathophysiological features, and diagnosis of DPN. Disease-modifying treatments are reviewed, with particular attention paid to DPN pain management.
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Postgraduate medicine · Jul 2012
ReviewTargeting renal glucose reabsorption for the treatment of type 2 diabetes mellitus using the SGLT2 inhibitor dapagliflozin.
Sodium-glucose co-transporter 2 (SGLT2) plays a key role in glucose homeostasis as the key transporter responsible for most renal glucose reabsorption in the proximal tubules of the kidney. Dapagliflozin is a potent, selective, and reversible inhibitor of SGLT2 that lowers blood glucose levels in an insulin-independent fashion. This novel agent has been studied extensively in patients with type 2 diabetes mellitus (T2DM). ⋯ While there are no clinically significant negative effects on renal function or electrolytes, dapagliflozin treatment is associated with increased frequencies of urinary tract infections and vulvovaginitis/balanitis. With a mechanism of action that is distinct from and complementary to that of existing antihyperglycemic therapies, dapagliflozin is an effective antihyperglycemic agent that is well tolerated and may enhance weight loss. As such, dapagliflozin promises to become an important adjunctive therapy for comprehensive treatment of T2DM.
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Postgraduate medicine · May 2012
ReviewClinical strategies for the primary health care professional to minimize prescription opioid abuse.
Prescription opioid analgesic therapy can be effective in managing chronic noncancer pain in appropriately selected patients. However, the risks and benefits of prescription opioids should be carefully considered when treating this patient population. A dramatic increase in opioid-related morbidity and mortality has been observed in the United States in the past decade. ⋯ This article reviews strategies and tools that providers may implement to help identify appropriate patients for chronic opioid therapy and recognize signs of drug-related aberrant behaviors and abuse. In addition, the potential role of abuse-deterrent, extended-release opioid formulations to reduce risk in patients and nonmedical users of opioids is introduced. Collectively, these preventative measures may effectively reduce opioid misuse, abuse, and diversion without denying adequate analgesia in appropriate patients.
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Postgraduate medicine · Mar 2012
Health care utilization and costs in type 2 diabetes mellitus and their association with renal impairment.
To evaluate the health economic burden of renal impairment (RI) in patients with type 2 diabetes mellitus (T2DM). ⋯ Renal impairment in T2DM is associated with high health care utilization and costs.