Postgraduate medicine
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Postgraduate medicine · Mar 2010
Review Case ReportsDiagnosing and treating gout: a review to aid primary care physicians.
Generalist physicians, specifically general internists and primary care physicians, are often the first to see patients with gout and therefore play a critical role in the diagnosis and management of these patients. The aim of this review is to aid generalist physicians in diagnosing and treating gout. A case report example is presented to highlight some of the problems in diagnosing and treating gout. Practical practice points are also highlighted.
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Postgraduate medicine · Mar 2010
ReviewBurden of community-acquired pneumonia in North American adults.
To determine the burden of community-acquired pneumonia (CAP) affecting adults in North America, a comprehensive literature review was conducted to examine the incidence, morbidity and mortality, etiology, antibiotic resistance, and economic impact of CAP in this population. In the United States, there were approximately 4.2 million ambulatory care visits for pneumonia in 2006. Pneumonia and influenza continue to be a common cause of death in the United States (ranked eighth) and Canada (ranked seventh). ⋯ Despite the availability and widespread adherence to recommended treatment guidelines, CAP continues to present a significant burden in adults. Furthermore, given the aging population in North America, clinicians can expect to encounter an increasing number of adult patients with CAP. Given the significance of the disease burden, the potential benefit of pneumococcal vaccination in adults is substantial.
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Postgraduate medicine · Mar 2010
ReviewEpidemiology, clinical manifestations, and recent advances in vaccination against human papillomavirus.
In October 2009, the Advisory Committee on Immunization Practices (ACIP) approved a newly licensed vaccine, Cervarix, directed against human papillomavirus (HPV) to prevent cervical cancer. The ACIP also expanded its recommendations against HPV by giving permission to physicians to vaccinate males aged 9 to 26 years with the previously licensed vaccine, Gardasil, to prevent genital warts, in addition to its previous recommendation for females aged 9 to 26 years to prevent cervical cancer and genital warts. The marketing, expense, safety, and reactivity of Gardasil continue to be the subject of controversy. ⋯ Gardasil has been shown to be safe and effective in preventing HPV infections by types 6, 11, 16, and 18; types 16 and 18 are associated with 2 high-risk types of cervical cancer and are associated with 70% of all cervical cancers. Types 6 and 11 are associated with 90% of anogenital warts. Cervarix has also been shown to be safe and effective in preventing HPV infections by types 16 and 18, but offers no known protection against anogenital warts.
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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.