Postgraduate medicine
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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.
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Postgraduate medicine · Jan 2010
The impact of crowding on time until abdominal CT interpretation in emergency department patients with acute abdominal pain.
We assessed the relationship between emergency department (ED) crowding and delays in care in patients presenting with abdominal pain who receive abdominal computed tomography (CT). ⋯ ED crowding is associated with an approximately 2-hour delay to CT interpretation availability. Attempts to reduce delays in abdominal CTs may include earlier provider evaluation and placement in the queue for scanning.
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Current intakes of very long-chain omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are low in most individuals living in Western countries. A good natural source of these fatty acids is seafood, especially oily fish. Fish oil capsules contain these fatty acids also. ⋯ On the basis of the recognized health improvements brought about by long-chain omega-3 fatty acids, recommendations have been made to increase their intake. The plant omega-3 fatty acid, alpha-linolenic acid (ALA), can be converted to EPA, but conversion to DHA appears to be poor in humans. Effects of ALA on human health-related outcomes appear to be due to conversion to EPA, and since this is limited, moderately increased consumption of ALA may be of little benefit in improving health outcomes compared with increased intake of preformed EPA + DHA.