Postgraduate medicine
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Postgraduate medicine · Nov 2008
ReviewHyperglycemia management in the hospital: about glucose targets and process improvements.
Hyperglycemia is prevalent in the inpatient setting and is associated with increased morbidity and mortality in patients with and without diabetes. Too often hyperglycemia is underrecognized, underreported, and suboptimally managed. Proactive assessment of inpatients' glycemic status and aggressive treatment approaches are needed. ⋯ Consequently, the question is whether tight glycemic control strategies should focus on achieving tight glycemic targets with early and intensive insulin therapy, on process improvements aimed at optimal and safe insulin delivery, or a combination of both approaches. The relative importance of each approach must be carefully balanced by integrated health care teams within each institution. If hyperglycemia management is championed from admission through discharge, patients could experience improved outcomes and institutions could achieve substantial health care cost savings.
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Obesity is a global health problem that is increasing in prevalence. The World Health Organization characterizes obesity as a pandemic issue, with a higher prevalence in females than males. Thus, many pregnant patients are seen with high body mass index (BMI). ⋯ When Cesarean section is performed, many obstetricians prefer an incision above the pannus to avoid skin infection. However, the incision should be decided upon the discretion of the surgeon. Peripartum, special attention is given to avoid thromboembolism by using compression stockings and early ambulation.
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There are compelling reasons why primary care physicians concerned about the well-being of their patients should strive to become competent in recognizing the symptoms of attention-deficit/hyperactivity disorder (ADHD). Despite lingering social controversy, the existence of ADHD among a portion of the adult population is well accepted among medical experts. ⋯ An estimated 4% to 5% of the adult population is impaired by ADHD. However,less than one-quarter of these adults have been diagnosed as having ADHD
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Addiction to drugs and alcohol is often undiagnosed and untreated. Physicians are often unaware or have negative attitudes regarding these patients, such as the perception that treatment is ineffective. Addiction--psychological dependence with or without tolerance and withdrawal--is essentially compulsive uncontrolled substance use despite physical, psychological, or social consequences. ⋯ An understanding of the biological reality of addiction allows physicians to understand addicts as having a brain disease. Further, the reality of effective pharmacological and cognitive-behavioral treatments for addiction allows physicians to be more optimistic in treating addicts. The challenge to the physician is to embrace the reality of addictive disease and fulfill his or her role in its treatment.
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Postgraduate medicine · Jul 2008
Randomized Controlled Trial Multicenter StudyA randomized, double-blind, parallel-group, multicenter, placebo-controlled study of the safety and efficacy of extended-release guaifenesin/pseudoephedrine hydrochloride for symptom relief as an adjunctive therapy to antibiotic treatment of acute respiratory infections.
This study assessed the efficacy and safety of guaifenesin 600 mg and pseudoephedrine hydrochloride 60 mg extended-release bilayer tablets in providing relief of acute respiratory symptoms when used as an adjunct to antibiotics in patients with an acute respiratory infection (ARI). ⋯ As adjunctive therapy for symptom relief for patients taking antibiotics for ARIs, guaifenesin/pseudoephedrine shortened time to relief and improved bothersome respiratory symptoms better than placebo, with greatest effects seen for nasal congestion and sinus headache.