Postgraduate medicine
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Postgraduate medicine · Jul 2001
ReviewApproaches to vitamin B12 deficiency. Early treatment may prevent devastating complications.
Vitamin B12 deficiency is a common problem that affects the general population and the elderly in particular. Persons with the deficiency may be asymptomatic or may have hematologic or neuropsychiatric signs and symptoms. If the disorder is untreated, complications may cause significant morbidity. In this article, Drs Dharmarajan and Norkus discuss approaches to screening and diagnosis as well as the nontoxic, low-cost treatments now available.
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Postgraduate medicine · May 2001
Review Practice Guideline GuidelineThe Expert Consensus Guideline Series. Treatment of behavioral emergencies.
Behavioral emergencies are a common and serious problem for consumers, their communities, and the healthcare settings on which they rely to contain, assess, and ultimately help the individual in a behavioral crisis. Partly because of the inherent dangers of this situation, there is little research to guide provider responses to this challenge. Key constructs such as agitation have not been adequately operationalized so that the criteria defining a behavioral emergency are vague. The significant progress that has been made for some disease states with better treatments and higher consumer acceptance has not penetrated this area of practice. A significant number of deaths of patients in restraint has focused government and regulators on these issues, but a consensus about key elements in the management of behavioral emergencies has not yet been articulated by the provider community. The authors assembled a panel of 50 experts to define the following elements: the threshold for emergency interventions, the scope of assessment for varying levels of urgency and cooperation, guiding principles in selecting interventions, and appropriate physical and medication strategies at different levels of diagnostic confidence and for a variety of etiologies and complicating conditions. ⋯ To evaluate many of the treatment options in this survey, the experts had to extrapolate beyond controlled data in comparing modalities with each other or in combination. Within the limits of expert opinion and with the expectation that future research data will take precedence, these guidelines provide some direction for addressing common clinical dilemmas in the management of psychiatric emergencies and can be used to inform clinicians in acute care settings regarding the relative merits of various strategies.
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Postgraduate medicine · Mar 2001
ReviewSERMs and cardiovascular disease in women. How do these agents affect risk?
The beneficial effects of SERMs, specifically tamoxifen in the treatment and prevention of breast cancer and raloxifene in the prevention of osteoporosis, are well established. In addition, numerous groups of investigators have reported that these agents have a positive impact on cardiovascular health, possibly as a result of their cholesterol-lowering and anticoagulation actions. ⋯ Similarly, raloxifene treatment had modest positive effects on cardiovascular risk factors but was associated with an increased risk of thromboembolism. When viewed as a whole, study results dictate that the benefits of SERM use for the prevention of cardiovascular disease be carefully weighed against the potential risks.
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Postgraduate medicine · Mar 2001
ReviewHematologic and oncologic emergencies. Doing the most good in the least time.
Broad categories of emergency hematologic and oncologic situations are metabolic crises, compressions and obstructions, and symptomatic cytopenias. In each instance, a decision to intervene should be made on the basis of findings on diagnostic assessment in combination with prognostic information. ⋯ Numerous diseases, including potentially curable cancer, can be modified and patients' quality of life substantially improved with appropriate emergency intervention. Fortunately, the modern therapeutic arsenal provides many specific measures to manage these challenging clinical situations.