Postgraduate medicine
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Postgraduate medicine · Feb 2001
ReviewInfectious diseases and antibiotic resistance in long-term care facilities.
Infectious diseases in the institutionalized elderly are emerging as 1 of the major issues challenging physicians treating adult patients. The most common syndromes encountered are nursing home-acquired pneumonia, urinary tract infections, and skin and soft tissue infections. As a complicating factor, immunocompromised elderly patients are often infected with bacteria highly resistant to antibiotics. ⋯ Developing algorithms for appropriate treatment of nursing home-acquired infections, assessing the factors that encourage the development of resistance, and finding interventions that can stem these processes are urgent priorities. Important clinical research questions include determining how frequently elderly patients are colonized with multiresistant pathogens and how these pathogens disseminate in this population. The future possibility of altering the aging immune system still remains an elusive goal.
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Many pressures play a role in escalating the emergence of antibiotic-resistant infections in intensive care units (ICUs), oncology and bone marrow transplant wards, and dialysis units. One is horizontal cross-transmission of antibiotic-resistant infections; another is the frequent use of broad-spectrum antibiotics. ⋯ This article discusses potential multidisciplinary interventions to prevent bacterial resistance. Among these wide-ranging strategies are adequate decontamination between patient contacts, antibiotic guidelines to limit unnecessary use, and use of combination antimicrobial therapy.
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Postgraduate medicine · Jan 2001
ReviewAbnormal uterine bleeding. Diagnostic considerations, management options.
The approach to diagnosis of abnormal uterine bleeding is guided by a sound knowledge of menstrual physiology and differential diagnosis. Often, simple anovulation is the underlying problem, although the possibility of pregnancy, endometrial hyperplasia with atypia, or benign reproductive tract disease must be considered. In the majority of cases, abnormal uterine bleeding can be fully evaluated and effectively treated medically without the need for gynecologic referral.