Postgraduate medicine
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Lower standards. Waiting lists. ⋯ These are just some of the consequences of national healthcare in Britain, according to the author of this article, a family physician who trained in Scotland. Through a series of extraordinary anecdotes, Dr Anderson comments on Britain's underfunded medical system and the coping mechanisms that doctors rely on to function within it.
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Postgraduate medicine · May 1994
ReviewAutomated blood pressure monitoring. Should it be used routinely in managing hypertension?
Twenty-four-hour automated blood pressure measurements are representative of and more reliable than casual office blood pressure measurements; they also are more closely correlated with evidence of target-organ damage caused by hypertension and may have better diagnostic specificity. Nevertheless, broad use of automated monitoring in the routine evaluation and management of hypertension has been discouraged because of the lack of prospective epidemiologic studies linking automated measurements to cardiovascular morbidity and mortality, the inability to define a normal range for such measurements, and the cost of the monitoring. However, if it is accepted that conventions established for casual office blood pressure measurements are applicable to data obtained by automated methods, then routine use of automated monitoring is justified, since automated monitoring has better diagnostic capabilities that offset much of its cost.
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Postgraduate medicine · Mar 1994
ReviewRadiographic evaluation of cervical spine trauma. Procedures to avoid catastrophe.
A cervical spine series that includes three views (ie, lateral, open-mouth odontoid, and anteroposterior) is usually adequate to exclude unstable injuries that have the potential for producing spinal cord injury. The films should be of the highest quality and need to be carefully and systematically viewed. ⋯ Conventional tomography, computed tomography, and flexion and extension lateral views may be helpful when findings on the three-view series are equivocal. In patients with neurologic deficits, further radiographic evaluation is also warranted.
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Postgraduate medicine · Mar 1994
ReviewMassive blood loss in trauma patients. The benefits and dangers of transfusion therapy.
In acutely injured patients, recognition of profound shock may be difficult initially. Ensuring adequate oxygenation, restoring intravascular volume, and controlling ongoing blood loss are key principles of treatment in these patients. Additionally, an appreciation for and recognition of the possible adverse consequences of massive transfusion (ie, hypothermia, coagulopathy, hypocalcemia, hyperkalemia, and hemolysis) enable physicians to prevent them or at least lessen their effects.
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Postgraduate medicine · Jan 1994
Opportunistic infections in AIDS patients. Current management and prevention.
The number of drugs available for treatment and prevention of opportunistic infections in patients who are seropositive for HIV infection is limited, although some agents currently being studied show promise. Pneumocystis carinii pneumonia, the most common opportunistic infection, can be effectively managed, although prophylaxis must be continued indefinitely. ⋯ Intensive therapy with five or six drugs may be necessary. Isoniazid (Nydrazid) is recommended for prophylaxis.