Connecticut medicine
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New training initiatives in ambulatory medicine are being developed in medical schools and residency training programs due to the need to expand education in ambulatory medicine. Most diagnostic and management decisions are being made in outpatient settings. ⋯ The skills of questioning, role modeling, emphasizing general principles, and concept comprehension are similar in both inpatient teaching and outpatient teaching. The approach to problem solving, site of teaching, and provision of feedback may differ from inpatient teaching.
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Connecticut medicine · Aug 1997
ReviewHyperkalemia and trimethoprim-sulfamethoxazole: a new problem emerges 25 years later.
Trimethoprim-sulfamethoxazole is a frequently prescribed antibiotic with a wide spectrum of antimicrobial activity. A previously unreported and potentially lethal adverse reaction associated with "high dose" trimethoprim-sulfamethoxazole therapy, hyperkalemia, was described. Subsequent to the descriptions of hyperkalemia with "high dose" trimethoprim-sulfamethoxazole, a handful of cases noted the development of hyperkalemia with "standard dose" trimethoprim-sulfamethoxazole in elderly patients without evidence of an obvious defect in potassium homeostasis. ⋯ Recognition of this potassium disorder led to investigation and description of the mechanism by which trimethoprim-sulfamethoxazole-induced hyperkalemia. Trimethoprim was found to act like the potassium-sparing diuretic amiloride and reduce renal potassium excretion. Hence, trimethoprim-sulfamethoxazole therapy was found to be associated with a new adverse reaction, hyperkalemia, nearly 25 years after its introduction into clinical practice as an antimicrobial agent.
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Connecticut medicine · Jul 1997
A regional weaning center for patients requiring mechanical ventilation: an 18-month experience.
This report reviews the outcomes of patients on mechanical ventilation admitted to a new regional weaning center. We reviewed the records of 47 patients admitted to the weaning center over an 18-month period. All patients had a tracheostomy, were ventilator dependent, and considered difficult to wean by their referring physician. ⋯ Patients were admitted to a 12-bed weaning unit at our chronic disease and rehabilitation hospital and assessed by a multi-disciplinary team of physicians, nurses, and therapists. Thirty patients were successfully weaned from prolonged mechanical ventilation and subsequently discharged from our unit. These data indicate that the majority of difficult to wean patients admitted to our regional weaning center were successfully liberated from prolonged mechanical ventilation.