Southern medical journal
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Southern medical journal · Oct 2007
ReviewManagement of chronic noncancer pain in the primary care setting.
While opioids are regarded as the mainstay of chronic pain management, their use is controversial in the minds of many primary care physicians due to clinical concerns about dependence, abuse, and addiction and medicolegal concerns regarding state and federal regulatory authorities. For patients with moderate to moderately severe pain, the treatment of choice is a long-acting opioid or opioid combination drug product to provide sustained analgesia along with improvements in sleep quality, compliance, and possibly quality of life. ⋯ These patients should not be denied access to opioid therapy, but they do require focused monitoring and case management. Ongoing monitoring should focus on the 4 A's (ie, analgesia, activities of daily living, adverse effects, and aberrant drug-related behaviors), and all aspects of patient care must be thoroughly documented.
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Although physicians began associating conspicuous neck veins with heart disease almost three centuries ago, the jugular venous pulse remains an often ignored component of the physical examination. Many physicians have not invested in the necessary understanding of the technique, and there is a misconception that its examination is difficult and of limited clinical value. ⋯ The jugular venous pulse provides a window into the right heart and an occasional glimpse of left heart hemodynamics. By peering through this window, clinicians can gain valuable information in the diagnostic evaluation of the cardiovascular patient.
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Southern medical journal · Oct 2007
Differences in the pre- and post-Katrina New Orleans HIV outpatient clinic population: who has returned?
Hurricane Katrina devastated the New Orleans area and dispersed the patient population of the HIV Outpatient Program (HOP) clinic of the Medical Center of Louisiana at New Orleans (MCLNO). Patients began returning to care following the clinic's reopening in a temporary location in November 2005. ⋯ These results highlight the need for medical facilities to anticipate changes inpatient populations in the wake of a disaster. Although this work was conducted in an HIV-positive patient population, the results may also apply to patients receiving care for other chronic illnesses.
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Southern medical journal · Oct 2007
A reliable and valid instrument to assess competency in basic surgical skills in second-year medical students.
Despite calls for competency based education, a dearth of validated instruments for measuring basic skills currently exists. We developed an instrument to assess competency in basic surgical skills in second-year medical students and tested it for psychometric reliability and validity. ⋯ The instrument has psychometric properties adequate for use as one criterion for summative evaluation and is educationally practical enough to provide focused and detailed feedback for student improvement.