The Western journal of medicine
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Persons infected with the human immunodeficiency virus are prone to the development of many fungal diseases. Normal hosts with intact immunity usually recover from infection by these less-invasive fungi. ⋯ In this review, we discuss the epidemiology, clinical manifestations, diagnosis, and treatment of the three major North American mycoses, histoplasmosis, blastomycosis, and coccidioidomycosis. In most cases, amphotericin B is the initial drug of choice, followed by one of the azoles for lifelong maintenance therapy.
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Comparative Study
Snowboarding injuries, a four-year study with comparison with alpine ski injuries.
Snowboarding is a rapidly growing winter sport. Its unorthodox maneuvers and young participants raise many safety concerns. We examined injury patterns in recreational snowboarders, comparing these patterns with those found in alpine skiers. ⋯ The sport of snowboarding brings with it a different set of injuries from those seen in alpine skiing. The data focus attention on improvements such as wrist guards or splints, releasable front-foot bindings, and better instruction for beginner snowboarders to improve the safety of this sport. Finally, the data confirm that snowboarders and skiers may be safely combined on the same slopes.
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The number of medical school applications continues to rise despite recent reports of decreased physician job satisfaction. To better understand this paradoxical trend, I surveyed 84 premedical students about their expectations of a medical career. Almost all respondents anticipated that as physicians they would be able to cure, heal, and help their patients (98%) and that their work would be intellectually satisfying (95%). ⋯ Far fewer than half the respondents would be discouraged from pursuing a medical career by the fear of being sued (38%), business worries (22%), or administrative duties (20%). Comparison of the student responses with results of a physician job satisfaction survey carried out the same year showed that the students, as a group, were modestly idealistic with respect to the daily work of being a physician and somewhat naive about the problems caused by various business and administrative issues. I conclude that premedical students could be better informed about the current reality of being a physician and that practicing physicians are responsible for providing this education.
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To control costs, managed care organizations have begun to restrict the use of hospital emergency departments by their enrollees. They are doing this by educating enrollees, providing better access to 24-hour urgent care, denying preauthorizations for care for some patients who do present to emergency departments, and retrospectively denying payment for certain patients who use emergency services. Changing traditional use of emergency departments has resulted in conflicts between managed care organizations and these departments. ⋯ In addition, conflicts occur over the scope and payment for the medical screening examination required by federal law of persons presenting to an emergency department. Finally, issues arise related to the safety of patients who present to emergency departments and request care but are denied care because the managed care organization does not authorize the visit. Recent legislation in California has attempted to reconcile differences between managed care practices and federal and state laws; however, areas of continued conflict need to be resolved to prevent possible adverse consequences for patients actually needing emergency care.