Harefuah
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The newly reLeased guidelines of infectious disease societies suggest abstaining from performing routine chest radiographs in the diagnosis of community acquired pneumonia in clinically stable children, based upon studies where the measured outcome is time to resolution of the disease not antibiotic use. However, the impact of possible over-treatment with antibiotics that might result from this clinical approach is not discussed. ⋯ Reliance on physical examination alone in the diagnosis of community-acquired pneumonia (CAP) in children may over-diagnose cases of pneumonia in a clinically significant manner. Further consideration of this possibility is needed before widely disseminating guidelines that advocate antibiotic treatment based on clinical diagnosis alone.
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Practice Guideline
[Guidelines for the diagnosis and treatment of the fibromyalgia syndrome].
Over the past years, considerable progress has been made in understanding the pathogenesis of the fibromyatgia syndrome and the evidence based approach to the diagnosis and management has been significantty extended. The purpose of the current project is to develop practicat and evidence based guidetine recommendations for the Israeli health care system. ⋯ Using an interactive discussion procedure, recommendations were reached and expert opinion was introduced where evidence was considered incomplete. The panel recommendations underline the importance of concomitant and integrated medical therapy, such as serotonin and noradrenaline reuptake inhibitor (SNRI) anti-depressants or gamma-aminobutyric acid (GABA) related anti-epileptics, with regular aerobic physical exercise.
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Neuropsychiatric disorders are generally accompanied by a change in brain activity (hyperactivity or deficiency compared to normal activity). Therefore, intervention in brain activity may provide treatment for different disorders. In this paper we review various methods of brain stimulation: some that are familiar and have been in use for several years such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS); and others that are new and still being studied but have obtained promising preliminary results such as vagus nerve stimulation (VNS), deep brain stimulation (DBS], magnetic seizure therapy, transcranial direct current stimulation (tDCS] and near-infrared therapy. For each method we describe the procedure, proposed mechanisms, side effects and current status in research and in the practical field.
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Münchausen syndrome by proxy (also known as factitious disorder by proxy) is a psychiatric disorder which consists of fabricating or inducing illness in a child, usually by his mother. The motivation for the perpetrator's behavior is receivng satisfaction from the investigations and treatments that the child receives and from the medical environment, as part of a unique mental disturbance. External incentives for the behavior (such as economic gain) are absent. ⋯ Suspicious signs and symptoms include prolonged and illogical course of disease, odd complications, exacerbation that appear just before discharge from the hospital and symptoms that occur only in the presence of a specific care giver. Münchausen syndrome by proxy is not very rare. It appears in all ethnic groups, socioeconomic status and educational backgrounds.