The Journal of the Florida Medical Association
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The United States embargo against Cuba, which makes trade illegal, contributes to that country's death and disease. The policy is obsolete, counterproductive and should be changed to bring peace between the two nations and help restore the health of the Cuban people. ⋯ The United States' controls contradict the most fundamental values upon which this country stands. Despite current restrictions, physicians can travel to Cuba and they should in order to observe the island's system for themselves.
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Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in the treatment of ophthalmic inflammatory disease. Currently four topical preparations are available: flurbiprofen and suprofen for the prevention of miosis during surgery; diclofenac for postoperative inflammation following cataract extraction, and ketorolac for the treatment of itching associated with seasonal allergic conjunctivitis. Caution should be exercised, however, as topical and systemic adverse effects may occur including stinging, photophobia, gastric sensitivity, and increased bleeding time. The mechanism of action of NSAIDs is discussed, complications associated with use, and the current and future roles of therapy.
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CPR is a procedure from which approximately 15% of patients survive to discharge. Patients have the right to request DNR orders and health professionals have an obligation to provide the information to make decisions. ⋯ Patients without decision-making capacity are dependent on advance directives, surrogates or proxies for DNR orders. The most recent version of the Florida statute has improved the procedural mechanism for writing DNR orders but continues to need further refinement.
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Critical care medicine integrates various treatment modalities to provide care of patients with multiple system dysfunction or failure and to determine the diagnosis of the particular condition. The pulmonary artery catheter advanced from a simple tool to measure intracardiac pressures and output to methodology enabling clinicians to understand the balance between oxygen delivery and utilization. Critical care developed new concepts in the treatment of respiratory failure including not only forms of mechanical ventilation such as pressure control but also methods such as ECMO and surfactant therapy which may preclude the need for mechanical ventilation or minimize its needs. ⋯ Continued development of genetically engineered drugs may ultimately improve survival and reduce complications. Critical care has become a subspecialty, synthesizing the basic knowledge from anesthesiology, internal medicine, pediatrics and surgery. Its multidisciplinary delivery represents the way of the future.