Primary care
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Patients with end-stage chronic obstructive pulmonary disease (COPD) have poor quality of life, with limited activity, breathlessness, dependence on others, and recurrent needs for medical evaluation and treatment. Such patients demonstrate significant and progressive impairments in physical, mental, and social functioning. ⋯ This article reviews quality of life issues, proposed prognostic indicators, and pharmacologic and nonpharmacologic treatments in advanced COPD. Palliative measures to address breathlessness and unmet needs among patients with end-stage COPD are discussed.
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The prevalence of heart failure (HF) is increasing and morbidity and mortality remain high. There is a clear need for palliative care for the growing population of chronically ill patients with HF. ⋯ This article discusses symptom burden in advanced HF and specific considerations for patients with HF regarding advance care planning and symptom-directed therapy. Options for care at the end of life, including hospice, chronic inotropic support, and deactivation of an internal cardiac defibrillator, are also discussed.
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Ethical problems in medicine are common, especially when caring for patients at the end of life. However, many of these issues are not adequately identified in the outpatient setting. Primary care providers are in a unique and privileged position to identify ethical issues, prevent future conflicts, and help patients make medical decisions that are consistent with their individual values and preferences. This article describes some of the more common ethical issues faced by primary care physicians caring for patients with life-limiting illness.
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Opioid dependence is becoming a more common problem in the United States that gives rise to many negative health and social consequences for both individuals and society as a whole. Opioid dependence presents a challenging issue for physicians to identify and treat. ⋯ Long-term therapy options include detoxification, nonpharmacologic treatment plans, and maintenance replacement treatment with either methadone or buprenorphine. Physicians meeting necessary requirements have the option of implementing office-based opioid-assisted maintenance therapy.
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Nicotine dependence is a significant addiction with many health consequences. Consistent attempts and efforts at addressing this condition, guiding and advising afflicted patients using motivational techniques and the 5-A stepwise strategies, and instituting appropriate therapies will result in better health outcomes and less incidence of diseases. In pharmacotherapy, Nicotine replacement therapy and oral medications can be used alone or in combination with varying degrees of success.