Internal medicine journal
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Vasovagal syncope (VVS) is the commonest cause of recurrent syncope and has a high level of morbidity in both young and elderly patients. Diagnosis and treatment are often unsatisfactory despite the fact that syncope has a lifetime cumulative incidence of 35%. A detailed history can often yield an accurate diagnosis in most young patients. ⋯ The backbone of therapy is educating the patient, avoiding precipitating factors, maintaining hydration and the application of physical counter-pressure manoeuvres. Drug therapy is rarely warranted; however, fludrocortisone, alpha-agonists, such as midodrine and dihydroergotamine, and selective serotonin reuptake inhibitors may be helpful in some patients. Permanent cardiac pacing is rarely needed and randomized trials do not support its use.
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Internal medicine journal · Jul 2010
Multicenter Study Comparative StudyBrief telephone intervention increases testing for osteoporosis in patients treated in emergency departments for wrist fractures.
Previous studies show that identification and treatment of osteoporosis in patients with minimal trauma fractures treated as outpatients are poor. Our aim was to test two interventions designed to increase rates of identification and treatment. This prospective, action research study, using explicit medical record review and scripted telephone interview, was conducted at emergency departments (ED) of three hospitals from April 2007 to February 2008. ⋯ A brief telephone intervention and provision of information pack significantly improved testing rates for osteoporosis after minimal trauma wrist fracture. An ED/clinic-based intervention resulted in low rates of testing. Treatment of clinical osteoporosis remains suboptimal.
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Echocardiography is the mainstay of cardiovascular diagnostics, and is the most performed test for the evaluation of cardiac function. Critical and costly management decisions are based on quantification of left ventricular volumes and ejection fraction. Recent advances in echocardiography, such as microsphere contrast echocardiography for left ventricular opacification and perfusion imaging, three-dimensional transthoracic and trans-oesophageal imaging, strain and tissue Doppler imaging, all contribute to improving accuracy and reproducibility of these important measurements. ⋯ Hand-carried ultrasound devices have been developed, which are portable, are affordable and offer increased availability of echocardiography to the wider community. Clinicians should be actively encouraged to adopt these technologies to improve the diagnostic quality and reproducability of echocardiography for our patients. This article provides an overview of important recent advances in echocardiographic imaging with an emphasis on their role in clinical practice today.
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Internal medicine journal · Jul 2010
Comparative StudyWhat is associated with being active in arthritis? Analysis from the Obstacles to Action study.
Many adults with arthritis do not achieve physical activity levels recommended for good health. This study aimed to identify factors associated with physical activity participation in people with arthritis. ⋯ Active adults with arthritis have lower levels of chronic disease, greater self-efficacy and fewer psychosocial barriers. Recognition of such barriers and motivators may be useful when designing intervention programmes to help people with arthritis initiate or intensify physical activity participation.