Articles: treatment.
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Am. J. Obstet. Gynecol. · Aug 2000
ReviewAlternatives to mifepristone regimens for medical abortion.
Alternatives to regimens with mifepristone and a prostaglandin analog for medical abortion emerged because of the need for accessible, effective, and safe options in areas of the world where mifepristone was unavailable. Studies of oral or intramuscular methotrexate combined with misoprostol have demonstrated complete abortion rates in the same range as mifepristone regimens at
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The technique or approach of damage control surgery in trauma is not new; packing liver injuries has been an accepted treatment strategy for some time. What is new is the realization that an abbreviated laparotomy, or completion of only the essential portions of the operation, is often the best treatment for the patient as a whole. Recent developments include strategies in the operating room and the intensive care unit to manage patients undergoing trauma laparatomy, including prevention of hypothermia, methods to accurately assess resuscitation status with right ventricular catheters and measurements of end-organ perfusion, and recognition of abdominal compartment syndrome, with emphasis on prevention.
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Chronic pain disorders, including fibromyalgia and myofascial pain syndrome often do not respond adequately to standard therapy. The cases reviewed herein suggest the strain and counterstrain (SCS) technique, described in 1981 by Jones, may be helpful in reducing pain and improving function in patients with localized myofascial pain syndromes. This was a case study and retrospective review of 20 patients who had had chronic pain for an average of 2.7 years and were treated with SCS for pain relief. ⋯ Areduction in pain and an increase in function of 50%-100% occurred in 19 of 20 patients immediately after SCS therapy. Partial improvement was maintained for 6 months in 11 of 20 patients, and 4 were still pain free. We believe that SCS techniques should be considered and evaluated further as adjunctive therapy for patients previously unresponsive to standard treatment for myofascial pain syndrome.
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Repeated assessment of pain and other symptoms is required for quality assurance in palliative care. However, physical and cognitive impairment of the patients may impede the use of standardized questionnaires and documentation systems in palliative care setting. We developed a minimal documentation system (MIDOS) for the specific requirements in this setting. ⋯ We conclude that MIDOS is a valid instrument for self-assessment of the patient's symptoms and may be used to monitor the efficacy of symptom management.