ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Chronic pain is commonly encountered in primary care, but it can be difficult to manage.Methods.The purpose of this article was to review the definition of chronic pain, general guidelines of management, pharmacologic and nonpharmacologic treatment, the role of pain clinics, and rehabilitation goals.Conclusions.Effective management of chronic pain is usually achieved by an interdisciplinary team, with involvement of both patients and their families, and integrates pharmacologic and nonpharmacologic treatment with needed surgical interventions, psychotherapy, and rehabilitation.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Noninvasive positive‐pressure ventilation (NIPPV) is increasingly used as an effective means of avoiding endotracheal intubation and mechanical ventilation in patients with respiratory insufficiency or failure.Methods.We retrospectively reviewed our experience with NIPPV to treat respiratory failure in five patients with cystic fibrosis (CF).Results.Despite chronic lung disease related to CF, none of our cases were end‐stage. All patients had recent pulmonary function tests showing a forced expiratory volume in 1 second (FEV1) of more than 30% predicted for age. All patients had progressive atelectasis, hypoxemia, and impending respiratory failure related to an acute pulmonary exacerbation or upper abdominal surgical procedure (open gastrostomy tube placement). Respiratory rates decreased, oxygen saturation increased, fraction of inspired oxygen (Fio2) requirement decreased, transcutaneous CO2decreased, and atelectasis resolved with NIPPV.Conclusions.Use of NIPPV provides effective respiratory support while avoiding the need for endotracheal intubation. The applications of NIPPV, reports of its use in patients with CF, and the equipment required are reviewed.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective.We examined and compared the efficacy of sildenafil in patients previously using other agents or devices for erectile dysfunction (ED) treatment.Methods.We identified 47 patients with organic ED who had tried other therapies (intracavernosal injection therapy [ICIT], intraurethral prostaglandin suppositories [IPS], vacuum erection devices [VEDs], or yohimbine) before using sildenafil. Comparisons of the efficacy of sildenafil to the previously used agent or device were assessed by telephone questionnaire. Responses were compared using nonparametric Wilcoxon rank sum and analysis of variance testing.Results.Sildenafil therapy was no more effective than ICIT or VEDs but was more effective than IPS. No significant difference occurred in response to sildenafil with age. Of 22 patients achieving erections adequate for intercourse with their previous therapy, 14 (63%) achieved equal or improved erections with sildenafil. Of the remaining 18 patients who had erections inadequate for intercourse with previous therapy, 5 (27%) had adequate erections with sildenafil.Conclusions.Oral sildenafil therapy provides results comparable to those of other available ED treatment modalities. A trial of this drug in this patient population is warranted.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Physicians are not immune to psychosocial problems but may face unique impediments to attending to them. Self‐care among physicians is not a topic generally included as a part of professional training, nor is it a topic that readily receives consideration in professional practice. The stresses of professional practice can exact a great toll, however, and self‐neglect can lead to tragic consequences. In some areas, particularly suicide rates, physicians have increased vulnerability, and in other areas problems may be unrecognized (depression, substance abuse, marital problems, and other stress‐related concerns). Female physicians show some particular areas of risk. In this paper, we raise questions about how and why physicians may be particularly vulnerable, review the available literature about the extent and nature of such problems in physicians, discuss possible factors related to the development of these problems in physicians, and suggest a variety of solutions to improve physician self‐care.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Evaluating the cervical spine for injury is an essential part of the assessment of a traumatized patient. Clinical examination and radiographs are the traditional techniques used for this evaluation. Often, however, a reliable clinical examination is not possible because of head injury, altered mental status, or “distracting” injuries. In such cases, cervical spine injury that is not apparent on radiographs may be missed. This case report illustrates a purely ligamentous cervical spine injury resulting in cervical instability. We describe our method of screening for and evaluating these types of injuries using physician‐controlled stretch, flexion, and extension examination under fluoroscopy.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Postpneumonectomy electrocardiographic (ECG) changes have not been well‐defined.Methods.We reviewed the clinical data and the preoperative and postpneumonectomy ECGs of 15 patients who had pneumonectomy.Results.All postpneumonectomy ECGs showed a higher heart rate and two (13%) showed diffuse ST elevation. Four patients (27%) had transient atrial arrhythmias. Five patients (33%) had some ECG findings of acute cor pulmonale. A leftward shift of the QRS axis occurred after left pneumonectomy. The precordial transitional zone shifted counterclockwise after right pneumonectomy.Conclusions.Except for one case of septal myocardial infarction, postpneumonectomy ECG changes appeared to result from the pneumonectomy and not from cardiopulmonary disease. Recognition of expected postpneumonectomy ECG findings will help avoid confusing these changes with acute cardiac and pulmonary events, which should reduce patient morbidity and costs.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.This study examined the factors that influenced African American women to select medicine as a career and their satisfaction with their career choice.Methods.Of 132 African American female physicians in South Carolina, 62 responded to a survey of open‐ended questions about why they chose medicine, what they liked and disliked about their career, and who influenced their decision to become a physician.Results.The majority chose medicine for altruistic reasons and found that medicine provided challenge and the opportunity to make a positive difference. Family members, teachers, and physicians served as the common external influences in their decision to become a physician. Managed care, paper work, and time demands constituted the most disliked aspects of medicine.Conclusion.Altruistic reasons and/or an interest in science motivated most of these African American female physicians to study medicine. Family members most often were their principal role models.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Studies suggest that the selective use of anaerobic blood cultures may represent a more cost‐effective laboratory approach when anaerobic bacterial infection is suspected.Methods.A 5‐year retrospective study was done at a Veterans' Affairs hospital to determine the utility of routinely including anaerobic blood culture when sampling for bacteremia.Results.A total of 22,075 anaerobic blood cultures were collected from our adult population. Significant anaerobic pathogens were isolated from only 0.14% of these blood cultures. An anaerobic infection could have been suspected in 92% of our patients.Conclusions.Significant anaerobic bloodstream infections occurred in only 0.14% of blood cultures. In addition, the majority of the patients identified with anaerobic bacteremia had clinical conditions that would have suggested a high likelihood of anaerobic bacteremia. These observations suggest that selective rather than routine use of anaerobic blood cultures may be appropriate in a veteran population.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.We characterized public health clinic users 4 years after implementation of a major public health insurance reform and identified barriers to health care access.Methods.We used face‐to‐face interviews and profile analysis of survey findings.Results.The typical public health client household is larger, poorer, and more likely to be black than the wider population. The health status of participants is generally good; the level of insurance coverage is preponderantly TennCare; and 90% of respondents are willing to pay some premium.Conclusions.Lack of health insurance does not present a serious health care access barrier, nor do transportation or location; but taking time off from work with loss of wages is a problem for those employed. A cost‐effective way to enroll uninsured children is to use the County Health Department clinics as a contact point.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID