摘要:

Background.Shortcomings of traditional pain relief agents have led physicians to investigate other alternatives, such as antiepileptic drugs. Safe, effective, nonhabituating agents are currently available to enhance pain treatment strategies.Methods.In this article, various pharmacologic options and their mechanisms of action are reviewed briefly, with a focus on treatment of chronic pain with antiepileptic drugs (AEDs).Results.Antiepileptic drugs have been widely studied and prescribed for the relief of acute and chronic pain. Similarities in the neurophysiology of pain and epilepsy suggest that AEDs may be a suitable adjunct in the management of chronic pain. Of the newer AEDs, gabapentin shows the greatest potential and appears to be well tolerated by patients.Conclusions.Treatment of chronic pain remains a challenge for physicians and patients. Further research is required to identify the role of various agents and their effect on patient return to function and quality of life.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.The companion animal population in the United States is both large in numbers and diverse in composition. Nearly 60% of households have one or more animals. Associated with this large and diverse group of animals are considerable risks for injuries and transmission of infections to humans.Methods.Through a review of the relevant literature and our collective professional experience in public health and veterinary medicine, we framed issues regarding companion animals and human health and safety.Results.We placed the identified issues in general contexts that could be applied to varying circumstances.Conclusions.Physicians, veterinarians, public health officials, and others need to work together to ensure that animal ownership is as risk free for people as possible.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The tragedies of William Shakespeare make frequent use of suicide, some accomplished, some merely contemplated. Although his intent was their dramatic context, the Bard nonetheless clearly anticipated many features being discussed today, including assisted suicide, imitative (“copycat“) suicide, and suicidal ideation by individuals with depression or disabilities. Recent debate over how often these factors influence the incidence of suicide rarely invokes their historical longevity. They are not new, so changes over the years in societal, religious, legal, and medical attitudes toward suicide must be considered when trying to understand their role. This review attempts to show that many such features of and attitudes toward suicide circa 1600 were perceived by Shakespeare and incorporated into his plays. In the 15 plays classified as tragedies, there are 13 definite and 8 possible suicides, ie, a total of 21 incidents for evaluation. Among the 13 overt suicides, at least 7 are depicted as being admirable under the circumstances at the time. Also, in various ways, 4 of these 13 were assisted, and at least 3 others contain an imitative element. Overall, the action of taking one's life is presented in a neutral or even favorable light, and the audience is left with a mingling of pity and admiration for the victim, not reproach.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.This study was done to determine the efficacy and ease of administration of education/behavior modification classes, provided by a nurse and a dietitian in a primary care clinic for improving control of type 2 diabetes mellitus.Methods.Patients were divided randomly into two groups. Eighteen patients completed 6 months of structured, office-based classes, and 20 similar patients served as control subjects. All were patients of the same group practice and had their usual office visits. Glycemic control, lipid levels, body weight, knowledge about diabetes, medication requirements, and symptoms were monitored during the 6 months, with follow-up at 12 months.Results.At the end of 6 months, the intervention group had significant reductions in mean fasting blood glucose, glycosylated hemoglobin, total cholesterol, and low-density lipoprotein cholesterol (LDL-C) values. Their mean body weight was significantly reduced at 12 months, and their knowledge of diabetes was improved. Control patients had significant improvement only in glycosylated hemoglobin and body weight at 6 months. Minimal physician time was required.Conclusion.The education/behavior modification program was clinically worthwhile, and it was easy to administer.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Little is known about the relationship between academic medical centers (AMCs) and community physicians (CPs). We examined this relationship for an individual specialty—dermatology.Methods.South Florida dermatologists were queried regarding their practice and referral patterns, as well as the effect of managed care on these patterns.Results.On average, the respondents see 7,342 patients annually. Ninety-eight percent refer one or more patients for aid in therapy (39%) and diagnosis (27%). Most were satisfied with the amount (63%) and quality (77%) of the service provided. Overall, only 0.2% of patients are referred. Sixty percent reported that managed care caused alterations in referral patterns.Conclusions.We found that, although community dermatologists diagnose and treat the vast majority of patients with skin disease seen by dermatologists, they also use and are satisfied with the AMC's services. Changes in referral patterns have occurred but have not negatively affected the relationship between the AMC and the CP.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Because AIDS is increasing in rural areas and small cities of the United States, we sought to further describe the epidemiology of HIV/AIDS in nonurban Alabama.Methods.Extensive interviews of HIV-infected residents of Alabama living outside of urban Birmingham were conducted at clinics throughout the state.Results.Of the 417 HIV-infected persons interviewed from January 1995 through January 1997, 310 (74%) were male, 229 (55%) were white, and 179 (43%) were black. Over time, increasing proportions of HIV infections have likely been acquired in nonurban areas. Of the 417 subjects, 43 (10%) had visited an STD clinic in the past year, and 31 (7%) had smoked crack-cocaine during the past month. Of the 166 persons who had been sexually active in the past month, 59 (36%) had used alcohol before sex and 56 (34%) used condomsinconsistently Of the 417 subjects, 161 (39%) currently had no health insurance, and 68 (16%) had lost medical insurance since becoming HIV-infected.Conclusions.HIV-infected persons in nonurban Alabama are likely to have practiced high-risk behavior, to have acquired HIV in nonurban settings, and to have inadequate health insurance.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.A significant number of patients with the acquired immunodeficiency syndrome (AIDS) are initially seen with symptoms related to the head and neck. It is becoming increasingly challenging for clinicians to accurately diagnose new lesions, considering the vast array of manifestations of AIDS in this region and their many atypical presentations. A comprehensive review is a valuable clinical tool.Methods.AMEDLINE search of the English language literature from 1984 to the present was done for this study.Results.Dermatologic,otologic,nose/paranasalsinuses/nasopharyn,oral cavity/oropharynx, laryngeal, and neck manifestations are reviewed. The gross and microscopic appearances of lesions are described, with particular emphasis on various presentations of the same lesion and lesions that may mimic the appearance of others. Practical treatment strategies are also discussed.Conclusions.Accurate and early recognition of the many common and uncommon manifestations of AIDS in the head and neck is of critical importance to the timely and effective management of these patients.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.In 1998, 41,600 new cases of melanoma with 7,300 deaths were expected. Worldwide, the incidence has risen 5% a year against a backdrop of generally decreasing cancer trends. Later stages of melanoma carry a severe prognosis. The need for newer, more effective therapeutic strategies for cancer is obvious. For melanoma, early diagnosis and surgical treatment are the only options that are currently curative. Chemotherapy and radiation therapy are of limited efficacy.Methods.We reviewed the various forms of immunotherapy, concentrating on vaccine therapy. We then reviewed the history of our own vaccine in the context of the field of immunotherapy, and compared efficacy, immune response, production methods, and survival.Results.Survival is improved among recipients of melanoma vaccine when compared with patients receiving conventional therapy.Conclusions.Immunotherapy in the form of melanoma vaccines is better than conventional therapy and is trending toward purer antigenic preparations.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Mycobacterium fortuitumis one of the rapidly growing mycobacteria found in soil, dust, and water. It can be isolated as a normal colonizing organism, but as a pathogen this organism causes mainly skin and soft tissue infection preceded by trauma. A wide variety of infections can occur in individuals with predisposing conditions. Central nervous system infection with Mfortuitumis rare, and meningitis occurs after surgery or trauma. We believe that ventriculoperitoneal (VP) shunt infection with this organism has not been reported in the literature. Practitioners should be aware of this rare entity and should suspect it in the presence of cerebrospinal fluid pleocytosis with sterile culture, and after trauma, surgery, or manipulation of the VP shunt hardware.Mycobacterium fortuitumis resistant to most first-line and second-line antituberculous drugs, and treatment should include surgical debridement in addition to prolonged antimicrobial therapy.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Among natural disasters, lightning is a leading cause of morbidity and mortality throughout the world. A well-informed bystander and an astute physician can make the difference between an outcome of death or lifelong disability versus complete or nearcomplete recovery. What is done in the first few minutes after such an event is the predominant predictor of success. This case report describes a young woman who was struck by lightning while talking on a cellular telephone at a mass gathering in an outdoor stadium. The discussion that follows the case centers on the pathophysiology of being struck by lightning and on issues unique to being struck in a stadium full of people.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID