摘要:

Background.Because of recent advances in the treatment and improved outcome of acute respiratory distress syndrome (ARDS), we present an overview of ARDS to update general practitioners on the management of this condition.Methods and Results.We searched MEDLINE for original articles, editorials, and reviews on ARDS, acute lung injury, and mechanical ventilation. A large amount of data is available on this subject. We reviewed relevant articles that address definition, pathogenesis, clinical presentation, and management of ARDS, giving special emphasis to ventilatory support of patients with ARDS.Conclusion.Acute respiratory distress syndrome is a severe form of acute lung injury associated with significant mortality and morbidity. In recent years, significant progress has been made in the understanding of this condition, but the management of ARDS remains complex and requires multidisciplinary and specialized care.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.As managed care organizations (MCOs) continue to expand into the care of the chronically ill, the concept of providing cost-effective care with a preventive approach is vital for primary care providers (PCPs) to embrace. Diabetes is an ideal disease to incorporate this concept.Methods.We reviewed the literature using MEDLINE. We used the American Diabetes Association (ADA) Provider Recognition Program guidelines as the foundation for MCOs to establish a diabetes disease management program.Results.The implementation of disease management protocols, the use of computerized management systems, and the team approach can provide cost-effective diabetic care.Conclusions.To compete in the managed care market, it is vital for providers to link with their Independent Practice Associations (IPA), the ADA, and MCOs to implement standard protocols and negotiate for adequate reimbursement.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.The management of acute pain is an aspect of hospital-based practice that has been neglected. Control of pain is important for ethical reasons, for compliance with new guidelines and standards, and for optimizing patient satisfaction and outcomes.Methods.We review the rationale for establishing priority to the control of acute pain, the importance of an institutional approach to improve pain management, and specific steps in the establishment and conduct of an acute pain program.Results.Improvement in pain control depends on an institutional approach to facilitate changes in attitude and prioritization. Pain management programs should provide for patient and staff education, adequate documentation of care, institutional standards for pain control, quality assurance/continuous quality improvement (CQI) activities, and periodic review of practice and policy.Conclusions.Effective pain management can set the stage for a rehabilitation approach to postoperative care, which should lead to earlier recovery and improved outcomes.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.The biologic significance of microchimerism from pregnancy in systemic sclerosis and other autoimmune diseases is not fully characterized.Methods.We based this brief review on a systematic search of the MEDLINE database for all relevant articles published between 1980 and July 1998, indexing systemic sclerosis, microchimerism, and pregnancy as key words. We also searched textbooks, meeting proceedings, and reference lists.Results.Fetal microchimerism and class II human leukocyte antigen (HLA) compatibility between mother and fetus are common among women with systemic sclerosis. Alternative sources of microchimerism include the engraftment of donor cells after a blood transfusion, from a dizygotic twin, or possibly from the mother.Conclusions.Systemic sclerosis could be a form of chronic graft-versus-host disease caused by fetal or maternal cells, which have crossed the placenta and have remained unrecognized by the host due to class II HLA compatibility.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Backgroud.Bone marrow aspirate and biopsy is universally recognized as being painful. Few descriptions of effective analgesia or premedication for this procedure exist. In this study, we assessed an oral narcotic and benzodiazepine combination in controlling pain associated with bone marrow examination.Methods.Twenty-four consecutive ambulatory, adult patients referred for bone marrow examination received oral medications 90 minutes before the scheduled procedure. Patients reported perceived pain, using both Likert numerical and “Faces Pain Rating Scale,” immediately after bone marrow examination and within 1 week after the procedure. Physicians' and nurses' evaluations of patient tolerance and the patients' memories of the aspiration and biopsy were recorded.Results.Two thirds (66%) of the respondents reported none or only mild pain (3 or less on a scale of 1 to 10). Memory of the procedure was vague or nonexistent in approximately half of the patients. There were no complications of biopsies or premedication.Conclusions.Premedication with oral narcotic and benzodiazepine is effective in preventing or lessening pain associated with bone marrow examination in adults. Premedication induces amnesia for some or most of the procedure in about half of the patients.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Advance directives (ADs) are advocated for many but executed by few. To ascertain the importance of education in the decision to execute an AD, I did this study to determine the rate at which health care workers (a medically educated group) and their families execute ADs.Methods.All clinical staff at an urban tertiary care VA medical center were surveyed.Results.Of 730 surveys mailed, 553 (76%) were returned, and 18% of respondents executed an AD. Age was the only variable that predicted execution of an AD. End-of-life medical decision-making discussions with family members were reported frequently (with spouses 74%, parents 50%).Conclusion.Health care workers do not appear to complete ADs at a rate any higher than the general population. Thus, education may be necessary, but alone it appears insufficient to increase use of ADs. Frequent family discussions occur among health care providers and their families. Such discussions may be an important outcome in their own right.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.The purpose of this study was to document adverse drug reaction (ADR)- related hospitalizations from a nursing facility population.Methods.This 4-year prospective observational study used monthly repeated measures of 332 residents present for 30 or more days. The review included admission and monthly drug regimen review for each resident. Each probable ADR was sent with monthly reports to attending physicians and charge nurses.Results.There were 64 ADR-associated hospitalizations in 52 of the 332 residents (15.7%). The most common events were for nonsteroidal anti-inflammatory drugs (NSAIDs) (30), psychotropic-related fall with fracture (14), digoxin toxicity (5), and insulin hypoglycemia (4). Five patients had recurrence of the hospitalization for the same problem. A significant factor noted between ADR hospitalized and non-ADR residents was the number of medications per patient (7.9 ± 2.6 vs 3.3 ± 1.3) for the same number of problems.Conclusions.Adverse drug reaction-related hospitalizations may affect as many as one of every seven nursing home residents and appear to be related to polypharmacy as well as inattention to patient history of contraindications and previous ADRs.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Although the frequency of group A streptococcal pharyngitis in adults is assumed to be low, there is little information on frequency other than in military populations.Methods.A prospective, observational study was done to determine the frequency of group A streptococcal pharyngitis in adults seen in the emergency department. Throat swabs were obtained on adults (30 to 65 years of age) with sore throat and pharyngitis on examination. Swabs were also obtained in a group of control subjects.Results.Of the 148 adults with pharyngitis, 65 (44%) had throat specimens positive for group A streptococci. In the 50 control subjects, all throat cultures were negative for group A streptococci. A significant number of patients with group A streptococcal pharyngitis had school-aged children at home.Conclusion.The high rate of detection of group A streptococci in adults outside the military has not been previously reported.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Age-adjusted rates of lung cancer among whites, but not blacks, in Duval County (Jacksonville), Florida, have been among the highest of any metropolitan area of the United States for three decades.Methods.We conducted a case-control study, interviewing 507 patients with lung cancer diagnosed from 1993 to 1996 and 1,007 control subjects, randomly selected from the county population.Results.Cigarette smoking was the dominant cause of lung cancer (odds ratios, 59 among male current smokers; 30 among female current smokers). Both prevalence and intensity of smoking were excessive for whites but less for blacks when compared with national norms. Little association was found with residential patterns, indices of air quality, or occupation. Risk doubled with increased intake of dietary fat and with a family history of lung cancer.Conclusions.Life-style factors, especially smoking, but not environmental factors, appear responsible for the high rates of lung cancer in northeast Florida.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In recent years, minocycline has become a commonly used agent for die treatment of acne vulgaris and rosacea. With this increased use have come reports of severe and in some cases life-threatening toxicity, often occurring in otherwise healthy young women after prolonged courses of minocycline. These adverse reactions include hepatotoxicity, druginduced lupus erythematosus, eosinophilic pneumonitis, and hypersensitivity syndrome. We describe a 35-year-old woman who had necrotizing vasculitis of the skin and uterine cervix after 2 years of minocycline therapy for acne vulgaris. Skin and cervical biopsies revealed acute inflammation involving through-and-through necrosis of vessel walls with thrombosis, focal fibrinoid change, and a perivascular lymphohistiocytic infiltrate. The disease fully resolved within 3 months of discontinuance of the minocycline therapy. Patients should be informed of these rare but potentially serious adverse effects before the initiation of minocycline therapy. Early recognition of these complications can result in complete resolution.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID