摘要:

Background.Depression is a common and highly treatable disorder, with most patients returning to predepression levels of functioning. Patients with depression must be carefully assessed for the presence of comorbid psychiatric or medical disorders, as well as psychosocial stresses.Methods.I present a clinical overview, supported by pertinent literature, of currently available treatments of depression, with an emphasis on primary practice.Results.Beyond diagnosis, treatment consists of patient education and support, evaluation of suicide risk, and treatment of symptoms with antidepressant medication, psychotherapy, or both. A multitude of antidepressants are available, including cyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and newer, more receptor-specific agents such as nefazodone, venlafaxine, and mirtazapine. These are reviewed with a focus on mechanism of action, side-effect profile, and clinical use.Conclusions.All available antidepressants have been found effective in the treatment of mild-to-moderate depression. Choice of agent is based primarily on side-effect profile. For patients with an atypical pattern of symptoms, SSRIs or MAOIs may be the most useful. Patients with severe depression or melancholic symptoms may respond better to tricyclic antidepressants, venlafaxine, or mirtazapine.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Ample clinical and epidemiologic evidence exists to implicate homocyst(e)ine as a risk factor for atherosclerotic vascular disease and thrombosis. The precise mechanisms by which this occurs are uncertain but probably involve injury to endothelium, impairment of endothelial function, lipid peroxidation, oxidation of low-density lipoprotein, and creation of a prothrombotic environment in areas of endothelial injury. Plasma homocyst(e)ine concentration (PHC) can be effectively reduced with oral administration of folic acid. Whether vitamins B6and B12are also required in the absence of vitamin deficiency remains uncertain. Studies currently in progress may help to determine whether reduction of PHC will translate into a decrease in clinical vascular events.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.The effects of chronic diuretic use on serum homocysteine and its metabolic cofactors vitamin B6, vitamin B12, and red blood cell (RBC) folate have not been well studied.Methods.Blood samples from 17 hypertensive patients receiving long-term diuretic therapy and 17 hypertensive patients not taking diuretics were analyzed for serum homocysteine, vitamin B6, vitamin B12, and RBC folate.Results.The mean serum homocysteine concentration for patients taking diuretics (17.87 ± 1.72 µmol/L) was significantly higher than the mean serum homocysteine concentration for patients not taking diuretics (10.31 ± 0.99 µmol/L). The mean RBC folate concentration for patients taking diuretics (281.01 ± 17.56 ng/mL) was significantly lower than the mean RBC folate concentration for patients not taking diuretics (430.85 ± 28.58 ng/mL). Serum vitamin B6and vitamin B12concentrations were not significantly different between the two groups.Conclusions.Chronic diuretic use is associated with a significant increase in serum homocysteine concentration, a significant decrease in RBC folate concentration, and no significant change in concentrations of vitamins B6and B12.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Speculation suggests that health care workers and patients who believe in ethical values that do not change—absolute values—will respond differently to ethical problems and personality tests than those who affirm changing—relative values.Methods.We did a cross-sectional survey to investigate the effects of absolute vs relative values on (1) decision making concerning ethical dilemmas and (2) questionnaire assessments of hostility, forgiveness, and social desirability. Two groups of participants were medical/surgical inpatients (n=60) at a Department of Veterans Affairs medical center and practicing physicians (n=73) in the larger Johnson City, Tennessee, area.Results.In both groups, relativists were more approving of birth control for sexually active single women, physician-assisted suicide, and abortion. For patients but not physicians, several indices of hostility were higher for relativists than absolutists. No overall group differences existed as a function of value type for forgiveness or social desirability scores. However, subgrouping by religious faith affected response pattern.Conclusion.The absolute/relative value dichotomy predicted differences in approval ratings for both physicians and patients. Ethically sensitive health care and health care training should explicitly consider this dimension of personal values.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Vascular devices are an integral part of modern medicine. Catheter thrombosis is a frequent complication that interferes with their use.Method.We have observed a series of patients in whom vascular access thrombosis occurred in close temporal association with infectious or inflammatory processes.Results.Laboratory and clinical evidence suggests that activation of the coagulation system may be triggered by certain infectious or inflammatory disorders. Patients with vascular devices are prone to infections that could lead to a transient hypercoagulable state.Conclusions.We are proposing that infections or other inflammatory processes may be involved in some vascular access thrombotic events. On the basis of our observations, we believe further studies are warranted regarding a possible association between infections or inflammatory disorders and vascular devices thrombosis. If an association is proven to exist, patients with vascular devices and infectious or inflammatory processes may be candidates for short-term anticoagulation during acute episodes of infection or inflammation.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.The study objective was to determine primary care residents' knowledge of pharmacotherapy.Methods.Eighty primary care residents at five Family Medicine residencies completed a pharmacotherapy survey used to assess their knowledge of drug interactions, adverse drug reactions, and new medications. Residents were asked whether they could benefit from more formal pharmacotherapy instruction.Results.Seventy-seven residents (96%) completed the survey. Scores ranged from 11 to 43 (22% to 86%) out of a possible 50. Scores showed no significant difference on the basis of sex or residency. The only statistically significant difference was between first and third year residents' scores. Third year residents' mean score was 32.39 ± 8.23 (64.8%). Ninety-one percent of residents believed they could benefit from more formal instruction in pharmacotherapy.Conclusions.Results suggest that primary care residents' pharmacotherapy knowledge may need improvement. Residents affirmed the need for formal instruction. Therefore, comprehensive pharmacotherapy curricula in primary care residencies should be considered.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Non-palpable suspicious mammographic abnormalities require image-guided breast biopsies. In this study, we examined primary care physicians' knowledge of breast biopsy procedures for non-palpable lesions and referral patterns for breast biopsies; we also identified channels to disseminate information.Methods.We mailed a baseline survey to all primary care physicians, surgeons, and radiologists in Vermont.Results.Primary care physicians are more likely to refer for excisional rather than percutaneous biopsy. Unlike surgeons and radiologists who learned about these procedures through journals and professional meetings, primary care physicians' most common source of information was from radiologists.Conclusions.Information about indications for using percutaneous breast biopsy should be available in journals and at meetings to help primary care providers decide on the most appropriate algorithm of workup for patients with non-palpable suspicious breast abnormalities requiring biopsy.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.In 1995, a program was begun at the University of South Alabama (USA) to improve the reporting of medical risk factors on birth certificates.Methods.Data on medical risk factors for USA Hospital and the remainder of the state for 1994 and 1996 were examined to observe the effects of the USA Medical Center program.Results.The number of medical risk factors reported changed markedly between 1994 and 1996 for most items and changed hardly at all for the remainder of the state. The changes for selected factors from 1994 to 1996 were as follows: anemia, 19 (0.4% of all birth certificates) to 489 (12.3%); acute or chronic lung disease, 1 (<0.1%) to 405 (10.2%); cardiac disease, 10 (0.2%) to 99 (2.5%); diabetes, 111 (2.6%) to 160 (4.0%); genital herpes, 3 (0.1%) to 81 (2.0%); and hemoglobinopathy 0 (0%) to 166 (4.2%). Changes in other factors were similar.Conclusions.The USA Medical Center program has significantly increased the frequency and percent of birth certificates indicating medical risk factors.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.While usually not the only factor in obese patients, prescription medications, which may increase appetite or body weight, can be important in some individuals. The cause of weight gain in such cases may go unrecognized or lead to cessation of medication with or without the practitioner's knowledge or approval.Methods.We found illustrative cases among patients treated at the Johns Hopkins Weight Management Center, searched MEDLINE and the Micromedex Drug Information database, and organized this information by drug mechanism and indications for use.Results.Most reports of medication-induced weight gain are anecdotal or gleaned from clinical trials. Notable offenders include hormones (especially corticosteroids and insulinotropic agents), and psychoactive medications (especially tricyclic antidepressants, lithium, and some antipsychotics).Conclusions.Medication-related increases in appetite and body weight are under-recognized and cause noncompliance with pharmacotherapy. A high index of awareness of the known mechanisms by which medications can lead to weight gain has the potential to prevent most medication-related contributions to weight gain and obesity.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

An elderly man had two completely reversible episodes of aphasia, each occurring after taking his antihypertensive medications. He was subsequently found to have a subdural hematoma. The association between subdural hematomas (and other intracranial mass lesions) and reversible neurologic deficits is discussed, as is the pathophysiology of the phenomenon. In addition, the relationship between the effects of the patient's antihypertensive medications and the neurologic deficits in the setting of a subdural hematoma is explored.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID