ISSN:0361-1817    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Diabetic nephropathy is the leading cause of end-stage renal disease in the United States and is associated with significant human and economic cost. It is recognized that care of the person with diabetes should be focused on the prevention of the many devastating long-term complications of the disease. The primary care provider is in a key position to implement good preventive care. Monitoring for microalbuminuria is the accepted method for identifying early nephropathy. Individual providers need to be aware of current guidelines for performing screening exams. Once early nephropathy is detected, prudent care with tight glycemic control, angiotension-converting enzyme therapy, control of hypertension, and lifestyle risk-factor modification are warranted. Currently, there is strong indication that the progression of renal disease can be slowed with appropriate early interventions. Positive outcomes are dependent on timely detection of microalbuminuria.

ISSN:0361-1817    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0361-1817    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Kawasaki disease is an acute febrile illness most commonly seen in children under the age of 5. It is characterized by fever, rash, cervical lymphadenopathy, bilateral nonexudative conjunctivitis, oropharyngeal mucosal changes, and erythema of the hands and feet followed by desquamation. However, a child with Kawasaki disease may not exhibit all of these symptoms. The disease resembles many other childhood illnesses, such as measles and scariet fever, and misdiagnosis is common. Left untreated, Kawasaki disease has potential life-threatening consequences; 20% to 25% of children develop coronary artery aneurysms as a result. Although no specific laboratory tests exist that identify Kawasaki disease definitively, there are clinical and laboratory findings that guide diagnosis and treatment. Treatment includes the hospitalization of the child and subsequent administration of high doses of aspirin and intravenous immunoglobulin. With recovery, aspirin doses are reduced and the child may be monitored at home with outpatient follow-up. It is imperative that the health care provider be aware of the symptoms of Kawasaki disease in order to make the diagnosis and treat the child before cardiac sequelae ensue.

ISSN:0361-1817    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Hyperthyroidism is the most common disorder of the thyroid. Patients typically present with complaints consistent with a hypermetabolic state, including nervousness, weight loss, heat intolerance, palpitations, irritability, and tremor. This case report reviews a 34-year-old woman who presented with unilateral upper extremity weakness, weight gain, and an episode of atrial fibrillation, the latter coinciding with a 36-hour lack of sleep and excess alcohol and caffeine intake. Although an extensive neurologic evaluation failed to identify any abnormality, the patient's laboratory analysis revealed elevations in thyroxine (T4) and trilodothyronine (T3) levels with unsuppressed thyroid-stimulating hormone levels. Subsequent treatment with the antithyroid drug methimazole (Tapazole) provided complete relief of symptoms. This case report illustrates how health care providers can be diverted to pursue a neurologic etiology when muscle weakness presents as a unilateral symptom. Plausible alternative causes for muscle weakness and other symptoms are presented.

ISSN:0361-1817    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Measuring health risk assessment and conselling recommendations can be challenging. In this study, unannounced standardized patients (lay individuals trained to replicate a clinical encounter consistently) were used to evaluate HIV preventive performance of 22 family nurse practitioners (NPs) and family physicians. Standardized patients were trained to present an identical scenario of a heterosexual individual at risk for HIV exposure. Audiotaping via a hidden microphone and recorder was used to validate the reproduclbility of clinical encounters and accuracy of standardized patient assessment. Standardized patients were highly accurate in both case protrayal and assessment activities with an indexed Kappa coefficient of 0.82. Determining risk, including condom use, sexual orienttation, and number of past sexual partners, was performed less often than experts advise by both physicians and NPs (done between 9% and 63% of encounters). Providing patient education to reduce risk, including educating about abstinence, mutual monogamy, and limiting sexual partners, was also done in only 9% to 36% of encounters. The methodology used was innovative. There is room for improvement in the provider participants' clinical performance of HIV risk assessment, patient education, and counseling. However, the results of this case study cannot be generalized.

ISSN:0361-1817    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0361-1817    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0361-1817    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0361-1817    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0361-1817    

出版商:OVID    

年代:1998

数据来源: OVID