1/22. Sudden death after typhoid and Japanese encephalitis vaccination in a young male taking pseudoephedrine.The case of a 21-year-old male taking over-the-counter pseudoephedrine for weight loss who died suddenly during exercise shortly after inoculation with Japanese encephalitis and phenol-inactivated typhoid vaccines is presented. The patient collapsed in mild weather while exercising 75 minutes after his vaccinations. He presented in asystole with a core temperature of 42.2 degrees C (108 degrees F). There was no evidence of urticaria or angioedema. It is likely that the combined pyrogenic effects of the vaccines, pseudoephedrine, exercise, and mild obesity contributed to a failure of the thermoregulatory system. fever is still a common side effect of numerous other vaccines. Military physicians should consider administrative controls on thermogenic activities for a period after inoculations. Additionally, the dangers of ephedrine-containing compounds need to be more widely publicized.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/22. Systems approach to childhood and adolescent obesity prevention and treatment in a managed care organization.OBJECTIVE: To outline an intervention approach to childhood and adolescent obesity prevention and treatment, that will systematically facilitate effective communication, provide long-term social support and access to resources, that may be accessed proactively or on demand. Furthermore, this approach operates in an environment that involves all critical parties: child/adolescent, family-unit, physician and allied health professionals. SYSTEMS thinking APPROACH: The objective is to bring together all key stakeholders and consider the interrelationships among them as a common process. In a managed care setting, this may be accomplished by optimizing the contributions of care delivery, health promotion and information systems. SETTING: A not-for-profit, community governed Managed Care Organization (MCO) in the midwestern united states. telephone-based, centralized services facilitate a process of access, communication, documentation and intervention implementation. CASE STUDIES:Two case studies are presented as examples of how access is obtained, the intervention is tailored to individual needs, communication is established, documentation is organized and long-term support is facilitated. CONCLUSIONS: A systems thinking approach to obesity prevention and treatment in youth has great potential. In a MCO setting, such an approach may be implemented, since integrated health care delivery systems may allow a common process to be established that can bring together all key stakeholders.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/22. Self-training of new eating behavior for weight reduction.The problems of obesity are well documented, but few medical treatment programs have proven successful. Recently developed behavioral techniques have offered promise in the treatment of obesity. However, the time invested by a therapist limited their practical use and adoption by the general physician. A pilot study was conducted which employed a brief period of explanation of behavior modification techniques, development of an individualized program of eating behavior and recording of weight changes to provide feedback on progress. The program is carried out by patients at home with a minimum of physician supervision. The results indicate that such an approach is feasible and successful. Comparing this program to other programs is difficult because of the variability in reporting data and results.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/22. Applying evidence-based medicine to current practice: a round table panel discussion.Over the past decade, an expanding body of epidemiological and clinical trial data has been collated, culminating in the development of guidelines designed to help physicians make decisions about intervention and the intensity of treatment, based on objective assessments of the overall level of risk for cardiovascular disease. However, guidelines are not prescriptive and allow physicians leeway in interpretation. Thus, it is of clinical interest to explore some of the issues that may influence the use of these guidelines in clinical practice. This paper summarises a round table panel discussion that highlighted the usefulness of current guidelines, but also demonstrated that these guidelines, and the evaluation of cardiovascular risk, need to be used with care and always interpreted in the light of sound clinical judgement.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/22. Detection of insomnia in primary care.Insomnia is a widespread condition with diverse presentations. Detection and diagnosis of insomnia present a particular challenge to the primary care physician. patients seldom identify their sleep habits as the source of the complaints for which they are seeking treatment. Insomnia may be the result of many different medical or psychiatric illnesses or the side effects of medications or legal or illegal recreational drugs. Insomnia has a serious impact on daily activities and can cause serious or fatal injuries. With ever-increasing competition with sleep from 24-hour television broadcasts from hundreds of channels and the internet, as well as more traditional distractions of late-night movies, clubs, and bars, we have become a society that sleeps 25% less than our ancestors did a century ago. We have no evidence, however, that we require less sleep than they did. This article presents strategies for detecting and diagnosing insomnia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/22. Orthopedic pitfalls in the ED: slipped capital femoral epiphysis.Slipped capital femoral epiphysis (SCFE), though a relatively common disorder, is frequently missed on initial presentation. Symptoms can be vague, the physical examination unrevealing, and radiographic abnormalities subtle. Prompt diagnosis of SCFE is important, however, to improve clinical outcome. The emergency physician needs to remain vigilant for this diagnosis to avoid this orthopedic pitfall. This article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency physician in the treatment of SCFE.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
7/22. Autonomy and intellectual disability: the case of prevention of obesity in prader-willi syndrome.BACKGROUND: The policy concerning care for people with intellectual disability (ID) has developed from segregation via normalization towards integration and autonomy. Today, people with ID are seen as citizens who need to be supported to achieve a normal role in society. The aim of care is to optimize quality of life and promote self-determination. The promotion of autonomy for people with ID is not easy and gives rise to ethical dilemmas. caregivers are regularly confronted with situations in which there is a conflict between providing good care and respecting the client's autonomy. This becomes evident in the case of prevention of obesity in people with prader-willi syndrome (PWS). METHOD: As part of a study about the ethical aspects of the prevention of obesity, in-depth qualitative interviews were conducted with the parents and professional caregivers of people with PWS. RESULTS: In analysing interviews with parents and formal caregivers, the present authors found that the dichotomy between respecting autonomy and securing freedom of choice on the one hand, and paternalism on the other, is too crude to do justice to the process of care. The stories indicated that caregivers see other options and act in other ways than to intervene without taking into account the wishes of the individual with PWS. The present authors elaborated these options, taking models of the physician-patient relationship as a heuristic starting point. They extended the logic of these models by focusing on the character of the process of interaction between caregiver and care receiver, and on the emotional aspects of the interactions. CONCLUSION: This approach results in more attention to processes of interpretation, deliberation and joint learning.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/22. Severe metabolic bone disease as a long-term complication of obesity surgery.BACKGROUND: Metabolic bone disease is a well-documented long-term complication of obesity surgery. It is often undiagnosed, or misdiagnosed, because of lack of physician and patient awareness. Abnormalities in calcium and vitamin D metabolism begin shortly after gastrointestinal bypass operations; however, clinical and biochemical evidence of metabolic bone disease may not be detected until many years later. CASE REPORT: A 57-year-old woman presented with severe hypocalcemia, vitamin d deficiency, and radiographic evidence of osteomalacia, 17 years after vertical banded gastroplasty and Roux-en-Y gastric bypass. Following these operations, she was diagnosed with a variety of medical disorders based on symptoms that, in retrospect, could have been attributed to metabolic bone disease. Additionally, she had serum metabolic abnormalities that were consistent with metabolic bone disease years before this presentation. Radiographic evidence of osteomalacia at the time of presentation suggests that her condition was advanced, and went undiagnosed for many years. These symptoms and laboratory and radiographic abnormalities most likely were a result of the long-term malabsorptive effects of gastric bypass, food intake restriction, or a combination of the two. CONCLUSION: This case illustrates not only the importance of informed consent in patients undergoing obesity operations, but also the importance of adequate follow-up for patients who have undergone these procedures. A thorough history and physical examination, a high index of clinical suspicion, and careful long-term follow-up, with specific laboratory testing, are needed to detect early metabolic bone disease in these patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/22. The management of adult obesity.obesity is canada's most prevalent metabolic disease: one-third of Canadians are obese. It is a major cause of type 2 diabetes, hypertension, hyperlipidaemia, and atherosclerosis. The treatment of disease caused by obesity accounts for an estimated 2.4 percent of canada's health care expenditures for all diseases (1.8 billion dollars in 1997). This article presents a treatment algorithm based on a number of international guidelines and aimed to help physicians play a more active role in the management of adult obesity. Two problems are briefly examined: pregnancy and stopping cigarettes smoking.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/22. Current practice in pulmonary function testing.More than 30 million Americans have chronic obstructive pulmonary disease (COPD) and asthma, with internists, pediatricians, and family physicians providing most of their medical care. Recent management guidelines for asthma and COPD recommend regular use of spirometry for the diagnosis and management of these disorders. Because of the development of easy-to-use office-based spirometers, an increasing number of physicians have ready access to spirometry. Beyond simple spirometry, various tests are available from many pulmonary function laboratories for more detailed evaluation of patients with respiratory disorders. For these reasons, all physicians who care for patients with pulmonary disease must understand basic pulmonary function testing and have a fundamental understanding of more sophisticated tests. A series of performance standards has been developed for improved accuracy and precision of pulmonary function tests. physicians responsible for administering and interpreting pulmonary function tests, even simple spirometry, must be aware of relevant guidelines. This concise review addresses current indications for pulmonary function testing, provides an overview of the studies commonly available in modern pulmonary function laboratories, and includes comments on basic interpretation and testing standards.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
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