Astrict definition of “dehydration” is a relative absence of water as manifested by hypernatremia. However, patients who are dehydrated are usually also volume-contracted; I prefer the latter term for a patient who has experienced vomiting, diarrhea, or decreased intake. Volume contraction denotes the need for replacement with saline equivalents, whereas dehydration indicates the need for water-and only possibly saline as well.
The medications currently approved for the treatment of insomnia include 9 benzodiazepine receptor agonist (BZRA) hypnotics and the selective melatonin receptor agonist ramelteon.
A novel H1N1 influenza virus has emerged from swine and is causing a worldwide pandemic. Children and young adults have been most affected, in terms of both numbers of cases and severity of disease. Perhaps the most striking feature of the pandemic so far is that fewer than half of those hospitalized or killed by this virus have had identifiable prior medical conditions or risk factors.
Many health care professionals are practicingwhat they preach daily-exercise forcardiovascular health. And an increasingnumber of patients are taking the exercisemessage to heart.
Despite the recent development of several new therapies, pulmonary arterial hypertension (PAH) remains an incurable disease. Careful monitoring of disease progression is vital to ensuring that patients receive maximal medical therapy before the onset of overt right-sided heart failure. In part 1 of this article, I reviewed the role of the history and physical examination, chest radiography, electrocardiography, echocardiography, and pulmonary artery catheterization. In part 2, I focus on MRI, cardiopulmonary exercise testing (CPET), the 6-minute walk test, and biomarkers.
In a recent editorial in The AIDS Reader, the “burden of responsibility for routine HIV testing” was accurately described as now falling on all clinicians, including those in emergency departments (EDs). Routine HIV testing in the ED seems logical because patients who seek health care in the ED are often underinsured and have low incomes, the very populations with a higher prevalence of undiagnosed HIV.
Estimates for the costs of treating breast cancer vary considerably, depending on patient population, time horizon, methodology, and other variables. According to a recent review by Campbell and Ramsey1 from the Fred Hutchinson Cancer Research Center in Seattle, estimates of lifetime per patient costs associated with breast cancer ranged from $20,000 to $100,000. As a result of the relatively long survival of patients with breast cancer, the costs of continuing care account for the largest proportion of lifetime costs.
Many psychotherapists adhere to psychotherapy protocols such as cognitive-behavioral therapy, interpersonal therapy, dialectic behavioral therapy, or psychoanalytically oriented psychotherapy. Nonetheless, what actually goes on between therapist and patient is often variable and sometimes unique.
The opioid antagonist naltrexone is approved for the treatment of alcohol dependence at an oral dosage of 50 mg daily.
Under new FDA rules going into effect this month, more patients will be able to access experimental drugs without taking part in clinical trials. The new rules are meant to clarify a formal process in place since 1987
When patients experience discomfort with Foley catheterization, fill a 2-mL syringe with lidocaine jelly and inject this (without using the needle!) through the urethral meatus and into the urethra. Wait several minutes, then insert the catheter.
THE CASE: A 77-year-old woman who has had shortness of breath and intermittent left flank pain for the past 2 to 3 days is brought by her family for evaluation. The dyspnea worsens when she lies down. She denies chest pain, back pain, and syncope. She has also had mild nonbloody diarrhea of 2 days’ duration but no vomiting or oral intake intolerance.
A healthy 33-year-old woman is seen in the office of her primary careclinician.
Dr Schommer is professor, University of Minnesota College of Pharmacy, Minneapolis. Cindy Chen, Jagannath Muzumdar and Siting Zhou are doctoral candidates at the University of Minnesota College of Pharmacy.
Allergic rhinitis is highly prevalent; about 20% of adults in the United States and 25% of children worldwide are affected. It is a major societal expense, with direct costs, attributable to physician visits and medications, of up to $5 billion per year, and indirect costs, mainly stemming from lost productivity, of up to $9.7 billion per year. In the United States, allergic rhinitis results in 3.5 million lost workdays and 2 million lost schooldays each year.
A 30-year-old man is admitted for profound, symptomatic anemia.
Petroleum jelly is a barrier not a moisturizer.
Careful monitoring of disease progression is vital to ensuring that patients with pulmonary arterial hypertension receive maximal therapy before the onset of overt right-sided heart failure. Routine follow-up includes the evaluation of symptoms, functional class, and exercise capacity and assessment of pulmonary pressures and right ventricular (RV) function. Transthoracic echocardiography (TTE) offers a noninvasive and fairly reliable technique for monitoring pulmonary artery pressure (PAP) and structural changes of the right side of the heart. However, TTE does not reliably assess cardiac output, right-sided filling pressures, or pulmonary venous pressure. Pulmonary artery catheterization may be particularly useful in patients who have inconsistent findings, such as a reduction in PAP measured by TTE in the presence of worsening symptoms or other signs of disease progression. An increase in RV end-diastolic pressure, usually above 10 mm Hg, is a concern and warrants consideration of additional therapy even if other hemodynamic and clinical parameters are unchanged. (J Respir Dis. 2009;30(1-2)
It is, of course, conflict and disagreement that make news. However, the coverage of protests at town hall meetings about health care reform legislation held by members of Congress in their home districts over summer recess and the differences between competing drafts of what such legislation should look like mask one core truth: there is a good bit of agreement on what should be in the final package.
The development of drug-resistant strains of Mycobacterium tuberculosis has increased morbidity and mortality associated with tuberculosis (TB) and has greatly increased the costs of care for patients with this disease.
