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Biomedical subjects

D S Carson

Publications and source records attributed to D S Carson.

At least 19 recordsLinked to original sources
PubMed2000

Diabetes guidelines: a summary and comparison of the recommendations of the American Diabetes Association, Veterans Health Administration, and American Association of Clinical Endocrinologists.

OBJECTIVE: This paper summarizes and compares 3 major organizations' guidelines for the management of diabetes mellitus. BACKGROUND: Diabetes mellitus is a chronic disease that affects >16 million Americans. A decrease in adverse events has been demonstrated when hyperglycemia and comorbid conditions such as hypertension and dyslipidemia are controlled in patients with diabetes. Although each patient with diabetes is unique and medical care should be tailored to his or her individual needs, clinical evidence and expert opinion have established a baseline level of care for all patients with diabetes. Guidelines have been created to guide practitioners in selecting appropriate care, but their length and complexity may serve as barriers to their use. METHODS: The diabetes management guidelines of the American Diabetes Association (ADA), Veterans Health Administration (VA), and American Association of Clinical Endocrinologists (AACE) are summarized and compared in both text and tabular form. CONCLUSION: Although the guidelines published by the ADA, VA, and AACE vary slightly, all of them can be used to ensure that patients with diabetes receive appropriate care.

Diabetes Complications↗
PubMed2000

Bisphosphonates in the prevention and treatment of glucocorticoid-induced osteoporosis.

OBJECTIVE: To summarize the literature concerning the use of bisphosphonates in the prevention and treatment of corticosteroid-induced osteoporosis and make recommendations concerning the proper use of these agents. SEARCH STRATEGIES: We conducted a literature search to identify studies in the English language concerning the use of bisphosphonates in the prevention or treatment of corticosteroid-induced osteoporosis using the MEDLINE, CURRENT CONTENTS, and HEALTHSTAR electronic databases, bibliographies of selected citations, and recent meeting abstracts. SELECTION CRITERIA: We included randomized controlled trials evaluating the use of oral bisphosphonates in adults by central dual X-ray absorptiometry. DATA COLLECTION AND ANALYSIS: We assessed the methodologic quality of the trials using the Jadad criteria. Data were collected concerning bone mineral density (BMD) changes in multiple areas, fracture rates, safety, and tolerability. MAIN RESULTS: Bisphosphonates generally increased BMD at the lumbar spine. Data were less clear concerning changes in the femoral area. Little information exists about the ability of bisphosphonates to reduce fracture risk in patients with corticosteroid-induced osteoporosis. Postmenopausal women seemed to receive the most benefit. CONCLUSIONS: Bisphosphonates significantly increased BMD in patients at risk for corticosteroid-induced bone loss. However, there is a sparsity of data concerning the ability of these agents to affect the clinically important outcome of fracture rate reduction, especially among premenopausal women in whom fractures are rare within the first year or 2 of exposure to corticosteroids. Long-term studies powered to detect fracture risk reduction are needed as well as comparative trials with bisphosphonates and other agents.

Adult↗
PubMed1999

Vitamin E and coronary artery disease.

Various studies have evaluated the antioxidant effects of vitamin E in the prevention or treatment of coronary artery disease (CAD). In vitro data suggest that vitamin E protects against oxidation of low-density lipoprotein and decreases the deposition of atherogenic oxidized low-density lipoprotein in arterial walls. Various observational and epidemiological studies also suggest a relationship between vitamin E serum concentrations or intake and CAD. One prospective, randomized trial suggested that low-dosage vitamin E supplementation (50 IU/d) decreases the risk of angina in patients without previously diagnosed CAD. Another study, using high-dosage vitamin E supplementation (400 or 800 IU/d), demonstrated a decrease in the combined end point of nonfatal myocardial infarction and cardiovascular death in patients with established CAD. Discordant data, however, have been published that imply no cardiovascular benefit of low-dosage vitamin E supplementation (50 IU/d) and detrimental effects if vitamin E is combined with beta carotene. At this point, clinicians should emphasize a low-fat diet with high intake of fruits and vegetable sources containing vitamin E. Supplemental vitamin E may be considered in patients at high risk for CAD or with documented CAD, but the potential beneficial effects should be weighed against possible long-term adverse effects. If vitamin E supplementation is initiated, the literature suggests dosages of 100 to 400 IU/d, with the higher dosage considered in patients with documented CAD. Additional investigation is warranted to further define the role of vitamin E supplementation in CAD and to critically evaluate the optimal dosage, duration of use, and method of consumption (dietary vs supplemental).

Antioxidants↗
PubMed1997

Management of obesity: medical treatment options.

Obesity is a common and serious health problem in the United States. Excess weight is associated with an increased mortality rate, as well as such risk factors as hypertension, hyperlipidemia and diabetes mellitus. Numerous treatments are available for obesity. Behavioral therapy, surgery and pharmacologic treatment have been used with varying degrees of success. Pharmacologic therapy includes primarily noradrenergic agents and/or serotonergic agents. Newer preparations are currently under development. Behavior modification, including regular exercise and the development of healthy eating habits remains the best hope for long-term weight loss. However, surgery or medication can be useful in specific circumstances.

Amphetamines↗
PubMed1997

Optimizing ADHD therapy with sustained-release methylphenidate.

Rapid-release psychostimulants are commonly used to treat attention-deficit hyperactivity disorder (ADHD), but midday dosing requirements and poor compliance rates have prompted the development of sustained-release formulations. Sustained-release methylphenidate has been shown to have efficacy equal to that of the regular-release formulation and may be preferable when it is difficult or impossible to provide midday doses. Proper management of ADHD includes choosing the proper medication dosage, minimizing side effects of medications and periodically reevaluating the patient's progress.

Attention Deficit Disorder with Hyperactivity↗
PubMed1996

Metformin: a new treatment option for non-insulin-dependent diabetes mellitus.

Metformin is a biguanide that can used alone or in combination with sulfonylureas or insulin in the treatment of non-insulin-dependent diabetes mellitus (NIDDM). Since biguanides do not increase pancreatic insulin secretion, they are referred to as antihyperglycemic agents, as opposed to hypoglycemic agents. Biguanides reduce hyperglycemia by increasing, insulin sensitivity, decreasing glucose absorption, and inhibiting hepatic gluconeogenesis. Advantages of metformin include achieving glycemic control without exacerbating weight gain or hyperinsulinemia and beneficially affecting serum cholesterol concentrations. Although metformin has the potential to cause lactic acidosis, the incidence is significantly lower compared with phenformin. Risk factors for lactic acidosis include renal serum creatinine > 1.5 mg/dL and cardiovascular, pulmonary, and hepatic disease. Metformin should be temporarily discontinued prior to surgery and before administration of radiologic intravenous contrast, and in patients with sepsis, severe gastrointestinal disease, trauma, and acute cardiovascular events.

Biguanides↗
PubMed1996

Menopause and osteoporosis: the role of HRT.

Bone loss resulting from estrogen deficiency is the leading cause of osteoporosis in postmenopausal women. Oral and transdermal estrogen can prevent osteoporosis. For most women, the benefits of hormone replacement therapy (HRT) outweigh any risks that exist. The recurrence of vaginal bleeding is the most common reason that women discontinue HRT.

Drug Interactions↗
PubMed1995

Clinical implications of white coat hypertension.

"White coat" or "office" hypertension is often defined as the transient rise or elevation of blood pressure that occurs in the medical setting. Patients with these elevated readings have normal ambulatory pressures as determined by individual home blood pressure measurements or continuous 24-hour blood pressure monitoring. This clinical finding is present in 20 to 40 percent of patients with hypertension. Although continuous blood pressure monitoring has several research implications, its use adds little to the diagnosis, prognosis and treatment options. Treatment decisions should be based on office blood pressure measurements evaluated in accordance with the recommended guidelines for the diagnosis of hypertension. The detection and confirmation of hypertension, as delineated in the fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, is based on multiple office measurements. Ambulatory blood pressure monitoring should not be used for the routine diagnosis or management of most patients.

Ambulatory Care↗
PubMed1992

Chronic-pain medications: equivalence levels and method of quantifying usage.

Medication use is an important consideration in chronic-pain rehabilitation programs (CPRPs). However, it is difficult to quantify this aspect of chronic-pain treatment, because patients often take multiple medications that can differ by pharmacological class as well as dosage level. The Medication Quantification Scale (MQS) provides a method for quantifying medication use in patients with chronic, nonmalignant pain. Scores are calculated for each medication based on weights assigned by medication class and dosage level, and these scores are summed to provide a quantitative index of total medication usage suitable for statistical analysis. The method for calculating MQS scores is illustrated, and research data on MQS reliability and validity are presented. Interrater reliability was rho = 0.985 (p less than 0.0001) for 30 MQS scores calculated by two clinicians. MQS scores for 88 patients correlated well with the clinical judgment of 12 health care professionals (mean rho = 0.755, p less than 0.0001). The MQS scores for 60 chronic-pain patients (30 treated in a CPRP and 30 untreated) were obtained at two time points: evaluation and 1-year follow-up. A two (groups) by two (time points) analysis of variance yielded a significant group-by-time interaction (F = 8.82, p less than 0.0043). Treated patients decreased their medication intake significantly (p less than 0.0001), whereas untreated patients did not (p greater than 0.57). The MQS offers a reliable and valid method for quantifying medication usage in chronic-pain patients.

Analgesics↗
PubMed1989

Effects of magnesium oxide on the lipid profile of healthy volunteers.

Elevated serum cholesterol is a risk factor in the development of coronary artery disease. Magnesium has been reported to decrease total serum cholesterol, low density lipoprotein, and very low density lipoprotein, and increase high density lipoprotein. A randomized, double-blind, placebo-controlled, crossover study was completed to determine if supplemented magnesium, in the form of magnesium oxide, would produce changes in the lipid profile. Fifty normal volunteers received placebo or magnesium oxide, 400 mg capsules, twice a day for 60 days, then switched to the alternate treatment. Weight, height, blood pressure, serum potassium, serum magnesium, and a lipid profile were determined initially and after each treatment. Analysis of variance (ANOVA), comparing the mean of each component of the lipid profile at baseline and after each treatment, showed no significant difference. In conclusion, supplemental magnesium oxide did not produce statistically significant changes in the lipid profile in this group of healthy volunteers.

Adolescent↗
PubMed1988

Pyrethrins combined with piperonyl butoxide (RID) vs 1% permethrin (NIX) in the treatment of head lice.

In a randomized controlled trial, 58 subjects were treated for Pediculus humanus var capitis with either pyrethrins combined with piperonyl butoxide (RID, Pfizer Inc, New York) or 1% permethrin (NIX, Burroughs Wellcome Co, Research Triangle Park, NC); 31 subjects received RID and 27 subjects received NIX. Both products were applied according to manufacturer's directions so that NIX was applied only on the first visit and RID was applied on the first visit and again seven days later. After each treatment with a pediculicide, the comb supplied by the manufacturer was used to remove nits. Seven days after the initial visit, NIX was determined to be significantly better than RID for eradicating the lice infestation. Of the 27 subjects receiving NIX, 26 were live free vs 14 of the 31 RID-treated subjects. At day 14, there was no statistically significant difference in the treatments (27 of 27 NIX-treated vs 29 of 31 RID-treated subjects were lice free). The RID comb was superior to the NIX comb for nit removal. Both treatments were effective and well tolerated, and no subject experienced adverse reactions.

Adolescent↗
PubMed1987

Influence of folk medicine on the family practitioner.

The practice of folk medicine in the United States is increasing. Awareness by the family practitioner is essential in order to effectively communicate and successfully recommend medical treatment to those patients who hold belief in these traditional practices. Root medicine is particularly thriving in the southeastern United States. The influx of refugees into the southern coastal states has introduced new concepts into traditional medical practices. Interaction with patients who are involved with traditional health care providers and the modern medical community occurs more frequently than may be appreciated by the physicians. This article is intended to increase physicians' knowledge of some of the basic philosophies and practices of folk medicine, particularly root medicine, and to provide some insight into the reasons why the practitioners of folk medicine can be strongly influential in the medical and psychologic concerns of patients who believe in the power of the supernatural.

Adult↗
PubMed1987

Infectious diseases in day-care centers: transmission and approaches to prevention.

Child day care is used increasingly by both single-parent and two-parent families. With the growth in numbers of children receiving day care outside the home comes a greater awareness of the potential for disease transmission. Epidemiologic patterns of spread of such diseases as Hemophilus influenzae type b, hepatitis A, diarrheal diseases, and cytomegalovirus are changing with respect to attendance at a day-care center. Not only is this a problem for the staff and children who attend a center, but it also may be a public health concern as these diseases could spread to households and the community at large. This review will identify those transmissible infectious agents frequently found in children who attend day-care centers with an emphasis on approaches to prevention and methods for decreasing secondary spread.

Child↗