Cost-effectiveness of screening for colorectal cancer.
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Biomedical subjects
Publications and source records attributed to M K Chelmowski.
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BACKGROUND: Domestic violence is a prevalent problem with significant health consequences. Early recognition and appropriate intervention with referral to local domestic violence agencies can be life-saving. Little is known, however, about the current level of training, knowledge base and attitudes of physicians in this area. METHODS: A survey was sent to 1300 physicians practicing in Milwaukee County in the following specialties: Family Practice, Internal Medicine, OB/GYN, Psychiatry. Demographic information was obtained. Questions were designed to explore attitudes towards domestic violence, frequency of encounters with victims or abusers, and knowledge of resources and appropriate intervention. RESULTS: Of the 192 respondents, 74% reported having some training in domestic violence. Thirty percent reported seeing victims in their practice on a daily or weekly basis. Seventy percent feel able to identify a victim of domestic violence. Less than a third of respondents screened at least half of the patients they see for the possibility of abuse. Less than half always refer victims to a hotline or shelter, and less than a quarter of the respondents discuss safety plans with victims. A potentially dangerous response is telling a victim not to go back to an abuser without providing referrals and safety supports. In spite of this, almost a quarter of respondents always tell a victim to not go back to the abuser. Family practitioners and psychiatrists were more likely to discuss abuse with patients than were internists. CONCLUSION: Significant numbers of physicians, in Milwaukee County, practicing certain specialties that potentially have a high rate of contact with domestic violence victims have had insufficient training in domestic violence assessment and intervention. Physicians should be familiar with the domestic violence hotlines and shelters in their communities and need to incorporate screen questions for domestic violence into their regular practice.
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The purpose of this review is to discuss and clarify the current understanding of the pathogenesis, clinical manifestations, and treatment of MF. MF may be either a primary or secondary disorder. It is characterized by an increased deposition of bone marrow collagen, fibronectin, and laminin. Present evidence indicates that MF may be mediated by platelet or megakaryocyte growth factors, decreased prostaglandin mediated stem cell inhibition, immune complex deposition, and both fibroblast and endothelial cell proliferation. Recently acute MF has been recognized to be identical to acute megakaryocytic leukemia. Secondary MF usually responds to appropriate treatment of the underlying disease. Primary MF is usually treated by blood product support, but may be responsive to androgens, splenectomy, splenic irradiation, chemotherapy, or bone marrow ablation with marrow reconstitution.
This paper reviews and clarifies the current understanding of the clinical and pathologic features and treatment of MF. Recent investigations indicate that MF may be mediated by platelet- and megakaryocyte-derived growth factors, impaired prostaglandin-mediated stem cell growth inhibition, or excessive endothelial cell and fibroblast proliferation. Immunologic disorders have been associated with MF. MF may be either a primary or a secondary phenomenon. Secondary MF often regresses with appropriate treatment of this underlying disorder. Primary MF may require androgen therapy, splenectomy, splenic irradiation, bone curettage, chemotherapy, or bone marrow transplantation.
Chest pain that is associated with hyperventilation is often considered to be benign and noncardiac in nature. While not commonly recognized, hyperventilation can provoke coronary vasospasm. We report a man who presented with hyperventilation and developed myocardial infarction. In the setting of hyperventilation, chest pain and ST segment elevation, coronary vasospasm must be considered.
We report a case of osteonecrosis in a 26-year-old woman treated with prednisone for immune thrombocytopenic purpura. The unusual complication occurred after a much shorter course of steroids of a considerably smaller cumulative dose than in previously reported cases.