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Biomedical subjects

P Amadio

Publications and source records attributed to P Amadio.

At least 19 recordsLinked to original sources
PubMed2000

Isolated acute knee injuries in the general population.

OBJECTIVE: Knee injuries are common in the general population, yet most studies have concentrated on special populations. The purpose of this study was to describe the types of injuries, injury events, age, and sex distributions in a community population. METHODS: The medical records of all residents of Olmsted County, Minnesota, 17 years of age or older who had a first visit for an isolated acute knee (acute was defined as occurring within 60 days of the physician visit) injury between January 1, 1993, and January 1, 1996, were abstracted. RESULTS: A total of 664 patients (4/1,000 community adults, 46% women and 54% men) presented to a physician for evaluation and treatment of an isolated acute knee injury. Injured men were on average younger than women and more likely to have an injury during a sports activity, whereas women's injuries were more likely to be the result of non-sports-related falls. Knee sprain or strain was the most common final diagnosis (36%). Approximately half (49%) of the patients had a single visit. The likelihood of orthopedic surgeon's care (37% overall) increased with injury severity and age of the patient. Overall, 12% of subjects had surgical treatment recommended. CONCLUSION: Knee injuries are common, often result in a single visit, seldom receive surgical intervention, and the majority are cared for entirely by generalist physicians.

Accidental Falls↗
PubMed1997

New drugs for schizophrenia: an update for family physicians.

The prognosis in patients with schizophrenia is worsened the longer the duration of psychosis before institution of effective antipsychotic therapy and the greater the number of psychotic relapses. Use of traditional antipsychotic medications has been limited by their substantial side effects and failure to achieve long-term control of symptoms in some cases. New "atypical" antipsychotic drugs show promise for the treatment of resistant cases of schizophrenia and improvement in patient tolerance and compliance. These medications have been more successful than traditional antipsychotic drugs in treating the negative symptoms of schizophrenia, such as social withdrawal and apathy. The atypical antipsychotic drugs produce fewer extrapyramidal side effects and no tardive dyskinesia or dystonia. However, they are associated with induction of neuroleptic malignant syndrome, and clozapine can produce fatal agranulocytosis. Atypical antipsychotic drugs on the market currently include clozapine, risperidone and olanzapine. Use of these medications in selected patients who do not benefit from, or cannot tolerate, traditional agents is an important step in improving the lives of patients with schizophrenia.

Antipsychotic Agents↗
PubMed1997

NSAIDs revisited: selection, monitoring, and safe use.

Although nonsteroidal anti-inflammatory drugs (NSAIDs) are effective analgesic and anti-inflammatory agents, they may have adverse effects on the gastrointestinal, hepatic, renal, pulmonary, and platelet aggregation systems in susceptible patients. Careful consideration of the risks and benefits, judicious dosing, and careful monitoring by the primary care physician are therefore essential. The authors of this article review both the therapeutic and adverse effects of NSAIDs and provide suggestions for safe clinical use.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

A review of selected newer nonsteroidal anti-inflammatory drugs.

Development of nonsteroidal anti-inflammatory drugs (NSAIDs) with a goal of improved efficacy and lower toxicity has continued, resulting in the introduction of etodolac, ketorolac, nabumetone and oxaprozin on the market. Each of these agents appears to be as effective as other commonly used NSAIDs in the treatment of rheumatoid arthritis or osteoarthritis. Studies of nabumetone and etodolac show a lower incidence of serious gastrointestinal toxicity with both drugs, but additional large clinical trials are necessary to confirm these findings. Although ketorolac, which is now available in oral form, is an effective analgesic, its long-term use is limited by a high incidence of gastrointestinal toxicity. Oxaprozin is an effective, long-acting anti-inflammatory analgesic, but its comparative advantages remain undefined.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1993

Nonsteroidal anti-inflammatory drugs. Tailoring therapy to achieve results and avoid toxicity.

When used appropriately, non-steroidal anti-inflammatory drugs (NSAIDs) are safe and effective for treating pain and inflammation. NSAIDs that block both the lipoxygenase and cyclooxygenase pathways may be advantageous in some patients. New classes of NSAIDs that may have a more favorable safety profile than older agents may improve patient outcome. However, all patients receiving NSAIDs, especially the elderly, should be carefully monitored for possible drug-related complications.

Absorption↗
PubMed1991

The role of calcium channel blockers in the treatment of essential hypertension.

Calcium channel blockers, originally developed for the treatment of angina and supraventricular arrhythmias, have been shown to lower elevated blood pressure effectively in hypertensive patients. Verapamil, nifedipine, and diltiazem represent prototype compounds for unique chemical classes with differing pharmacologic properties. These drugs lower elevated blood pressure with efficacy comparable with other commonly used antihypertensives. Combination therapy with other agents usually results in an additive response. Side effects are usually mild and reversible and usually are an extension of the drug's pharmacologic effects. Moreover, adverse metabolic effects on lipid, glucose, or potassium levels are not common. Because of the excellent antihypertensive effects of calcium channel blockers and their potential importance in a variety of other disease states, these agents should be routinely considered for use as a first-line antihypertensive agent in appropriately selected patients with hypertension of any severity as part of a comprehensive plan to minimize cardiovascular risk.

Animals↗
PubMed1990

ACE inhibitors. A safe option for hypertension and congestive heart failure.

The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure has recently recommended angiotensin-converting enzyme (ACE) inhibitors, beta blockers, and diuretics as potential first-step agents for the pharmacologic treatment of hypertension. ACE inhibitors should be considered an important option in most patients because of their safety profile, absence of adverse metabolic effects, and positive cardiac and renal effects. If the response to an ACE inhibitor is inadequate, a diuretic or another agent can be added, and this combination should be effective and well tolerated in 85% to 90% of patients. ACE inhibitors can be used to treat congestive heart failure and to prevent the renal complications of hypertension and diabetes mellitus, significantly expanding their use in patients with these high-risk conditions. They also can be used concurrently with other antihypertensive agents, digitalis, cardiac glycosides, and lithium and are not contraindicated in most of the diseases commonly seen in hypertensive patients.

Aged↗
PubMed1989

The antihypertensive response to lisinopril: the effect of age in a predominantly black population.

After a 2-4 week no-treatment period, 24 patients (12 young, age 29-45 yr.; 12 elderly, age 65-81 yr.; 20 black, 4 white) with an untreated sitting diastolic blood pressure between 91-120 mm Hg received the nonsulfhydryl angiotensin converting enzyme inhibitor, lisinopril for three weeks in a singleblind, parallel group comparison. Patients who did not achieve goal blood pressure with the initial low-dose (10 mg/day) were treated with a high-dose regimen (40 mg/day) for three weeks. In those who remained incompletely responsive, hydrochlorothiazide 25 mg/day was added for four weeks in an attempt to normalize blood pressure (less than or equal to 90 mm Hg). Low-dose lisinopril monotherapy produced comparable reductions in the mean systolic and diastolic blood pressures (approximately -15/-8 mm Hg in both younger and older patients). Increasing the dose produced a slightly greater fall in mean blood pressures which normalized the blood pressure in five of six elderly patients unresponsive to the lower dose; addition of hydrochlorothiazide normalized three of the five remaining subjects from both groups who were unresponsive to high dose lisinopril. Lisinopril administration resulted in a rise in plasma renin activity and a fall in plasma aldosterone concentrations which were similar in both groups and which returned over time toward the baseline. The drug was well tolerated, producing one episode of symptomatic hypotension following the addition of hydrochlorothiazide to lisinopril monotherapy. Lisinopril alone or in combination with hydrochlorothiazide produces favorable antihypertensive effects in both younger and older predominantly black, low-renin patients with essential hypertension.

Adult↗
PubMed1988

Students' certainty during course test-taking and performance on clerkships and board exams.

Psychometric aspects of multiple-choice tests were investigated using a confidence-weighted scoring technique. The contributions of two indices, overconfidence and underconfidence, in the prediction of subsequent academic performance of examinees were studied. A total of 444 sophomore students (entering classes of 1982 and 1983) in one medical school were asked to indicate their confidence, on a 5-point scale (100, 75, 50, 25, and 0), in the correctness of their responses to each multiple-choice item on an Introduction to Clinical Medicine examination. Examinations were scored in two ways: in the conventional way, using the total number of correct responses, and by a confidence-weighted technique based on the level of certainty indicated for each response by the examinee. Only the conventional score determined the grade; the confidence-weighted score was calculated for the purely experimental purposes of this study. Overconfidence and underconfidence indices were also calculated by using the indicated levels of certainty. Improvements in the psychometrics of the examinations were observed when confidence-weighted scoring was used. In multiple-regression models, the confidence-weighted scores and indices of over- and underconfidence contributed significantly to predicting scores of the students studied on Parts I and II of the National Board of Medical Examiners examinations, whereas the conventional score did not contribute to the prediction of Part II scores. Significant differences on junior clerkship examinations and ratings were observed between those who were highly overconfident and those who were slightly overconfident. The highly overconfident students also estimated higher future incomes than did those who were slightly overconfident.

Attitude↗
PubMed1988

A framework for management of chronic pain.

The management of chronic pain requires a physician who is motivated to provide care for patients with this difficult problem. A thorough search must be made to determine the cause of the pain, the extent of psychiatric overlay, the importance of the pain to the patient (litigation, secondary gain), the extent of illness behavior and the response to previous therapy. The physician must be part of the treatment rather than part of the problem. Narcotic analgesics should be avoided except in patients with cancer pain or terminal illness.

Analgesia↗
PubMed1986

Comparison of two rapid latex agglutination methods for detection of group A streptococcal pharyngitis.

Throat swabs from 404 patients with suspected pharyngitis were collected using duplicate swabs. Both swabs were used to inoculate 5% sheep blood agar plates, which were incubated in an anaerobic atmosphere for the isolation of Group A streptococci. The throat swabs were tested for the presence of Group A antigen using the Culturette Brand 10-Minute Group A Strep ID kit (Marion Scientific, Kansas City, MO), and the Direct Antigen Identification D.A.I. Strep A Test (Difco Laboratories, Inc., Detroit, MI). We found that 77 of the 404 specimens were culture positive for Group A streptococci. The Strep ID kit had a sensitivity of 83.7% and a specificity of 91.6%. The positive and negative predictive values were 72% and 95.6%, respectively. The D.A.I. test had a sensitivity of 80.2% and a specificity of 100%. The positive and negative predictive values were 100% and 94.5%, respectively. There was not a significant difference in the sensitivity of the two kits (P less than 0.1), but there was a significant difference in the specificity (P less than 0.01).

Humans↗
PubMed1986

Tailoring the antihypertensive drug regimen.

The challenge to the clinician is the need to choose among an array of antihypertensive agents in order to arrive at a regimen that is not only effective but also safe and convenient. Tailoring the regimen to the individual patient requires careful consideration of the pathophysiologic mechanisms that may be operative, concurrent risk factors and diseases, previous responses to other antihypertensive agents and the patient's general lifestyle, including diet and exercise.

Adrenal Glands↗
PubMed1986

Nonsteroidal anti-inflammatory agents: an update.

Nonsteroidal anti-inflammatory drugs (NSAIDs) provide potent analgesic, anti-inflammatory activity as a result of their inhibition of prostaglandin synthesis. They are highly bound to plasma proteins and have half-lives that vary from two hours to more than 24 hours. While gastrointestinal reactions are well known, the renal and hepatic toxicities of NSAIDs have only recently been characterized. Elderly patients in general may be at risk of toxicity and should be evaluated frequently.

Anti-Inflammatory Agents, Non-Steroidal↗