Biomedical subjects

R E Nesse

Publications and source records attributed to R E Nesse.

8 recordsLinked to original sources

PubMed1992

Pharmacologic treatment of COPD. Optimum therapy for ambulatory patients.

Chronic obstructive pulmonary disease (COPD) has a wide variety of pathophysiologic mechanisms that involve the bronchi, bronchioles, and acini. For typical patients, first-line treatment with inhaled beta 2-selective agonists or ipratropium bromide (Atrovent) significantly improves lung function with minimal side effects. Theophylline is no longer routinely used as a first-line agent for the treatment of COPD but may be a useful addition to therapy if proper attention is given to serum drug levels and symptoms of toxicity. Oral prednisone is useful as an adjunctive agent for patients with serious disease who do not respond to other agents; a therapeutic trial showing objective evidence of benefit from this drug is essential. Mucolytics have recently been shown to have a role in improving lung function and also may be useful as adjunctive therapy.

Adrenal Cortex Hormones↗

PubMed1991

Managing abnormal vaginal bleeding.

Abnormal vaginal bleeding is a diagnostic and therapeutic challenge. A carefully directed patient history and physical examination along with basic laboratory tests can lead to accurate diagnosis. In most cases, symptoms can be controlled with use of oral contraceptives, progesterone supplements, and/or nonsteroidal anti-inflammatory drugs.

Adolescent↗

PubMed1989

Abnormal vaginal bleeding in perimenopausal women.

The incidence of abnormal vaginal bleeding increases as women approach the end of their reproductive years. In the perimenopausal age group, the most common cause of abnormal vaginal bleeding is anovulation. In most patients, diagnosis and management can be accomplished in a family physician's office.

Adult↗

PubMed1989

Pseudoparasitism with Gordius robustus.

The Gordius worm is a parasite of crickets and other arthropods, but not of humans. In almost all cases, the association between humans and the Gordius species, such as Gordius robustus, is purely coincidental. Gordius pseudoparasitism must be distinguished from true helminthic disease to alleviate patient anxiety and to avoid an unnecessary course of antihelminthics.

Animals↗

PubMed1988

Office management of sexually transmitted disease and management of pelvic inflammatory disease in the ambulatory patient.

Sexually transmitted disease poses an increasing challenge for the clinician in the 1980s, with increasing numbers of pathogens and diseases. This article discusses the diagnosis and outpatient management of gonorrhea, herpes virus type II, chlamydia trachomatis, and condyloma accuminatum. In addition, the diagnosis and outpatient management of pelvic inflammatory disease is reviewed.

Family Practice↗

PubMedDate not supplied

Intrapartum intervention and delivery outcome in low-risk pregnancy.

A retrospective cohort study of 1597 low-risk pregnancies assessed the effects of obstetrical intervention using logistic regression. Both maternal and neonatal morbidity were low (15.2 percent and 3.8 percent, respectively). Epidural analgesia, oxytocin, or both, were associated with worse maternal outcome, and neonatal outcome was worse when oxytocin was used. However, epidural analgesia seemed to provide a protective neonatal effect when oxytocin was used during labor. Both elective and medically necessary use of these interventions were associated with increased morbidity. If obstetrical interventions, particularly oxytocin and epidural analgesia, are applied in low-risk pregnancies, labors must be monitored carefully and the risk-benefit ratios judged advantageous.

Adolescent↗

PubMedDate not supplied

Influence of site of obstetric care and delivery on pregnancy management and outcome.

A retrospective cohort study of 863 pregnancies cared for by family physicians at three sites--rural-rural (RR), rural-urban (RU), and urban-urban (UU)--was designed to test the hypothesis that ready on-site access to perinatal subspecialists would improve pregnancy outcome. No differences in delivery type, length of gestation, birth weight, or nursery care were found. An Apgar score of less than 7 at 1 minute or less than 8 at 5 minutes was 2.17 and 2.31 times more likely at RU and 2.48 and 2.60 times more likely at UU, respectively, than at RR. The overall Cesarean section rate was 9.6 percent, forceps rate was 7.2 percent, and nonroutine nursery care rate was 7.9 percent. Neonatal and perinatal mortality rates were 3.5 and 4.6 per 1,000 live births. There is no evidence that on-site perinatal subspecialists improve perinatal outcome when care is provided by board-certified family physicians. Small obstetric centers provide quality perinatal care with outcome dependent on physician's skill rather than on technology.

Adult↗

PubMedDate not supplied

The effects of epidural anesthesia on type of delivery.

A retrospective cohort study of 626 low-risk patients admitted for labor and delivery under the care of a family physician was designed to test the hypothesis that epidural anesthesia increases the frequency of instrumental and operative deliveries. The crude odds ratio of instrumental or operative delivery in women electing to have epidural anesthesia was 9.56 (95 percent confidence interval, 5.57 to 16.40; P less than 0.001). Controlling for bias by multivariate analysis did not change the conclusion indicated by the crude odds ratio--use of elective epidural anesthesia results in markedly increased odds of instrumental or operative delivery.

Adult↗