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Biomedical subjects

S Leiner

Publications and source records attributed to S Leiner.

17 recordsLinked to original sources
PubMed2000

Acute pharyngitis with lifelong implications.

A 32-year-old man presents with exudative pharyngitis and constitutional symptoms. This article discusses diagnostic pitfalls and explores the intricacies of therapeutic options.

Acute Disease↗
PubMed1997

Acute bronchitis in adults: commonly diagnosed but poorly defined.

This article reviews the existing literature about acute bronchitis, a condition commonly diagnosed but poorly defined. The little epidemiologic research that has been done has failed to identify a microbiologic etiology approximately 60% to 85% of the time. The majority of cases appear to be caused by viruses, but 25% of adults with nonspecific lower respiratory symptoms may actually have pertussis. Mycoplasma pneumoniae and Chlamydia pneumoniae probably play minor roles. Although clinicians frequently prescribe antibiotics to patients they have diagnosed with acute bronchitis, there is little evidence in support. General treatment studies have failed to demonstrate benefit, and the natural history of even potentially curable pathogens is not altered by antimicrobial therapy. Some recent studies suggest that albuterol may be the best treatment choice for acute bronchitis; it can successfully ameliorate symptoms, and does not pose the same public health risk as inappropriate antibiotics do. Erythromycin may occasionally be indicated for patients in frequent contact with small infants not yet immunized against pertussis, but careful surveillance of the child is probably more effective than treating the contagious adult.

Acute Disease↗
PubMed1997

HIV case study.

Explore the source record for details and available documents.

Adult↗
PubMed1996

Diagnosing latent and active pulmonary tuberculosis: a review for clinicians.

Tuberculosis (TB) is once again a major public health concern. Primary care providers play a key role in controlling its spread, both by case-finding patients with active TB and providing preventive therapy to persons at high risk for developing it. This article describes the natural history and different stages of illness (latent infection, active disease, and old healed disease) in terms of direct implications for management. Diagnostic tools are examined in detail. Pitfalls in administration and interpretation of tuberculin skin tests are reviewed, including the factors that may cause false-negative and false-positive readings. Radiographic findings are explained and illustrated. Sputum analysis is discussed in detail in terms of specimen collection, laboratory methodologies for performing smears and cultures, and their respective specificity and sensitivity. A basic approach to workup and management is also outlined, distinguishing screening from diagnosis and emphasizing how to identify those persons at greatest risk for TB.

Acute Disease↗
PubMed1996

Traveling healthy.

Explore the source record for details and available documents.

Communicable Disease Control↗
PubMed1995

Recurrent urinary tract infections in otherwise healthy adult women. Rational strategies for work-up and management.

Recurrent urinary tract infections (UTIs) are common, but clinicians unfamiliar with the natural history or pathogenesis may order unnecessarily expensive tests and provide unsubstantiated advice to their patients. A large body of literature indicates that recurrent UTIs do not progress to permanent kidney damage or end-stage renal disease. The vast number of UTIs are due to the interplay between minor weaknesses in host defenses and bacterial virulence factors. Sexual intercourse and diaphragm/spermicide use are the two behavioral factors most consistently associated with UTIs. Basic history, physical exam, and urinalysis are able to identify the few patients likely to benefit from invasive urologic workups, which usually have a very low yield when ordered routinely. Effective management options include daily or post-coital antimicrobial prophylaxis, or patient-initiated treatment. Patients can be reassured of an excellent prognosis. There is no evidence validating proscription of personal preferences, such as soda pop, tight clothing, or direction of perineal cleansing after defecation.

Adult↗
PubMedDate not supplied

Asthma. A comprehensive review.

Asthma is common among women of childbearing and childrearing age. As a primary health care provider, the certified nurse-midwife is often called upon to play a direct role in diagnosis and collaborative co-management. This article reviews the pathogenesis of asthma and its natural history during pregnancy. Patient symptoms and findings on physical examination are described in depth, enabling clinicians to detect subtle presentations and avoid common pitfalls. A section on pulmonary function tests and other laboratory tools provides a foundation for objective monitoring of pulmonary function. Environmental control measures and pharmacologic therapies are described in detail. An algorithm for treatment strategies allows certified nurse-midwives to play an active role in co-management of their asthmatic patients, while a section on patient education highlights the essential teaching points her clients will require. Specific issues regarding antenatal fetal well-being and intrapartal management are discussed. With a sound knowledge base, and through their expertise in client education and counselling, the certified nurse-midwife is in a special position to optimize care for women with asthma.

Asthma↗
PubMedDate not supplied

Primary care for women. Management of common respiratory problems.

This article reviews the clinical management of common respiratory illness that primary care providers encounter in an outpatient setting. The latest recommendations from the American Thoracic Society, the National Heart, Lung, and Blood Institute, and the Centers for Disease Control and Prevention are summarized. The article discusses the causative organisms and antibiotics of choice for community-acquired pneumonia, and how to determine which patients require hospitalization. The appropriate use of asthma medications is described in detail, along with strategies for reducing aeroallergen exposure and for educating patients. An extensive section covers the interpretation of tuberculin skin tests and use of prophylactic isoniazid for prevention therapy of latent tuberculous infection, as well as the treatment of active tuberculosis. Controversies regarding antibiotics for both acute and chronic bronchitis are discussed along with other treatment options including over-the-counter medications, bronchodilators, and non-pharmacologic interventions. Finally, a strategy for dealing with the complaint of chronic cough is outlined. Although many of these conditions require active comanagement by collaborating physicians, the nurse-midwife will be better able to communicate with an advocate for her clients if she possesses expanded and current knowledge of treatment strategies.

Female↗
PubMedDate not supplied

Pharmacologic management of common lower respiratory tract disorders in women.

In a primary care setting, nurse-midwives will collaboratively manage common lower respiratory conditions that require pharmacologic therapy. As such, they must maintain up-to-date knowledge about the indications, use, and potential side effects of these medications. This article reviews the drugs most commonly used for the out-patient treatment of pneumonia, asthma, tuberculosis, and bronchitis (both acute and chronic). Differences among common oral antibiotics recommended by the American Thoracic Society are described. Inhaled bronchodilator and anti-inflammatory medications are covered, as well as systemic corticosteroids. The use of isoniazid preventive therapy for latent tuberculous infection is described in detail, with brief mention made of other drugs used for active tuberculosis. Adjunct treatments including immunotherapy, vaccines, oxygen supplementation, and nicotine replacement for smoking cessation also are discussed.

Ambulatory Care↗