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At least 469 records · Page 26Linked to original sources
PubMed2005

Benzodiazepines and anxiety disorders: a review for the practicing physician.

UNLABELLED: OBJECTIVES AND SCOPE: The objective of this article is to briefly review for practicing clinicians differences among the benzodiazepines (BZDs) that are commonly used to treat anxiety, the efficacy of BZDs in various anxiety disorders, and potential safety issues associated with BZDs, including adverse events, tolerance, dependence, and withdrawal. METHODOLOGY: Information for this review was obtained using literature searches through PubMed (1966-2004), Google, and the Food and Drug Administration Catalog of Approved Drugs. Data sources were searched for information regarding anxiety disorders and the safety and efficacy of BZDs. Wherever possible and appropriate, information from randomized controlled trials was given priority. FINDINGS: Benzodiazepines have demonstrated efficacy in treating patients with anxiety disorders, with varying degrees of efficacy. Use of BZDs is advantageous because they have a quick onset of action and are generally well tolerated. Extended-release formulations of BZDs may be particularly advantageous in some patients with anxiety as they allow for maximization of a drug's therapeutic window with consistent serum drug concentrations. CONCLUSIONS: BZDs remain a mainstay in the treatment of anxiety, as both monotherapy and adjunctive therapy. Factors to consider prior to prescribing a BZD include the patient's diagnosis, as well as drug characteristics, including the potential for interactions with other drugs, the risk of dependence and withdrawal, and the required frequency of dosing.

Anti-Anxiety Agents↗
PubMed1986

Recent developments in organizing and financing health-care services.

Recent developments in the organization and financing of health-care services are described. All recent developments reflect an effort by both private and public payers to restrict use of health-care services, as well as to control price. Private use-review programs, such as second-surgical-opinion services and case-management services, are increasingly being used. The number of hospital admissions and length of patient stay continue to decline, but, because of increasing complexity of care, the cost of pharmaceutical services has not decreased proportionately. Points relating to health-care financing in the federal reconciliation budget effective May 1, 1986, are reviewed, as are other new federal regulations affecting the structure of services and terms of reimbursement under the Medicare and Medicaid programs. For Medicare, these include new scope objectives for professional review organizations, decreased return-on-equity payments to for-profit hospitals for outpatient services and to skilled nursing facilities, and elimination of waiver-of-liability presumptions for hospitals. Also, physicians must now identify specific services provided during each inpatient hospital visit. Most developments related to home health-care services pertain to limiting the cost of durable medical equipment. Alternative types of health care based on capitation funding, such as health maintenance organizations, competitive medical plans, and preferred provider organizations, will continue to grow in both the public and private sectors, and the use of private use-review programs for controlling costs is expected to accelerate in the next year.

Delivery of Health Care↗
PubMed1992

[The Romberg head-shake test within the scope of equilibrium diagnosis].

We review the standard functional tests of static and dynamic equilibrium and discuss the value of these tests. The pendular platform test and the tilting table test were developed for provocation of the balance system, but are not used in clinical investigation because of the complicated apparatus and the difficulties of judgement of the curves recorded. A simple modification for provocation of the balance system, available in the clinic, the consulting room or the doctor's office is recommended, consisting of horizontal head-shaking in the Romberg position during posturographic recording. In healthy subjects little increase of body sway is found, but in patients with peripheral or central vestibular disorders a distinct tendency of disequilibrium is seen.

Adult↗
PubMed1998

Periprosthetic hip and knee fractures: the scope of the problem.

This review covers the present incidence, site, and outcome of periprosthetic fractures of the hip and the knee. Fractures can occur intraoperatively or postoperatively as an early or a late complication. Late postoperative fractures are related to osteolysis secondary to wear debris. These late fractures will become more prevalent with time. Intraoperative fractures can be avoided by careful technique and improved instrument design. Fractures can affect the acetabulum, femur, and trochanter of hip replacements: and the femur, tibia, and patella of knee replacements. The femur is most commonly involved for both joints. Stress fractures have been described as a rare complication of both sites of arthroplasty. If the fracture is recognized and the bone stock is good, a good outcome can be achieved if rigid fixation is obtained Unfortunately poor bone stock is often present, leading to late periprosthetic fractures, which compromise the outcome.

Aged↗
PubMed1994

[Therapy of hypopharyngeal cancer. Part II: Review of the literature for using chemotherapy within the scope of multimodality therapy].

Supplemental to the previous publication on the results of surgery and/or radiotherapy, the application of various cytostatic drugs--neoadjuvant, sequential, simultaneous, alternating or adjuvant--in addition to surgery and/or radiotherapy in the treatment of hypopharynx carcinomas is subjected to critical analysis. Exclusively for these carcinomas there are still no results of prospectively randomized studies, although this may reflect their relatively small incidence when compared with all head and neck tumors. Induction chemotherapy (before standard therapy) has been disappointing clinically, at least concerning hypopharynx carcinomas. To date, organ and function preservation with improved survival in these neoplasms has not been shown clearly, even for resectable tumors. Simultaneous radiochemotherapy is obviously superior to sequential chemotherapy and has demonstrated higher remission rates when compared to conventional radiotherapy, but the effectiveness of modified fractionizing patterns must be kept distinct from the effectiveness of simultaneous chemotherapy. Moreover, it must be defined whether the observed decline in the rate of distant metastases after adjuvant chemotherapy entails (statistically) significant higher survival rates. Only with the help of prospective randomized multicenter studies can the true benefits of chemotherapy be verified and specified in the treatment of hypopharynx carcinomas. The results of chemotherapy to date are critically reviewed and future concepts planned.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

The Ponseti method for treatment of congenital club foot.

PURPOSE OF REVIEW: This review of the Ponseti technique for the treatment of congenital club foot covers a topic of recently renewed interest. Pediatric orthopedists and parents have become increasingly enthusiastic about the success of this technique, which has been practiced continuously at the University of Iowa since 1948 but only recently become widely utilized. RECENT FINDINGS: Current literature has emphasized the reproducibility of these excellent results among multiple centers throughout the world. In addition, the role of the Internet, and accessibility of medical information have been central elements in the development of this phenomenon. SUMMARY: The current research should convince physicians that all children should be managed by the Ponseti technique at the outset. This research should also reassure physicians and parents that the overwhelming majority of children with club feet can be successfully managed, without the need for major reconstructive surgery.

Braces↗
PubMed2001

Sports and recreation for persons with limb deficiency.

UNLABELLED: Opportunities for persons with limb deficiency to participate in sport and recreational activities have increased dramatically over the past 20 years. Various factors have contributed to this phenomenon, including an increased public interest in sports and fitness as well as improvements in disability awareness. An even more essential element has been a consumer-driven demand for advances in prosthetic technology and design. Whether the activity is a music performance, a friendly round of golf, or a high-level track-and-field competition, the benefits of participation in sports and recreation are numerous both at the individual and at the societal level. This article provides an overview of the development and scope of sport and recreational opportunities available to persons with limb deficiency. In addition, specific prosthetic considerations for several common sport and recreational activities are presented in a case-discussion format. OVERALL ARTICLE OBJECTIVE: To review the development and scope of sport and recreational opportunities available to persons with limb deficiency.

Adolescent↗
PubMed1995

Antepartum fetal surveillance.

In recent years the advances in prenatal diagnosis of fetal asphyxia have been dramatic and increasing at a remarkable pace. Now that a solid base of multivariable testing has been accepted as the method of choice for assessment of fetal health, the focus of clinical research has shifted towards identification of factors and signs that might predict not only risk of death and immediate morbid outcome but also the quality of life after delivery. The papers reviewed here outline the scope of the problem of cerebral palsy and offer clues as to how fetal disease may become manifest as child or adult sustained neurological injury. Concurrently, the advances in refinement of the testing methods are reviewed. Clearly a better understanding of the etiology, physiology, and range of fetal responses to asphyxia will be the key to effecting not only better survival rates but also a higher quality of survival.

Cerebral Palsy↗
PubMed1996

Office radiotherapy in dermatology: a contemporary perspective.

Ionizing radiation was recognized very early after its discovery as a useful weapon against both neoplasia and inflammation. Following an initial period of enthusiastic use, recognition of its drawbacks and the development of safe and effective alternative treatments for many applications have resulted in a marked reduction in the use of radiotherapy in most dermatological offices. Nonetheless, this modality remains an important component of our modern therapeutic armamentarium. It is a treatment of choice in some situations, and a useful alternative in many more. A thorough understanding of the principles and practice of safe radiotherapy remains vital to the full practice of dermatology in 1996. The present review summarizes the current practice of radiotherapy and offers some guidelines for safe and effective use of this important tool. Detailed discussions of radiobiology, deep radiotherapy (DXRT) and electron beam (EB) therapy are beyond the scope of this clinical review.

Contraindications↗
PubMed1975

The neurologic effects of noxious marine creatures.

The concept of the sea as a source of noxious agents is perhaps not a familiar one to clinical neurologists, judging by the lack of reference to these agents in standard textbooks. Chemical, physiologic, and pharmacologic laboratories are increasingly investigating the properties of marine toxins, finding in them compounds with interesting and novel structures or unusual physiologic effects. Such substances are seen as possible agents for biologic and, more particularly, physiologic research, and as possible sources of new pharmaceuticals. These include hormone-like substances and antiviral or antitumor agents. Despite these specialized developments, which are in large measure a consequence of the technological advances of the present century, the clinician is at times directly concerned with the effects of marine toxic substances. For example, in Japan, puffer fish or tetrodotoxic poisoning is one of the major causes of deaths from food poisoning. Another marine toxin that has caused many explosive outbreaks of food poisoning. with many deaths in various parts of the world, comes from clams or mussels. This toxin, saxitoxin, is produced by species of marine protozoa including Gonyaulax, and is concentrated in filter-feeding molluscs. These two examples were of significant interest in medicine long before the technologic developments of the twentieth century. In the last few decades, entirely new problems of marine intoxication have arisen as a result of marine pollution from the disposal of industrial wastes in the sea. The most striking example of a man-made marine intoxication has been the outbreak of Minamata disease. In Minamata, Japan, the disposal of mercury-contaminated industrial wastes from a plastics factory into an enclosed bay, followed by human consumption of the contaminated fishes, crabs, or shellfish, led to many instances of acute cerebral degeneration. With the increasing exploration of the sea for both pleasure and economic exploitation, which is a feature of the second half of the twentieth century, it may be expected that the frequency and variety of human intoxications by marine creatures will be increased. This chapter reviews the neurologic effects of noxious substances of marine biologic origin. The subject is now developing so rapidly that overall surveys, such as this, of the general animal life of theocens will soon be beyond the scope of a single review. Nevertheless, it is hoped that the references given will enable the interested reader to pursue particular aspects further.

Adult↗
PubMed1976

Juvenile-onset diabetes.

While information regarding the diagnosis of diabetes and acute care of the diabetic, i.e., management of ketoacidosis, is readily available, much less has been written about long-term management. In addition to a brief review of background information and recent developments in diabetes, some of the more common management problems are discussed from a practical viewpoint. Because an exhaustive review of diabetes is beyond the scope of this article, readers are referred to recent review articles for additional background information.

Adult↗
PubMed2004

Whiplash: pathophysiology, diagnosis, treatment, and prognosis.

We have reviewed the literature relevant to pathophysiology, diagnosis, treatment, and prognosis of whiplash-associated disorder (WAD) since 1995 and provided a brief summary of literature pertaining to forces action on the head and neck during a motor vehicle accident. The scope of the current review is confined to the Quebec guidelines for WAD grades 1-3 but excludes grade 4 (neck complaints and fracture or dislocation). After excluding papers without scientific data and single case reports or case series with fewer than 20 patients, articles were reviewed for methodological quality. The diagnosis remains clinical. No imaging, physiological, or psychological study provides specific diagnostic criteria. In the acute period up to 2 weeks, soft collars or rest and work-leave do not shorten the duration of neck pain. Sick leave is reduced by high-dose methylprednisolone given within 8 h of injury, but confirmatory studies examining the cost-benefit relationship are needed. In the first 6 months, active as opposed to passive treatment results in improved outcomes. Specific exercise strategies have not been studied. For those with symptoms lasting more than 6 months, percutaneous radio-frequency neurotomy can provide pain relief for many months in those responding to blind local anesthetic facet blocks. Intra-articular corticosteroids are ineffective. Uncontrolled trials suggest that multimodal rehabilitation programs result in improved overall function. The overall prognosis for recovery has varied considerably across studies. Such variability is likely due to differences in case identification methods and whether outcome is assessed in terms of symptoms or the receipt of financial compensation for injury. The impact on prognosis of both collision- and patient-related factors is also reviewed.

Humans↗
PubMed2003

The psychosocial determinants of hypertension.

AIM: To present currently available evidence on the role that adverse psychosocial factors play in the pathogenesis of hypertension. The specific objectives of the review were to (1) provide a picture of what is known about the relationship between psychosocial factors and hypertension, (2) summarize the major methodological and conceptual pitfalls, and (3) identify gaps in the literature and suggest areas for future research. DATA SYNTHESIS: The scope of the literature review was adults and the literature published since 1990 (acknowledging that some articles published earlier would need to be taken into account). A number of journal searches were carried out. They included Medline, PsychInfo, and SocioFile, with keywords, such as hypertension, blood pressure, psychosocial, psychological, social, acculturation, occupation, socio-economic status, social class, education, depression, anger, and anxiety. The search included articles related to hypertension in developed countries and was limited to studies in the English language. CONCLUSION: A growing body of evidence supports the thesis that psychosocial factors play a role in the pathogenesis for hypertension.

Anger↗
PubMed2014

Annual research review: Secular trends in child and adolescent mental health.

BACKGROUND: Child and adolescent mental health problems are common, associated with wide-ranging functional impairments, and show substantial continuities into adult life. It is therefore important to understand the extent to which the prevalence of mental health problems has changed over time, and to identify reasons behind any trends in mental health. SCOPE AND METHODOLOGY: This review evaluates evidence on whether the population prevalence of child and adolescent mental health problems has changed. The primary focus of the review is on epidemiological cross-cohort comparisons identified by a systematic search of the literature (using the Web of Knowledge database). FINDINGS: Clinical diagnosis and treatment of child and adolescent psychiatric disorders increased over recent decades. Epidemiological comparisons of unselected population cohorts using equivalent assessments of mental health have found little evidence of an increased rate of ADHD, but cross-cohort comparisons of rates of ASD are lacking at this time. Findings do suggest substantial secular change in emotional problems and antisocial behaviour in high-income countries, including periods of increase and decrease in symptom prevalence. Evidence from low- and middle-income countries is very limited. Possible explanations for trends in child and adolescent mental health are discussed. The review also addresses how cross-cohort comparisons can provide valuable complementary information on the aetiology of mental illness.

Adolescent↗
PubMed1991

Clinical review 23: The use of the long-acting somatostatin analog octreotide in the treatment of gut neuroendocrine tumors.

The SRIF analog octreotide (SMS 201-995) has been in clinical use for over 6 yr in the treatment of acromegaly and metastatic endocrine pancreatic and carcinoid tumors. The use of the analog in the treatment of acromegaly and TSH-secreting tumors is beyond the scope of this clinical review. Patient acceptance of the analog, given chronically by the sc route, has been excellent and side effects have been few with the exception of the development of gallstones. In endocrine pancreatic and carcinoid tumors the hypersecretion of hormones such as VIP, glucagon, and gastrin and the secretory products of carcinoid tumors (e.g. 5-hydroxytryptamine and tachykinins) and their clinical effects may be successfully blocked. This allows excellent palliation of such tumors and often enables the patients to return home and lead normal social lives. Initial hopes that long-term octreotide therapy would be an effective antitumor drug, reducing tumor growth, based on experimental animal models and human tumor cell lines, have not been born out in clinical practice. A reduction in gut tumor bulk due to octreotide, rarely or never occurs as a sustained phenomenon. Eventually a decrease in, and finally an absence of, clinical effectiveness occurs despite the reintroduction of other treatment modalities.

Adenoma, Islet Cell↗