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At least 1,009 records · Page 56Linked to original sources
PubMed1997

Epilepsy in pregnancy.

Family physicians who provide obstetric care may periodically encounter a patient with a history of epilepsy, which may manifest before or after pregnancy. In either case, several issues need to be addressed. Pregnant women with epilepsy may have an increased frequency of seizures, with the potential for resultant maternal and fetal morbidity and mortality. Teratogenic effects of antiepileptic drugs include craniofacial abnormalities and neural tube defects. Management strategies include the prenatal use of folic acid and vitamin K, monotherapy with a single antiepileptic drug, and obtaining at least monthly free serum drug levels. Fortunately, with close monitoring and proper management, more than 90 percent of pregnancies in women with epilepsy will be uncomplicated.

Anticonvulsants↗
PubMed1998

The integration of a tuberculosis control plan into a standard of care for tuberculosis.

Tuberculosis is a significant public health problem. Health care agencies and hospitals are mandated to have in place protocols to manage patients with suspected or confirmed cases and to implement infection control measures to prevent the spread of the disease. A facility with a high percentage of infected patients developed and integrated a standard of care to improve the management and outcomes of infected patients.

Humans↗
PubMed1998

Use of immunotherapy in a primary care office.

Immunotherapy has been used for over 80 years. It is a safe and effective therapeutic intervention for allergic rhinitis, but its use in the treatment of asthma is more controversial. Patients with unstable asthma are at increased risk of adverse effects from immunotherapy; therefore, if immunotherapy is used in such patients, it should be instituted cautiously. Indications for immunotherapy include evidence of IgE-mediated disease and positive results on skin tests or radioallergosorbent test (RAST). In addition, before immunotherapy is considered, measures to avoid exposure to offending agents and drug therapy should have failed to provide relief of symptoms. Before administering immunotherapy in the office, physicians should be knowledgeable about the use of immunotherapy and the treatment of anaphylaxis, and should have ready access to the equipment needed to avert anaphylaxis.

Asthma↗
PubMed1998

[Methods for evaluating diagnostic tests in Enfermedades Infecciosas y Microbiología Clínica].

BACKGROUND: In the field of infectious diseases and clinical microbiology, the evaluation of diagnostic tests (DT) is an important research area. The specific difficulties of this type of research has motivated that have not caught the severity methodological of others areas of clinical research. This article try to asses and characterize the methodology of articles about DT published in Enfermedades Infecciosas y Microbiología Clínica (EIMC) journal. METHODS: Forty-five articles was selected in the EIMC journal during the 1990-1996 period, because of determinate the sensitivity and specificity of different DT. Methodological standards, extensively accepted was used. RESULTS: In all of articles, except one (98%) the gold standard was specified yours use, however in 4 studies (9%) include the DT in the gold standard (incorporation bias). The correct description of DT was reported in 75% of cases, but only in 11% cases the reproducibility of test was evaluated. The description of source of reference population, standard of inclusion and spectrum of composition was described in 58, 33 and 40% of articles, respectively. In 33% of studies presented workup bias, only 6% commented blind-analysis of results, and 11% presented indeterminate test results. Half of the studies reported test indexes for clinical subgroups, only one article (2%) provided numerical precision for test indexes, and only 7% reported receiver operating characteristics curves. CONCLUSIONS: The methodological quality of DT research in the EIMC journal may improve in different aspects of design and presentation of results.

Diagnostic Techniques and Procedures↗
PubMed1998

The gestational diabetes mellitus conferences. Three are history: focus on the fourth.

This study reviews the summary and recommendations of the first three International Workshops Conferences on Gestational Diabetes Mellitus (GDM) and highlights areas of controversy requiring further research and discussion. The International Workshop Conferences on GDM held in 1979, 1984, and 1990 established a definition of GDM, confirmed the value of universal screening with a 50-g oral glucose load, recommended use of the 100-g oral glucose tolerance test with interpretation according to the diagnostic criteria of O'Sullivan and Mahan, and emphasized the importance of classification after pregnancy with a 75-g oral glucose tolerance test with classification according to the criteria of the National Diabetes Data Group or the World Health Organization. Recommendations for management have included nutritional counseling with limitation of the intake of concentrated sweets, monitoring maternal glucose levels to maintain the fasting plasma glucose < 105 mg/dl and the 2-h postprandial plasma glucose < 120 mg/dl, initiating insulin therapy if treatment with diet fails, and prohibiting the use of oral hypoglycemic agents. Antepartum fetal surveillance with emphasis on the evaluation of fetal growth using clinical and ultrasonographic techniques to detect macrosomia were also proposed. Although much has been accomplished in the first three conferences, areas of continued controversy include establishing a definition and method of detection for GDM that can be agreed on worldwide; defining the appropriate glucose levels to initiate dietary and/or insulin therapy; preventing macrosomia, as well as detecting and managing it, to reduce the cesarean delivery rate; and determining the long-term consequences for the mother with GDM and her infant through further studies.

Blood Glucose↗