|
12/31/1969 03:59 PM
|
|
Unexpected Economics of Ulcer Care Protocols
|
The cost of managing chronic ulcers, both venous leg and decubiti (sacral pressure), was reviewed using 36 randomized, controlled studies with a focus on saline, hydrocolloid, and a human skin construct. When one includes the labor intensiveness of dressing changes three to four times per day, the application of hydrocolloid dressings becomes the most cost-effective.
(C) 2004 Southern Medical Association
|
|
12/31/1969 03:59 PM
|
|
Negative Pressure Wound Therapy: An Important Adjunct to Wound Care
|
Mendonca, Derick Amith MBBS, MSC, MRCS therapy (NPWT) is a major development in wound care. It has now given physicians and primary care providers another option in dealing with complex wounds
|
|
12/31/1969 03:59 PM
|
|
Clinical Application of Treating Biofilms-Associated Infections in Family Medicine
|
Abstract: The management of common infections in family medicine may be complicated by poor treatment response or infection recurrence. In many cases, difficulty in treating these infections can be explained by the important role of biofilms, complex microbial communities with unique survival properties that promote infection resistance, recurrence, and persistence. Biofilms have been demonstrated to play important roles in infections involving the sinuses, ears, and ischemic wounds. Biofilms also commonly grow on medical devices, such as indwelling catheters, where they serve as an important nidus of persistent infection. Understanding the role of biofilms in medical infections suggests preventive and treatment strategies that will directly target the important resistive mechanisms of biofilms.
|
|
12/31/1969 03:59 PM
|
|
How Do You Teach an Old Dog New Tricks? Lessons from Venous Thromboembolism Prophylaxis Guidelines
|
reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med 2001 catheter-related urinary tract infections and pressure ulcers. Ostomy Wound Manage 2007;53:34-42
|
|
12/31/1969 03:59 PM
|
|
Risk Factors of Cellulitis Treatment Failure with Once-Daily Intravenous Cefazolin Plus Oral Probenecid
|
Objectives: Once-daily intravenous cefazolin with probenecid is used commonly to treat cellulitis. The primary objective of this study was to determine the risk factors of treatment failure with this regimen.
Methods: This was a retrospective cohort study of adult outpatients with cellulitis who were initially treated with once-daily intravenous cefazolin plus probenecid. Treatment failure is defined as inadequate improvement that necessitates either hospital admission or a change in antibiotic therapy to a different intravenous regimen. A stepwise logistic regression analysis was performed to determine the risk factors for regimen failure.
Results: From January 2003 to December 2008, 159 patients with cellulitis were initially treated with once daily intravenous cefazolin plus probenecid. Thirty-five (22%) patients had treatment failure. The treatment for 53% (9/17) of the patients with a history of chronic venous disease (CVD) failed, whereas the treatment for 18% (26/142) of patients without CVD failed (P = 0.001). Multivariate analysis identified the presence of CVD as the only risk factor associated with treatment failure (odds ratio 4.4, 95% confidence interval 1.5–13; P = .007).
Conclusions: Patients with cellulitis and CVD who are being treated with once-daily intravenous cefazolin plus probenecid should be monitored closely for treatment failure.
|
|
12/31/1969 03:59 PM
|
|
Skin Toxicity During Breast Irradiation: Pathophysiology and Management
|
Radiotherapy is a critical component in the treatment of breast cancer, a disease that is estimated to have affected 203,500 US women in 2002. According to the data from some series, an estimated 90% of patients treated with radiotherapy for breast cancer will develop a degree of radiation-induced dermatitis. This review describes the indications and techniques of radiotherapy for breast cancer. The pathophysiology, clinical presentation, and contributing factors of radiation-related skin injury are discussed. A review of recent clinical research addressing skin toxicity is provided.
(C) 2004 Southern Medical Association
|
|
12/31/1969 03:59 PM
|
|
Spontaneous Cholecystocutaneous Fistula
|
Spontaneous cholecystocutaneous fistula is rarely observed today because of the early diagnosis and management made possible by ultrasonography, broad-spectrum antibiotics, and effective surgical management of biliary tract disease. We present a case of spontaneous cholecystocutaneous fistula due to cholecystitis.
(C) 2004 Southern Medical Association
|
|
12/31/1969 03:59 PM
|
|
Stress Urinary Incontinence in Active Elderly Women
|
Urinary incontinence in the elderly is a significant health problem fraught with isolation, depression, and an increased risk of institutionalization and medical complications. Stress urinary incontinence (SUI), the complaint of involuntary loss of urine during effort or exertion or during sneezing or coughing, is the most common type of urinary incontinence. SUI can seriously degrade the quality of life for many active seniors, and has become an economic challenge for society. With the rapid increase in the active elderly worldwide, SUI is becoming a significant global problem. However, since only a fraction of women with SUI have consulted a physician, the clinical extent and public health impact of SUI are probably underestimated. The mounting social, medical, and economic problem of SUI in active elderly women as a rapidly growing segment of the population worldwide is reviewed. We evaluate the age-related changes of the lower urinary tract, examine risk factors, and suggest different treatment options shown to be effective in reducing SUI in this population.
(C) 2005 Southern Medical Association
|
|
12/31/1969 03:59 PM
|
|
Pilot Study on Gastric Electrical Stimulation on Surgery-associated Gastroparesis: Long-term Outcome
|
Objectives: Patients with postgastric surgery gastroparesis are often unresponsive to conventional medical therapy. Gastric electrical stimulation (GES) with the use of high-frequency and low-energy neural stimulation is an approved technique for patients with idiopathic and diabetic gastroparesis.
Methods: We hypothesized that GES would improve symptoms, health resource utilization, and gastric emptying in six patients with postsurgical gastroparesis from a variety of surgical procedures. Patients were evaluated by means of the following criteria: symptoms, health-related quality of life, and gastric emptying tests at baseline over time.
Results: All patients noted improvements after device implantation for up to 46 months: the frequency score for weekly vomiting went from a baseline of 3.2 down to 0.4 immediately after treatment before settling at 1.4 by the long-term follow up. Total gastrointestinal symptom score went from 36.5 at baseline down to 12.3 before settling at 20.5 at long-term follow up. Improvements were also seen in health-related quality of life and solid and liquid gastric emptying.
Conclusions: We conclude that GES is associated with clinical improvements in this group of patients with either postsurgical or surgery-associated gastroparesis. This pilot study with long-term outcomes offers evidence for a new therapy for otherwise refractory patients with gastroparesis associated with previous surgery.
(C) 2005 Southern Medical Association
|
|
12/31/1969 03:59 PM
|
|
Platypnea-Orthodeoxia: Bilateral Lower-Lobe Pulmonary Emboli and Review of Associated Pathophysiology and Management
|
Platypnea-orthodeoxia is a rare syndrome characterized by dyspnea and arterial deoxygenation, which is exacerbated in an upright position and relieved with recumbency. We report a case of platypnea-orthodeoxia in a 56-year-old male who was found to have bilateral lower-lobe pulmonary emboli. He did not have any evidence of an intracardiac shunt. A comprehensive review of the pathophysiology and management of platypnea-orthodeoxia is provided.
|
