The consequences of chronic deep venous insufficiency are a major medical concern and result in significant loss of human productivity in addition to a significant compromise of lifestyles. The postphlebitic syndrome of chronic venous stasis and ulceration is a result of chronic venous hypertension and reflects a sequela of events ...

BACKGROUND: Dizziness is a lay term used to describe a variety of sensations. Unfortunately, the term "dizziness" does not have a precise medical definition, and additional information is typically required to further define the patient's problem. METHODS: When dizziness is a presenting complaint, distinctions must be made between vertigo (a ...

OBJECTIVE: Ocular allergy is a frequent accompaniment of systemic allergy and in some situations ocular signs and symptoms are the most prominent features of allergic disease. This paper will describe an approach to ocular allergy intended to aid in the recognition, differentiation from other ocular conditions, and management of ocular ...

This document provides clinical engineers, facility managers and hospital administrators a how-to guide for establishing a medical equipment replacement program based on the equipment's projected useful life after procurement and installation. This will allow managers a benchmark for establishing realistic budgets and plans for the phase-in of replacement medical equipment.

1. Hip involvement in inflammatory arthritis is a relatively common entity. 2. Total hip replacement offers the most reliable surgical treatment option for pain relief and the restoration of hip function when medical management is exhausted. 3. Preoperative evaluation and perioperative medical management should focus on the particular medical problems ...

This article examines the impact of greater management involvement by the medical director on efficiency of bed allocation in the intensive care unit (ICU) or critical care unit. Managerial involvement is modeled using a principal components approach in terms of perceived supervision, conflict resolution regarding bed allocation at critical times, ...

Training in social skills has been shown to have a strong, positive impact, according to behavioral measures, on social skills, self-rated assertiveness, and the hospital discharge rate. It is important to establish a system of assessing social skills because it is necessary for the effects of social skills training to ...

Human encounters with cobras in Africa and Asia are common with substantial mortality and primarily respiratory paralysis in untreated cases. First aid includes maintaining calm, placing a lymphatic retardant on the bitten extremity, and transportation to a medical facility. Medical management is antivenin. Physiologic monitoring and the ability to manage ...

1. Nurses working with older adults and caregivers should consider medication management a complex activity. 2. Effective self-management of medication includes not only administering medication as prescribed, but also diverse actions and decisions from obtaining medications to monitoring for side effects of medications. 3. Nurses should be sure to include ...

Extremity deformities in patients with hypophosphatemic rickets (HPR) are often complex and multiplanar. Described methods for correcting these deformities are imprecise and require interruption of the medical management of the condition. Corrective osteotomies were performed on 29 bones in nine children with HPR. Use of the Orthofix external fixator enabled ...

In a fast-moving trend, radiology administrators are being asked to assume responsibility for other hospital departments. Pressure to reduce costs is the primary force behind restructuring that results in expanded roles for managers. The changes mean fewer management positions and increased responsibilities for those who retain their jobs. To maximize ...

Emergency field medical facilities constructed after a disaster are frequently managed by medical staff even though many of the day-to-day problems of hospital management are unrelated to medicine. In this paper we discuss the short-term management of one of these problems, namely the control and disposal of sanitary wastes. It ...

This study quantifies some of the outcome predictors in a group of children with primary vesicoureteral reflux who were initially managed medically. METHODS: We studied 133 patients with primary reflux for 7.1 +/- 2.2 yr. Direct vesicoureteral scintigraphy (DVS) was used to prospectively measure the absolute bladder volume at which ...

All transient ischemic attacks are not created equal. However, they are a medical emergency, and all patients should be hospitalized for urgent evaluation of their risk for stroke or myocardial infarction. For optimal management, it must be determined whether an ischemic attack affects the anterior or posterior circulation. In this ...

Recent studies have shown associations among combat experience, PTSD, anger and hostility, and involvement in violence. Clinical observations of veterans enrolled in the Substance Use/Posttraumatic Stress Disorder Team (SUPT) program at the San Francisco Veterans Affairs Medical Center revealed relatively high levels of anger and aggressive behavior, including physical assaults ...

Advances over the last several years have led to a better understanding of the etiology of hyperparathyroidism in renal disease and to more effective means of medical prevention and therapy. Thus, in most dialysis populations, many of the serious complications, such as bone fractures, refractory hypercalcemia, and hyperphosphatemia with vascular ...

Acne vulgaris can affect both adolescents and adults. The pathogenesis of acne is multifactorial and involves overproduction of sebum, an abnormal follicular keratinization process, proliferation of Propionibacterium acnes, and hormonal and immunologic factors. Clinical manifestations of acne range from noninflammatory comedones to inflammatory papules, pustules and cysts. Current therapy allows ...

Upper endoscopy is currently one of the most frequently performed procedures. The most common indications for diagnostic EGD include dyspepsia unresponsive to medical therapy or associated with systemic signs, dysphagia or odynophagia, persistent gastroesophageal reflux symptoms, occult gastrointestinal bleeding, and surveillance for malignancy. These guidelines, however, are largely based on ...

The production of medical audiovisual material for the advancement of medical education in China is a problem requiring an urgent solution. To achieve faster, better and more economical results, the production of audiovisual material must be undertaken with careful planning and efficient management. A systematic approach is essential to control ...

The signs and symptoms associated with necrotizing enterocolitis (NEC) and the common scenarios in which NEC is observed are described to help physicians appreciate the breadth of this illness and to aid in the identification and diagnosis of those affected. An outline for medical management of infants with NEC is ...

Deconditioning brought on by inactivity or bed rest affects important body systems and results in reduced functional capacity. Elderly individuals are particularly vulnerable to becoming deconditioned. Risk factors for deconditioning include illness, disability, chronic disease, medications, and psychosocial circumstances. Deconditioned individuals present multiple physical and psychosocial signs and symptoms. Prevention ...

Traditional methods of managing acute pain have expanded to include PCA and epidural analgesia. The lumbar plexus block can be added to these methods. It is useful for patients undergoing some knee surgeries, both preoperatively and postoperatively. The lumbar plexus innervates both motor and sensory components of much of the ...

Urinary incontinence due to incompetence of the urethral sphincter mechanism was diagnosed in five neutered female dogs. After poor clinical responses to medical treatment, the five bitches were managed by a combination of colposuspension and sling urethroplasty. No major complications developed, although three bitches voided small volumes of urine more ...

This paper interprets the experience of a sample of 60 clinicians becoming involved in formal management, mainly at hospital unit level, in the historical context of changing health service organisation. This includes the introduction of managerialism and the evolution of the NHS into a structured network based around purchaser/provider relationships. ...

Deliberate self-administration of recombinant human erythropoietin (rHuEpo) in a patient without anemia has never been documented. The case of a 62-year-old man who worked in an allied health care field and surreptitiously injected the drug, causing his hematocrit to increase to a dangerously high level is presented. Resultant complications of ...

A case of Churg-Strauss syndrome causing mesenteric intestinal ischaemia and small bowel necrosis is described in a 29-year-old man. Despite conservative management, the patient's condition deteriorated and he underwent five laparotomies. Small and medium-sized arteries within the mesentery and lymph nodes showed necrotizing vasculitis. Currently he is doing well on ...

In this article, authors Robert Hurley, Ph.D.,and Jon Thompson, M.S.P., report results of a survey involving interviews with employee benefits managers. The results are notable in that they reveal purchasers in the process of challenging many of the fundamental assumptions regarding buying medical benefits and the services of medical professionals.

Toxic megacolon, its incidence, differential diagnosis, and presenting signs and symptoms are reviewed in this article. The typical histologic and radiographic features are described with a review of the potential triggering factors. An outline of requirements for adequate monitoring of the patient with toxic megacolon is provided. The general management ...

Cocaine use among middle-class North Americans increased dramatically during the 1980s. Medical complications involve almost every organ system and are produced by intense vasoconstriction. Managing cocaine-induced disease requires careful identification and the use of alpha-adrenergic blocking agents, in addition to standard therapy and referral to specialists to manage cocaine withdrawal.

Dysosmia, or the distortion of olfaction, is most commonly preceded by viral illness or head trauma, but has a variety of etiologies. The precise nature of the disease process remains obscure. Medical management is largely empiric, and has been aimed at treating underlying illnesses, restricting triggering medications, as well as ...

A review of 10 years' experience of all patients with profuse epistaxis requiring hospitalisation in a tertiary care centre in India is presented. There were 106 patients among which only 72% of cases had associated medical illness. Hypertension (44%) and bleeding diathesis (11%) were found to be the most frequently ...

Raynaud's phenomenon is a common condition that affects about 5 per cent of the population, although not all patients affected seek medical attention. At present it is useful to categorize the condition as either primary or secondary. In most instances the diagnosis of Raynaud's phenomenon is straightforward, however it may ...

Medical consultation is frequently requested to assist the trauma team in the management of the patient with multiple traumatic injuries. Four areas are commonly encountered as problems for management in this patient population. In this article, myocardial contusion, stress ulceration, seizure prophylaxis, and deep vein thrombosis prevention are addressed with ...

Medical management is a large and growing profession. The need for physicians in management roles grows unabated in hospitals, managed care organizations, group practices, and myriad other environments. But entry is not merely a matter of wishful thinking. Painstakingly assembled credentials and skills are the order of the day. The ...

A 69 year old woman developed intractable episodic hepatic encephalopathy 12 years after an end-to-side portacaval shunt for variceal haemorrhage. Medical management was ineffective in preventing repeated episodes of encephalopathy and caused incapacitating faecal incontinence. A loop ileostomy was created with minimal morbidity and was effective in preventing further episodes ...

A case of aconitine poisoning following the ingestion of 'chuanwu', the main root of Aconitum carmichaeli, and 'caowu', the root of Aconitum kusnezoffii is described. A 35-year-old man became unwell about 90 minutes after ingesting these herbs and his symptoms lasted for about two days. In addition to the typical ...

In summary, it appears that much work remains to be done in ensuring medical information privacy, especially in larger healthcare facilities. Managers of these organizations are urged to confront these issues now, while there is still time to act in a proactive management mode. Media and legislative scrutiny with respect ...

BACKGROUND: From 1958 to 1969, 462 patients (mostly children) with aortic stenosis were admitted to the First Natural History Study of Congenital Heart Defects (NHS-1) after cardiac catheterization. Most with gradients < 50 mm Hg were managed medically; most with gradients > or = 80 mm Hg had aortic valvotomy. ...

Letterman Army Medical Center (LAMC) began a phased downsizing in July 1991 which will lead to closure by June 30, 1994. An analysis of the downsizing and closure process has yielded information which can be valuable to medical treatment facility managers faced with similar challenges in the future. By review ...

Most physicians have long felt that there must be a better way to address the need for improving the cost effectiveness of medical care other than the process-heavy, invasive tactics of traditional UR. The QE strategy of replacing case-by-case pretreatment authorizations and certifications with a more thorough retrospective analysis of ...

Psychosocial disorders frequently complicate sickle cell disease. Psychological problems include neurotic illness, personality changes and psychotic reactions. Social problems may relate to work, marital and financial difficulties. Patients' siblings, parents and significant others may also suffer from emotional disorders. The role of nonpsychiatric medical and para-medical personnel in the identification ...

Automatic junctional tachycardia is frequently refractory to medical management and difficult to treat with nonpharmacological methods. A 12-year-old female with symptomatic, refractory automatic junctional tachycardia is reported. Earliest atrial activation during supraventricular tachycardia was in the posterior portion of the intraatrial septum. The patient underwent electrophysiological study and successful radiofrequency ...

The sudden development of cyanotic lesions on the feet may be a result of atheroembolic disease or a number of medical conditions. A careful history and physical examination, basic laboratory tests, and noninvasive vascular assessment usually distinguish between medical and surgical causes and direct the choice of further investigations. Specific ...

One of the most common and distressing side effects after surgery performed under general anaesthetic is postoperative nausea and vomiting (PONV). Indeed, for many patients, PONV is the most distressing feature of their operation and some may become anxious about having another operation because of this. The medical and economic ...

The failure of a femoral embolectomy presents a difficult problem. The role of popliteal embolectomy in the subsequent management is still not clear. A study of 12 patients who underwent a secondary popliteal embolectomy is reported. Nine of the 12 patients had successful results in terms of limb salvage. The ...

Hip dysplasia has been managed conservatively and medically since the initial description of this disease in 1935. However, little factual information is known about the benefits of the various forms of conservative and medical management. Nonsteroidal anti-inflammatory drugs have been a mainstay of treatment, with the only real debate being ...

MetLife developed a corporate-wide health promotion program based on a survey of its employees, its local management, and its medical personnel. The survey's goals were to determine the wellness topics of greatest interest to employees, as well as topics believed by local management and medical personnel to be of greatest ...

This article presents an overview of some of the more commonly encountered disorders of the gastrointestinal tract that are seen in athletes. As with other medical conditions, the clinician can often be blinded by an athlete's physical activity and overlook underlying disease. Fortunately, most of the maladies described here are ...

A 14-year-old girl had a granulomatous conjunctival lesion, proven histologically to be malakoplakia. This is the first reported case of malakoplakia arising from conjunctiva, although three others have involved the ocular adnexa. Malakoplakia is a rare disease often associated with immunodeficiency and is characterized by the presence of intracellular inclusions ...

This article reviews the modern approach and advances in the management of aneurysmal subarachnoid hemorrhage. Early diagnosis along with aggressive medical and surgical clipping appears to reduce morbidity and mortality. Computed tomography scan is greater than 95% sensitive for diagnosis. Aneurysm clipping within 48 hours has been performed successfully in ...