Both transurethral microwave thermotherapy (TUMT) and medical management by alpha-blockade or 5-alpha-reductase inhibition are increasingly being considered as alternatives to surgery for treatment of patients with benign prostatic hyperplasia (BPH). We review current evidence supporting the effectiveness and safety of TUMT and medical management. Factors for consideration in appropriately selecting ...

The management of colonoscopic perforations is still evolving. Many now agree to the selective management strategy: Perforations during diagnostic colonoscopy being treated surgically and therapeutic ones treated conservatively. However, patients with diagnostic perforation, if they have clean bowel and no signs of peritonitis, are still treated conservatively. We report here ...

Pictographs have been used in nonliterate societies to help people remember spoken instructions and, today, they could be used to help nonliterate people remember spoken medical instructions. This study tested the hypothesis that pictographs can improve recall of spoken medical instructions. Twenty-one junior college subjects listened to lists of 38 ...

Hyperlipidemia is a common disease that leads to considerable morbidity and mortality. It is a major risk factor for the development of atherosclerosis. Hyperlipidemia is often undertreated by medical providers. Several large, randomized trials have established the benefit of aggressive management of hyperlipidemia. Effective treatment requires a multidisciplinary approach. There ...

Stroke survivors can be plagued by numerous medical complications, including aspiration pneumonia, heart disease, depression, and venous thromboembolism. Given the impairment already caused by stroke itself, these patients require careful management by a comprehensive rehabilitation team. Dr Harvey discusses common stroke syndromes, possible complications, and appropriate rehabilitation options covering a ...

In little more than a decade, allergic fungal sinusitis has gone from a medical curiosity to one of the more perplexing problems to challenge the otorhinolaryngologist. These patients are typically immunocompetent adolescents or young adults with pansinusitis (unilateral and bilateral) and polyposis, atopy, and characteristic radiographic findings. Allergic mucin contained ...

A case-control study was designed using equine medical records from the UC Davis Veterinary Medical Teaching Hospital (VMTH) and data derived through a mailed survey. The objective was to evaluate the associations between horse demographics, horse-management factors, and equine Corynebacterium pseudotuberculosis infection in California. Horses admitted to the VMTH between ...

The provision of medications to patients is not a departmental task managed by the pharmacy. Rather, it is an enterprise-wide task with management shared by physicians, pharmacists, and nurses. Only automation approaches that integrate all three axes in real time will be able to effectively support the desired goal: the ...

Keeping geriatric patients healthy and out of the hospital can save your organization big dollars, but it's a task much more easily said than done. In this "second generation" DM pilot, find out how a broad-based approach that addresses functional and psychosocial needs, as well as medical issues, may become ...

There are many conflicting opinions among health professionals and parents regarding care of the normal foreskin in young boys as well as the highly controversial subject of circumcision. Minor foreskin related complaints are very common in the first few years of life. Most of these can be managed with advice ...

A management services organization (MSO) has emerged as one structure to manage professional and hospital risk agreements. Health plans and direct payers are transferring traditional functions to medical groups and health systems under these agreements. How does a hospital and affiliated medical group develop a strategy to assume, manage, and ...

The presence of gastric spirochaetal organisms was first documented over a century ago. Though repeatedly reported in the medical literature, it was felt that these spiral bacteria were merely contaminants and the reports were generally ignored by the medical community. On 22 October 1982, at a meeting of the Royal ...

"Medical" thoracoscopy as compared with "surgical" thoracoscopy (which is more precisely known as video-assisted thoracic surgery (VATS)) has the advantage that it can be performed under local anaesthesia or conscious sedation, in an endoscopy suite, using nondisposible rigid instruments. Thus, it is considerably less invasive and less expensive. The main ...

In the next decade, "better" management will be defined by cost effectiveness including morbidity, mortality, and cost. We used a cost-effectiveness model for children with Wolff-Parkinson-White syndrome (WPW) and supraventricular tachycardia (SVT) comparing medical, surgical, and catheter ablative treatment between age 5 years (estimated average age at first recurrence after ...

The medical management of the subarachnoid hemorrhage patient has changed considerably over the past two decades. The widespread acceptance of early aneurysm obliteration allows the aggressive prophylaxis and treatment of many of the serious complications of this condition. Recognition of cerebral vasospasm and the prevention of the delayed ischemic deficits ...

As neuroradiologic techniques become more critical to the care of patients suffering from aneurysmal subarachnoid hemorrhage, a thorough understanding of the natural history and medical management of this disorder by neuroradiologists is required to insure appropriate diagnosis and therapy. This article addresses the medical and perioperative management of subarachnoid hemorrhage, ...

Though neuropathic plantar ulcers are known to be "round-like," systematic quantitative data on their shape and geometric features are not readily available. A sample of 305 ulcers were retrospectively assessed to provide distribution data on quantitative geometric and shape parameters. After tracing the ulcer during the patient's initial visit, the ...

Replicated the efficacy of a short-term, combined medical and behavioral intervention protocol for retentive encopresis. Fifty-nine children who had failed standard medical management for retentive encopresis and their parents participated in six 1-hour group treatment sessions. Treatment protocol combined the medical management strategies of enema clean out, increasing dietary fiber, ...

Data File: This month's column analyzes the results of the 1997 Capitation Survey conducted by the publisher of PSCR. While providers report ups and downs in Medicare PMPM rates from 1996 to 1997, utilization is clearly on the rise, signaling that providers need to beef up their medical management of ...

As an elder's functional impairment increases, so in general does the tendency for the caregiver to intervene in the elder's daily activities and initiatives. To a certain extent, such intervention is necessary to compensate for the elder's loss of independent ability, and without such intervention, adverse outcomes for the elder ...

With enrollments in HMOs increasing at double digit rates, independent practice associations, integrated medical groups, hospitals and specialty networks are experiencing a substantial increase in the share of their business paid for through capitation. Experience has shown that once one contract is signed, many are sure to follow. Providers must ...

Patients recovering from alcohol and other drug addiction have unique medical and pharmacological needs. Careful selection of medications call decrease the risk of relapse. Angiotensin-converting enzyme inhibitors and calcium channel-blocking medications are excellent choices to treat hypertension. Most gastrointestinal problems resolve with abstinence and can be treated nonpharmacologically. In managing ...

The authors review the current conservative management of ureteric stones. The physiopathology of the renal colic is analyzed with its implications in the medical treatment. The role of NSAID is enhanced. Stone size and stone location are to be considered when evaluating the possibility of spontaneous passage of the stone. ...

The modern medical management of endometriosis has changed considerably since the first attempts were made to control this disease hormonally over four decades ago. Currently, there are multiple choices for the clinician and patient, including oral contraceptives, danazol, GnRH agonist analogues, and gestrinone. Several advances have been made in the ...

Many survivors of the newborn intensive care units who were premature do very well; some, however, go on to have a variety of medical complications related, in part, to their prematurity. An overview of the medical outcomes of prematurity are discussed in the areas of respiratory disease (bronchopulmonary dysplasia), gastrointestinal ...

Ulcerative colitis (UC) is a chronic disease that may require extensive medical and, at times, surgical intervention. Patients with UC are encouraged to form a multidisciplinary healthcare team to provide the support needed to cope with this chronic, debilitating illness. In this article, the authors provide the personal perspective of ...

BACKGROUND: Menorrhagia is a well-known complication of factor V deficiency. CASE: A 13-year-old girl with factor V deficiency presented with acute hemorrhage on day 4 of menses. Laboratory assessment revealed a hemoglobin of 36 g/L. The ultrasound appearance of a large loculated cystic mass was consistent with substantial intraperitoneal bleeding. ...

Travel-associated dermatoses are among the six most frequent medical problems encountered by international travelers. Skin disorders caused by parasites previously confined to the tropics are seen with increasing frequency by physicians in nonendemic areas. Cutaneous manifestations may provide important clues to the underlying infection. This article describes the epidemiology, assessment, ...

People and organizational issues are critical in both implementing medical informatics systems and in dealing with the altered organizations that new systems often create. The people and organizational issues area--like medical informatics itself--is a blend of many disciplines. The academic disciplines of psychology, sociology, social psychology, social anthropology, organizational behavior ...

Control of hyperparathyroidism is a major goal of the management of bone diseases in chronic dialysis patients. Severity of hyperparathyroidism has been evaluated mainly by the level of parathyroid hormone (PTH), however, parathyroid size can be another critical marker. Patients with larger parathyroid glands are usually more resistant to calcitriol ...

The diagnosis and management of a newborn with ambiguous genitalia is a diagnostic challenge. Rapid medical evaluation is necessary to uncover and treat potentially life-threatening illnesses, and to allay the psychological stress placed on new parents awaiting announcement of their baby's sex of rearing. Understanding the mechanisms of sexual differentiation ...

Noninvasive mechanical ventilation (NMV) now represents the first step in the management of acute on chronic respiratory failure (A/CRF). During the last 5 yrs, many studies have confirmed the feasibility of NMV in an acute setting, either by facial or nasal interface, used in addition to volumetric or barometric respirators, ...

Traveler's diarrhea occurs with considerable frequency in individuals traveling to underdeveloped countries. It is acquired through the ingestion of fecally contaminated food and water. Traveler's diarrhea is caused by a variety of bacterial, protozoal, viral, and parasitic organisms. Typically self-limiting, traveler's diarrhea is more of an inconvenience than a life-threatening ...

In 1993, Continental Medical Systems, Inc. (CMS), a provider of comprehensive medical rehabilitation, developed the Total Outcomes and Prediction Program (TOPP) to measure and evaluate key medical rehabilitation outcomes, quality indicators, and patient satisfaction at its 37 acute rehabilitation hospitals. The broad purposes of TOPP are to manage patient treatment, ...

There are different types of wandering patterns as well as different etiologies which include both emotional and physiological origins. All interventions should focus on understanding why the behavior is present. Wandering may have beneficial effects for the client such as satisfying emotional needs as well as improving physical limitations--poor circulation ...

CVI is a common disease with significant morbidity that results from venous hypertension of the extremities. Increased perfusion pressure probably traps excessive numbers of white blood cells in the capillaries. Activated leukocytes subsequently damage capillary endothelium, increase capillary permeability, and cause ischemia of the overlying skin as a result of ...

OBJECTIVE: To identify risk factors for poor medication management skills in community-dwelling older adults by using a performance-based medication management assessment instrument. DESIGN: A cross-sectional investigation. SETTING: A university outpatient geriatric assessment clinic. PARTICIPANTS: Fifty-nine community-dwelling older adults aged 62-102 years. MEASUREMENTS: Patients were assessed on their ability to perform ...

This paper reports on a pilot study where a scheme for the self-management of medication has been devised as an intervention strategy, where the mental health nurse and the mentally ill client work together to improve the client's knowledge of prescribed medication and medication-related issues. Aspects of non-compliance and the ...

PURPOSE: To study prospectively the effectiveness of medical management of congenital dacryoceles. METHODS: All patients presenting with congenital dacryocele that were not infected were treated with warm compresses, massage, and topical antibiotics. Dacryoceles that did not resolve with at least two weeks of medical management were probed. Dacryoceles that were ...

Alopecia is a common side effect in patients managed on the mood stabilizers lithium, valproate, and carbamazepine. Clinicians may be reluctant to discontinue medications in patients suffering from hair loss if the mood stabilizer is otherwise efficacious. Therefore it is important to be familiar with the epidemiology, diagnosis, and management ...

Brain edema, seizures, and venous thromboembolism are frequently encountered complications of cerebral metastases that result in increased morbidity and mortality. Effective medical management of these complications with steroids, anticonvulsants, and anticoagulants can result in symptomatic improvement and a better quality of life for these patients. However, these medical therapies should ...

Munchausen syndrome by proxy often is managed differently from other forms of child maltreatment, although it is differentiated from them only by the active engagement with the medical profession in the production of morbidity. We suggest a more rigorous approach to Munchausen syndrome by proxy, with explicit acknowledgement that it ...

Lesions in the alimentary tract were studied in eight medically fragile Holstein cattle homozygous for the bovine leukocyte adhesion deficiency (BLAD) allele as determined by polymerase chain reaction and restriction endonuclease analysis. These cattle received institutional medical care but died or were euthanatized because of chronic debilitation associated with diarrhea ...

BACKGROUND: This paper examines the pattern and frequency of implementation of environmental strategies and the use of psychotropic medication in the management of patients with delirium in an acute hospital setting. METHOD: The study involved 46 consecutive referrals to a consultation psychiatry service each of whom met ICD-10 criteria for ...

GERD is a common clinical problem. Generally, its clinical presentation and management are straightforward. Greater awareness of the numerous extraesophageal manifestations of the disease aids patients and physicians in appropriate recognition and treatment. Medical therapy is effective in the majority of cases but often requires long-term medication for acceptable symptom ...

In more than 15 years of functioning as a medical director, addressing the needs and wants of patients, physicians, hospitals, and ancillary health care suppliers, I have accumulated pieces of ¿wisdom¿ that I now feel I should share with others in medical management. The concepts are fairly simple, but they ...

Chylothorax is the presence of lymphatic fluid in the pleural space resulting from a leak of the thoracic duct or one of its major divisions. This condition is being recognized more frequently after both cardiac and general thoracic surgical procedures. Increased understanding of the physiology, pathogenesis, diagnosis, and management of ...

Fifty years ago, Wegener's granulomatosis was a uniformly fatal condition; the diagnosis was usually made post-mortem. Today, many patients survive, with a 93% complete remission rate reported 4 years after diagnosis. Four medical advances over the past 50 years have enhanced our understanding and management of this rheumatologic disorder. They ...

A substantial percentage of the positions that open in medical management are filled through the use of recruitment firms. This is especially true of more senior positions, but it applies across the full spectrum of openings. If the working arrangement between the recruitment firm and the potential candidate is to ...

OBJECTIVE: To describe clinical and laboratory guidelines for assessment and management of patients presenting with chronic fatigue syndrome (CFS). DATA SOURCES: Relevant international consensus diagnostic criteria and research literature on the epidemiology, pathophysiology, concurrent medical and psychological disturbance and clinical management of CFS. CONCLUSIONS: Medical and psychiatric morbidity should be ...