Diabetes mellitus--to predict or not to predict.
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This clinical practice guideline makes specific recommendations for identifying at-risk adults and for defining early interventions for preventing pressure ulcers. The guideline may also be used to treat Stage I pressure ulcers (nonblanchable erythema of intact skin). These guideline recommendations are not intended as the basis of care of infants and children, nor do they apply to individuals with existing Stage II or greater pressure ulcers or to individuals who are fully mobile.
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The effects of life events and previous symptoms on current symptom levels were examined in a model using data from a 3-year prospective study. Male psychiatric patients and nonpatients reported on life events and symptoms every 2 months on 18 occasions. Logistic regression analysis of these data revealed little dependence of psychiatric symptoms on preceding life events as measured by the Holmes and Rahe Schedule of Recent Experiences (SRE). The best predictor of the current symptom level was the level of previous symptoms. It is concluded that efforts to relate changes in the social environment to health must first consider the possible contribution of the antecedent symptom level to the variability in health outcome.
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Surrogate markers in clinical medicine provide a useful means to assess therapeutic response to pharmacologic therapy in a wide range of chronic disease states. In the area of osteoporosis, the surrogate markers of change in bone mineral density (BMD) and bone turnover markers (BTM) provide the clinician with a means of assessing the biologic response to osteoporosis-specific pharmacologic agents. Increases in BMD and/or reductions in BTM can independently be correlated to reductions in vertebral and nonvertebral fracture risk. In managing osteoporosis patients, the BTM change at an earlier point of time after initiation of therapy and a change in BTM can provide earlier feed-back to the patient and clinician regarding issues such as compliance and a bone biologic response. An increase in BMD at 12 or 24 months after initiation of therapy is also evidence of an improvement in bone strength though with antiresorptive agents no change in BMD may also be associated with risk reduction within clinical trial sets. In this regard, changes in BMD and BTM are complimentary in their application to patient management.
Various aspects of the medical and social history of 12 743 children examined at the age of 5 years were related to two risk scores for the sudden infant death syndrome (SIDS) computed from data collected in the neonatal period. Children at high risk of SIDS were also at high risk of pneumonia, non-accidental injury and repeated or prolonged hospital admissions. There were stronger associations, however, with factors indicating social disruption and environmental disadvantage.
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