Disease: its cause and effect. 10: Iatrogenic disease.
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Based on current commercial aquaculture production practices, the production cycle for Atlantic salmon (Salmo salar) extends over a 36-month period during which time the fish are first exposed to intensive freshwater rearing conditions followed by transportation to marine netpen sites for ongrowing. It is predictable that, because of the duration of the production cycle and the variety of water conditions, deleterious environmental conditions have many opportunities to affect salmon health directly and indirectly. Furthermore, diseases which are iatrogenic arise from current methods used to prevent or treat infectious diseases. Specific, more frequently encountered examples are explored, with reference to the possible roles which these diseases may have in favouring the onset of infectious diseases.
Physicians should consider iatrogenic disease in every differential diagnosis. This article reviews some of the more frequent undesirable events that may result from the use of commonly prescribed drugs, as well as strategies to prevent their occurrence.
The author considers iatrogenesis as a phenomenon, determines therapeutic manipulations responsible for iatrogenic complications, indicates the commonest iatrogenic diseases relevant to children's surgery, analyzes psychogenic and somatogenic iatrogenic diseases. The problem involving a number of unresolved terminological and statistical problems assumes ever greater importance. It can be managed only with mutual attempts of the clinicians and pathologists.
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Iatrogenic respiratory disease is an important cause of patient morbidity and mortality. Clinical and radiologic findings are nonspecific and diagnosis can be difficult. Therefore, it is important for physicians to be familiar with the iatrogenic diseases for which their patients are at risk, as well as their common radiologic appearances. Causes of iatrogenic respiratory disease include drugs, transplantation, radiation, transfusion, or other miscellaneous therapies.
BACKGROUND: Data on iatrogenic diseases (IDs) have been recorded for the past 25 years. We determined whether aging of the general population and medical advances, including more powerful drugs and complex procedures, have altered the incidence, causes, and consequences of severe IDs during this period. METHODS: One-year retrospective study was conducted in an adult medical-surgical intensive care unit (ICU) affiliated with a French general hospital in an area of 200 000 inhabitants. All the patients admitted to the ICU during 1994 were screened for IDs. Patients with community or hospital-acquired IDs on admission were included. Follow-up assessed morbidity, mortality, workload, and costs of care for IDs, and the rate of preventable IDs. were included; the cause of the ID was drugs in 41, medical acts in 12, and surgical acts in 15. These 68 patients were in the ICU for 472 days, with a 13% fatality rate (9 patients) and a financial cost of US $688 470. They were not different from the 555 other ICU patients in terms of severity, mortality, workload, and length of stay in the ICU. Risk factors for ID were old age and the number of prescribed drugs. The rate of preventable ID was 51%. CONCLUSIONS: Iatrogenic diseases are a persistent and important reason for admission to the ICU, and the risk factors, causes, and consequences remain unchanged since 1980. Despite 25 years of experience with high-technology medicine, ID still has a negative impact on the health and resources of society.
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Primary care physicians need to be aware of iatrogenic disease and its causes. Adverse drug reactions, including drug-drug interactions, and certain diagnostic procedures may lead to iatrogenic complications. Hospitalized patients, especially the elderly, face increased risks of such complications. Physicians who are aware of common adverse reactions to drugs, drug combinations, and medical procedures may be able to help patients avoid unnecessary distress and morbidity.
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