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At least 361 records · Page 20Linked to original sources
PubMed1998

Care of the renal transplant recipient: a field guide for the generalist.

More than 60,000 kidney transplant recipients currently live in the United States. It is not uncommon for these persons to receive medical care through a primary care physician. The widely held belief that only physicians and surgeons with "special knowledge" can care for these patients is clearly not the case. In addition to considering the immediate posttransplantation problems, this section attempts to demystify the care of kidney transplant recipients beyond the first few months of recovery after surgery. It also serves as a guide to help determine which problems can be handled by a primary care physician and which indicate referral back to the transplant center. Common infectious problems, both bacterial and viral, are discussed. This section also considers metabolic abnormalities such as hypertension, increased lipids, gout, calcium/bone diseases, and hematologic issues. Common conditions that cause real or perceived decreases in function but are not related to graft rejection are also explained.

Bacterial Infections↗
PubMed1997

The role of the generalist in the care of the substance-abusing patient.

It will be some time before known effective practices on behalf of patients with ATOD problems are integrated into the mainstream of medical care. Ironically, much of the medical literature centers on the medical and psychiatric complications of substance abuse and on physician attitudes regarding treatment of these patients. Rather the focus should be on the ways in which physicians can intervene early and effectively to treat the substance abuse problem itself. Much of this issue serves to correct the imbalance.

Family Practice↗
PubMed1997

Managed care of substance abuse disorders. Implications for generalist physicians.

Given the rapidly changing landscape of both private and public health plan programs, it is foolhardy to suggest that a definitive characterization of managed care and substance abuse issues can be made. Among other topics, this article discusses goals of managed care organizations, managed care models, and physicians' roles in managed care.

Cost Control↗
PubMed1984

Children with chronic asthma: care by the generalist and the specialist.

We have come a long way since 1882 when Dr. Henry Salter published his treatise, On Asthma: Its Pathology and Treatment. His task then was even more complex than ours is today. He not only worked alone in a medical void, providing care for over 200 patients with chronic asthma, but he also suffered from the same disease. But not only is asthma not an uncommon disease, but it is one of the direst suffering; the horrors of the asthmatic paroxysm far exceed any acute bodily pain; the sense of impending suffocation, the agonizing struggle for the breath of life, are so terrible, that they cannot even be witnessed without sharing in the sufferer's distress. With a face expressive of the intensest anxiety, unable to move, speak, or even make signs, the chest distended and fixed, the head throne back between the elevated shoulders, the muscles of respiration ridged and tightened like cords, and tugging and straining for every breath that is drawn, the surface pallid or livid, cold and sweating--such are signs by which this dreadful suffering manifests itself. And, even in the intervals of health the asthmatic's sufferings do not cease; he seems well, he goes about like his fellows and among them, but he knows that he is altogether different from them; he bears about his disease within him wherever he goes; he knows he is struck; he is conscious that he is not sound--he cannot be warranted; he is not certain of a days, perhaps not of an hours health; he only knows that a certain percentage of his future life must be dedicated to suffering; he cannot make an engagement except with a proviso, and from any of the occupations of life he is cut-off; the recreations, the enjoyments, the indulgences of others are not for him; his usefulness is crippled, his life is marred; and if he knows anything of the nature of his complaint he knows that his sufferings may terminate in a closing scene worse only than the present. Today, this need not be the case.

Asthma↗
PubMed2001

Endometrial adenocarcinoma: a primer for the generalist.

Endometrial cancer is the most common gynecologic malignancy in the United States. The mean and median age of women with endometrial adenocarcinoma is 61 years. Most endometrial cancers are type I estrogen-dependent endometrioid adenocarcinomas. Most women with endometrial adenocarcinoma have stage I disease. Patients with stage I disease endometrial adenocarcinoma can be treated with a simple hysterectomy, bilateral salpingo-oophorectomy, peritoneal lavage, and periaortic node dissection in selected cases. The probability of survival according to international statistics is as follows: stage IA, 91%; stage IB, 88%; stage IC, 81%; stage IIA, 77%; stage IIB, 67%; stage IIA, 60%; stage IIIB, 41%; stage IIC, 32%; stage IVA, 20%; stage IVB, 5%.

Adenocarcinoma↗
PubMed2003

Chronic idiopathic urticaria for the generalist.

Chronic idiopathic urticaria (CIU) manifests as frequently occurring, short-lived wheals, surrounded by a bright-red flare, and often accompanied by angioedema. The cause of CIU is undefined and its diagnosis requires exclusion of other conditions with somewhat similar symptoms. Recent evidence has indicated that IgG autoantibodies directed against high-affinity IgE receptors (FcepsilonRI) may be involved in the pathophysiology of CIU. Following the release of mast cell or basophil-derived histamine, this mediator binds to H(1) and H(2) receptors, leading to vasodilatation and increased vascular permeability. Individuals with CIU may be unable to conduct normal daily activities; therefore, prompt initiation of effective treatment is essential. General management of patients should include avoidance of substances likely to trigger or intensify episodes. Treatment with antihistamines is the mainstay of pharmacotherapy for CIU. Selection of antihistamine therapy for patients with CIU should be based on the following key properties: (1) proven clinical efficacy in providing a high rate of symptom improvement, (2) rapid onset of action and a long-lasting response, and (3) an excellent safety profile and a high degree of tolerability. The benefit of some second-generation antihistamines is limited by sedation, drug-drug interactions, or a variable therapeutic response. The H(1)-receptor antagonist desloratadine is a new, once-daily treatment option that is potent and nonsedating, and has a low potential for drug-drug interactions. Desloratadine has a rapid onset of action and has been shown to effectively and safely reduce pruritus and the number and size of hives in patients with CIU, leading to improvements in quality of life.

Journal Article↗
PubMed1999

Workforce dilemmas: a comparison of staffing in a generalist and a specialist intensive care unit.

Intensive care units are arguably one of the most costly resources a hospital has to maintain in terms of nursing staff, skills and technology. Given that the Government's agenda on quality remains one of obtaining cost-effective healthcare, it is imperative that nursing managers consider the implications of the new policy shift for how they currently provide services. The purpose in this paper is to compare the different staffing levels adopted by managers in generalized and neurosurgical intensive care in an acute hospital trust. The dilemmas facing managers making staffing decisions without any definitive guidelines for resourcing these specialized units are examined.

Cost-Benefit Analysis↗