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At least 73 records · Page 4Linked to original sources
PubMed1997

Mood Disorders Secondary to Systemic Medical Conditions.

Evidence that secondary mood disorders are distinct clinical entities is mounting; and comparisons of mood disorders due to various medical or systemic conditions are only now beginning in earnest. Unlike mood disorders secondary to neurological illness, those secondary to medical conditions show wide variability in their prevalence rates and lack evidence of structural lesions within the central nervous system (CNS) as a pathophysiologic basis for their emergence. The authors selectively review literature published since 1990 concerning mood disorders secondary to four areas of medical illness: endocrine disorders, coronary artery disease, cancer, and end-stage renal disease. Potential pathophysiologic mechanisms for these depressions are examined, these include the role of cytokines in the CNS, subclinical cerebrovascular disease or leukoencephalopathy, altered platelet function, and dysregulation of CNS functions. Recent advances are dispelling old constructs regarding depressiosn in medical illness, but longitudinal studies of specific diseases are needed together with further work on the pathophysiology of these mood disorders.

Journal Article↗
PubMed1997

Physicians' guide to interactions between glaucoma and systemic medications.

PURPOSE: To develop a Physicians' Guide to assist clinicians in the concomitant use of glaucoma and systemic medications. METHODS: The records of 100 consecutive patients with chronic open-angle glaucoma were retrospectively studied to determine the most common systemic medications that are prescribed in this population. The ten most common drug classes were then used to construct a guide to potential interactions and side effects when these medications are used concomitantly with glaucoma drugs. RESULTS: Eighty-four patients were receiving 1 or more medications (a mean of 3.5) for a mean of 2.6 systemic conditions. Systemic antihypertensive agents was the most common class of drugs, being used by 48 patients. Aspirin, the most common single systemic drug, was being used by 25 patients. CONCLUSIONS: A high percentage of patients with chronic open-angle glaucoma receive a wide variety of medications for coexisting systemic disorders. The concomitant use of glaucoma and systemic medications creates the potential for drug interactions, as well as side effects for both groups of drugs, for which the Physicians' Guide may be beneficial.

Adrenergic beta-Antagonists↗
PubMed2001

Database reusability in intelligent medical systems.

Reuse or reusability is not a specific, algorithmic, heuristic or only a simple set of guidelines. Database reuse means the use of an existing component--a database entity--in a new context, either elsewhere in the same system or in another system. According to different definitions, an intelligent system is a "power tool for thinking"; but on the other side it is only a kind of information system with built-in knowledge to support decisions made by human experts. Similar conclusions could be made for intelligent medical systems and introduce the database reusability in this environment with a purpose to increase the quality of an intelligent medical system. In the paper the problem of the database reusability will be presented more in detail, especially its integration in an intelligent medical system. Finally, the results of such integration and the benefits for the medicine will be discussed.

Artificial Intelligence↗
PubMed1992

The effect of certain systemic medications on oral calculus formation.

A quantitative comparison was made of supragingival calculus that formed in individuals using systemic medications for defined systemic medical problems and individuals not using medication. Measurements of supragingival plaque and calculus were made on the lingual surfaces of the 4 mandibular incisors of 68 consecutive patients presenting for dental examinations and oral prophylaxes. Variables noted in addition to medication and plaque status were: age, sex, time interval since previous prophylaxis, and smoking status. Analysis of results indicated a statistically significant reduction of calculus among individuals medicated with beta-blockers, diuretics, anticholinergics, synthroid and allopurinol despite the high quantity of plaque present.

Adult↗
PubMed2003

The effects of antiglaucoma and systemic medications on ocular blood flow.

Based on the body of evidence implicating ocular blood flow disturbances in the pathogenesis of glaucoma, there is great interest in the investigation of the effects of antiglaucoma drugs and systemic medications on the various ocular vascular beds. The primary aim of this article was to review the current data available on the effects of antiglaucoma drugs and systemic medications on ocular blood flow. We performed a literature search in November 2002, which consisted of a textword search in MEDLINE for the years 1968-2002. The results of this review suggest that there is a severe lack of well-designed long-term studies investigating the effects of antiglaucoma and systemic medications on ocular blood flow in glaucomatous patients. However, among the 136 articles dealing with the effect of antiglaucoma drugs on ocular blood flow, only 36 (26.5%) investigated the effects of medications on glaucoma patients. Among these 36 articles, only 3 (8.3%) were long-term studies, and only 16 (44.4%) were double-masked, randomized, prospective trials. Among the 33 articles describing the effects of systemic medications on ocular blood flow, only 11 (33.3%) investigated glaucoma patients, of which only one (9.1%) was a double-masked, randomized, prospective trial. Based on this preliminary data, we would intimate that few antiglaucoma medications have the potential to directly improve ocular blood flow. Unoprostone appears to have a reproducible antiendothelin-1 effect, betaxolol may exert a calcium-channel blocker action, apraclonidine consistently leads to anterior segment vasoconstriction, and carbonic anhydrase inhibitors seem to accelerate the retinal circulation. Longitudinal, prospective, randomized trials are needed to investigate the effects of vasoactive substances with no hypotensive effect on the progression of glaucoma.

Eye↗
PubMed2002

Argon laser peripheral iridoplasty versus conventional systemic medical therapy in treatment of acute primary angle-closure glaucoma : a prospective, randomized, controlled trial.

OBJECTIVE: To study whether argon laser peripheral iridoplasty (ALPI) is as effective and safe as conventional systemic medications in treatment of acute primary angle-closure glaucoma (PACG) when immediate laser peripheral iridotomy is neither possible nor safe. DESIGN: Prospective, randomized, controlled trial. PARTICIPANTS: Seventy-three eyes of 64 consecutive patients with their first presentation of acute PACG, with intraocular pressure (IOP) levels of 40 mmHg or more, were recruited into the study. INTERVENTION: The acute PACG eye of each consenting patient received topical pilocarpine (4%) and topical timolol (0.5%). The patients were then randomized into one of two treatment groups. The ALPI group received immediate ALPI under topical anesthesia. The medical treatment group was given 500 mg of intravenous acetazolamide, followed by oral acetazolamide 250 mg four times daily, and an oral potassium supplement until IOP levels normalized. Intravenous mannitol also was administered to the latter group if the presenting IOP was higher than 60 mmHg. The acute PACG eye of both groups continued to receive topical pilocarpine (1%) until peripheral iridotomy could be performed. MAIN OUTCOME MEASURES: Intraocular pressure profile, corneal clarity, symptoms, visual acuity, angle status by indentation gonioscopy, and complications of treatment. RESULTS: Thirty-three acute PACG eyes of 32 patients were randomized to receive immediate ALPI, whereas 40 acute PACG eyes of 32 patients had conventional systemic medical therapy. Both treatment groups were matched for age, duration of attack, and IOP at presentation. The ALPI-treated group had lower IOP levels than the medically treated group at 15 minutes, 30 minutes, and 1 hour after the start of treatment. The differences were statistically significant. The difference in IOP levels became statistically insignificant from 2 hours onward. The duration of attack did not affect the efficacy of ALPI in reducing IOP in acute PACG. No serious laser complications occurred, at least in the early postlaser period. CONCLUSIONS: Argon laser peripheral iridoplasty significantly is more effective than conventional systemic medications in reducing IOP levels in acute PACG in eyes not suitable for immediate laser peripheral iridotomy within the first 2 hours from the initiation of treatment. Argon laser peripheral iridoplasty is a safe and more effective alternative to conventional systemic medications in the management of acute PACG not amenable to immediate laser peripheral iridotomy.

Acetazolamide↗
PubMedDate not supplied

Prevalence of errors in a pediatric hospital medication system: implications for error proofing.

The purpose of this study was to determine the prevalence of errors in the medication system of a pediatric teaching hospital. Error was defined broadly to capture all deviations in the process from medication order through administration of the dose. The long-term goal was to provide direction to efforts to error-proof the system. The sample was 3,312 medication orders written during 669 patient-days for which a total of 11,978 doses were passed. Errors were categorized as intercepted errors (intercepted through the normal processes of the medication system) or administration errors (errors that involve the patient with or without adverse sequelae). Errors were also categorized as errors in primary activities (e.g., prescribing or preparing the medication for administration) or supporting activity (e.g., transferring the order to another record). A total of 784 errors were identified; 98% were intercepted and 2% were administration errors. More errors (71%) occurred in supporting activities than in primary activities. Medication systems are complex processes. Errors are imbedded in the medication system and are typically intercepted before patients are involved. Intercepting errors involves additional work that adds to an already cumbersome process. Error proofing will be different for errors in primary activities and for supporting activities.

Child↗
PubMed2000

Ocular toxicity of systemic medications: a case series.

BACKGROUND: There are many visually threatening conditions that may result from long-term use of systemic medications. Many of these adverse side effects can be greatly reduced or prevented with close monitoring of patients. In view of current knowledge, updated clinical guidelines for appropriate monitoring of ocular toxicity from systemic medications need to be developed for the eye care practitioner. CASE REVIEW: There have been many reports of ocular toxicity from isoniazid, thioridazine, steroids, and amiodarone therapy. Clinical cases illustrating possible adverse ocular side effects are presented, which include INH-induced optic neuropathy, phenothiazine-induced retinopathy, steroid-induced glaucoma, and vortex epitheliopathy secondary to amiodarone. CONCLUSION: Optometrists should be aware of the potential for ocular side effects from systemic medications. Eye care guidelines for monitoring ocular side effects from thioridazine, INH, steroids, and amiodarone use are suggested.

Adult↗
PubMed1989

A preliminary trial of the programmable implantable medication system for insulin delivery.

We undertook a trial to determine whether an implanted insulin-delivery system, the programmable implantable medication system (PIMS), could be used to treat patients with insulin-dependent diabetes. PIMS is a pulsatile, programmable pump with a battery life expectancy of five years. The reservoir is refilled transcutaneously every two months with a surfactant-stabilized human insulin preparation containing 400 U of insulin per milliliter. Eighteen patients received PIMS-delivered insulin for 4 to 25 months (mean, 18). The total PIMS-implantation experience comprised 28 patient-years. Good glycemic control was established and sustained during treatment (mean plasma glucose level, 7.3 mmol per liter; mean glycohemoglobin level, 8 percent [upper limit of normal, 7.5 percent]), with significantly reduced glycemic fluctuations. The total mean daily insulin dose did not change. Insulin solutions withdrawn from the pump reservoirs contained 92 percent native insulin and preserved biologic activity. There were no surgical or skin complications, severe hypoglycemic episodes, or instances of diabetic ketoacidosis. One pump was replaced because of a manufacturing defect, and four patients had catheter blockages due to omental-tissue encapsulation; two withdrew from the study and two had devices that were repaired successfully. The actuarial rate of survival of catheter function was 78 percent at 1.5 years. We conclude from this pilot study that insulin treatment with an implanted, variable-rate, programmable pump is feasible for periods up to two years.

Adult↗
PubMed1995

An interactive patient information and education system (Medical HouseCall) based on a physician expert system (Iliad).

Informed patients are better equipped to participate in their own health care decisions. We present Medical HouseCall (TM), a consumer expert system and medical information guide, derived in part from a diagnostic and treatment software used by physicians (Iliad). HouseCall(TM) generates a differential diagnosis based on the user symptoms and medical history. HouseCall(TM) also provides alerts for potentially harmful drug interactions, allows for the recording of personal medical history, and offers extensive but easy-to-read information about a variety of medical topics. Focus group evaluations of HouseCall (TM) have demonstrated the program's ease of use, as well as an appreciation of technology that can be used at home to investigate and understand health issues and participate in solving medical problems.

Attitude to Computers↗
PubMed2006

Rape survivors' experiences with the legal and medical systems: do rape victim advocates make a difference?

This study used a naturalistic quasi-experimental design to examine whether rape survivors who had the assistance of rape victim advocates had more positive experiences with the legal and medical systems compared to those who did not work with advocates. Eighty-one survivors were interviewed in two urban hospitals about what services they received from legal and medical system personnel and how they were treated during these interactions. Survivors who had the assistance of an advocate were significantly more likely to have police reports taken and were less likely to be treated negatively by police officers. These women also reported less distress after their contact with the legal system. Similarly, survivors who worked with an advocate during their emergency department care received more medical services, including emergency contraception and sexually transmitted disease prophylaxis, reported significantly fewer negative interpersonal interactions with medical system personnel, and reported less distress from their medical contact experiences.

Adult↗
PubMed1988

The physician as a locus of authority, responsibility, and operational control of medical systems.

Physicians are commonly being excluded from meaningful participation in the planning, implementation, and operation of automated medical systems in hospitals. The authors advocate a rapid shift toward greater physician involvement in such systems, arguing that such a shift is desirable, feasible, and also inevitable. After reviewing the organization of information systems in hospitals, the authors describe the manner in which physician control of medical systems adds to the worth of such systems by enhancing the quality and efficiency of health care delivery. The proposed information system management role of physicians is characterized in terms of authority, responsibility, and operational control. Finally, advice is offered from an organizational perspective for establishing a physician as the hospital Medical Information Director.

Attitude to Computers↗
PubMed2005

"We are not completely Westernised": dual medical systems and pathways to health care among Chinese migrant women in England.

This examination of how Chinese migrant women resident in England engage with Western and Chinese healthcare systems when seeking treatment considers whether medical pluralism can enhance the cultural appropriateness of health care. The paper identifies the extent to which women's pathways to healthcare can be seen as 'Chinese' or as a reflection of the Western culture in which they live. It is based on an analysis of in-depth interviews with 42 women of Chinese origin living in the South East of England. Their use of Western and Chinese medicine is related to explanatory models underpinning health beliefs, treatment barriers encountered and resources drawn upon when seeking treatment. Variation is described, with some women using only Western medicine and others returning to their place of origin for indigenous Chinese medical treatment. Most, however, draw upon both medical systems. Women who are more connected with majority English culture are more successful in their consultations with Western health service practitioners but do not necessarily discontinue using Chinese medicine. We find that recourse to two different systems helps to overcome barriers when accessing health care. The health policy implications of the findings would suggest that a system that acknowledges and embraces medical pluralism would assist the development of culturally appropriate health care provision.

Adult↗
PubMed1992

University of Maryland Medical System: American medicine's first teaching facility reinvents the academic hospital.

The University of Maryland Medical School, established in 1807, focused on bedside teaching. This emphasis has continued and expanded through the growth of University Hospital and, ultimately, the University of Maryland Medical System, such that Maryland can now boast of a superb medical care system providing excellent medical education and research opportunities in a patient care setting.

History, 19th Century↗
PubMed2004

Saving President Reagan's life. The need for an organized emergency medical system in the United States to save lives of all casualties.

We are describing a heretofore untold narrative description of the emergency medical plan that saved the life of President Reagan on March 30th 1981. In 1976, Dr. Richard Edlich, director of the Emergency Medical Services at the University of Virginia Medical Center, wrote an editorial on the need for an emergency medical plan for the President of the United States. One year later Dr. Edlich enlisted the help of five distinguished experts in emergency medical systems in our nation to develop an emergency medical plan for the President of the United States. This published emergency medical plan was coauthored by Dr. David Boyd, the Director of Emergency Medical Services of the Department of Public Health and Welfare. Dr. Boyd wisely alerted both the Department of Health and Welfare as well as the White House staff, including Secret Service, of this plan. Realizing the importance of immediate emergency care, the Secret Service agent wisely recommended that the wounded President Reagan be immediately transported to the George Washington University Health Center, which has skilled emergency physicians as well as trauma surgeons, who saved the President's life. Realizing the benefits of this emergency medical plan that saved the life of the President of the United States, Drs. Edlich, Britt, and Wish will now be coordinating a medical narrative report that describes the development of emergency medical systems in the United States as well as modern trauma care in our nation.

Emergency Medical Services↗
PubMed2006

[Cancer board--new medical system in cancer clinic].

To proceed with more patient-oriented cancer medicine, the development of a new medical system is necessary in Japan. In Ariake Hospital of the Japanese Foundation for Cancer Research, a new medical system has been developed, which is composed of a common outpatient clinic and a conference system. The core conference system is called "Cancer Board". The practice of patient-oriented medicine in gastroenterological cancer has been introduced as a sample of the Cancer Board system in our hospital.

Ambulatory Care Facilities↗