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PubMed2002

[Practical management of diabetic foot].

Prevention and the correct treatment of the diabetic foot have important social and economic consequences. Risk stratification is essential for choosing the appropriate treatment strategy. History and careful clinical examination identify the risk in each individual patient with diabetes. Peripheral neuropathy (PNP), foot deformation, peripheral arterial disease (PAD) and a history of previous ulcer or amputation are the most important risk factors. PAD must be diagnosed and treated by percutan transluminal angioplasty or bypass surgery where necessary. Primary foot deformation or secondary due to PNP require shoe modifications. Good metabolic control of diabetes and treatment of other cardiovascular risk factors (dyslipidemia, hypertension) delay or prevent the development of PNP and PAD. Therefore an early multidisciplinary approach is essential for each patient with diabetes and foot problems. In the presence of a foot ulcer, it's important to diagnose osteomyelitis by clinical or radiological examination. The choice and duration of antibiotic treatment and surgical intervention depends on the localisation and extension of infection around the ulcer and the presence of osteomyelitis. In case of limb threatening infection, the patient should be referred to a specialized treatment facility immediately.

Arthropathy, Neurogenic↗
PubMed2005

[Practical management of common arrhythmias in children].

Premature supraventricular or ventricular beats are frequently seen in children of all age groups and are in most instances a benign condition. Intermittent and infrequent premature beats usually are not an indication for a cardiologic work-up. If ventricular or supraventricular premature beats are frequent and persist over a period of weeks or months, we usually recommend a cardiological evaluation. In those patients where ventricular or supraventricular tachycardias are found, the treatment is based on symptomatology, frequency of arrhythmias and impact on quality of life. In ventricular tachycardias, the presence of underlying cardiac disease is of prognostic importance and treatment more aggressive. Idiopathic ventricular tachycardia without structural heart disease usually shows a benign course and has a good prognosis.

Age Factors↗
PubMed1997

A survey of clinician attitudes and management practices in hypertension.

In order to determine the compliance of Canadian physicians with evidence-based hypertension guidelines, a self-administered questionnaire survey was distributed to a stratified random sample of 473 physicians in Central Alberta, Canada in December 1995. Excluding non-deliverable questionnaires, a response rate of 67% was obtained. Twenty-five per cent of respondents routinely used the fourth Korotkoff sound to define diastolic blood pressure (DBP). Investigations recommended for the initial workup of a patient with mild hypertension included serum creatinine (90%), electrolytes (72%), glucose (50%), cholesterol (44%), electrocardiogram (65%), and urinalysis (76%). The non-pharmacologic treatment advice routinely advocated for patients with mild hypertension included salt restriction (87%), weight loss (100%), and regular aerobic exercise (92%). While 46% of respondents recommended antihypertensive therapy for an otherwise healthy patient with an average DBP of 95 mm Hg, 76% recommended therapy for patients with the same BP plus target organ damage or other cardiovascular risk factors. Medication choices varied, although angiotensin-converting enzyme inhibitors were chosen by 46% for patients with uncomplicated essential hypertension and 67% for patients with other cardiovascular risk factors, and beta-blockers were the most frequently chosen first-line agents (56%) for the patient with target organ damage. There was considerable variability in the self-reported practice patterns, and concordance was greater for those recommendations which were consistent across the currently available guidelines. Consistent with the principle underlying all of the current hypertension guidelines, respondents were more aggressive in their treatment of hypertensive patients with other cardiovascular risk factors or target organ damage.

Adult↗
PubMed2002

Practical management of anticoagulation, bleeding and blood product support for cardiac surgery. Part two: transfusion issues.

We summarise recent advances in transfusion medicine applicable to cardiac surgery and cardiac transplantation. It is important that clinicians know the risks of blood transfusion in Australia. They should also be aware of the different types of transfusion reaction so that there is early recognition and investigation. Blood conservation strategies including acceptance of normovolaemic anaemia in clinically stable patients are important in reducing the requirement for red cell transfusion. Cytomegalovirus (CMV) seronegative blood products are recommended for heart transplant recipients with no evidence of prior CMV infection. Leucodepletion of units of unknown CMV status reduces the risk of CMV infection and are an acceptable alternative when seronegative units are unavailable. Leucodepletion of cellular blood products has been shown to reduce infection rates postoperatively in a large trial involving cardiac surgical patients. Further studies are needed to confirm this promising finding. Irradiation of blood products eliminates the risk of transfusion-associated graft versus host disease. Routine preoperative screening for cold agglutinins is no longer recommended.

Journal Article↗
PubMed2006

Clinical experience: practical management of five patients with cutaneous T-cell lymphoma (CTCL)-related symptoms.

There are now a wide variety of therapeutic options for managing patients with cutaneous T-cell lymphoma-related symptoms. These include skin-directed therapies such as psoralen with UVA irradiation (PUVA), topical chemotherapies such as mechlorethamine (nitrogen mustard) and carmustine (BCNU), electron beam radiation, and systemic therapies such as chemotherapy, photopheresis, and interferons. Although treatment algorithms exist for patients with early stage disease, often treatments are individualized, based on patient specific factors, cost, and accessibility of referral centers for specialized therapies. This article provides details of five real-life case studies to illustrate how cutaneous T-cell lymphoma management can be tailored to the needs of each individual patient.

Aged↗
PubMed1988

Snakebites. Guidelines for practical management.

Snakebite treatment remains a controversial subject, even among experts. Nevertheless, all physicians need to be aware of current concepts in snakebite management, because incorrect treatment could be detrimental or even fatal. This article discusses the mechanisms of envenomation and presents guidelines for snakebite prevention, emergency field therapy, and emergency department therapy.

Edema↗
PubMed1988

Practical management of ingrown toenails.

An ingrown toenail acts as a foreign body, causing an inflammatory reaction and opening the way to secondary infection. Treatment consists of removing the offending portion of the nail and taking steps to prevent recurrence. The treatment should be simple to minimize expense, operative risks, and posttreatment disability. The most important step in preventing recurrence is teaching the patient the correct way to trim toenails.

Humans↗
PubMed1989

Acute and chronic bronchitis. A practical management strategy.

Bronchitis is a common diagnosis in the primary care physician's office, especially during winter. Acute bronchitis is usually caused by viruses but a number of other pathogens may also be responsible. Therapy for acute bronchitis is generally supportive. Chronic bronchitis, characterized by prolonged sputum production, is most often caused by cigarette smoking, which decreases mucociliary transport velocity. This and other pathophysiologic effects of smoking can lead to exacerbations of the disease that may necessitate antimicrobial therapy. Antimicrobial agents and vaccines may have both prophylactic and therapeutic roles in the management of chronic bronchitis.

Acute Disease↗