Showing papers in "Primary Care in 2008"
TL;DR: A multidisciplinary approach is required to accomplish this goal of reducing morbidity and mortality in CKD patients with a number of serious complications.
Abstract: Chronic kidney disease (CKD) is a complex disease affecting more than 20 million individuals in the United States. Progression of CKD is associated with a number of serious complications, including increased incidence of cardiovascular disease, hyperlipidemia, anemia, and metabolic bone disease. CKD patients should be assessed for the presence of these complications and receive optimal treatment to reduce their morbidity and mortality. A multidisciplinary approach is required to accomplish this goal.
383 citations
TL;DR: Patients who have hypercalcemia have hyperparathyroidism or malignancy; those who have hypocalcemia, hypophosphatemia, and hypomagnesemia have reduced gastrointestinal absorption, and those who has hyperphosphatemicemia and hypermagnesia have increased intake in the setting of kidney disease.
Abstract: Disorders of mineral metabolism are common in both the office and hospital setting. The diagnosis can be simplified by remembering the target organs involved—intestine, kidney, and bone—and by assessing the presence of kidney disease, levels of parathyroid hormone, and vitamin D status. Although the list of possible causes for these derangements is long, most patients who have hypercalcemia have hyperparathyroidism or malignancy; those who have hypocalcemia, hypophosphatemia, and hypomagnesemia have reduced gastrointestinal absorption, and those who have hyperphosphatemia and hypermagnesemia have increased intake in the setting of kidney disease.
308 citations
TL;DR: It is important to note that definitions of normal sleep patterns, sleep requirements, and sleep disorders in childhood must necessarily incorporate the wide range of normal developmental and physical maturational changes across childhood and adolescence, and cultural, environmental, and social influences.
Abstract: Approximately 25% of all children experience some type of sleep problem at some point during childhood. A number of studies have examined the prevalence of parent- and child-reported sleep complaints in large samples of healthy, typically developing children and adolescents; many of these have also further delineated the association between disrupted sleep and behavioral concerns. Sleep problems are even more prevalent in children and adolescents with chronic medical, neurodevelopmental, and psychiatric conditions. It is important to note that definitions of normal sleep patterns, sleep requirements, and sleep disorders in childhood must necessarily incorporate the wide range of normal developmental and physical maturational changes across childhood and adolescence, and cultural, environmental, and social influences.
218 citations
TL;DR: Efforts should be made not to detect or treat asymptomatic bacteriuria and funguria; to ensure an appropriate duration of therapy for symptomatic infections; and to limit the use of broad-spectrum agents, especially fluoroquinolones, if narrower spectrum agents are available.
Abstract: Urinary tract infection (UTI), with its diverse clinical syndromes and affected host groups, remains one of the most common but widely misunderstood and challenging infectious diseases encountered in clinical practice. Antimicrobial resistance is a leading concern, with few oral options available to treat infections caused by Gram-negative organisms resistant to trimethoprim-sulfamethoxazole and fluoroquinolones, especially for patients with upper tract disease. Efforts should be made not to detect or treat asymptomatic bacteriuria and funguria; to ensure an appropriate duration of therapy for symptomatic infections; and to limit the use of broad-spectrum agents, especially fluoroquinolones, if narrower spectrum agents are available. Further research is needed regarding rapid diagnosis of UTI, accurate presumptive identification of patients with resistant pathogens, and development of new antimicrobials for drug-resistant UTI.
212 citations
TL;DR: The literature regarding the pathophysiology, causes, diagnosis, and treatment for vocal cord dysfunction is reviewed.
Abstract: Vocal cord dysfunction, also called paradoxical vocal cord motion, is a common mimicker of asthma, allergies, and severe upper airways obstruction with consequent misdiagnosis and mismanagement, and is frequently overlooked. Unfortunately, there is no unified understanding of this disorder, nor is there any consensus on its evaluation, etiology, or treatment. This article reviews the literature regarding the pathophysiology, causes, diagnosis, and treatment for this common disorder.
78 citations
TL;DR: Age-related hormone loss and supplementation therapies for age-related hormonal deficiencies as possible first-line therapeutic modalities to be considered in the search to improve quality of life, prevent chronic illnesses, and maintain wellness.
Abstract: Confusion and controversy surround the use of estrogen, progesterone, testosterone, growth hormone, and thyroid hormones. This article discusses age-related hormone loss and supplementation therapies for age-related hormonal deficiencies as possible first-line therapeutic modalities to be considered in our search to improve quality of life, prevent chronic illnesses, and maintain wellness. The well-informed use of hormones in wellness and disease prevention will result in symptomatic improvement and should be considered an integral part in the armamentarium of options we offer our patients.
55 citations
TL;DR: There are various ways by which a patient with renal disease can present as either an initial outpatient or an inpatient consultation, including a percutaneous renal biopsy and an algorithmic approach to hematuria and proteinuria.
Abstract: There are various ways by which a patient with renal disease can present as either an initial outpatient or an inpatient consultation. Some patients can present with incidental hematuria and/or proteinuria. Symptoms generally vary but are more commonly noted with advanced stages of chronic kidney disease. A systematic, well organized approach is of utmost necessity in arriving at the correct diagnosis. A multitude of laboratory and ancillary studies, including a percutaneous renal biopsy (performed when necessary), are available to arrive at the right diagnosis. An algorithmic approach to hematuria and proteinuria is also presented.
48 citations
TL;DR: The current understanding of infant crying and sleeping problems, together with the implications of this understanding for services and research, with a focus on the first months of infancy are summarized.
Abstract: This article summarizes the current understanding of infant crying and sleeping problems, together with the implications of this understanding for services and research, with a focus on the first months of infancy.
47 citations
TL;DR: The presentation of bedtime problems and night wakings, empirically validated interventions, and challenges to treatment in both typically developing and special populations of children are reviewed.
Abstract: Bedtime problems and night wakings in children are extremely common, and the treatment literature demonstrates strong empirical support for behavioral interventions. Empirically validated interventions for bedtime problems and night wakings include extinction, graduated extinction, positive routines, and parental education. Most children respond to behavioral interventions, resulting not only in better sleep for the child, but also better sleep and improved daytime functioning for the entire family. This article reviews the presentation of bedtime problems and night wakings, empirically validated interventions, and challenges to treatment in both typically developing and special populations of children.
41 citations
TL;DR: This article reviews the diagnosis and management of both acute and chronic sinusitis and includes discussion of the prevalence of disease, the current understanding of disease pathogenesis, diagnosis, and contemporary treatment.
Abstract: Both acute and chronic sinusitis are common diseases associated with significant morbidity and consumption of health care dollars. Acute sinusitis is caused by an infectious process and can often be difficult to distinguish from a viral upper respiratory infection, as signs, symptoms, and even the results of most diagnostic tests overlap. In contrast, chronic sinusitis is an inflammatory disease and, contrary to common practice, long term antibiotics are likely not useful. This article reviews the diagnosis and management of both acute and chronic sinusitis and includes discussion of the prevalence of disease, our current understanding of disease pathogenesis, diagnosis, and contemporary treatment.
40 citations
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TL;DR: The importance of stress screening in primary care is emphasized, and several methods of stress reduction appropriate to primary care settings are described.
Abstract: The impact of stress on physical functioning (endocrine, gastrointestinal, immune, and cardiovascular systems) is reviewed. The effect of stress on psychiatric functioning and health behaviors also is discussed. The importance of stress screening in primary care is emphasized, and several methods of stress reduction (including exercise, cognitive-behavioral therapy, and mindfulness-based stress reduction) appropriate to primary care settings are described.
TL;DR: Physicians can use background information regarding the regulation, production, and possible health impact of bottled water to counsel patients.
Abstract: Health and safety concerns have dramatically increased the consumption of bottled water in developed countries, including the United States. The economic and environmental impact of the many different bottled water products on the market is considerable, and the role and impact of bottled water for routine use is unclear, outside the setting of emergencies or natural disasters, when routine water sources may be unsafe. Evidence for routine health risks or benefits from using bottled water is limited. Patients who have specific health needs may wish to use bottled or filtered water. Physicians can use background information regarding the regulation, production, and possible health impact of bottled water to counsel patients.
TL;DR: A series of steps that can be used in both the outpatient and inpatient settings to ensure the clinician identifies not only overt abnormalities but also subtle disturbances that may lay hidden in a routine set of serum chemistry values are reviewed.
Abstract: Employing a systematic approach to the interpretation of serum chemistries is the most effective way to ensure abnormalities are detected and correctly interpreted. This article reviews a series of steps that can be used in both the outpatient and inpatient settings. These steps will help to ensure the clinician identifies not only overt abnormalities but also subtle disturbances that may lay hidden in a routine set of serum chemistry values.
TL;DR: Insomnia, jet lag, and shift work sleep disorders are presented and issues related to women's health and sleep are reviewed and Pharmacologic and behavioral treatments for sleep conditions are explored.
Abstract: Until recently, sleep has been a mystery even to scientists. Research has defined sleep function and the effects of sleep deprivation. Sleep disorders are interrelated with medical and psychiatric illnesses. This article presents insomnia, jet lag, and shift work sleep disorders and reviews issues related to women's health and sleep. Pharmacologic and behavioral treatments for sleep conditions are explored.
TL;DR: An evidence-based look at the latest research in vitamin and mineral supplements is given so primary care physicians can be proactive in advising patients about proper use of vitamins and minerals.
Abstract: Some vitamin and mineral supplements have proved to be clinically useful in preventing various diseases and health problems. Many widely used supplements, however, have shown no benefit when carefully studied. There are also several disease states and medications that should prompt the physician to recommend certain preventive supplements. This article gives an evidence-based look at the latest information in this area. Primary care physicians should be familiar with the latest research so they can be proactive in advising patients about proper use of vitamins and minerals.
TL;DR: An evidence-based approach is used to demonstrate how exercise affects health, mental health, disease prevention, and productivity.
Abstract: How would you define exercise? If you look up exercise in the dictionary, it is defined as physical activity used for the purpose of conditioning any part of the body. Exercise is an important topic because in the United States less than 50% of the total population exercises on a regular basis. The lack of regular physical activity is linked to an increased rate of obesity, development of chronic diseases, and an overall decline in health. This article uses an evidence-based approach to demonstrate how exercise affects health, mental health, disease prevention, and productivity.
TL;DR: Determining the type of adverse reaction to the food responsible is important because of the implications regarding the mechanism involved, reproducibility, and the prognosis.
Abstract: A rise in food allergy, accompanied by heightened public awareness, guarantees that clinicians will increasingly be consulted to accurately distinguish adverse reactions to foods from other disorders. The potential impact of inaccurately labeling a food as a cause of symptoms includes delaying appropriate treatment for another disorder or needlessly removing a food from the diet, with potential adverse nutritional and social consequences. When symptoms are triggered by food ingestion, determining the type of adverse reaction to the food responsible is important because of the implications regarding the mechanism involved, reproducibility, and the prognosis.
TL;DR: The various treatment options for patients with end stage renal disease are addressed, with the goal of avoiding renal replacement therapy.
Abstract: The latest National Health and Nutrition Study revealed an increasing incidence of kidney disease among aging baby boomers, as the incidence of diabetes mellitus and hypertension rises. Because of this trend, a greater proportion of a primary care physician's practice will involve patients with chronic kidney disease, and consequently, end stage renal disease. Unfortunately, far too many of these chronic kidney disease patients are referred to a nephrologist very late. More often than not, the opportunity for secondary preventive intervention, with the goal of avoiding renal replacement therapy, is lost. This article addresses the various treatment options for patients with end stage renal disease.
TL;DR: The new criteria for diagnosis and staging of AKI is reviewed and the current understanding of the many causes ofAKI is summarized and the approach to diagnosis and management is summarized.
Abstract: During the past half decade there has been a paradigm shift in the view of acute kidney disease that has resulted in a change in nomenclature from the older term, "acute renal failure," to "acute kidney injury" (AKI). This article reviews the new criteria for diagnosis and staging of AKI and summarizes the current understanding of the many causes of AKI and the approach to diagnosis and management.
TL;DR: As kidney transplant recipients survive for longer periods of time with functioning allografts, primary care physicians will likely become more involved in their management, mandating at least a basic understanding of immunosuppression and its complications.
Abstract: The short-term outcomes of kidney transplant recipients have improved dramatically in the past 20 years, in large part resulting from the availability of more potent immunosuppressive drugs capable of preventing or treating acute allograft rejection. Ironically, side effects from these same immunosuppressants play a role in the long-term morbidity and mortality of this patient population. As kidney transplant recipients survive for longer periods of time with functioning allografts, primary care physicians will likely become more involved in their management, mandating at least a basic understanding of immunosuppression and its complications.
TL;DR: This article reviews some of the commonly used herbal supplements and others focusing mainly on disease prevention, and when possible, a summary of efficacy and safety is provided to facilitate decision making.
Abstract: The use of complimentary and alternative medicine is on the rise. This article reviews some of the commonly used herbal supplements and others focusing mainly on disease prevention. A summary table of medical conditions is provided, and when possible, a summary of efficacy and safety is provided to facilitate decision making.
TL;DR: An overview of the range of secondary causes, including key clinical features and appropriate diagnostic and treatment options is provided, including selection of patients for testing should incorporate historical and clinical clues, previous treatment course, and comorbidities.
Abstract: Secondary hypertension is the presence of a specific condition known to cause hypertension, which may be the primary cause or a contributing factor in a patient who already has primary hypertension. Although uncommon, it may cause major morbidity for a subset of patients. This article provides an overview of the range of secondary causes, including key clinical features and appropriate diagnostic and treatment options. Selection of patients for testing should incorporate historical and clinical clues, previous treatment course, and comorbidities. Decisions regarding the extent of secondary evaluation require consideration of the likelihood of diagnosis, the patient's overall health status and prognosis, and balancing the risks of intervention against the risks of missing a diagnosis. Referral is advised when these risks seem prohibitive or if there are questions regarding the selection of the most optimal studies or the extent of intervention to pursue when blood pressure remains uncontrolled.
TL;DR: This primer on occupational asthma is intended for the primary care clinician to provide the essential tools to diagnose and treat airways disease in the workplace.
Abstract: Although most adult patients seen by a clinician are employed, medical school curricula and residency training rarely cover occupational exposures and resultant diseases, even common ones that are encountered in a typical medical practice. This primer on occupational asthma is intended for the primary care clinician to provide the essential tools to diagnose and treat airways disease in the workplace. Using a case vignette format, we review the basic approach to suspecting and establishing a diagnosis of occupational asthma and address the thornier question of what to do about it. After reviewing this primer, the reader will be able to routinely include occupational asthma as part of the differential diagnoses in the adult patient with new or worsened asthma.
TL;DR: An assessment of the tempo and severity of renal deterioration is critical to separate potential medical emergencies, such as RPGN, from those more indolent disorders that can be managed by the primary care physician.
Abstract: This article provides a general overview of some of the more common or illustrative glomerular and tubulointerstitial disorders encountered in clinical practice. Disorders are grouped into those causing the nephrotic syndrome, the acute nephritic syndrome and rapidly progressive glomerulonephritis (RPGN), and chronic tubulointerstitial disease. This division is useful for narrowing the differential diagnosis and deciding on further testing and management. Elements of the past history, including detailed family, medication, and social histories, and recent symptoms and physical examination findings are as much a part of the diagnostic workup as are urinary and blood tests. An assessment of the tempo and severity of renal deterioration is critical to separate potential medical emergencies, such as RPGN, from those more indolent disorders that can be managed by the primary care physician.
TL;DR: The epidemiology, recognition, screening, and management of six systemic diseases that commonly present with renal manifestations: diabetic nephropathy, lupus nephritis, congestive heart failure, HIV, liver disease, and dysproteinemias are discussed.
Abstract: This article discusses the epidemiology, recognition, screening, and management of six systemic diseases that commonly present with renal manifestations: diabetic nephropathy, lupus nephritis, congestive heart failure, HIV, liver disease, and dysproteinemias. Diabetic nephropathy remains the leading cause of end-stage renal disease in the United States. The outlook for patients who have lupus nephritis and HIV-associated nephropathy has improved in the last decade. Kidney disease is common in patients who have advanced liver disease, and creatinine-based methods do not provide an accurate estimation of renal function in this population. Dysproteinemias are associated with protean renal manifestations, and renal disease may be the presenting manifestation.
TL;DR: The evolving epidemiology of renal disorders among the elderly is reviewed and evidence put forward to explain this phenomenon is summarized.
Abstract: Population aging has been accompanied by a growing burden of chronic medical conditions. Elderly individuals represent an increasing proportion of the total number of patients with chronic kidney disease, acute renal failure, and end-stage renal disease. In addition, age-related changes in the kidneys and other organ systems predispose the older person to disturbances in fluid and electrolyte balance, which exacerbate renal dysfunction. This article reviews the evolving epidemiology of renal disorders among the elderly and summarizes evidence put forward to explain this phenomenon.
TL;DR: The primary care office is the most likely entry point to the health care system for most of the population and should be the preferred venue for addressing chronic disease prevention.
Abstract: This article outlines steps on how to move the treatment of obesity to a new paradigm of prevention in the primary care setting. Almost all Americans visit their primary care physician or health care provider for routine health maintenance or some unexpected illness or sickness at one point or another. The primary care office is the most likely entry point to the health care system for most of the population and should be the preferred venue for addressing chronic disease prevention. Prevention in the primary care setting is the short- and long-term solution to obesity.
TL;DR: This article attempts to give an overview of the evidence as regards all of these aspects and definitions of health.
Abstract: What are the best dietary practices and farming methods to promote health? The answer may depend on whether one looks at the health of individuals or the health of the planet (planetary health or PH). PH will equate to a healthy ecosphere fostered by dietary/farming practices that are less resource-intense, potentially decreasing starvation and carbon emissions. Best practices also may depend on whether by health one means lack of observable disease (such as obesity, nutritional deficiency, diabetes, or cancer), optimal health (also known as wellness), or longevity. This article attempts to give an overview of the evidence as regards all of these aspects and definitions of health.
TL;DR: The rapid and often relentless progression of type 2 diabetes suggests that high-risk patients should be provided with an equally aggressive strategy to protect their remaining beta-cell function and endogenous insulin secretion.
Abstract: The rapid and often relentless progression of type 2 diabetes suggests that high-risk patients should be provided with an equally aggressive strategy to protect their remaining β-cell function and endogenous insulin secretion. Management of patients with prediabetes should incorporate both lifestyle and pharmacologic intervention. Although no specific recommendations are published for the management of prediabetes, one can assume that preservation of pancreatic β-cell function, improvement in peripheral insulin resistance and pancreatic insulin secretion, reducing pancreatic α-cell secretion of glucagon, preventing long- and short-term diabetes-related complications, and assisting patients to loose weight are beneficial. Aggressive, timely, and physiologic management of prediabetes should be advocated.
TL;DR: The recognition and management of exposure to indoor and outdoor pollutants, heavy metals, pesticides, electromagnetic fields, and endocrine-disrupting chemicals are listed.
Abstract: This article reviews the sources of exposure and health effects of common toxicants encountered by patients in primary care practice. The recognition and management of exposure to indoor and outdoor pollutants, heavy metals, pesticides, electromagnetic fields, and endocrine-disrupting chemicals are listed. A sample environmental history form is included.