2886 research outputs found
Sort by
Management and Prevention of Recurrent, Uncomplicated Urinary Tract Infections in Premenopausal Women
No full textUrinary tract infections (UTIs) are a common complaint encountered by healthcare providers in a multitude of clinical settings and primarily affect non-pregnant women of reproductive age. Many of these individuals experience chronically recurring UTIs either due to a relapsing infection or reinfection following resolution of the initial infection. The current cornerstone and most effective form of prophylaxis utilizes long term, low dose antibiotics. However, the emergence of worldwide antimicrobial resistance highlights the need for further exploration of alternatives to antibiotics in the management of recurrent UTIs. This article reviews the pathophysiology of recurrent UTIs and presents both antibiotic and non-antibiotic approaches to care
Current Discharge Guidelines and Interventions for Patients with COPD to Reduce Avoidable 30-day Readmissions
No full textAvoidable readmissions place a major strain on the American healthcare system and contribute to poor patient outcomes. Patients with COPD are one population that experience avoidable 30-day readmissions at a high rate. Many discharge interventions have been trialed to reduce readmissions with varying levels of success. This special article reviews the global and national guidelines regarding discharge practices for patients with COPD, then compares those to current discharge interventions, with an exploration into the appropriate timing of post discharge follow-up appointments
Magnesium Sulfate as an Adjunctive Treatment to Therapeutic Hypothermia in Neonatal Hypoxic-ischemic Encephalopathy (HIE)
No full textNeonatal hypoxic-ischemic encephalopathy (HIE) is a critical condition characterized by impaired oxygen and blood supply to the newborn brain, resulting in potential long-term neurological deficits.1,2 HIE remains a significant cause of morbidity and mortality in newborns, necessitating the exploration of therapeutic strategies. Magnesium sulfate (MgSO4), used in conjunction with therapeutic hypothermia, has emerged as a promising neuroprotective agent in the context of HIE. This research delves into current literature and clinical trials examining the efficacy of MgSO4 in mitigating HIE\u27s consequences, emphasizing its neuroprotective mechanisms involving modulation of excitotoxicity, inflammation, and oxidative stress.2,3 Notably, the American College of Obstetricians and Gynecologists (ACOG) recommends MgSO4 administration in cases of anticipated preterm birth before 32 weeks of gestation to prevent cerebral palsy (CP).16 However, the specific use of MgSO4 in the treatment of neonatal HIE remains an evolving area of research. The timing of administration and the severity of the hypoxic-ischemic insult are crucial factors influencing the effectiveness of MgSO4. While promising, further studies are needed to establish standardized protocols for MgSO4 use in neonatal HIE, ensuring optimal neuroprotective outcomes and minimizing potential adverse effects. Healthcare professionals should consider individual patient factors and adhere to the latest guidelines when making treatment decisions
Coronary Artery Disease – Future Tools for Optimizing Primary Prevention
No full textCoronary artery disease (CAD) is a progressive, obstructive, and inflammatory process affecting the endothelial lining of the coronary arteries, which ultimately compromises the perfusion of the myocardium and can lead to ischemic infarction. This narrowing of vasculature which supplies the myocardial tissue leads to a spectrum of anginal syndromes and inevitably, catastrophic consequences. This article is focused on understanding the pathophysiology of this disease process and educating providers on emerging clinical tools that can be utilized to prevent progression, and ultimately reduce morbidity and mortality of this insidious disease process
The Management of Gastroparesis and Other Possible Comorbid Conditions
No full textGastroparesis is a chronic gastrointestinal disorder characterized by delayed gastric emptying without mechanical obstruction. This paper explores the nature of gastroparesis, with a primary focus on idiopathic and diabetic etiologies. The pathophysiology, diagnostic modalities, risk factors, clinical presentation, and management strategies are discussed. Various theories are presented, including the role of proinflammatory macrophages, oxidative stress, and vagus nerve dysfunction. The standard diagnostic tools, including gastric emptying scintigraphy, wireless motility capsule, and breath testing, are also reviewed. A multidisciplinary approach encompassing dietary modifications, pharmacological therapies, and invasive procedures is essential for optimizing patient outcomes. The paper also addresses ongoing research into the relationship between gastroparesis and comorbid conditions such as Ehlers-Danlos syndrome, postural orthostatic tachycardia syndrome, and mast cell activation syndrome. This comprehensive CME aims to provide insight into the complexities of gastroparesis and the importance of individualized patient care
Male Infertility: From Root Causes to Modern Interventions
No full textMale infertility impacts up to 15% of men and contributes significantly to worldwide infertility.1 A multifaceted issue with etiologies from before, after or during spermatogenesis. It includes hypothalamic-pituitary-gonadal axis dysfunction, genetic abnormalities, congenital malformations, systemic illnesses and environmental factors.2 The evaluation of male infertility considers contributing factors and interconnections with broader health issues. Pre-testicular factors discussed include Klinefelter syndrome, Y-chromosome microdeletions, hyperprolactinemia, thyroid dysfunction, obesity, diabetes mellitus, nutrition, pharmaceuticals and lifestyle. Problems within the testicles are cryptorchidism, varicoceles, infections, neoplasms, trauma and anti-sperm antibodies. Common post-testicular reasons are cystic fibrosis, erectile dysfunction, premature ejaculation, hypoactive sexual desire, vasectomies and retrograde ejaculations. Narrowing down causes includes semen analysis, history-taking, examination, hormonal and genetic testing. Treatments vary as patients may benefit from assisted reproductive technologies, surgical interventions, behavior modifications, medication adjustments and hormone therapies.1 Correcting male infertility requires a personalized approach and is unattainable in 30% of cases
Addressing Sleep Behaviors in Children with Autism Spectrum Disorder
No full textSleep behaviors consist of one’s sleep habits and schedule, such as the total time spent asleep, sleep onset latency, nightmares, dreams, and any disruptions to sleep. Sleep onset latency is the amount of time it takes to fall asleep once the lights are off. Sleep behaviors are a common issue in children with autism spectrum disorder (ASD). These sleep issues can have a detrimental impact on a child and their parents since they affect the child’s behaviors and may cause stress for the parents. “Sleep problems are associated with poorer child functioning, including increased ASD symptom severity, behavioral problems, and poorer health related quality of life”. 6 It is essential that clinicians understand how to treat different sleep behaviors using either pharmacologic or non-pharmacologic methods. Treating the sleep behaviors can help reduce behavioral issues and increase quality of life. This article will provide guidelines on how to diagnose and treat sleep behaviors in children with ASD
Exercise Interventions for Treatment of Osteoporosis
No full textOsteoporosis is a very prevalent degenerative bone disease, causing fractures in 1 out of 3 women and 1 out of 5 men over the age of 50. Osteoporotic fractures lead to severe pain, immobility, and loss of quality of life. They also increase the risk of fractures with falling, leading to further disability and potentially mortality. Treatment is a combination of pharmacologic interventions and lifestyle modifications, including exercise.9,20 While exercise is considered an important intervention, there are not well defined guidelines for optimal exercise regimens for osteoporosis.1,7,20 Exercise can be a daunting task for many people, but even more so with fragility from osteoporosis. The aim of this article is to use evidence based medicine to determine effective and manageable exercise regimes for patients with osteoporosis
Utility of the Pelvic Organ Prolapse Quantitative System (POP-Q): Education for the Primary Care Provider
No full textPelvic organ prolapse (POP) is the prolapse of the bladder or rectal wall, uterus, or vaginal vault into the vaginal canal and potentially through the vaginal introitus. The pelvic organ prolapse quantification system (POP-Q) is a tool that is used to diagnose and stage POP using anatomical measurements. Nearly half of patients assigned female at birth will experience POP in their lifetime, however up to one third of them will not have access to specialty care. In patients who utilize primary care providers for their gynecologic care, using the POP-Q to diagnose suspected prolapse may not only increase provider and patient awareness of the condition but also improve access to preliminary assessment and care. This continuing medical education article will examine how this assessment tool can be used in the primary care setting as well as explore the etiology, presentation, and first line therapeutic options for POP
Hypertrophic Cardiomyopathy: Current Diagnosis and Management
No full textHypertrophic cardiomyopathy (HCM) is a cardiac condition characterized by excessive thickness of the left ventricular wall and septum. A diagnosis of HCM is life-changing and the consequences of a missed diagnosis are life-threatening. HCM is the most common cause of sudden cardiac death in those under the age of 30. The prevalence of HCM is 1 in 500 in the general population based on echocardiographic studies. However, it is estimated that only 1 in 1,395 people in the United States have a clinical diagnosis of HCM based on diagnosis codes. Undiagnosed HCM is a risk to patient safety and early detection is key to management, thus healthcare providers must be well-versed in the signs, symptoms, and process of diagnosis. Additionally, about half of cases of HCM are caused by known genetic mutations and inherited in an autosomal dominant pattern, so providers must be able to counsel patients and families as to their risks. Finally, it is important to remain educated on best practice guidelines for HCM management, particularly with the inclusion of the novel drug mavacamten