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Defensive Medicine

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5081. Aseptic Meningitis (Treatment)

Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University in St Louis School of Medicine; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital Glenn Lopate, MD is a member of the following medical societies: , , Disclosure: Serve(d) as a director, officer, partner, employee, advisor (...) , consultant or trustee for: Alnylam Pharmaceuticals
Received income in an amount equal to or greater than $250 from: Alnylam Pharmaceuticals; GLG. Chief Editor Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM Adjunct Associate Professor of Neurology, University of Missouri-Columbia School of Medicine; Medical Director of St Mary's Stroke Program, SSM Neurosciences Institute, SSM Health Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM is a member of the following medical societies: , , Disclosure: Nothing

2014 eMedicine.com

5082. Assistive Devices to Improve Independence (Treatment)

, female sex, cognitive impairment, poor self-rated health, low BMD, osteoporosis, inactivity, sedative use, alcohol use, and orthostatic hypotension. Extrinsic risk factors include adverse effects of medications, polypharmacy, and environmental hazards. Psychotropics, neuroleptics, tricyclic antidepressants, benzodiazepines, analgesics, sedatives, skeletal muscle relaxants, cardiac drugs (diuretics, antiarrhythmics), vasodilators, and antihistamines may contribute to falls. Results of studies suggest (...) that the risk of falls and fractures in elderly patients taking selective serotonin reuptake inhibitors (SSRIs) is not different from that of patients taking tricyclic antidepressants. The use of 4 or more medications of any type also increases the risk of falls. Fatigue induced by radiation therapy or chemotherapy also creates a risk of falls in an elderly patient with cancer. Environmental barriers include stairs, uneven footpaths, polished floors, thick mats or carpeting, and poor footwear choices (eg

2014 eMedicine.com

5083. Amyloidosis, overview

. Disease-modifying antirheumatic drugs (DMARDs) such as colchicine, a microtubule inhibitor and weak immunosuppressant, can prevent secondary renal failure due to amyloid deposition specifically in familial Mediterranean fever. Newer therapies have become more targeted to avoid the cytotoxicity of older agents (eg, chlorambucil, cyclophosphamide). The SAA amyloid seen in CAPS was reduced with a biologic interleukin (IL)–1β trap called rilonacept. Tumor necrosis factor–alpha (TNF-alpha) is also thought (...) antiretroviral therapy (HAART). [ ] Previous Next: Treatment of Amyloidosis Patisiran (Onpattro) was the first drug approved by the US Food and Drug Administration (FDA), in August 2018, for treatment of polyneuropathy caused by hereditary transthyretin-mediated amyloidosis (hATTR) in adults. The first of a new class of targeted RNA-based therapies, patisiran acts by using RNA to interfere with the production of mutant transthyretin (TTR) protein, thereby reducing serum TTR protein levels and TTR protein

2014 eMedicine.com

5084. Delusional Disorder (Treatment)

of Psychiatry, Texas A&M University Health Science Center College of Medicine James A Bourgeois, MD, OD, MPA is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s) Raheel A Khan, DO Assistant Clinical Professor in Psychosomatic Medicine, Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center Raheel A Khan, DO is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Donald M Hilty, MD Associate (...) Chief of Staff, Mental Health, Northern California VA Healthcare System; Vice-Chair of VA Mental Health Services Donald M Hilty, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief Editor David

2014 eMedicine.com

5085. Munchausen Syndrome (Treatment)

Virginia Medical School; Attending Physician, Division of Emergency Medicine, Children's Hospital of The King's Daughters Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment What would you like to print? What would you like to print? Sections Factitious Disorder Imposed on Self (Munchausen's Syndrome) Find Us On About (...) helpful. Options include the following: Family therapy Cognitive-behavioral therapy Supportive psychotherapy There is little evidence to support the efficacy of any particular pharmacologic intervention in treating factitious disorder; however, the following principles should apply: Pharmacologic therapy may be indicated for concurrent psychiatric diagnoses Drugs may also be considered for treatment of the presenting symptoms Caregivers should routinely copy each other on every progress note

2014 eMedicine.com

5086. Multisystem Organ Failure of Sepsis (Treatment)

of Medicine, Wayne State University School of Medicine; Consulting Staff, Pulmonary Disease and Critical Care Medicine Service, Henry Ford Health System Daniel R Ouellette, MD, FCCP is a member of the following medical societies: and Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment What would you like to print? What would (...) of a potential source of infection. Patients in septic shock require immediate cardiorespiratory stabilization with large volumes of intravenous (IV) fluids, infusion of vasoactive drugs, and, often, endotracheal intubation and mechanical ventilation. Empiric IV antimicrobial therapy should be immediately directed toward all potential infectious sources. The drugs used for hemodynamic support of patients with sepsis have adverse effects on splanchnic circulation. Accordingly, the ideal hemodynamic therapy

2014 eMedicine.com

5087. Mucormycosis (Treatment)

initiation of liposomal amphotericin B therapy, and surgical resection are critical. [ , , ] Other important considerations in medical management include the following: requires insulin and volume repletion with intravenous fluids. associated with hematologic malignancy and its treatment should be reversed, if possible, with the use of colony-stimulating factors and the withdrawal of cytotoxic chemotherapy. Wean glucocorticosteroids and other immunosuppressive drugs. Interrupt therapy; hydroxypyridine (...) : Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance John L Brusch, MD, FACP is a member

2014 eMedicine.com

5088. Mucormycosis (Treatment)

initiation of liposomal amphotericin B therapy, and surgical resection are critical. [ , , ] Other important considerations in medical management include the following: requires insulin and volume repletion with intravenous fluids. associated with hematologic malignancy and its treatment should be reversed, if possible, with the use of colony-stimulating factors and the withdrawal of cytotoxic chemotherapy. Wean glucocorticosteroids and other immunosuppressive drugs. Interrupt therapy; hydroxypyridine (...) : Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance John L Brusch, MD, FACP is a member

2014 eMedicine.com

5089. Mucosa-Associated Lymphoid Tissue (Treatment)

but an increased risk of developing gastric cancer later. In addition, this population had an increased risk of developing non-Hodgkin lymphoma. [ ] A study by Gong et al suggests that H pylori eradication therapy may be worthwhile as an initial treatment for gastric MALTomas even in patients who test negative for H pylori, regardless of stage. [ , ] Inappropriately aggressive surgical, radiation, or medical therapy that results in serious injury or long-term disability is a potentially serious medicolegal (...) . The anti-CD20 monoclonal antibody rituximab has been reported to achieve remissions in patients with gastric MALTomas who either were not responsive to anti– H pylori therapy or were not infected with H pylori. Amiot et al conducted a single-center retrospective study to evaluate effectiveness of gastric MALToma treatment in 106 H pylori –negative patients. Outcomes of oral alkylating monotherapy, rituximab monotherapy, and combination therapy with both drugs were compared. At 2-year followup, both

2014 eMedicine.com

5090. Multifocal Choroidopathy Syndromes (Treatment)

that do not correspond to clinical lesions have also been noted. [ ] Etiology The etiology of MCP remains unknown. Extensive systemic medical evaluations have not yet identified a single common cause for MCP. Unlike POHS, where 90% of patients exhibit positive reactions to the histoplasmin skin test, only 25% of patients with MCP exhibit positive reactions to this skin test. [ ] Positive treponemal serology is evident in up to 27% of patients with MCP, yet no modification of the disease (...) with penicillin treatments has been achieved to date. Radiologic investigations of patients with MCP have demonstrated hilar adenopathy in a small minority of patients (approximately 4%) along with pulmonary calcification (approximately 10%). In conjunction with this, approximately 20% of patients with MCP have a positive Mantoux test. Half of those patients, when treated with antituberculous medications, have a decrease in the ocular inflammation. Sarcoidosis has also been diagnosed in more than one third

2014 eMedicine.com

5091. Cocaine-Related Psychiatric Disorders (Treatment)

chest pain is usually benign. However, these patients may have an acute coronary syndrome, pneumothorax, pulmonary embolism, pulmonary edema, or aortic dissection. Before these patients are discharged home or admitted to a psychiatric ward, the clinicians involved must evaluate the patient for other nonpsychiatric medical problems. Cocaine intoxication Acute cocaine intoxication is usually self limited and can be managed with supportive care. Benzodiazepines are the first-line therapy in treating (...) trials of medications for cocaine dependence. NIDA Res Monogr . 1997. 175:182-91. . Crits-Christoph P, Siqueland L, Blaine J, et al. Psychosocial treatments for cocaine dependence: National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Arch Gen Psychiatry . 1999 Jun. 56(6):493-502. . Cubells JF, Feinn R, Pearson D. Rating the severity and character of transient cocaine-induced delusions and hallucinations with a new instrument, the Scale for Assessment of Positive Symptoms

2014 eMedicine.com

5092. Cobb Syndrome (Treatment)

Charles Egan, DO is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. Specialty Editor Board David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic David F Butler, MD is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. Rosalie Elenitsas, MD Herman Beerman (...) Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System Rosalie Elenitsas, MD is a member of the following medical societies: , , , Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor. Chief Editor Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

2014 eMedicine.com

5093. Clostridium Difficile Colitis (Treatment)

inflammation and deteriorating clinical condition despite antibiotic treatment, total abdominal colectomy or diverting loop ileostomy combined with colonic lavage is recommended. Additional management measures include discontinuing unnecessary antimicrobial therapy, adequate replacement of fluids and electrolytes, avoiding antimotility medications, and reviewing the use of proton pump inhibitors. CDC promotes improving inpatient antibiotic prescribing to reduce drug resistance and increase patient safety (...) Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine BS Anand, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Acknowledgements Acknowledgments The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US government. LCDR Jennifer Curry is a military service member. This work was prepared

2014 eMedicine.com

5094. Chronic Obstructive Pulmonary Disease (Treatment)

sustained cessation with the placebo. Bupropion may also be effective in patients who have not been able to quit smoking with nicotine replacement therapy. Another drug used in smoking cessation is varenicline (Chantix). Varenicline is a partial agonist selective for alpha4, beta2 nicotinic acetylcholine receptors. Its action is thought to result from activity at a nicotinic receptor subtype, where its binding produces agonist activity while simultaneously preventing nicotine binding. Agonistic activity (...) showed no benefit at low-dose therapy and short-lived benefit with higher doses (>30 mg of prednisolone). [ ] Inhaled corticosteroids provide a more direct route of administration to the airways and, similar to other inhaled agents, are only minimally absorbed. Consequently, aside from the development of thrush, the systemic adverse effects of these medications at standard doses are negligible. Despite the theoretical benefit, the current consensus is that inhaled corticosteroids do not decrease

2014 eMedicine.com

5095. Cesarean Delivery (Treatment)

in the rate of cesarean delivery. The benefit was driven by the effect of the intervention in low-risk pregnancies. [ , ] Indications Many indications exist for performing a cesarean delivery. In those women who are having a scheduled procedure (ie, an elective or indicated repeat, for malpresentation or placental abnormalities), the decision has already been made that the alternate of medical therapy, ie, a vaginal delivery, is least optimal. For other patients admitted to labor and delivery (...) . Unfortunately, many obstetricians admit that their practice of medicine has become more defensive. Given the fear of inquiry regarding how a particular patient’s labor was managed, many obstetricians may have a lower threshold to perform a cesarean delivery despite the fact that the incidence of neonatal seizures or cerebral palsy has not been affected by increasing cesarean delivery rates. [ ] Previous Next: Technique Overview As with any procedure, take care to avoid injury to adjacent organs. Potential

2014 eMedicine.com

5096. Chronic Pelvic Pain Syndrome and Prostatodynia (Treatment)

and patient. The urologist institutes treatment through, and in close communication with, the patient's primary care physician, who remains the mainstay of care. Remind the patient that he is free to seek the advice of other physicians and health care providers while he is under a urologist's care. However, the patient must keep the urologist informed of all other treatments and medications tried, including alternative medicines and home remedies. Remind the patient that his problem is taken very (...) manipulate their trigger points. Patients are also taught methods of relaxation in order to relieve autonomic dysfunction. A study showed an improvement in pain and urinary symptoms in 72% of patients with refractory CPPS following intensive Stanford protocol therapy. [ ] The widespread acceptance of this approach among practicing urologists awaits further demonstration of its reproducibility and efficacy in multiple medical centers with larger numbers of patients and a greater variety of practitioners

2014 eMedicine.com

5097. Evaluation of the Injured Worker (Treatment)

of Medicine Richard Salcido, MD is a member of the following medical societies: , , , , and Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment What would you like to print? What would you like to print? Sections Evaluation of the Injured Worker Find Us On About Membership WebMD Network Editions All material on this website (...) the employee, employer, insurance adjusters, and physician. This list of involved parties eventually can grow to include nurse case managers, medical consultants, ergonomic consultants, physical therapists, occupational therapists, applicant attorneys (representing the employee), defense attorneys (representing the insurer or employer), vocational rehabilitation specialists, disability raters, and workers' compensation judges or referees. The involvement of so many professionals can quickly complicate

2014 eMedicine.com

5098. Estimation of Fetal Weight (Treatment)

from another study suggests that resident physicians in obstetrics and gynecology are systematically better than medical students at estimating term birth weight by using this technique (see Table 8). [ , ] In a study by Noumi et al that assessed the accuracy of clinical and sonographic estimations of fetal weight performed during the active phase of labor by resident physicians, the correlation between the clinical and sonographic estimates and actual birth weight was 0.59 (P < .0001) and 0.65 (P (...) , g (P Value .06); % (P Value .05) Within 10% of Actual Weight, % (P Value .05) Obstetric-Gynecologic Residents 261; 7.5 71 Medical Students 388; 11.5 38 Source: Nahum, 2002 [ ] Accuracy of obstetric ultrasonography for estimating fetal weight Obstetric sonographic assessment for the purpose of obtaining fetal biometric measurements to predict fetal weight has been integrated into the mainstream of obstetric practice in the past quarter century. From its inception, this method has been presumed

2014 eMedicine.com

5099. Esophagitis (Treatment)

morbidity. Fungal esophagitis Medical therapy for fungal conditions falls into the following three categories: Topically active agents include nystatin, clotrimazole, and oral amphotericin B Orally administered absorbable agents include fluconazole and itraconazole [ ] Parenterally administered agents include amphotericin B, fluconazole, and flucytosine The choice of agent depends on the severity of infection and the degree of host defense impairment. Most patients with fungal esophagitis who (...) Pharmaceuticals Honoraria Board membership Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Chun-hing Ludwig Tsoi MB, ChB, MPH, MRCP, FRCS(Edin), Senior Medical Officer, Accident and Emergency Department, Tseng Kwan O Hospital, Hong Kong; Chairman, Committee on Training, Hong Kong St John Ambulance Chun-hing Ludwig Tsoi is a member of the following medical

2014 eMedicine.com

5100. Erythroplasia of Queyrat (Bowen Disease of the Glans Penis) (Treatment)

of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA Richard P Vinson, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Chief Editor Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine Dirk M Elston, MD is a member of the following medical societies: Disclosure: Nothing to disclose (...) Erythroplasia of Queyrat (Bowen Disease of the Glans Penis) (Treatment) Erythroplasia of Queyrat (Bowen Disease of the Glans Penis) Treatment & Management: Medical Care, Surgical Care Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache

2014 eMedicine.com

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