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Defensive Medicine

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5121. Pseudotuberculosis (Yersinia) (Overview)

at Augusta University David R Haburchak, MD, FACP 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. Joseph F John, Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology (...) . Available at . Jul 14, 2015; Accessed: Mar 24, 2017. Yersinia pseudotuberculosis infection. microbewiki. Available at . Accessed: May 15, 2017. Slee KJ, Brightling P, Seiler RJ. Enteritis in cattle due to Yersinia pseudotuberculosis infection. Aust Vet J . 1988 Sep. 65 (9):271-5. . Media Gallery of 0 Tables Contributor Information and Disclosures Author David R Haburchak, MD, FACP Professor Emeritus of Medicine, Department of Medicine, Division of Infectious Diseases, Medical College of Georgia

2014 eMedicine.com

5122. Pseudomonas Aeruginosa Infections (Overview)

Medicine, Department of Medicine, Northwell Health; Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Kevin Gerard G Lazo, DO 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 (...) late-onset nosocomial pneumonia in the ICU setting. Chest . 2000 May. 117(5):1434-42. . Janeczko L. Study Finds Rapid Spread of Extensively Drug-Resistant P. aeruginosa. Medscape Medical News. Available at . Accessed: August 4, 2013. Karlowsky JA, Draghi DC, Jones ME, Thornsberry C, Friedland IR, et al. Surveillance for antimicrobial susceptibility among clinical isolates of Pseudomonas aeruginosa and Acinetobacter baumannii from hospitalized patients in the United States, 1998 to 2001. Antimicrob

2014 eMedicine.com

5123. Preoperative Evaluation and Management (Overview)

. Drug interactions The geriatric population consumes more systemic medications than any other group. Numerous drug interactions and complications arise in this population, and special attention should be paid to them. Diuretics are commonly prescribed medications for hypertension, congestive heart failure, and other fluid-retaining states. Common complications of diuretic therapy are hypokalemia and hypomagnesemia. Both abnormal electrolyte states, especially in combination with epinephrine use (...) preferences. A thorough assessment ensures that the patient's chronic diseases are under appropriate medical therapy prior to an elective procedure and establishes a rapport and confidence with the patient to allay fears and answer any questions. Finally, the preoperative preparation involves procedures that are implemented based on the nature of the expected operation and the findings of the diagnostic workup and preoperative evaluation. Many dermatologic surgical procedures are uncomplicated

2014 eMedicine.com

5124. Poxviruses (Overview)

of Preventive Medicine, Stony Brook Medical Center John D Shanley, MD, MPH 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. Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine (...) , Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center Charles V Sanders, MD is a member of the following medical societies: , , , , , , , , , , , , , , , , , , , , , American Venereal Disease Association, , , , , , , , Disclosure: Received royalty from Baxter International for other. Chief

2014 eMedicine.com

5125. Posttraumatic Stress Disorder (Overview)

trial. Br J Psychiatry . 2012 Mar. 200(3):224-31. . Harrison P. Evidence Supports Psychological Therapies for PTSD Kids. Medscape Medical News. December 11, 2012. . Gillies D, Taylor F, Gray C, O'Brien L, D'Abrew N. Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents. Cochrane Database Syst Rev . 2012 Dec 12. 12:CD006726. . Davis LL, Frazier EC, Williford RB, Newell JM. Long-term pharmacotherapy for post-traumatic stress disorder. CNS Drugs . 2006 (...) 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 Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine David Bienenfeld, MD

2014 eMedicine.com

5126. Prostatitis, Tuberculous (Overview)

, 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. Richard A Santucci, MD, FACS Specialist-in-Chief, Department of Urology, Detroit Medical Center; Chief of Urology, Detroit Receiving Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State University College of Medicine Richard A Santucci (...) . Before starting medications, investigate regional drug-resistance data. The chemoprophylaxis protocol for unconfirmed clinical disease is isoniazid (INH) for 6 months (9 mo in patients who are positive for human immunodeficiency virus [HIV]), INH and rifampin for 3 months, or rifampin and pyrazinamide for 2 months. Previous Next: Complications of GUTB Complications of genitourinary tuberculosis (GUTB) include the following: Superinfection Abscess Sinus formation Renal hypertension Scarring of renal

2014 eMedicine.com

5127. Impairment Rating of Neuromusculoskeletal Conditions (Treatment)

to evaluate, report on, and communicate information about impairments to any human organ system. [ ] According to the AMA Guides, impairment is an alteration of an individual's health status that has been assessed by medical means. Impairment is used to describe a static or stable condition that has had sufficient time to allow optimal tissue repair and that is unlikely to change, despite further medical or surgical therapy. The Florida Impairment Schedule defines impairment as anatomic or functional (...) in the 1950s. The American Medical Association (AMA) released the first edition of its AMA Guides to the Evaluation of Permanent Impairment in 1971. [ ] The sixth edition is currently available. [ ] The impairment rating is an estimate of the severity of human impairment based on acceptable medical standards (see the images below). Work Evaluation System Technology (WEST) schematic. Symptom-discomfort chart. Various reference books, including the AMA Guides, provide a standard method of analysis

2014 eMedicine.com

5128. Hypertension (Treatment)

activator (tPA) should have their BP slowly lowered to below 185/110 mm Hg before thrombolytic therapy is initiated. In adults with an acute ischemic stroke, BP should be less than 185/110 mm Hg before administration of IV tPA and should be maintained below 180/105 mm Hg for at least the first 24 hours after initiating drug therapy. For adults who experience a stroke or transient ischemic attack (TIA), treatment with a thiazide diuretic, ACEI, or angiotensin receptor blocker (ARB), or combination (...) below 10% and an SBP of 140 mm Hg or higher or a DBP of 90 mm Hg or higher. Adults with an elevated BP or stage 1 hypertension who have an estimated 10-year ASCVD risk below 10% should be managed with nonpharmacologic therapy and have a repeat BP evaluation within 3 to 6 months. Adults with stage 1 hypertension who have an estimated 10-year ASCVD risk of 10% or higher should be managed initially with a combination of nonpharmacologic and antihypertensive drug therapy and have a repeat BP evaluation

2014 eMedicine.com

5129. Keratitis, Herpes Simplex (Treatment)

unable to tolerate topical medications and with good renal function A cycloplegic agent may be added to any of the above regimens for comfort from ciliary spasm. Topical therapy Topical ganciclovir ophthalmic gel, approved by the US Food and Drug Administration (FDA) in 2009, has the advantages of low corneal toxicity, less frequent applications, and gel formulation. Trifluridine solution and vidarabine ointment are also effective in treating HSV keratitis. However, epithelial toxicity is a frequent (...) adverse effect, especially with prolonged use. Response to topical therapy usually occurs in 2-5 days, with complete resolution in 2 weeks. Topical therapy should be tapered rapidly after initial response and discontinued after complete healing, generally within 10-14 days. Failure of epithelial healing after 2-3 weeks of antiviral therapy suggests epithelial toxicity, neurotrophic keratopathy, or, rarely, drug-resistant strains of HSV. Vidarabine is often effective against HSV strains

2014 eMedicine.com

5130. Osteitis Pubis (Treatment)

Medicine, University of Miami, Leonard A Miller School of Medicine Andrew L Sherman, MD, MS 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 Osteitis Pubis Find Us On About Membership WebMD (...) time to full recovery is 9.5 months in men and 7.0 months in women. Some reports suggest that recovery may take up to 32 months. Recurrence is more common in males. More aggressive therapy is often needed when an athlete refuses to modify activities or rest. [ ] With aggressive physical therapy and judicious use of medications, the athlete often returns to the previous level of activity. Previous Next: Patient Education Osteitis pubis is a frustrating condition both for the patient

2014 eMedicine.com

5131. Oral Manifestations of Systemic Diseases (Treatment)

that then is also demineralized. [ ] The prevalence of caries is not increased in persons with GERD, possibly because the acidic environment interferes with the formation of the dental bacterial biofilms. Good dental care and control of acid helps decrease the prevalence of erosion. However, once the erosion occurs, it is irreversible and can only be treated with restorative procedures. Therefore, early recognition and patient education is the most effective treatment. The most effective medical therapy (...) , purpura, paraneoplastic pemphigus, Sweet syndrome) or therapy-induced lesions (eg, drug reactions, graft vs host disease). [ , ] Oral manifestations are more common in acute leukemias than in chronic leukemias. [ ] Gingival hypertrophy and hyperplasia are most commonly associated with acute myelogenous leukemia and acute promyelocytic leukemia. [ ] The gingiva are friable, edematous, and erythematous. [ , ] Thrombocytopenia commonly manifests as petechiae and ecchymoses on the mucosal surfaces

2014 eMedicine.com

5132. Wegener Granulomatosis (Treatment)

maintenance therapy in 28 AAV patients (four with microscopic polyangiitis, 24 with GPA). The patients received a median of four rituximab infusions of differing dose and frequency over 38 months. Combined treatment included corticosteroids and other immunosuppressives (azathioprine, mycophenolate mofetil, methotrexate, leflunomide) at the time of the first rituximab maintenance infusion, although most had their immunosuppressive medication held for an average of 8 months after their first infusion (...) to comment on the efficacy of infliximab. [ , ] The safety of infliximab therapy in patients with GPA, similar to the results in trials with etanercept, seems to be the limiting factor, as there were increased serious infections in the infliximab group. [ ] Further studies are needed. 15-Deoxyspergualin The drug 15-deoxyspergualin (0.5 mg/kg/day subcutaneous or intravenous) is a synthetic derivative of spergualin, a protein from Bacillus laterosporus that is capable of preventing T-cell and B-cell

2014 eMedicine.com

5133. Vulvovaginitis (Treatment)

Hospital Omnia M Samra-Latif, 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 Anuritha Tirumani, MD Research Coordinator, Department of Emergency Medicine, Brooklyn Hospital Center Disclosure: Nothing to disclose. Ellen Wood, DO, FACOOG Voluntary Assistant Professor (...) the relationship, if any, between HPV and vulvar vestibulitis. Noninfectious etiologies Possible noninfectious causes of vulvar vestibulitis include the following: Vulvovaginal candidiasis therapy - Some authors believe that the disease may result from allergic sensitization within the vulvar vestibule to several types of topical medication for vulvovaginal candidiasis HPV therapy - Treatments for clinical and subclinical HPV, [ ] such as cryosurgery, trichloroacetic acid, podophyllin, and laser treatment

2014 eMedicine.com

5134. Nosocomial Pneumonia (Treatment)

, 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 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 of the following medical societies: , Disclosure: Nothing (...) bypass normal respiratory defense mechanisms or when the patient inhales aerobic gram-negative organisms that colonize the upper respiratory tract or respiratory support equipment. is due to the aspiration of colonized upper respiratory tract secretions. The stomach appears to be an important reservoir of gram-negative bacilli that can ascend and colonize the respiratory tract. A prospective observational study found that patients who used acid-suppressive medications were more likely to develop

2014 eMedicine.com

5135. Neurofibromatosis, Type 2 (Treatment)

of the Air Force, Department of Defense or the U.S. Government. David A Griesemer, MD Professor, Departments of Neuroscience and Pediatrics, Medical University of South Carolina David A Griesemer, MD is a member of the following medical societies: , , , , and Disclosure: Nothing to disclose. Beth A Pletcher, MD Associate Professor, Co-Director of The Neurofibromatosis Center of New Jersey, Department of Pediatrics, University of Medicine and Dentistry of New Jersey Beth A Pletcher, MD is a member (...) with neurofibromatosis type 2. Small ependymoma in a patient with neurofibromatosis type 2. Multiple meningiomas in a patient with neurofibromatosis type 2. of 10 Tables Contributor Information and Disclosures Author David T Hsieh, MD, FAAP Associate Professor of Pediatrics and Neurology, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine David T Hsieh, MD, FAAP is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s) Luis O Rohena, MD

2014 eMedicine.com

5136. Neurofibromatosis, Type 1 (Treatment)

of Medicine; Associate Professor of Pediatrics, University of Texas Health Science Center at San Antonio Luis O Rohena, MD, FAAP, FACMG 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. Kenneth J Mack, MD, PhD Senior (...) . Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force, Department of Defense or the U.S. Government. Beth A Pletcher, MD Associate Professor, Co-Director of The Neurofibromatosis Center of New Jersey, Department of Pediatrics, University of Medicine and Dentistry of New Jersey Beth A Pletcher, MD is a member of the following medical societies: , , , and Disclosure: Nothing to disclose. What would you like to print? What would you like to print? Sections

2014 eMedicine.com

5137. Neurogenic Bladder (Treatment)

or external trauma, disease, or injury. Symptoms of neurogenic bladder range from detrusor underactivity to overactivity, depending on the site of neurologic insult. The urinary sphincter also may be affected, resulting in sphincter underactivity or overactivity and loss of sphincter coordination with bladder function. The appropriate therapy for neurogenic bladder and a successful treatment outcome are predicated upon an accurate diagnosis through a careful medical and voiding history, together (...) with coordinated urethral sphincter activity. This occurs because the PMC is released from the cerebral inhibitory center. Patients with detrusor hyperreflexia complain of urinary frequency, urinary urgency, and urge incontinence. The treatment for the cerebral shock phase is indwelling Foley catheter placement or clean intermittent catheterization (CIC). Detrusor hyperreflexia is treated with anticholinergic medications to facilitate bladder filling and storage. Brain tumor Detrusor hyperreflexia

2014 eMedicine.com

5138. Obsessive-Compulsive Disorder (Treatment)

Strategies should always include an assessment of complicating diagnoses, medication compliance, drug dose, and duration of therapy. The presence of a comorbid diagnosis that has not been addressed, such as depression or panic disorder, can interfere with clinical recovery, and identification may guide the choice of interventions. Targeted interventions might include, for example, lithium or antipsychotic augmentation or ECT for depression. Interventions for patients with treatment resistance include (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTkzNDEzOS10cmVhdG1lbnQ= processing > Obsessive-Compulsive Disorder Treatment & Management Updated: May 17, 2018 Author: William M Greenberg, MD; Chief Editor: David Bienenfeld, MD Share Email Print Feedback Close Sections Sections Obsessive-Compulsive Disorder Treatment Approach Considerations OCD is a chronic illness that usually can be treated in an outpatient setting. The mainstays of treatment of OCD include the use of serotoninergic antidepressant medications, particular forms of behavior therapy (exposure

2014 eMedicine.com

5139. Nursing Home Acquired Pneumonia (Treatment)

do not require dietary alterations. Clinicians usually advise bed rest for patients with NHAP, with gradual transition to ambulation as tolerated. Transferring a patient with NHAP to an acute care facility simply to receive intravenous antibiotics is usually not necessary. Such transfer may be appropriate if there is a diagnostic question or if the patient requires oxygen therapy, pulmonary toilet, or adjustment of cardiac drugs. Make certain that the pneumonia is resolving and that the patient (...) appropriate empiric therapy is the critical component of medical management. Promptly instituting empiric antimicrobial therapy significantly decreases the likelihood of mortality and morbidity associated with NHAP and CAP. Direct antimicrobial coverage against the most likely pathogens (ie, S pneumoniae, H influenzae, M catarrhalis ). Select antibiotics that have the appropriate spectrum and minimal resistance potential, have excellent safety profiles, are cost effective, and are available in intravenous

2014 eMedicine.com

5140. Neutrophilia (Treatment)

University of New York School of Medicine and Biomedical Sciences; Chief, Anesthesiology and Peri-Operative Care Services, Veterans Affairs Western New York Healthcare System Nader D Nader, MD, PhD, FCCP is a member of the following medical societies: , Disclosure: Nothing to disclose. Coauthor(s) Sina Davari-Farid, MD Research Assistant, Department of Anesthesiology, University at Buffalo State University of New York School of Medicine and Biomedical Sciences Disclosure: Nothing to disclose. Chief (...) Editor Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University Emmanuel C Besa, MD is a member of the following medical societies: , , , , , Disclosure: Nothing to disclose. What would you like to print? What would you like to print? Sections Neutrophilia Find Us On About Membership WebMD Network Editions All material on this website

2014 eMedicine.com

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