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561. Anxiety (Treatment)

& Conditions 2002 290955-overview Diseases & Conditions Diseases & Conditions 2001 http://www.medscape.com/resource/anxiety-disorders Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) -enabled headphones and the first CES managed through an app. [ ] Deciding which treatment or combination of treatments to prescribe depends on a careful interview and assessment of the patient's goals and level of pathology. The outcome of treatment is determined by several factors, including the following: Specific type of anxiety disorder Severity of diagnosis level of functioning prior to onset of symptoms Degree of motivation for treatment Level of support (eg, family, friends, work, school

2014 eMedicine Emergency Medicine

562. Coccidioidomycosis (Treatment)

because of respiratory tract or systemic manifestations. Management in symptomatic patients varies with the clinical syndrome. Because most Coccidioides infections resolve without specific therapy, few clinical trials have assessed outcomes in less-severe disease. Most treatment recommendations represent consensus guidelines based on the Mycosis Study Group trials and the experience of many investigators. Even physicians in endemic regions disagree on who should be treated, the length of treatment (...) , and what agent should be used. [ , ] However, the Infectious Diseases Society of America has published . [ ] Three questions should be asked before a case of coccidioidomycosis is treated. Is intervention necessary? If antifungal therapy would be beneficial, which agents are appropriate? Is a surgical procedure necessary for debridement and reconstruction of destructive lesions? In the decision-making process, significant weight is given to the severity of infection, risk factors for dissemination (eg

2014 eMedicine Emergency Medicine

563. Foreign Bodies, Nose (Treatment)

and Diseases Medscape Consult News & Perspective Tools Slideshow Most Popular Articles According to Family Medicine Physicians Recommended 2002 858001-overview Procedures Procedures 2002 849233-overview Procedures Procedures 2001 /viewarticle/889211 Journal Article Journal Article 2001 /viewarticle/908860 News News Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) to the investigators, this suggested that emergency room providers need to be educated with regard to nasal anatomy and NFB removal methods. The study included 102 patients, 36 (35%) of whom were referred to the otolaryngology clinic, with 58.9% of these children managed in the operating room. Of the 66 (65%) patients who underwent NFB removal in the emergency room, 30 (45%) were treated by an otolaryngology resident or attending physician. [ ] Patient education For patient education information, see the , as well

2014 eMedicine Emergency Medicine

564. Pediatrics, Sudden Infant Death Syndrome (Follow-up)

Slideshow Most Popular Articles According to Emergency Physicians Recommended 2002 804412-overview Diseases & Conditions Diseases & Conditions 2001 /viewarticle/910149 News News 2001 /viewarticle/713479 News News 2001 /viewarticle/904105 News News Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) of emergency physicians, pediatricians, pediatric pathologists, radiologists, pediatric neuropathologists, and other medical specialists, in addition to the medicolegal death investigator and forensic pathologist. Issues such as baptism, grief counseling, religious support, reactions of surviving siblings, and risk of SIDS in subsequent siblings may have to be addressed. Return clothes or personal belongings to the parents, after receipt of permission from the coroner or medical examiner. In addition

2014 eMedicine Emergency Medicine

565. Neoplasms, Lung (Follow-up)

. [ ] Patients with stage IIIB and IV NSCLC are usually offered chemotherapy with the option of surgery. Molecular-targeted therapy plays an increasingly important role in the treatment of advanced NSCLC. Radiation is a reasonable option for treatment in patients who are not candidates for surgery. The role of adjuvant radiation therapy after resection of the primary tumor remains controversial. See the table below, as well as . Because most NSCLC cannot be cured with currently available therapeutic (...) had less depressive symptoms, and fewer patients in this group received aggressive end-of-life care. [ ] Emergency Treatment All patients thought to have lung cancer should be encouraged to obtain follow-up care with their primary care physician. In almost all cases, document the possible diagnosis and discuss it with the patient. Definitive treatment of the underlying cancer is not the purview of the emergency department (ED). Emergency treatment is based on symptoms. In cases of upper airway

2014 eMedicine Emergency Medicine

566. Anxiety (Follow-up)

& Conditions 2002 290955-overview Diseases & Conditions Diseases & Conditions 2001 http://www.medscape.com/resource/anxiety-disorders Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) -enabled headphones and the first CES managed through an app. [ ] Deciding which treatment or combination of treatments to prescribe depends on a careful interview and assessment of the patient's goals and level of pathology. The outcome of treatment is determined by several factors, including the following: Specific type of anxiety disorder Severity of diagnosis level of functioning prior to onset of symptoms Degree of motivation for treatment Level of support (eg, family, friends, work, school

2014 eMedicine Emergency Medicine

567. Pediatrics, Sudden Infant Death Syndrome (Treatment)

Slideshow Most Popular Articles According to Emergency Physicians Recommended 2002 804412-overview Diseases & Conditions Diseases & Conditions 2001 /viewarticle/910149 News News 2001 /viewarticle/713479 News News 2001 /viewarticle/904105 News News Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) of emergency physicians, pediatricians, pediatric pathologists, radiologists, pediatric neuropathologists, and other medical specialists, in addition to the medicolegal death investigator and forensic pathologist. Issues such as baptism, grief counseling, religious support, reactions of surviving siblings, and risk of SIDS in subsequent siblings may have to be addressed. Return clothes or personal belongings to the parents, after receipt of permission from the coroner or medical examiner. In addition

2014 eMedicine Emergency Medicine

568. Foreign Bodies, Nose (Overview)

and Diseases Medscape Consult News & Perspective Tools Slideshow Most Popular Articles According to Family Medicine Physicians Recommended 2002 858001-overview Procedures Procedures 2002 849233-overview Procedures Procedures 2001 /viewarticle/889211 Journal Article Journal Article 2001 /viewarticle/908860 News News Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) to the investigators, this suggested that emergency room providers need to be educated with regard to nasal anatomy and NFB removal methods. The study included 102 patients, 36 (35%) of whom were referred to the otolaryngology clinic, with 58.9% of these children managed in the operating room. Of the 66 (65%) patients who underwent NFB removal in the emergency room, 30 (45%) were treated by an otolaryngology resident or attending physician. [ ] Patient education For patient education information, see the , as well

2014 eMedicine Emergency Medicine

569. Neoplasms, Lung (Treatment)

. [ ] Patients with stage IIIB and IV NSCLC are usually offered chemotherapy with the option of surgery. Molecular-targeted therapy plays an increasingly important role in the treatment of advanced NSCLC. Radiation is a reasonable option for treatment in patients who are not candidates for surgery. The role of adjuvant radiation therapy after resection of the primary tumor remains controversial. See the table below, as well as . Because most NSCLC cannot be cured with currently available therapeutic (...) had less depressive symptoms, and fewer patients in this group received aggressive end-of-life care. [ ] Emergency Treatment All patients thought to have lung cancer should be encouraged to obtain follow-up care with their primary care physician. In almost all cases, document the possible diagnosis and discuss it with the patient. Definitive treatment of the underlying cancer is not the purview of the emergency department (ED). Emergency treatment is based on symptoms. In cases of upper airway

2014 eMedicine Emergency Medicine

570. Pervasive Developmental Disorder: Autism (Diagnosis)

-by-case basis. (See Treatment.) Practice guidelines The American Academy of Child and Adolescent Psychiatry's practice guidelines for the assessment and treatment of children and adolescents with ASD include the following recommendations: [ , ] Questions about core symptoms of ASD should be a routine part of psychiatric and developmental assessments of young children. If screening reveals significant ASD symptomatology, a thorough evaluation should be performed and possible comorbid diagnoses should (...) with an ongoing seizure disorder requires treatment because maternal seizures can result in serious morbidity and mortality for the mother and the fetus. To stop anticonvulsant therapy when a woman with a seizure disorder becomes pregnant to avoid teratologic effects may precipitate uncontrolled seizures that may be fatal to the mother and the fetus. Therefore physicians treating women with child-bearing potential can appropriately initiate frank conversations about future pregnancies. Juvenile myoclonic

2014 eMedicine Pediatrics

571. Tumors of the Conus and Cauda Equina (Follow-up)

to Oncologist/Hematologists Recommended 2002 251302-overview Procedures Procedures 2002 249203-overview Procedures Procedures 2002 1148690-overview Diseases & Conditions Diseases & Conditions 2002 277621-overview Diseases & Conditions Diseases & Conditions Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) extremity weakness, sensory problems and physical findings. Particular evaluation should be for patients with evolving or rapidly progressing neurologic deficits. Most patients with back pain do not have spinal tumors. Thus, the diagnosis is frequently not considered until an imaging study is performed. The emergency department (ED) workup for patients who present with persistent back pain or subacute or chronic neurological deficits should include an interview and a careful examination and timely

2014 eMedicine Surgery

572. Somatoform Disorder: Somatization (Diagnosis)

. [ ] Illness Attitude Scales and Soma Assessment Interview (SAI) are parental interview questionnaires. [ ] Treatment An integrated medical and psychiatric approach is strongly recommended. [ , ] The goals are to improve overall functioning, to identify concurrent psychiatric disorders, to rule out concurrent physical disorders, and to minimize “doctor shopping” and unnecessary invasive tests. It is important for the family to directly hear from their pediatric practitioner that the symptoms are not solely (...) . The presence of biopsychosocial risk factors described above should be elicited as positive symptoms. If the consultant is unable to elicit any of the diagnostic criteria except for the motor or sensory symptoms, then the possibility of an underlying general medical condition should be reconsidered. The physician must also be alert to the dual existence of a physical condition and a conversion disorder (eg, epileptic and nonepileptic seizures) in the same patient. [ ] Conversion disorder case example Julia

2014 eMedicine Pediatrics

573. Hearing Impairment (Diagnosis)

858001-overview Procedures Procedures 2002 849233-overview Procedures Procedures 2001 /viewarticle/889211 Journal Article Journal Article 2001 /viewarticle/908860 News News Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) in the care of children with hearing loss. In the past two decades, recommendations for universal neonatal hearing screening resulted in numerous articles regarding the tests, the efficacy of testing, the role of the audiologist in amplification, and the importance of early intervention programs. [ , , , , , , , , , , , ] The role of the primary care physician cannot be overemphasized. In many instances, the otolaryngologist develops a long-term relationship with patients and their families, caring

2014 eMedicine Pediatrics

574. Coccidioidomycosis (Follow-up)

because of respiratory tract or systemic manifestations. Management in symptomatic patients varies with the clinical syndrome. Because most Coccidioides infections resolve without specific therapy, few clinical trials have assessed outcomes in less-severe disease. Most treatment recommendations represent consensus guidelines based on the Mycosis Study Group trials and the experience of many investigators. Even physicians in endemic regions disagree on who should be treated, the length of treatment (...) , and what agent should be used. [ , ] However, the Infectious Diseases Society of America has published . [ ] Three questions should be asked before a case of coccidioidomycosis is treated. Is intervention necessary? If antifungal therapy would be beneficial, which agents are appropriate? Is a surgical procedure necessary for debridement and reconstruction of destructive lesions? In the decision-making process, significant weight is given to the severity of infection, risk factors for dissemination (eg

2014 eMedicine Pediatrics

575. Somatoform Disorder: Somatization (Follow-up)

. [ ] Illness Attitude Scales and Soma Assessment Interview (SAI) are parental interview questionnaires. [ ] Treatment An integrated medical and psychiatric approach is strongly recommended. [ , ] The goals are to improve overall functioning, to identify concurrent psychiatric disorders, to rule out concurrent physical disorders, and to minimize “doctor shopping” and unnecessary invasive tests. It is important for the family to directly hear from their pediatric practitioner that the symptoms are not solely (...) . The presence of biopsychosocial risk factors described above should be elicited as positive symptoms. If the consultant is unable to elicit any of the diagnostic criteria except for the motor or sensory symptoms, then the possibility of an underlying general medical condition should be reconsidered. The physician must also be alert to the dual existence of a physical condition and a conversion disorder (eg, epileptic and nonepileptic seizures) in the same patient. [ ] Conversion disorder case example Julia

2014 eMedicine Pediatrics

576. Tumors of the Conus and Cauda Equina (Treatment)

to Oncologist/Hematologists Recommended 2002 251302-overview Procedures Procedures 2002 249203-overview Procedures Procedures 2002 1148690-overview Diseases & Conditions Diseases & Conditions 2002 277621-overview Diseases & Conditions Diseases & Conditions Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) extremity weakness, sensory problems and physical findings. Particular evaluation should be for patients with evolving or rapidly progressing neurologic deficits. Most patients with back pain do not have spinal tumors. Thus, the diagnosis is frequently not considered until an imaging study is performed. The emergency department (ED) workup for patients who present with persistent back pain or subacute or chronic neurological deficits should include an interview and a careful examination and timely

2014 eMedicine Surgery

577. Anxiety Disorder: Social Phobia and Selective Mutism (Diagnosis)

Diseases & Conditions 2002 290955-overview Diseases & Conditions Diseases & Conditions 2001 http://www.medscape.com/resource/anxiety-disorders Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) of social anxiety disorder as measured by the World Health Organization Composite International Diagnostic Interview 3.0, and 5.2% of adolescents who did not identify as having shyness had social phobia. [ ] There is significant comorbidity of social phobia with anxiety disorders, major depressive disorder, and drug use disorders, without regard to the presence or absence of shyness. Adolescents with shyness were more likely to report agoraphobia compared with the no-shyness group. Adolescents

2014 eMedicine Pediatrics

578. Rehabilitation of Persons With Spinal Cord Injuries (Treatment)

of a physiatrist (ie, a physician who specializes in physical medicine and rehabilitation) or a physician with a subspecialty certification in spinal cord medicine. While each team member has primary responsibilities, any member of a properly functioning interdisciplinary team can contribute to the resolution of any problem. SCIRehab project The , a 5-year project led by the Rocky Mountain Regional Spinal Injury System (RMRSIS) at Craig Hospital, used practice-based evidence (PBE) research to identify (...) the rehabilitation interventions most strongly associated with positive outcomes. The aim of the SCIRehab project was to provide detailed information on treatments delivered by rehabilitation disciplines and to contribute to outcomes-based guidelines for clinical decision-making. The SCIRehab project included 1376 patients with acute SCIs, with outcome data being abstracted from medical records (clinical outcomes data) at six SCI rehabilitation facilities and obtained from patient interviews at 6 and 12 months

2014 eMedicine Surgery

579. Neoplasms, Lung (Diagnosis)

, but in older patients or those with significant comorbidities, carboplatin may be substituted. Radiation In the treatment of stage I and stage II NSCLC, radiation therapy alone is considered only when surgical resection is not possible. [ ] Radiation is a reasonable option for lung cancer treatment among those who are not candidates for surgery. [ ] Beta blockers have been found to improve overall survival, disease-free survival, and distant metastasis–free survival, though not locoregional progession–free (...) care is an important part of the treatment of patients with NSCLC. (See .) The American College of Chest Physicians (ACCP) updated its comprehensive set of lung cancer guidelines in 2013. The guideline set includes an executive summary of current recommendations for diagnosis and treatment. [ ] For a summary of guidelines issued by major organizations, see . Go to for complete information on this topic. Previous Next: Pathophysiology Both exposure (environmental or occupational) to particular

2014 eMedicine Emergency Medicine

580. Anxiety (Diagnosis)

& Conditions 2002 290955-overview Diseases & Conditions Diseases & Conditions 2001 http://www.medscape.com/resource/anxiety-disorders Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) patients. J Affect Disord . 2010 Jul. 124(1-2):215-8. . Kendler KS, Karkowski LM, Prescott CA. Fears and phobias: reliability and heritability. Psychol Med . 1999 May. 29(3):539-53. . Fyer AJ, Mannuzza S, Chapman TF, Liebowitz MR, Klein DF. A direct interview family study of social phobia. Arch Gen Psychiatry . 1993 Apr. 50(4):286-93. . . Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States

2014 eMedicine Emergency Medicine

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