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581. Cancer and Rehabilitation (Follow-up)

provide services to patients throughout the course of illness, during all stages. Treatment plans must be individualized to meet each patient's unique and specific needs. Physicians Professional clinicians composing the interdisciplinary team include physicians from several specialties. Primary care physicians, surgeons, radiation oncologists, and medical oncologists make active and concurrent contributions to rehabilitation efforts to manage the disease process. The physiatrist, a specialist in PM&R (...) of the disease are simultaneous. Cancer rehabilitation is an emerging field within PM&R and it has many unique characteristics that may require specialized fellowship training. Fellowship training programs teach physicians to evaluate the functional needs of cancer patients during treatment and follow-up. Cancer rehabilitation is a challenging and rewarding field since it combines many aspects of medicine, such as inpatient and outpatient care, patient continuity of care, clinical assessment, diagnostic

2014 eMedicine.com

582. Anxiety Disorders (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.com

583. Body Dysmorphic Disorder (Follow-up)

Disorder What to Read Next on Medscape Related Conditions and Diseases Medscape Consult News & Perspective Tools Slideshow Most Popular Articles According to Psychiatrists Recommended 2002 286227-overview Diseases & Conditions Diseases & Conditions 2002 916933-overview Diseases & Conditions 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 (...) the effectiveness of escitalopram vs placebo with regards to relapse prevention. Escitalopram delayed time to relapse and fewer escitalopram-treated subjects relapsed than did placebo-treated subjects. In addition, body dysmorphic disorder severity significantly improved during the additional six months of escitalopram treatment following acute response, and more than one-third of escitalopram-treated subjects experienced further improvement. [ ] Use of SSRIs in pediatric patients Physicians are advised

2014 eMedicine.com

584. Sudden Unexpected Death in Epilepsy (Diagnosis)

-overview Diseases & Conditions Diseases & Conditions 2002 1181649-overview Diseases & Conditions Diseases & Conditions 2002 1138154-overview Diseases & Conditions Diseases & Conditions 2002 1140724-overview Diseases & Conditions Diseases & Conditions Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) vulnerability to cardiac arrhythmia. [ ] Seizure threshold also might diminish, leading to rebound effect and increase in seizure frequency. Patients on multiple antiepileptic drugs had a significantly higher rate of SUDEP than patients with epilepsy who were not on multiple antiepileptic drugs. Also, a questionable role has been attributed to recent sudden changes in medication regimen of patients. Genetic predisposition The following genes have been studied in SUDEP autopsy cases: KCNQ1 , SCN1A , LQTS

2014 eMedicine.com

585. Smokeless Tobacco Lesions (Diagnosis)

and Diseases Medscape Consult News & Perspective Tools Slideshow Most Popular Articles According to Dermatologists Recommended 2001 /viewarticle/894869 Journal Article Journal Article 2001 /viewarticle/887977 Journal Article Journal Article 2001 /viewarticle/909468 News News 2001 /viewarticle/901890 News News Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) , including counteracting bronchoconstriction and vasoconstriction, inhibiting platelet aggregation, host defense, and cytotoxicity, lower levels may lead to increased vulnerability of the airway to carcinogenic development. [ ] Previous Next: Etiology Alcohol consumption, cigarette smoking, candidal infection, [ ] and poor dentition are causes of oropharyngeal cancers. Additionally, human papillomavirus (HPV), especially HPV type 16, has been implicated in the pathogenesis of 20-30% of oropharyngeal

2014 eMedicine.com

586. 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.com

587. Coccidioidomycosis (Infectious Diseases) (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.com

588. Chronic Obstructive Pulmonary Disease (Follow-up)

both pharmacologic and non-pharmacologic modalities, and will likely require multiple attempts to maintain success. The transition from smoking to not smoking occurs in the following 5 stages: Precontemplation Contemplation Preparation Action Maintenance Smoking intervention programs include self-help, group, health care provider delivered, workplace, and community programs. Setting a quit date may be helpful. Physicians and other health care providers should participate in setting the target date (...) is invasive and requires special training for the physician, the patient, and the caregiver. The procedure has risks as well as medical benefits but has limited application. NIPPV for hypercapneic respiratory failure Noninvasive positive-pressure ventilation (NIPPV), as the name suggests, allows the delivery of positive-pressure ventilation without the use of an endotracheal tube. In place of the tube is a tight-fitting nasal or facial mask that is attached to a continuous positive airway pressure (CPAP

2014 eMedicine.com

589. Gonococcus (Follow-up)

patients, seeking specialist help (in the form of specialist nurses or physicians) to interview and collect specimens (if necessary) for testing is prudent. Careful documentation of physical findings, even if apparently normal, is crucial for medicolegal reasons. Notification of child-protective services is required if abuse is suspected. Previous Next: Monitoring Per the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines, a test-of-cure is no longer needed for patients with uncomplicated (...) & Perspective Tools Slideshow Most Popular Articles According to Infectious Disease Physicians Recommended 2002 218059-overview Diseases & Conditions Diseases & Conditions 2002 782913-overview Diseases & Conditions Diseases & Conditions 2001 /viewarticle/895833 News News 2001 /viewarticle/895915 Journal Article Journal Article Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult.

2014 eMedicine.com

590. Gonococcemia (Follow-up)

patients, seeking specialist help (in the form of specialist nurses or physicians) to interview and collect specimens (if necessary) for testing is prudent. Careful documentation of physical findings, even if apparently normal, is crucial for medicolegal reasons. Notification of child-protective services is required if abuse is suspected. Previous Next: Monitoring Per the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines, a test-of-cure is no longer needed for patients with uncomplicated (...) & Perspective Tools Slideshow Most Popular Articles According to Infectious Disease Physicians Recommended 2002 218059-overview Diseases & Conditions Diseases & Conditions 2002 782913-overview Diseases & Conditions Diseases & Conditions 2001 /viewarticle/895833 News News 2001 /viewarticle/895915 Journal Article Journal Article Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult.

2014 eMedicine.com

591. Gonococcal Infections (Follow-up)

patients, seeking specialist help (in the form of specialist nurses or physicians) to interview and collect specimens (if necessary) for testing is prudent. Careful documentation of physical findings, even if apparently normal, is crucial for medicolegal reasons. Notification of child-protective services is required if abuse is suspected. Previous Next: Monitoring Per the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines, a test-of-cure is no longer needed for patients with uncomplicated (...) & Perspective Tools Slideshow Most Popular Articles According to Infectious Disease Physicians Recommended 2002 218059-overview Diseases & Conditions Diseases & Conditions 2002 782913-overview Diseases & Conditions Diseases & Conditions 2001 /viewarticle/895833 News News 2001 /viewarticle/895915 Journal Article Journal Article Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult.

2014 eMedicine.com

592. 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

593. 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

594. 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

595. Amyotrophic Lateral Sclerosis (Diagnosis)

of a faulty regulatory gene product responsible for motor network maintenance, or failure to regulate such a product, may account for the specific disintegration of the motor network. MicroRNAs are particularly attractive candidates for this role. The affirmation of spread substantiates the concept of a biologic focal onset for ALS. This in turn lends credibility to the concept of a focal trigger for ALS onset that generates the production of 1 or more agents of spread. [ ] Under this hypothesis, disease (...) , and the level of knowledge of the person being interviewed. [ ] In addition, first-degree relatives of patients with apparently sporadic disease have an increased risk of ALS. The overall lifetime risk of ALS in these relatives is low, however (approximately 1 in 50). [ ] Familial cases A family history of ALS is obtained in about 5% of cases and is often consistent with a Mendelian autosomal dominant pattern of inheritance. While most cases of familial ALS are indistinguishable from sporadic disease

2014 eMedicine.com

596. Drug-Induced Hepatotoxicity (Diagnosis)

drug reactions result in or death. Drug-induced hepatic injury is the most common reason cited for withdrawal of an approved drug. Physicians must be vigilant in identifying drug-related liver injury because early detection can decrease the severity of hepatotoxicity if the drug is discontinued. The manifestations of drug-induced hepatotoxicity are highly variable, ranging from asymptomatic elevation of liver enzymes to fulminant hepatic failure. Knowledge of the commonly implicated agents (...) is not familiar with the drug or if any question remains about the safety of continuing a drug, consultation with a hepatologist should be considered. Elevated aminotransferase levels with acute hepatocellular injury Drug-induced liver injury is designated hepatocellular if the ALT levels are increased to more than twice the upper limit of the reference range, with alkaline phosphatase levels that are within the reference range or are minimally elevated. Elevation of aspartate aminotransferase (AST) greater

2014 eMedicine.com

597. Cancer and Rehabilitation (Diagnosis)

provide services to patients throughout the course of illness, during all stages. Treatment plans must be individualized to meet each patient's unique and specific needs. Physicians Professional clinicians composing the interdisciplinary team include physicians from several specialties. Primary care physicians, surgeons, radiation oncologists, and medical oncologists make active and concurrent contributions to rehabilitation efforts to manage the disease process. The physiatrist, a specialist in PM&R (...) of the disease are simultaneous. Cancer rehabilitation is an emerging field within PM&R and it has many unique characteristics that may require specialized fellowship training. Fellowship training programs teach physicians to evaluate the functional needs of cancer patients during treatment and follow-up. Cancer rehabilitation is a challenging and rewarding field since it combines many aspects of medicine, such as inpatient and outpatient care, patient continuity of care, clinical assessment, diagnostic

2014 eMedicine.com

598. Bipolar Affective Disorder (Diagnosis)

with susceptibility to bipolar disease in a cohort of 41 Finnish families. [ ] MAFD5 is located at 2q22-q24, and MAFD6 is located at 6q23-24. Interestingly, evidence suggests a strong interaction between genes located in these 2 regions. It has been concluded that the candidate gene in the MAFD5 locus shows epistatic interaction with the MAFD6 risk locus. [ ] MAFD7 is located at 22q12.1 and was detected using microsatellite markers in a North American population; a large region on 22q12 was associated (...) %), bipolar disorder type II (BPII) (1.1%), and subthreshold bipolar disorders (2.4–4.7%). [ ] International statistics Globally, the lifelong prevalence rate of bipolar disorder is 0.3–1.5%. In cross-sectional, face-to-face household surveys of more than 61,000 adults across 11 countries, Merikangas et al, using the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, determined that the aggregate lifetime prevalences were 0.6% for BPI

2014 eMedicine.com

599. Anxiety Disorders (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.com

600. Primary Biliary Cirrhosis (Diagnosis)

-overview Diseases & Conditions Diseases & Conditions 2001 /viewarticle/909476 News News 2002 104439-overview Procedures Procedures 2002 936591-overview Diseases & Conditions Diseases & Conditions Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) frequently a disease of women and occurs between the fourth and sixth decades of life. The symptoms may strongly affect patients' quality of life and may induce incapacitation. Various therapeutic approaches have been implemented with variable results; in selected candidates, liver transplantation is the only treatment option for the terminal stages of the disease. After the procedure, the disease has a relatively high recurrence rate despite immunosuppressive therapy. The image below demonstrates

2014 eMedicine.com

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