Items in AFP with MESH term: Severity of Illness Index
Outpatient vs. Inpatient Treatment of Community-Acquired Pneumonia - Point-of-Care Guides
Saw Palmetto for Prostate Disorders - Article
ABSTRACT: Saw palmetto is an herbal product used in the treatment of symptoms related to benign prostatic hyperplasia. The active component is found in the fruit of the American dwarf palm tree. Studies have demonstrated the effectiveness of saw palmetto in reducing symptoms associated with benign prostatic hyperplasia. Saw palmetto appears to have efficacy similar to that of medications like finasteride, but it is better tolerated and less expensive. There are no known drug interactions with saw palmetto, and reported side effects are minor and rare. No data on its long-term usage are available. The herbal product also has been used to treat chronic prostatitis, but currently there is no evidence of its efficacy.
ABSTRACT: Heart failure caused by systolic dysfunction affects more than 5 million adults in the United States and is a common source of outpatient visits to primary care physicians. Mortality rates are high, yet a number of pharmacologic interventions may improve outcomes. Other interventions, including patient education, counseling, and regular self-monitoring, are critical, but are beyond the scope of this article. Angiotensin-converting enzyme inhibitors and beta blockers reduce mortality and should be administered to all patients unless contraindicated. Diuretics are indicated for symptomatic patients as needed for volume overload. Aldosterone antagonists and direct-acting vasodilators, such as isosorbide dinitrate and hydralazine, may improve mortality in selected patients. Angiotensin receptor blockers can be used as an alternative therapy for patients intolerant of angiotensin-converting enzyme inhibitors and in some patients who are persistently symptomatic. Digoxin may improve symptoms and is helpful for persons with concomitant atrial fibrillation, but it does not reduce cardiovascular or all-cause mortality. Serum digoxin levels should not exceed 1.0 ng per mL (1.3 nmol per L), especially in women.
Is the San Francisco Syncope Rule Reliable? - AFP Journal Club
ABSTRACT: The most useful individual signs for identifying dehydration in children are prolonged capillary refill time, abnormal skin turgor, and abnormal respiratory pattern. However, clinical dehydration scales based on a combination of physical examination findings are better predictors than individual signs. Oral rehydration therapy is the preferred treatment of mild to moderate dehydration caused by diarrhea in children. Appropriate oral rehydration therapy is as effective as intravenous fluid in managing fluid and electrolyte losses and has many advantages. Goals of oral rehydration therapy are restoration of circulating blood volume, restoration of interstitial fluid volume, and maintenance of rehydration. When rehydration is achieved, a normal age-appropriate diet should be initiated.
Screening for Chronic Obstructive Pulmonary Disease Using Spriometry - Putting Prevention into Practice
ABSTRACT: The Expert Panel Report 3 of the National Asthma Education and Prevention Program represents a major advance in the approach to asthma care by emphasizing the monitoring of clinically relevant aspects of care and the importance of planned primary care, and by providing patients practical tools for self-management. Treatment of asthma should be guided by a new system of classification that assesses severity at initial evaluation and control at all subsequent visits. Asthma severity is determined by current impairment (as evidenced by impact on day-to-day activities) and risk of future exacerbations (as evidenced by frequency of oral systemic corticosteroid use), and allows categorization of disease as intermittent, persistent-mild, persistent-moderate, and persistent-severe. Initial treatment is guided by the disease-severity category. The degree of control is also determined by the analysis of current impairment and future risk. Validated questionnaires can be used for following the impairment domain of control with patients whose asthma is categorized as "well controlled," "not well controlled," and "very poorly controlled." Decisions about medication adjustment and planned follow-up are based on the category of disease control. Whereas a stepwise approach for asthma management continues to be recommended, the number of possible steps has increased.
The New Asthma Guidelines - Editorials
Sleep Apnea - Clinical Evidence Handbook
ABSTRACT: Poorly controlled hypertension is a common finding in the outpatient setting. When patients present with severely elevated blood pressure (i.e., systolic blood pressure of 180 mm Hg or greater, or diastolic blood pressure of 110 mm Hg or greater), physicians need to differentiate hypertensive emergency from severely elevated blood pressure without signs or symptoms of end-organ damage (severe asymptomatic hypertension). Most patients who are asymptomatic but have poorly controlled hypertension do not have acute end-organ damage and, therefore, do not require immediate workup or treatment (within 24 hours). However, physicians should confirm blood pressure readings and appropriately classify the hypertensive state. A cardiovascular risk profile is important in guiding the treatment of severe asymptomatic hypertension; higher risk patients may benefit from more urgent and aggressive evaluation and treatment. Oral agents may be initiated before discharge, but intravenous medications and fast-acting oral agents should be reserved for true hypertensive emergencies. High blood pressure should be treated gradually. Appropriate, repeated follow-up over weeks to months is needed to reach desired blood pressure goals.