Abstract:
:Careful attention to the practical aspects of oral anticoagulant therapy can improve patient compliance and lessen the risk of bleeding complications. A variety of risk factors for bleeding associated with oral anticoagulant therapy have been defined and should be assessed before initiating therapy. Recent investigations have provided a means for estimating what constitutes a significant change in an individual patient's serial International Normalized Ratio (INR) by allowing for combined analytic and biologic variation in prothrombin time determinations. Dosing adjustments with warfarin sodium (Coumadin, Panwarfin, Sofarin) should be appropriate to the level of the INR and spread over the total weekly dosage for optimum stable control. Elderly patients are more sensitive to any given dose of warfarin and need a significantly lower total weekly dose. Attention must be paid to the vitamin K content of the diet and a variety of additional factors, including other drug therapy, alcohol consumption, and metabolic status. Hematuria or gastrointestinal bleeding should always be assessed, because the chance of finding a clinically significant lesion is good, especially when the INR has been in the therapeutic range. Although a minor prolongation of the INR without bleeding may be treated by watchful waiting, vitamin K administration and other therapeutic measures may be necessary for active bleeding. Comprehensive patient education is paramount and may be facilitated by a checklist approach. A well-informed patient provides one of the best defenses against bleeding complications.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Brigden MLsubject
Has Abstractpub_date
1996-06-01 00:00:00pages
81-4, 87-9, 93-4 passimissue
6eissn
0032-5481issn
1941-9260journal_volume
99pub_type
杂志文章,评审abstract:BACKGROUND:Binge eating disorder (BED) is now a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). However, post-DSM-5 patient profiles and viewpoints on BED diagnosis and treatment remain unclear. This study used a focus group methodology to examine demographic and cl...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2014.09.2800
更新日期:2014-09-01 00:00:00
abstract::Rocky Mountain spotted fever, caused by a rickettsial organism transmitted by the bite of a tick, can be confused with many more common diseases. Diagnosis is made more challenging by the fact that treatment is most efficacious if begun before the second week of illness. Tetracycline and doxycycline are the most succe...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1990.11704599
更新日期:1990-03-01 00:00:00
abstract::With the recent availability of human insulin, we have entered a new era in therapy for diabetes mellitus. Human insulin is not a cure for diabetes; however, no disadvantages are known to be associated with its use at present. Human insulin costs less than the other purified insulins, and because of its potential adva...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1986.11699459
更新日期:1986-07-01 00:00:00
abstract::Sjögren's syndrome is a chronic, systemic, autoimmune inflammatory disorder characterized by lymphocytic infiltration of exocrine glands, most notably the salivary and lacrimal glands. It results in loss of functional epithelium, diminished exocrine function, and gradual onset of dryness of the eyes, mouth, and other ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2004.09.1587
更新日期:2004-09-01 00:00:00
abstract::Male factors play a role in up to half of subfertile couples, contrary to the myth that male factors rarely play a role. In this article, Dr Sandlow counters this and other myths about male infertility and suggests that primary care physicians can increase a couple's chance of conceiving by evaluating for male as well...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2000.02.902
更新日期:2000-02-01 00:00:00
abstract::Patients with chronic pelvic pain are challenging, from both diagnostic and therapeutic viewpoints. At the pain clinic at the Medical College of Georgia School of Medicine, Augusta, we have discovered over the past 3 years that psychiatric disease is probably underrecognized in these patients and that physicians are o...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1993-12-01 00:00:00
abstract::Thrombosis results from the dynamic interaction of venous stasis, hypercoagulability, and endothelial injury. Protection against thrombosis may be lost if there is deficiency of any of the factors that mediate platelet deaggregation, block fibrin deposition, or initiate fibrinolysis. A thrombus lodged in the pulmonary...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715447
更新日期:1980-05-01 00:00:00
abstract::Patients with chronic obstructive lung disease (COLD) experience one or more episodes of acute respiratory failure in the late years of their illness. Initial evaluation is aimed at assessing the precipitating factor or factors as well as the severity of the acute episode and the need for intubation and mechanical ven...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699246
更新日期:1986-01-01 00:00:00
abstract::The recent resurgence of rheumatic fever reported in eight locations in the United States after years of decline has several noteworthy characteristics. Most patients were children of families in high- to middle-income brackets with ready access to medical care. In four of the outbreaks, the majority of patients were ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1992.11701445
更新日期:1992-09-01 00:00:00
abstract::Use of "designer drugs" has created a new dilemma for physicians. Generally, it is possible to recognize symptoms and signs of intoxication that fit a specific class of substances, such as amphetamine-like effects for the phenylethylamines and opioid effects for the fentanyl analogues. Designer compounds have crossed ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1991.11700917
更新日期:1991-05-01 00:00:00
abstract::Pelvic inflammatory disease (PID) is a common infection in women of reproductive age. PID is actually a spectrum of disease, beginning with cervicitis and progressing to endometritis and eventually salpingitis. Sequelae include ectopic pregnancy, infertility, chronic pelvic pain, hydrosalpinx, and tubo-ovarian abscess...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1993.11701600
更新日期:1993-02-01 00:00:00
abstract::Although Charcot's disease and its association with diabetes have been described many times in the literature, it is still often misdiagnosed and incorrectly treated as osteomyelitis, arthritis, or gout. The best safeguard is a high index of suspicion. A warm, swollen foot in a diabetic patient with long-standing neur...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1991.11700869
更新日期:1991-03-01 00:00:00
abstract::The cultural drive to be thin can lead to eating disorders in many women and girls. In adolescent females with diabetes, the increased focus on eating and the weight gain associated with good glycemic control likely increase their susceptibility to abnormal eating. It is clear that nonspecified and subthreshold eating...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2001.04.910
更新日期:2001-04-01 00:00:00
abstract::The use of opioids for patients with chronic noncancer pain has increased dramatically, and with increasing use there is increasing concern about the potential for abuse and addiction during long-term treatment. Clinicians should avoid viewing formal or subjective risk assessment as a means of classifying patients int...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2014.09.2810
更新日期:2014-09-01 00:00:00
abstract::Hypertension in diabetic patients must be treated aggressively if patients are to benefit from reduced risk of morbidity and mortality. Diabetes itself must be diagnosed promptly, particularly in at-risk patients, so appropriate lifestyle modifications can be made at the earliest opportunity. Although this may reduce ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2000.04.990
更新日期:2000-04-01 00:00:00
abstract::Wound healing calls for little outside interference. All the physician need do is ensure that the wound is clean and debrided and decide whether closure by suture or by granulation tissue formation is indicated. Suture repair should be delayed if the wound is heavily contaminated. Use of skin tapes or of constant-pres...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1983.11698475
更新日期:1983-10-01 00:00:00
abstract::What clinical circumstances call for aggressive treatment of jaundice in newborns? Is cessation of breast-feeding necessary to help bring down the high bilirubin concentration? When should phototherapy be started--and stopped? The authors address these and other questions in this thorough guide to differential diagnos...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1996-03-01 00:00:00
abstract::Occlusive peripheral arterial disease is rather easy to diagnose because of its characteristic symptoms and the ease with which the extremities and their circulation can be examined. Elevation and dependency tests give a rough but reliable estimate of the degree of ischemia, and if more objective data are desired, the...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11715993
更新日期:1982-02-01 00:00:00
abstract::Unresolved grief refers either to the absence or to the prolongation of normal grief. It is identified by (1) painful response to recall of the deceased, (2) realization of not having accepted the loss or of not being able to grieve, and (3) unaccountable depression, emergence of medical symptoms on the anniversary of...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1976.11714374
更新日期:1976-05-01 00:00:00
abstract::Preview An elevated serum calcium level requires thorough investigation. Is hyperparathyroidism at the root of the abnormality? Malignant disease? Vitamin toxicity? In this article, Dr Kaye discusses clinical evaluation of hypercalcemia and outlines pharmacologic therapy, surgical intervention, and other treatment opt...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1995.11945953
更新日期:1995-01-01 00:00:00
abstract::Serum electrolyte levels by themselves may be difficult to interpret. For example, an abnormal serum potassium concentration cannot be understood without taking into account the patient's history, other serum electrolyte values, and possibly results of other laboratory tests. Knowledge of the principles of serum elect...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1991.11701146
更新日期:1991-12-01 00:00:00
abstract::Over the past decade, despite the controversies surrounding prostate cancer screening, significant refinements have improved its application. PSA screening, although it has been questioned, appears to confer a mortality benefit and remains the most effective way to identify the possible presence of prostate cancer. Me...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2020.1822067
更新日期:2020-12-01 00:00:00
abstract::Preview Back pain can be a symptom of any number of problems, most commonly mechanical, or structural, in nature. Among the nonmechanical causes is ankylosing spondylitis, an inflammatory disease that involves the spine and sometimes other joints and extra-articular organs. Dr Escalante explains how to differentiate t...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1993.11945685
更新日期:1993-07-01 00:00:00
abstract::Many medical conditions that clearly have a strong genetic component are not transmitted in a straightforward dominant, recessive, or X-linked pattern. Recent progress in understanding other modes of inheritance, such as imprinting, trinucleotide repeat expansion, mitochondrial inheritance, and mosaicism, has allowed ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2000.09.1.1210
更新日期:2000-09-01 00:00:00
abstract::The Editor welcomes readers' comments, and selected letters are published each month. Letters must be signed and should be sent to Editor's Mail at the address shown. The journal reserves the right to condense letters if necessary for space. ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11716008
更新日期:1982-03-01 00:00:00
abstract::Irritable bowel syndrome (IBS), which is characterized by recurrent abdominal pain and disordered bowel habits, is one of the most common functional bowel disorders. IBS is a substantial burden on both patient health-related quality of life and healthcare costs. Several pathophysiologic mechanisms have been postulated...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2017.1383819
更新日期:2017-11-01 00:00:00
abstract::Glaucoma is a group of diseases leading to characteristic cupping and damage of the optic nerve head associated with progressive visual loss. The exact mechanism of damage is unknown, but current research is pointing toward a multifactorial disease process, in which elevated intraocular pressure is just one of the fac...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1996-05-01 00:00:00
abstract::Both recreational and elite athletes often sustain musculoskeletal injuries. Common problems--muscle cramps, burners (or stingers), and ankle and shoulder injuries--can be managed effectively with certain basic techniques. Initial measures are particularly important in facilitating the injured athlete's rapid return t...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:
更新日期:1992-08-03 00:00:00
abstract::Management of patients with diabetes mellitus and chronic kidney disease (CKD) is a challenging task because multiple factors in each condition may impact the other. Glycemic control offers significant benefits in the prevention of diabetic kidney disease (DKD), but other associated morbidities are also important to a...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2009.05.2002
更新日期:2009-05-01 00:00:00
abstract::Anemia is one of the consistent findings with inflammation. Whether the anemia is helpful or harmful in the general context of the illness is unclear. It may be recognized by demonstration of iron-deficient erythropoiesis due to an internal block in iron supply. Only when its severity is disproportionate to the severi...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1978.11714951
更新日期:1978-10-01 00:00:00