Abstract:
:Pain is among the most common reasons patients seek medical attention, and the care of patients with pain is a significant problem in the United States. Acute pain (mild-to-moderate intensity) represents one of the most frequent complaints encountered by primary care physicians (PCPs) and accounts for nearly half of patient visits. However, the overall quality of pain management remains unacceptable for millions of US patients with acute or chronic pain, and underrecognition and undertreatment of pain are of particular concern in primary care. Primary care physicians face dual challenges from the emerging epidemics of undertreated pain and prescription opioid abuse. Negative impacts of untreated pain on patient activities of daily living and public health expenditures, combined with the success of opioid analgesics in treating pain provide a strong rationale for PCPs to learn best practices for pain management. These clinicians must address the challenge of maintaining therapeutic access for patients with a legitimate medical need for opioids, while simultaneously minimizing the risk of abuse and addiction. Safe and effective pain management requires clinical skill and knowledge of the principles of opioid treatment as well as the effective assessment of risks associated with opioid abuse, addiction, and diversion. Easily implementable patient selection and screening, with selective use of safeguards, can mitigate potential risks of opioids in the busy primary practice setting. Primary care physicians can become advocates for proper pain management and ensure that all patients with pain are treated appropriately.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
McCarberg BHdoi
10.3810/pgm.2011.03.2270subject
Has Abstractpub_date
2011-03-01 00:00:00pages
119-30issue
2eissn
0032-5481issn
1941-9260journal_volume
123pub_type
杂志文章,评审abstract::Stroke is the most feared complication among patients with atrial fibrillation. Oral anticoagulation therapy with vitamin K antagonists (VKAs) has been the gold standard for stroke prevention for the past 60 years. However, VKA therapy has many downsides, including risk for bleeding, a narrow therapeutic window, and t...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2013.03.2648
更新日期:2013-03-01 00:00:00
abstract::Cardiovascular disease (CVD) is the major cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Recent major publications, such as the Action to Control Cardiovascular Risk in Diabetes trial, the Advance in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation tria...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2011.11.2501
更新日期:2011-11-01 00:00:00
abstract::Performing office surgery well is an art. You can accomplish this by being attentive to several factors. These include, but are not limited to, providing an office environment that is pleasant, restful, and happy; using proper lighting, instruments, and suture techniques; using gentle techniques for local infiltration...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1983.11698400
更新日期:1983-08-01 00:00:00
abstract::Non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used to treat inflammatory pain for decades. More recently, newer NSAIDs were developed to target the inducible isoform of cyclooxygenase (COX), COX-2, with the aim of reducing gastrointestinal toxicity. While the COX-2 selective inhibitors were effective...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2018.1412799
更新日期:2018-01-01 00:00:00
abstract::Gastroesophageal reflux provokes asthma in many patients. Conversely, asthma predisposes to gastroesophageal reflux. In many patients, reflux therapy will ameliorate asthma. Recognition of this relationship is facilitated by physician awareness, clinical history, selected laboratory tests, and ultimately, a careful mo...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1989.11704343
更新日期:1989-07-01 00:00:00
abstract::Varicose veins are a common problem that still presents a major challenge to the physician and the patient. Complete surgical removal of the malfunctioning veins has proved to be the most effective management for significant varicosities, although several nonsurgical methods are available for mild cases or those not s...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1979.11715178
更新日期:1979-06-01 00:00:00
abstract::In an era when air travel is commonplace, middle ear block is not unusual. Educating patients about the simple techniques they can perform at the first signs of a problem may save a business trip or vacation from becoming a trip to the emergency department and a train ride home. The most important preventive measure i...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-08-01 00:00:00
abstract::Eradication of H pylori and cure of peptic ulcer disease are possible if effective regimens are used correctly. Treatment markedly improves clinical outcomes and significantly decreases cost of care. As primary care physicians take a larger role in management of these infections, they need to understand the importance...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1998.03.423
更新日期:1998-03-01 00:00:00
abstract::Overactive bladder is a prevalent condition with bothersome symptoms that greatly impact health-related quality of life. Despite a multitude of treatment options, many patients go untreated or undertreated. This article addresses the contemporary management of overactive bladder, including behavioral and lifestyle mod...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2012.01.2523
更新日期:2012-01-01 00:00:00
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 investigati...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1996-06-01 00:00:00
abstract:STUDY OBJECTIVES:To compare the safety and efficacy of U.S. Food and Drug Administration (FDA)-recommended doses of labetalol and nicardipine for hypertension (HTN) management in a subset of patients with renal dysfunction (RD). DESIGN:Randomized, open label, multicenter prospective clinical trial. SETTING:Thirteen U...
journal_title:Postgraduate medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.3810/pgm.2014.07.2790
更新日期:2014-07-01 00:00:00
abstract:PURPOSE:To evaluate patient access, provider productivity, and patient satisfaction during a 24-month redesign process of an academic medical center, which requires balance between clinical and educational missions. METHODS:A series of activities were conducted to optimize primary care across 17 attending physicians, ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2020.1773685
更新日期:2020-09-01 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::Chronic neck and shoulder pain is a complex, multifactorial problem. Often many months have passed since its onset. During this time the patient may have seen many physicians and tried many medications, some with abuse potential. Most patients are depressed and have lost their ability to cope with the stresses of dail...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698897
更新日期:1985-02-15 00:00:00
abstract::Contrary to long-standing mores, what goes on in the person's home is not always sacred. When family relationships break down and family members deal violently with various stresses and problems, intervention is in order. Certain changes in societal attitudes would help prevent the problem. Physicians-alone or working...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11716255
更新日期:1982-11-01 00:00:00
abstract::Migraine is a common hereditary disorder manifested by episodic headache, irritability, and gastrointestinal upset. The condition may be triggered by dietary, environmental, psychological, or pharmacologic factors. With proper diagnosis and judicious use of abortive and prophylactic therapy, patients often obtain exce...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699870
更新日期:1987-06-01 00:00:00
abstract::Cataracts are the most common treatable form of reduced vision in older adults. Although the incidence of cataracts is high after age 65, careful history taking and clinical examination are essential to establish the diagnosis. Cataract surgery is medically indicated when the view to the retina is obscured or lens-ind...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1998.05.478
更新日期:1998-05-01 00:00:00
abstract::Treatment of asymptomatic diverticulosis is geared to the prevention of constipation, with vigilance for possible signs of complications. A bulky stool decreases colonic intraluminal pressures, probably lessening pain and the chance of development of new diverticula. Increased stool weight may be achieved by the addit...
journal_title:Postgraduate medicine
pub_type: 临床试验,杂志文章
doi:10.1080/00325481.1976.11708409
更新日期:1976-12-01 00:00:00
abstract::Lyme disease can be difficult to recognize because not all patients have erythema migrans or other classic symptoms. Therefore, laboratory testing has become an important aid to clinical diagnosis. But the story doesn't end there-serologic testing presents another set of problems and concerns. Drs. Still and Ryan expl...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.1997.07.260
更新日期:1997-07-01 00:00:00
abstract::Many patients who require evaluation for coronary artery disease are unable to undergo exercise stress testing because of physiologic or psychological limitations. Drs Vacek and Baldwin describe three alternative methods for assessment of cardiac function in these patients, all of which have high levels of diagnostic ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1989.11704412
更新日期:1989-09-15 00:00:00
abstract::Sleep is increasingly being recognized as an important factor in the homeostasis of multiple body functions, including blood glucose metabolism. One of the most common sleep disorders, obstructive sleep apnea, is not only highly prevalent in patients with type 2 diabetes mellitus, but may contribute to the development...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2012.07.2573
更新日期:2012-07-01 00:00:00
abstract::Benign essential tremor can be distinguished from parkinsonism by its rapid frequency, the involvement of voice and head, and the common finding of a positive family history. Essential tremor is less incapacitating than parkinsonism and less inexorably progressive. Propranolol (Inderal) is the best therapy available a...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11715961
更新日期:1982-01-01 00:00:00
abstract::Human growth and development are a continuum starting at conception. Prenatal growth can only be estimated at present but is an important consideration in an evaluation of a child's developmental status. Postnatal growth can be assessed for size attained (distance curve) or change over time (velocity curve). Velocity ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1977.11714699
更新日期:1977-12-01 00:00:00
abstract:OBJECTIVE:This study aims to compare the effectiveness of insulin glargine 300 U/mL (Gla-300) with its accompanying patient support program with that of other basal insulin and available patient support programs in patients with type 2 diabetes (T2D) in a real-world setting in terms of achieving HEDIS (Healthcare Effec...
journal_title:Postgraduate medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1080/00325481.2016.1241663
更新日期:2016-11-01 00:00:00
abstract::The hydroxyl-methyl-glutaryl-coenzyme-A (HMG-CoA) reductase inhibitors of statin action are very effective and safe drugs, and they are widely used for the treatment of hyperlipidemia and the prevention of primary and secondary cardiovascular diseases (CVDs). However, recent meta-analyses of previous studies done with...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2017.1292107
更新日期:2017-05-01 00:00:00
abstract::The compatibility of a medication with other drugs and implanted materials is an important factor impacting drug safety and efficacy. The liposomal formulation of the local anesthetic bupivacaine is designed to provide prolonged postsurgical analgesia. Its compatibility with other drugs and materials depends on the co...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2014.01.2733
更新日期:2014-01-01 00:00:00
abstract::Phencyclidine (PCP) is a dissociative anesthetic whose abuse is a growing problem. Historically, its effects have been considered remarkably like those of the schizophrenic state, but in vitro and in vivo neuropharmacologic data are somewhat inconsistent with the dopaminergic hypothesis of schizophrenia. The physiolog...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715603
更新日期:1980-11-01 00:00:00
abstract::Common variable immunodeficiency (CVID) is readily considered in patients presenting with recurrent sino-pulmonary infections, however this disease has a broad range of clinical manifestations and diagnosis can be delayed by several years. We present the case of a 44-year-old postpartum female who presented with nause...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2016.1199250
更新日期:2016-08-01 00:00:00
abstract::All lumps in the parotid region must be assumed to originate in the parotid gland. A mobile, superficial-appearing lesion cannot be assumed to be located just beneath the skin. Open incisional biopsy should never be used in approaching lumps in this region because of the danger of tumor seeding or damage to the facial...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699754
更新日期:1987-03-01 00:00:00
abstract:OBJECTIVES:Multilevel noncontiguous thoracic and lumbar spinal tuberculosis (MNST) is a relatively rare entity. The objective of this retrospective study was to investigate whether a technique involving a one-stage posterior debridement and decompression, combined with an intervertebral fusion and posterior instrumenta...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2019.1552824
更新日期:2019-01-01 00:00:00