Assuntos
Anti-Infecciosos/efeitos adversos , Anticoagulantes/efeitos adversos , Ciprofloxacina/efeitos adversos , Hemorragias Intracranianas/induzido quimicamente , Varfarina/efeitos adversos , Idoso , Anti-Infecciosos/uso terapêutico , Anticoagulantes/uso terapêutico , Ciprofloxacina/uso terapêutico , Interações Medicamentosas , Evolução Fatal , Humanos , Masculino , Varfarina/uso terapêuticoRESUMO
Adequate nutritional support is an important aspect of the care of all patients. Enteral nutritional support accesses the gastrointestinal tract and includes both oral supplementation and tube-feeding techniques. Enteral nutritional support should be considered when a patient has functioning intestines but cannot or will not eat. Most patients require a caloric intake of 25 to 35 kcal per kg per day. The choice of route of administration for tube feedings should be based primarily on the anticipated length of therapy and patient comfort. Three schedules for the initiation and delivery of tube feedings are presented in this article. Both nasogastric and percutaneous endoscopic gastrostomy tubes are associated with potential complications, including aspiration and gastrointestinal intolerance. Important parameters include the patient's weight and volume status, and periodic laboratory determinations of the patient's serum electrolytes and protein status.
Assuntos
Nutrição Enteral , Ingestão de Energia , Nutrição Enteral/normas , Alimentos Formulados , Humanos , Intubação Gastrointestinal , Estado NutricionalRESUMO
Obstetric services are a critical health care need in the southeastern United States. Until recently, many family physicians included obstetrics as a part of their practice. In recent years there has been significant attrition from the practice of obstetrics among family physicians. This survey looks at attrition among graduates of the Tuscaloosa Family Practice Residency Program and their practice patterns, as well as the reasons family physicians give for discontinuing obstetric practice. We also discuss implications for residency curricula and remedial measures at the state and national levels.
Assuntos
Obstetrícia , Médicos de Família/provisão & distribuição , Alabama , Currículo , Coleta de Dados , Medicina de Família e Comunidade/educação , Prática de Grupo , Humanos , Seguro de Responsabilidade Civil/tendências , Internato e Residência , Obstetrícia/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos , Prática Profissional/tendências , Área de Atuação Profissional/estatística & dados numéricos , Sudeste dos Estados Unidos , Recursos HumanosRESUMO
Hypoglycemia associated with sulfamethoxazole therapy in patients with chronic renal insufficiency has previously been documented. We report the case of an elderly patient with relatively normal renal function who developed severe hypoglycemia associated with trimethoprim-sulfamethoxazole therapy.
Assuntos
Anti-Infecciosos Urinários/efeitos adversos , Hipoglicemia/induzido quimicamente , Sulfametoxazol/efeitos adversos , Trimetoprima/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos Urinários/uso terapêutico , Combinação de Medicamentos/efeitos adversos , Combinação de Medicamentos/uso terapêutico , Feminino , Humanos , Sulfametoxazol/uso terapêutico , Trimetoprima/uso terapêutico , Combinação Trimetoprima e SulfametoxazolRESUMO
Although immunization practices have dramatically reduced the incidence of measles, several populations remain at risk of the disease. Modified measles may occur in those who received immune globulin in childhood. Atypical measles, often confused with Rocky Mountain spotted fever, may develop in those who received inactivated measles virus vaccine and were subsequently exposed to the natural disease. The diagnosis of measles requires a high index of suspicion and a careful immunization history.
Assuntos
Sarampo , Adulto , Humanos , Masculino , Sarampo/complicações , Sarampo/diagnóstico , Sarampo/prevenção & controle , Vacina contra Sarampo , VacinaçãoRESUMO
The authors report the formal evaluation of a competency-based curriculum in psychiatry in a family practice residency program at a community hospital five years after the program was implemented. In interviews, the 35 residents in the program in 1985 responded to a questionnaire on their understanding of and attitude toward the requirements of the competencies and the difficulties they encountered in documenting the competencies. All but two of the residents were aware of the nature of the curriculum, but only 43 percent had completed one or more of the 15 required competencies. The residents' attitude toward the requirements of demonstrating specific competencies in psychiatry during the residency were generally negative, although they were favorable toward required competencies in other disciplines. The results of the present study identify specific problems in implementing such a curriculum. Successful implementation may have been impeded by the novelty of the new educational format and a lack of reinforcement by faculty members.
Assuntos
Educação Baseada em Competências , Currículo , Medicina de Família e Comunidade/educação , Internato e Residência/normas , Psiquiatria/educação , Docentes de Medicina/normasRESUMO
In brief: A number of universities have started screening intercollegiate athletes for drugs. A 26-item questionnaire administered to students, athletes, former athletes, parents of athletes, high school athletes, alumni, faculty members, and coaches at the University of Alabama revealed significant differences between student and nonstudent perceptions of drug abuse as a problem. There was widespread support for the screening program among nonathletes but significantly less support among the athletes.
