A basic approach to the patient presenting with acute monoarthritis includes a careful history, a physical examination and a selected battery of laboratory tests and radiographs. Because of the possibility of septic joint, rapid assessment and treatment
Uncommon headache syndromes can be classified into two broad categories: (1) urgent conditions, including subarachnoid hemorrhage, giant cell arteritis and bacterial meningitis, and (2) special syndromes, such as cluster headache, migraine with aura and
The etiology of primary nocturnal enuresis remains somewhat controversial but may include genetic factors, decreased functional bladder capacity, increased diuresis at night, and constipation. Deep sleep and emotional illness usually play only a minimal
In evaluating recurrent childhood infections, the physician must keep in mind the rarity of true immunodeficiency and the frequency of atopy, day care, exposure to cigarette smoke and anatomic variations as predisposing factors in recurrent childhood il
Recent reviews of the effect of estrogen on the cardiovascular system suggest that long-term estrogen replacement therapy after menopause may prevent cardiovascular disease in women who are at risk. Short-term effects of estrogen on coronary vascular re
Chlamydia trachomatis and Trichomonas vaginalis are common sexually transmitted infections associated with adverse pregnancy outcome. Since patients are frequently asymptomatic, diagnosis on the basis of symptoms or physical findings is unreliable. If m
Acute cholecystitis is a common abdominal condition resulting from chemical or bacterial inflammation of the gallbladder. It is generally related to gallstones and subsequent unresolved obstruction. Early surgery is the treatment of choice because of th
Lindane has been the primary therapy for scabies for more than 30 years. However, because of neurotoxic side effects attributed to this drug, alternative drugs such as 5 percent permethrin have been used, particularly in the pediatric population where t
Clodronate is a second-generation bisphosphonate that has shown the ability to induce substantial gains in bone mineral density when administered in a cyclical regimen in patients with osteoporosis. Because progressive gains in calcium balance and bone
Diagnostic imaging of the spinal canal in the pediatric population is primarily performed to evaluate the presence of congenital malformations, trauma, neoplasms and inflammation. Although magnetic resonance imaging (MRI) is considered the diagnostic mo
Date: August, 1991
Recent studies indicate that cardiopulmonary resuscitation (CPR) for cardiopulmonary arrest has limited success in achieving survival to hospital discharge in patients over 70 years of age, especially among patients with multiple disease processes. At the time that a patient is acutely ill, a discussion concerning whether CPR should be performed is often awkward; the patient may not be able to make an informed decision. It is more appropriate to educate, discuss and determine preferences for CPR with healthy adult patients during routine office visits. Schonwetter and colleagues conducted a study to evaluate an elderly population's attitudes and knowledge about CPR before and after patient education.
Sixty-four ambulatory patients who attended a veterans outpatient clinic during a three-month period were interviewed and educated about CPR. The patients were all over 74 years of age (mean age: 82 years). A questionnaire that documented demographic data was administered to the patients. The interviewer also tested the patients knowledge about what is involved when CPR is administered for cardiopulmonary arrest. All of the patients were then given a standard description of a sudden cardiopulmonary arrest and subsequent CPR, with its possible risks and benefits.
Most of the patients thought that the use of CPR should be routinely discussed with a physician. Only 17 percent had discussed decisions about CPR with their family, and none had done so with physicians. Knowledge about what was involved with CPR was variable; most patients overestimated their chances of survival with CPR. In considering five hypothetical scenarios, 9 percent of the patients said that they would not have wanted CPR and 17 percent stated that they would have wanted CPR in each instance. Although knowledge significantly increased after CPR education intervention, the patients' preferences regarding CPR did not change significantly.
The study findings indicate that most older patients wish to discuss their opinions about CPR with their physicians. In addition, most elderly patients have fixed preferences that may be easily discussed while their clinical condition is stable. journal of the American Geriatrics Society, April 1991, vol. 39, p. 372.)
COPYRIGHT 1991 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group