Gonorrhea—The Office Management of Acute Infections

Gonorrhea has recently increased to epidemic proportions and is poorly controlled. The principal causes are probably increasing resistance of Neisseria gonorrheae to penicillin, the difficulty of establishing the diagnosis and proving the cure in female patients and the inadequacy of resources devoted to the eradication of the disease by public health agencies.While examination of smears is adequate for diagnosis of the disease in males, in females cultures of vaginal exudate are necessary. Gonorrhea can usually be successfully treated with large doses of short-acting penicillins. Intramuscular administration of aqueous procaine penicillin will bring about cure in most cases. Female patients should have cultures for several weeks to make sure they are cured.The physician should report all cases to the local health department so that contacts can be traced and treated.     

Dental Implications of Pharmacological Management of the Alzheimer's Patient

Medications used for the management of the Alzheimer's patient are of two types: agents prescribed for treatment of cognitive disorders and agents used for symptomatic relief of mood disorders. This article reviews the mechanisms of action and side-effects of the more common of these agents. In addition, dental management of the Alzheimer's patient is discussed in relation to specific medications being taken.     

构建患者安全管理体系的实践与思考

保障患者安全是各级医疗的机构管理重心,以事前管理为重点,事后管理为补充,构建患者安全管理体系,从不良事件上报、高危哨点预警、患者安全文化、医疗风险转移四个维度构建患者安全管理的事前管理架构,进而从系统上保障患者安全,降低医疗风险。     

What Is the Role of Cognitive-Behavior Therapy in Patient Management?

This review summarizes the role of cognitive-behavior therapy (CBT) in obesity treatment. Although not a specific intervention per se, CBT is the systematic application of principles of social cognitive theory to modify behaviors that are thought to contribute to or maintain obesity. Most forms of CBT include the use of five strategies: self-monitoring and goal setting; stimulus control for the modification of eating style, activity, and related habits; cognitive restructuring techniques that focus on challenging and modifying unrealistic or maladaptive thoughts or expectations; stress management; and social support. The use of these strategies in comprehensive obesity programs has been helpful in improving short-term weight losses, but long-term success remains elusive, even though these strategies are predictors of long-term weight loss maintenance. Given that obesity is a chronic condition, not unlike hypertension or diabetes, CBT interventions will need to focus on broader treatment outcomes, such as improved metabolic profiles, quality of life, psychological functioning, and physical fitness. In addition, new methods for delivering CBT interventions should be explored, including home-based programs and combination with adjunctive pharmacotherapy delivered in primary care centers.     

Dental Management of the Geriatric Head and Neck Cancer Patient1

The geriatric patient presenting with cancer of the head and neck region constitutes slightly less than half of all oral cancers diagnosed. Cancers of this region are generally treated with surgery, radiation, chemotherapy or combinations of these three. These patients not only present with special problems due to their age but also with challenging ones resulting from treatment of their disease. The dentist plays an important role in evaluating the patient's oral health and providing necessary services prior to any curative treatment. The dental diagnosis and treatment protocol practiced at Memorial Hospital are discussed for each therapeutic modality along with the measures taken for follow up care.     

随机模型在患者流管理中的应用研究综述

基于运筹学的优化理论对医疗服务系统进行运作管理是近年来国外热门的研究方向。而患者作为医疗系统中的主体,其合理的分布和流动是促使医疗系统运作效率提高的重要因素。综述了近年来随机模型和仿真实验方法对患者流管理的研究进展,包括模型建立、求解方法以及研究结论。最后总结了随机模型对患者流管理研究的难点和未来努力的方向。     

Myasthenia Gravis: Anesthetic and Surgical Management of the Patient Undergoing Thymectomy

Experience in the anesthetic and surgical management of 25 patients with myasthenia gravis is recorded. These are subdivided into two groups: those operated on during the period 1950-1958 and those operated on during the period 1959-1964. The purpose of this paper is to indicate improvement in mortality and morbidity due to three major advances: (1) use of the decamethonium diagnostic test in a myasthenia gravis clinic; (2) improvements in assessment and management of respiratory insufficiency; and (3) avoidance of anticholinesterase treatment in the immediate and early postoperative recovery period.Fourteen patients with myasthenia gravis, including five with thymoma and two who were refractory to medication, were in the second (1959-1964) group. There were no deaths and no myasthenic or cholinergic crises. Three prophylactic tracheostomies were performed. No emergency bronchoscopies or tracheostomies were required.     

Clinical Features and Patient Management of Lujo Hemorrhagic Fever

Background

In 2008 a nosocomial outbreak of five cases of viral hemorrhagic fever due to a novel arenavirus, Lujo virus, occurred in Johannesburg, South Africa. Lujo virus is only the second pathogenic arenavirus, after Lassa virus, to be recognized in Africa and the first in over 40 years. Because of the remote, resource-poor, and often politically unstable regions where Lassa fever and other viral hemorrhagic fevers typically occur, there have been few opportunities to undertake in-depth study of their clinical manifestations, transmission dynamics, pathogenesis, or response to treatment options typically available in industrialized countries.

Methods and Findings

We describe the clinical features of five cases of Lujo hemorrhagic fever and summarize their clinical management, as well as providing additional epidemiologic detail regarding the 2008 outbreak. Illness typically began with the abrupt onset of fever, malaise, headache, and myalgias followed successively by sore throat, chest pain, gastrointestinal symptoms, rash, minor hemorrhage, subconjunctival injection, and neck and facial swelling over the first week of illness. No major hemorrhage was noted. Neurological signs were sometimes seen in the late stages. Shock and multi-organ system failure, often with evidence of disseminated intravascular coagulopathy, ensued in the second week, with death in four of the five cases. Distinctive treatment components of the one surviving patient included rapid commencement of the antiviral drug ribavirin and administration of HMG-CoA reductase inhibitors (statins), N-acetylcysteine, and recombinant factor VIIa.

Conclusions

Lujo virus causes a clinical syndrome remarkably similar to Lassa fever. Considering the high case-fatality and significant logistical impediments to controlled treatment efficacy trials for viral hemorrhagic fever, it is both logical and ethical to explore the use of the various compounds used in the treatment of the surviving case reported here in future outbreaks. Clinical observations should be systematically recorded to facilitate objective evaluation of treatment efficacy. Due to the risk of secondary transmission, viral hemorrhagic fever precautions should be implemented for all cases of Lujo virus infection, with specialized precautions to protect against aerosols when performing enhanced-risk procedures such as endotracheal intubation.