The American journal of medicine
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Review
Approaches to patient education: emphasizing the long-term value of compliance and persistence.
Approximately 50% of patients with chronic disease do not obtain optimal clinical benefit from treatment because of poor compliance with medication regimens. Lack of compliance is associated with poor clinical outcomes, increased hospitalizations, lower quality of life, and higher overall healthcare costs. Although poor compliance and persistence are common across many disease states, they may be particularly poor in treatment for asymptomatic chronic diseases such as osteoporosis. ⋯ Patient satisfaction with treatment has been linked to compliance with therapy; by improving patient care through fulfilling expectations for physician visits and providing frequent feedback, the healthcare provider can dramatically improve compliance. Self-management programs focusing on day-to-day management of chronic diseases have been shown to significantly improve heath behaviors and health status. Regardless of the strategy used, attention must be directed to identifying the patients least likely to persist with treatment and to providing the education and support these patients need to adhere to osteoporosis therapy.
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To assess the diagnostic accuracy and additional information provided by 123I-labeled serum amyloid P component (SAP) scintigraphy in patients with systemic and localized amyloidosis. ⋯ SAP scintigraphy is diagnostic of amyloid in most patients with AA and AL type but fewer with hereditary ATTR type, relating to differing distributions and burdens of amyloid in these disorders. It usually reveals more widespread organ involvement than is identified clinically, and certain distributions of amyloid are characteristic of particular fibril types.
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The guidelines for cardiopulmonary resuscitation (CPR) have been in place for decades; but despite their international scope and periodic updates, there has been little improvement in survival rates in out-of-hospital cardiac arrest for patients who did not receive early defibrillation. The Emergency Medical Service directors in 2 rural Wisconsin counties initiated a new protocol for the pre-hospital management of adult cardiac arrest victims in an attempt to improve survival rates. The results observed after implementation of this protocol are presented and compared with those observed during a three-year period that preceded initiation of the project. ⋯ Instituting the new cardiocerebral resuscitation protocol for managing prehospital cardiac arrest improved survival of adult patients with witnessed cardiac arrest and an initially shockable rhythm.
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Hypothermia-related cases typically occur after exposure to low ambient temperatures; however, numerous cases occur in individuals with no history of exposure to cold environment. Hypothermia is associated with such complications as acidosis, impaired myocardial function, bleeding diathesis, and decreased kidney and liver function. ⋯ The choice of rewarming therapy is based on the degree of hypothermia. The evaluation, electrocardiographic manifestations, and management of hypothermia are reviewed.