Cleveland Clinic journal of medicine
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Intimate partner violence is as prevalent as many conditions for which we routinely screen. Yet intimate partner violence remains underdiagnosed and undertreated. Physicians and other health care workers are in a unique position to detect it and intervene. This article reviews what we can do, what we should do, and what we legally and ethically must do.
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Review
Stroke prevention in atrial fibrillation: current anticoagulation management and future directions.
Atrial fibrillation (AF) is an important cause of stroke, and stroke risk stratification is critical to the management of patients with AF. Anticoagulation with warfarin is the current standard of care for stroke prevention in these patients, despite the need for close monitoring. ⋯ Other novel anticoagulants and antiplatelet combinations are under investigation. Curative procedures for AF are possible, but their long-term safety and effect on stroke risk are unknown.
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For over 50 years, anticoagulant options for the treatment and prevention of thrombosis have been limited mainly to traditional agents such as unfractionated heparin and oral vitamin K antagonists such as warfarin. These traditional agents are fraught with limitations that complicate their clinical use. ⋯ Specifically, progress has been made in the development of low-molecular-weight heparins, factor Xa inhibitors, and direct thrombin inhibitors. Because of their convenience and ease of use, some of these novel compounds are competing with the traditional anticoagulants and are needed additions to the antithrombotic arsenal.
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Epidural injections of glucocorticoids may help some patients with back and leg pain. The efficacy of this therapy has not been conclusively proved; however, when weighed against the risks, cost, and outcomes of spinal surgery, epidural glucocorticoids are a reasonable alternative in selected patients whose back and leg pain is functionally limiting. We review the rationale, available data, techniques, and indications for these injections.
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Many physicians avoid prescribing opioid analgesics for chronic pain because of misconceptions or fears about efficacy, adverse effects, abuse, and addiction potential. We discuss these issues and offer suggestions for the rational use of opioid analgesics in patients with chronic noncancer pain.