Annals of internal medicine
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Feedback control is an important mechanism for reaching a targeted goal. Biologic examples range from achieving the appropriate blood pressure level to glycemia control. Computer-based feedback control systems have many potential applications in medicine. ⋯ However, existing applications have only scratched the surface. Many more facets of diabetes management could be standardized and assisted by open-loop control systems if the management rules could be more exactly specified, a task requiring substantial time commitments by diabetologists. Efforts to translate existing knowledge bases into precise guidelines will be helpful, but new primary studies and decision analyses are needed to define the optimal use of some interventions.
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To review prospective epidemiologic studies and randomized trials regarding the role of antioxidant vitamins (vitamins E and C and beta-carotene) in the prevention of cardiovascular disease, with emphasis on differences in results obtained by these two types of studies. ⋯ The epidemiologic data suggest that antioxidant vitamins reduce cardiovascular disease, with the clearest effect for vitamin E; however, completed randomized trials do not support this finding. Much of this controversy should be resolved by the ongoing large-scale and long-term randomized trials designed specifically to evaluate effects on cardiovascular disease.
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As many as 45% to 80% of nursing home residents have pain that contributes materially to functional impairment and decreased quality of life. Substantial barriers, including a high frequency of dementia, multiple pain problems, and increased sensitivity to drug side effects often make pain assessment and management more difficult in the nursing home setting. Logistic problems in carrying out diagnostic procedures and management interventions are also common. ⋯ Elderly nursing home residents are more sensitive to the side effects associated with many analgesic drugs, but this does not justify the failure to treat pain, especially in those who are terminally ill or near the end of life. Structured programs for routine pain assessment and treatment are needed. Physician involvement in pain assessment and management is necessary if pain control is to be improved for nursing home patients.
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To review the literature on the causes, epidemiology, prevention, and treatment of pressure ulcers in nursing homes and to summarize this information for clinicians caring for nursing home residents. ⋯ Pressure ulcers in the nursing home are common problems associated with significant morbidity and mortality. Because resident characteristics can identify residents likely to develop ulcers, preventive measures can be implemented early. Therapy for advanced stages of pressure ulcers is expensive and prolonged. Involvement of the physician with the multidisciplinary nursing home team is essential for prevention and therapy.
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To 1) consider the problem of sudden death from heart disease and the role of beta-blockers and other agents in preventing sudden death and 2) review perceived problems with beta-blocker therapy, such as effects on blood lipids, complications in diabetes, and adverse effects on heart failure and quality of life. ⋯ Clinicians should reappraise the evidence for the significant effect of beta-blockers on morbidity and mortality, and they should recognize the importance of initiating and maintaining beta-blocker therapy when the less well-informed might suggest otherwise.