CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Diabetes mellitus is a chronic disease that is growing in prevalence worldwide. Pharmacologic therapy is often necessary to achieve optimal glycemic control in the management of diabetes. ⋯ This review article is designed to help with these decisions. We review the mechanism of action, efficacy and side effects of the different classes of OHAs (alpha-glucosidase inhibitors, biguanides, insulin secretagogues, insulin sensitizers and intestinal lipase inhibitor) and discuss the current recommendations for their use.
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There is uncertainty about whether physician specialty influences the outcomes of outpatients with congestive heart failure after adjustment for differences in case mix. Our objective was to determine the impact of physician specialty on outcomes in outpatients with new-onset congestive heart failure. ⋯ Patients with congestive heart failure followed by both specialists and FPs had significantly better survival than those followed by FPs alone (or those who received no specific cardiovascular follow-up care). Methods to improve timely and appropriate access to specialists and to improve collaborative care structures are needed.
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Comparative Study
Patients who leave the pediatric emergency department without being seen: a case-control study.
Children who visit pediatric emergency departments (EDs) and leave before being seen by a physician may present with particular health problems and may be at risk for preventable health outcomes. We compared children who left without being seen with those who stayed and were seen by a pediatrician, and followed all of the study subjects after they left the ED. ⋯ Children who left the ED without being seen had lower acuity levels and were more likely to be taken elsewhere for follow-up care than children who stayed. Most of those who left did so because the wait was too long or their symptoms resolved.
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Hyperhidrosis, a condition characterized by excessive sweating, can be generalized or focal. Generalized hyperhidrosis involves the entire body and is usually part of an underlying condition, most often an infectious, endocrine or neurologic disorder. Focal hyperhidrosis is idiopathic, occurring in otherwise healthy people. ⋯ However, patients rarely seek a physician's help because many are unaware that they have a treatable medical disorder. Early detection and management of hyperhidrosis can significantly improve a patient's quality of life. There are various topical, systemic, surgical and nonsurgical treatments available with efficacy rates greater than 90%-95%.