Arch Intern Med
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Continuing medical education plays an essential role in efforts to improve physician performance. This article deals with remedial or personalized physician education. The experience of selected institutions and state organizations that have and/or continue to provide such remedial education is reviewed. The emphasis of remedial or focused physician education is educational enhancement, not suspension or revocation of license.
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Review Case Reports
Aldicarb poisoning. A case report with prolonged cholinesterase inhibition and improvement after pralidoxime therapy.
Aldicarb is the most potent of the commercially available carbamate pesticides and is an unusual source of acute human poisonings. We present the case of a 43-year-old man exposed to aldicarb who developed severe cholinergic symptoms and progressive weakness requiring intubation for 5 days. ⋯ He demonstrated neuromuscular improvement concurrent with pralidoxime administration. The pertinent medical literature on aldicarb poisoning is reviewed.
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Despite the strong association between hypertension and accelerated atherosclerosis, and the known beneficial clinical effects of beta-blockers in patients with coronary artery disease, antihypertensive trials of beta-blockers have shown only modest protection against fatal and nonfatal myocardial infarction. This review explores the explanations put forth for this apparent failure of beta-blockers. It also examines the clinical relevance of the metabolic effects of beta-blockers within the framework of the heterogeneity of this class of drugs. ⋯ There are no data to show a quantified effect on clinical outcome of the lipid and glucose changes associated with beta-blocker therapy. The metabolic influence of these drugs varies considerably within the class and may be of little clinical relevance. Unless it is contraindicated, an appropriate beta-blocker should be considered for the treatment of hypertension in patients who have coronary artery disease or who are at high risk for coronary artery disease.
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Review
Results of cardiopulmonary resuscitation. Failure to predict survival in two community hospitals.
The use of closed chest cardiopulmonary resuscitation (CPR) has, since its initial description in 1960, expanded greatly. Recently, much energy has focused on identifying patients' probabilities of responding to CPR. The goal of this study was to determine the current rate of successful CPR in two community teaching hospitals and to identify patient characteristics associated with the likelihood of successful resuscitation. ⋯ Other than the length of resuscitation, easily accessible clinical variables provided limited predictive information about CPR results.