J Natl Med Assoc
-
We report our experience of providing chronic opioid pharmacotherapy on an outpatient basis to selected patients with frequent episodes of moderate-to-severe pain from sickle cell disease (SCD). Three cases illustrate our clinical experience in approximately 40 patients with sickle cell pain. Patients were seen at our sickle cell pain clinic at Beth Israel Hospital once each month for a three-hour visit. ⋯ Pain was well controlled. For each patient, hospital admissions were reduced to < or = 1 visit per year. These reduced levels of ED visits and hospital admissions have remained constant for more than three years.
-
Comparative Study
Comparison of the prevalence of first-degree atrioventricular block in African-American and in Caucasian patients: an electrocardiographic study III.
Electrocardiographic (ECG) differences occur between African-American and Caucasian patients. ⋯ First-degree atrioventricular (AV) block was more prevalent in African-American patients compared with Caucasian patients in all age groups of the study except for those patients in the eighth decade of life. The prevalence of first-degree AV block began to increase at age 50 years in both ethnic groups and gradually increased with advancing age, peaking in African-American patients in the 10th decade of life, and in Caucasian patients in the ninth decade of life. The continuing increase in first-degree AV block in African-American patients in the 10th decade of life suggests increasing impairment but greater durability of the AV conduction system in African-American compared with Caucasian patients. The dramatic decline of the prevalence of first-degree AV block in Caucasian patients in the 10th decade of life suggests more frequent failure of the AV conduction system in this group of patients at ages 90-99 years, compared with African-American patients in the same age group. In population-based surveys, first-degree AV block was more prevalent in African-American subjects compared with Caucasian subjects.
-
Information on breast and colorectal cancer risk factors is widely available to women and the physicians who provide their healthcare; however, many women are unable to identify the major risk factors, continue to misperceive their personal risk of developing these cancers, and do not engage in routine early detection. ⋯ Healthcare professionals who serve low-income African-American and Hispanic female populations should deliver information to them about the personal risk of developing targeted cancers and ways to reduce this risk in formats that are meaningful and effectively address the special needs of these populations.
-
Secondary osteoarthritis of the hip joint often complicates avascular necrosis of the femoral head in young adults suffering from sickle cell anemia. These patients, particularly in our environment, are usually reluctant to use walking aids like crutches to alleviate the pain since they believe that these devices are temporary measures. They often demand long-term solutions which border on surgery. ⋯ With the advent of various forms of hip implants, osteotomies are not as popular in modern-day orthopedic practice. In this series, we treated five patients with secondary osteoarthritis in six hip joints (bilateral in one patient) using cementless bipolar arthroplasty with good outcome. This implant is available and affordable in Nigeria, and the use of a cementless implant obviates damage to the acetabulum and may make revision surgeries less hazardous both for the surgeon and the patient.
-
Reducing the high morbidity and mortality associated with stroke continues to be a major healthcare challenge in the United States. Recent advances in the management and prevention of atherothrombotic events are significant; however, the clinical application of evidence-based "best practices" is lagging in many hospitals across the country. The "Stroke Best Practices" program was designed to assist institutions that lack established stroke centers integrate recent evidence-based recommendations into individualized, in-hospital initiatives to optimize the management of acute stroke, prevent secondary vascular events, and enhance the quality of care for patients with established cerebrovascular disease. Programs that bridge the gap between evidence-based medicine and clinical practice can improve patient outcomes.