Postgraduate medicine
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Postgraduate medicine · Sep 2010
ReviewInnovations to achieve excellence in COPD diagnosis and treatment in primary care.
Recognition of chronic obstructive pulmonary disease (COPD) is often missed or delayed in primary care. Once recognized, COPD is often undertreated or episodically treated, focusing on acute exacerbations without establishing maintenance treatment to control ongoing disease. Diagnostic and therapeutic pessimism result in missed opportunities to reduce exacerbations, maintain physical functioning, and reduce emergent health care requirements. ⋯ Practice redesign for whole-patient primary care provides additional tools for comprehensive COPD management. Innovations such as group visits and the patient-centered medical home provide newer ways to interact with COPD patients and their families. Patient-focused and evidence-based options enable primary care practices to manage COPD longitudinally and improve patient outcomes through the course of the disease.
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Postgraduate medicine · Sep 2010
ReviewThe role of alpha2-adrenergic agonists in attention-deficit/hyperactivity disorder.
Psychostimulants are first-line therapy for patients with attention-deficit/hyperactivity disorder (ADHD). However, some patients are not optimal responders to monotherapy or present as comorbid for a variety of other disorders that either preclude the use of stimulants or produce a symptom complex that is resistant to monotherapy. Unfortunately, there are few agents well studied in combination with psychostimulants for patients with ADHD. ⋯ New controlled-release formulations of the alpha2-adrenergic agonists have overcome some of these limitations, with recent clinical trials demonstrating their enhanced tolerability and effectiveness for treatment of ADHD in children and adolescents. Studies with each of these new formulations (ie, guanfacine extended release and clonidine hydrochloride extended-release tablets) in combination with psychostimulants have demonstrated that the addition of an alpha2-adrenergic agonist to psychostimulant therapy significantly enhances efficacy without compromising safety. This review will encompass the clinical study database for novel formulations of alpha2-adrenergic agonists, enabling the reader to appreciate their place in ADHD treatment as well as the potential utility of a combination approach with psychostimulants for patients with complex ADHD.
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Postgraduate medicine · Sep 2010
ReviewUnderstanding attention-deficit/hyperactivity disorder from childhood to adulthood.
Attention deficit/hyperactivity disorder (ADHD) is among the most common neurobehavioral disorders requiring treatment in children and adolescents. The disorder is often chronic, with prominent symptoms and impairment spanning into adulthood. It is often associated with co-occurring disorders, including disruptive, mood, anxiety, and substance abuse disorders. ⋯ Multimodal treatment includes educational, family, and individual support. Psychotherapy alone and in combination with medication is helpful for treating patients with ADHD and comorbid disorders. Pharmacotherapy, including stimulants, noradrenergic agents, α-agonists, and antidepressants, plays a fundamental role in the long-term management of ADHD.