Postgraduate medicine
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Postgraduate medicine · Sep 2020
The 'attended alone' and 'attended with' signs in the assessment of cognitive impairment: a revalidation.
Objectives: To examine the diagnostic utility of the 'attended alone' (AA) and 'attended with' (AW) signs for the diagnosis of major and minor neurocognitive disorder. Methods: Consecutive unselected new outpatient referrals (N = 1209) to a dedicated cognitive disorders clinic over a 5-year period (2015-2019 inclusive) were observed for the AA and AW signs. Criterion diagnoses were by usual clinic assessment using standard (DSM-5) diagnostic criteria. ⋯ Diagnostic utility of AW and AA was independent of patient gender. Conclusion: AW and AA are easily observed and categorized signs. AW has a high sensitivity for cognitive impairment while AA has a high positive predictive value for its absence.
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Postgraduate medicine · Sep 2020
ReviewAdvances in the use of chloroquine and hydroxychloroquine for the treatment of COVID-19.
Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spreading worldwide. Antiviral therapy is the most important treatment for COVID-19. Among the drugs under investigation, anti-malarials, chloroquine (CQ) and hydroxychloroquine (HCQ), are being repurposed as treatment for COVID-19. ⋯ However, recent studies indicated that the use of CQ/HCQ, alone or in combination with a macrolide, did not show any favorable effect on patients with COVID-19. Adverse effects, including prolonged QT interval after taking CQ/HCQ, may develop in COVID-19 patients. Therefore, current data are not sufficient enough to support the use of CQ/HCQ as therapies for COVID-19 and increasing caution should be taken about the application of CQ/HCQ in COVID-19 before conclusive findings are obtained by well-designed, multi-center, randomized, controlled studies.
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Health care has become increasingly fragmented, partly due to advancing medical technology. Patients are often managed by various specialty teams when presenting with symptoms that could be manifestations of different diseases. Approximately one third of them are referred to specialists, at over half for outpatient appointments. ⋯ Communication between doctors could improve continuity. There are many differences and similarities in the pathophysiology, symptomatology, diagnosis, and treatment of fibromyalgia, Sjogren's syndrome, and depression. Understanding the associations between fibromyalgia, Sjogren's syndrome and depression should improve clinical outcome via a common holistic approach.
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Postgraduate medicine · Sep 2020
ReviewThe current state of acute treatment for migraine in adults in the United States.
Migraine is a common and disabling disorder with substantial personal, social, and economic burden that affects 37 million people in the United States. Risk factors for migraine include age, sex, and genetics. The goal of acute treatment of migraine attacks is to stop the pain and associated symptoms of the migraine attack and return the patient to normal function. ⋯ Unmet acute treatment needs still exist due to lack of efficacy, unwanted side effects, or contraindication to treatment. Effective treatment of migraine requires the clinician to assess the patient, make an accurate diagnosis, and then offer appropriate therapy based on the patient's medical history, comorbidities, and preferences, as well as published clinical evidence. The objective of this narrative review is to familiarize primary care clinicians with the variety of acute treatment options available in the United States today based on clinical trial findings, meta-analyses, evidence-based guidelines, and professional society consensus statements.
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Postgraduate medicine · Sep 2020
ReviewLessons from mass vaccination response to meningococcal B outbreaks at US universities.
College students in the United States are at an increased risk for meningococcal serogroup B disease or MenB, which causes the majority of invasive meningococcal disease in the country among adolescents and young adults (62%) and also across all age groups (36%) as of 2018. Approximately one-third of MenB cases among college students occur during campus outbreaks, which trigger substantial public health concern and costs associated with conducting rapid mass vaccination campaigns in an emergency setting. ⋯ This review recounts shifts in US meningococcal outbreak epidemiology, lessons from immunogenicity evaluations of MenB vaccines with outbreak strains, and recent college outbreak experiences and mass vaccination responses. The challenges of reactive MenB outbreak containment and potential benefits of preventive immunization of US adolescents are also considered.