Duodecim; lääketieteellinen aikakauskirja
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For patients with cardiovascular disease, statins belong to routine medical treatment irrespective of blood lipid levels. In primary prevention also, statins have been found to prevent cardiovascular diseases, associated deaths and decrease overall mortality. In previously healthy persons the use of statins should be based on the assessment of total risk--mere cholesterol level does not usually constitute an indication for treatment. The use of statins may lead to adverse effects, the major one being myopathy, for which an elevated risk is associated with increasing statin dosages.
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Referral to a specialist has a significant influence on management of the patient and costs associated with the treatments. However, development and research of the process by which patients are referred has been almost neglected. ⋯ A structured, electronic consultation letter was developed to respond this need. Functionality and interactivity are the key elements of the referral, including (1) an electronic referral letter to a specialist, (2) interactive education in clinical examination and management of shoulder disorders, and (3) an instrument of clinical examination and documentation of shoulder disorders.
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Rocuronium bromide is a muscle relaxant used in general anesthesia, inhibiting cholinergic neurotransmission of neuromuscular junction. Donepezil used for the treatment of Alzheimer's disease inhibits decomposition of acetylcholine. ⋯ Prior to general anesthesia, a 2-4-week pause in anticholinesterase medication has been recommended. So far, reliable scientific data on the subject is lacking.
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The updated Current Care guideline for children and adolescents with ADHD covers both diagnosis and treatment. Psychosocial support is provided when hyperactivity problems arise, even before specific diagnosis. While psychosocial interventions are effective in the treatment of ADHD, the core symptoms are best treated with medication, such as methylphenidate, dexamphetamine, lisdexamphetamine or atomoxetine. Collaboration between families, primary health care services, specialist consultation services and day-care and school professionals is essential within the chain of care.
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Bronchiolitis is the most common disease leading to hospitalization of infants of less than one year of age in Finland. Among each age group, the disease needs hospitalization in approx. 3% of the cases. ⋯ When required, inhalations of racemic epinephrine are given for severe symptoms. The authors' treatment practice for bronchiolitis is presented in this article.