Missouri medicine
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Despite advances in pain management research and technology, physicians are constantly challenged by patients with chronic pain who appear to require narcotics to function. This article assists physicians in making appropriate decisions regarding when to start long-term opioid therapy. The concept of a triage system will also be introduced to help in identifying high-risk patients and offer recommendations and appropriate referral for these patients.
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Acute and chronic pulmonary complications are a very important cause of morbidity and mortality in sickle cell disease. The Acute Chest Syndrome (ACS) is the most common form of acute pulmonary disease and will be reviewed in this article. ⋯ The development of pulmonary hypertension is a very important cause of chronic pulmonary disease and contributes to mortality. Because of the increased numbers of sickle cell patients living to adulthood, it is important for primary care providers to become familiar with these complications.
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Delirium is a serious complication of physical illness that is commonly seen in the elderly individuals admitted to the hospital. It is associated with increased mortality, increased length of stay in the hospital, institutionalization and other complications. ⋯ There is increasing evidence suggesting that primary prevention of delirium is the most effective treatment strategy. This article presents current management for prevention and management of delirium.
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Brachial plexus injuries can be difficult to diagnose and manage. A combination of injury history, as well as radiology, electrodiagnostics, and physical exam skills can aid in this diagnosis. While some patients will regain function spontaneously, many require surgical reconstruction. Surgical options have changed with technological advances in microsurgery, and the availability of long-term outcome data following plexus reconstruction.