Comprehensive therapy
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Comprehensive therapy · Jan 2009
ReviewBariatric surgery: important considerations for the primary care provider.
Bariatric surgery has become an acceptable therapy for the management of the patient with medically complicated obesity. This paper will review important considerations for the primary care provider as they identify, counsel and care for patients interested in these interventions.
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Women of childbearing age with depression present with a unique set of risks. This article will discuss the following topics: these specific risks, current literature on treating depression in the peripartum, and roles of physician and patient in peripartum treatment.
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Vasomotor symptoms affect the majority of postmenopausal women. Given the risks of hormone replacement therapy, alternative treatments for hot flashes have emerged over recent years. This article will review currently available treatments for hot flashes, including hormonal and non-hormonal therapies.
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Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity throughout the world. It is the only cause of death among the top 10 causes that is increasing and is expected to become the third leading cause of death in the world by 2020. A diagnosis of COPD should be considered in any patient with previous exposure to risk factors for the disease and/or the presence of chronic cough, sputum production, or dyspnea. ⋯ Other adjunctive measures include vaccination, oxygen therapy, pulmonary rehabilitation, and certain surgical measures like bullectomy and lung transplantation. Management of acute exacerbations includes the use of systemic steroids, antibiotics, bronchodilators, and oxygen therapy. During very severe exacerbations, patients may need ventilatory support.
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Comprehensive therapy · Jan 2006
ReviewTreatment of heart failure with decreased left ventricular ejection fraction.
Class I recommendations for treating patients with current or prior symptoms of heart failure with reduced left ventricular ejection fraction (LVEF) include using diuretics and salt restriction in individuals with fluid retention. Use angiotensin-converting enzyme (ACE) inhibitors, beta blockers, and angiotensin II receptor blockers if intolerant to ACE inhibitors because of cough or angioneurotic edema. Nonsteroidal anti-inflammatory drugs, most antiarrhythmic drugs, and calcium channel blockers should be avoided or withdrawn. ⋯ ICD is indicated in patients with ischemic heart disease for at least 40 d post-myocardial infarction or nonischemic cardiomyopathy, an LVEF of 30% or less, New York Heart Association (NYHA) class II or III symptoms on optimal medical therapy, and an expectation of survival of at least 1 yr. Cardiac resynchronization therapy should be used in individuals with an LVEF of 35% or below, NYHA class III or IV symptoms despite optimal therapy, and a QRS duration greater than 120 ms. An aldosterone antagonist can be added in selected patients with moderately severe to severe symptoms of heart failure who can be carefully monitored for renal function and potassium concentration (serum creatinine should be