Canadian family physician Médecin de famille canadien
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To review 4 topics in hypoglycemia (HoG) care: diagnosis, circumstances predisposing to HoG, risk of adverse effects, and prevention. QUALITY OF EVIDENCE MEDLINE: was searched using the words hypoglycemia and diabetes mellitus. Other relevant sources were hand searched. Evidence was mostly level III and IV from consensus, from observation, and from the author's clinical experience. ⋯ Clinical diagnosis of HoG deserves greater emphasis; when patients are unaware of having HoG, physicians must rely on blood glucose testing. Patients not taking insulin or insulin secretagogues need neither fear nor test for HoG. The risk of HoG should not preclude efforts to achieve best possible control of blood sugar. Patients with unstable cardiac arrhythmias, drivers of motor vehicles, and those in high-risk industrial occupations require special vigilance for HoG.
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Editorial Review
Does epidural analgesia increase rate of cesarean section?
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To review the evidence on prevention and management of childhood obesity and to offer suggestions for family physicians. ⋯ Family physicians have a role in promoting preventive measures and identifying and treating obesity-related comorbidity. Pediatric obesity is not an individual child's problem, but a problem that involves the whole family and the community. Recommending a healthy diet and increased physical activity and counseling families on behaviour change is the best approach to preventing and managing childhood obesity.
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Review Case Reports
Approach to managing behavioural disturbances in dementia.
To review practical evidence-based treatment of behavioural symptoms in dementia. SOURCES OF INFORMATION MEDLINE: Was searched from January 1966 to December 2004 and PsycINFO from January 1967 to December 2004 using the key words "BPSD" (behavioural and psychological symptoms of dementia) and "behavioral disturbances dementia." I also reviewed the bibliographies of recent review papers and original articles. ⋯ Optimal treatment of behavioural disturbances in patients with dementia involves nonpharmacologic approaches and using medications with demonstrated efficacy. Pharmacologic treatment should target only those symptoms or behaviours that respond to medication. This approach minimizes unnecessary medication use and reduces adverse outcomes.
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Young parents often visit my office because their infants are crying inconsolably. Results of physical examination are unremarkable, so colic is the most likely cause. Colic has been known for many years, but I am unaware of any good remedy for it. Are there any modern, effective, safe methods of managing colic? ⋯ In most cases, colic is a "noisy phenomenon"for which there is no good explanation or treatment. Changing babies' feedings rarely helps, and effective pharmacologic remedies are as yet unavailable. Several behavioural and complementary therapies have been suggested, but they have not been found effective. Addressing parental concerns and explaining about colic is the best solution until the colic goes away.