Canadian family physician Médecin de famille canadien
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To review the evidence on the effectiveness of medical management of bowel obstruction for patients with advanced cancer and to summarize treatment options for home and hospital care. ⋯ Pharmacologic management and percutaneous gastrostomy for intractable vomiting and hypodermoclysis or oral fluids for hydration can control symptoms without surgery or nasogastric tubes.
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Alcohol-related problems are common among patients in emergency departments. Primary care physicians must recognize and treat a variety of alcohol-related and alcohol-induced problems: alcohol withdrawal, alcohol-related seizures, delirium tremens, malnutrition, concomitant illness, poisoning, trauma, and lack of social support. This paper focuses an recognizing and managing acute alcohol withdrawal.
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Review Case Reports
Opiate-dependent patients receiving methadone. How physicians should manage therapy.
Methadone treatment can reduce illicit drug use, needle sharing, and the social costs and health risks of heroin addiction. It is superior to no treatment, detoxification, or treatment programs lasting less than 3 months. ⋯ Supervised, random urine drug specimens should be collected at least twice weekly. Long-term counseling is essential and should include information on the risks of needle sharing and on screening for HIV and hepatitis B and C.
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Review Comparative Study
Antithrombotic therapy in atrial fibrillation.
To review the evidence for antithrombotic therapy in patients with nonrheumatic atrial fibrillation. ⋯ Anticoagulant therapy should be considered for all patients with atrial fibrillation. Oral anticoagulant therapy is more effective than ASA in reducing the risk of stroke among patients with nonrheumatic atrial fibrillation.