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Mental health and primary care delivery systems have evolved to operate differently. For example, attention to multiple medical issues, health maintenance, and structured diagnostic procedures are standard elements of primary care rarely incorporated into mental health care. ⋯ Advances in treatments for mental health disorders and increased knowledge of the integral link between mental health and physical health encourage mental health disorder treatment in primary care settings, which reach the most patients. Effective integration of mental health care into primary care requires systematic and pragmatic change that builds on the strengths of both mental health and primary care.
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Previous researchers have shown that non-medical endoscopists can perform lower gastrointestinal endoscopy as safely and effectively as medical staff. However, it is not known if upper gastrointestinal endoscopy performed by medical and non-medical endoscopists in clinical practice yields similar results in terms of performance, patient discomfort, and satisfaction. ⋯ Experienced nurses perform routine diagnostic gastroscopy safely in everyday clinical practice and with as little discomfort and as much patient satisfaction as medical staff.
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Despite major developments in medicine, surgery, and intensive care, acute renal failure (ARF) still remains a common problem affecting approximately 5% of all general hospital patients. Mortality of all forms of ARF continues to be greater than 50%, and this percentage has not decreased significantly over the last 30 years. There are multiple factors, which may explain the persistence of such high mortality; the most important of these is probably the evolution of the disease spectrum underlying the development of ARF. ⋯ Vasoactive agents, such as dopamine, may have the advantage of increasing the urine output in patients with oliguric ARF; however, their efficacy in otherwise altering the course of ARF is not well substantiated. Finally, growth factors and atrial natriuretic peptide appear to have the potential for accelerating renal recovery and decreasing morbidity and mortality from this commonly encountered medical problem. Prospective randomized clinical studies are the key to many of the dilemmas encountered with ARF.
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Human molecular genetics · Jan 2005
Genetic basis for individual variations in pain perception and the development of a chronic pain condition.
Pain sensitivity varies substantially among humans. A significant part of the human population develops chronic pain conditions that are characterized by heightened pain sensitivity. We identified three genetic variants (haplotypes) of the gene encoding catecholamine-O-methyltransferase (COMT) that we designated as low pain sensitivity (LPS), average pain sensitivity (APS) and high pain sensitivity (HPS). ⋯ The LPS haplotype produces much higher levels of COMT enzymatic activity when compared with the APS or HPS haplotypes. Inhibition of COMT in the rat results in a profound increase in pain sensitivity. Thus, COMT activity substantially influences pain sensitivity, and the three major haplotypes determine COMT activity in humans that inversely correlates with pain sensitivity and the risk of developing TMD.
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Higashi Nihon Shigaku Zasshi · Dec 1990
[Changes in Po2, Pco2, pH, and HCO3 concentration and flow rates in human parotid saliva by tongue sour stimulation at various intervals].
The PO2, PCO2, pH, and HCO3- concentration and flow rates of parotid saliva were observed by tongue stimulation with 3% tartaric acid at various intervals in a human subject after about a one hour rest. The PO2, PCO2, pH, and HCO3- concentrations in parotid saliva were measured with a Blood Gas Analyzer System. The results are summarized as follows: 1) The mean PO2 and PCO2 of parotid saliva immediately before tongue stimulation were about 40 mmHg (range 33-44 mmHg) and 45 mmHg (41-48). ⋯ When the interval between stimulations was 1 min. or 30 sec., it remained at about 7.5. 5) The HCO3- concentration in parotid saliva depends almost exclusively on the pH when Pco2 remained unchanged. When Pco2 was high, however, the HCO3- concentration was affected by the change in Pco2. 6) There was no relationship between changes in the flow rate of parotid saliva and Po2, Pco2, pH, and the HCO3- concentration. Particularly, when the interval between stimulations was shorter than 5 min., the changes in flow rate had no effect on Po2, Pco2, pH, and the HCO3- concentration.