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Handhelds in Medicine
Have you ever wanted to calculate the predicted peak flow for one of your asthmatic patients without spending valuable minutes searching for that confounded little slide rule gizmo? Wouldn’t it be great if you could somehow remember all Mrs. Jones’ medications when the nursing home calls to see if it’s OK to treat her acutely elevated blood pressure with some atenolol? Handheld computers are emerging as the stethoscopes of the twenty-first century, and no clinician should be without this essential tool. These small, easy-to-use devices are now powerful enough to help clinicians manage information and make medical decisions at the point of care. This comprehensive how-to guide targets a...
Evidence-Based Diagnosis
Covering a full range of topics from cardiovascular and pulmonary disease to ophthalmology, hematology and pediatrics, this is the only single volume, quick reference designed for use in daily practice. The 150+ clinical prediction rules as well as the background information necessary to determine its validity and relevance are essential for every physician in a time of limited health care resources. Designed as an aid in diagnosis and treatment, these rules allow more accurate diagnosis and treatment decisions while eliminating superfluous testing.
Essential Evidence
This manual helps clinicians easily to find the best available evidence to facilitate sound medical decisions. It is the first published compilation of highly relevant InfoPOEMs that the editors believe has the potential to change a clinician's practice. The editors have selected over 300 of the most influential, compelling POEMs, and organized them by topic for easy reference. Each POEM contains: Clinical Question: Poses a question that the study seeks to answer. Bottom line: Summarizes the findings of the research and places these findings into the context with the known information on the topic. The bottom line also is designed to help readers understand how to apply the results. LOE: Eac...
Oral antidiabetic drugs and GLP-1 analogues in the treatment of type 2 diabetes
Oral medication should be introduced at an early stage. In the absence of contraindications, medication should be started when the HbA1c concentration exceeds 6.5–7.0% (48–53 mmol/mol) despite non-pharmacological intervention. Metformin is the drug of choice. If one antidiabetic drug does not lower the HbA1c value to below 7.0 % (53 mmol/mol), add another and possibly a third antidiabetic drug unless there are contraindications. Insulin therapy must be initiated at the latest when HbA1c remains over 7.0% despite medication with oral antidiabetic drugs or with injectable GLP-1 analogues. A GLP-1 analogue may also be combined with basic insulin treatment.
Chronic lymphocytic leukaemia (CLL)
Chronic lymphocytic leukaemia is a slowly progressing (chronic) malignant blood disease where morphologically normal looking B lymphocytes accumulate in the bone marrow, blood and lymphoid tissue (lymph nodes, spleen), leading to leucocytosis, lymphocytosis and, in some cases, to enlarged lymph nodes and/or splenomegaly. The clonal lymphocyte population gradually displaces the normal healthy haematopoiesis in the bone marrow. The subsequent bone marrow failure will lead to anaemia, neutropenia and/or thrombocytopenia. The diseased cells exhibit characteristic chromosomal changes, which have formed as a result of acquired mutations. The disease is not hereditary. In chronic monoclonal B-cell lymphocytosis (MBL), blood lymphocytes frequently carry surface antigens typical to CLL, i.e. they have the immunophenotype of CLL, but the number of lymphocytes is only slightly increased (less than 5 × 109/l) and other cell counts are normal. MBL is not considered a malignant condition, but the patient should, however, be monitored (for example, annually) because in some cases MBL may progress to CLL.
Nasal polyps
Nasal polyps (nasal polyposis) is a manifestation of chronic sinusitis. Nasal polyps should be suspected when a patient presents with nasal congestion. Polyps must be distinguished from normal nasal conchae and tumours. Nasal polyps are particularly common in individuals with aspirin sensitivity. Nasal corticosteroids are the treatment of choice.
Brain death
The death of a person refers to the permanent cessation of all integrated brain function. Brain death denotes a state where all brain function has permanently ceased, but the heart continues to beat. There is no global consensus in diagnostic criteria, and the guidelines and protocols regarding the confirmation of brain death vary from country to country. This article is based on the protocol applied in Finland. Declaration of brain death follows a certain set of tests that demonstrate the complete absence of brain function (brain stem function in the UK). Provided that the cause of the irremediable brain damage is known and the absence of all cranial nerve reflexes has been confirmed with clinical tests, death can be declared whilst the heart continues to beat. At least two physicians, of specified status and experience, are required to act together to diagnose brain death.
Frozen shoulder
Spontaneous frozen shoulder should be identified from three diagnostic characteristics: severe pain during sudden movements especially in extreme positions, continuous pain at night and limited range of motion at the shoulder joint both during active and passive movements. A frozen shoulder will usually heal on its own but may be treated at an early stage with an intra-articular corticosteroid injection. Symptom relief may be achieved with analgesia and an application of cold.
Rickets
Rickets is a disorder of bone mineralization usually caused by vitamin D deficiency.Risk groups include e.g. breastfed infants, children with milk allergy as well as sedentary and dark-skinned children. In rickets, the plasma concentration of calcium may be either low or normal, plasma phosphate concentration is decreased and plasma alkaline phosphatase concentration is usually increased.Diagnosis is based on the clinical picture and the typical radiological and laboratory findings.
Idiopathic sudden sensorineural hearing loss
Idiopathic sudden sensorineural hearing loss (ISSHL) is defined as an abrupt hearing loss of unexplained aetiology. Diagnosis is based on the clinical presentation, a sensorineural defect detected with tuning fork tests and on hearing tests. ISSHL should be treated as a medical emergency and an urgent consultation of an otolaryngologist is indicated. Spontaneous recovery is common in mild cases. There is research evidence, albeit limited, to support the early and short term use of corticosteroids in patients with no contraindications to steroid treatment.
