Clostridium difficile: An Update for the Primary Care Clinician.
South Med J. 2010 Aug 6;
Authors: Salkind AR
Clostridium difficile infection (CDI) is an important cause of intestinal disease, primarily affecting hospitalized patients exposed to antibiotics. Infection has been associated with prolonged hospital stays and excess healthcare expenditures. Recent changes in the epidemiology, pathogenesis, and treatment of CDI have occurred, leading to renewed scrutiny of this pathogen. Increases in its incidence and severity have been documented, possibly due to the emergence of a hypervirulent strain that produces high levels of toxins. Community-acquired cases in individuals without traditional risk factors have been reported. Furthermore, oral metronidazole may not be as effective as oral vancomycin for patients with severe CDI. New therapies are being investigated for patients with recurrent disease. This review highlights the new developments in the epidemiology, pathogenesis, and management of CDI, serving as an up-to-date resource for primary care clinicians.
20697321
– Clostridium difficile: An Update for the Primary Care Clinician.
Management of generalized anxiety disorder in primary care: identifying the challenges and unmet needs.
Prim Care Companion J Clin Psychiatry. 2010;12(2):
Authors: Davidson JR, Feltner DE, Dugar A
BACKGROUND: Generalized anxiety disorder (GAD) is one of the most common psychiatric disorders in primary care, although it is often underrecognized and undertreated. GAD is chronic, disabling, and associated with other health problems. Treatment response is often unsatisfactory, but the clinical evidence base for new treatments has expanded substantially in the past decade and suggests a growing range of options for reducing the burden of GAD. The objective of this article was to review current literature on GAD and its management to provide an overview of the clinical importance of GAD in primary care and available treatments. DATA SOURCES: Recent studies (ie, over the past decade) on the epidemiology and treatment of GAD were identified by searching Medline using the term generalized anxiety disorder only and in combination with the terms epidemiology and treatment and for each drug class (benzodiazepines, azapirones, antidepressants, antihistamines, alpha-2-delta ligands, and antipsychotics) and for named drugs (buspirone, venlafaxine, duloxetine, fluoxetine, escitalopram, olanzapine, paroxetine, pregabalin, quetiapine, and risperidone in addition to psychological therapies and cognitive-behavioral therapy. The literature search was conducted in August 2008 for the period 1987-2009. STUDY SELECTION: Studies were included if judged to be relevant to a review of the epidemiology and management of GAD. Articles were excluded if they were not written in English or were published more than 10 years before the literature search was conducted. A few older studies were included for which more recent research evidence was not available. Recent national and international guidelines for the management of GAD were also reviewed. DATA EXTRACTION/SYNTHESIS: Most currently available interventions have similar overall efficacy, and treatment choices should reflect the situation of individual patients. Important unmet needs exist for treatments (1) that work rapidly, with (2) broad spectrum benefits, (3) that can improve rates of remission and well-being, (4) are devoid of risk for withdrawal symptoms, and (5) have few if any adverse interactions with other drugs. Additional needs include (6) safer drugs for the elderly, (7) safe and effective drugs for children with GAD, (8) further evaluation of psychotherapy, and (9) understanding the appropriate circumstances for, and optimal choices of, drug combination. CONCLUSION: While the development of novel treatments evolves, current management approaches can focus on improving identification and defining optimal use of available therapies for GAD.
20694114
– Management of generalized anxiety disorder in primary care: identifying the challenges and unmet needs.
Association of local capacity for endoscopy with individual use of colorectal cancer screening and stage at diagnosis.
Cancer. 2010 Jun 15;116(12):2922-31
Authors: Haas JS, Brawarsky P, Iyer A, Fitzmaurice GM, Neville BA, Earle C, Kaplan CP
BACKGROUND: Limited capacity for endoscopy in areas in which African Americans and Hispanics live may be a reason for persistent disparities in colorectal cancer (CRC) screening and stage at diagnosis. METHODS: The authors linked data from the National Health Interview Survey on the use of CRC screening and data from Surveillance, Epidemiology, and End Results-Medicare on CRC stage with measures of county capacity for colonoscopy and sigmoidoscopy (endoscopy) derived from Medicare claims. RESULTS: Hispanics lived in counties with less capacity for endoscopy than African Americans or whites (for National Health Interview Survey, an average of 1224, 1569, and 1628 procedures per 100,000 individuals aged > or = 50 years, respectively). Individual use of CRC screening increased modestly as county capacity increased. For example, as the number of endoscopies per 100,000 residents increased by 750, the odds of being screened increased by 4%. Disparities in screening were mitigated or diminished by adjustment for area endoscopy capacity, racial/ethnic composition, and socioeconomic status. Similarly, among individuals with CRC, those who lived in counties with less endoscopy capacity were marginally less likely to be diagnosed at an early stage. Adjustment for area characteristics diminished disparities in stage for Hispanics compared with whites but not African Americans. CONCLUSIONS: Increasing the use of CRC screening may require interventions to improve capacity for endoscopy in some areas. The characteristics of the area where an individual resides may in part mediate disparities in CRC screening use for both African Americans and Hispanics, and disparities in cancer stage for Hispanics.
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