MedGenMed : Medscape general medicine最新文献

Functional dyspepsia or nonulcer dyspepsia, and nonerosive reflux disease (NERD) or endoscopy-negative reflux disease, are common reasons for referral to a gastroenterologist. Although there is much confusion with regard to definition, recent research would suggest that these 2 conditions are linked and may represent components in the spectrum of the same disease entity, in terms of both symptoms and pathophysiology. Several theories have been proposed regarding the etiology of these disorders, including acid exposure, visceral hypersensitivity, impaired fundal accommodation, delayed gastric emptying, and Helicobacter pylori infection.

This article addresses the advantages, disadvantages, and traps to which evidence-based medicine (EBM) may lead and suggests that, to be ethically valid, EBM must be aimed at the patient's best interests and not at the financial interests of others. While financial considerations are by no means trivial, it is hypocritical - if not dangerous - to hide them behind words like "evidence" or "quality."

Secondary aortoenteric fistula (SAF) is an uncommon but very important complication of abdominal aortic reconstruction. The complication often occurs months to years after aortic surgery. The clinical manifestation of the aortoenteric fistula is always upper gastrointestinal bleeding. Treatment of the disease is early surgical intervention. If operative treatment is not performed promptly, the mortality is high. A case of secondary aortoduodenal fistula found 6 years after aortic reconstructive surgery, with the clinical presentation of upper gastrointestinal bleeding, is presented. On Immediate exploratory laparotomy, the proximal part of abdominal aorta was clamped. Duodenorrhaphy and aortic reconstruction with patch graft at the proximal suture line of aortic prosthesis was performed. Fortunately there was no pus, so tissue culture was not done. The intervention was concluded with an omentoplasty to protect the patch graft and to separate it from duodenorrhaphy. The patient did well after the surgical management. Because of the increasing number of elective aortic aneurysm repairs in the aging population, it is likely that more patients with secondary aortoenteric fistula will present to the clinical physicians in the future. So, a high index of suspicion is necessary for prompt diagnosis and treatment of this life-threatening event.

Context: Primary care physicians provide care for the majority of patients with mild-to-moderate chronic obstructive pulmonary disease (COPD). Although clinical practice guidelines have been developed for COPD, their influence on primary care practice is unclear.

Objective: To examine primary care decision making, perceptions, and educational needs relating to COPD.

Design: A survey centered on COPD case-vignettes was developed and distributed to a random sample of physicians in adult primary care specialties.

Results: From 943 respondents, 784 practicing primary care physicians were used in analysis. On average, physicians estimated that 12% of their patients had COPD. Although 55% of physicians were aware of major COPD guidelines, only 25% used them to guide decision-making. Self-identified guidelines showed that users were more likely to order spirometry for subtle respiratory symptoms (74% vs 63%, P < .01), to initiate therapy for mild symptoms (86% vs. 77%, P < .01), and to choose long-acting bronchodilators for persistent dyspnea (50% vs 32%, P < .01).

Conclusions: Practice guidelines and CME programs are both valued resources, but have not yet adequately reached many physicians. Because guidelines appear to influence clinical decision-making, efforts to disseminate them more broadly are needed. Future education should present COPD assessment algorithms tailored to primary care settings, assess and strengthen spirometry interpretation skills, and discuss a reasoned approach to medication management. Patient-centered content that accurately reflects the nature of primary care practice may enhance physician's learning experience. Internet-based and distance learning formats may be essential for reaching physicians in many high-need areas.

A 71-year-old man presented with a 2-week history of pain and swelling of his left arm. Subsequent investigations revealed an intramuscular lesion, suggestive of soft tissue sarcoma. Histologic analysis was surprisingly consistent with metastasis from a primary squamous cell lung cancer. Skeletal muscle metastasis as a mode of presentation of primary lung cancer is an unusual phenomenon. A brief literature review accompanies this report.

Context: Determining the authorship of scientific papers can be difficult and authorship disputes are common. Less experienced authors may benefit from clear advice about authorship from journals while both authors and readers would benefit from consistent policies between journals. However, previous surveys of authors have suggested that there are no universally known or accepted criteria for determining authorship.

Objective: To review instructions to contributors from a broad sample of biomedical journals to discover how much guidance they provide about authorship and whether their advice is consistent with one another and with international guidelines.

Design: Review and analysis of published instructions to authors.

Setting: Biomedical journals that publish instructions in English on the Internet.

Methods: I examined the instructions to contributors from 234 biomedical journals (randomly selected from the membership list of the World Association of Medical Editors and from Medline).

Results: Of the 234 instructions examined, 100 (41%) gave no guidance about authorship, 68 (29%) were based on the International Committee of Medical Journal Editors' (ICMJE) criteria, 33 (14%) proposed other criteria, and 33 (14%) said nothing except that all authors should have approved the manuscript. Of those instructions that were based on the ICMJE criteria, 18/51 (35%) cited an outdated version. Only 21 of the journals (9%) required individuals' contributions to be described.

Conclusions: Journals do not provide consistent guidance about authorship and many editors are therefore missing an important opportunity to educate potential contributors and to improve the accuracy, fairness, and transparency of author listing.