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American Family Physician Aug 2020Neck pain is a common presenting symptom in the primary care setting and causes significant disability. The broad differential diagnosis requires an efficient but global... (Review)
Review
Neck pain is a common presenting symptom in the primary care setting and causes significant disability. The broad differential diagnosis requires an efficient but global assessment; therefore, emphasis is typically placed on red flags that can assist in the early recognition and treatment of more concerning diagnoses, such as traumatic injuries, infection, malignancy, vascular emergencies, and other inflammatory conditions. The critical element in appropriate diagnosis and management of these conditions is an accurate patient history. Physical examination findings complement and refine diagnostic cues from the history but often lack the specificity to be of value independently. Diagnostic tools such as imaging and electrodiagnostic tests have variable utility, especially in chronic or degenerative conditions. Treatment of mechanical or nonneuropathic neck pain includes short-term use of medications and possibly injections. However, long-term data for these interventions are limited. Acupuncture and other complementary and alternative therapies may be helpful in some cases. Advanced imaging and surgical evaluation may be warranted for patients with worsening neurologic function or persistent pain.
Topics: Adult; Aged; Aged, 80 and over; Curriculum; Diagnostic Tests, Routine; Education, Medical, Continuing; Female; Guidelines as Topic; Humans; Male; Medical History Taking; Middle Aged; Neck Pain
PubMed: 32735440
DOI: No ID Found -
Medizinische Klinik, Intensivmedizin... Oct 2020Medical history taking and the clinical examination are the traditional medical tools in making a diagnosis. Both the medical history taking and clinical examination... (Review)
Review
Medical history taking and the clinical examination are the traditional medical tools in making a diagnosis. Both the medical history taking and clinical examination have wrongly lost their practical value in modern emergency and intensive care medicine. When diagnosing an acutely or critically ill patient, the sequence, technique and focus of history taking and the clinical examination must be adapted to the individual situation and the condition of the patient. In this article the continuing central importance of both techniques in the diagnostics of emergency and intensive care patients is practically evaluated and discussed.
Topics: Critical Care; Critical Illness; Emergency Medicine; Emergency Service, Hospital; Humans; Medical History Taking; Physical Examination
PubMed: 32885280
DOI: 10.1007/s00063-020-00731-x -
American Family Physician May 2021Dyspareunia is recurrent or persistent pain with sexual intercourse that causes distress. It affects approximately 10% to 20% of U.S. women. Dyspareunia may be...
Dyspareunia is recurrent or persistent pain with sexual intercourse that causes distress. It affects approximately 10% to 20% of U.S. women. Dyspareunia may be superficial, causing pain with attempted vaginal insertion, or deep. Women with sexual pain are at increased risk of sexual dysfunction, relationship distress, diminished quality of life, anxiety, and depression. Because discussing sexual issues may be uncomfortable, clinicians should create a safe and welcoming environment when taking a sexual history, where patients describe the characteristics of the pain (e.g., location, intensity, duration). Physical examination of the external genitalia includes visual inspection and sequential pressure with a cotton swab, assessing for focal erythema or pain. A single-digit vaginal examination may identify tender pelvic floor muscles, and a bimanual examination can assess for uterine retroversion and pelvic masses. Common diagnoses include vulvodynia, inadequate lubrication, vaginal atrophy, postpartum causes, pelvic floor dysfunction, endometriosis, and vaginismus. Treatment is focused on the cause and may include lubricants, pelvic floor physical therapy, topical analgesics, vaginal estrogen, cognitive behavior therapy, vaginal dilators, modified vestibulectomy, or onabotulinumtoxinA injections.
Topics: Adult; Dyspareunia; Female; Genital Diseases, Female; Gynecological Examination; Humans; Medical History Taking; Pain Measurement; Patient Care Management; Quality of Life; Risk Assessment; Risk Factors; Stress, Psychological
PubMed: 33983001
DOI: No ID Found -
Ear, Nose, & Throat Journal May 2024
Topics: Humans; Otoscopes; History, 20th Century; Otolaryngology; Otoscopy; History, 21st Century; History, 19th Century
PubMed: 37596948
DOI: 10.1177/01455613231194029 -
Ear, Nose, & Throat Journal Aug 2023
PubMed: 37641920
DOI: 10.1177/01455613231196088 -
Medical History Oct 2019
Topics: Awards and Prizes; Historiography; History, 21st Century; United Kingdom
PubMed: 31571692
DOI: 10.1017/mdh.2019.61 -
Bioinformation 2023Orofacial injuries constitute the medico-legal cases reported, especially, in cases associated with road traffic accidents, assaults, and violence making it an emerging...
Orofacial injuries constitute the medico-legal cases reported, especially, in cases associated with road traffic accidents, assaults, and violence making it an emerging healthcare problem. Therefore, it is of interest to document data on the maxillofacial trauma and fractures among Indians. 150 subjects within the age of 15 to 60 years with maxillofacial fractures, detailed medical history including demographics, radiographs, medical history, associated injuries, and etiology of fractures were used for this study. Sites for both maxillary and mandibular fractures were noted. The type of intubation (medical insertion procedure) used and post-operative complications were also recorded. Lefort I, II, and III fractures were seen in 4%, 12%, 6% subjects respectively, whereas, ZMC fracture was seen in 66% study subjects. Mandibular fractures were most commonly seen in the para-symphysis region with 30% subjects followed by condylar region with 28.66% subjects. Data shows that maxillofacial trauma has a high incidence in India with RTA (road traffic accidents being the most common reason for the trauma seen in young males with significant concomitant injuries. Most common fracture is seen in mandible region. However, they can be managed well with very few postoperative complications.
PubMed: 37908612
DOI: 10.6026/97320630019876 -
MMW Fortschritte Der Medizin Nov 2022
Topics: Humans; Medical History Taking; Hypertension
PubMed: 36424496
DOI: 10.1007/s15006-022-2031-4 -
Cureus Apr 2023Purpose At present, clinicians typically prescribe antidepressants based on the widely accepted "serotonin hypothesis." This study explores an alternative mechanism,...
Purpose At present, clinicians typically prescribe antidepressants based on the widely accepted "serotonin hypothesis." This study explores an alternative mechanism, the stress mechanism, for selecting antidepressants based on patients' medical history. Methods This study investigated clinicians' prescribing patterns for the 15 most common antidepressants, including amitriptyline, bupropion, citalopram, desvenlafaxine, doxepin, duloxetine, escitalopram, fluoxetine, mirtazapine, nortriptyline, paroxetine, ropinirole, sertraline, trazodone, and Venlafaxine. The least absolute shrinkage and selection operator (LASSO) logistic regression was used to identify factors that affect the remission of depression symptoms after receiving an antidepressant. Results The study found that a wide range of factors influenced the propensity of clinicians to prescribe antidepressants, with the number of predictors ranging from 51 to 206 variables. The prevalence of prescribing an antidepressant ranged from 0.5% for doxepin to 24% for the combination of more than one antidepressant. The area under the receiver operating curves (AROC) ranged from 77.2% for venlafaxine to 90.5% for ropinirole, with an average AROC of 82% for predicting the propensity of medications. A variety of diagnoses and prior medications affected remission, in agreement that the central mechanism for the impact of medications on the brain is through stress reduction. For example, psychotherapy, whether done individually or in a group, whether done for a short or long time, and whether done with evaluation/assessment or not, had an impact on remission. Specifically, teenagers and octogenarians were less likely to benefit from bupropion, citalopram, escitalopram, fluoxetine, and sertraline compared to patients between 40 and 65 years old. The findings of this study suggest that considering a patient's medical history and individual characteristics is crucial for selecting the most effective antidepressant treatment. Conclusions Many studies have raised doubt about the serotonin hypothesis as the central mechanism for depression treatment. The identification of a wide range of predictors for prescribing antidepressants highlights the complexity of depression treatment and the need for individualized approaches that consider patients' comorbidities and previous treatments. The significant impact of comorbidities on the response to treatment makes it improbable that the mechanism of action of antidepressants is solely based on the serotonin hypothesis. It is hard to explain how comorbidities lead to the depletion of serotonin. These findings open up a variety of courses of action for the clinical treatment of depression, each addressing a different source of chronic stress in the brain. Overall, this study contributes to a better understanding of depression treatment and provides valuable insights for clinicians in selecting antidepressants based on patients' medical history.
PubMed: 37168173
DOI: 10.7759/cureus.37117