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You asked:Which medication should be administered when managing patients with suspected acute opioid overdose
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[Acute Pain]:1.0
  1. The high negative exploration rate in patients with suspected acute appendicitis is the main compelling reason to improve the accuracy in managing patients with acute abdominal pain. In this article, data from a prospective study on a group of patients undergoing an acute appendectomy were used to devise a scoring system for the purpose of differentiating between the patients with an acute appendicitis and those found to have a normal appendix at operation..[Arnbj?rnsson:1986]{Human}
  2. The outcomes with respect to pain, function and patient satisfaction provide evidence to support the use of conservative therapeutic interventions when managing patients with acute cases of calcific tendinopathy..[Jason:2012]
  3. Managing patients with acute intermittent porphyria involves removing the precipitating factors, increasing carbohydrate intake, controlling pain, and administering medications..[Shively:1995]{Human}
  4. Two thirds of patients with medication-overuse headache (MOH) fulfilled criteria for dependence on acute symptomatic treatments for pain, not exclusive of psychoactive medications, based on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Several questionnaires have been used to assess dependent behavior in patients with MOH..[Jong-Ling:2012]
  5. Clinicians treating human immunodeficiency virus (HIV)-infected patients with substance use disorders often face the challenge of managing patients' acute or chronic pain conditions while keeping in mind the potential dangers of prescription opiate dependence. In this clinical review, we critically appraise the existing data concerning barriers to appropriate treatment of pain among HIV-infected patients with substance use disorders. We then analyze published studies concerning the choice of pharmacological pain control regimens for acute and chronic pain conditions in HIV-infected patients, keeping in mind HIV-specific issues related to drug interactions and substance use disorders. We summarize this information in the form of flowcharts for physicians approaching HIV-infected patients who present with complaints of pain, providing evidence-based guidance for the structuring of pain management services and for addressing aberrant drug-taking behaviors..[Sanjay:2007]{Human}
  6. Prompt, accurate pain assessment is the cornerstone of effective pain management and a comprehensive, multidisciplinary team strategy is essential, particularly for managing patients with frequent acute pain or chronic pain..[Lucy:2005]{Human}
  7. We have identified specific variables associated with self-reported prescription drug abuse in primary care patients. Chronic pain is associated both with an indication for prescribing opioids and with abuse of prescription medications. Clinicians are encouraged to follow treatment algorithms when managing patients with chronic pain as a method for reducing misuse..[William:2009]{Human}
  8. General internists often care for patients with advanced cancer. These patients have substantial morbidity caused by moderate to severe pain and by spinal cord compression. With appropriate multidisciplinary care, pain can be controlled in 90% of patients who have advanced malignant conditions, and 90% of ambulatory patients with spinal cord compression can remain ambulatory. Guidelines have been developed for assessing and managing patients with these problems, but implementing the guidelines can be problematic for physicians who infrequently need to use them..[Abrahm:1999]{Human}
  9. The purpose of this case is to present the results of a conservative approach, including therapeutic exercise, for the management of calcific tendinopathy of the supraspinatus, with an emphasis on patient outcomes. CASE The patient was a self-referred 41 year old male with complaints of acute, right shoulder pain and difficulty sleeping..[Jason:2012]
  10. Acute painful episodes among patients with sickle cell disease may occur in any body part or several sites simultaneously..[Lucy:2005]{Human}
  11. Residents found the sessions and educational strategy to be excellent and reported higher confidence levels in managing patients with chronic noncancer pain..[Huda:2010]{Human}
  12. Chronic pain is common and can be devastating to the patient and challenging to the health care provider..[Huda:2010]{Human}
  13. Conservative management included superficial modalities and medication for pain and a regimen of scapulothoracic & glenohumeral range of motion and strengthening exercises..[Jason:2012]

[Unit]:0.53102213
  1. It is this very biology that can dictate the selection of drugs and treatment approaches for managing these patients, strategies that can range from very aggressive combination chemotherapy administered in an intensive care unit (for example, patients with Burkitt's lymphoma), to watch and wait approaches that may go on for years in patients with SLL..[Owen:2005]{Human}
  2. We studied the acute effects of intranasal and subcutaneous calcitonin in 40 patients with active Paget's disease of bone. Patients received a single dose of either 400 units of calcitonin delivered as a nasal spray, or 1, 10 or 100 units of subcutaneous calcitonin, or placebo. 2. Subcutaneous salmon calcitonin, administered at doses of 1, 10 and 100 units to nine patients with Paget's disease of bone, induced a dose-dependent fall in the serum calcium. This calcium-lowering effect was not seen with a second group of nine patients receiving placebo. 3. The lower doses of calcitonin had significant effects, and these were more pronounced in patients with lower rates of bone turnover. 4. Four hundred units of calcitonin administered as a nasal spray induced effects qualitatively similar to those seen with subcutaneous calcitonin, with an efficacy equivalent to approximately 30 units of subcutaneous calcitonin. 5..[O'Doherty:1990]{Human}
  3. Poisoning is a common presentation to hospital acute medical units, and can produce a variety of clinical scenarios. This review discusses the epidemiology of poisoning, a framework for managing patients with drug toxicity and considerations in the diagnosis of toxicity with unknown substances..[Edward:2011]
  4. The challenges in managing patients with infection in the intensive care unit are increased in an era where there are dwindling antimicrobial choices for multidrug-resistant pathogens. Clinicians in the intensive care unit must balance between choosing appropriate antimicrobial treatment for patients with suspected infection and utilizing antimicrobials in a judicious fashion..[Tejal:2010]{Human,Guideline}
  5. With the aim of estimating and comparing the direct hospital costs of managing patients with advanced colorectal cancer in various countries, data on resource utilisation and unit prices were collected. Data on the consumption of medical resources were collected by a retrospective examination of the hospital charts for 20 patients in each of 10 centres in five European countries..[Neymark:2000]{Human}
  6. Managing patients who are morbidly obese in the intensive care unit is associated with a variety of problems uncommonly experienced with the those who are not morbidly obese..[David:2010]{Human}
  7. All single and double rooms of INMI are equipped with negative air pressure, sealed doors, high efficiency particulate air (HEPA) filters and a fully-equipped anteroom; moreover, a dedicated high isolation unit with a laboratory next door for the initial diagnostic assays is available for admission of sporadic patients requiring high isolation. For patient transportation, two fully equipped ambulances and two stretcher isolators with a negative pressure section are available..[Ippolito:2005]{Human}
  8. We pilot-tested one unit ( opioid therapy) in March 2008..[Huda:2010]{Human}
  9. Acute intermittent porphyria is the most common form of porphyria found in the United States..[Shively:1995]{Human}

[Family Physicians]:0.5052559
  1. Withdrawal symptoms in IDUs living with HIV reflect physicians' difficulties in managing their patients' opioid dependence..[Laurent:2008]{Human}
  2. Much has been written on how physicians should manage patients in emotional distress, including recommendations for making successful referrals to mental health providers. Little has been written, however, on the management of distressed patients who are already in psychotherapy. This article, drawing on three cases, a review of the literature, and systems theory, presents recommendations for managing these patients. Physicians are encouraged to assess these patients for risk of suicide or homicide, substance abuse, and indications for psychotropic medication. They are advised to seek a patient's permission to speak to his or her therapist when the patient may be in immediate danger, when psychotropic medications, hospitalization, or psychiatric consultation is considered, and when the patient fails to respond to ongoing treatment. For patients whose therapists are not psychiatrists, psychiatric consultation is recommended when there are questions about psychotropic medications, when psychiatric and substance abuse disorders coexist, and when hospitalization is considered. Therapists skilled in applying systems theory should be consulted when the patient, psychotherapist, and physician agree that the patient is not making sufficient progress. In most cases, however, physicians should reassure patients about distressing symptoms, avoid expressing opinions about the therapist and psychosocial issues, and encourage patients to renew or to expand their commitment to their psychotherapy..[Brown:1990]{Human}
  3. Family physicians play a key role in assessing and managing patients with Alzheimer's disease and in linking the families of these patients to supportive services within the community. As part of comprehensive management, the family physician may be responsible for coordinating assessments of patient function, cognition, comorbid medical conditions, disorders of mood and emotion, and caregiver status. Suggestions for easily administered and scored assessment tools are provided, and practical tips are given for supporting primary caregivers, thereby increasing efficiency and quality of care for patients with Alzheimer's disease..[Jeffrey:2002]{Human}
  4. Physicians perceived a high prognostic benefit to antiarrhythmic treatment in patients with sustained ventricular tachycardia or history of cardiac arrest, and a generally low prognostic benefit in those with mitral valve prolapse. Opinion was divided on the prognostic benefit in other patient groups including those with frequent ventricular premature beats following myocardial infarction. These results help quantify current physician practices in managing patients with chronic ventricular arrhythmias..[Schmidt:1990]{Human}
  5. Therefore, it is imperative that generalist physicians be adept at recognising, evaluating and managing patients with these syndromes..[Johnson:1995]{Human}
  6. Physicians need more training for their role in identifying and managing patients with alcohol problems..[Rush:1994]{Human}
  7. To screen, manage, dose adjust, and counsel, the physician and other health care professionals are highly advised and encouraged to consult with an infectious disease clinical pharmacist when managing patients receiving highly active antiretroviral therapy..[Ian:2004]
  8. To better understand how physicians manage patients with chronic ventricular arrhythmias, questionnaires were mailed in July, 1989, to 680 internists, family physicians and cardiologists in West Virginia..[Schmidt:1990]{Human}
  9. Physicians can use the techniques described to more readily implement existing guidelines and provide comfort and optimize quality of life for patients with advanced cancer..[Abrahm:1999]{Human}
  10. Using discreet threshold values to measure quality in primary care may result in physicians focusing on managing patients by the numbers at the expense of making individualized and nuanced clinical decisions..[Robert:2012]

[Significant Differences]:0.47578895
  1. Results of this study suggest that there are differences between symptoms at presentation of men and women, and those in various age groups, hospitalized with acute coronary disease. Clinicians should be aware of these differences when diagnosing and managing patients suspected to have coronary heart disease..[Goldberg:2000]{Human}
  2. These decisions were fully undertaken in 86% of patients. Reasons for aberration in the remaining 21 patients included patient refusal (CABG 29%, PCI 10%) and further co-morbidities (28%). On re-discussion of the same patient data (n = 50) a year later, 24% of decisions differed from the original HT recommendations reflecting the fact that, for certain coronary artery disease pattern, either CABG or PCI could be appropriate..[Jenny:2012]
  3. Expanded identification of MoAbs against leukemia-specific markers and the use of QFCM be a significant in managing patients with ALL in the future..[Huh:2001]{Human}
  4. When administered post-myocardial infarction, conventional metoprolol was associated with significant improvements in quality of life and was cost saving over a 3-year period. Significant improvements in quality of life were also evident for metoprolol-treated patients with idiopathic dilated cardiomyopathy..[Peters:1994]{Human}
  5. This index showed that there were considerable differences in the amounts of resources used for treating these patients, between, as well as within, countries. Differences of the same order of magnitude were found, when the treatment of subgroups of patients, according to site and stage of disease, were examined..[Neymark:2000]{Human}
  6. The cost of managing patients with CHB disease varies significantly between the noncirrhotic CHB/compensated cirrhosis states and the other four disease states. Within the noncirrhotic CHB state, there is also a significant difference between the cost of managing active and inactive disease..[James:2004]{Human}
  7. Pharmacoeconomic data supporting an advantage for metoprolol over high dose thiazides in hypertension needs further assessment in settings reflecting usual general practice approaches to managing patients with hypertension, while differences in quality of life between metoprolol and other antihypertensive agents appear to be marginal..[Peters:1994]{Human}
  8. In patients treated with indapamide, systolic pressure was significantly lower than in those given the placebo at 3 out of the 4 follow-up visits; diastolic pressure, however, was significantly lower only at the end of the trial..[Schaller:1985]{Human}
  9. Ultimately, it is hoped that further definition of subgroups of ALL by immunophenotyping using prognostically significant markers and the use of hybrid technologies of flow cytometry and molecular analysis or cytogenetics will improve treatment strategies for patients with ALL..[Huh:2001]{Human}
  10. The results of the prospective study were compared with the results of a retrospective study on the same group of patients demonstrating a significant difference and hence the unreliability of retrospective studies..[Arnbj?rnsson:1986]{Human}

[High Effects]:0.4666645
  1. Intraindividual variability in the response to various opioids is a factor to be considered when selecting analgesics. Methadone is a useful second-line or third-line opioid for the patient who is highly tolerant to other opioids, as it may demonstrate incomplete cross-tolerance with other agonist opioids. Switching of the opioid to methadone may be a worthwhile option to consider in managing patients who are highly tolerant to other opioids..[Thomas:1995]{Human}
  2. An alarmingly high proportion of South African drug-resistant M. tuberculosis isolates are PZA-resistant, indicating that PZA should not be relied upon in managing patients with MDR-TB in the Western Cape. A method for the rapid detection of PZA resistance would be beneficial in managing patients with suspected drug resistance..[Louw:2006]{Human}
  3. Methotrexate is an important drug in the armamentarium available to physicians to treat patients with moderate to severe psoriasis. The drug has a 40-year track record and has proven to be effective in cases in psoriasis that are refractory to other intense forms of treatment. While it has proven efficacy, methotrexate also has the potential for both acute and chronic toxicity. Patients must be carefully selected and the drug administered according to specific guidelines to guard against the development of serious side effects. Methotrexate is best used by individuals very familiar with psoriasis and equally well-versed in the complexities of managing patients on antimetabolite therapy..[Bright:1999]{Human}
  4. Even in the highly active antiretroviral therapy (HAART) era, individuals HIV-infected through injecting drug use (IDUs) are at increased risk of death due to the burden of competing events such as liver disease, overdose and suicide..[Laurent:2008]{Human}
  5. Thus, when used as an adjunct to a prudent diet, lovastatin produces favorable changes in the entire lipoprotein profile and is a highly effective agent for managing patients with primary hypercholesterolemia..[Bradford:1991]{Human}
  6. To screen, manage, dose adjust, and counsel, the physician and other health care professionals are highly advised and encouraged to consult with an infectious disease clinical pharmacist when managing patients receiving highly active antiretroviral therapy..[Ian:2004]
  7. The Dead Sea environment was highly effective in managing patients with severe Crohn's disease, including perianal complications in this small, uncontrolled series..[Fraser:1996]{Human}
  8. All single and double rooms of INMI are equipped with negative air pressure, sealed doors, high efficiency particulate air (HEPA) filters and a fully-equipped anteroom; moreover, a dedicated high isolation unit with a laboratory next door for the initial diagnostic assays is available for admission of sporadic patients requiring high isolation. For patient transportation, two fully equipped ambulances and two stretcher isolators with a negative pressure section are available..[Ippolito:2005]{Human}
  9. All patients previously diagnosed with sleep apnea were correctly classified at high risk by ARES questionnaire..[Daniel:2008]{Human}

[Reported]:0.44692755
  1. A friend accompanying the patient reported that when the patient started to become stuporous, he attempted to revive him with intranasally administered aliquots of crystal methamphetamine..[Francis:2004]{Human}
  2. The authors report the physical findings and implications for increased difficulty in managing such patients..[Francis:2004]{Human}
  3. We present a case report of traumatic subarachnoid hemorrhage in a patient with acute MDMA intoxication and a review of the anesthetic implications..[Samuel:2009]{Human}
  4. Residents found the sessions and educational strategy to be excellent and reported higher confidence levels in managing patients with chronic noncancer pain..[Huda:2010]{Human}
  5. The US cases of anthrax in 2001 and the recent severe acute respiratory syndrome outbreak have heightened the need for preparedness and response to naturally emerging and re-emerging infections or deliberately released biological agents. This report describes the response model of the Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (INMI), Rome, Italy for managing patients suspected of or affected by smallpox or viral haemorrhagic fever (VHF) either in the context of an intentional release or natural occurrence..[Ippolito:2005]{Human}
  6. We report a child with acute promyelocytic leukaemia (APL) who was treated with etoposide (VP16) for Langerhans cell histiocytosis (LCH)..[Matsuzaki:1994]{Human}
  7. Aripiprazole is generally well tolerated compared with other antipsychotic medications, although commonly reported side effects include extrapyramidal symptoms and motoric activation similar to akathisia..[Margarita:2006]{Human,Guideline}

[Acute Coronary Syndromes]:0.40943265
  1. Antiplatelet therapy has proven to be crucial for managing patients with acute coronary syndromes, coronary artery disease and in patients undergoing percutaneous coronary interventions. However, residual platelet reactivity on antiplatelet treatment confers a five-fold increased risk of major adverse cardiovascular events which indicates a need for more effective antiplatelet medications to address the substantial burden of cardiovascular disease..[Mukesh:2011]{Human}
  2. The implications of an elevated Creatine kinase (CK)-MB isoenzyme (MB) in suspected acute coronary syndromes, with a normal total CK, is not well established. Despite many guidelines on managing patients with acute coronary ischemia, none indicates strategies for patients with elevated MB and with a normal CK..[Peacock:2001]{Human}
  3. Our objective was to prospectively evaluate outcomes in patients with suspected acute coronary syndromes, normal initial total CK, and increased MB. All Emergency Department patients with suspected acute coronary syndromes and creatinine < 2.0 mg/dL were eligible for study entry..[Peacock:2001]{Human}
  4. We conclude that the adverse event rate for patients with suspected acute coronary syndromes and an elevated MB is the same whether or not the total CK is elevated. These patients should be considered as having had an acute coronary syndrome..[Peacock:2001]{Human}
  5. Direct thrombin inhibitors in cardiovascular patients are discussed. Patients presenting with acute coronary syndromes (ACS) of ST- and non-ST-segment elevation myocardial infarction (STEMI and NSTEMI, respectively) or unstable angina develop mural thrombi within minutes of plaque disruption or erosion. Initial acute therapy includes heparin and aspirin. Up to 60% of patients have coronary revascularization to reduce the high risk of death, new myocardial infarction (MI), or recurrent angina. In addition, heparin may initiate a serious allergic, prothrombotic drug reaction, heparin-induced thrombocytopenia (HIT), in 1-5% of patients. Acute cessation of heparin and initiation of direct thrombin inhibitor (DTI) therapy for suspected HIT are vital and well established..[James:2003]{Human}
  6. This case demonstrates the difficulties for managing patients without superior vena cava syndrome in which acute, non-programmed intra-operative SVC clamping is performed, as this is followed by systemic and brain hemodynamic deteriorations that may lead to bad outcome..[Vretzakis:2006]{Human}
  7. Results of this study suggest that there are differences between symptoms at presentation of men and women, and those in various age groups, hospitalized with acute coronary disease. Clinicians should be aware of these differences when diagnosing and managing patients suspected to have coronary heart disease..[Goldberg:2000]{Human}
  8. Therefore, it is imperative that generalist physicians be adept at recognising, evaluating and managing patients with these syndromes..[Johnson:1995]{Human}

[Managing Including]:0.34509766
  1. Clinicians managing patients with acute recreational drug toxicity should be aware of the potential for methaemoglobinaemia in these patients, particularly in patients with cyanosis or unexplained low oxygen saturations on pulse oximetry, and ensure that appropriate and timely management is provided, including, where appropriate, the use of methylthioninium chloride (methylene blue)..[Laura:2011]{Human}
  2. Small bowel lesions potentially responsible for the bleeding were identified in 15 (75%) of 20 patients, including 9 angiodysplasias, 2 gastrointestinal stromal tumors (GISTs), 2 ulcers, 1 jejunal granulation polyp, and 1 Peutz-Jeghers polyposis. Endoscopic treatments including heater probe coagulation, polypectomy, and endoscopic mucosal resection were performed in 11 patients. Two patients with GISTs received surgical intervention. Two patients with angiodysplasias that endoscopic treatment failed underwent laparoscopic resections following tattooing..[Chen-Ming:2007]{Human}
  3. Thirty-one patients with uncomplicated essential hypertension were included. After a run-in period of 3 weeks without any treatment, either indapamide (n = 16) or a placebo (n = 15) were administered for 8 weeks in double-blind fashion..[Schaller:1985]{Human}
  4. The Dead Sea environment was highly effective in managing patients with severe Crohn's disease, including perianal complications in this small, uncontrolled series..[Fraser:1996]{Human}
  5. Intrathecal cytarabine (cytosine arabinoside) is included in many protocols for the treatment of acute lymphoblastic leukaemia of childhood..[Lafolie:1988]{Human}
  6. Aripiprazole is generally well tolerated compared with other antipsychotic medications, although commonly reported side effects include extrapyramidal symptoms and motoric activation similar to akathisia..[Margarita:2006]{Human,Guideline}
  7. Conservative management included superficial modalities and medication for pain and a regimen of scapulothoracic & glenohumeral range of motion and strengthening exercises..[Jason:2012]
  8. This review examines several issues including sedation, invasive monitoring, venous thromboembolism prophylaxis, surgical infections, nutritional support, and other complications that may be of particular importance to the critically ill patient who is morbidly obese..[David:2010]{Human}

[Diagnostic Skills and Referral Practice]:0.33884728
  1. Two thirds of patients with medication-overuse headache (MOH) fulfilled criteria for dependence on acute symptomatic treatments for pain, not exclusive of psychoactive medications, based on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Several questionnaires have been used to assess dependent behavior in patients with MOH..[Jong-Ling:2012]
  2. General practitioners' diagnostic skills and referral practices in managing patients with drug and alcohol-related health problems: implications for medical training and education programmes..[Lisa:2003]{Human}
  3. The aim of this study was to determine the current practices of established general practitioners in managing patients with drug and alcohol-related problems and identify gaps in training. A random sample of general practitioners completed a survey assessing diagnostic skills and referral practices concerning alcohol and illicit drug use in general practices in February 1999, comprising 110 general practitioners registered with the Central Sydney Division of General Practice..[Lisa:2003]{Human}
  4. Drug-induced thrombocytopenias present diagnostic challenges, because many medicines can cause thrombocytopenia and critically ill patients often receive multiple medications..[Reed:2004]{Human}
  5. However, in view of its profound nephrotoxic potential, the use of this drug in renal transplant patients has caused diagnostic confusion. An accurate assessment of whether the allograft dysfunction is from drug overdose or from acute rejection is important before one can manage the problem appropriately. The two practical measures that would help in distinguishing acute rejection from cyclosporine-induced toxicity are 1) a trial of cyclosporine dose-reduction and subsequent assessment of renal function, and 2) histologic assessment of the renal allograft biopsy specimen..[Rao:1994]{Human}
  6. The objective of this study was to review evaluations of current clinical practice among rheumatologists managing patients with rheumatoid arthritis..[Milka:2002]{Human}
  7. All single and double rooms of INMI are equipped with negative air pressure, sealed doors, high efficiency particulate air (HEPA) filters and a fully-equipped anteroom; moreover, a dedicated high isolation unit with a laboratory next door for the initial diagnostic assays is available for admission of sporadic patients requiring high isolation. For patient transportation, two fully equipped ambulances and two stretcher isolators with a negative pressure section are available..[Ippolito:2005]{Human}
  8. The use of multiple MoAbs and multicolor study by flow cytometry has revealed heterogeneity among ALL and mixed-lineage acute leukemia, which are assigned to the same diagnostic categories by morphology..[Huh:2001]{Human}

[Obscure Gastrointestinal Bleeding]:0.3289302
  1. During a 20-month period, more than 500 splenic aspirations were performed in 89 patients with suspected or proven visceral leishmaniasis. The two complications which occurred (intra-abdominal bleeding and penetration of the intestine in one patient each) both resolved with conservative management..[Chulay:1983]{Human}
  2. Among the 15 patients who had a lesion identified with subsequent treatment, rebleeding occurred in 3 (20%) patients with angiodysplasias. Of the five patients in whom no definite lesion was detected, rebleeding developed in four (80%). For patients with an identified lesion that was further treated, the rebleeding rate was lower than for those with "persistent" obscure gastrointestinal bleeding (P=0.031). We conclude that double-balloon enteroscopy offers a safe and effective method for diagnosing and managing patients with obscure gastrointestinal bleeding..[Chen-Ming:2007]{Human}
  3. Small bowel lesions potentially responsible for the bleeding were identified in 15 (75%) of 20 patients, including 9 angiodysplasias, 2 gastrointestinal stromal tumors (GISTs), 2 ulcers, 1 jejunal granulation polyp, and 1 Peutz-Jeghers polyposis. Endoscopic treatments including heater probe coagulation, polypectomy, and endoscopic mucosal resection were performed in 11 patients. Two patients with GISTs received surgical intervention. Two patients with angiodysplasias that endoscopic treatment failed underwent laparoscopic resections following tattooing..[Chen-Ming:2007]{Human}
  4. Recommendations in managing patients with nonvariceal upper gastrointestinal bleeding were recently updated, addressing resuscitation, risk assessment and pre-endoscopic care, endoscopy, pharmacotherapy, and secondary prophylaxis..[Joshua:2010]{Human,Guideline}
  5. This study evaluated the value of double-balloon enteroscopy in diagnosing and managing obscure gastrointestinal bleeding. From October 2003 to January 2006, a total of 20 patients (6 men, 14 women; mean age, 55.2 years old) with obscure gastrointestinal bleeding (18 obscure overt bleeding, 2 obscure occult bleeding) were investigated by double-balloon enteroscopy..[Chen-Ming:2007]{Human}
  6. Diagnosing and treating patients with obscure gastrointestinal bleeding is clinically challenging..[Chen-Ming:2007]{Human}

[Present a Challenges]:0.2790674
  1. The first patient presented with acute drug overdose and required an emergency laparotomy. The second patient presented with pyloric obstruction and was treated by endoscopic removal of the bag. One must be aware that these patients are walking time bombs, carrying drugs that may be well packed but have the potential to deliver a lethal dose without warning. Knowledge of the type of drug and type of packaging are essential in managing these patients..[Robinson:1993]{Human}
  2. General medicine is being challenged by increasing numbers of patients who are presenting with multiple comorbidities and a decline in numbers of suitably trained personnel to manage these patients. A resurgence in generalist care, with collaboration between generalists and specialists, is the key to successfully managing patients who present with acute medical conditions..[Paul:2011]{Human}
  3. Fluid therapy in patients with pulmonary disease is challenging. Although a single set of rules cannot be applied to every patient, the following guidelines can be used when managing patients with pulmonary disease. Euvolemic patients with adequate tissue perfusion should be given sufficient isotonic fluid to balance insensible losses. If severe pulmonary compromise is present, cessation of all fluid therapy may be considered if the patient is able to match its losses by voluntary intake. In hypovolemic or hypotensive patients, small boluses of isotonic crystalloids or colloids should be given to restore perfusion, avoiding rates of more than 30 mL/kg an hour for isotonic crystalloids. If perfusion is not restored by adequate volume resuscitation, vasopressors or positive inotropes should be administered to prevent fluid overload and deterioration in pulmonary function..[Sophie:2008]{Non-Human,Non-Trail,Non-Review,Non-Guidline}
  4. Drug-induced thrombocytopenias present diagnostic challenges, because many medicines can cause thrombocytopenia and critically ill patients often receive multiple medications..[Reed:2004]{Human}
  5. Digoxin is the oldest cardiac medication used in contemporary medicine. With a complex pharmacokinetic profile and narrow therapeutic index, its use in managing patients with atrial arrhythmias or heart failure can present a challenge to today's clinicians..[Michael:2011]{Human}
  6. While most anesthesiologists are facile with the intricacies of managing patients intoxicated by alcohol, cocaine and narcotics the new "club" drugs present a challenge, especially under emergency conditions..[Samuel:2009]{Human}
  7. We present a case report of traumatic subarachnoid hemorrhage in a patient with acute MDMA intoxication and a review of the anesthetic implications..[Samuel:2009]{Human}
  8. Frequently, clinicians encounter challenges in initiating opioid therapy and, then, in weaning paediatric patients off opioids..[Harold:2009]
  9. Specialized medical, public health, community and home environments all contribute challenges of managing patients with IMDs in developing countries..[Phyllis:2005]{Human}
  10. Chronic pain is common and can be devastating to the patient and challenging to the health care provider..[Huda:2010]{Human}

[Glucose Level]:0.27671885
  1. In affected patients, postprandial glucose may be an early indicator of glucose intolerance or a prediabetes condition, which may be a better predictor of cardiovascular risk than impaired fasting glucose level. Treating patients who have early signs of hyperglycemia, including elevated postprandial glucose level, with intensive glucose control that does not lead to weight gain, and ideally may be associated with weight reduction, may be vital to preventing or reducing later cardiovascular morbidity and mortality. Because hypoglycemia is an important complication of current DM treatments and may cause acute secondary adverse cardiovascular outcomes, not causing hypoglycemia is mandatory. Given that weight loss can significantly lower cardiovascular risk and improve other cardiovascular risk factors in patients with type 2 DM and that medications are available that can result in weight reduction without leading to hypoglycemia, the successful treatment of patients with type 2 DM should be individualized and should address the complete pathophysiologic process..[Stanley:2010]{Human}
  2. An algorithm is presented in which the goal for managing patients with type 2 DM is to lower the blood glucose level as much as possible for as long as possible without causing hypoglycemia..[Stanley:2010]{Human}
  3. Residents found the sessions and educational strategy to be excellent and reported higher confidence levels in managing patients with chronic noncancer pain..[Huda:2010]{Human}
  4. This case illustrates a relatively new approach to managing patients with highly unstable INR levels and provides extra understanding of factors influencing INR stability..[Cassandra:2011]

[Appropriate Treatment]:0.27595633
  1. Clinicians managing patients with acute recreational drug toxicity should be aware of the potential for methaemoglobinaemia in these patients, particularly in patients with cyanosis or unexplained low oxygen saturations on pulse oximetry, and ensure that appropriate and timely management is provided, including, where appropriate, the use of methylthioninium chloride (methylene blue)..[Laura:2011]{Human}
  2. A negative Helicobacter pylori test requires confirmation in the acute setting. Following appropriate discussions, acetylsalicylic acid (ASA) can soon be restarted acutely after bleeding; long-term PPI co-therapy is imperative in patients having bled on nonsteroidal anti-inflammatory drugs if still needed (preferably with a cyclooxygenase-2, if appropriate) or ASA (not clopidogrel alone)..[Joshua:2010]{Human,Guideline}
  3. The ability to recognize digoxin overdose, which can manifest in both the acute and chronic settings, helps guide the appropriate dosing of digoxin immune globulins to reverse toxicity. Understanding this unique medication is essential for clinicians to ensure digoxin is used safely and effectively in practice..[Michael:2011]{Human}
  4. The challenges in managing patients with infection in the intensive care unit are increased in an era where there are dwindling antimicrobial choices for multidrug-resistant pathogens. Clinicians in the intensive care unit must balance between choosing appropriate antimicrobial treatment for patients with suspected infection and utilizing antimicrobials in a judicious fashion..[Tejal:2010]{Human,Guideline}
  5. Most general practitioners reported that they were unwilling to treat heroin and cocaine problems themselves but expressed willingness to refer patients appropriately. More than a quarter of general practitioners were unaware of the safe drinking levels for men and women or the appropriate treatment for patients consuming above such levels. Age, years in practice, type of practice, willingness to obtain drug use histories and post-graduate training were all significantly associated with general practitioners' willingness to treat and competence in managing drug and alcohol-related problems..[Lisa:2003]{Human}
  6. The intranasal route may be more appropriate for managing patients with disorders associated with low bone turnover..[O'Doherty:1990]{Human}
  7. Intrathecal cytarabine (cytosine arabinoside) is included in many protocols for the treatment of acute lymphoblastic leukaemia of childhood..[Lafolie:1988]{Human}

[Blood Products]:0.24278432
  1. The patient rapidly decompensated despite blood products administered through the patient's implanted medication port..[James:2009]{Human}
  2. An algorithm is presented in which the goal for managing patients with type 2 DM is to lower the blood glucose level as much as possible for as long as possible without causing hypoglycemia..[Stanley:2010]{Human}
  3. Crystalloid and colloid fluids, blood products, and drugs were administered via the IO route, stabilizing the patient's condition during the central access procedure..[James:2009]{Human}
  4. In critically ill patients, administering RBCs can enhance oxygen delivery to tissues. Among euvolemic patients who do not have ischemic heart disease, guidelines recommend a transfusion threshold of HGB levels in the range of 6.0 to 8.0 g/dL; patients who have HGB that is at least 10.0 g/dL are unlikely to benefit from blood transfusion..[Reed:2004]{Human}
  5. Four of the five patients had positive blood cultures and all five patients had positive bile cultures..[Slater:1989]{Human}

[Data Support]:0.2313115
  1. The outcomes with respect to pain, function and patient satisfaction provide evidence to support the use of conservative therapeutic interventions when managing patients with acute cases of calcific tendinopathy..[Jason:2012]
  2. Family physicians play a key role in assessing and managing patients with Alzheimer's disease and in linking the families of these patients to supportive services within the community. As part of comprehensive management, the family physician may be responsible for coordinating assessments of patient function, cognition, comorbid medical conditions, disorders of mood and emotion, and caregiver status. Suggestions for easily administered and scored assessment tools are provided, and practical tips are given for supporting primary caregivers, thereby increasing efficiency and quality of care for patients with Alzheimer's disease..[Jeffrey:2002]{Human}
  3. With the aim of estimating and comparing the direct hospital costs of managing patients with advanced colorectal cancer in various countries, data on resource utilisation and unit prices were collected. Data on the consumption of medical resources were collected by a retrospective examination of the hospital charts for 20 patients in each of 10 centres in five European countries..[Neymark:2000]{Human}
  4. Pharmacoeconomic data supporting an advantage for metoprolol over high dose thiazides in hypertension needs further assessment in settings reflecting usual general practice approaches to managing patients with hypertension, while differences in quality of life between metoprolol and other antihypertensive agents appear to be marginal..[Peters:1994]{Human}
  5. The combination is indicated for all other patients with high-risk stigmata as there is currently a lack of high-quality generalizable data supporting other intravenous or oral PPI regimens..[Joshua:2010]{Human,Guideline}
  6. This review examines several issues including sedation, invasive monitoring, venous thromboembolism prophylaxis, surgical infections, nutritional support, and other complications that may be of particular importance to the critically ill patient who is morbidly obese..[David:2010]{Human}

[Involved Patients]:0.22871429
  1. Managing patients with acute intermittent porphyria involves removing the precipitating factors, increasing carbohydrate intake, controlling pain, and administering medications..[Shively:1995]{Human}
  2. Enquiries most commonly involved antibiotics (32%), but dental health professionals also asked for advice on legal issues relating to medicines (10%), and on managing patients receiving bisphosphonates (9%), local anaesthetics (6%) and antiplatelet drugs (5%). One hundred and forty-six (97%) enquirers used the advice provided: for managing current patients, planning the care of future patients, for continuing professional development and teaching others..[McEntee:2011]{Human}
  3. 'Treating to target' meant involving patients where necessary to tailor care to their needs and abilities, but limiting patient involvement in decisions about the overall agenda. 'Personalized care' meant involving patients to tailor care to patient preference..[Tim:2011]
  4. The expert consensus panel recognizes that specific patient care decisions might be at variance with this guideline and are the prerogative of the patient and the health professionals providing care, considering all of the circumstances involved..[Peter:2007]{Human}
  5. Involving patients in decision-making may be a means to this end, rather than an end in itself..[Tim:2011]

[Treatment Strategies]:0.22355145
  1. It is this very biology that can dictate the selection of drugs and treatment approaches for managing these patients, strategies that can range from very aggressive combination chemotherapy administered in an intensive care unit (for example, patients with Burkitt's lymphoma), to watch and wait approaches that may go on for years in patients with SLL..[Owen:2005]{Human}
  2. Strategic treatment decisions include (1) whether to treat with medication, psychotherapy, ECT, or other methods; (2) selection among specific agents with long-term efficacy and tolerability (preferably established by randomized controlled trials); (3) selection of the next treatment should the initial treatment fail or be found intolerable; and (4) deciding whether to provide maintenance treatment. Tactical decisions are those needed to optimally implement the strategies selected; for example, (1) how to optimally dose, (2) how long to continue an acute phase treatment trial, (3) how to measure outcome, and (4) how to identify and manage subsequent symptomatic breakthroughs or side effects (which may also require revisions in the initial strategies). Some antidepressant medications evidence efficacy and safety in acute phase treatment of the chronically depressed, but continuation and maintenance phase treatments for these patients are less well investigated and deserve further study. The clinical implications of what is known to date for managing these patients are discussed..[Rush:1997]{Human}
  3. Residents found the sessions and educational strategy to be excellent and reported higher confidence levels in managing patients with chronic noncancer pain..[Huda:2010]{Human}
  4. This issue is important because it implies a treatment strategy in managing patients with MOH by providing the treatment of dependence..[Jong-Ling:2012]
  5. Ultimately, it is hoped that further definition of subgroups of ALL by immunophenotyping using prognostically significant markers and the use of hybrid technologies of flow cytometry and molecular analysis or cytogenetics will improve treatment strategies for patients with ALL..[Huh:2001]{Human}
  6. Intrathecal cytarabine (cytosine arabinoside) is included in many protocols for the treatment of acute lymphoblastic leukaemia of childhood..[Lafolie:1988]{Human}

[Stroke Study]:0.22269881
  1. Furthermore, the recent publication of the results from the European Cooperative Acute Stroke Study II (ECASS II) and Alteplase Thrombolysis of Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) studies will feed the controversy, since the results of these two studies are disappointing and do not confirm the positive results of the NINDS Stroke Study as expected by clinicians managing patients with acute stroke. The Standard Treatment with Alteplase to Reverse Stroke (STARS) and Cleveland studies, which involved a large number of community hospitals to assess the safety profile and the benefit of rt-PA thrombolysis for acute stroke patients in clinical practice, have shown controversial results..[Devuyst:2001]{Human}
  2. The publication of the positive results of the National Institute of Neurological Disorders and Stroke (NINDS) trial of alteplase (a recombinant tissue plasminogen activator; rt-PA) for acute stroke patients in 1995 and its approval by the US Food and Drug Administration as well as the American Academy of Neurology and American Heart Association increased the interest and attention of the medical community in acute stroke treatment..[Devuyst:2001]{Human}
  3. The recent publication of the results from the Prolyse in Acute Cerebral Thromboembolism (PROACT II) study has shown that intra-arterial thrombolysis with prourokinase is a benefit treatment in stroke patients with a proven middle cerebral artery occlusion within 6 h of stroke onset. Numerous trials devoted to neuroprotection against acute ischemic stroke have been prematurely stopped because of safety concerns or poor risk-benefit ratios, but some new neuroprotective drugs seem promising and are being tested in ongoing studies. The third issue under study concerns the use of antithrombotic drugs in the acute phase of stroke, particularly the new potent platelet glycoprotein IIb/IIIa antagonists such as abciximab. In this paper, we have reviewed selected recent clinical trials focusing on recent advances in acute stroke therapy..[Devuyst:2001]{Human}
  4. The results of the prospective study were compared with the results of a retrospective study on the same group of patients demonstrating a significant difference and hence the unreliability of retrospective studies..[Arnbj?rnsson:1986]{Human}
  5. The use of multiple MoAbs and multicolor study by flow cytometry has revealed heterogeneity among ALL and mixed-lineage acute leukemia, which are assigned to the same diagnostic categories by morphology..[Huh:2001]{Human}

[Agents]:0.21820259
  1. Overcoming resistance to taking opioids; initiating, titrating, and changing opioid routes and agents; and preventing or relieving the side effects they induce are also covered..[Abrahm:1999]{Human}
  2. Thus, when used as an adjunct to a prudent diet, lovastatin produces favorable changes in the entire lipoprotein profile and is a highly effective agent for managing patients with primary hypercholesterolemia..[Bradford:1991]{Human}
  3. There are 20 antiretroviral agents approved by the US Food and Drug Administration (FDA), four of which were approved in 2003. With 20 antiretrovirals FDA-approved, interactions occur when the medications alter the toxicity profile or efficacy of the other medication..[Ian:2004]
  4. The US cases of anthrax in 2001 and the recent severe acute respiratory syndrome outbreak have heightened the need for preparedness and response to naturally emerging and re-emerging infections or deliberately released biological agents. This report describes the response model of the Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (INMI), Rome, Italy for managing patients suspected of or affected by smallpox or viral haemorrhagic fever (VHF) either in the context of an intentional release or natural occurrence..[Ippolito:2005]{Human}
  5. Pharmacoeconomic data supporting an advantage for metoprolol over high dose thiazides in hypertension needs further assessment in settings reflecting usual general practice approaches to managing patients with hypertension, while differences in quality of life between metoprolol and other antihypertensive agents appear to be marginal..[Peters:1994]{Human}
  6. Despite improvements in cytotoxic chemotherapy agents over the last 50 years, the outlook for patients with many of the most common solid tumours has remained poor..[Diana:2010]{Human}

[Sleep Apnea]:0.21537274
  1. The purpose of this case is to present the results of a conservative approach, including therapeutic exercise, for the management of calcific tendinopathy of the supraspinatus, with an emphasis on patient outcomes. CASE The patient was a self-referred 41 year old male with complaints of acute, right shoulder pain and difficulty sleeping..[Jason:2012]
  2. The aim of this study is to assess the prevalence of probable obstructive sleep apnea/sleep disordered breathing and symptoms associated with this condition in a population of dental patients using a validated questionnaire and software that could be administered in a dental office. A retrospective analysis conducted at two dental practices using questionnaire responses obtained from 175 men and 156 women, and sleep study data obtained in the patient's homes from 75 men and 30 women with a portable recorder..[Daniel:2008]{Human}
  3. The high prevalence of undiagnosed sleep apnea in dental patients suggests that dentists could provide a valuable service to their patients by incorporating sleep apnea screening and treatment into their practice. Those who practice sedation dentistry should consider additional precautions when managing patients with risk of sleep apnea..[Daniel:2008]{Human}
  4. All patients previously diagnosed with sleep apnea were correctly classified at high risk by ARES questionnaire..[Daniel:2008]{Human}
  5. In a subgroup of 105 patients classified at high risk who completed an overnight sleep study, 96% had an apnea hypopnea index (AHI) greater than five events per hour..[Daniel:2008]{Human}

[Following Treatment]:0.21045029
  1. A hyperventilation clinic was established specifically to deal with patients referred from the accident and emergency department with the hyperventilation syndrome. This was run by a staff nurse, who counselled the patients and taught abdominal breathing techniques and relaxation. In 30 patients so managed, 63% said their symptoms were much better or had completely gone and in only 6% was there no improvement; 43% had previously had more than one attendance at the A&E department, but following treatment only 2 patients represented during 5 months of follow up. The use of a nurse counsellor seems to be a simple and effective approach to managing these patients and considerably reduces both casualty and outpatient physician time..[Pinney:1987]{Human}
  2. Clinicians should suspect factor inhibitors when the prolonged PT or aPTT does not correct or only partially corrects following an immediate assay of a 1:1 mix of patient and normal plasma..[Reed:2004]{Human}
  3. A negative Helicobacter pylori test requires confirmation in the acute setting. Following appropriate discussions, acetylsalicylic acid (ASA) can soon be restarted acutely after bleeding; long-term PPI co-therapy is imperative in patients having bled on nonsteroidal anti-inflammatory drugs if still needed (preferably with a cyclooxygenase-2, if appropriate) or ASA (not clopidogrel alone)..[Joshua:2010]{Human,Guideline}
  4. This case demonstrates the difficulties for managing patients without superior vena cava syndrome in which acute, non-programmed intra-operative SVC clamping is performed, as this is followed by systemic and brain hemodynamic deteriorations that may lead to bad outcome..[Vretzakis:2006]{Human}
  5. Managing patients with venous ulceration who are unable to tolerate therapeutic compression bandaging is a challenging clinical problem. This study followed a group of 28 such patients who were treated with three layers of graduated Tubigrip as an alternative to therapeutic compression..[Sue:2003]{Human}
  6. Small bowel lesions potentially responsible for the bleeding were identified in 15 (75%) of 20 patients, including 9 angiodysplasias, 2 gastrointestinal stromal tumors (GISTs), 2 ulcers, 1 jejunal granulation polyp, and 1 Peutz-Jeghers polyposis. Endoscopic treatments including heater probe coagulation, polypectomy, and endoscopic mucosal resection were performed in 11 patients. Two patients with GISTs received surgical intervention. Two patients with angiodysplasias that endoscopic treatment failed underwent laparoscopic resections following tattooing..[Chen-Ming:2007]{Human}
  7. Intrathecal cytarabine (cytosine arabinoside) is included in many protocols for the treatment of acute lymphoblastic leukaemia of childhood..[Lafolie:1988]{Human}

[Ventilation Setting]:0.2087084
  1. Although adverse events were common among patients treated for opioid overdose in an out-of-hospital setting, serious complications were rare..[Ingebj?rg:2004]{Human}
  2. Recent studies have advanced our understanding of the pathogenesis and treatment of acute asthma. The purpose of this review is to provide practical guidance in the assessment and treatment of adults with acute asthma in the hospital setting. Managing patients with acute asthma involves assessing the severity of the exacerbation, implementing measures to rapidly reverse airflow limitation, and instituting therapies that limit the progression of airway inflammation. Some patients may benefit from other supportive measures such as heliox and noninvasive ventilation. If the patient continues to deteriorate and requires mechanical ventilation, then ventilator settings that minimize the risk of hyperinflation should be chosen. After an episode of acute asthma, long-term preventive medications, especially inhaled corticosteroids, should be prescribed and education should be provided to prevent future episodes..[Teal:2002]{Human}
  3. Optimizing patient-ventilator synchrony is essential in managing patients who require prolonged mechanical ventilation in the long-term acute-care hospital..[Maher:2011]
  4. Achieving optimal synchrony in the long-term acute-care hospital depends on a number of factors, including adjusting ventilator settings in response to improving lung function; adjusting psychotropic medications to control delirium, anxiety, and depression; and ensuring there is a well positioned correctly sized tracheostomy tube in the airway..[Maher:2011]

[Patients with Advanced Cancer]:0.20735502
  1. General internists often care for patients with advanced cancer. These patients have substantial morbidity caused by moderate to severe pain and by spinal cord compression. With appropriate multidisciplinary care, pain can be controlled in 90% of patients who have advanced malignant conditions, and 90% of ambulatory patients with spinal cord compression can remain ambulatory. Guidelines have been developed for assessing and managing patients with these problems, but implementing the guidelines can be problematic for physicians who infrequently need to use them..[Abrahm:1999]{Human}
  2. Breast cancer is one of the most common cancers in women, and although the prognosis is good for patients with early-stage, localized disease, it is relatively poor for patients with metastatic breast cancer. Treatment options become progressively limited with advancing lines of therapy, primarily because of the development of tumor drug resistance. Nurses have a crucial role in managing patients with breast cancer; therefore, awareness of the clinical efficacy and side-effect profiles of traditional and newer treatment options is of great importance. The taxanes (docetaxel and paclitaxel) are well known for their efficacy in patients with breast cancer..[Jane:2010]{Human}
  3. One such therapy, a tyrosine kinase inhibitor (sorafenib) is now used to treat patients with advanced hepatocellular carcinoma (HCC) and metastatic renal cell carcinoma. This article will explore the role of the oncology nurse in managing patients receiving sorafenib for advanced HCC..[Diana:2010]{Human}
  4. With the aim of estimating and comparing the direct hospital costs of managing patients with advanced colorectal cancer in various countries, data on resource utilisation and unit prices were collected. Data on the consumption of medical resources were collected by a retrospective examination of the hospital charts for 20 patients in each of 10 centres in five European countries..[Neymark:2000]{Human}
  5. Importantly, ixabepilone retains clinical efficacy in patients with metastatic breast cancer who show resistance to taxanes and anthracyclines..[Jane:2010]{Human}
  6. Physicians can use the techniques described to more readily implement existing guidelines and provide comfort and optimize quality of life for patients with advanced cancer..[Abrahm:1999]{Human}

[Quality of Life]:0.15821111
  1. When administered post-myocardial infarction, conventional metoprolol was associated with significant improvements in quality of life and was cost saving over a 3-year period. Significant improvements in quality of life were also evident for metoprolol-treated patients with idiopathic dilated cardiomyopathy..[Peters:1994]{Human}
  2. Pharmacoeconomic data supporting an advantage for metoprolol over high dose thiazides in hypertension needs further assessment in settings reflecting usual general practice approaches to managing patients with hypertension, while differences in quality of life between metoprolol and other antihypertensive agents appear to be marginal..[Peters:1994]{Human}
  3. Physicians can use the techniques described to more readily implement existing guidelines and provide comfort and optimize quality of life for patients with advanced cancer..[Abrahm:1999]{Human}
  4. Quality of life in patients with mild to moderate hypertension did not deteriorate in most investigations with metoprolol..[Peters:1994]{Human}
  5. Using discreet threshold values to measure quality in primary care may result in physicians focusing on managing patients by the numbers at the expense of making individualized and nuanced clinical decisions..[Robert:2012]

[Acute Asthma]:0.15134901
  1. As patients with asthma get older, their medication regimen can become even more complex with the development of numerous other age-related diseases requiring their own list of medications. Diseases of the joints, diseases of the eye, cardiovascular disease, neurological disease and urological problems represent the most common conditions that patients develop, at times needing medications which might interfere with asthma management. Many of these diseases require the use of nonsteroidal anti-inflammatory agents, well known to provoke wheezing in patients with intrinsic asthma, and diseases of the eye and cardiovascular system frequently require use of beta-blockers which can cause or exacerbate asthma. Managing patients with asthma who have other diseases requires constant supervision of their medication usage and careful and cautious review of the entire list of medications at each presentation..[Hunt:1998]{Human}
  2. Recent studies have advanced our understanding of the pathogenesis and treatment of acute asthma. The purpose of this review is to provide practical guidance in the assessment and treatment of adults with acute asthma in the hospital setting. Managing patients with acute asthma involves assessing the severity of the exacerbation, implementing measures to rapidly reverse airflow limitation, and instituting therapies that limit the progression of airway inflammation. Some patients may benefit from other supportive measures such as heliox and noninvasive ventilation. If the patient continues to deteriorate and requires mechanical ventilation, then ventilator settings that minimize the risk of hyperinflation should be chosen. After an episode of acute asthma, long-term preventive medications, especially inhaled corticosteroids, should be prescribed and education should be provided to prevent future episodes..[Teal:2002]{Human}
  3. All asthma patients are at risk for acute asthma exacerbations..[Teal:2002]{Human}

[Rebound-withdrawal Headache]:0.13442218
  1. Two thirds of patients with medication-overuse headache (MOH) fulfilled criteria for dependence on acute symptomatic treatments for pain, not exclusive of psychoactive medications, based on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Several questionnaires have been used to assess dependent behavior in patients with MOH..[Jong-Ling:2012]
  2. After withdrawal of the medication, there is often a high relapse rate of using the medication again with redevelopment of the rebound-withdrawal headache. Even in patients who do not relapse to drug use, headache usually remains a major problem. Recognition and treatment of rebound headache are key factors in management of these patients. Perhaps more important in regard to this entity is recognizing its existence and preventing patients from entering a pattern of rebound withdrawal, which can be achieved by early attention to their use of analgesic narcotic or migraine-abortive medications. Overall, it is likely that this will continue to be an increasing worldwide problem in managing patients with headache..[James:2005]
  3. The key feature of this entity is that the patient initially uses a symptomatic treatment for headache with good result. Use of this medication may increase over time, but as the use increases to more than 10 to 15 days per month, headache frequency may also increase, reaching a point where metabolic processing of the medication and removal from the system triggers another headache. The patient then finds that as use of the medication increases, the frequency and intensity of the headaches also increases, and the overall headache worsens. Once this pattern is established, therapy requires removal of the medication in order for the rebounding process to be terminated..[James:2005]
  4. Rebound-withdrawal headache ( medication overuse headache) is a problem that affects 1% of the population or perhaps more..[James:2005]

[Mg Day]:0.13008904
  1. The cumulative dose of the administered VP16 was 12,120 mg/m2, which suggested that VP16 may be responsible for the development of APL. The risk of developing secondary leukaemia after the administration of VP16 should therefore be considered when managing patients with LCH..[Matsuzaki:1994]{Human}
  2. The magnitude of the effect of this lipoprotein was further reflected by the percentage of patients who achieved National Cholesterol Education Program (NCEP) goals. In the absence of coronary artery disease (CAD) or two other CAD risk factors, the LDL-cholesterol goal of 4.14 mmol/L (160 mg/dL) was attained by 22% of patients in the placebo group and between 81% (20 mg/day) and 96% (80 mg/day) of those treated with lovastatin. For those with CAD or at least two other CAD risk factors, the LDL-cholesterol goal of 3.36 mmol/L (130 mg/dL) was attained by 4% of placebo patients and between 38% (20 mg/day) and 83% (80 mg/day) of those treated with lovastatin..[Bradford:1991]{Human}
  3. Patients were randomly assigned to 48 weeks of treatment with diet and placebo or diet and lovastatin 20 or 40 mg once a day, or 20 or 40 mg twice a day..[Bradford:1991]{Human}

[Platelet Transfusions]:0.104486525
  1. Refractoriness to platelet transfusions continues to be a major problem for many thrombocytopenic patients. A proposed algorithm for managing these patients is presented which proceeds from easily instituted changes in platelet transfusion therapy such as provision of ABO-compatible and "fresh" platelet transfusions to the more difficult and costly process of selecting compatible platelets for patients who are documented to be alloimmunized..[Slichter:1997]{Human}
  2. Future research should examine whether clinical outcomes from rHuEPO use in critically ill patients are important and cost-effective. Because platelets play an instrumental role in primary hemostasis, platelet transfusions are often important in managing patients who are bleeding or at risk of bleeding with thrombocytopenia or impaired platelet function..[Reed:2004]{Human}
  3. Identifying which of these factors are causally associated with poor platelet responses in any given patient remains a substantial challenge..[Slichter:1997]{Human}

[(Other)]:1.001358E-5
  1. The grade of recommendation is in parentheses. 1) All patients with suicidal intent, intentional abuse, or in cases in which a malicious intent is suspected (e.g., child abuse or neglect) should be referred to an emergency department (Grade D). 2) Patients who exhibit more than mild effects (e.g., infrequent vomiting or somnolence [lightly sedated and arousable with speaking voice or light touch]) after an acute dextromethorphan ingestion should be referred to an emergency department (Grade C). 3) Patients who have ingested 5-7.5 mg/kg should receive poison center-initiated follow-up approximately every 2 hours for up to 4 hours after ingestion. Refer to an emergency department if more than mild symptoms develop (Grade D). 4) Patients who have ingested more than 7.5 mg/kg should be referred to an emergency department for evaluation (Grade C). 5) If the patient is taking other medications likely to interact with dextromethorphan and cause serotonin syndrome, such as monoamine oxidase inhibitors or selective serotonin reuptake inhibitors, poison center-initiated follow-up every 2 hours for 8 hours is recommended (Grade D). 6) Patients who are asymptomatic and more than 4 hours have elapsed since the time of ingestion can be observed at home (Grade C). 7) Do not induce emesis (Grade D). 8) Do not use activated charcoal at home. Activated charcoal can be administered to asymptomatic patients who have ingested overdoses of dextromethorphan within the preceding hour..[Peter:2007]{Human}
  2. New international standards no longer require directly observed therapy for all tuberculosis (TB) patients, but state that practitioners must be capable of assessing adherence and addressing poor adherence. Mass-produced electronic medication monitors, which record removal of medication from a container, could help overcome the problem of assessing treatment adherence accurately even in poor countries. Both health facilities and community workers could dispense drugs for self-administered treatment in medication monitors and retrieve the adherence record with inexpensive built-in displays. These devices could keep the adherence record from the beginning of therapy for managing patients who move. Pharmacists using medication monitors could provide surveillance of self-administered treatment prescribed by private physicians with less adherent patients referred to the health departments. Less adherent patients could be managed with focused counselling, directly observed therapy when necessary, and extensions in treatment duration. Removal of the directly observed therapy burden would encourage patients to seek free high-quality supervised pubic care and help expand effective TB treatment services. If resources saved by giving less directly observed therapy were focused on poorly adherent patients, medication monitor-based programmes could create less acquired drug resistance than overwhelmed treatment programmes that attempt but fail to give uninterrupted directly observed therapy to all patients..[Thomas:2007]{Human}
  3. Primary phacoemulsification plus intraocular lens implantation lowered IOP, reduced the use of antiglaucoma medications, and improved vision in patients with acute PAC. This is a safe and effective method of IOP control and can be considered a first treatment option in managing patients with acute PAC and coexisting cataract..[Wei-Wen:2011]{Human}
  4. By the exchange of cerebrospinal fluid with isotonic saline started 1 hour after overdose through a lumbar needle, about 27% of the administered dose was recovered. The estimated recovery in view of the time elapsed between overdose and start/end of the exchange procedure was 36%. This indicates that this procedure is of value in managing patients with heavy overdose of intrathecal cytarabine in hospitals without neurosurgical facilities..[Lafolie:1988]{Human}
  5. Although emerging data indicate that atypical antipsychotics will be a promising addition to those therapies that are currently available for managing patients during the maintenance phase of bipolar illness, their potential in the long-term management of bipolar disorder remains to be fully explored. Aripiprazole is a recently released antipsychotic medication that differs from other atypical antipsychotic agents by its mode of action as a dopamine D2 partial agonist. It is administered orally and has a long half-life. Randomized studies have demonstrated the efficacy of aripiprazole compared with placebo in the treatment of acute relapse of schizophrenia and schizoaffective disorder, maintenance treatment of schizophrenia, treatment of acute mania, and prevention of manic relapse in patients who responded to the drug during a manic episode..[Margarita:2006]{Human,Guideline}
  6. Four patients underwent cholecystectomy and one patient underwent a cholecystostomy. Four patients survived and were discharged from the hospital. All five patients were receiving nutritional support. Factors such as prolonged fasting, dehydration, narcotic administration, and sepsis have been suggested as contributing factors in the development of acute cholecystitis. Acute cholecystitis is a serious complication in such patients and must be considered and treated promptly. Serial ultrasound studies have been helpful in managing patients suspected of having acute septic cholecystitis..[Slater:1989]{Human}
  7. Ip cisplatin can be administered safely to patients with malignant ascites and may be useful in patients with minimal residual intraperitoneal disease, particularly ovarian carcinoma..[Casper:1983]{Human}
  8. Do not delay transportation in order to administer activated charcoal (Grade D). 9) For patients who have ingested dextromethorphan and are sedated or comatose, naloxone, in the usual doses for treatment of opioid overdose, can be considered for prehospital administration, particularly if the patient has respiratory depression (Grade C). 10) Use intravenous benzodiazepines for seizures and benzodiazepines and external cooling measures for hyperthermia (>104 degrees F, >40 degrees C) for serotonin syndrome. This should be done in consultation with and authorized by EMS medical direction, by a written treatment protocol or policy, or with direct medical oversight (Grade C). 11) Carefully ascertain by history whether other drugs, such as acetaminophen, were involved in the incident and assess the risk for toxicity or for a drug interaction..[Peter:2007]{Human}
  9. The objective of this guideline is to assist poison center personnel in the appropriate out-of-hospital triage and initial out-of-hospital management of patients with a suspected ingestion of dextromethorphan by 1) describing the process by which an ingestion of dextromethorphan might be managed, 2) identifying the key decision elements in managing cases of dextromethorphan ingestion, 3) providing clear and practical recommendations that reflect the current state of knowledge, and 4) identifying needs for research..[Peter:2007]{Human}
  10. Imaging studies should be obtained selectively in patients with signs and symptoms, such as focal neurological findings and gait disturbances, which are suggestive of structural lesions: stroke, subdural haematoma, normal pressure hydrocephalus and brain tumours. Appropriate management involving pharmacological and nonpharmacological measures will result in significant improvement in most patients with these syndromes. Potentially offending drugs should be discontinued. In delirious patients the underlying illness must be treated concomitantly with the use of psychotropics, if necessary. Although no current medications have been shown to have a significant effect on the functional status of patients with the 2 most common causes of dementia, Alzheimer's disease and multi-infarct dementia, the management of concomitant illness in these patients may result in improved function for as long as a year. Tacrine, an anticholinesterase inhibitor, improves cognitive function slightly in selected patients with Alzheimer's disease over short periods. Finally, the treatment of depression with medications or electroconvulsive therapy (ECT) results in significant reductions in mortality and morbidity..[Johnson:1995]{Human}
  11. Acute cholecystitis continues to be a life-threatening complication in patients after trauma. In an 18-month period we have recognized and treated five patients with burn injuries who had acute cholecystitis..[Slater:1989]{Human}
  12. Managing patients with relapsed acute myeloid leukemia is a major clinical challenge. Although 60-70% of patients with AML achieve complete remission following induction therapy with cytarabine and an anthracycline, at least 70-80% of patients achieving remission eventually relapse. While there are few comparative trials that provide therapeutic guidelines, an initial decision as to treatment can be seen as a choice between reusing previously effective drugs or initiating new classes of drugs..[Schiffer:1991]{Human}
  13. Ip chemotherapy may be useful in managing patients with malignant ascites. This approach should result in a high concentration of drug at the site of disease, while the plasma concentration and therefore systemic toxicity remain low. Six patients with malignant ascites were treated with cisplatin at a dose of 60 mg/m2. Three patients received the drug iv; one of these patients and three other patients were treated with ip cisplatin..[Casper:1983]{Human}
  14. In the 698 patients entered, the acute composite outcome rate was 25% (175) and 6.3% (44) at 6 months. Acute and 6 month adverse outcome rates were statistically the same for all patients with an elevated MB fraction, regardless of the total CK level..[Peacock:2001]{Human}
  15. This paper discusses the problem of delirium and the challenges of accurately assessing, preventing and managing patients with delirium in an acute care setting. PRIMARY Acute confusion, also known as delirium, is misdiagnosed and under-treated in up to 94% of older patients in hospitals..[Chantal:2006]{Human}
  16. Information supplied by enteroscopy has proven invaluable in managing patients with suspected NSAID enteropathy..[Morris:1999]{Human}
  17. The extensive clinical experience with r-hirudin in cardiovascular patients suggests that it is an excellent choice for managing patients with HIT and is easy to use in converting to warfarin, since it does not significantly change the prothrombin time..[James:2003]{Human}
  18. Carefully managing patients undergoing elective surgeries is difficult in the perioperative setting. However, this becomes increasingly complex in patients hospitalized for acute conditions that may or may not be related to the pending surgery. Not only must the consulting physician take into consideration any complications inherent to the surgical procedure, but must also consider all related comorbidities of the acute condition for which the patient was initially hospitalized plus any existing chronic conditions..[Stephen:2008]{Human}
  19. Patients unwilling or unable to take beta-blockers do not need to be screened. For patients with acute variceal bleeding, the combination of pharmacologic therapy plus endoscopic therapy is superior to either therapy alone..[Lisa:2002]
  20. Managing patients with delirium is challenging not only for the management of their basic nursing care needs but also because they are prone to adverse events such as falls and medication problems. In order to address this issue it is vital that health care professionals routinely assess patients for signs of delirium..[Chantal:2006]{Human}
  21. Background  Most studies of shared decision-making focus on acute treatment or screening decision-making encounters, yet a significant proportion of primary care is concerned with managing patients with chronic disease..[Tim:2011]
  22. Antiarrhythmic drugs have been associated with delirium, and digitalis toxicity can be associated with hallucinations, mania, euphoria, and depression. Antiarrhythmic agents such as verapamil are used as adjunctive treatment for managing patients with bipolar disorders. Because neuropsychiatric disorders can be seen in patients with cardiovascular disease, it is important for the clinician to be aware of the possible relationships between these disorders and concurrent cardiovascular drug therapy..[Keller:2001]{Human}
  23. Commonly used cardiovascular medications have neuropsychiatric effects, which can be either harmful or of therapeutic benefit to patients. For example, sedation and mental depression have been described with centrally acting antihypertensive drugs and beta-adrenergic drugs, and are related to their antiadrenergic actions..[Keller:2001]{Human}
  24. Patients were followed until their ulcers healed or for a maximum of 12 weeks. The decision to use three layers of graduated Tubigrip was based on 19 patients' desire to wear their normal shoes (67.9%) and the convenience of access to the ulcer by eight patients (28.6%) (to permit frequent dressing changes for large or infected ulcers, and for the daily application of steroidal creams to periulcer skin). Fourteen patients' ulcers had healed within the 12-week study period. The remaining 14 patients had a mean reduction in ulcer area of 4.6 cm(2) ( SD = 7.4), and median of 2.3 cm(2) (range 28.5). The authors found three layers of graduated Tubigrip useful for managing patients who cannot tolerate therapeutic forms of compression..[Sue:2003]{Human}
  25. In this article, we review some of the general principles involved with perioperative anticoagulation and discuss the perioperative management of patients taking vitamin K antagonists (VKAs), bridging regimens for anticoagulants and antiplatelet agents, and strategies for managing patients on the newer oral anticoagulants..[Marc:2011]
  26. Among 46 newly diagnosed and 17 relapsed or drug-resistant patients with visceral leishmaniasis, the average initial parasite grade was 4.35 +/- 0.92 (mean +/- SD) and 4.15 +/- 1.37, respectively..[Chulay:1983]{Human}
  27. Reducing morbidity and mortality from esophageal varices remains a challenge for physicians managing patients with chronic liver disease. For patients who have never bled from varices, prophylactic therapy with nonselective beta-blockers reduces the risk of initial variceal bleeding and bleeding-related death. Thus, patients with newly diagnosed cirrhosis should be considered for endoscopic variceal screening. All patients with Child's class B and C cirrhosis should be offered endoscopic screening, whereas those with Child's class A with evidence of portal hypertension (eg, platelet count less than 140,000 per milliliter, portal vein diameter larger than 13 mm, evidence of splenic varices on ultrasound) should be screened..[Lisa:2002]
  28. There are limited reliable data to guide clinicians managing patients with toxicity due to these substances. The harms associated with emerging recreational drugs are not fully documented, although it is clear that they are not without risk. Management of users with acute toxic effects is pragmatic and primarily extrapolated from experience with longer established stimulant or hallucinogenic drugs such as amfetamines, 3,4-methylenedioxymethamfetamine (MDMA) and lysergic acid diethylamide (LSD)..[Simon:2011]{Human}
  29. Many patients with underlying cardiovascular disease require long-term anticoagulation. The perioperative or periprocedural management of patients who require temporary interruption of anticoagulant or antiplatelet medications is a common and often challenging clinical problem. It requires a fine balance between the risk of thromboembolic events during anticoagulant interruption and the risk of bleeding in the setting of antithrombotic therapy administered around the time of surgery..[Marc:2011]
  30. The article downplays the use of rigid rules in managing patients on opioids, and emphasizes a flexible and patient-centred approach..[Harold:2009]
  31. SCD is a long-term chronic condition which is manifested by periods of acute painful sickling crisis, known as vaso-occlusive crisis (VOC) and is the cause of 90% of sickle cell-related hospital admissions. SCD is one of the most common genetic conditions worldwide and in the UK there are approximately 12,500 people living with it (Streetly et al,1997; Howard et al, 2008), making it more common than cystic fibrosis, yet there still remains many challenges in managing these patients when they become acutely ill. Lack of awareness and understanding of the illness, concerns regarding addiction and limited attention to the psycho-social implications of the illness, leads to less than effective care for this patient group when they are hospitalized. The aims of this article are to outline the pathophysiology of SCD, identify the causes of VOC and discuss the key principles of nursing management for patients experiencing a VOC..[Marvelle:2012]
  32. Two patients with active Crohn's disease and on high-dose corticosteroids were able to stop all medication during their stay..[Fraser:1996]{Human}
  33. After the overdose the patient had dilated pupils during the first hour..[Lafolie:1988]{Human}
  34. Dentists prescribe a limited range of medicines but it is important that they consider the effects of all medicines their patients are taking when providing dental care..[McEntee:2011]{Human}
  35. No significant change in body weight, plasma potassium and uric acid occurred during the study in either group of patients. It appears therefore that indapamide, at a dose which apparently has no major diuretic effect, may be useful for practitioners in managing patients with mild to moderate hypertension..[Schaller:1985]{Human}
  36. These four conditions are addressed in this paper using four accepted emergency ultrasound applications to be performed during resuscitation of a cardiac arrest patient with the aim of determining the underlying cause of a cardiac arrest. Identifying the underlying cause of cardiac arrest represents the one of the greatest challenges of managing patients with asystole or PEA and accurate determination has the potential to improve management by guiding therapeutic decisions..[Caleb:2008]{Human}
  37. Acute intermittent porphyria is characterized by intermittent, acute, occasionally fatal attacks of abdominal, neurologic, psychiatric, and renal symptoms. Attacks are often confused with acute abdomen or bowel obstruction..[Shively:1995]{Human}
  38. The effects of concurrent medication, alcohol and compliance on stable control are well documented. Recent evidence also shows that supplemental vitamin K in patients with low body stores improves the stability of INR in these patients..[Cassandra:2011]
  39. Recent ESC/EACTS revascularization guidelines advocate a 'Heart Team' (HT) approach in the decision-making process when managing patients with coronary disease. We prospectively assessed HT decision-making in 150 patients analysing personnel attendance, data presented, the 'actioning' of the HT decision and, if not completed, then the reasons why. Additionally, 50 patients were specifically re-discussed after 1 year in order to assess consistency in decision-making..[Jenny:2012]
  40. Six patients with Crohn's disease unresponsive to medical treatment spent periods of 1-3 weeks at the Dead Sea. Four patients had discharging perianal fistulas..[Fraser:1996]{Human}
  41. While these models clearly serve an important role in understanding biology, and perhaps more importantly, in identifying promising new drugs for these diseases, they fall short in truly representing the broader, more heterogenous biology found in patients..[Owen:2005]{Human}
  42. This was especially valuable for managing patients with drug-resistant visceral leishmaniasis..[Chulay:1983]{Human}
  43. However, these sophisticated techniques are not readily available to most clinicians who are currently managing patients with graft dysfunction..[Rao:1994]{Human}
  44. Intraosseous infusion is a valuable and underutilized technique in managing patients in hemorrhagic shock with poor IV access..[James:2009]{Human}
  45. Patients with moderate or large sized varices and those with varices exhibiting color changes (eg, red wale marks, cherry red spots) should be treated with beta-blockers..[Lisa:2002]
  46. The main problems encountered in managing patients with inherited metabolic disorders (IMDs) are inadequate numbers of clinicians and scientists with experience in IMDs, ill-equipped laboratory facilities, lack of funding, and lack of a well-organized plan..[Phyllis:2005]{Human}
  47. In patients on anticoagulants, correction of a coagulopathy is recommended, but should not delay early endoscopy (within 24 h), as it improves clinical outcomes. In patients with high-risk endoscopic stigmata, although better than doing nothing, epinephrine injection alone provides suboptimal efficacy and should be combined with another modality such as clips, thermal or sclerosant injection, which are also efficacious alone..[Joshua:2010]{Human,Guideline}
  48. Atypical antipsychotics have been used to treat patients with schizophrenia for many years, but now there is increasing evidence of their utility in the treatment of mood disorders..[Margarita:2006]{Human,Guideline}
  49. For perioperative risk stratification, the Revised Cardiac Risk Index is the simplest tool for accurately identifying those patients at increased perioperative risk for cardiac mortality and morbidity. Medical optimization involves performing any necessary preoperative testing that would help identify concurrent undiagnosed medical conditions that might require preoperative intervention or the initiation of certain medication regimens to optimize disease treatment..[Stephen:2008]{Human}
  50. Patients with bleeding refractory to combined medical plus endoscopic therapy should be considered for transjugular intrahepatic portosystemic shunts or shunt surgery..[Lisa:2002]
  51. Adequate housing, clothing, and fuel are essential to help prevent frequent infections that may lead to serious illness or death of patients with IMDs..[Phyllis:2005]{Human}
  52. A recent investigation has also highlighted a potential role for metoprolol in selected patients with idiopathic dilated cardiomyopathy..[Peters:1994]{Human}
  53. As a starting point for further work in this area, we suggest the development of metrics that track identification and management of depression; management of transitions of care; care coordination; team-based care; identification and support of socially frail/isolated individuals; pharmacologic management, including optimizing medication and dealing with adherence issues; and establishment of a therapeutic environment..[Robert:2012]
  54. These individuals require prompt surgical attention under two circumstances: when they are found to suffer from drug overdosage caused by inadvertent leakage or when obstruction in the body is caused by the drug-laden bags..[Robinson:1993]{Human}
  55. Stratifying patients into thromboembolic risk groups may be helpful in directing anticoagulation management in the perioperative setting..[Marc:2011]
  56. While dementia and depression are prevalent in the community, hospitals and nursing homes, delirium is seen most often in acute care hospitals..[Johnson:1995]{Human}
  57. Delirium is an acute disturbance of consciousness marked by an attention deficit and a change in cognitive function..[Johnson:1995]{Human}
  58. Continuing education and training of hospital staff, consistent application of infection control practices, and availability of adequate personnel protective equipment are additional resources implemented for the care of highly infectious patients and to maintain the readiness of an appropriately trained workforce to handle large scale outbreaks..[Ippolito:2005]{Human}
  59. Research aimed at designing acute services to match local clinical demand is also required..[Paul:2011]{Human}
  60. Allogeneic, autologous, and syngeneic bone marrow transplantation probably represent the preferred approaches in suitable patients, either in early relapse or after second remission is achieved..[Schiffer:1991]{Human}
  61. Results  Providers described a conflict between their responsibilities to deliver evidence-based diabetes care and to respect patients' rights to make decisions..[Tim:2011]
  62. After 2 weeks the index decreased to 2.0 +/- 0.4 (p = 0.037) in four patients..[Fraser:1996]{Human}