Tìm thấy 13+ kết quả cho từ khóa "Clinical Approach"
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Overview and Clinical Approach. Sexually Transmitted Infections: Overview and Clinical Approach. Worldwide, most adults acquire at least one sexually transmitted infection (STI), and many remain at risk for complications. Each year, for example, an estimated 6.2 million persons in the United States acquire a new genital human papillomavirus (HPV) infection, and many of these individuals are at risk for genital neoplasias.
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Overview and Clinical Approach. Pelvic Inflammatory Disease: Treatment. The 2006 CDC guidelines recommend initiation of empirical treatment for PID in sexually active young women and other women at risk for PID if they are experiencing pelvic or lower abdominal pain, if no other cause for the pain can be identified, and if pelvic examination reveals one or more of the following criteria for PID: cervical motion tenderness, uterine tenderness, or adnexal tenderness..
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Overview and Clinical Approach. Such patients should undergo anoscopy to detect rectal ulcers or vesicles and petechiae after swabbing of the rectal mucosa;. and to obtain rectal swab specimens for testing for rectal gonorrhea, chlamydial infection, herpes, and syphilis.
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In resource-poor settings lacking ready access to diagnostic tests, this approach to syndromic treatment for. syphilis and chancroid has helped bring these two diseases under control. Finally, empirical antimicrobial therapy may be indicated if ulcers persist and the diagnosis remains unclear after a week of observation despite attempts to diagnose herpes, syphilis, and chancroid..
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Unilateral pain or pelvic mass, although not incompatible with PID, is a strong indication for laparoscopy unless the clinical picture warrants laparotomy instead. Atypical clinical findings, such as the absence of lower genital tract infection, a missed menstrual period, a positive pregnancy test, or failure to respond to appropriate therapy, are other common indications for laparoscopy..
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Table 124-7 Clinical Features of Genital Ulcers. 3 days–6 weeks. Usua lly. elevated, round, or oval. Elevated, round, or oval. erficial or deep. Superfici al or deep. Usua lly very tender. Tend er, may suppurate, loculated, usually unilateral. Tender, may suppurate, loculated,. usually unilateral. Source: From RM Ballard, in KK Holmes et al (eds): Sexually Transmitted Diseases, 4th ed
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Bacterial vaginosis is conventionally diagnosed clinically with the Amsel criteria, which include any three of the following four clinical abnormalities: (1) objective signs of increased white homogeneous vaginal discharge. Wet mount of vaginal fluid showing typical clue cells from a woman with bacterial vaginosis
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STD care and management begin with risk assessment and proceed to clinical assessment, diagnostic testing or screening, treatment, and prevention.. Indeed, the routine care of any patient begins with risk assessment (e.g., for risk of heart disease, cancer). STD/HIV risk assessment is important in primary care, urgent care, and emergency care settings as well as in specialty clinics providing adolescent, prenatal, and family planning services.
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Further, comparison of telephone and office management of vulvovaginal symptoms has documented the inaccuracy of the former, and comparison of evaluations by nurse-midwives with those by physician- practitioners showed that the practitioners' clinical evaluations correlated poorly. The diagnosis and treatment of the three most common types of vaginal infection are summarized in Table 124-5.. Table 124-5 Diagnostic Features and Management of Vaginal Infection.
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Hospitalized patients should show substantial clinical improvement within 3–5 days. Women treated as outpatients should be clinically reevaluated within 72 h. A follow-up telephone survey of women seen in an emergency room and given a prescription for 10 days of oral doxycycline for PID found that 28% never filled the prescription and 41% stopped taking the medication early (after an average of 4.1 days), often because of persistent symptoms, lack of symptoms, or side effects..
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The following summarizes the approach to the patient with suspected urethritis:.
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These typical clinical manifestations make detection of the virus optional. however, many patients want confirmation of the diagnosis, and differentiation of HSV-1 from HSV-2 has prognostic implications, since the latter causes more frequent genital recurrences.. Painless, nontender, indurated ulcers with firm, nontender inguinal adenopathy suggest primary syphilis.
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The difficulty of determining the exact microbial etiology of an individual case of PID—short of using invasive procedures for specimen collection—has implications for the approach to empirical antimicrobial treatment of this infection.
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Studies in man (clinical studies) (see Chapter 4).
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Gene Therapy in Clinical Medicine. Another local approach uses adenoviral-mediated expression of the tumor suppressor p53, which is mutated in a wide variety of cancers. This strategy has shown complete and partial responses in squamous cell carcinoma of the head and neck, esophageal cancer, and non-small cell lung cancer after direct intratumoral injection of the vector.
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Discussion: ASPECT trial will investigate functional avoidance method of radiation delivery in clinical practice, and will establish toxicity outcomes for patients with lung cancer undergoing curative chemo-RT.. Therefore, RT is a trade-off between eradicating the tumour and minimiz- ing damage to the lung. The rationale of the functional lung avoidance approach is to guide the radiation away from functional lung regions.
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Early-phase trials of siRNAs that target VEGF RNA are underway, but these require repeated intravitreal injection of the siRNAs. an AAV vector–mediated approach might allow long-term knockdown of VEGF.. Gene Therapy for Cancer. The majority of clinical gene transfer experience has been in subjects with cancer (Fig.
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An important approach to quantifying this reduction is to consider that drug concentration at the beginning and end of a time period are unchanged, and that a specific volume of the body has been "cleared". of the drug. during that time period. Clinical Implications of Altered Clearance
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Many of the principles in clinical pharmacology and examples outlined below, which can be applied broadly to therapeutics, have been developed in these arenas.
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This model, which required over 75 separate data points, provides novel insights into a clinical management problem that has not been subjected to a randomized clinical trial.. The process of building and evaluating decision models is generally too complex for use in real-time clinical management.