Posted by James
The April 2003 guidelines for HIV testing from the CDC advocated routine offering of HIV tests in both inpatient and outpatient settings in order to increase the number of patients who are aware of their serostatus. The implementation of this recommendation in the primary care setting is difficult. It is cumbersome, especially in a time-restricted encounter, for a primary care provider to bring up a sensitive or embarrassing topic that could potentially lead to a prolonged discussion simply to screen for the “traditional” risk factors associated with HIV infection.
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Posted by James
One-hundred-one patients participated in the study (Table 1). The mean age of the participants was 33 years. Eighty percent of the sample was female, of which nearly 40% were married. Most respondents self-identified their race/ethnicity as black, Hispanic or white. Sixteen percent self-identified as American Indian/Alaskan Native, Asian and Pacific Islander, Cape Verdian, or mixed race/ethnicity. Due to sample size restrictions, we combined all of the latter groups into one category: “other” (Table 1).
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Posted by James
An anonymous, self-administered cross-sectional survey of primary care outpatients was conducted from April until August 2002 at a group of community health centers affiliated with Providence Ambulatory Community Health Centers, Inc. (PACHC) located in Providence, Rl.
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Posted by James
INTRODUCTION
The Centers for Disease Control and others estimate that up to one million people in the United States are HIV infected. Approximately one-third of those infected are unaware of their HIV status. Heterosexual transmission is increasing, especially among young men and women without traditional risk factors, such as substance abuse or same-sex relationships. The outpatient primary care setting represents an ideal place to identify those who are HIV infected by offering routine testing for HIV. This setting could easily provide earlier identification of HIV infection and immediate linkage to healthcare of those infected.
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Posted by Alex
Table 2 presents a conceptual summary of the possible risk and prognostic factors for asthma prevalence and morbidity that we have identified through a review of the scientific literature and clinical experience. For the purposes of this discussion, we distinguish between risk and prognostic factors. Causal risk factors are positively associated with incidence of disease, protective risk factors are negatively associated with incidence of disease, and prognostic factors affect the disease’s morbidity and remission, once it has occurred. Research to date, however, has not completely clarified whether certain factors are risk factors, prognostic factors, or both.
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Posted by Alex
Currendy, the range of therapy for managing ED in the general population includes oral PDE-5 inhibitors such as sildenafil citrate, sublingual apomorphine, intracavernosal injection or transurethral alprostadil, vacuum constriction devices and penile implants. However, in cardiac patients on warfarin, injections and vacuum devices are not indicated because of increased risk of haematoma or bleeding
Figure 1A. Mechanism of action of sildenafil NO(S)=nitric oxide (synthase), GC=guanyl cyclase, GTP=guanosine triphosphate, cGMP=cyclic guanosine monophosphate, PDG=phophodiesterase enzymes.
Figure IB. Mechanism of action of concurrent use of sildenafil and nitrates. NO=nitric oxide, GC-guanyl cyclase, GTP=guanosine triphosphate, cGMP=cyclic guanosine monophosphate.
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Posted by Alex
All patients with ED should undergo adequate medical assessment. It is important to establish a baseline measure of the type of activities and level of physical exertion a patient normally undertakes. The risk of a cardiac event in a patient with cardiovascular disease is higher than in a patient without cardiovascular disease; therefore, cardiovascular risk assessment should focus on the risk of further cardiovascular events at a return to sexual activity. Cardiovascular status has been split into three categories defining patients at low, intermediate or high risk. A practical framework for assessing the potential level of cardiovascular risk following a return to sexual activity is shown in table 3. Most of the patients with low or intermediate risk can be managed in primary care; otherwise exercise testing can guide management when cardiovascular risk is in doubt. If a patient can perform stage I of the Bruce protocol without significant ST-segment changes, arrhythmia or drop in systolic blood pressure, the patient is not at risk during normal sexual activity. Patients falling into the high-risk category should be evaluated and treated by their cardiologist before instituting treatment for ED. Buy Cialis Soft Tabs
Cardiovascular drug-induced ED
There are a number of drugs that are suspected of contributing to ED in cardiovascular patients. Reports have indicated an incidence range of 5 to 43% with propranolol and 4 to 32% with thiazide diuretics. There is not much evidence to confirm the effectiveness of changing drug therapy to reverse ED. However, if a relation in time exists between the start of therapy and onset of symptoms it is conceivable to stop or safely change medication and evaluate the effect on improvement of ED after two to four weeks. However, physicians should realise that the development of ED might be due to the condition being treated, rather than the drugs used.
