Intimate partner violence: analysis of current screening practices in the primary care setting.

Background: Intimate partner violence (IPV) is a largely undetected occurrence in the United States reported by 36-50% of women in their lifetime and associated with extensive physical and psychological implications. Currently, conflicting recommendations exist regarding screening practices with the United States Preventative Services Task Force (USPSTF) and the World Health Organization (WHO) advocating for and against universal screening, respectively. With research suggesting that women are seldom asked about IPV during clinic visits, further information is needed regarding current screening practices.

Opioid overdoses: Emerging clinical challenges.

Objective: Analysis of a large consecutive case series of cases brought to an Emergency Department (ED).

Design: Retrospective chart review.

Setting: Emergency Department in Broward County, Florida.

Improvement in lipid profiles in antiretroviral-experienced HIV-positive patients with hyperlipidemia after a switch to unboosted atazanavir.

Objective: The primary objective was to compare the change in fasting low-density lipoprotein (LDL) cholesterol from baseline to week 12 between patients receiving an atazanavir-containing regimen and those receiving comparator protease inhibitor (PI) regimens.

Design: AI424-067 was a 48-week, open-label, randomized, prospective study of 246 patients on PI-based regimens with hyperlipidemia [fasting LDL cholesterol >130 mg/dL (>3.4 mmol/L)] and with HIV RNA <50 copies per milliliter.

Ritonavir-boosted protease inhibitors: impact of ritonavir on toxicities in treatment-experienced patients.

The purpose of this review is to discuss the basis for ritonavir boosting of protease inhibitors as well as the complications and benefits associated with ritonavir boosting when designing an antiretroviral regimen for treatment-experienced patients. Such patients have fewer viable options because of cross-resistance arising from previous regimen failures. Ritonavir administered at a low dose to boost another protease inhibitor may be a useful strategy for achieving virological efficacy while minimizing the toxicities associated with full-dose ritonavir.

Long-Term suppression of HIV infection: benefits and limitations of current treatment options.

HIV type 1, a causative agent of AIDS, is a source of worldwide morbidity and mortality. There are an estimated 1 million people in North America currently living with HIV infection, and more than 40,000 new cases occur annually. Before the advent of highly active antiretroviral therapy (HAART), the mortality rate of HIV infection was nearly 100%, and life expectancy was short.

Nonequivalent results of tetrofosmin and sestamibi imaging of parathyroid tumors.

Objective: To report the case of a patient with a large parathyroid carcinoma missed by dual-phase technetium Tc 99m tetrofosmin (TETRO) parathyroid scanning.

Methods: We present the clinical findings, laboratory results, imaging studies, and surgical pathology report in a man with parathyroid carcinoma and review the literature regarding the use of TETRO scintigraphy in patients with hyperparathyroidism.

Results: In an 83-year-old man with hyperparathyroidism, severe hypercalcemia developed in the context of nephrolithiasis.

Initial therapy for human immunodeficiency virus: broadening the options.

The goal of investigation into new therapeutic options for HIV/AIDS is to further the achievements of highly active antiretroviral therapy by developing new drugs with improved efficacy. Although several therapies are currently available for initial therapy in HIV-infected patients, ongoing research focuses on additions to existing and novel drug classes that might have improved pharmacokinetic and tolerability profiles, as well as on new therapeutic combinations that might result in synergistic activity. To retain activity against resistant strains, novel drugs need to target the numerous critical points in the life cycle of HIV, inhibiting different enzyme subsites than those affected by antiretroviral agents currently in use.

The synergy model and the role of clinical nurse specialists in a multihospital system.

The role of clinical nurse specialists was formalized in the 1950s; the goal was to prepare inpatient, bedside nurses who would serve acutely ill patients via consultation and direct care. Clinical nurse specialists were to be expert clinicians, consultants, educators, and researchers. In the early stages of practice development, the focus was the specific needs of the assigned unit or floor.

Reducing the hazards of exposure to cornstarch glove powder.

Latex allergy has received considerable attention during the past decade. The occurrence of latex allergy in health care workers is higher than in the general population. Latex gloves are the most frequent form of exposure that health care workers have to natural rubber latex; therefore, the relationship between gloves and latex allergies, has been well studied.

Urinary tract infections.

Urinary tract infections are some of the most commonly treated bacterial infections in adults. Factors contributing to development of UTIs include personal habits, sexual habits, altered immune status, presence of diabetes, lack of estrogen and use of spermacides. Untreated or persistant UTIs may cause other more serious complications such as kidney damage or prostate infections.

Wound healing and lymphedema: a new look at an old problem.

As the science of wound healing has evolved in the past two decades, so has awareness of the "hidden epidemic" of lymphedema. Substantial information has been accumulated regarding the pathophysiology and therapy of lymphedema. However, until now, the relationship between wound care and lymphedema has received little attention.

Lopinavir-Ritonavir: a new protease inhibitor.

Lopinavir is a new protease inhibitor that is structurally related to ritonavir. It recently was approved by the Food and Drug Administration as a coformulation with ritonavir under the brand name Kaletra. Ritonavir substantially increases lopinavir drug exposure by inhibiting cytochrome P450 isoenzyme 3A4.

Quality of life after obesity surgery, an evidence-based medicine literature review: how to improve systematic searches for enhanced decision-making and clinical outcomes.

Background: Research attests to the exponential sweep of clinical obesity in America. Obesity has become one of the most profound public health concerns, closely linked to increased morbidity, mortality, and social, occupational, and psychological discrimination. It is incumbent for specialists to design treatment and outcome analysis based accurately upon systematic research.

Challenges of antiretroviral treatment in transient and drug-using populations: the SUN study.

This is an open-label, single-arm, phase 3b study (part of phase 3 development) to evaluate the efficacy and safety of Fortovase-soft gelatin formulation (saquinavir-SGC), combined with zidovudine (ZDV) and lamivudine (3TC), human immune deficiency virus type 1 in (HIV-1)-positive, antiretroviral-naive individuals. Forty-two HIV-1-positive adults with plasma HIV RNA >10,000 copies per milliliter (Roche Amplicor HIV Monitor assay) and CD4 cell count >100 cells/mm(3) were treated with SQV-SGC, 1200 mg three times per day; ZDV, 300 mg; and 3TC, 150 mg each twice per day for 48 weeks. High proportions were drug users (26%), demonstrated psychiatric disorders (alcohol abuse [14%]/depression [14%]), or were inadequately housed (5%).

Collaboration, problem solving, reevaluation: foundation for the Heart Center of Excellence.

Today's rapidly changing health care environment has thrust upon the caregivers, patients, and their families many challenges. A multidisciplinary team continuously analyzes strengths, weaknesses, and threats to the success of heart centers. Prolonged hospitalization for cardiac surgery patients is consistently identified as a priority with multiple opportunities for improvement.