ACP Medicine

Palliative Medicine Part 2

Clinical Skills Caring for dying patients and for those who suffer from chronic and severe illnesses with uncertain prognoses requires an interdisciplinary approach and specific clinical skills. In particular, the clinician who provides palliative care must be competent in clinical communication, management of symptoms (physical, emotional, and psychological), and planning for continuity of care. Communication […]

Symptom Management in Palliative Medicine Part 1

The goal of palliative care is to provide comfort and support for both patient and family through the course of a life-threatening illness. Symptom control is essential to meeting that goal. This topic discusses symptoms that commonly contribute to patients’ suffering in terminal illness: pain; respiratory, gastrointestinal, mouth, and skin problems; and delirium. Although this […]

Symptom Management in Palliative Medicine Part 2

Nausea and Vomiting Nausea and vomiting occur in up to 62% of patients with terminal cancer41 and 27% of patients dying of other causes. There are multiple potential causes for both nausea and vomiting [see Table 4].37 Once the cause has been determined, symptomatic relief is relatively easy to achieve with the appropriate medications [see […]

Symptom Management in Palliative Medicine Part 3

Malignant Ulcers For uncomplicated malignant ulcers, pain relief and wound care are managed in the same way as pressure ulcers. Malignant wounds can present special problems, however, which may include bleeding, exudate, infection, odor, and disfigurement. A bleeding malignant ulcer should be treated with radiation therapy, topical sucralfate, or topical tranexamic acid. Dirty ulcers should […]

Management of Psychosocial Issues in Terminal Illness Part 1

Like all good medical care, palliative care addresses patients’ needs at many levels. The physical deterioration as death approaches can challenge the ingenuity and equanimity of health care professionals [see CE:IX Palliative Medicine and CE:X Symptom Management in Palliative Medicine]. Yet symptom management is only one aspect of the care that these patients need; the […]

Management of Psychosocial Issues in Terminal Illness Part 2

Despondency Despondency—a mixture of dread, bitterness, and despair— is the result of an attack on the patient’s self-image. The patient feels broken, scarred, and ruined. Work and personal relationships appear jeopardized. It may seem too late to realize cherished goals. The patient is haunted by disappointment with both what has been done and what has […]

Complementary and Alternative Medicine Part 1

Definitions The term alternative medicine encompasses a spectrum of approaches to medical conditions not routinely used by conventional practitioners. Historically, the term has been associated with negative conceptions about medical practices that did not conform to accepted standards of care. The term complementary medicine has since evolved to describe a more positive, symbiotic relationship between […]

Complementary and Alternative Medicine Part 2

Manipulative and body-based therapies Chiropractic Many would argue that chiropractic medicine should not be considered alternative therapy. Patients, physicians, and insurance companies have all shown some degree of support for chiropractic care in recent years. Between 10% and 20% of the population have used chiropractors.6 Health care insurance plans, including Medicare, cover many of the […]

Performance Measurement in Clinical Practice

Performance in health care is the degree to which desirable objectives are accomplished. Performance measurement can inform quality-improvement activities and allow health care consumers and commercial health care purchasers to hold physicians and health care organizations accountable for the services they provide. Over the past decade, the methodology supporting performance measurement has matured. With this […]

Approach to The Cardiovascular Patient Part 1

The complete evaluation of the cardiovascular patient begins with a thorough history and a detailed physical examination. These two initial steps will often lead to the correct diagnosis and assist in excluding life-threatening conditions. The history and physical examination findings should be assessed in the context of the overall clinical status of the patient, including […]