Why I would recommend complementary or alternative therapies: a physician's perspective

The successes of science and technology have created new health challenges. The use of various complementary therapies by patients reflects a response to one of those challenges, which is the need we all have to tell our stories, find meaning, and seek healing relationships. Although several alternative medical systems are conceptually incompatible with conventional medicine, the therapeutic modalities associated with them can be evaluated by standard clinical investigative approaches. These approaches, however, are intrinsically more difficult to apply in some cases because of the nature of objectivity and reductionism in complex, relationship-centered therapy, and because it is hard to study something that, by design, works slowly, mildly, and individually.     

Why I would not recommend complementary or alternative therapies: a physician's perspective

The use of complementary or alternative therapies by patients with rheumatic diseases is widespread and under-reported by patient to physician. The most commonly used forms of therapy are herbal/nutrient supplements, chiropractic, homeopathy, and acupuncture. The use of these therapies for treatment of rheumatic disease is not substantiated by review of the available medical literature. Furthermore, these therapies are expensive and potentially toxic. Incorporation of these treatments into the therapeutic armamentarium of the rheumatologist cannot be recommended until they are shown to be effective, safe, and affordable.     

Optimising monitoring in the management of Crohn's disease: A physician's perspective

Management of Crohn's disease has traditionally placed high value on subjective symptom assessment; however, it is increasingly appreciated that patient symptoms and objective parameters of inflammation can be disconnected. Therefore, strategies that objectively monitor inflammatory activity should be utilised throughout the disease course to optimise patient management. Initially, a thorough assessment of the severity, location and extent of disease is needed to ensure a correct diagnosis, identify any complications, help assess prognosis and select appropriate therapy. During follow-up, clinical decision-making should be driven by disease activity monitoring, with the aim of optimising treatment for tight disease control. However, few data exist to guide the choice of monitoring tools and the frequency of their use. Furthermore, adaption of monitoring strategies for symptomatic, asymptomatic and post-operative patients has not been well defined. The Annual excHangE on the ADvances in Inflammatory Bowel Disease (IBD Ahead) 2011 educational programme, which included approximately 600 gastroenterologists from 36 countries, has developed practice recommendations for the optimal monitoring of Crohn's disease based on evidence and/or expert opinion. These recommendations address the need to incorporate different modalities of disease assessment (symptom and endoscopic assessment, measurement of biomarkers of inflammatory activity and cross-sectional imaging) into robust monitoring. Furthermore, the importance of measuring and recording parameters in a standardised fashion to enable longitudinal evaluation of disease activity is highlighted.     

Quality of patient care by nurse practitioners and physician's assistants: a ten-year perspective.

A remarkable development in primary care is the recent emergence of a new class of health professional: nurse practitioners and physician's assistants. These practitioners diagnose and treat a wide variety of medical problems, usually with supervision by physicians. Their clinical competence has been evaluated in over 40 studies. Twenty-one studies in which care given by nurse practitioners or physician's assistants was directly compared with that given by physicians are analyzed. These studies show that nurse practitioners and physician's assistants provide office-based care that is indistinguishable from physician care. Because these studies were limited in scope, there is no experimental basis for extending this conclusion to care given outside the office, care that is unsupervised, or care of the seriously ill patient.     

Treatment of pituitary tumors: a surgical perspective.

Surgical intervention is a necessary part of a multimodal approach to pituitary lesions. This article summarizes the surgical approach to different neoplastic processes affecting the sellar region.     

The impact of exercise on activities of daily living and quality of life: a primary care physician's perspective

Evaluation of the environment of patients is an important function of the primary care physician and assists the caregiver in providing an improved quality of life for one's patients. In addition to data collection and therapy, assessment of both the basic and instrumental activities of daily living is a primary concern, especially in patients with chronic diseases such as chronic obstructive pulmonary disease. This article presents the perspective and observation of a primary care physician's management of chronic obstructive pulmonary disease and will give examples of how combined pulmonary rehabilitation and medication improved the quality of life for three patients and show how activities of daily living and quality of life may be seen as a continuum in chronic obstructive pulmonary disease.     

Prosthetic cardiac pacers in community hospitals: a physician's experience

This report deals with 53 patients treated with prosthetic cardiac pacers solely by one “interested” physician at the community level over a period of 5 years and 2 months.The 5-year mortality rate was 41.5 per cent; (15.1 per cent cardiogenic and 26.4 per cent noncardiogenic). A complication rate of 28.2 per cent with one fatality (1.9 per cent) due to a faulty pacemaker was experienced. These results compare favorably with a similar medically treated group, who had an immediate in-hospital cardiogenic mortality of 35 per cent. Contrary to other reports, premature battery depletion was not found in this series.This community study compares favorably to several university studies, who report a complication rate of 63 per cent, a mortality rate of 6.7 per cent versus 28.2 and 1.9 per cent, respectively, as experienced in this group. This study indicates that community standards are equal to or superior to university standards in this particular mode of therapy.