ABSTRACT
Older drivers are putting more miles on the road during their "golden years" than generations prior. Many older adults have safe driving habits, but unique age-related changes increase the risk for crash-related morbidity and mortality. Generalists are poised to assess and guide older adults' driving fitness. Although there is no uniformly accepted tool for driving fitness, assessment of 5 key domains (cognition, vision, physical function, medical comorbidities, and medications) using valid tools can help clinicians stratify older drivers into low, intermediate, and high risk for unsafe driving. Clinicians can then make recommendations about fitness to drive and appropriate referrals for rehabilitation or alternative transportation resources to optimize mobility, independence, and quality of life for older adults.
Subject(s)
Accidents, Traffic/prevention & control , Aging/psychology , Automobile Driving/psychology , Counseling/methods , General Practitioners , Aged , Aged, 80 and over , Automobile Driving/statistics & numerical data , Cognition Disorders/epidemiology , Female , Geriatric Assessment , Humans , Male , Physician's Role , Risk Assessment , Safety , Vision Disorders/epidemiologyABSTRACT
A 54-year-old woman was seen by her primary care internist for a general health maintenance visit. Her major chronic illness was immune thrombocytopenic purpura (ITP) for which she had been treated with prednisone therapy for the past 15 years. Recent review of possible aetiologies of her chronic thrombocytopenia revealed infection with Helicobacter pylori. Successful eradication resulted in complete resolution of her thrombocytopenia within 2 months. She was weaned from steroid therapy and at 1-year follow-up, her platelet counts remained in the normal range. This case report summarises what is known about the association of H. pylori infection and ITP.
Subject(s)
Helicobacter Infections , Helicobacter pylori , Purpura, Thrombocytopenic, Idiopathic/microbiology , Blood Platelets/pathology , Chronic Disease , Female , Glucocorticoids/therapeutic use , Helicobacter Infections/complications , Helicobacter Infections/microbiology , Humans , Middle Aged , Platelet Count , Prednisone/therapeutic use , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Purpura, Thrombocytopenic, Idiopathic/etiology , Thrombocytopenia/drug therapy , Thrombocytopenia/etiology , Thrombocytopenia/microbiologyABSTRACT
OBJECTIVE: To report our diagnostic and treatment experiences, and patient outcomes, in patients with suprascapular neuropathy (SSN). DESIGN: Retrospective cohort study. SETTING: A tertiary medical center. PATIENTS: 65 patients with electromyographically (EMG)-confirmed SSN. METHODS: A 5-year retrospective chart review of patients with EMG-confirmed SSN. MAIN OUTCOME MEASURES: Descriptive statistics were used to summarize demographics, risk factors, causes, EMG findings, diagnostic evaluation, treatments, and self-reported outcomes. Exact Mantel-Haenszel χ(2) tests and Fisher exact tests were used to assess correlation between these measures. RESULTS: The 3 most common causes of SSN were trauma (32 patients), an inflammatory process (ie, brachial neuritis) (14), and the presence of a cyst (13). Remaining cases were related to a rotator cuff tear or were due to overuse. No cases were attributed to notch abnormalities. At the time of follow-up (a mean of 50 months [range, 15-84 months] after EMG), 50% of subjects returned to activity with no restrictions (excellent outcome) and 40% returned to activity with restrictions (good outcome), regardless of cause and treatment. EMG findings, specifically the presence/absence of fibrillation potentials, did not predict recovery. CONCLUSIONS: SSN should be considered in patients with shoulder pain and weakness. Magnetic resonance imaging and ultrasound help to exclude a structural process. Identifying a structural cause, specifically a cyst or rotator cuff tear, is important because it appears that these patients have improved recovery with return to normal activities when treated surgically. Although EMG data did not have prognostic value in this study, the data were limited and further study is warranted. Regardless of cause or treatment, most patients with SSN returned to activities in some capacity.
