Patient Management Strategies

DM originated in the USA, where it is sometimes referred to as Patient Management Strategies. It is to the US system that we must first turn for evidence. Health insurers exert pressure on clinicians to perform uniformly and to aim at benchmarked and similar outcomes at comparable costs. The payer relationships are visible in the USA, where systems are funded, for the most part, by premium-... 

Recommend optimal nonpharmacologic and pharmacologic management strategies for patients with oncologic emergencies. 

Boden WE, O Rourke RA, Crawford MH, et al. Outcomes in patients with acute non-Q wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy (VANQUISH). N Engl J Med 1998 338 1785-1792. 

The treatment of AML in patients older than 60 is problematic due to intrinsic adverse AML features plus diminished performance status potentially leading to poorer outcomes compared to younger patients. The options include standard induction therapy for those who are fit, low dose cytarabine, investigational therapies or supportive care only. It is vital that good information and open discussion are made available to older patients before a management strategy is defined. 

For most children and adolescents, multimodal therapies are recommended. However, if antidepressant medications are used alone, psychosocial maintenance strategies should be implemented to help the patient manage inner and interpersonal conflicts, improve coping and social skills, deal with the psychosocial and personal scars left by the depression, and improve academic and social functioning. The reduction of family stress, promotion of a supportive environment, and the effective treatment of parents and siblings with psychiatric disorders may also help diminish the risk for... 

Limited data exist to support drug management in phobic disorders. Behavioral techniques, especially for specific phobic conditions, are currently the treatment of choice. MAOIs, SSRIs, clonidine, and alprazolam may benefit some patients. Figure 12-3 summarizes the management strategy we would recommend. 

Margolese, H. C., Chouinard, G., Kolivakis, T. T., Beauclair, L., Miller, R., Annable, L. 2005, Tardive dyskinesia in the era of typical and atypical antipsy-chotics. Part 2 Incidence and management strategies in patients with schizophrenia, Can.J.Psychiatry, vol. 50, no. 11, pp. 703-714. 

Many of the trials of therapy in acute stroke did not distinguish between stroke subtypes other than by division into hemorrhagic and ischemic stroke. Therefore, there is little evidence for different effectiveness for most acute ischemic stroke treatments according to stroke subtype and location. However, stroke subtype determines patient selection for specific secondary preventive strategies. Therefore, better characterization of stroke will aid overall patient management (Ch. 6). 

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