Improving acute treatment outcomes might prevent new-onset CM, although reverse causality cannot be excluded. Inadequate acute treatment efficacy was associated with an increased risk of new-onset CM over the course of 1 year. In the fully adjusted model, the very poor treatment efficacy group had a more than 2-fold increased risk of new-onset CM (odds ratio = 2.55, 95% confidence interval 1.42-4.61) compared to the maximum treatment efficacy group.
Rates of new-onset CM increased in the moderate treatment efficacy (2.7%), poor treatment efficacy (4.4%), and very poor treatment efficacy (6.8%) groups. Only 1.9% of the group with maximum treatment efficacy developed CM. Among 5,681 eligible study respondents with EM in 2006, 3.1% progressed to CM in 2007. Logistic regression models were used to examine the dichotomous outcome of transition from EM in 2006 to CM in 2007 as a function of mTOQ-4 category, adjusting for covariates. Total mTOQ-4 scores were used to define categories of acute treatment response: very poor, poor, moderate, and maximum treatment efficacy. The mTOQ-4 is a validated questionnaire that assesses treatment efficacy based on 4 aspects of response to acute treatment. In the American Migraine Prevalence and Prevention Study, respondents with EM in 2006 who completed the Migraine Treatment Optimization Questionnaire (mTOQ-4) and provided outcome data in 2007 were eligible for analyses. To test the hypothesis that ineffective acute treatment of episodic migraine (EM) is associated with an increased risk for the subsequent onset of chronic migraine (CM). Lipton, Richard B Fanning, Kristina M Serrano, Daniel Reed, Michael L Cady, Roger Buse, Dawn C Ineffective acute treatment of episodic migraine is associated with new-onset chronic migraine. Employ a thoroughly educated patient, formulary, testimonials, stratification, and rational cotherapy against the race to central sensitization for optimum outcomes. Migraine-ACT evaluates 2-hour pain freedom with return to normal function, comfort with treatment, and consistency of response. This therapy needs to provide cost-effective fast results, meaningful to the patient while minimizing the need for additional drugs. Clinicians should utilize evidence-based acute migraine-specific therapy stressing the imperative acute treatment goal of early intervention, but not too often with the correct drug, formulation, and dose. Older nonspecific drugs, particularly butalbital and opioids, contribute to medication overuse headache and are to be avoided. Migraine-specific triptans, dihydroergotamine, and several antiinflammatories have substantial empirical clinical efficacy. Optimum management of acute migraine nearly always requires pharmacologic treatment for rapid resolution. Successful treatment requires excellent patient-clinician communication enhancing confidence and mutual trust based on patient needs and preferences. Recognition of the multitude of migraine presentations, the frequency of total headache attacks, and number of days of headache disability are critical. John P.Optimum acute treatment of migraine requires prevention of headache as a top priority.
#DR AGENA DAVENPORT NICHOLSON PROFESSIONAL#
This division emphasizes the development of professional work habits, efficient patient care methods, and comprehensive primary medical care. Federally-sponsored and industry-sponsored projects both are available for residents who are interested in pursuing research relevant to this arena.
Finally, the division plays an active role in clinical studies currently being conducted at Emory University. The resident experience in general gynecology-obstetrics involves one-on-one clinical teaching between residents and faculty. Surgical experience is gained by active participation in faculty surgical cases. Residents rotate through the faculty private practice at Emory University Hospital Midtown and participate in ambulatory care, inpatient hospital care, and both major and minor surgical care of patients. This division provides the resident an education with experience in ambulatory patient care in a gynecology-obstetrics setting. The Division of General Obstetrics and Gynecology provides a unique opportunity for house officers to become involved in comprehensive well-women's care, in normal and high risk obstetrical care, and in primary medical and gynecological care for women of all ages.
0 kommentar(er)
