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Beck E et al Management of cluster headache Am Fam Physician 2005 Feb 15;71(4):717 24 [PMID: 15742909] Detsky ME et al Does this patient have migraine JAMA 2006 Sep 13;296(10):1274 83 [PMID: 16968852] Dodik DW Chronic daily headache N Engl J Med 2006 Jan 12;354(2):158 65 [PMID: 16407511] Gladstein J Headache Med Clin North Am 2006 Mar;90(2):275 90 [PMID: 16448875] van de Beek D et al Clinical features and prognostic factors in adults with bacterial meningitis N Engl J Med 2004 Oct 28;351(18):1849 59 [PMID: 15509818]

Guidance on when to perform neuroimaging is summarized in Table 2 7 Under most circumstances, a noncontrast head CT is sufficient to exclude intracranial hypertension with impending herniation, intracranial hemorrhage, and

van Gijn J et al Subarachnoid hemorrhage Lancet 2007 Jan 27;369(9558):306 18 [PMID: 17258671]

Fever Nausea or vomiting New back or flank pain Vaginal discharge Pregnancy risk Structural abnormalities Instrumentation of urethra or bladder

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Because fever and back pain, as well as nausea and vomiting, are considered harbingers of (or clinical criteria for) acute pyelonephritis, women with these symptoms should usually be examined by a clinician prior to treatment in order to exclude coexistent urosepsis, hydronephrosis, or nephrolithiasis Other major risk factors for acute pyelonephritis (among women 18 49 years of age) relate to sexual behaviors (frequency of sexual intercourse three or more times per week, new sexual partner in previous year, recent spermicide use), as well as diabetes mellitus and recent urinary tract infection or incontinence Finally, pregnancy risk, underlying structural factors (polycystic kidney disease, nephrolithiasis, neurogenic bladder), immunosuppression, diabetes, and a history of recent bladder or urethral instrumentation usually alter the treatment regimen (antibiotic choice or duration of treatment, or both) of uncomplicated cystitis

The presence of fever, tachycardia, or hypotension should alert the clinician to the possibility of urosepsis and the potential need for hospitalization A focused examination in women, in uncomplicated circumstances, could be limited to ascertainment of costovertebral angle tenderness and to a lower abdominal and pelvic examination, if the history suggests vulvovaginitis or cervicitis

There are many sales document types and SAP allows you to create many more However, the sales document types we will focus on are the standard process most commonly used in SAP Sales and Distribution These documents encompass their own business process procedures The document flows we will look at are the following: the quotation; special sales orders such as the cash sale process and rush order process; the credit and debit cycle; as well as the returns and invoice correction request process, which is a combination of the credit and debit document We will also look at contracts and scheduling agreements

Dysuria (painful urination) is a common reason for adolescents and adults to seek urgent medical attention An inflammatory process (eg, infection; autoimmune disorder) underlies most causes of dysuria In women, cystitis will be diagnosed in up to 50 60% of cases and has an incidence of 05 07% per year in sexually active young women The key objective in evaluating women with dysuria is to exclude serious upper urinary tract disease, such as acute pyelonephritis, and sexually transmitted diseases In contrast, in men, urethritis accounts for the vast majority of cases of dysuria

Urinalysis is probably overutilized in the evaluation of dysuria The probability of culture-confirmed urinary tract infection among women with a history and physical examination compatible with uncomplicated cystitis is about 70 90% Urinalysis is most helpful when the woman with dysuria does not have other typical features of cystitis Dipstick detection (> trace) of leukocytes, nitrites, or blood supports a diagnosis of cystitis When both leukocyte and nitrite tests are positive, the likelihood ratio is 42, and when both are negative, the likelihood ratio is 03 The negative predictive value of urinalysis is not sufficient to exclude culture-confirmed urinary tract infection in women with multiple and typical symptoms; and randomized trial evidence shows that antibiotic treatment is beneficial to women with typical symptoms and negative urinalysis dipstick tests

The most common complaint is shortness of breath, chiefly exertional dyspnea at first and then progressing to orthopnea, paroxysmal nocturnal dyspnea, and rest dysp-

Heart failure is a common syndrome that is increasing in incidence and prevalence Approximately 5 million patients

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