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Postgraduate Medicine

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https://www.readbyqxmd.com/read/29676667/evaluating-the-clinical-value-of-the-hypoxia-burden-index-in-patients-with-obstructive-sleep-apnea
#1
Fengwei Chen, Kun Chen, Cheng Zhang, Xue Chen, Junjun Huang, Peng Jia, Jing Ma, Jue Zhang, Jing Fang, Guangfa Wang
PURPOSE: We aimed to develop a novel index, the hypoxia burden index (HBI), that reflects the degree and duration of oxygen desaturation, and to determine whether this index is better than the apnea hypopnea-index (AHI) for evaluating obstructive sleep apnea (OSA) and cardiovascular diseases morbidities. METHODS: We retrospectively analyzed 459 adult subjects who underwent overnight polysomnography (PSG) in this study. The HBI was calculated by dividing the total desaturation area of SpO2 below 90% by the TST measured in seconds...
April 20, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29667921/glycemic-control-of-type-2-diabetes-mellitus-across-stages-of-renal-impairment-information-for-primary-care-providers
#2
Lili Tong, Sharon Adler
Chronic kidney disease (CKD) is a frequent complication of type 2 diabetes mellitus (T2DM) and elevates individuals' risk for cardiovascular disease, the leading cause of morbidity and mortality in T2DM. Achieving and maintaining tight glycemic control is key to preventing development or progression of CKD; however, improving glycemic control may be limited by effects of renal impairment on the efficacy and safety of T2DM treatments, necessitating dosing adjustments and careful evaluation of contraindications...
April 18, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29667860/educational-needs-in-the-diagnosis-and-management-of-pediatric-functional-constipation-a-us-survey-of-specialist-and-primary-care-clinicians
#3
Justin Barnes, Brandon Coleman, Sharon Hwang, Aleksandra Stolic, Athos Bousvaros, Samuel Nurko, Gregory D Salinas
OBJECTIVES: The goal of this study was to identify opportunities among gastroenterologists and gastroenterology nurse practitioners (NPs)/physician assistants (PAs) for continuing medical education (CME) related to functional constipation. METHODS: An online, case-vignette survey was designed to identify and quantify practice patterns of pediatric gastroenterology clinicians. Case vignettes are a validated method for assessing clinician practice patterns. The survey consisted of three patient cases: a 3-year-old female with a 6-month history of constipation; a 6-year-old male with a 1-year history of constipation refractory to treatment and a sacral dimple with nearby tuft of hair; and a 16-year-old male with a 10-year history of constipation, and a sullen, depressed mood...
April 18, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29596012/utility-of-natriuretic-peptides-to-assess-and-manage-patients-with-heart-failure-receiving-angiotensin-receptor-blocker-neprilysin-inhibitor-therapy
#4
Alan S Maisel, Lori B Daniels, Inder S Anand, Peter A McCullough, Sheryl L Chow
Levels of natriuretic peptides (NPs), such as B-type NP (BNP) and the N-terminal fragment of its prohormone (NT-proBNP), are well-established biomarkers for patients with heart failure (HF). Although these biomarkers have consistently demonstrated their value in the diagnosis and prognostication of HF, their ability to help clinicians in making treatment decisions remains debated. Moreover, some new HF drugs can affect concentrations of NPs, such as the prevention of BNP degradation by angiotensin receptor/neprilysin inhibitors (ARNIs), and may present a challenge in the interpretation of levels of BNP...
March 29, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29542370/role-of-primary-care-physicians-in-intrathecal-pain-management-a-narrative-review-of-the-literature
#5
Gladstone C McDowell, Joseph Winchell
OBJECTIVES: The majority of patients seeking medical care for chronic pain consult a primary care physician (PCP). Because systemic opioids are commonly prescribed to patients with chronic pain, PCPs are attempting to balance the competing priorities of providing adequate pain relief while reducing risks for opioid misuse and overdose. It is important for PCPs to be aware of pain management strategies other than systemic opioid dose escalation when patients with chronic pain fail to respond to conservative therapies and to initiate a multimodal treatment plan...
March 28, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29571275/insulin-non-persistence-among-people-with-type-2-diabetes-how-to-get-your-patients-to-stay-on-insulin-therapy
#6
Theresa L Garnero, Nichola J Davis, Magaly Perez-Nieves, Irene Hadjiyianni, Dachuang Cao, Jasmina I Ivanova, Mark Peyrot
Continuing use of medication is key to effective treatment and positive health outcomes, particularly in chronic conditions such as diabetes. However, in primary care, non-persistence (i.e. discontinuing or interrupting treatment) with insulin therapy is a common problem among patients with type 2 diabetes. To help primary care physicians manage patients who are non-persistent or likely not to be persistent, this review aimed to provide an overview of modifiable and non-modifiable factors associated with insulin non-persistence as well as practical strategies to address them...
March 23, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29569978/anticipatory-guidance-in-type-2-diabetes-to-improve-disease-management-next-steps-after-basal-insulin
#7
Eric L Johnson, Juan P Frias, Jennifer M Trujillo
The alarming rise in the number of people living with type 2 diabetes (T2D) presents primary care physicians with increasing challenges associated with long-term chronic disease care. Studies have shown that the majority of patients are not achieving or maintaining glycemic goals, putting them at risk of a wide range of diabetes-related complications. Disease- and self-management programs have been shown to help patients improve their glycemic control, and are likely to be of particular benefit for patients with diabetes dealing with these issues...
March 23, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29486621/comorbidities-and-cardiovascular-risk-factors-in-an-aged-cohort-of-hiv-infected-patients-on-antiretroviral-treatment-in-a-spanish-hospital-in-2016
#8
Carmen Fontela, Jesús Castilla, Regina Juanbeltz, Iván Martínez-Baz, María Rivero, Aisling O'Leary, Natalia Larrea, Ramón San Miguel
OBJECTIVES: The increased survival of HIV-infected individuals has resulted in a premature aging of this population, with the consequent development of premature age-related comorbidities and risk factors. We aimed to describe the prevalence of age-related comorbidities and cardiovascular risk factors in older adults with HIV infection on antiretroviral therapy (ART). METHODS: A retrospective cross-sectional study was undertaken in a cohort of HIV patients aged ≥50 years on ART in September 2016 in Spain...
March 12, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29521173/fixed-ratio-combination-therapy-for-type-2-diabetes-the-top-ten-things-you-should-know-about-insulin-and-glucagon-like-peptide-1-receptor-agonist-combinations
#9
Ian Blumer, Jeremy H Pettus, Tricia Santos Cavaiola
Many individuals with type 2 diabetes (T2D) will eventually require insulin therapy to help achieve and maintain adequate glycemic control. However, the use of insulin can be associated with adverse effects such as hypoglycemia and weight gain, and in some patients the addition of insulin to treatment regimens is often still insufficient to achieve target glycemic control. Combining basal insulin with a glucagon-like peptide-1 receptor agonist (GLP-1 RA) for the treatment of patients with T2D has been demonstrated to be effective and well tolerated, while mitigating many of the adverse events associated with giving either of these drug classes alone...
March 9, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29486632/bilateral-hyperkeratosis-of-the-nipples-and-areolae-with-linear-nevus-a-rare-case-report-and-review-of-the-literature
#10
Mei-Fang Wang, Li Wang, Lin-Feng Li
Hyperkeratosis of the nipple and areola is an uncommon dermatosis without well-defined etiology, which occurs mostly in young women and may only be a cosmetic problem. In 1938, Levy-Frankel classified this disease into three variants; type I involves hyperkeratosis with an epidermal nevus, and has rarely been reported. We report a case of a 23-year-old woman with long-term bilateral pigmentation and thickening of the nipples and areolae, accompanied with dark brown, flat lesions with a linear distribution on her left forearm...
February 28, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29478365/validity-of-cardiometabolic-index-lipid-accumulation-product-and-body-adiposity-index-in-predicting-the-risk-of-hypertension-in-chinese-population
#11
Haoyu Wang, Yintao Chen, Guozhe Sun, Pengyu Jia, Hao Qian, Yingxian Sun
OBJECTIVES: Adiposity, defined by higher cardiometabolic index (CMI), lipid accumulation product (LAP), and body adiposity index (BAI), has conferred increased metabolic risk. However, the incremental utility of CMI, LAP, and BAI in association with prevalent hypertension has not been well described in a population-based setting. We hypothesized that CMI, LAP, and BAI would provide important insight into hypertension risk. METHODS: Blood pressure (BP), fasting lipid profiles, and anthropometric parameters were recorded in a cross-sectional study of 11,400 participants (mean age, 54 years; 53% women) from China...
February 26, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29411675/pcsk9-inhibitors-a-non-statin-cholesterol-lowering-treatment-option
#12
Gregory S Pokrywka
Elevated low-density lipoprotein cholesterol (LDL-C) plays a major role in the development of atherosclerotic cardiovascular disease. Statins are the first-line treatment to lower LDL-C in patients with hypercholesterolemia; however, some high cardiovascular risk patients may have inadequate responses to statin therapy or are intolerant to statins, and may need additional and/or alternative non-statin therapies to further reduce their LDL-C levels. Monoclonal antibodies that inhibit proprotein convertase subtilisin/kexin type 9 (PCSK9), a key regulator of circulating LDL-C levels, have received considerable attention as promising non-statin therapeutic options for the management of hypercholesterolemia...
February 23, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29460653/risk-of-osteoporosis-in-microscopic-colitis
#13
Signe Wildt, Lars K Munck, Sabine Becker, Helle Brockstedt, Ole K Bonderup, Mette F Hitz
OBJECTIVES: Patients with microscopic colitis (MC) have several risk factors for osteoporosis. The prevalence of osteopenia and osteoporosis in MC is unknown. The primary purpose of this study was to evaluate bone mineral status in MC. METHODS: Patients with MC and disease activity within the last 2 years were included. Bone turnover markers were analyzed and bone mineral density (BMD) was measured with Dual Energy X-ray Absorptiometry (DXA) at inclusion and after one year...
February 22, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29460659/video-assisted-patient-education-improves-compliance-with-follow-up-and-depression-scores-in-inflammatory-bowel-diseases
#14
Nagesh Kamat, Surulivel Rajan Mallayasamy, P S V N Sharma, Asha Kamath, C Ganesh Pai
OBJECTIVES: Patients with inflammatory bowel diseases (IBD) have to deal with a poor quality of life (QOL) and psychomorbidity resulting from an incurable illness. We aimed to study the effect of patient education on QOL, compliance, anxiety and depression in IBD. METHODS: Patients were prospectively enrolled over two years beginning July 2014 and divided into an interventional and usual care group. Both received the standard of care, but the former in addition received an 8 minute session of video-assisted education...
February 20, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29446691/early-insights-into-the-characteristics-and-evolution-of-clinical-parameters-in-a-cohort-of-patients-prescribed-sacubitril-valsartan-in-germany
#15
Rolf Wachter, Daniel Viriato, Sven Klebs, Stefanie S Grunow, Matthias Schindler, Johanna Engelhard, Catia C Proenca, Frederico Calado, Raymond Schlienger, Markus Dworak, Bogdan Balas, Sara Bruce Wirta
OBJECTIVES: This study aimed to provide early insights into sacubitril/valsartan (sac/val) prescription patterns and the demographic and clinical characteristics of patients prescribed sac/val in primary care and cardiology settings in Germany. METHODS: The study used electronic medical records from the German IMS® Disease Analyzer database. Patients with ≥1 prescription for sac/val during 1 January-31 December 2016 (n = 1643) were identified and followed up for ≤12 months from first prescription...
February 15, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29417856/gastrointestinal-safety-and-tolerability-of-oral-non-aspirin-over-the-counter-analgesics
#16
Nicholas Moore, James M Scheiman
Over-the-counter (OTC) analgesics are routinely used worldwide for self-management of various painful conditions. Despite this, there has been little in-depth review of the safety of non-aspirin analgesics at OTC doses. This paper reviews the available literature on the gastrointestinal (GI) and hepatic safety of non-aspirin OTC analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs; ibuprofen, ketoprofen, diclofenac, and naproxen) and acetaminophen; safety in overdose is also reviewed. Each non-aspirin OTC analgesic has a distinct adverse event (AE) profile, with GI AE rates for OTC dosing in one study ranging from 37% for diclofenac to 7...
February 8, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29415606/cutaneous-irritancy-of-an-ibuprofen-medicated-plaster-in-healthy-volunteers
#17
Manisha Maganji, Mark P Connolly, Aomesh Bhatt
OBJECTIVES: To assess the irritation and contact sensitization potential of a 200 mg ibuprofen medicated plaster. METHODS: This double-blind, phase-1 placebo controlled study had two phases; the induction phase to evaluate the irritant potential of continuous application of the plaster, and the challenge phase to assess contact sensitivity (allergy). The cumulative irritancy potential was evaluated using an adaptation of the Shelanski method. Healthy adults (≥18 years of age) (N=210) were treated simultaneously with one ibuprofen medicated and one placebo plaster applied in a randomized fashion to either the left or right side of the lower back...
February 8, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29405077/barriers-to-implementation-of-a-pelvic-examination-among-family-doctors-in-primary-care-clinics
#18
Nassar Saleh, Mousa Abu-Gariba, Ilan Yehoshua, Roni Peleg
OBJECTIVE: Although the pelvic examination of female patients should be an integral part of the physical examination in family medicine there are many barriers to the conduct of this intimate examination by family doctors. THE OBJECTIVE: an assessment of the attitudes and barriers reported by family doctors on conducting a pelvic examination. METHODS: An anonymous, self-administered questionnaire. RESULTS: Two hundred thirty doctors participated in the study, of who 157 were males (68...
February 6, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29369696/disease-or-adaptation-another-look-at-the-practice-of-medicine
#19
Peter B Soeters, Peter W De Leeuw
The practice of medicine has changed considerably over the past few decades and is now focusing more and more on early intervention strategies. As a result, we tend to consider pre-symptomatic abnormalities, however small, already as a potential target for treatment. In this viewpoint, we argue that we should put more emphasis on pathophysiological thinking as many of the so-called early abnormalities may, in fact, reflect adaptive mechanisms rather than disease. This view should influence medical care and education, emphasizing the importance of knowledge of pathophysiology...
February 2, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29380646/a-simple-risk-score-based-on-sleep-quality-for-predicting-depressive-symptoms-in-menopausal-women-a-multicenter-study
#20
Yanwei Zheng, Yang Zhou, Jieping Zhu, Qi Hua, Minfang Tao
OBJECTIVE: We aim to establish a simple risk score based on sleep quality for predicting depressive symptoms in menopausal women through a cross-sectional investigation. MATERIALS AND METHODS: A total of 705 Chinese women aged 40-60 years were included in this cross-sectional investigation of a self-report questionnaire from the Physical Examination Center at Shanghai Jiao Tong University Affiliated Sixth People's Hospital. Depressive symptoms and sleep quality were evaluated using self-rating depressive symptom scale (SDS)and the Pittsburgh Sleep Quality Index (PSQI), respectively...
January 30, 2018: Postgraduate Medicine
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