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https://www.readbyqxmd.com/read/29431385/glucose-management-in-hospitalized-patients
#1
Charles Kodner, Laurie Anderson, Katherine Pohlgeers
Glucose management in hospitalized patients poses challenges to physicians, including identifying blood glucose targets, judicious use of oral diabetes mellitus medications, and implementing appropriate insulin regimens. Uncontrolled blood glucose levels can lead to deleterious effects on wound healing, increased risk of infection, and delays in surgical procedures or discharge from the hospital. Previously recommended strict blood glucose targets for hospitalized patients result in more cases of hypoglycemia without improvement in patient outcomes...
November 15, 2017: American Family Physician
https://www.readbyqxmd.com/read/29374047/use-of-direct-oral-anticoagulants-in-canadian-primary-care-practice-2010-2015-a-cohort-study-from-the-canadian-primary-care-sentinel-surveillance-network
#2
Finlay A McAlister, Scott Garrison, Leanne Kosowan, Justin A Ezekowitz, Alexander Singer
BACKGROUND: As questions have been raised about the appropriateness of direct oral anticoagulant (DOAC) dosing among outpatients with atrial fibrillation, we examined this issue in patients being managed by primary care providers. METHODS AND RESULTS: This was a retrospective cohort new-user study using electronic medical records from 744 Canadian primary care clinicians. Potentially inappropriate DOAC prescribing was defined as prescribing lower or higher doses than those recommended by guidelines for patients with nonvalvular atrial fibrillation...
January 26, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29369958/epidural-hematoma-following-cessation-of-a-direct-oral-anticoagulant-a-case-report
#3
Jessica E Burjorjee, Rachel Rooney, Melanie Jaeger
OBJECTIVE: In this case report, we describe a case of epidural hematoma following epidural analgesia in a patient with recent cessation of a direct oral anticoagulant (DOAC). CASE REPORT: An 89-year-old woman requiring upper abdominal surgery presented with multiple comorbidities, including a prior cerebrovascular accident resulting in a left-sided hemiparesis and atrial fibrillation requiring anticoagulation with rivaroxaban. In accordance with our departmental guidelines at the time of procedure, rivaroxaban was discontinued 4 days preoperatively...
January 24, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29357854/individualised-treatment-targets-in-patients-with-type-2-diabetes-and-hypertension
#4
Roland E Schmieder, Diethelm Tschöpe, Cornelia Koch, Taoufik Ouarrak, Anselm K Gitt
AIM: Patients with type-2 diabetes mellitus (T2DM) are at high risk of cardiovascular events, accentuated in the presence of hypertension. At present, it is unclear to what extent the guidelines for the management of T2DM, advocating reduction in HbA1c levels to below target levels, are being adhered to in clinical practice. METHODS: DIALOGUE was a prospective, observational, non-interventional registry performed across multiple centres in Germany. Patients aged 18 years or older who had T2DM and hypertension for whom the treating physician considered blood glucose lowering medication as inadequate and/or not safe/tolerable and chose to add a further oral drug or switch drug treatment were included...
January 22, 2018: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/29352368/endocrine-therapy-and-related-issues-in-hormone-receptor-positive-early-breast-cancer-a-roundtable-discussion-by-the-breast-cancer-therapy-expert-group-bcteg
#5
REVIEW
Jame Abraham, Humberto Caldera, Robert Coleman, Anthony Elias, Matthew P Goetz, Muaiad Kittaneh, Elyse Lower, Reshma Mahtani, E Terry Mamounas, Mark Pegram, Hope Rugo, Lee Schwartzberg, Tiffany Traina, Chuck Vogel
PURPOSE: Management of breast cancer is a rapidly evolving field, and, although evidence-based guidelines are available for clinicians to provide direction on critical issues in patient care, clinicians often left to address these issues in the context of community practice situations with their patients. These include the patient's comorbid conditions, actual versus perceived benefit of treatments, patient's compliance as well as financial/reimbursement issues, and long-term tolerability of therapy...
January 19, 2018: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/29348709/perioperative-medicine-a-burgeoning-field-with-profound-importance-to-a-modern-clinician
#6
EDITORIAL
Vinaya Gaduputi, Sridhar Chilimuri, Kinesh Changela
AIMS AND SCOPE This article serves in introducing the readers to the developing field of perioperative medicine. We have made an effort to come up with the latest management guidelines covering multiple subspecialties in form of a special supplement. This compendium in perioperative medicine serves as a comprehensive guide to a practicing clinician, in managing patients with various medical comorbidities undergoing surgical procedures and avoiding common pitfalls.
2018: Health Services Insights
https://www.readbyqxmd.com/read/29332840/examining-patterns-of-multimorbidity-polypharmacy-and-risk-of-adverse-drug-reactions-in-chronic-obstructive-pulmonary-disease-a-cross-sectional-uk-biobank-study
#7
Peter Hanlon, Barbara I Nicholl, Bhautesh Dinesh Jani, Ross McQueenie, Duncan Lee, Katie I Gallacher, Frances S Mair
OBJECTIVE: This study aims: (1) to describe the pattern and extent of multimorbidity and polypharmacy in UK Biobank participants with chronic obstructive pulmonary disease (COPD) and (2) to identify which comorbidities are associated with increased risk of adverse drug reactions (ADRs) resulting from polypharmacy. DESIGN: Cross-sectional. SETTING: Community cohort. PARTICIPANTS: UK Biobank participants comparing self-reported COPD (n=8317) with no COPD (n=494 323)...
January 14, 2018: BMJ Open
https://www.readbyqxmd.com/read/29326340/rare-cause-of-pulmonary-cavitation-in-a-75-year-old-man
#8
Jaffar Al-Sheikhli, Hussein Taqi, John Drake, Ayaaz Habib
A 75-year-old man of Asian descent presented to the acute medical unit with signs and symptoms suggestive of a community-acquired pneumonia. He had multiple comorbidities and was relatively immunocompromised as a result. Initial investigations supported the diagnosis of community-acquired pneumonia complicated by a cavitating lung lesion, and the patient was treated as per hospital guidelines. He continued to deteriorate despite appropriate therapy and developed a hydropneumothorax, requiring the insertion of a chest drain...
January 10, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29305814/histopathology-findings-in-patients-undergoing-laparoscopic-sleeve-gastrectomy
#9
Ammiel Martínez Canil, Angelo Iossa, Pietro Termine, Daniela Caporilli, Vincenzo Petrozza, Gianfranco Silecchia
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has gained popularity in the last 10 years for its good results in weight loss and comorbidity control. However, guidelines on the pathological examination of the specimen are lacking. The aim of this retrospective study was to determine the usefulness of the routine specimen examination when presurgery endoscopy (upper gastrointestinal endoscopy, UGIE) and multiple gastric biopsies are part of the preoperative work-up. METHODS: A retrospective review of records of the patients submitted to LSG between January 2012 and August 2017 was carried out...
January 5, 2018: Obesity Surgery
https://www.readbyqxmd.com/read/29295878/understanding-comorbidity-profiles-and-their-effect-on-treatment-and-survival-in-patients-with-colorectal-cancer
#10
Erin E Hahn, Michael K Gould, Corrine E Munoz-Plaza, Janet S Lee, Carla Parry, Ernest Shen
Background: Patients with colorectal cancer (CRC) commonly present at an older age with multiple comorbid conditions and complex care needs at the time of diagnosis. Clusters of comorbid conditions, or profiles, have not been systematically identified in this patient population. This study aimed to identify clinically distinct comorbidity profiles in a large sample of patients with CRC from an integrated healthcare system, and to examine the effect of comorbidity profiles on treatment and survival. Methods: In this retrospective cohort study, we used latent class analysis (LCA) to identify comorbidity profiles in a sample of 7,803 patients with CRC diagnosed between 2008 and 2013...
January 2018: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/29288404/paradoxical-impact-of-decreased-low-density-lipoprotein-cholesterol-level-at-baseline-on-the-long-term-prognosis-in-patients-with-acute-coronary-syndrome
#11
Takuya Nakahashi, Hayato Tada, Kenji Sakata, Yohei Yakuta, Yoshihiro Tanaka, Akihiro Nomura, Tadatsugu Gamou, Hidenobu Terai, Yuki Horita, Masatoshi Ikeda, Masanobu Namura, Masayuki Takamura, Kenshi Hayashi, Masakazu Yamagishi, Masa-Aki Kawashiri
Although statin therapy is beneficial in the setting of acute coronary syndrome (ACS), a substantial proportion of patients with ACS still do not receive the guideline-recommended lipid management in contemporary practice. We hypothesize that the low-density lipoprotein cholesterol (LDL-C) level at the time of admission might affect patient management and the subsequent outcome. Nine-hundred and forty-two consecutive patients with ACS who underwent percutaneous coronary intervention were analyzed retrospectively...
December 29, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/29277857/percutaneous-mitral-valve-interventions-and-heart-failure
#12
Abhishek Sharma, Sunny Goel, Sahil Agarwal
Mitral regurgitation (MR) is the most frequent Valvular Heart Disease (VHD) and is an important cause of heart failure. MR can be caused by primary valve abnormality (Degenerative MR/Primary MR) or it can be secondary to cardiomyopathy (Functional MR/Secondary MR). Medical management alleviates symptoms but does not alter the progression of the disease. Current guidelines recommend surgery for moderate-to-severe (Grade > 3) MR in patients with symptoms or evidence of left ventricular dysfunction. Despite current practice guidelines, the majority of patients with severe MR do not undergo surgery...
December 27, 2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29274807/deintensification-of-hypoglycaemic-medications-use-of-a-systematic-review-approach-to-highlight-safety-concerns-in-older-people-with-type-2-diabetes
#13
REVIEW
A H Abdelhafiz, A J Sinclair
IMPORTANCE: Intensive treatment of older people with diabetes is common placing them at increased risk of adverse events such as hypoglycaemia and hospitalisation for drug errors. Little is known about when, how or for whom to deintensify hypoglycaemic medications. OBJECTIVE: To explore the characteristics of patients for whom deintensification is appropriate and to determine the outcome of deintensification. EVIDENCE REVIEW: Medline, Google scholar and EmBase search from 1997 to present was performed using keywords relating to diabetes mellitus, polypharmacy, hypoglycaemia, hospitalisation, deintensification, deprescribing and reduction, simplification or withdrawal of hypoglycaemic medications...
November 29, 2017: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/29262399/sacubitril-valsartan-in-clinical-practice-a-report-of-2-cases
#14
Eugenio Cosentino
Following the results of the PARADIGM-HF trial, the European Society of Cardiology (ESC) guidelines recommend sacubitril/valsartan to replace ACE inhibitors in ambulatory patients with heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal therapy and who fit trial criteria. However, the optimal use of sacubitril/valsartan in clinical practice needs further investigation. We report here the cases of 2 patients with HFrEH successfully treated with sacubitril/valsartan in our daily practice...
2017: Cardiology
https://www.readbyqxmd.com/read/29249179/real-life-use-of-diagnostic-biopsies-before-treatment-of-kidney-cancer-results-from-a-norwegian-population-based-study
#15
Christian Beisland, Tom B Johannesen, Lars Anders R Reisæter, Karin M Hjelle
OBJECTIVE: Interest in renal mass biopsies (RMBs) has increased in recent years. However, most publications are low-volume and/or single-center studies, so their generalizability is questionable. The aim of this study was to describe population-based, real-life use of diagnostic RMBs for localized and advanced kidney cancer (KC). MATERIALS AND METHODS: All KC patients diagnosed during 2008-2013 extracted from the database at the Cancer Registry of Norway were included...
December 16, 2017: Scandinavian Journal of Urology
https://www.readbyqxmd.com/read/29221453/the-extra-cost-of-comorbidity-multiple-illnesses-and-the-economic-burden-of-non-communicable-diseases
#16
Sébastien Cortaredona, Bruno Ventelou
BACKGROUND: The literature offers competing estimates of disease costs, with each study having its own data and methods. In 2007, the Dutch Center for Public Health Forecasting of the National Institute for Public Health and the Environment provided guidelines that can be used to set up cost-of-illness (COI) studies, emphasising that most COI analyses have trouble accounting for comorbidity in their cost estimations. When a patient has more than one chronic condition, the conditions may interact such that the patient's healthcare costs are greater than the sum of the costs for the individual diseases...
December 8, 2017: BMC Medicine
https://www.readbyqxmd.com/read/29220099/supportive-palliative-care-should-be-integrated-into-routine-care-for-paediatric-patients-with-life-limiting-kidney-disease
#17
REVIEW
Julia Thumfart, Tobias Reindl, Cornelia Rheinlaender, Dominik Müller
Paediatric palliative care is no longer restricted to patients with cancer and has been extended to patients with other chronic conditions, such as cystic fibrosis or neuromuscular disorders. This review focused on the current state of palliative care for children and adolescents with chronic kidney disease (CKD). We assessed the literature on CKD published up to August 2017. All the papers, except one from 1996, were published this century. This review discusses the role that palliative care plays in the process of decision-making and explores the possibilities of implementing palliative care into the routine therapy of affected patients and providing support for their families...
December 8, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/29202104/a-health-profile-of-senior-aged-women-veterans-a-latent-class-analysis-of-condition-clusters
#18
Margaret E Gonsoulin, Ramon A Durazo-Arvizu, Karen M Goldstein, Guichan Cao, Qiuying Zhang, Dharani Ramanathan, Denise M Hynes
Background and Objectives: This study characterizes the multiple morbidities experienced by senior-aged women Veterans so that the Veterans Health Administration (VHA) and other healthcare systems may be better prepared to meet the healthcare needs of this growing cohort. Research Design and Methods: Using the VHA's Corporate Data Warehouse (CDW), we conducted a retrospective observational study of the 38,597 female veteran patients who were at least sixty-five years old and received care in the VHA during 2013 and 2014...
September 1, 2017: Innovation in Aging
https://www.readbyqxmd.com/read/29176633/epidemiology-and-predictors-of-ntm-pulmonary-infection-in-taiwan-a-retrospective-five-year-multicenter-study
#19
Hung-Ling Huang, Meng-Hsuan Cheng, Po-Liang Lu, Chin-Chung Shu, Jann-Yuan Wang, Jann-Tay Wang, Inn-Wen Chong, Li-Na Lee
Multicenter, longitudinal studies on nontuberculous mycobacteria (NTM) pulmonary infection (PI) are lacking. This study provides a 5-year epidemiological overview of NTM-PI in Taiwan and investigated its predictors. The clinical relevance of each respiratory NTM isolate in six hospitals between 2008 and 2014 was determined according to current guidelines. Recurrent episodes were judged by serial bacteriological results. New episodes of NTM-PI and pulmonary colonization (PC) occurring since 2010 were analyzed...
November 24, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29176352/new-science-and-treatment-paradigms-for-atopic-dermatitis
#20
James G Dinulos, Alyssa Trickett, Caroline Crudele
PURPOSE OF THE REVIEW: The prevalence of atopic dermatitis is increasing in industrialized countries for unclear reasons. One theory centers on reduced exposure to microbes during infancy and childhood. Alterations in the epidermal permeability barrier, place certain patients at risk for the immunological dysfunction seen in atopic dermatitis. This review examines current research pertaining to the epidermal permeability barrier, the cutaneous microbiome, and the immunology of atopic dermatitis...
February 2018: Current Opinion in Pediatrics
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