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https://www.readbyqxmd.com/read/29777519/combination-glucose-lowering-therapy-plans-in-t2dm-case-based-considerations
#1
REVIEW
Lawrence Blonde, Susana Dipp, Daniel Cadena
Type 2 diabetes mellitus (T2DM) is a complex disease, and while lifestyle interventions remain the cornerstone of therapy, most patients will also require pharmacotherapy. Current diabetes treatment guidelines and algorithms recommend an individualized approach to setting glycemic goals and selecting treatment. Although a single antihyperglycemic agent may be appropriate as the initial T2DM pharmacotherapy, the progressive nature of the disease due to declining pancreatic β-cell function will result in the vast majority of T2DM patients eventually requiring two or more antihyperglycemic agents...
May 18, 2018: Advances in Therapy
https://www.readbyqxmd.com/read/29774749/excess-costs-of-non-infectious-comorbidities-among-people-living-with-hiv-estimates-from-denmark-and-sweden
#2
Frida Hjalte, Paul S Calara, Anders Blaxhult, Marie Helleberg, Karoline Wallace, Peter Lindgren
People living with HIV have an increased risk of comorbidities with non-communicable diseases such as cardiovascular disease, chronic kidney disease and osteoporotic fractures, compared to the general population. The burden of these comorbidities is expected to rise as the HIV-infected population ages. This development may require additional health care resources and it is relevant to ascertain the costs associated with these comorbidities. The population attributed risk approach was applied to estimate excess costs associated with the higher rates of comorbidities among HIV patients in Denmark and Sweden compared to their respective general populations...
May 18, 2018: AIDS Care
https://www.readbyqxmd.com/read/29771897/is-general-practice-identification-of-prior-cardiovascular-disease-at-the-time-of-cvd-risk-assessment-accurate-and-does-it-matter
#3
Sue Wells, Katrina Poppe, Vanessa Selak, Andrew Kerr, Romana Pylypchuk, Billy Wu, Wing Cheuk Chan, Corina Grey, Suneela Mehta, Dudley Gr Gentles, Rod Jackson
AIMS: To determine the accuracy of general practice recording of prior cardiovascular disease (CVD) at the time of CVD risk assessment and whether recording impacts on CVD management. METHODS: Prior CVD status entered at the time of a first CVD risk assessment from 2002-2015 was compared to prior ischaemic CVD hospitalisations from national datasets using anonymous linkage with an encrypted National Health Index identifier. Clinical factors associated with inaccurate recording of prior events were identified using multivariable logistic regression...
May 18, 2018: New Zealand Medical Journal
https://www.readbyqxmd.com/read/29769507/a-randomized-controlled-trial-to-compare-the-efficacy-of-intravenous-dexmedetomidine-and-clonidine-as-adjuvants-to-low-dose-opioid-in-attenuation-of-hemodynamic-response-to-laryngoscopy-and-tracheal-intubation
#4
N Gupta, A Kumar, A Jain, N Hayaran, P Mishra
Increase in sympathetic activity as a result of cardiovascular stress response to laryngoscopy can be detrimental to the patient. The primary objective is to compare intravenous dexmedetomidine and clonidine as adjuvants to low dose opioid (fentanyl) for attenuation of hemodynamic response to laryngoscopy and tracheal intubation. The secondary objectives are to compare the perioperative dose requirement of fentanyl and thiopentone, to compare the duration of postoperative analgesia, and to look for side effects in all three groups...
April 2018: Mymensingh Medical Journal: MMJ
https://www.readbyqxmd.com/read/29767472/the-impact-of-real-world-cardiovascular-related-pharmacogenetic-testing-in-an-insured-population
#5
Jennifer Billings, Patrick N Racsa, Kristine Bordenave, Charron L Long, Jeffrey J Ellis
BACKGROUND: Pharmacogenomics is intended to help clinicians provide the right drug to the right patient at an appropriate dose. However, limited evidence of clinical utility has slowed uptake of pharmacogenomic testing (PGT). OBJECTIVE: To evaluate the impact of real-world cardiovascular (CV)-related PGT on clinical outcomes, healthcare resource utilisation (HCRU) and cost in a large, heterogeneous population. METHODS: Individuals with Medicare Advantage Prescription Drug, Medicaid, or commercial coverage between 1/1/2011 and 9/30/2015 and ≥1 atherosclerotic CV-related diagnosis were identified...
May 16, 2018: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/29764436/prevalence-and-incidence-of-complications-at-diagnosis-of-t2dm-and-during-follow-up-by-bmi-and-ethnicity-a-matched-case-control-analysis
#6
Ebenezer S Owusu Adjah, Srikanth Bellary, Wasim Hanif, Kiran Patel, Kamlesh Khunti, Sanjoy K Paul
AIMS: To estimate the risk of developing long-term major cardiovascular and renal complications in relation to levels of body mass index (BMI) in a population of White European (WE), African-Caribbean (AC), and South Asian (SA) patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: Patients with new diagnosis of T2DM, aged ≥ 18 years from January 2000 (n = 69,436) and their age-sex-ethnicity matched non-diabetic controls (n = 272,190) were identified from UK primary care database...
May 15, 2018: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/29763267/top-20-research-studies-of-2017-for-primary-care-physicians
#7
Mark H Ebell, Roland Grad
Based on systematic surveillance of more than 110 medical journals, 247 studies met criteria as POEMs (patient-oriented evidence that matters) in 2017. Members of the Canadian Medical Association identified 20 of these POEMs as most relevant to practice. This article reviews the clinical questions and bottom-line answers from these studies. Blood pressure should be measured after a period of rest, using a bare arm, and orthostatic blood pressure is more predictive when measured after one minute of standing rather than three minutes...
May 1, 2018: American Family Physician
https://www.readbyqxmd.com/read/29762314/effectiveness-of-dexmedetomidine-versus-propofol-on-extubation-times-length-of-stay-and-mortality-rates-in-adult-cardiac-surgery-patients-a-systematic-review-and-meta-analysis
#8
John Nguyen, Noel Nacpil
OBJECTIVE: To determine the effects of dexmedetomidine versus propofol on extubation time, intensive care unit (ICU) length of stay, total hospital length of stay and in-hospital mortality rates in cardiac surgery patients. INTRODUCTION: Recovery from cardiovascular surgery involves weaning from mechanical ventilation. Mechanical ventilation decreases the work of breathing for patients by inhaling oxygen and exhaling carbon dioxide via a ventilator or breathing machine...
May 2018: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/29762273/patient-engagement-in-aco-practices-and-patient-reported-outcomes-among-adults-with-co-occurring-chronic-disease-and-mental-health-conditions
#9
Susan L Ivey, Stephen M Shortell, Hector P Rodriguez, Yue Emily Wang
BACKGROUND: Accountable care organizations (ACOs) have increased their use of patient activation and engagement strategies, but it is unknown whether they achieve better outcomes for patients with comorbid chronic physical and mental health conditions. OBJECTIVES: To assess the extent to which practices with patient-centered cultures, greater shared decision-making strategies, and better coordination among team members have better patient-reported outcomes (PROs) for patients with diabetes and/or cardiovascular and comorbid mental health diagnoses...
May 12, 2018: Medical Care
https://www.readbyqxmd.com/read/29761293/stable-but-progressive-nature-of-heart-failure-considerations-for-primary-care-physicians
#10
REVIEW
Inder Anand
Primary care physicians play a significant role in managing heart failure (HF), with the goals of reducing mortality, avoiding hospitalization, and improving patients' quality of life. Most HF-related hospitalizations and deaths occur in patients with New York Heart Association functional class II or III, many of whom are perceived to have stable disease, which often progresses without clinical symptoms due to underlying deleterious effects of neurohormonal imbalance and endothelial dysfunction. Management includes lifestyle changes and stepped pharmacological therapy directed at the four stages of HF, with aggressive uptitration of therapies, including beta-blockers and inhibitors of the renin-angiotensin-aldosterone system...
May 14, 2018: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/29757761/aspirin-resistance-cardiovascular-risk-game-changer
#11
Ahmed S Yassin, Hossam Abubakar, Tushar Mishra, Ahmed Subahi, Melanie Hartman, Abdelrahman Ahmed, Walid Ibrahim, Manmohan Singh, Mohit Pahuja
BACKGROUND: Aspirin (ASA) is the most used medication on the globe. ASA is a primary pillar of the secondary prevention of cardiovascular atherothromboembolic events. However, a fraction of the population does not respond to ASA as expected in a unique phenomenon called ASA resistance. Multiple mechanisms were described and studied in the literature to explain this phenomenon. AREA OF UNCERTAINTY: ASA resistance is an interesting phenomenon that is worth studying and reviewing...
May 3, 2018: American Journal of Therapeutics
https://www.readbyqxmd.com/read/29756524/chest-pain-atherosclerotic-cardiovascular-disease-risk-and-cardiology-referral-in-primary-care
#12
Vishaal Buch, Hayley Ralph, Joanne Salas, Paul J Hauptman, Dawn Davis, Jeffrey F Scherrer
BACKGROUND: The atherosclerotic cardiovascular disease (ASCVD) 10-year risk estimate is recommended by cardiologists for determining risk of a cardiac event. However, the majority of patients presenting to primary care with chest pain have noncardiac etiologies. Therefore, we determined if high versus low ASCVD risk was associated with primary care physicians' referral to cardiology in patients with and without chest pain. METHODS: Deidentified electronic health record (EHR) data was obtained from 5795 patients treated in academic primary care clinics from 2008 to 2015...
January 2018: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/29754716/sex-disparity-persists-in-the-prevention-of-cardiovascular-disease-in-women-on-statin-therapy-compared-to-that-in-men
#13
S Moreno-Arellano, J Delgado-de-Mendoza, M J Santi-Cano
BACKGROUND AND AIMS: The aim of this study was to assess whether women differ from men with regard to lowering lipid levels, achieving target of optimal lipid levels, and analyzing evidence-based dose and intensity of statin prescription in primary care patients. METHODS AND RESULTS: A multicenter cross-sectional survey was conducted among 1046 patients with dyslipidemia (554 women) who were receiving statin therapy from the Primary Health Care of Andalucía (Spain)...
April 7, 2018: Nutrition, Metabolism, and Cardiovascular Diseases: NMCD
https://www.readbyqxmd.com/read/29754664/investigation-of-motivational-interviewing-and-prevention-consults-to-achieve-cardiovascular-targets-impact-trial
#14
Eugenia Gianos, Antoinette Schoenthaler, Yu Guo, Judy Zhong, Howard Weintraub, Arthur Schwartzbard, James Underberg, Michael Schloss, Jonathan D Newman, Sean Heffron, Edward A Fisher, Jeffrey S Berger
BACKGROUND: Patients undergoing cardiovascular (CV) procedures often have suboptimal CV risk factor control and may benefit from strategies targeting healthy lifestyle behaviors and education. Implementation of prevention strategies may be particularly effective at this point of heightened motivation. METHODS: A prospective, randomized, pilot study was conducted in 400 patients undergoing a nonurgent CV procedure (cardiac catheterization ± revascularization) to evaluate the impact of different prevention strategies...
May 2018: American Heart Journal
https://www.readbyqxmd.com/read/29754661/catheter-ablation-versus-antiarrhythmic-drug-therapy-for-atrial-fibrillation-cabana-trial-study-rationale-and-design
#15
Douglas L Packer, Daniel B Mark, Richard A Robb, Kristi H Monahan, Tristram D Bahnson, Kathleen Moretz, Jeanne E Poole, Alice Mascette, Yves Rosenberg, Neal Jeffries, Hussein R Al-Khalidi, Kerry L Lee
The Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation (CABANA,NCT00911508)(1) trial is testing the hypothesis that the treatment strategy of percutaneous left atrial catheter ablation for the purpose of eliminating atrial fibrillation (AF) is superior to current state-of-the-art pharmacologic therapy. This international 140-center clinical trial was designed to randomize 2200 patients to a strategy of catheter ablation versus state-of-the-art rate or rhythm control drug therapy. Inclusion criteria include: 1) age> 65, or ≤65 with≥ 1 risk factor for stroke, 2) documented AF warranting treatment, and 3) eligibility for both catheter ablation and≥ 2 anti-arrhythmic or≥ 2 rate control drugs...
May 2018: American Heart Journal
https://www.readbyqxmd.com/read/29754122/schizophrenia-and-type-2-diabetes-mellitus
#16
V Mamakou, A Thanopoulou, F Gonidakis, N Tentolouris, V Kontaxakis
Schizophrenia is associated with increased risk for type 2 diabetes mellitus, resulting in elevated cardiovascular risk and limited life expectancy, translated into a weighted average of 14.5 years of potential life lost and an overall weighted average life expectancy of 64.7 years. The exact prevalence of type 2 diabetes among people with schizophrenia varies across studies and ranges 2-5fold higher than in the general population, whereas the aetiology is complex and multifactorial. Besides common diabetogenic factors, applied similarly in the general population, such as obesity, hyperlipidemia, smoking, hypertension, poor diet and limited physical activity, the co-occurrence of schizophrenia and diabetes is also attributed to unique conditions...
January 2018: Psychiatrikē, Psychiatriki
https://www.readbyqxmd.com/read/29752853/dexmedetomidine-for-the-reduction-of-emergence-delirium-in-children-undergoing-tonsillectomy-with-propofol-anesthesia-a-double-blind-randomized-study
#17
Adelais G Tsiotou, Anna Malisiova, Elena Kouptsova, Maria Mavri, Maria Anagnostopoulou, Evagelia Kalliardou
BACKGROUND: Postanesthesia emergence delirium is a motor agitation state complicating pediatric anesthesia. We investigated the efficacy of dexmedetomidine in reducing emergence delirium in children undergoing tonsillectomy with and without adenoidectomy using total intravenous anesthesia with propofol. METHODS: This was a prospective, single-center, double-blind, randomized study. The primary outcome was the presence or absence of emergence delirium with and without dexmedetomidine...
May 12, 2018: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29751285/improving-identification-and-management-of-familial-hypercholesterolaemia-in-primary-care-pre-and-post-intervention-study
#18
Stephen Weng, Joe Kai, Jennifer Tranter, Jo Leonardi-Bee, Nadeem Qureshi
BACKGROUND AND AIMS: Familial hypercholesterolaemia (FH) is a major cause of premature heart disease but remains unrecognised in most patients. This study investigated if a systematic primary care-based approach to identify and manage possible FH improves recommended best clinical practice. METHODS: Pre- and post-intervention study in six UK general practices (population 45,033), which invited patients with total cholesterol >7.5 mmol/L to be assessed for possible FH...
April 30, 2018: Atherosclerosis
https://www.readbyqxmd.com/read/29750174/factors-affecting-the-length-of-stay-in-the-intensive-care-unit-our-clinical-experience
#19
Mehmet Toptas, Nilay Sengul Samanci, İbrahim Akkoc, Esma Yucetas, Egemen Cebeci, Oznur Sen, Mehmet Mustafa Can, Savas Ozturk
Background and Aim: Long hospital days in intensive care unit (ICU) due to life-threatening diseases are increasing in the world. The primary goal in ICU is to decrease length of stay in order to improve the quality of medical care and reduce cost. The aim of our study is to identify and categorize the factors associated with prolonged stays in ICU. Materials and Method: We retrospectively analyzed 3925 patients. We obtained the patients' demographic, clinical, diagnostic, and physiologic variables; mortality; lengths of stay by examining the intensive care unit database records...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29748558/the-gastroenterologist-s-guide-to-management-of-the-post-liver-transplant-patient
#20
REVIEW
David M Chascsa, Hugo E Vargas
The management of the post-liver transplant patient is complex and involves a large interdisciplinary team. After referral to a transplant center, evaluation and listing, and eventual transplantation, the patient is cared for closely by the transplant center. Once deemed ready for discharge, the patient returns to the primary care provider for ongoing management of the various issues that increase in incidence post transplant such as osteoporosis, cardiovascular, and renal diseases, as well as metabolic syndrome...
May 11, 2018: American Journal of Gastroenterology
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