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Renal dysfunction in older age groups and mortality after acute myocardial infarctionOnly one third of patients admitted to the hospital with acute myocardial infarction have normal renal function, and 17% have severe renal impairment. Decreased renal function is associated with the presence of comorbid conditions, underuse of effective treatments, and higher mortality. Renal function parameters should not only be included in scoring systems to assess risk levels, but patients with abnormal renal function should benefit from careful application of guidelines-recommended treatments for acute and long-term care.
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24-Hour ICH Score Better Prognostic Indicator Than ICH Score at AdmissionAlthough the intra-cerebral hemorrhage (ICH) score at hospital admission is typically used to estimate the potential prognosis in stroke patients, a new study suggests that the 24-hour ICH score is a more accurate assessment.
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Pharmacotherapy for chronic cardiovascular disease in womenCardiovascular drugs affect women differently than they do men because of differences in pharmacokinetics, pharmacodynamics, and physiology. Results of recent studies on the use of cardiovascular agents in women are presented, with an emphasis on the need to include an appropriate proportion of women in future studies, to adapt the dosage to the weight of the patient, and to incorporate hormonal aspects into the analysis.
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Opinion: Extend Reach of Patient-Centered Medical Home, Enhance Physician Practice with Specialized Community-Based Palliative CareAs those age 65 and older face more serious illness, unprecedented burdens to serve a burgeoning population in need of high quality, coordinated care outside the acute care setting have emerged.
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Analysis of regional left ventricular functionWe performed cineventriculography, unenhanced echocardiography, contrast-enhanced echocardiography, and magnetic resonance imaging to define the presence of regional left ventricular wall motion abnormalities. Interobserver agreement in the analysis of regional wall motion abnormality was highest for contrast-enhanced echocardiography, followed by cineventriculography and cardiac magnetic resonance imaging; it was lowest for unenhanced echocardiography. Contrast-enhanced echocardiography also showed the highest accuracy in the detection of panel-defined regional wall motion abnormalities.
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10 Ways to Build ResilienceOne of the best ways to fight burnout is to build resilience. The American Psychological Association has put forth these tips to do just that.
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Congestive heart failure in the elderlyStudies have shown that elderly patients with heart failure are undertreated with evidence-based therapy, such as angiotensin-converting enzyme inhibitors and beta-blockers, although these therapeutic options appear to be effective in this age group. The risk of some side effects may be increased in elderly patients, and physicians should be aware of those when prescribing therapy. Cardiac resynchronization therapy is predicted to play a major role in future heart failure treatment, including in the elderly population.
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Emergent Management of Ischemic Stroke: Treatment ABCsStroke affects nearly 700,000 Americans a year. Emergency management is key to a positive patient outcome.
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A Heart Swings Sadly to a DiagnosisA 47 year old woman with no past medical history presented with back pain a month prior, and an MRI of the lumbar spine was performed and demonstrated a mass protruding into S1 concerning for hemangioma.
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Navy Medicine: A Strategic Roadmap for Implementing a Virtual Mental Health ProgramA military service member talks about some of the ways the Navy is implementing new programs to improve mental health conditions.
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The New Weight-Loss Drugs: Lorcaserin and Phentermine-TopiramateThe authors of this review believe the efficacy of a drug is important, but it is not the full story.
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Oral Medication Option May Lead to Improved Treatment Adherence in Patients with Psoriatic ArthritisUntil apremilast was approved earlier this year, patients with psoriatic arthritis had to rely primarily on injectable therapies, which contributed to less than optimal treatment adherence in many patients.
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Unusual appearance of a left ventricular mural thrombusPostpartum cardiomyopathy is a serious disorder that can present from the third trimester to up to 5 months after pregnancy. Although spontaneous resolution of cardiac function occurs in more than half of patients (over a period of 6-12 months), the balance is left with persistent cardiac dysfunction. Cardiac dysfunction results in signs and symptoms of left heart failure, formation of apical or left ventricular thrombi, and arrhythmias and requires management similar to that in patients with nonischemic dilated cardiomyopathy.
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The Approach to the Patient with Allergic AsthmaAsthma is a chronic respiratory disease affecting 20 million people in the United States, including 6.1 million children. Allergies are among the most common risk factors for the development of asthma, and they often trigger acute episodes. Because the economic and health care burden of asthma has increased over the past 20 years, physicians should be familiar with current management guidelines, as well as with the many medications available. Early diagnosis and appropriate treatment can prevent asthma exacerbations and improve the quality of life of patients.
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Preventing atrial fibrillation recurrenceIn patients with lone paroxysmal atrial fibrillation (AF) and normal cardiac function, in the absence of hypertension, myocardial infarction, and cardiac insufficiency, perindopril (Aceon) or losartan (Cozaar) and low-dose amiodarone (Cordarone) therapy are more effective in preventing recurrence of AF than low-dose amiodarone alone. Adding losartan or perindopril to amiodarone therapy can inhibit left atrial enlargement.
