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Valproic Acid and Carbapenem Antibiotics InteractionThe effect of a carbapenem on VPA is significant and may result in reduced efficacy and increased seizure activity. Because of the mechanism of this interaction, increasing the dose of the VPA will unlikely achieve therapeutic plasma concentrations.
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Video Capsule Endoscopy: Recent Advances in DiagnosisInvestigation of the small intestine or the esophagus with conventional diagnostic and imaging modalities can be challenging. Video capsule endoscopy is a relatively new and noninvasive technique that allows direct visualization of the small bowel or the esophagus and can obviate the need for or guide the use of more invasive procedures. The capsule contains a miniature camera that takes pictures of the lining of the small intestine or the esophagus. Unlike conventional diagnostic procedures, video capsule endoscopy can often successfully identify the source of the problem quickly and painlessly. It is also useful in assessing patients with a variety of other conditions affecting the small intestine or the esophagus, including Crohn's disease, celiac disease, tumors, reflux disease, esophagitis, and Barrett's esophagus.
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Cutting through the Fog of Cloud ComputingMore than one technology pundit has claimed that desktop software and computing that relies on local servers is on life support, soon to be replaced by an Internet-based approach that relies on a "cloud" of applications and virtual resources that are delivered over the Web via your browser. Are proponents who want to apply this concept to EMRs correct when they say that this is the future of health IT, or do they have their head in the clouds?
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Estate Planning Essentials for PhysiciansPlanning can dramatically reduce-or avoid altogether-some common tax hits, including: capital gains, state, inheritance, and estate and gift taxes. There are several options to consider when building an estate plan.
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CMS Proposed Changes to Medicare Graduate Medical Education PaymentsOn July 2, 2010, CMS released the proposed changes to the Medicare Outpatient Hospital Prospective Payment System for 2011.
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Comprehensive lifestyle modification and blood pressure controlLifestyle recommendations for the prevention and treatment of hypertension include weight loss, reduced sodium intake, increased physical activity, limited alcohol intake, and the Dietary Approaches to Stop Hypertension (DASH) diet. The 18-month results of the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER) randomized clinical trial showed that individuals with prehypertension and stage 1 hypertension can make and sustain many of these lifestyle changes over the long term, thereby reducing their risk of cardiovascular disease.
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Multislice computed tomography coronary angiography: A study in search of a clinical nicheThe study presented in this issue of Cardiology Review by Schuijf and colleagues investigated various aspects of what is rapidly becoming an accepted imaging modality for the assessment of coronary artery disease.
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On Epilepsy, Insurers Should Follow Their Own Rhetoric on In-home CareIf CVS and Aetna are truly charting the future of healthcare in this country, then it’s long past-time that their actions align to their rhetoric.
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Lipid-lowering therapy and atherosclerotic aortic plaquesWe showed that a significant reduction in thoracic aortic plaques and low-density lipoprotein cholesterol levels occurred after 12 months of treatment with atorvastatin. In the abdominal aorta, however, the change in atherosclerotic plaques correlated with age. These results show that plaques in the thoracic and abdominal aortas may respond differently to lipid-lowering therapy, and other factors, such as aging, may be more important for plaque progression in the abdominal aorta.
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FCS Diet and DangersWahida Karmally, MS, RD, CDE, explains the challenges and importance of diet in patients with familial chylomicronemia syndrome (FCS), how much fat can be eaten (and which kind), and the dangers of pancreatitis when too much fat is consumed.
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Experts Share Best Practice Tips for Managing Knee Osteoarthritis PainNon-surgical management options for osteoarthritis (OA) of the knee include low-impact exercise, physical therapy, and anti-inflammatories.
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Insulin as a strategy to optimize glycemic control in patients with type 2 diabetesTreatment of type 2 diabetes should achieve and maintain euglycemia, thereby preventing complications from this progressive disease. Current antidiabetic therapies should be a part of a multimodal management program that includes diet, exercise, and blood pressure and lipid control. Oral antidiabetic drugs are still first-line therapy for type 2 diabetes, but intensification of therapy, including starting insulin, should occur every 2 to 3 months as needed to achieve euglycemia. The first insulin added is typically a basal insulin, which is effective in lowering fasting plasma glucose (FPG). A persistently elevated glycated hemoglobin (HgbA1C) level despite near or complete normalization of FPG, however, indicates postprandial hyperglycemia. In these cases, the addition of bolus insulin is required to reduce postprandial glucose (PPG). Several approaches to initiate and titrate insulin can be used based on FPG, PPG, HgbA1C, and patient factors.
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"One Cannot Measure What One Does Not Manage": The Regulators Are Not Your Friends (Part XIII-i)Continuation of last week's post, "If you lie down with dogs, you get up with fleas"
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How Accurate are Cardiac Risk Calculators?This prospective epidemiological study compares the capabilities of the new 2013 American Heart Association and American College of Cardiology ASCVD risk calculator against several alternative cardiovascular risk calculators and explores the potential effect of preventive therapy on risk overestimation in the AHA-ACC-ASCVD model.
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Suffering in Silence: The Scourge of Physician SuicidePhysician suicide is a taboo topic—and despite high rates of depression and PTSD among doctors, little help exists for those at risk.
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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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ADA 2011: Ranibizumab Improves Visual Acuity in Patients with Diabetic Macular EdemaMore patients in the RIDE and RISE trials treated with the VEGF inhibitor showed improvements in vision test scores compared to patients who received placebo.
