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Cardiac catheterization in higher-risk NSTE-ACS patients: Why is it being underutilized by physicians?We compared the rates of cardiac catheterization in 2136 non–ST-segment elevation acute coronary syndrome patients who were stratified according to their baseline thrombolysis in myocardial infarction (TIMI) risk score. Higher-risk patients were referred for catheterization at a similar rate as low-risk patients. The main reasons why physicians did not make referrals included (1) clinical trial evidence did not support an early invasive approach and (2) 68% of patients were thought not to be at high enough risk; however, 59% of these patients were found to be higher risk when their baseline TIMI risk scores were recalculated. Patients who were referred for catheterization had better in-hospital and 1-year outcomes. Our findings indicate that a significant opportunity remains to improve upon accurate risk stratification and adherence to an early invasive strategy for higher-risk patients.
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Evaluating the Effectiveness of Tonabersat for Migraine ProphylaxisA recent review found that tonabersat, a novel benzoylamino benzopyran compound, is well-tolerated, but no better than placebo for migraine prophylaxis.
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Can corticosteroids prevent atrial fibrillation after cardiac surgery?We conducted a prospective, double-blind, randomized, multicenter study among 241 patients who underwent their first on-pump coronary artery bypass graft (CABG) surgery, aortic valve replacement (AVR), or combined CABG and AVR surgery to determine whether the use of hydrocortisone prevents atrial fibrillation after cardiac surgery. Results showed that the incidence of postoperative atrial fibrillation was significantly lower in the hydrocortisone group compared with the placebo group.
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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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Opinion: As Healthcare Evolves, So Must PA Practice LawsL. Gail Curtis, PA-C, MPAS, DFAAPA, details the use of Optimal Team Practice by the AAPA, and the role of the physician assistant in medicine.
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Oncology Nurse Navigators Address Psychosocial SupportOncology nurse navigators (ONNs) provide individualized assistance to patients, families, and caregivers to help overcome healthcare system barriers and to facilitate timely access to quality medical and psychosocial care from pre-diagnosis through all phases of the cancer experience.
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Study Challenges Marijuana Use Linked to Several ConditionsRegarding pulmonary and mental health, an emerging study has reported teen marijuana use is not associated to the development of several conditions including depression, psychosis, allergies, headaches, or high blood pressure.
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Niacin Plus Laropiprant: Does the Harm Outweigh the Benefit?Is the final word on high-dose niacin finally in?
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Coronary artery disease in asymptomatic diabetic patientsWe evaluated the effectiveness of the current American Diabetes Association guidelines for the detection of coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes and assessed whether a more aggressive diagnostic strategy would permit detection of silent CAD at an earlier stage. The prevalence of myocardial perfusion defects and CAD in asymptomatic diabetic patients was high independent of risk factor profile, and an aggressive diagnostic approach in patients who would normally be excluded from screening permitted identification of CAD at an earlier stage, when coronary anatomy is more likely to respond to treatment.
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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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A Crushing Epidemic: Unintentional Misuse of Prescription Drugs in the USBrought to you by Collegium Pharmaceutical: Patients with swallowing difficulties unintentionally misuse medication by crushing and/or chewing their pills and unknowingly put themselves at risk.
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Health Plans to Provide Free Preventive CareLast Wednesday, the White House announced new regulations that will require all health insurance plans to provide certain preventive services at no cost to patients.
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A misleading ECGA 10-year-old girl was brought to her primary care provider by her mother because she complained of chest pain earlier that morning. She also reported abdominal pain and nausea.
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New Statin Myopathy Warning: Best to Heed This"Statin" (HMG CoA reductase inhibitors, used for dyslipidemia) use in the US is very high and climbing. As the population becomes fatter and even some children become extremely obese, these agents are often prescribed to address elevated LDL and other lipid perturbations.
