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Insulin as a strategy to optimize glycemic control in patients with type 2 diabetes

Treatment 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.

Integrating the existing emergency medical system with automated external defibrillators for out-of-hospital cardiac arrest

We investigated whether a program based on diffuse deployment of automated external defibrillators operated by trained volunteers and laypersons across the largest county in Italy would safely and effectively improve the current survival rate among patients with out-of-hospital cardiac arrest. Compared with historical control subjects, the new strategy resulted in a 3-fold increase in 1-year survival free of neurologic impairment.

High Stress Levels Result in Higher Mortality Rates

If you didn't know it already, you do now: stress kills. That's according to the results of a new study that concludes that men who experience persistently moderate or high levels of stressful life events over a number of years have a 50% higher mortality rate.

Anomalous origin of the left anterior descending artery from a separate ostium of the right sinus of Valsalva with abnormal stress test

A 67-year-old man with positive results on a stress myocardial perfusion test was found to have isolated anomalous origin of the left anterior descending coronary artery from a separate coronary ostium of the right sinus of Valsalva. This anomalous artery was not stenotic and coursed over the anterior free wall of the right ventricle, in front of the pulmonary artery. It did not appear to have an intra-arterial or intramyocardial course.

ACAAI 2011: Air Fresheners Impact Respiratory Health

The growing market for home air fresheners is impacting respiratory health, according to Stanley Fineman, MD, MBA, president-elect of ACAAI, associate clinical professor department of pediatrics, Emory University School of Medicine, Atlanta Allergy & Allergy Clinic.

Oral Morphine Versus Ibuprofen to Manage Post-fracture Pain in Children

Is orally administered morphine superior to ibuprofen for outpatient pain management for children with uncomplicated fractures?

Maintaining sinus rhythm after cardioversion of atrial fibrillation

We performed a meta-analysis of the effect of long-term treatment with antiarrhythmic drugs for the prevention of recurrent atrial fibrillation after conversion to sinus rhythm. We found that several class IA, IC, and III drugs are effective in maintaining sinus rhythm, but virtually all of them increase adverse effects, including proarrhythmia. In addition, class IA drugs are associated with increased mortality. The final risk-benefit ratio of antiarrhythmic drugs on clinically relevant outcomes is still unclear.

High insulin levels and the risk of hypertension

Insulin resistance has been linked to an increased risk of hypertension, type 2 diabetes mellitus, and cardiovascular disease.

LITIGATION POX

Fighting the Spread of Dangerous Misinformation During the COVID-19 Pandemic

How providers can stop the spread of dangerous information during the COVID-19 pandemic.

Practices to Ensure the Best Communication Across the Patient Journey

What technology should be implemented to ensure a positive experience for patients?

New Framingham Heart Study global cardiovascular risk instruments for use in primary prevention of atherosclerotic events

Cardiovascular risk factors vary somewhat for each specific atherosclerotic cardiovascular disease event; however, there is sufficient commonality to enable crafting of a global CVD risk-assessment instrument that accurately predicts total CVD risk and the risk of its individual components.

Fundamentals of clinical research: Cohort studies and randomized controlled trials

Where's the Love for Tablet PCs in Psychiatry?

Our most modern iteration of the portable, wirelessly connected, handwriting- and speech-recognition-capable computer is the "tablet PC."

Don't Get Caught Up in the Great Debate