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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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Integrating the existing emergency medical system with automated external defibrillators for out-of-hospital cardiac arrestWe 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.
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Systemic Lupus Erythematosus and Nonadjuvant H1N1 VaccinationClinicians have reported that influenza vaccination increases autoantibody production and/or disease activity in a significant proportion of patients with systemic lupus erythematosus (SLE).
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Anomalous origin of the left anterior descending artery from a separate ostium of the right sinus of Valsalva with abnormal stress testA 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.
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ACAAI 2011: Cutting Cat Dander and Allergic ResponsePets can cause a variety of health problems for those with sensitivities but there are environmental changes that can help, according to Dana Wallace, MD, PA, associate clinical professor, Nova Southeastern University.
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Oral Morphine Versus Ibuprofen to Manage Post-fracture Pain in ChildrenIs orally administered morphine superior to ibuprofen for outpatient pain management for children with uncomplicated fractures?
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Maintaining sinus rhythm after cardioversion of atrial fibrillationWe 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.
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High insulin levels and the risk of hypertensionInsulin resistance has been linked to an increased risk of hypertension, type 2 diabetes mellitus, and cardiovascular disease.
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LITIGATION POX
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ACA Ruling a Big Win for Mental HealthThe King v. Burwell US Supreme Court decision yesterday means that people who could have lost mental health insurance coverage don't have to worry.
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Fighting the Spread of Dangerous Misinformation During the COVID-19 PandemicHow providers can stop the spread of dangerous information during the COVID-19 pandemic.
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Practices to Ensure the Best Communication Across the Patient JourneyWhat technology should be implemented to ensure a positive experience for patients?
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Prognosis of "masked" hypertension vs. "white-coat" hypertensionWe compared the prognosis of patients with "white-coat" hypertension (WCHT) with that of patients with "masked" hypertension (MHT). The 10-year composite risk of stroke morbidity and cardiovascular mortality for patients with WCHT was similar to the risk for patients with sustained normal blood pressure, whereas the risk was markedly increased for patients with MHT and sustained hypertension. This indicates that conventional blood pressure measurements may fail to distinguish some patients at high or low risk.
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Sex-related differences in atrial fibrillation: Data from the RACE studyWe evaluated the effects of rate control treatment versus sinus rhythm restoration and maintenance in patients with persistent atrial fibrillation in a substudy of the Rate Control Versus Electrical Cardioversion (RACE) trial. Rhythm control treatment was associated with greater cardiovascular morbidity and mortality in women. Because treatment did not improve quality of life in these patients, rate control may be considered as first-choice therapy for women.
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New Framingham Heart Study global cardiovascular risk instruments for use in primary prevention of atherosclerotic eventsCardiovascular 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.
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Cardiovascular events in hypertension trials: A focus on perindoprilPharmacologic inhibition of the renin-angiotensin aldosterone system (RAAS) has become a widely accepted approach to lowering blood pressure (BP).
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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."
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Non–ST-segment elevation ACS: Should all patients undergo cardiac catheterization?We performed a systematic review and meta-analysis of all clinical trials comparing routine invasive strategy with selective invasive strategy in patients with non–ST-segment elevation acute coronary syndrome. We did not find either strategy to offer an advantage over the other, even when we excluded trials that did not use coronary stents and glycoprotein IIb/IIIa inhibitors.
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The Importance of Rare Disease Awareness Among PhysiciansJames J. Maciejko, MS, PhD, FACC, stresses the importance of rare disease awareness among physicians for proper diagnosis and treatment.
