RSS Medical Articles

Cardiac Conduction System Disease
Δευτέρα, 08.01.2016, 03:00am
Cardiac conduction system disorders on the electrocardiogram (ECG) are common. Left bundle branch block (LBBB) is associated with adverse outcomes, and variants previously considered normal, such as right bundle branch block (RBBB), left anterior fascicular block, or PR interval prolongation, may also portend morbidity and mortality.
Family Assessment of Quality of Care in the Last Month of Life
Δευτέρα, 08.01.2016, 03:00am
There is often a fog that descends on patients, families, and health care professionals when they are navigating the difficult situation at the end of life. There is a lack of clarity regarding the trajectory of the illness, the true burdens and benefits of the myriad interventions, and how best to integrate palliative care into the overall care plan. In some illnesses, such as progressive cancer and dementia, there may be more clarity than in other conditions, such as advanced organ failure; this clarity can make overall decision making easier.
How Society Subsidizes Big Food and Poor Health
Δευτέρα, 08.01.2016, 03:00am
Approximately 80% of calories eaten in the United States are grown domestically. Yet, the US diet is a leading cause of morbidity. The analysis by Siegel et al in this issue ofJAMA Internal Medicinesuggests that through commodity subsidies that encourage poor diet we are, in part, paying for our own demise.
Habitual Prescribing of Laxatives
Δευτέρα, 08.01.2016, 03:00am
Constipation is a common and distressing symptom among those who are ill. In addition to adequate fluid intake and mobilization, the mainstay of constipation treatment has traditionally been the “bowel regimen,” a stimulant laxative such as sennosides combined with the stool softener docusate. Years ago, as trainees fatigued by endless pages alerting us to constipated patients, we too routinely ordered sennosides and docusate for every patient admitted to the hospital. Only after tasting various laxatives—and memorably, gagging on liquid docusate—did we feel compelled to change this practice. There is now evidence demonstrating that docusate is ineffective for the treatment of constipation. It is time to stop a habitual practice that is wasteful and harmful to patients.
Low-Density Lipoprotein Cholesterol Levels and Statin Treatment
Δευτέρα, 08.01.2016, 03:00am
Statins are a staple of secondary prevention for individuals with stable cardiovascular disease. However, there is controversy on how to determine the right statin dose, and whether it should be based on low-density lipoprotein cholesterol (LDL-C) levels. Guidelines for secondary prevention in individuals with stable cardiovascular disease differ in recommending a statin intensity goal or a particular LDL-C level (typically
Industry Payments to Physicians and Prescribing of Brand-name Drugs
Δευτέρα, 08.01.2016, 03:00am
Under the Open Payments program (the Physician Payment Sunshine Act, which is part of the Affordable Care Act), the Centers for Medicare&Medicaid Services has published nearly 16 million financial transactions from health care industries to physicians and teaching hospitals for August 2013 through December 2014. The total value of these payments was $9.92 billion. The Centers for Medicare&Medicaid Services will soon publish billions of dollars of additional transactions from 2015. Health care companies are investor-owned businesses that are obliged to maximize profits by any legal means. They are not charities; clearly they believe that billions of dollars of investments will have good returns.
Anticoagulation in the Very Old
Δευτέρα, 08.01.2016, 03:00am
One of the most fraught choices clinicians make is deciding which older patients should receive anticoagulant therapy. Risk of thrombosis and bleeding both increase with age, and these risks must be balanced with the burdens of anticoagulant monitoring, cost, adherence, and polypharmacy. Studies evaluating the net benefit of anticoagulation therapy often exclude the oldest and sickest patients. Consequently, physicians caring for older adults with complex medical conditions instead must rely on extrapolated data and clinical experience; surveys show that patient age acts as a significant deterrent to the use of anticoagulation regardless of other risk factors.
Policy Framework for Covering Preventive Services
Δευτέρα, 08.01.2016, 03:00am
This Special Communication proposes a new, comprehensive framework and associated criteria to help policy makers develop a more evidence-based, consistent, and ethically sound approach for covering preventive services without cost sharing.
Percutaneous Coronary Intervention in Stable Ischemic Heart Disease
Δευτέρα, 08.01.2016, 03:00am
This article examines the role of percutaneous coronary intervention in the treatment of patients with stable ischemic heart disease.
Aspirin for Primary Prevention of Atherosclerotic Cardiovascular Disease
Δευτέρα, 08.01.2016, 03:00am
This review examines which patients derive benefit from being prescribed aspirin for the primary prevention of atherosclerotic cardiovascular disease.
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