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Milly A van der Ploeg, Carmen Floriani, Wilco P Achterberg, Jonathan M K Bogaerts, Jacobijn Gussekloo, Simon P Mooijaart, Sven Streit, Rosalinde K E Poortvliet, Yvonne M Drewes
OBJECTIVES: As a person's age increases and his/her health status declines, new challenges arise that may lead physicians to consider deprescribing statins. We aimed to provide insight into recommendations available in international cardiovascular disease prevention guidelines regarding discontinuation of statin treatment applicable to older adults. DESIGN: We systematically searched PubMed, EMBASE, EMCARE, and the websites of guideline development organizations and online guideline repositories for cardiovascular disease prevention guidelines aimed at the general population...
October 30, 2019: Journal of the American Geriatrics Society
Aldo J Peixoto
New England Journal of Medicine, Volume 381, Issue 19, Page 1843-1852, November 2019.
November 7, 2019: New England Journal of Medicine
Alexander Makhnevich, Kenneth H Feldhamer, Charles L Kast, Liron Sinvani
Aspiration pneumonia refers to an infection of the lung parenchyma in an individual that has inhaled a bolus of endogenous flora that overwhelms the natural defenses of the respiratory system. While there are not universally agreed upon criteria, the diagnosis can be made in patients with the appropriate risk factors and clinical scenario, in addition to a radiographic or an ultrasonographic image of pneumonia in the typical dependent lung segment. Treatment options for aspiration pneumonia vary based on the site of acquisition (community-acquired aspiration pneumonia [CAAP] versus healthcare-associated aspiration pneumonia [HCAAP]), the risk for multidrug-resistant (MDR) organisms, and severity of illness...
July 1, 2019: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Marija Barbateskovic, Sara R Krauss, Marie O Collet, Nina C Andersen-Ranberg, Ole Mathiesen, Janus C Jakobsen, Anders Perner, Jørn Wetterslev
BACKGROUND: Haloperidol is the most frequently used drug to treat delirium in the critically ill patients. Yet, no systematic review has focussed on the effects of haloperidol in critically ill patients with delirium. METHODS: We conducted a systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials (RCTs) assessing the effects of haloperidol versus any intervention on all-cause mortality, serious adverse reactions/events, days alive without delirium, health-related quality of life (HRQoL), cognitive function and delirium severity in critically ill patients with delirium...
October 29, 2019: Acta Anaesthesiologica Scandinavica
Shankar Kumar, Emma Lim, Adrian Covic, Peter Verhamme, Chris P Gale, A John Camm, David Goldsmith
Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist as they share multiple risk factors, including hypertension, diabetes mellitus, and coronary artery disease. Although there is irrefutable evidence supporting anticoagulation in AF in the general population, these data may not be transferable to the setting of advanced CKD, where the decision to commence anticoagulation poses a conundrum. In this cohort, there is a progressively increased risk of both ischemic stroke and hemorrhage as renal function declines, complicating the decision to initiate anticoagulation...
October 29, 2019: Journal of the American College of Cardiology
Ronald J Maughan, Susan M Shirreffs
Muscle cramp is a temporary but intense and painful involuntary contraction of skeletal muscle that can occur in many different situations. The causes of, and cures for, the cramps that occur during or soon after exercise remain uncertain, although there is evidence that some cases may be associated with disturbances of water and salt balance, while others appear to involve sustained abnormal spinal reflex activity secondary to fatigue of the affected muscles. Evidence in favour of a role for dyshydration comes largely from medical records obtained in large industrial settings, although it is supported by one large-scale intervention trial and by field trials involving small numbers of athletes...
November 6, 2019: Sports Medicine
Anthony M-H Ho, Glenio B Mizubuti
Prophylactic administration of a vasopressor to mitigate the hypotensive effect of propofol (and/or other co-induction agents) during sedation/anesthesia immediately prior to tracheal intubation in frail patients in the intensive care unit and emergency and operating rooms appears to be not an uncommon practice. We submit that this practice is unnecessary and potentially harmful. Despite restoring the blood pressure, phenylephrine, for instance, may have an additive or synergistic effect with propofol in reducing the cardiac output and, ultimately, organ perfusion...
September 12, 2019: Journal of Critical Care
Fahimeh Ramezani Tehrani, Mina Amiri
Context: Despite the importance of timely diagnosis and treatment of polycystic ovary syndrome (PCOS) among adolescent females, considering the paucity of data focusing on this group and controversies documented on its recognition and management, the purpose of this review was to summarize challenges and recommendations of diagnosis and treatment for adolescents with PCOS. Evidence Acquisition: This review summarizes papers documented on PCOS among adolescent females...
July 2019: International Journal of Endocrinology and Metabolism
Catherine M Clase, Juan-Jesus Carrero, David H Ellison, Morgan E Grams, Brenda R Hemmelgarn, Meg J Jardine, Csaba P Kovesdy, Gregory A Kline, Gregor Lindner, Gregorio T Obrador, Biff F Palmer, Michael Cheung, David C Wheeler, Wolfgang C Winkelmayer, Roberto Pecoits-Filho
Potassium disorders are common in patients with kidney disease, particularly in patients with tubular disorders and low glomerular filtration rate. A multidisciplinary group of researchers and clinicians met in October 2018 to identify evidence and address controversies in potassium management. The issues discussed encompassed our latest understanding of the regulation of tubular potassium excretion in health and disease; the relationship of potassium intake to cardiovascular and kidney outcomes, with increasing evidence showing beneficial associations with plant-based diet and data to suggest a paradigm shift from the idea of dietary restriction toward fostering patterns of eating that are associated with better outcomes; the paucity of data on the effect of dietary modification in restoring abnormal serum potassium to the normal range; a novel diagnostic algorithm for hypokalemia that takes into account the ascendency of the clinical context in determining cause, aligning the educational strategy with a practical approach to diagnosis; and therapeutic approaches in managing hyperkalemia when chronic and in the emergency or hospital ward...
October 10, 2019: Kidney International
Sam D Gumbert, Felix Kork, Maisie L Jackson, Naveen Vanga, Semhar J Ghebremichael, Christy Y Wang, Holger K Eltzschig
Perioperative organ injury is among the leading causes of morbidity and mortality of surgical patients. Among different types of perioperative organ injury, acute kidney injury occurs particularly frequently and has an exceptionally detrimental effect on surgical outcomes. Currently, acute kidney injury is most commonly diagnosed by assessing increases in serum creatinine concentration or decreased urine output. Recently, novel biomarkers have become a focus of translational research for improving timely detection and prognosis for acute kidney injury...
October 25, 2019: Anesthesiology
Matthew Cove, John A Kellum
No abstract text is available yet for this article.
October 28, 2019: American Journal of Respiratory and Critical Care Medicine
William J Powers, Alejandro A Rabinstein, Teri Ackerson, Opeolu M Adeoye, Nicholas C Bambakidis, Kyra Becker, José Biller, Michael Brown, Bart M Demaerschalk, Brian Hoh, Edward C Jauch, Chelsea S Kidwell, Thabele M Leslie-Mazwi, Bruce Ovbiagele, Phillip A Scott, Kevin N Sheth, Andrew M Southerland, Deborah V Summers, David L Tirschwell
Background and Purpose- The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations in a single document for clinicians caring for adult patients with acute arterial ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 Acute Ischemic Stroke (AIS) Guidelines and are an update of the 2018 AIS Guidelines. Methods- Members of the writing group were appointed by the American Heart Association (AHA) Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise...
October 30, 2019: Stroke; a Journal of Cerebral Circulation
Isabel Cornejo-Pareja, Mercedes Clemente-Postigo, Francisco J Tinahones
Obesity is one of the most serious worldwide epidemics of the twenty-first century according to the World Health Organization. Frequently associated with a number of comorbidities, obesity threatens and compromises individual health and quality of life. Bariatric surgery (BS) has been demonstrated to be an effective treatment to achieve not only sustained weight loss but also significant metabolic improvement that goes beyond mere weight loss. The beneficial effects of BS on metabolic traits are so widely recognized that some authors have proposed BS as metabolic surgery that could be prescribed even for moderate obesity...
2019: Frontiers in Endocrinology
Wilmar M Wiersinga
Guidelines on T4 + T3 combination therapy were published in 2012. This review investigates whether the issue is better understood 7 years later. Dissatisfaction with the outcome of T4 monotherapy remains high. Persistent symptoms consist mostly of fatigue, weight gain, problems with memory and thinking and mood disturbances. T4 monotherapy is associated with low serum T3 levels, which often require TSH-suppressive doses of L-T4 for normalization. Peripheral tissue thyroid function tests during T4 treatment indicate mild hyperthyroidism at TSH < 0...
October 2019: Endocrine
Manuel Ramos-Casals, Pilar Brito-Zerón, Stefano Bombardieri, Hendrika Bootsma, Salvatore De Vita, Thomas Dörner, Benjamin A Fisher, Jacques-Eric Gottenberg, Gabriela Hernandez-Molina, Agnes Kocher, Belchin Kostov, Aike A Kruize, Thomas Mandl, Wan-Fai Ng, Soledad Retamozo, Raphaèle Seror, Yehuda Shoenfeld, Antoni Sisó-Almirall, Athanasios G Tzioufas, Claudio Vitali, Simon Bowman, Xavier Mariette
The therapeutic management of Sjögren syndrome (SjS) has not changed substantially in recent decades: treatment decisions remain challenging in clinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. In view of this scenario, the European League Against Rheumatism (EULAR) promoted and supported an international collaborative study (EULAR SS Task Force) aimed at developing the first EULAR evidence and consensus-based recommendations for the management of patients with SjS with topical and systemic medications...
October 31, 2019: Annals of the Rheumatic Diseases
Gregory W J Hawryluk, Sergio Aguilera, Andras Buki, Eileen Bulger, Giuseppe Citerio, D Jamie Cooper, Ramon Diaz Arrastia, Michael Diringer, Anthony Figaji, Guoyi Gao, Romergryko Geocadin, Jamshid Ghajar, Odette Harris, Alan Hoffer, Peter Hutchinson, Mathew Joseph, Ryan Kitagawa, Geoffrey Manley, Stephan Mayer, David K Menon, Geert Meyfroidt, Daniel B Michael, Mauro Oddo, David Okonkwo, Mayur Patel, Claudia Robertson, Jeffrey V Rosenfeld, Andres M Rubiano, Juan Sahuquillo, Franco Servadei, Lori Shutter, Deborah Stein, Nino Stocchetti, Fabio Silvio Taccone, Shelly Timmons, Eve Tsai, Jamie S Ullman, Paul Vespa, Walter Videtta, David W Wright, Christopher Zammit, Randall M Chesnut
BACKGROUND: Management algorithms for adult severe traumatic brain injury (sTBI) were omitted in later editions of the Brain Trauma Foundation's sTBI Management Guidelines, as they were not evidence-based. METHODS: We used a Delphi-method-based consensus approach to address management of sTBI patients undergoing intracranial pressure (ICP) monitoring. Forty-two experienced, clinically active sTBI specialists from six continents comprised the panel. Eight surveys iterated queries and comments...
October 28, 2019: Intensive Care Medicine
Gregory R Dobson
No abstract text is available yet for this article.
October 29, 2019: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Sarah N Bernstein, Gaston A Cudemus-Deseda, Vilma E Ortiz, Annekathryn Goodman, Arminder S Jassar
New England Journal of Medicine, Volume 381, Issue 17, Page 1664-1673, October 2019.
October 24, 2019: New England Journal of Medicine
Scott J Millington, Ariel Hendin, Ariel L Shiloh, Seth Koenig
Peripheral intravenous (PIV) catheter insertion is the most commonly performed procedure in hospitals. Multiple patient factors can make PIV insertion challenging, and ultrasound guidance has been demonstrated to improve the rate of success in these difficult patients. This article outlines the suggested techniques for the ultrasound-guided insertion of PIV catheters, midline catheters, and peripherally inserted central catheters. Illustrative figures and narrative videos demonstrating these techniques are included...
October 22, 2019: Chest
Sudarshini Ramanathan, Adam Al-Diwani, Patrick Waters, Sarosh R Irani
The autoimmune encephalitis (AE) syndromes have been characterised by the detection of autoantibodies in serum and/or cerebrospinal fluid which target the extracellular domains of specific neuroglial antigens. The clinical syndromes have phenotypes which are often highly characteristic of their associated antigen-specific autoantibody. For example, the constellation of psychiatric features and the multi-faceted movement disorder observed in patients with NMDAR antibodies are highly distinctive, as are the faciobrachial dystonic seizures observed in close association with LGI1 antibodies...
October 26, 2019: Journal of Neurology
2019-11-11 00:24:58
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