Der Internist
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Randomized Controlled Trial Multicenter Study Clinical Trial
[Atorvastatin for primary prevention of cardiovascular events. ASCOT-LLA Study].
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Patients in circulatory shock are being treated in emergency as well as in intensive care units. Despite different resources in personnel and technical equipment in both areas, patient management has to follow standardized protocols. Diagnosis of shock has to be based upon objective parameters (lactate, pH, standard bicarbonate, arterial blood pressure, central venous pressure, cardiac output). ⋯ Target values are: mean arterial blood pressure >80 mmHg, central venous pressure >6 mmHg, hemoglobin >8.0 g/dl, cardiac index >3.5 l/min/m(2). New concepts for optimization of hemodynamics and hematocrit, cortisone, intraaortic balloon counterpulsation, mechanical ventilation with low tidal volumes, and intensive insulin therapy are discussed. However, as shock reversal is dependent on its reason, clarification and treatment of the shock causing event has to be performed with highest priority.
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Faced with the obesity epidemic there is need for therapy as well as public health strategies for health promotion and obesity prevention. Both strategies add to each other, none should be done in isolation. Obesity is not only an individual problem. ⋯ We are now an overweight society, which is on the way to a fat society. There is urgent need for a national public health strategy for population wide prevention of overweight and obesity. Health authorities as well as politicians are asked to support public health strategies creating a supportive environment for making healthy choices the easier choices.