Cleveland Clinic journal of medicine
-
Review
Stroke prevention in atrial fibrillation: current anticoagulation management and future directions.
Atrial fibrillation (AF) is an important cause of stroke, and stroke risk stratification is critical to the management of patients with AF. Anticoagulation with warfarin is the current standard of care for stroke prevention in these patients, despite the need for close monitoring. ⋯ Other novel anticoagulants and antiplatelet combinations are under investigation. Curative procedures for AF are possible, but their long-term safety and effect on stroke risk are unknown.
-
The 2004 update to the National Cholesterol Education Program guidelines goes farther than the 2001 version in suggesting an optional low-density lipoprotein cholesterol (LDL-C) goal of less than 70 mg/dL for patients at "very high risk." It recommends starting both diet and drug therapy in all patients at high or very high risk whose LDL-C level is above the goal level, with the goal of reducing LDL-C by 30% to 40%. These more aggressive guidelines are based on results of five clinical studies published since 2001.
-
Epidural injections of glucocorticoids may help some patients with back and leg pain. The efficacy of this therapy has not been conclusively proved; however, when weighed against the risks, cost, and outcomes of spinal surgery, epidural glucocorticoids are a reasonable alternative in selected patients whose back and leg pain is functionally limiting. We review the rationale, available data, techniques, and indications for these injections.
-
Review Case Reports
A practical program for preventing delirium in hospitalized elderly patients.
Delirium in hospitalized elderly patients is common and often unrecognized (especially the hypoactive type), and can lead to serious complications. A systematic program can improve the rate of recognition of this problem and decrease its incidence, and is cost-effective.
-
Many physicians avoid prescribing opioid analgesics for chronic pain because of misconceptions or fears about efficacy, adverse effects, abuse, and addiction potential. We discuss these issues and offer suggestions for the rational use of opioid analgesics in patients with chronic noncancer pain.