Cleveland Clinic journal of medicine
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Review Comparative Study
Helicobacter pylori: why it still matters in 2005.
Despite falling prevalence rates in the developed world, H pylori is still present in the United States and is particularly prevalent among racial minorities and recent immigrants. H pylori infection is clearly associated with an increased risk of peptic ulcer disease, gastric cancer, and MALT lymphoma, and it is associated with some cases of uninvestigated dyspepsia. ⋯ It is uncertain whether H pylori eradication will improve outcomes in patients with gastric cancer. Decision analytic models suggest that a test-and-treat strategy for H pylori is rational and cost-effective for patients with uninvestigated dyspepsia.
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Intimate partner violence is as prevalent as many conditions for which we routinely screen. Yet intimate partner violence remains underdiagnosed and undertreated. Physicians and other health care workers are in a unique position to detect it and intervene. This article reviews what we can do, what we should do, and what we legally and ethically must do.
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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.
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For over 50 years, anticoagulant options for the treatment and prevention of thrombosis have been limited mainly to traditional agents such as unfractionated heparin and oral vitamin K antagonists such as warfarin. These traditional agents are fraught with limitations that complicate their clinical use. ⋯ Specifically, progress has been made in the development of low-molecular-weight heparins, factor Xa inhibitors, and direct thrombin inhibitors. Because of their convenience and ease of use, some of these novel compounds are competing with the traditional anticoagulants and are needed additions to the antithrombotic arsenal.
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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.