Cleveland Clinic journal of medicine
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The limitations of current therapies for atrial fibrillation are forcing a rethinking of how they should be used. Questions are being raised about the use of antiarrhythmic drugs, and new nonpharmacologic procedures are promising alternatives. Most patients with atrial fibrillation still require warfarin therapy, but some low-risk patients can forego it. ⋯ Certain antiarrhythmic drugs should be avoided in patients with congestive heart failure, in whom the risks may exceed the benefits. The maze procedure is emerging as an option to restore and maintain sinus rhythm. Radiofrequency atrioventricular node ablation and modification hold promise as options to control the ventricular rate without drugs.
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Despite the discovery of new pathogens and the evolving problem of antibiotic resistance, the basic trends in community-acquired pneumonia remain remarkably constant. This article reviews the common pathogens, new pathogens, their clinical presentations, the diagnostic workup, the decision to hospitalize, antibiotic resistance, and antibiotic choices.
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The cornerstones of the evaluation of cardiac risk in patients undergoing noncardiac surgery remain a thorough history and physical examination, and a resting electrocardiogram. However, new techniques to assess cardiac function allow more complete evaluation of high-risk patients.
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Patients with pre-existing pulmonary disease and certain other conditions are at increased risk of postoperative pulmonary complications. This article surveys how internists can identify high-risk patients clinically, use pulmonary function studies, use specific therapy to reduce risk, and manage postoperative complications.
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The preoperative evaluation often includes more tests than are necessary. This article reviews the usefulness of and indications for nine commonly ordered preoperative tests.