The American journal of the medical sciences
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African American communities traditionally mistrust academic research. This forms a significant barrier to understanding cardiovascular risk factors in this population, which bears an excess risk of cardiovascular disease and stroke. A clergy/academic partnership was established to build a gateway for salient research and for improving resources for reducing cardiovascular disease risk in the community. ⋯ Only 13% of African American male siblings and 14% of female siblings from these families were without any major remediable risk factors. The fact that so many siblings were at extremely high risk calls into question the current applications by provider systems of national guidelines in high-risk African American families. This is an easily identifiable population that would be likely to benefit greatly from targeted screening and culturally sensitive and appropriate treatment.
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African American communities traditionally mistrust academic research. This forms a significant barrier to understanding cardiovascular risk factors in this population, which bears an excess risk of cardiovascular disease and stroke. A clergy/academic partnership was established to build a gateway for salient research and for improving resources for reducing cardiovascular disease risk in the community. ⋯ Only 13% of African American male siblings and 14% of female siblings from these families were without any major remediable risk factors. The fact that so many siblings were at extremely high risk calls into question the current applications by provider systems of national guidelines in high-risk African American families. This is an easily identifiable population that would be likely to benefit greatly from targeted screening and culturally sensitive and appropriate treatment.
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Review
A shock toxin that produces disseminated intravascular coagulation and multiple organ failure.
To introduce a new concept in the etiology and treatment of traumatic and septic shock. It describes 3 types of shock: (1) hypovolemic shock, (2) traumatic shock, and (3) septic shock. ⋯ The mortality of septic shock in both total number and mortality rate has been increasing over the past 40 years despite major advances in diagnosis and treatment, including a number of "magic bullets." Trauma is the No. 1 cause of death in persons under the age of 44 and the No. 3 cause of all deaths. Traumatic shock has been assumed to be caused by hypovolemia; however, many traumatic shock patients die with a normal blood volume, usually after several days. Septic shock in pigs using an injection of killed Escherichia coli organisms produced disseminated intravascular coagulation (DIC). Control pigs treated with plasminogen activator survived. Septic shock in humans also treated with plasminogen activator showed excellent results. Traumatic shock studied in pigs showed excellent results with plasminogen activator. A normal blood volume was maintained with the use of intravenous fluids. Traumatic shock in humans also treated by plasminogen activator showed excellent results. The improvement in PaO2 and other parameters demonstrated in these studies provides a new possibility in the treatment of trauma and/or sepsis induced acute respiratory distress syndrome (ARDS). DIC is almost always present in traumatic and septic shock and probably in the course of ARDS and multiple organ failure. The DIC is probably initiated by tissue cell or bacterial cell destruction, which liberates a thrombogenic aminophospholipid that forms the inner layer of all cell walls.
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The population of hospitalized older patients is increasing. We investigated whether clinicians accurately detected renal insufficiency in older patients and chose correct doses of commonly prescribed antibiotics. ⋯ Widespread errors in medication dosing are made in elderly hospitalized patients. The Cockroft-Gault equation reveals significant renal insufficiency requiring dose adjustments in most elderly patients studied, especially those > 85 years of age and with low body weight. Estimation of glomerular filtration rate should be performed routinely on all admitted patients older than 80 and in any patient with low lean body mass.