J Natl Med Assoc
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Hypertension is a major modifiable risk factor for stroke, congestive heart failure, and end-stage renal disease. Hypertension is particularly prevalent and deadly among African Americans. Effective treatment for hypertension has been available for decades, yet only one fourth of all individuals have their blood pressure under control. ⋯ This theoretical paper was conducted using a literature review and a model to explain psychosocial antecedents of blood pressure control is presented. We conclude that improved understanding of important antecedents of blood pressure control coupled with technological advances, such as tailored interventions, provide clinicians with a tool that may lead to improved blood pressure control. These interventions will require the involvement of clinicians and consideration of sociocultural factors to be successful.
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Comparative Study
Reduced prevalence of atrial fibrillation in black patients compared with white patients attending an urban hospital: an electrocardiographic study.
Electrocardiographic differences occur between African-American and white persons. The cardiac rhythms of 2123 African-American and white hospital patients from 20 through 99 years of age were studied in a consecutive manner. The prevalence of atrial fibrillation increases dramatically with advancing age in both African-American and white patients. ⋯ Atrial fibrillation occurs in 2.5% of African-American patients compared with 7.8% of white patients attending an urban hospital. There is little difference in the prevalence of atrial fibrillation between men and women. Atrial fibrillation occurs nearly seven times more often than does atrial flutter.
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Editorial Comment
Atrial fibrillation: an important issue for African Americans?
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Optimal therapy for serious Streptococcal pneumoniae infections with intermediate or high-grade resistance to penicillin is controversial. It should be noted that data regarding the efficacy of penicillins or cephalosporins for penicillin-resistant strains are limited. Despite the paucity of clinical trials, most clinicians still agree that penicillins remain the mainstay of therapy for community-acquired pneumonia caused by Streptococcal pneumoniae-susceptible strains. ⋯ The indicators also address documentation of influenza and pneumococcal vaccine status in patients. Several other indicators, such as obtaining blood cultures before antibiotic administration, using antibiotics according to current guidelines, and timely administration of antibiotics, will play critical roles in the management of community-acquired pneumonia. Because of increased incremental costs associated with community-acquired pneumonia, early diagnosis and timely intravenous to oral switch therapy will continue to be emphasized and monitored in those admitted into hospitals, together with the appropriate decision tree-based pneumonia specific severity of illness scoring system.