Postgraduate medicine
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Postgraduate medicine · Mar 2020
ReviewPharmacological treatment of stable COPD: need for a simplified approach.
Chronic obstructive pulmonary disease (COPD) is one of the most common diseases worldwide. Although different guidelines regarding therapeutic algorithms exist, the most widely adopted approach is the one suggested by the Global Initiative in Chronic Obstructive Lung Disease in which patients are stratified according to their dyspnea severity and their exacerbation history during the previous year. ⋯ This complexity is probable one of the causes that most health care professionals are not adherent to the guidelines when treating COPD patients. Here, we propose a simplified therapeutic algorithm for the treatment of COPD patients taking into consideration the current evidence on the use of bronchodilators and inhaled corticosteroids.
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Postgraduate medicine · Mar 2020
ReviewThe new kid on the block in physical diagnosis? Introducing digital microscopy.
Emerging microprocessor technology has revolutionized all aspects of life in the modern era. Feats previously achieved through sophisticated, cumbersome and expensive devices are currently both commonplace and feasible with convenient instruments available at low-cost. Body surface inspection can prove very challenging when seeking minute alterations of anatomy and miniature inflicting culprits. ⋯ Body regions amenable for improved visualization with this method extend from scalp hair, skin and ocular structures, all the way to the anal sphincter. The objective of this paper is to familiarize physicians with the advantages of digital microscopy through numerous clinical illustrations, as: characterization and surveillance of lesions, sores, cutaneous and corneal foreign bodies, painful conditions of the nipple, hematomas retained sutures, secretions and purulent lesions. This introduction is hoped to arouse enthusiasm towards digital microscopy and encourage its adoption into routine practice.
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Postgraduate medicine · Mar 2020
ReviewType 2 diabetes mellitus and cardiovascular risk; what the pharmacotherapy can change through the epigenetics.
Diabetes mellitus and cardiovascular diseases are part of the metabolic syndrome and share similar risk factors, including obesity, arterial hypertension, and dyslipidemia. Atherosclerosis and insulin resistance contribute to the development of the diseases, and subclinical inflammation is observed in both conditions. ⋯ Interestingly, recent studies show that at least some anti-diabetic drugs, as well as blockers of the renin-angiotensin-aldosterone system (RAAS), exert epigenetic effects aside from their hypoglycemic and antihypertensive functions, respectively. More studies are needed to discover other positive effects of the medications established through epigenetic mechanisms and to find out more about the epigenetic role in the development of diabetes mellitus and cardiovascular diseases.
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Postgraduate medicine · Mar 2020
Observational StudyReal-world management of hyperkalemia with patiromer among United States Veterans.
Objective: Patiromer is a sodium-free, non-absorbed, potassium (K+) binder approved for the treatment of hyperkalemia (HK). Among US Veterans with HK, this retrospective, observational cohort study evaluated patiromer utilization, RAASi continuation, and K+ concentration change following patiromer initiation. Methods: Using data from the Veterans Affairs Corporate Data Warehouse, Veterans with HK (K+ ≥5.1 mmol/L) were included upon patiromer initiation (index date) during the study period (1/2016-8/2018). ⋯ Clinically relevant K+ concentration reductions were observed at all study time points. The successful management of HK may have contributed to the observed high rate of RAASi therapy continuation. Further research is warranted to corroborate and extend these findings.
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Postgraduate medicine · Mar 2020
The influence of value reference point and risk preference on adherence in hypertensive patients in a low-income area of China.
Aims: Prevention and control of hypertension can be achieved by improving patient adherence to long-term treatment regimens. Non-adherence is an obstacle to chronic disease management. We studied the impact of value reference point and risk preference on patient adherence and influencing factors from the perspective of behavioral economics so as to offer targeted recommendations to improving patient adherence in low-income areas. ⋯ Satisfaction with current services and relationship with physicians, as well as type of drugs also influenced adherence. Conclusions: Adherence may be improved by changing patients' value reference points and perceptions through health education and better health service resources. One of the key to increasing adherence is through identifying and eliminating bias.