Postgraduate medicine
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Postgraduate medicine · Nov 2022
ReviewStepwise approach to continuous glucose monitoring interpretation for internists and family physicians.
Continuous glucose monitoring (CGM) use has expanded rapidly in recent years among people with both type 1 and type 2 diabetes. In concert with the globally increasing prevalence of type 2 diabetes, the majority of whom receive diabetes care from internists or family physicians rather than specialists, it is becoming increasingly incumbent upon physicians within internal medicine and family practice to interpret and utilize CGM data in real-world clinical practice. ⋯ Given the limited amount of time available to internists and family physicians to address multiple complex topics in a typical office visit, a pragmatic, simple, and systematic approach to CGM interpretation is crucial. This article aims to provide internists and family physicians with a simplified and systematic approach to CGM interpretation that can be easily and efficiently implemented in a brief office visit.
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Postgraduate medicine · Nov 2022
Initial and terminal T wave angle as hyperkalemia indicator in chronic kidney disease.
Hyperkalemia is one prevalent complication in chronic kidney disease and is considered fatal since it potentially causes malignant arrhythmias and mortality. It is associated with electrocardiography (ECG) changes, such as peaked T wave in all ECG leads. However, the universal definition of the peaked T wave is still unclear, with low sensitivity and specificity. ⋯ The terminal T wave angle outperformed the initial angle in predicting hyperkalemia in CKD patients.
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Postgraduate medicine · Nov 2022
Machine learning model for predicting 1-year and 3-year all-cause mortality in ischemic heart failure patients.
Machine learning (ML) model has not been developed specifically for ischemic heart failure (HF) patients. Whether the performance of ML model is better than the MAGGIC risk score and NT-proBNP is unknown. The current study was to apply ML algorithm to build risk model for predicting 1-year and 3-year all-cause mortality in ischemic HF patient and to compare the performance of ML model with the MAGGIC risk score and NT-proBNP. ⋯ ML models predicted prognosis in ischemic HF with good discrimination and well calibration. These models may be used by clinicians as a decision-making tool to estimate the prognosis of ischemic HF patients.
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Postgraduate medicine · Nov 2022
ReviewLDL-C target attainment in secondary prevention of ASCVD in the United States: barriers, consequences of nonachievement, and strategies to reach goals.
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States. Elevated low-density lipoprotein cholesterol (LDL-C) is a major causal risk factor for ASCVD. Current evidence overwhelmingly demonstrates that lowering LDL-C reduces the risk of secondary cardiovascular events in patients with previous myocardial infarction or stroke. ⋯ LDL-C goals are not met due to several factors: lipid-lowering therapy is not initiated and intensified as directed by clinical guidelines (clinical inertia); most patients do not adhere to prescribed medications; and high-risk patients are frequently denied access to add-on therapies by their insurance providers. Promoting patient and clinician education, multidisciplinary collaboration, and other interventions may help to overcome these barriers. Ultimately, achieving population-level guideline-recommended reductions in LDL-C will require a collaborative effort from patients, clinicians, relevant professional societies, drug manufacturers, and payers.