Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Feb 2019
Management of elderly patients with type 2 diabetes in long-term care and skillednursing facilities.
Abstract
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Pol. Arch. Med. Wewn. · Feb 2019
CommentTime to rethink the role of sodium-glucose co-transporter 2 inhibitors in the elderly.
Abstract
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Pol. Arch. Med. Wewn. · Jan 2019
Knowledge gaps in patients with venous thromboembolism: usefulness of a new questionnaire.
INTRODUCTION The current awareness of venous thromboembolism (VTE) and knowledge of thromboprophylaxis among patients receiving oral anticoagulation therapy (OAC) are insufficient. OBJECTIVES We sought to develop and evaluate the usefulness of the Jessa AF Knowledge Questionnaire (JAKQ), modified for VTE patients. PATIENTS AND METHODS Consecutive patients at least 1 month since the VTE event (n = 273, mean [SD] age, 51 [17] years; 52.7%, women; 55.9%, unprovoked event) were enrolled to the study. ⋯ Education applied in 27 patients resulted in an increase in the median percentage of correct responses from 60% to 80% (P = 0.0001). CONCLUSIONS Knowledge on VTE and anticoagulation is suboptimal among patients on VKA and NOACs. Education of VTE patients should be improved especially in older individuals on NOACs.
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Pol. Arch. Med. Wewn. · Jan 2019
Prospective study on the prognostic value of repeated carotid intima-media thickness assessment in patients with coronary and extra coronary steno-occlusive arterial disease.
INTRODUCTION It is debatable whether the rate of change in carotid intima‑media thickness (CIMT) may be used as a risk indicator of major adverse cerebral and coronary events (MACCEs) in patients with either coronary (CAD) and peripheral artery disease (PAD). OBJECTIVES This prospective study aimed to evaluate the association between CIMT changes and the incidence of MACCEs, in patients with symptomatic CAD and PAD. PATIENTS AND METHODS The study comprised 466 patients admitted with steno‑occlusive disease, in whom revascularization was performed for an index lesion. ⋯ Maintained CIMT regression was independently associated with a reduced risk of MACCEs (hazard ratio [HR], 0.25; 95% CI, 0.15-0.42), MI (HR, 0.32; 95% CI, 0.20-0.51), ischemic stroke (HR, 0.29; 95% CI, 0.18-0.45), and CVD (HR, 0.24; 95% CI, 0.15-0.40), while the CIMT progression rate of 0.056 mm/y was associated with an increased risk of MACCEs (sensitivity, 53.2%; specificity, 72.2%; area under the receiver operating curve, 0.65). CONCLUSIONS Maintained CIMT regression is associated with 68% to 75% reduction in the risk of a cardiovascular event. However, a long‑term maintained CIMT regression is achieved in one‑fourth of patients with either CAD or PAD.
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Pol. Arch. Med. Wewn. · Dec 2018
ReviewPerioperative management of patients who are receiving antiplatelet therapy: a case-based, evidence-informed approach.
Addressing the optimal management approach for patients who are receiving single or dual antiplatelet therapy is a common and sometimes challenging clinical problem, especially for patients with coronary stents who are receiving dual antiplatelet therapy with acetylsalicylic acid (ASA) combined with a P2Y12 inhibitor. Using a case-based format, we summarize the findings of recent clinical trials and key observational studies which help inform best practices for the perioperative antiplatelet management of noncardiac surgery and coronary artery bypass graft surgery. In this review, we explore the evidence to address 3 key questions: What is the minimum duration that a surgery should be delayed after coronary stent implantation? In patients who are receiving single antiplatelet therapy with ASA, how to manage patients who require noncardiac and cardiac surgery? In patients who are receiving dual antiplatelet therapy for a coronary stent, how to manage patients who require noncardiac and cardiac surgery?