Mayo Clinic proceedings
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Mayo Clinic proceedings · Aug 2009
Comparative StudyImpact of asthma controller medications on clinical, economic, and patient-reported outcomes.
To comprehensively evaluate clinical, economic, and patient-reported outcomes associated with various therapeutic classes of asthma controller medications. ⋯ Inhaled corticosteroids were associated with a lower risk of INP/ED visits, and a lower cost if adherence was achieved. When adherence cannot be achieved, LMs may be a reasonable alternative. Combination therapy with ICS plus a long-acting beta-agonist was associated with better or equivalent clinical, economic, and patient-reported outcomes.
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Mayo Clinic proceedings · Aug 2009
ReviewManaging asthma in primary care: putting new guideline recommendations into context.
Many patients with asthma are treated in the primary care setting. The primary care physician is therefore in a key position to recognize poorly controlled asthma and to improve asthma management for these patients. ⋯ The current review is intended to assist primary care physicians in improving asthma control among their patients; this review clarifies the new guidelines and provides a specialist's perspective on diagnosis, appropriate therapy, disease control surveillance, and appropriate referral when necessary. This discussion is based primarily on the new guidelines and the references cited therein, supplemented by the author's own clinical experience.
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Mayo Clinic proceedings · Aug 2009
ReviewTreating tobacco dependence in light of the 2008 US Department of Health and Human Services clinical practice guideline.
Cigarette smoking is the most important preventable cause of morbidity, mortality, and excess health care costs in the United States. From 2000 through 2004, cigarette smoking caused an estimated annual average of 443,595 deaths and cost $193 billion per year in smoking-attributable productivity losses and smoking-related health care expenditures. ⋯ The new guideline updates the previous guidelines published in 1996 and 2000 and presents many new research findings to provide a broader evidence base for effective intervention. This article briefly reviews the major updates and recommendations from the new guideline and highlights its practical clinical applications.
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Mayo Clinic proceedings · Aug 2009
ReviewPrimary and secondary prevention of cardiovascular diseases: a practical evidence-based approach.
Despite the fact that we possess highly effective tools for the primary and secondary prevention of myocardial infarction and other complications of atherosclerosis, coronary heart disease remains the most common cause of death in our society. Arterial inflammation and endothelial dysfunction play central roles in the pathogenesis of atherosclerosis and adverse cardiovascular (CV) events. Therapeutic lifestyle changes in conjunction with an aggressive multidrug regimen targeted toward the normalization of the major CV risk factors will neutralize the atherogenic milieu, reduce vascular inflammation, and markedly decrease the risk of adverse CV events and need for revascularization procedures. Specific CV risk factors and optimal therapies for primary and secondary prevention are discussed.
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Mayo Clinic proceedings · Aug 2009
Comparative StudyDisease associations with monoclonal gammopathy of undetermined significance: a population-based study of 17,398 patients.
To systematically study the association of monoclonal gammopathy of undetermined significance (MGUS) with all diseases in a population-based cohort of 17,398 patients, all of whom were uniformly tested for the presence or absence of MGUS. ⋯ These results have major implications both for confirmed associations and for 61 diseases in which the association with MGUS is likely coincidental.