Articles: ninos.
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The first class at USUHS took its initial course in medical ethics in 1977. I directed this course until recently when COVID first emerged. In this piece, I review what these students were taught during the first 3 of 8 class sessions involving children, end-of-life care, and rersearch. This review provides readers with information regarding some of the faculty brought in to provide these lectures, and key points they emphasized. It also summarizes the more subtle points regarding ethics that it was hoped students would gain and use throughout their medical careers and lifetimes. ⋯ Medical ethics is now taught in all medical schools but at USUHS this education must include traditional core medical topics and military medical issues as well. A challenge posed throughout the course was whether to emphasize what ethical and professional behaviors would be expected of students in their later military careers or to challenge them to engage in original analysis of ethical questions that had no self-evident answers. The decision was made in most cases to encourage students to discuss and debate controversial issues in their discussion groups, especially since they would learn what was expected of them in their military roles from multiple other sources. The priming for these discussions in the presentations seemingly succeeded in engaging the students and in provoking relevant debate throughout all of these cases. This learning is highly important in that in the future in both medicine and the military new unanticipated ethical issues will continue to arise. Since there will be no self-evident best ethical answers to these issues, those tasked with and thus seeking to resolve them will have to depend on having the optimal ethical skills for approaching and resolving these issues. This course sought to initiate this process, engaging these students and moving them hopefully to want to increase their skills in analyzing ethical dilemmas as they continue to progress throughout their military careers.
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Both heart failure and type 2 diabetes are prevalent conditions and share similar pathogenesis, risk factors, and treatment medications. This review aims to inform clinical practice by summarizing the interaction between heart failure and type 2 diabetes, as well as the medications used to manage them. Novel medications such as Sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-likepeptide-1 receptor agonists, and finerenone have been shown to protect patients with type 2 diabetes from hospitalization for heart failure. ⋯ When choosing diabetes treatment medications for patients with heart failure and type 2 diabetes, shared decision-making can be helpful in weighing the benefits and harms based on individual scenarios. The selection of guideline-directed medical therapy aligns with patients without type 2 diabetes. Given the rapid evolution of knowledge in this field, clinicians need to stay updated with the latest evidence to provide optimal medical care.
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Takotsubo syndrome (TTS) is an acute reversible heart dysfunction affecting mostly post-menopausal women, frequently precipitated by a significant stressful event, presenting as an acute coronary syndrome (ACS) in the absence of obstructive coronary artery disease. The pathogenesis is not fully understood, but a close relationship between individual's mind, brain, neuroendocrine system and the heart may be involved in a mind-heart axis. The purpose of this study was to compare the prevalence of psychopathological findings in TTS patients as compared to healthy subjects, patients affected by psychiatric diseases and patients affected by ACS. ⋯ Psychosocial and psychopathological dimensions of TTS patients have been explored and analyzed in a cohort of TTS patients vs. ACS, healthy subjects and psychiatric patients, showing statistically significant differences among the various groups. Psychopathological symptoms were more frequent in TTS patients, suggesting an evident involvement of mind-heart axis in this disease. Future studies are needed to investigate the cause-effect relationship between psychopathological features and the occurrence of TTS.