The American journal of medicine
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Trends in the use of inferior vena cava (IVC) filters in patients with pulmonary embolism (PE) who are stratified according to whether they are stable or unstable (in shock or ventilator dependent) may show where improvements of management could be made according to the best evidence that we now have. ⋯ Mortality is markedly reduced in unstable patients who receive an IVC filter. Despite this, the proportion of unstable patients who receive an IVC filter is decreasing. The largest number of IVC filters continues to be inserted in stable patients, although there is no evidence of a clinically meaningful reduced mortality with IVC filters in stable patients unless age >80 years.
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Randomized Controlled Trial Multicenter Study Comparative Study
CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction.
The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. ⋯ A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction.
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Pain is often the initial complaint for which patients seek medical care, presenting both a diagnostic and therapeutic challenge to the primary care provider. The appreciation of pain is not merely the result of abnormal sensory stimulation causing an unpleasant sensation but rather a combination of the recognition of the somatic discomfort in association with an emotional response to that discomfort. ⋯ Chronic pain may be the result of an injury, irreversible underlying disease, or clinical conditions such as fibromyalgia for which the mechanism remains unclear. Treatment of the underlying cause will usually effect a resolution or improvement in the pain, but when the discomfort persists, a consultation with a neurologist or pain management specialist should be considered.