The American journal of medicine
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Biography Historical Article
A white dean and black physicians at the epicenter of the civil rights movement.
Robert Q. Marston, MD, a gregarious Rhodes and Markel Scholar, native Virginian, and well-connected National Institutes of Health-trained medical scientist found himself the new dean and hospital director of a promising academic medical center at age 38. It was 1961 and the University of Mississippi Medical Center (UMMC) in Jackson was, unknown to him, about to be at the geographic center of the struggle for African American civil rights. ⋯ The desire of the black physicians to see UMMC become an equal opportunity health resource resulted in their quiet assistance that aided UMMC compliance initiatives and played a major role in the successful outcome of the 1965 investigation of the charges of Title VI violations. This success established Marston as a national figure in academic medicine and contributed to his selection for positions as Director of The National Institutes of Health and President of the University of Florida. As commemorations of the 50(th) anniversary of Freedom Summer of 1964 proceed, UMMC has become arguably the most racially integrated academic health center in the United States.
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Current guidelines strongly recommend that oral anticoagulation should be offered to patients with atrial fibrillation and ≥1 stroke risk factors. The guidelines also recommend that oral anticoagulation still should be used in the presence of stroke risk factors irrespective of rate or rhythm control. ⋯ The EURObservational Research Programme on Atrial Fibrillation Pilot Survey provides contemporary data on oral anticoagulation prescribing by European cardiologists for atrial fibrillation. Although the uptake of oral anticoagulation (mostly vitamin K antagonist therapy) has improved since the Euro Heart Survey a decade ago, antiplatelet therapy is still commonly prescribed, with or without oral anticoagulation, whereas elderly patients are commonly undertreated with oral anticoagulation.
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The placebo effect is defined as any improvement of symptoms or signs following a physically inert intervention. Its effects are especially profound in relieving subjective symptoms such as pain, fatigue, and depression. Present to a variable extent in all therapeutic encounters, this effect is intensified by hands-on contact with close verbal communication between caregiver and recipient. ⋯ Physicians must be skeptical about apparent "responses" to treatments, using the information described herein to better understand what we are-or are not-accomplishing to provide the best possible outcomes for our patients. Less well studied, the "nocebo effect" defines negative responses to placebo interventions. This latter effect may be quite profound and likely is causative in many maladies believed to have psychic origins.
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Multicenter Study Observational Study
Beta-blocker use in ST-segment elevation myocardial infarction in the reperfusion era (GRACE).
Current guidelines recommend early oral beta-blocker administration in the management of acute coronary syndromes for patients who are not at high risk of complications. ⋯ Early beta-blocker use is common in patients presenting with ST-elevation myocardial infarction, with oral administration being the most prevalent. Oral beta-blockers were associated with a decrease in the risk of cardiogenic shock, ventricular arrhythmias, and acute heart failure. However, the early receipt of any form of beta-blockers was associated with an increase in hospital mortality.