The Netherlands journal of medicine
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Review Case Reports
Diagnostic and (new) therapeutic options for resistant hypertension: a short review.
Hypertension is a major risk factor for ischaemic heart disease and stroke. Despite the availability of numerous pharmacological treatment options, blood pressure (BP) targets are often not achieved. The inability to reach BP levels below 140/90 mmHg despite the use of three or more antihypertensive drugs is defined as resistant hypertension (RH). ⋯ First, BP should be appropriately measured. In order to improve BP control, lifestyle modification should be recommended, adherence should be carefully assessed to exclude pseudo-resistance, and efforts should be made to exclude secondary causes of hypertension before initiating new drugs or considering device-based treatment strategies. This short review will highlight several aspects of RH management along with a focus on several new treatment options. act available.
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To review the procedural diagnosis of male breast cancer. ⋯ Most of the diagnosed cases are advanced stage ductal invasive carcinomas, express hormone receptors in the great majority, and are less likely to over-express HER2-neu. They present usually as a painless retroareolar mass that requires triple assessment. The diagnosis needs a high index of suspicion primarily due to the unawareness of such a cancer in males.
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Monitoring low-molecular-weight heparins is generally not required. However, guidelines advise to monitor anti-Xa levels in patients with renal insufficiency or a BMI above 50, and in pregnancy. Measuring anti-Xa levels is a complex challenge since sampling should be performed three to five hours after subcutaneous injection and after steady state concentrations have been reached. Strict compliance is pivotal for justified dose adjustments. ⋯ Monitoring anti-Xa levels is a complex clinical challenge. This study showed that non-compliance with recommendations for anti-Xa monitoring was high, often resulting in unjustified dose adjustments.
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Comparative Study
Physician race and specialty influence Press Ganey survey results.
The Press Ganey survey is widely used to evaluate physician and institution quality and performance, with some institutions making their survey results publicly available. However, given its subjective nature, the survey results may be subject to bias regarding physician characteristics, such as race, sex, and specialty, that are unrelated to competence. The goal of this study was to determine if and what physician characteristics influence Press Ganey results. ⋯ These results suggest that physician race and specialty choice impact Press Ganey results. Given that neither race nor specialty influence physician competence, this data suggests that the Press Ganey survey is a biased measure of physician quality and should not be used to evaluate physician skill or ability.
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Acute withdrawal of calcium channel blockers can lead to the so-called calcium channel blocker withdrawal phenomenon, in particular, when high dosages are used. In the case presented, inadequate drug substitution led to this phenomenon which resulted in a serious course of events. Careful monitoring the process of drug substitution with respect to equal therapeutic dosages is therefore a necessity, especially in vulnerable patients.