The American journal of the medical sciences
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Review
Preventing Hospitalizations From Acute Exacerbations of Chronic Obstructive Pulmonary Disease.
Chronic obstructive lung disease is among the leading causes of adult hospital admissions and readmissions in the United States. Preventing acute exacerbations is the primary approach in therapy. Combinations of smoking cessation, pulmonary rehabilitation, vaccinations and inhaled and oral medications may all reduce the overall risk of acute exacerbations. ⋯ In the patient who does not require mechanical ventilation or who manifests respiratory acidosis, oxygen supplementation, frequent short-acting inhaled bronchodilators, oral corticosteroids and often antibiotics can abort the decompensation and sometimes return the patient to his or her pre-attack baseline lung function. Several models exist for delivering this care in the ambulatory setting. Follow-up care after an exacerbation has resolved is important, though there are few hard data suggesting which approach is best in this setting.
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Randomized Controlled Trial
Telemedicine in the Management of Type 2 Diabetes Mellitus.
To explore a model of Internet-based integrated management of diabetes, we established a remote diabetes medical service platform (U-Healthcare) and evaluated its effectiveness and practicality. ⋯ The Internet-based U-Healthcare system of integrated management in diabetes not only achieved better glycemic control, effectively improved HbA1c levels and decreased triglyceride levels but also enhanced patients' adherence to the medical team's instructions.
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Extreme obesity may hamper successful peritoneal dialysis (PD) delivery. Among our PD patients, we have identified 15 markedly obese (class 2-3 obesity: body mass index [BMI] ≥35kg/m2) and 20 lean (BMI: 20-25kg/m2) dialysis patients and reviewed multiple clinical, laboratory and dialysis-related parameters. Extreme outliers of obesity (BMI > 40; 6 subjects) received detailed review. ⋯ Serum albumin, calcium, phosphorus, hemoglobin and parathyroid hormone levels did not differ, either. Analogous results have been obtained for extremely obese subjects (BMI 44.3 ± 4.2kg/m2; range: 40.2-51.6). Our study shows only limited effect of class ≥2 obesity for successful PD in this predominantly African American cohort.