American journal of therapeutics
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Clinical trials have demonstrated the usefulness of antiplatelet agents, percutaneous coronary intervention, and glycoprotein (GP) IIb/IIIa inhibitors in patients with acute coronary syndrome (ACS) based on risk stratification. Studies like RITA 3 and FRISC II have shown that an early invasive strategy in high-risk patients was associated with lower mortality over the long term compared with conservative treatment. High-risk patients with unstable angina/non-ST-elevation myocardial infarction derive particular benefit from GP IIb/IIIa inhibitors and an early invasive strategy. ⋯ Increasing adherence to American College of Cardiology/American Heart Association guidelines is key to improving outcomes. The optimal management of patients with ACS continues to change as new therapies and strategies of care are developed and proven effective. The clinical challenge remains to increase physician adherence to evidence-based cardiac care for all patients.
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Surgical repair of pectus excavatum can be associated with significant postoperative pain. Various analgesic modalities have been suggested including thoracic epidural analgesia and intravenous patient-controlled analgesia (IV PCA). The current study compares the efficacy and adverse efficacy profile of these 2 analgesic modalities. ⋯ Epidural analgesia provided better pain control than the intravenous route for the management of patients after pectus excavatum repair. No adverse effects related to epidural analgesia were noted. The only issue identified with thoracic epidural anesthesia was a mean increase of 18 minutes for anesthesia time required for catheter placement before the start of the case.