Postgraduate medicine
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Postgraduate medicine · Mar 2021
ReviewHeart failure with preserved ejection fraction: Disease burden for patients, caregivers, and the healthcare system.
Heart failure with preserved ejection fraction (HFpEF) will soon become the most prevalent form of HF because of an aging population and an accompanying increase in the number of risk factors for this disease. The high frequency of comorbidities typical of this population contributes to an increased risk for hospitalization and death. ⋯ Financial burden is associated with HFpEF, stemming from hospitalization and long-term care costs, as well as absenteeism from work in the case of caregivers. Early identification of patients at risk and aggressive management are key to preventing this disease and its progression.
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Postgraduate medicine · Mar 2021
Review Case ReportsExercise parameters for the chronic type B aortic dissection patient: a literature review and case report.
The conservative management of a Stanford type B aortic dissection (TBD) is optimal blood pressure management, cardiac rehabilitation, and progressive return to activities of daily living (ADL) while preventing advancing dissection and aortic dilation. Recent case reports indicate higher levels of activity may be safe; however, the exercise parameters for chronic TBD conditions span a broad range and the research is limited. ⋯ In conjunction with the appropriate anti-hypertensive medication treatment, understanding the concepts of aortic hemodynamics as they relate to exercise can serve as a guideline for clinicians in developing an individualized exercise program for their TBD patients. Moreover, these physical training programs may include particular exercise guidelines beyond general recommendations of light to moderate cardiovascular activities.
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Postgraduate medicine · Mar 2021
Communicating value to patients-a high value care communication skills curriculum.
With rising health care costs in the United States, trainees will be increasingly challenged in discussing testing stewardship with patients. ⋯ There was no difference in overall performance on the CARE empathy scale. Our HVC high-intensity skills curriculum was well received by interns and provided opportunities to practice structured conversations and debrief around testing stewardship.
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Postgraduate medicine · Mar 2021
Prevalence and associated factors of inter-arm blood pressure difference in Chinese community hypertensive population.
This study aimed to investigate the prevalence and associated factors of inter-arm blood pressure difference (IAD) in Chinese community hypertensive population. ⋯ The elevated prevalence of large IAD was shown in hypertensive population. Meanwhile, higher levels of SBP, triacylglycerol, total cholesterol, LDL-C, and lower eGFR were associated with higher sIAD.
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Postgraduate medicine · Mar 2021
Clinical effectiveness of a cardiology outpatient management plan to reduce inefficiency in consultations.
Objectives: Longer delays in carrying out complementary tests in cardiology services have resulted in patients arriving for consultation without these tests being performed (inefficient consultations). To ameliorate this situation, a management-based intervention was designed, optimizing the available resources and modifying the appointment system. Therefore, our objective was to determine the effectiveness of this intervention to reduce the number of inefficient consultations and improve the clinical care process. ⋯ When the patients had all the tests completed, there was an increase in the number of new examinations (p < 0.001), outpatient discharges (p < 0.001) and new diagnoses (p = 0.004). Treatment modifications were not significant (p = 0.223). Conclusions: The intervention proved effective, clinically relevant, and statistically significant in reducing the proportion of inefficient consultations, thereby enabling continuation of the clinical care process.