Postgraduate medicine
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Postgraduate medicine · May 2024
ReviewNonobstructive epicardial coronary artery disease: an evolving concept in need of diagnostic and therapeutic guidance.
For decades, we have been treating patients presenting with angina and concerning electrocardiographic changes indicative of ischemia or injury, in whom no culprit epicardial coronary stenosis was found during diagnostic coronary angiography. Unfortunately, the clinical outcomes of these patients were not better than those with recognized obstructive coronary disease. Improvements in technology have allowed us to better characterize these patients. ⋯ Despite all the progress made regarding INOCA and MINOCA, many important knowledge gaps continue to exist. For the time being, prompt identification and early diagnosis remain crucial in managing these patients. Even though we are still not clear whether intensive medical therapy alters clinical outcomes, we remain vigilant and wait for more data.
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Postgraduate medicine · May 2024
ReviewMaking treatment guideline recommendations in chronic kidney disease and type 2 diabetes more accessible to primary care providers in the United States.
Clinical practice guidelines for the management of chronic kidney disease (CKD) associated with type 2 diabetes (T2D) are designed to assist healthcare professionals with clinical decision making by providing recommendations on the screening, detection, management, and treatment of these conditions. However, primary care practitioners (PCPs) may have clinical inertia when it comes to routinely enacting CKD and T2D guideline recommendations in their clinical practices. ⋯ In this review, we explore reasons behind the low level of awareness and poor uptake of published evidence-based care approaches to the optimal management of patients with T2D and CKD. Finally, we present suggestions on strategies to improve the implementation of guideline-directed recommendations in primary care.
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Postgraduate medicine · May 2024
Calcium deficiency is associated with malnutrition risk in patients with inflammatory bowel disease.
Patients with inflammatory bowel disease (IBD) often have the condition of malnutrition, which can be presented as sarcopenia, micronutrient deficiencies, etc. Trace elements (magnesium, calcium, iron, copper, zinc, plumbum and manganese) belonging to micronutrients, are greatly vital for the assessment of nutritional status in humans. Trace element deficiencies are also the main manifestation of malnutrition. Calcium (Ca) has been proved to play an important part in maintaining body homeostasis and regulating cellular function. However, there are still a lack of studies on the association between malnutrition and Ca deficiency in IBD. This research aimed to investigate the role of Ca for malnutrition in IBD patients. ⋯ In patients with IBD, Ca deficiency is an independent factor for high malnutrition risk.
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Over-testing and over-treatment are common in children with croup at pediatric emergency departments (PED). The objective of the study was to improve care for children with croup. ⋯ With this QI intervention, decreases in the rate of administration of NE to mild croup cases, antibiotic prescription, X-ray, laboratory blood and respiratory PCR panel tests in all croup cases were achieved without an increase in revisits. However, unnecessary NE, antibiotic, and X-ray rates are still high.
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Postgraduate medicine · May 2024
Recognizing cardiac murmurs in childhood: a survey of physicians' approaches and knowledge levels.
This study aimed to assess physicians' approach to cardiac murmurs and their level of knowledge about this sign, which is a crucial finding in childhood cardiac anomalies. ⋯ The study highlights the significant impact of various factors such as gender, specialization, internship duration, experience, and theoretical knowledge on the ability to recognize and approach cardiac murmurs. These findings underscore the importance of incorporating these factors into medical education and development programs, especially those aimed at improving cardiac examination skills.