Mayo Clinic proceedings
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Mayo Clinic proceedings · Dec 2014
ReviewWhat clinicians should know about the 2014 Ebola outbreak.
The ongoing Ebola outbreak that began in Guinea in February 2014 has spread to Liberia, Sierra Leone, Nigeria, Senegal, Spain, and the United States and has become the largest Ebola outbreak in recorded history. It is important for frontline medical providers to understand key aspects of Ebola virus disease (EVD) to quickly recognize an imported case, provide appropriate medical care, and prevent transmission. Furthermore, an understanding of the clinical presentation, clinical course, transmission, and prevention of EVD can help reduce anxiety about the disease and allow health care providers to calmly and confidently provide medical care to patients suspected of having EVD.
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Mayo Clinic proceedings · Dec 2014
Mitigating the safety risks of drugs with a focus on opioids: are risk evaluation and mitigation strategies the answer?
Approximately 40% of all newly approved drugs are subject to safety restrictions inclusive of Risk Evaluation and Mitigation Strategies (REMS), which were created with the US Food and Drug Administration Amendments Act of 2007. This law expanded Food and Drug Administration (FDA) authority to require REMS of manufacturers but left implementation to the FDA. ⋯ So, are REMS, which were conceived as a tool to improve medication safety, working? Specifically, are REMS achieving their intended outcomes (mitigating safety risks of effective drugs) without causing unintended consequences (creating a burden to the health care system and physicians and/or diminishing patient access to drugs)? Sitting squarely in the crosshairs, the approved shared REMS for extended-release/long-acting opioid analgesics provide a lens through which this question can be examined. This article discusses the current status, stakeholders, and key policy issues for clinicians with a focus on the shared REMS for opioids, as well as the anticipated role of clinicians in optimizing patient care in the new world of REMS.
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Mayo Clinic proceedings · Dec 2014
Review Meta Analysis Comparative StudyComparative efficacy of biologic therapy in biologic-naïve patients with Crohn disease: a systematic review and network meta-analysis.
To study the comparative efficacy of biologic therapy in the management of biologic-naïve patients with Crohn disease (CD). ⋯ On the basis of network meta-analysis, IFX may be most efficacious agent for inducing remission in CD in biologic-naïve patients. In the absence of head-to-head treatment comparison, the confidence in these estimates is low. Future comparative efficacy studies are warranted.
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Mayo Clinic proceedings · Dec 2014
ReviewNonsteroidal anti-inflammatory drugs, proton pump inhibitors, and gastrointestinal injury: contrasting interactions in the stomach and small intestine.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors (PPIs) are among the most frequently prescribed groups of drugs worldwide. The use of NSAIDs is associated with a high number of significant adverse effects. Recently, the safety of PPIs has also been challenged. ⋯ PubMed was searched using the following key words (each key word alone and in combination): gut microbiota, microbiome, non-steroidal anti inflammatory drugs, proton pump inhibitors, enteropathy, probiotic, antibiotic, mucosal injury, enteroscopy, and capsule endoscopy. Google engine search was also carried out to identify additional relevant articles. Both original and review articles published in English were reviewed.
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Mayo Clinic proceedings · Dec 2014
ReviewSudden cardiac death from the perspective of coronary artery disease.
Sudden cardiac death accounts for approximately 50% of all deaths attributed to cardiovascular disease in the United States. It is most commonly associated with coronary artery disease and can be its initial manifestation or may occur in the period after an acute myocardial infarction. ⋯ Searches were enhanced by scanning bibliographies of identified articles, and those deemed relevant were selected for full-text review. This review outlines various mechanisms for sudden cardiac death in the setting of coronary artery disease, describes risk factors for sudden cardiac death, explores the management of cardiac arrest, and outlines optimal practice for the monitoring and treatment of patients after an acute ST-segment elevation myocardial infarction to decrease the risk of sudden death.