Mayo Clinic proceedings
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Mayo Clinic proceedings · Sep 2020
ReviewPrevention, Diagnosis, and Management of Chronic Wounds in Older Adults.
Chronic wounds are common, disproportionately affect older adults, and are likely to be encountered by providers across all specialties and care settings. All providers should be familiar with basic wound prevention, identification, classification, and treatment approach, all of which are outlined in this article.
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Mayo Clinic proceedings · Sep 2020
ReviewA Review of Hypertension Management in Black Male Patients.
Hypertension affects approximately 85 million Americans, or almost 1 in 3 adults. Black men have disproportionately higher rates of hypertension and are more likely to experience complications of hypertension, including stroke, myocardial infarction, and death. In addition, hypertensive black men are less likely to achieve optimal blood pressure (BP) than women and persons of other races. ⋯ Subsequent findings indicated that targeted identification (ie, barbershops), medication management, and close follow-up resulted in greater control of BP. Also, a reduction of systolic blood pressure greater than 20 mm Hg occurred with the use of pharmacists following algorithms specifically for the management of hypertension in black men. Continued emphasis to identify strategies to improve control of BP and outcomes in this population is needed.
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Mayo Clinic proceedings · Sep 2020
ReviewEvidenced-Based Pharmacotherapies for Alcohol Use Disorder: Clinical Pearls.
Pathologic alcohol use affects more than 2 billion people and accounts for nearly 6% of all deaths worldwide. There are three medications approved for the treatment of alcohol use disorder by the US Food and Drug Administration (FDA): disulfiram, naltrexone (oral and long-acting injectable), and acamprosate. Of growing interest is the use of anticonvulsants for the treatment of alcohol use disorder, although currently none are FDA approved for this indication. ⋯ Despite effective pharmacotherapies, less than 9% of patients who undergo any form of alcohol use disorder treatment receive pharmacotherapies. Current evidence does not support the use of pharmacogenetic testing for treatment individualization. The objective of this review is to provide knowledge on practice parameters for evidenced-based pharmacologic treatment approaches in patients with alcohol use disorder.
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Mayo Clinic proceedings · Sep 2020
ReviewCerebral Cavernous Malformation: What a Practicing Clinician Should Know.
Cavernous malformations (CMs) are angiographically occult, low-flow vascular malformations of the central nervous system. They are acquired lesions, with approximately 80% of patients having the sporadic form and 20% the familial form of the disease. The lesions may also develop years after radiotherapy. ⋯ Research aimed at understanding the genes and signaling pathways related to CMs have provided potential drug targets, and clinical trials are underway to determine whether medications reduce the risk of future bleeding without surgery or modify the disease course. In addition, recent epidemiologic data have aided practitioners in determining how to treat comorbid conditions in patients with a potentially hemorrhagic lesion. This review provides an overview of the epidemiology, presentation, and clinical management of CMs.
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Pulmonary hypertension (PH) is classified into 5 clinical subgroups: pulmonary arterial hypertension (PAH), PH due to left-sided heart disease, PH due to chronic lung disease, chronic thromboembolic PH (CTEPH), and PH with an unclear and/or multifactorial mechanisms. A range of underlying conditions can lead to these disorders. Overall, PH affects approximately 1% of the global population, and over half of patients with heart failure may be affected. ⋯ Targeted treatments (phosphodiesterase type 5 inhibitors, soluble guanylate cyclase stimulators, endothelin receptor antagonists, prostacyclin analogues, and prostacyclin receptor agonists) are licensed for patients with PAH. The soluble guanylate cyclase stimulator riociguat is the only licensed targeted therapy for patients with inoperable or persistent/recurrent CTEPH. Management of PH resulting from left-sided heart disease primarily involves treatment of the underlying condition.