Clinical cornerstone
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Clinical cornerstone · Jan 2009
Treatment of overweight and obesity: lifestyle, pharmacologic, and surgical options.
Recent statistics indicate that overweight and obesity have become an increasingly serious clinical and socioeconomic problem worldwide, and one of the greatest public health challenges of our time. In the United States, 133.6 million (66%) adults are overweight or obese (body mass index [BMI] >/=25 kg/m(2)), with 63.3 million (31.4%) considered to be obese (BMI >/=30 kg/m(2)). The International Obesity Task Force estimates that worldwide at least 1.1 billion adults are overweight, including 312 million who are obese. ⋯ However, patients who choose adjunctive pharmacotherapy should be advised of the risks and benefits of drug therapy, the lack of long-term safety data, and the temporary and modest nature of the weight loss that can be achieved with these agents. Bariatric surgery is an effective treatment option for morbidly obese patients or obese patients with multiple comorbidities who have not been successful in achieving sufficient weight loss with nonsurgical approaches. However, appropriate candidates for bariatric surgery must also be committed to long-term lifestyle changes.
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Clinical cornerstone · Jan 2009
From the page to the clinic: Implementing new National Asthma Education and Prevention Program guidelines.
The National Asthma Education and Prevention Program's (NAEPP) revised guidelines, the Expert Panel Report 3 (EPR-3), published in 2007, represents a shift in the approach to asthma: the EPR-3 recommends that clinicians think of asthma as a chronic disease with an inflammatory basis. EPR-3 guidelines also represent a shift in the treatment paradigm for asthma in line with the shift in approach: although symptomatic relief is still necessary, the primary goal of asthma treatment is now long-term control, with the aim of minimizing exacerbation frequency and severity and limiting possible permanent airway damage that can result from frequent asthma exacerbations. To help clinicians implement the new EPR-3 guidelines into daily practice, the NAEPP's Guidelines Implementation Panel has identified 6 key action-focused recommendations. This article describes those recommendations and the evidence supporting them.
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Clinical cornerstone · Jan 2007
ReviewIdentification and treatment of prediabetes to prevent progression to type 2 diabetes.
Overt type 2 diabetes is usually preceded by a condition known as prediabetes, which is characterized by impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Both IFG and IGT exhibit elevated glucose levels that are not sufficient to be classified as diabetes but that represent the development of insulin resistance. Achieving glycemic control in patients with prediabetes through lifestyle and pharmacologic interventions can effectively prevent or delay the development of diabetes and its associated complications. ⋯ Although patients can be identified with an oral glucose tolerance test (OGTT) or a fasting plasma glucose (FPG) screening, a normal FPG does not preclude an elevated OGTT and, therefore, the presence of prediabetes. For patients who progress to type 2 diabetes, intensive therapy aimed at reducing and maintaining glycosylated hemoglobin (A1C) levels <7% has been shown to reduce the risk of complications. An A1C level > or =7% should signal the need to initiate or change therapy to achieve glycemic goals.
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Clinical cornerstone · Jan 2005
ReviewVenous thromboembolism prophylaxis guidelines: use by primary care physicians.
Venous thromboembolism (VTE), a prevalent, costly medical condition, is one of the most common causes of death in the United States. Although risk factors for VTE are well known, thromboembolic events cannot be predicted because patients are asymptomatic and screening methods have limitations. Anticoagulant therapy (eg, low-molecular-weight heparin, unfractionated heparin, selective factor Xa inhibitors) has proved effective for preventing thromboembolism, including deep vein thrombosis and pulmonary embolism. ⋯ Both primary and secondary prevention of VTE remain inadequate for several reasons, including lack of awareness of the American College of Chest Physicians guidelines, of the seriousness of VTE, of the benefits of prophylaxis, and of the relatively low risk of bleeding complications. To provide appropriate treatment, physicians must assess the numbers and types of risk factors for each patient, the underlying illness or surgical procedure, and the benefits and risks of possible therapies. The problem of VTE will grow as the US population ages, as surgery is performed on increasingly sick patients, and as the length of hospital stays continues to decrease.
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Clinical cornerstone · Jan 2005
ReviewVenous thromboembolism in medically ill patients: identifying risk and strategies for prevention.
Venous thromboembolism (VTE) is a condition that has multiple causes but few warning signs. Consequently, the 2 manifestations of VTE-pulmonary embolism and deep vein thrombosis-often go unpredicted. This is especially true for medical patients. ⋯ These patients are at significant risk of VTE and require prophylaxis, an objective that is supported by the recent guidelines of the American College of Chest Physicians. In addition, several lines of clinical evidence support the use of prophylaxis in this subgroup of patients. Improved systems are needed in medically ill patients to help improve outcomes and compliance for the use of VTE prophylaxis.