Articles: disease.
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Pol. Arch. Med. Wewn. · Sep 2024
Short- and long-term outcomes of mechanical thrombectomy in acute ischemic stroke patients with chronic kidney disease.
Chronic kidney disease (CKD) is a risk factor of acute ischemic stroke (AIS). Outcomes of treatment with mechanical thrombectomy (MT) in patients with CKD seem to be poorer than in the general population. Long‑term follow‑up studies are lacking. ⋯ MT outcomes in CKD patients are worse, especially in advanced stages of the disease, but CKD is not independently associated with poor prognosis. CKD alone should not be a contraindication for MT in otherwise eligible patients, although patients with impaired kidney function require more careful postprocedural monitoring.
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Since 2013, the American College of Cardiology (ACC) and American Heart Association (AHA) have recommended the pooled cohort equations (PCEs) for estimating the 10-year risk of atherosclerotic cardiovascular disease (ASCVD). An AHA scientific advisory group recently developed the Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations, which incorporated kidney measures, removed race as an input, and improved calibration in contemporary populations. PREVENT is known to produce ASCVD risk predictions that are lower than those produced by the PCEs, but the potential clinical implications have not been quantified. ⋯ By assigning lower ASCVD risk predictions, application of the PREVENT equations to existing treatment thresholds could reduce eligibility for statin and antihypertensive therapy among 15.8 million US adults.
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Cigarette smoking remains the leading cause of preventable disease and death in the United States. Brief discussions with doctors increase cessation rates by two-thirds, and physicians trained in smoking cessation are more likely to perform counseling. Multiple organizations also recommend connecting counseling with lung cancer screening (LCS), yet physicians and patients report a lack of such integration. We sought to characterize the education received and the barriers to providing smoking cessation counseling, and to determine its integration with LCS among military Family Medicine physicians. ⋯ Smoking cessation education is provided in family medicine residencies but rarely offered afterwards. Time and lack of support staff and resources are recognized as notable barriers within the military health care system. A large proportion of uniformed Family Medicine physicians also do not link LCS guidelines with patient education on tobacco cessation and resources. Further research is needed to guide interventions to overcome these challenges within the military health care system.