ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Insulin resistance is characterized by impaired responsiveness to endogenous or exogenous insulin. Loss of responsiveness is associated with a “clustering” of cardiovascular risk factors that includes abdominal obesity, hypertension, dyslipidemia, glucose intolerance, and hyperinsulinemia; this association is referred to as the insulin resistance syndrome (IRS).Methods.We searched MEDLINE, using the term insulin resistance, and reviewed relevant publications.Results.We review the mechanisms and clinical consequences attributed to IRS, along with patient assessment and treatment options.Conclusions.It is possible to improve insulin sensitivity by caloric restriction, weight loss, exercise, and drug therapy. Metformin and troglitazone, approved for use in the treatment of type 2 diabetes mellitus (DM), improve insulin sensitivity and lower plasma glucose concentrations. Several other medications that may improve insulin sensitivity are currently under clinical investigation. Studies are needed to determine the effect of these medications on morbidity and mortality of patients with insulin resistance and type 2 DM.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.With advances in computer technology and mounting pressure to cut health care costs, there is a desire to automate clinical and patient records.Methods.We reviewed the barriers that hindered automation in the past, changes in the business environment, and the recent developments that could encourage automation, including the enactment of the Health Insurance Portability and Accountability Act (HIPAA).Results.Although conditions for automation have improved, significant barriers remain, including variation in state laws, lack of comprehensive data to assure return on automation investment, and most importantly, lack of clinical data and record‐keeping standards.Conclusions.Congress needs to enact HIPAA follow‐up legislation that addresses the legal and standards issues. To minimize the risks for automation, institutions are advised to take a buy‐a‐little, test‐a‐little, and fix‐a‐little approach.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Coronary heart disease (CHD), the leading cause of death in the United States, accounted for approximately 490,000 deaths in 1993. Angina pectoris, a manifestation of CHD, accounted for 13,586 Medicare discharges in 1993 in Texas. A pilot project showed aspirin prophylaxis that reduces cardiovascular morbidity and mortality in individuals with acute angina is underused. Texas Medical Foundation collaborated with 10 acute‐care facilities to improve aspirin prophylaxis.Methods.Collaborators assessed processes of care and implemented clinical pathways to improve aspirin administration. Data were abstracted from medical records before and after pathway implementation to evaluate impact.Results.Aspirin administration during hospital stay increased 10.8%, aspirin administration on discharge increased 11.7%, and average time from arrival to aspirin administration decreased 2.9 hours.Conclusions.Results suggest collaborator‐implemented clinical pathways significantly improved care received by Medicare patients admitted for cardiac‐related acute chest pain/angina. Data suggest room for further improvement.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Differences in risk factor prevalence and distribution of atherosclerotic cerebrovascular disease have been reported among different racial‐ethnic groups. Identification of stroke syndromes and risk factors specific to the Puerto Rican male population should lead to more effective diagnosis, treatment, and prevention programs.Methods.We prospectively and consecutively evaluated 118 Hispanic male veterans admitted to our Stroke Unit from June 1994 to September 1995.Results.Ninety patients (76%) had an ischemic infarct, 26 (22%) had a transient ischemic attack, and 2 (2%) had an intracerebral and/or subarachnoid hemorrhage. Hypertension was the most common risk factor. Echocardiographic studies were done in 64% of the patients, and the most common findings were concentric left ventricular hypertrophy and diastolic dysfunction. Cerebral angiography was done in 40 cases, and findings were abnormal in 32 (80%).Conclusions.We believe this is the largest descriptive study of Hispanic male veterans with stroke syndromes. It provides baseline data to serve as a comparison group for future research.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.In recent years, mitral valve reconstructive techniques have become an increasingly preferential alternative to replacement. The purpose of this study was to evaluate short‐term and long‐term outcomes associated with mitral valve repair.Methods.This study involved 99 patients who had mitral valve repair for mitral regurgitation from January 1990 to June 1996. Short‐term and long‐term outcomes evaluated included mortality, clinical complications, readmissions, valve deterioration, reoperation, thromboembolism, endocarditis, functional heart class, and health perception.Results.Overall mortality was 18%, which included 11 operative deaths and 7 late deaths. Ischemic valve disease and NYHA class III and IV were significant predictors of early and late mortality. Overall 5‐year survival was 79%. Freedom from all valve‐related morbid events was 90% at 5 years.Conclusions.Functional heart class and etiology of valve disease are the most important indicators of overall survival and morbidity. Transesophageal echocardiography should be used to evaluate the adequacy of repair.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.The appendix may be an immune modulator of the gut, and its absence may lead to an increase in gastrointestinal illnesses. If this is true, we may expect patients needing endoscopy to have a higher prevalence of previous appendectomy.Methods.We did a case‐control study at the University of Oklahoma Hospital for 13 months. Subjects having endoscopic evaluation at the University of Oklahoma Hospital formed the study group. Patients seen at the general medicine clinic of the University of Oklahoma served as controls. We recorded the patient's name, age, sex, race, history of smoking, and history of appendectomy or tonsillectomy.Results.The endoscopy group had 524 patients; 469 patients were in the control group. There were no differences based on race or history of smoking. There was greater prevalence of previous appendectomy in the endoscopy group (33.46% vs 20.55%). The prevalence of tonsillectomy was 29.28% in the study group vs 21.61% among the controls. Multiple regression revealed that history of appendectomy and not tonsillectomy was related to the performance of endoscopy.Conclusion.History of appendectomy is associated with greater performance of endoscopy.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Gastrointestinal (GI) bleeding remains a common medical condition, with a mortality rate believed to have remained unchanged over the past five decades.Methods.Over a 50‐month period, the gastroenterology consultative service at a large inner‐city hospital prospectively evaluated acute upper GI (UGI) bleeding or lower GI (LGI) bleeding in consecutive patients. A number of clinical variables were recorded at admission on a standardized data collection form. The cause of bleeding was determined in most patients by endoscopic examination.Results.Of the 796 patients assessed for UGI bleeding, 727 (91%) had upper endoscopy. The most common causes of UGI bleeding were gastric ulcer (32%), duodenal ulcer (28%), esophageal varices (9%), and Mallory‐Weiss tear (6%). The rebleeding rate was 14% and 20% of patients had endoscopic therapy. Surgical therapy for bleeding was required in 7% of patients. Of the 165 patients assessed for LGI bleeding, 150 (91%) had colonoscopy. Colonic diverticulosis was considered etiologic in 56% of patients, followed by colonic ulcers in 10%, carcinoma in 7%, and vascular ectasias in 5%. The rebleeding rate in these patients was 20%, and surgical therapy for bleeding was required in 10%. The overall mortality for patients with UGI bleeding was 9% and was independently associated with portal hypertension and rebleeding. In contrast, the mortality rate for LGI bleeding was 4%, and there was little power to determine significant factors associated with death.Conclusions.The causes of gastrointestinal bleeding remain little changed over the past several decades, though in our large series the need for surgical therapy and the mortality from both upper and lower GI bleeding were low.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.In the 1980s, Tennessee ranked among the top 10 states in per capita consumption of several controlled substances. We describe efforts designed to reduce non‐criminally motivated misprescribing in Tennessee, present Tennessee's recent Drug Enforcement Administration (DEA) rankings, and suggest how physicians may reduce misprescribing.Methods.Tennessee's Board of Medical Examiners (BME) consults with Tennessee Physician Health Program (PHP) and refers selected physicians to a continuing medical education (CME) program offered at Vanderbilt University School of Medicine. The BME has also published a clear set of prescribing guidelines.Results.Of more than 160 CME participants, only two have reappeared before the BME for prescribing infractions. Tennessee's overall DEA ranking improved from 7th highest to 17th from 1994 to 1997.Conclusions.The reasons the rankings improved cannot be established, but the changes occurred at the same time as the BME, PHP, and Vanderbilt CME collaborations. We will continue to promote professional and patient health throughout the region.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

&NA;DisseminatedAcanthamoebainfections are almost invariably fatal, with no universally accepted standard for treatment. Reports of acanthamoebiasis in non‐human‐immunodeficiency‐virus infected hosts are rare. We successfully treated a lung transplant patient who had disseminated acanthamoebiasis using a combination of pentamidine, 5‐fluorocytosine, itraconazole, and topical chlorhexidine gluconate/ketoconazole cream.

ISSN:0038-4348    

出版商:OVID    

年代:1999

数据来源: OVID