Clinical cornerstone最新文献

{"title":"Case Study","authors":"Martin Quan MD","doi":"10.1016/S1098-3597(09)60017-X","DOIUrl":"10.1016/S1098-3597(09)60017-X","url":null,"abstract":"","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 ","pages":"Pages S34-S35"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)60017-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28146488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Management and Treatment of Hypertension","authors":"F. Wilford Germino MD","doi":"10.1016/S1098-3597(09)60016-8","DOIUrl":"10.1016/S1098-3597(09)60016-8","url":null,"abstract":"<div><p><span><span><span><span>High blood pressure (HBP) is one of the most prevalent conditions seen today by clinicians, affecting an estimated 73 million–or 1 in 3—adult Americans, only one third of whom have achieved control of their hypertension (HBP). Central to the management of this pervasive medical condition are the issues of accurate diagnosis and maintaining control through appropriate treatment. Accurate diagnosis depends primarily on reliable measurement. Over the years, it has become increasingly recognized that blood pressure (BP) measurement occurring in clinical settings produces far less accurate and reliable readings than do other methods, notably 24-hour </span>ambulatory BP monitoring and home BP measurement. Beyond technique, there are additional challenges to obtaining accurate readings, including emotional factors that produce either falsely elevated or lowered results, having the potential to mislead the clinician. The need to overcome obstacles to proper diagnosis and determine effective treatments has reached heightened urgency, especially for patients with compelling comorbidities such as diabetes, </span>renal disease<span><span>, congestive heart failure, and other cardiovascular diseases. The continuing evolution of the management of HBP is reflected in updated guidelines from the American Heart Association and evidence-based information stemming from recent studies and </span>randomized clinical trials. The appropriate selection of </span></span>antihypertensive agents, at the proper doses, is a complex issue requiring greater understanding of our pharmacologic options. The contributions of some of the more recent and salient studies and trials are mentioned here, although there is no attempt in this brief review to match </span>drug<span><span> classes with compelling indications. The trials discussed involve such pharmacologic treatments as diuretic therapy<span><span>, α-blockers, conventional β-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and </span>angiotensin receptor blockers. Trial outcomes shed light on the relative benefits and drawbacks of these agents, often within the context of various </span></span>patient characteristics such as age, comorbidities, and risk status. Successful management of HBP is a multi-faceted and ongoing endeavor, in which developing knowledge constantly tempered by new questions moves us toward the goal of improving the lives of our patients.</span></p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 ","pages":"Pages S27-S33"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)60016-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28146486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From the page to the clinic: Implementing new National Asthma Education and Prevention Program guidelines","authors":"Gary S. Rachelefsky MD (Director Executive Center for Allergy, Asthma, and Respiratory Disease Professor)","doi":"10.1016/S1098-3597(09)80008-2","DOIUrl":"10.1016/S1098-3597(09)80008-2","url":null,"abstract":"<div><p>The National Asthma Education and Prevention Program's (NAEPP) revised guidelines, the <em>Expert Panel Report 3</em> (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.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 3","pages":"Pages 9-19"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)80008-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40036524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical importance of identifying immunoglobulin E-mediated disease in patients with Asthma","authors":"Thomas B. Casale MD (Vice President, Respiratory & Allergic Disease Foundation Executive Vice President, American Academy of Allergy, Asthma, and Immunology Professor of Medicine Chief),&nbsp;Richard J. Martin MD","doi":"10.1016/S1098-3597(09)80009-4","DOIUrl":"10.1016/S1098-3597(09)80009-4","url":null,"abstract":"<div><p>The strong association between allergy and asthma is well documented; however, few practitioners—even asthma specialists—accurately estimate the percentage of patients with asthma who have clinically relevant allergies. Because allergen exposure can prompt airway inflammation, trigger asthma exacerbations, and possibly lead to negative health outcomes for patients with asthma, identifying allergies and immunoglobulin E (IgE)-mediated disease in patients with persistent asthma is crucial. Updated Expert Panel 3 asthma guidelines from the National Asthma Education and Prevention Program reinforce the need for clinicians to identify allergic sensitivities in patients with persistent asthma and determine their clinical relevance. Allergy testing can be useful in educating the patient with IgE-mediated asthma about the need for allergic trigger avoidance and can help determine optimal therapy for patients with concomitant asthma and allergy. Implementing this guideline recommendation, however, requires active clinical engagement. Data from a recent observational study indicate that there may be a substantial gap between guideline recommendations and actual clinical practice. These data also suggest that when clinicians participate in education about the role of IgE in asthma and begin testing their patients for allergy, the recognition of allergies among patients with asthma dramatically increases.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 3","pages":"Pages 20-29"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)80009-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40036525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using long-acting β2-agonists safely: What will be the impact of the US Food and Drug Administration's panel recommendations?","authors":"Brian A. Smart MD","doi":"10.1016/S1098-3597(09)80011-2","DOIUrl":"https://doi.org/10.1016/S1098-3597(09)80011-2","url":null,"abstract":"<div><p>The US Food and Drug Administration (FDA) has launched an investigation into the safety of long-acting β₂-agonists (LABAs). While the impact of this investigation is yet to be seen, clinicians should be circumspect in the use of these agents and prescribe them according to the recommendations of current asthma guidelines, informing patients and their caretakers about potential risks.</p><p>As clinical trials attempt to address the question of whether LABAs are safe for use in pediatric and adult populations, current data provide no clear answers. A special hearing of the FDA's Pulmonary-Allergy Drugs Advisory Committee, Drug Safety and Risk Management Advisory Committee, and Pediatric Advisory Committee attempted to seek consensus on the matter as it reviewed the results of controlled clinical trials and conducted a benefit:risk assessment of LABAs to make recommendations on their safety.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 3","pages":"Pages 40-44"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)80011-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90002281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhaled anticholinergics and the long-term treatment of chronic obstructive pulmonary disease: Weighing benefits and risks","authors":"D. Kyle Hogarth MD, FCCP (Assistant Professor of Medicine Director),&nbsp;Terry A. Jacobson MD, FACP, FAHA (Professor, Department of Medicine Director)","doi":"10.1016/S1098-3597(09)80012-4","DOIUrl":"10.1016/S1098-3597(09)80012-4","url":null,"abstract":"<div><p>A meta-analysis recently published in the <em>Journal of the American Medical Association</em> found an increased risk of nonfatal myocardial infarction, stroke, and cardiovascular death associated with inhaled anticholinergic use in patients with chronic obstructive pulmonary disease (COPD); however, inherent limitations in the meta-analysis and contradictory results from other studies cast uncertainty onto its conclusions. For example, the Understanding Potential Long-term Impacts on Function with Tiotropium trial, a large, prospective, 4-year outcome study in nearly 6000 patients with COPD, did not demonstrate an increase in cardiovascular events with anticholinergic therapy. Until more data are available, clinicians should always carefully weigh safety and efficacy data and help patients make informed decisions about their COPD care.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 3","pages":"Pages 45-49"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(09)80012-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40035974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Endocannabinoid System as a Target for Obesity Treatment","authors":"Louis J. Aronne MD ,&nbsp;Uberto Pagotto MD, PhD ,&nbsp;Gary D. Foster PhD ,&nbsp;Stephen N. Davis MD, FRCP","doi":"10.1016/S1098-3597(08)60028-9","DOIUrl":"10.1016/S1098-3597(08)60028-9","url":null,"abstract":"<div><p><span>Overweight and obesity are major factors contributing to the development of type 2 diabetes mellitus (DM) and cardiovascular disease (CVD). In addition to the many physical and metabolic consequences of obesity, there are also mental health consequences, in particular, the risk for depression. Depression can lead to poor self-care, poor treatment compliance, and possible increased morbidity and mortality from such illnesses as type 2 DM and CVD. Lifestyle modification for the treatment of overweight and obesity is rarely successful over the long term, and use of surgery is limited by eligibility criteria; therefore, researchers and clinicians continue to explore pharmacotherapy, with intense efforts being directed toward the development of agents that, optimally, will reduce weight and simultaneously reduce or eliminate modifiable cardiovascular and metabolic risk factors. Among the promising new agents are the CB</span>₁<span><span> receptor antagonists. These agents target receptors of the endocannabinoid system, a neuromodulatory system recently found to influence energy balance, </span>eating behavior<span>, and metabolic homeostasis via central and peripheral mechanisms. In animal and clinical studies, antagonism of CB</span></span>₁<span><span> receptors has resulted in meaningful weight loss and improvement of lipid and glycemic profiles. Thus, these agents may provide a rational and effective approach for the management of not only overweight and obesity but also their metabolic and cardiovascular </span>sequelae.</span></p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 1","pages":"Pages 52-66"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(08)60028-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27870645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CME test answer sheet and evaluation form for therapeutic options for cardiometabolic risk factors","authors":"","doi":"10.1016/S1098-3597(08)80007-5","DOIUrl":"https://doi.org/10.1016/S1098-3597(08)80007-5","url":null,"abstract":"","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 ","pages":"Pages S43-S44"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(08)80007-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138289140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive clinical assessment of modifiable cardiometabolic risk factors","authors":"Richard W. Nesto MD","doi":"10.1016/S1098-3597(08)80003-8","DOIUrl":"10.1016/S1098-3597(08)80003-8","url":null,"abstract":"<div><p>Cardiovascular disease (CVD) is associated with significant morbidity and mortality. Some of the risk factors for CVD are unmodifiable such as male gender, family history, race, and increasing age. There are, however, several modifiable risk factors for CVD, including tobacco use, hypertension, obesity, diabetes, physical inactivity, and dyslipidemia. Patients' overall or global risk of CVD, which takes into account the presence or absence of both modifiable and unmodifiable risk factors, should be determined periodically. Patients found to be at increased risk due to the presence of modifiable risk factors should be counseled on how to make lifestyle changes and thereby decrease their risk of developing CVD. Weight loss and increased physical activity have a positive effect on most of the modifiable risk factors. Some patients, however, will also require pharmaco-therapy to address such risk factors as hypertension, obesity, diabetes, and dyslipidemia.</p></div>","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"9 ","pages":"Pages S9-S19"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(08)80003-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"56553760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CME test questions","authors":"","doi":"10.1016/S1098-3597(08)80016-6","DOIUrl":"https://doi.org/10.1016/S1098-3597(08)80016-6","url":null,"abstract":"","PeriodicalId":80265,"journal":{"name":"Clinical cornerstone","volume":"8 4","pages":"Pages 78-80"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1098-3597(08)80016-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136940016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}