Search results for "Practice"
showing 10 items of 2812 documents
“Ultra-sensitive” cardiac troponins: Requirements for effective implementation in clinical practice
2018
The measurement of cardiac troponins, either cardiac troponin I or T, has become the culprit of clinical decision making in patients with suspected acute coronary syndrome (ACS), especially in those with non-ST elevation myocardial infarction (NSTEMI). The leading analytical mainstays of cardiac troponin immunoassays include the limit of blank (LoB), limit of detection (LoD), functional sensitivity, the 99th percentile of a healthy reference population, along with the percentage of “ostensibly healthy” subjects displaying measurable values 50% in the general healthy population. The very recent commercialization of methods with further improved analytical sensitivity (i.e., “ultra-sensitive”…
Acute Coronary Syndrome in the Older Patient
2021
Coronary artery disease is one of the leading causes of morbidity and mortality, and its prevalence increases with age. The growing number of older patients and their differential characteristics make its management a challenge in clinical practice. The aim of this review is to summarize the state-of-the-art in diagnosis and treatment of acute coronary syndromes in this subgroup of patients. This comprises peculiarities of ST-segment elevation myocardial infarction (STEMI) management, updated evidence of non-STEMI therapeutic strategies, individualization of antiplatelet treatment (weighting ischemic and hemorrhagic risks), as well as assessment of geriatric conditions and ethical issues in…
C-Reactive Protein in Acute Coronary Syndrome. Looking Back in Order to Move Forward
2006
Recent years have seen a spectacular rise in the importance of biomarkers in acute coronary syndrome (ACS). The most notable of these biomarkers is, without doubt, troponin. Its usefulness for diagnosis, decision making, and prognostic stratification have been fully validated, and its use in daily clinical practice is now widespread.1 It should be pointed out that the kinetics of troponin release were studied in detail for different types of ACS right from the outset. This approach has clearly laid a solid foundation which has contributed to the current popularity of this marker. However, it was soon evident that not all patients with ACS and elevated troponin had a very poor prognosis,2-6 …
Actualización en cardiopatía isquémica
2009
This article contains a review of the main developments reported in 2011 on the pathophysiology, prevention, prognosis and treatment of chronic coronary artery disease and acute coronary syndrome, with or without ST-segment elevation. It also discusses the recommendations of the latest clinical practice guidelines.
First German Guideline on Diagnostics and Therapy of Clinically Non-Functioning Pituitary Tumors
2021
AbstractAlthough non-functioning pituitary tumors are frequent, diagnostic and therapeutic concepts are not well standardized. We here present the first German multidisciplinary guideline on this topic. The single most important message is to manage the patients by a multidisciplinary team (consisting at least of an endocrinologist, a neurosurgeon, and a (neuro-) radiologist). The initial diagnostic work-up comprises a detailed characterization of both biochemical (focusing on hormonal excess or deficiency states) and morphological aspects (with magnetic resonance imaging of the sellar region). An ophthalmological examination is only needed in presence of symptoms or large tumors affecting …
World Health Organization guidelines for cancer pain: a reappraisal
2005
Pain is a prevalent symptom experienced by at least 30% ofpatients undergoing an oncological treatment for metastaticdisease and by more than 70% of advanced cancer patients[1]. In 1986 the World Health Organization [2] published a setof guidelines for cancer pain management based on the three-step analgesic ladder [2]. The main aim of WHO guidelienswas to legitimize the prescribing of strong opioids, arisingfrom evidence of poor management of cancer pain, due toreluctance of health care professionals, institutions, and gov-ernment to use opioids because of fears of addition, toleranceand illegal abuse.Its application is reported to achieve satisfactory pain reliefin up to 90% of patients w…
Morning and smooth 24-h ambulatory blood pressure control is not achieved in general practice: results from the SURGE observational study.
2013
BACKGROUND The aim of this large-scale, practice-based observational study [Survey with HBPM and ABPM Under Real clinical conditions in General practice to Evaluate BP control in the early morning (SURGE)] was to ascertain the degree of morning and 24-h ambulatory blood pressure (ABP) control in hypertensive patients. METHODS Hypertensive patients [with uncontrolled clinic blood pressure (BP) >140/90 mmHg at screening] from nine different countries were included. Ambulatory BP monitoring was performed over 24 h at 15-min intervals during the day and at 20-min intervals during the night. Assessments included morning (0600-1159 h) and daytime ABP control (BP < 135/85 mmHg), and 24-h ABP contr…
Management of the paediatric airway: new developments
2006
During the last 2 years, some interesting new devices have been made available to improve airway management in children and infants, and several studies have advanced our understanding concerning risks and benefits of the current practice in the field. Certain risk factors for airway related problems during anaesthesia in children having a cold have been identified, and new aspects of the controversy concerning the use of cuffed endotracheal tubes in children presented. Novel video-assisted systems have been introduced for the management of the difficult airway in paediatric patients, and new applications for well known devices have been suggested, such as the laryngeal mask airway serving …
Combined Dyslipidemia: Should the Focus be LDL Cholesterol or Atherogenic Dyslipidemia?
2012
As the population becomes more obese and the prevalence of diabetes and the metabolic syndrome increases, low-density lipoprotein-cholesterol (LDL-C) may lose its value as a sole predictor for cardiovascular risk among lipids. Combined dyslipidemia is typically characterized by elevations in LDL-C and triglyceride levels, often accompanied by decreased high-density lipoproteincholesterol (HDL-C) concentrations and increased levels of small, dense LDL. This common disorder results from overproduction of hepatically synthesized apolipoprotein B in very low-density lipoproteins. In the last few years most of the international scientific guidelines as well as several expert panels have confirme…
How to assess and manage cardiovascular risk associated with lipid alterations beyond LDL
2017
Background and aims: The maintenance of clinically recommended levels of low-density lipoprotein cholesterol (LDL-C) through a statin therapy is a gold standard in the management of patients with dyslipidaemia and cardiovascular disease (CVD). However, even when LDL-C levels are at or below clinically recommended target levels, residual cardiovascular (CV) risk still remains. Therefore, assessing lipoproteins beyond LDL-C in managing CV risk is imperative. Methods: A working group of clinical experts have assessed the role of lipoproteins other than LDL-C in identifying the CV risk in patients with dyslipidaemia and CVD and in the management of atherogenic dyslipidaemia associated with a nu…