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In a previous study, omeprazole infusion reduced recurrent bleeding after endoscopic therapy for ulcers with nonbleeding visible vessels or adherent clots. In this study, patients receiving an omeprazole infusion had a lower rate of recurrent bleeding if they also received endoscopic therapy. Combination therapy is most effective.
Achieving a systolic blood pressure between 110 and 129 mm Hg may slow the progression of nondiabetic kidney disease when the urinary protein excretion exceeds 1.0 g/d. Systolic blood pressure less than 110 mm Hg may be associated with a higher risk for progression.
In this experiment, obesity was associated with the development of acute mountain sickness in simulated ascents to 15 000-feet elevation. Obese participants had greater nocturnal arterial desaturation with exposure to high altitude.
When HIV-infected people used smoked or oral cannabinoids for 21 days, HIV RNA levels, CD4+ and CD8+ cell counts, and protease inhibitor drug levels did not change significantly.
Critics of tort liability for medical malpractice claim that it does not achieve its theoretical goals of compensating injured patients, deterring negligence, and dispensing corrective justice. Working from an actual malpractice case involving serious injury but no apparent negligence, the authors of this Quality Grand Rounds paper explore these criticisms from the perspectives of both the plaintiff-patient and the defendant-physician.
The description of screening mammography results correlates well with the risk for breast cancer. High-risk women need biopsy, intermediate-risk women need diagnostic mammography or ultrasonography to decide about biopsy, and low-risk women need follow-up screening mammography. Diagnostic mammography is not useful in women with a palpable breast mass.
In this issue, Sung and colleagues report on a randomized clinical trial of treatments used when an endoscopist finds clots or nonbleeding visible vessels in a patient with recent upper gastrointestinal bleeding. The researchers compared medical therapy using an intravenous proton-pump inhibitor with medical therapy plus endoscopic hemostasis. This editorial explains the rationale for this study and its findings.
In this issue, Jafar and colleagues address three questions about the management of patients with nondiabetic kidney disease and hypertension: Does the amount of urinary protein affect outcomes? Are blood pressure targets less than 130/80 mm Hg too high? Should clinicians use both urinary protein and blood pressure levels during follow-up to guide management?
The institution of marriage has been my pleasure for 17 years, but the beeper has been my mistress longer.
A phenomenon in psychology states that active observers—people who are involved in an action—have a great need to predict and control a situation. This couldn't hold more true for me, the mother of a child who is “medically complicated.” My 20-month-old son is the actor, and I am the active observer.
This essay explores ethically important issues involved in writing about patients for publication. The physician-writer wears two hats: that of a physician with obligations to one's patients and that of a writer with obligations to readers.
This Update incorporates a diverse range of topics, including hormone replacement therapy, statins, exercise, hypertension, prostate cancer, diabetes care, and antioxidant vitamins.
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