Hypertension: Current Trends and Choices in Pharmacotherapeutics

1992 ◽  
Vol 3 (2) ◽  
pp. 507-526
Author(s):  
Judith Hopfer Deglin ◽  
Stuart Deglin
Keyword(s):  
Health Care Professionals ◽  
Organ Damage ◽  
Emergency Situations ◽  
Current Trends ◽  
Care Approach ◽  
Step Care ◽  
Hypertensive Crises ◽  
Step Care Approach ◽  
Special Patient

Many new choices exist in the management of hypertension. Armed with a basic understanding of the definition and causes of hypertension, the pharmacotherapeutics, and special patient populations, health care professionals should be able to optimally educate, treat, and follow up patients with hypertension. In the step-care approach, four different classes of agents may be used as Step 1 choices. Selection is determined by concurrent illnesses, patient age, or concomitant drug therapy. In emergency situations, additional choices exist. Tailoring therapy in hypertensive crises may prevent or minimize end-organ damage. These areas are reviewed, and guidelines for patient assessment and education are presented

Overview: The allergic reaction and site-based therapy

1992 ◽  
Vol 107 (6_part_2) ◽  
pp. 828-830 ◽  
Author(s):  
Richard L. Mabry
Keyword(s):  
Allergic Reaction ◽  
Environmental Control ◽  
Allergic Patient ◽  
Control Measures ◽  
Rational Approach ◽  
Upper Respiratory Tract ◽  
Mediators Of Inflammation ◽  
Care Approach ◽  
Step Care ◽  
Step Care Approach

The successful management of upper respiratory tract allergy is based on a triad of interdependent approaches that, with rare exceptions, must all be considered in every allergic patient. They consist of allergen avoidance with environmental control measures, pharmacotherapy with use of a step-care approach, and immunotherapy. Environmental control measures should be used to prevent events that trigger and sustain the condition. Once started, the allergic reaction includes the release of mediators of inflammation that produce well-known symptoms of allergic rhinitis. Treatment should consist of a step-wise, rational approach that includes site-based therapy with one or more drugs acting at different sites. The drugs used are antihistamines, decongestants, cromolyn sodium, and corticosteroids. Immunotherapy should be considered at any step, because it offers the only curative approach.

Almotriptan in Triptan-Naïve Patients: New Evidence of Benefits

Cephalalgia ◽  
2008 ◽  
Vol 28 (2_suppl) ◽  
pp. 14-20 ◽  
Author(s):  
J Pascual
Keyword(s):  
Treatment Plan ◽  
Symptom Control ◽  
Standard Of Care ◽  
Time Interval ◽  
Inadequate Response ◽  
Stratified Care ◽  
Care Approach ◽  
Step Care ◽  
Step Care Approach ◽  
Post Hoc

Although triptans represent the standard of care for migraine that is severe, disabling and/or suboptimally responsive to migraine non-specific analgesia, they are often underused in clinical practice. Simple analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) may provide effective treatment in some patients, but it is an inadequate response to these drugs that drives the therapeutic progression to triptans at the end of the traditional ‘step-care’ approach. However, there are several disadvantages to this approach. It may cause patients to lose confidence in their physician during this hierarchical ‘trial-and-error’ search for optimal treatment when prescribed medications are ineffective, leading them to cease consulting before triptans are tried. It may also result in a protracted time interval of suboptimal treatment, with unnecessary suffering in patients who are triptan candidates. The alternative approach of ‘stratified care’, in which medication is prescribed according to the severity of symptoms, enables triptans to be used earlier in the treatment plan, especially when triptan candidates are given a choice between simple analgesic/NSAID and triptan medication from the start. This raises the question about the efficacy of triptans in triptan-naïve (TN) patients. A recent exploratory post-hoc analysis compared the effect of almotriptan 12.5 mg in TN patients ( n = 342) with that in triptan-experienced patients ( n = 237). Almotriptan was effective in both cohorts with a consistent trend in favour of the efficacy of almotriptan in TN patients, notably for sustained pain freedom (SPF) and SPF plus no adverse events. Moreover, both headache recurrence at 24 h and the use of rescue medication was lower in the TN patients, whereas tolerability was equally good in both cohorts. These findings indicate that TN patients can expect excellent symptom control when they progress from non-specific analgesia to treatment with almotriptan and support the earlier use of triptans in line with the stratified care paradigm.

Assessing Sexual Dysfunction, Part 1: Male Sexual Dysfunction

2016 ◽  
Vol 21 (2) ◽  
pp. 3-8
Author(s):  
Seth D. Cohen ◽  
Steven Mandel ◽  
David B. Samadi
Keyword(s):  
Sexual Dysfunction ◽  
Health Care Professionals ◽  
Laboratory Testing ◽  
Aging Male ◽  
Testosterone Deficiency ◽  
Subjective Complaint ◽  
Validated Questionnaire ◽  
Male Sexual Dysfunction ◽  
Multiple Health

Abstract To properly assess men and women with sexual dysfunction, evaluators should take a biopsychosocial approach that may require consultation with multiple health care professionals from various fields in order to get to the root of the sexual dysfunction; this multidisciplinary methodology offers the best chance of successful treatment. For males, this article focuses on erectile dysfunction (ED) and hypogonadism. The initial evaluation of ED involves a thorough case history, preferably taken from the patient and partner, physical examination, and proper laboratory and diagnostic tests, including an acknowledgment of the subjective complaint. The diagnosis is established on the basis of an individual's report of the consistent inability to attain and maintain an erection sufficient to permit satisfactory sexual intercourse. Initial workups for ED should entail a detailed history that can be obtained from a validated questionnaire such as the International Index of Erectile Function and the Sexual Health Inventory for Men. Hypogonadism is evaluated using the validated Androgen Deficiency in the Aging Male questionnaire and laboratory testing for testosterone deficiency. Treatments logically can begin with the least invasive and then progress to more invasive strategies after appropriate counseling. The last and most important treatment component when caring for men with sexual dysfunction—and, arguably, the least practiced—is close follow-up.

scholarly journals A case of hypereosinophilic syndrome with STAT5b N642H mutation

2021 ◽  
Vol 2021 (1) ◽  
Author(s):  
Feihong Ding ◽  
Chaoping Wu ◽  
Yun Li ◽  
Sudipto Mukherjee ◽  
Subha Ghosh ◽  
...  
Keyword(s):  
Complete Blood Count ◽  
Hypereosinophilic Syndrome ◽  
Organ Damage ◽  
Myeloid Neoplasm ◽  
Acute Eosinophilic Pneumonia ◽  
Myeloid Neoplasms ◽  
Somatic Signal ◽  
Generation Sequencing

ABSTRACT Hypereosinophilia is defined as persistent eosinophilia (>1.5 × 109/L). Hypereosinophilic syndrome (HES) is a term used to describe a group of disorders characterized by sustained hypereosinophilia associated with end-organ damage. Based on underlying molecular mechanism of eosinophilia, there are different subtypes of HES. Diagnosis of HES subtype can be challenging, especially in the absence of overt lymphoid/myeloid neoplasms or discernable secondary causes. Long-term outpatient follow-up with periodic complete blood count and repeated bone marrow biopsy may be needed to monitor disease activity. Somatic signal transducer and activation transcription 5b (STAT5b) N642H mutation was recently found to be associated with myeloid neoplasms with eosinophilia. We report a case of HES who presented with pulmonary embolism and acute eosinophilic pneumonia, found to have recurrent STAT5b N642H mutation by next-generation sequencing, suggesting possible underlying myeloid neoplasm.

scholarly journals Translation and Validation of the Spanish Version of the Spiritual Care Competence Questionnaire (SCCQ)

2021 ◽  
Vol 60 (5) ◽  
pp. 3621-3639 ◽  
Author(s):  
Tania Pastrana ◽  
Eckhard Frick ◽  
Alicia Krikorian ◽  
Leticia Ascencio ◽  
Florencia Galeazzi ◽  
...  
Keyword(s):  
Spiritual Care ◽  
Health Care Professionals ◽  
Spanish Version ◽  
Spiritual Needs ◽  
Self Awareness ◽  
Good Internal Consistency ◽  
Spiritual Self ◽  
Team Spirit ◽  
Translation And Validation

AbstractWe aimed to validate the Spanish version of the Spiritual Care Competence Questionnaire (SCCQ) in a sample of 791 health care professionals from Spanish speaking countries coming principally from Argentina, Colombia, Mexico and Spain. Exploratory factor analysis pointed to six factors with good internal consistency (Cronbach’s alpha ranging from 0.71 to 0.90), which are in line with the factors of the primary version of the SCCQ. Conversation competences and Perception of spiritual needs competences scored highest, and Documentation competences and Team spirit the lowest, Empowerment competences and Spiritual self-awareness competences in-between. The Spanish Version of the SCCQ can be used for assessment of spiritual care competencies, planning of educational activities and for comparisons as well as monitoring/follow-up after implementation of improvement strategies.

scholarly journals COVID-19-associated rhino-orbital mucormycosis (CAROM)—a case report

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Humsheer Singh Sethi ◽  
Kamal Kumar Sen ◽  
Sudhansu Sekhar Mohanty ◽  
Sangram Panda ◽  
Kolluru Radha Krishna ◽  
...  
Keyword(s):  
Case Report ◽  
Health Care Professionals ◽  
Opportunistic Infections ◽  
Fungal Spores ◽  
Nasal Discharge ◽  
Contributing Factors ◽  
Post Discharge ◽  
Pulmonary Mucormycosis ◽  
The Right

Abstract Background There has been a rapid rise in the number of COVID-19-associated rhino-orbital mucormycosis (CAROM) cases especially in South Asian countries, to an extent that it has been considered an epidemic among the COVID-19 patients in India. As of May 13, 2021, 101 CAROM cases have been reported, of which 82 cases were from India and 19 from the rest of the world. On the other hand, pulmonary mucormycosis associated with COVID-19 has a much lesser reported incidence of only 7% of the total COVID-19-associated mucormycosis cases (Singh AK, Singh R, Joshi SR, Misra A, Diab Metab Syndr: Clin Res Rev, 2021). This case report attempts to familiarize the health care professionals and radiologists with the imaging findings that should alarm for follow-up and treatment in the lines of CAROM. Case presentation Rhino-orbital mucormycosis (ROM) is a manifestation of mucormycosis that is thought to be acquired by inhalation of fungal spores into the paranasal sinuses. Here, we describe a 55-year-old male, post COVID-19 status with long standing diabetes who received steroids and ventilator therapy for the management of the viral infection. Post discharge from the COVID-19 isolation ICU, the patient complained of grayish discharge from the right nostril and was readmitted to the hospital for the nasal discharge. After thorough radiological and pathological investigation, the patient was diagnosed with CAROM and managed. Conclusion Uncontrolled diabetes and imprudent use of steroids are both contributing factors in the increased number of CAROM cases. Our report emphasizes on the radiological aspect of CAROM and reinforces the importance of follow-up imaging in post COVID-19 infection cases with a strong suspicion of opportunistic infections.

scholarly journals Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2635
Author(s):  
Koen Huysentruyt ◽  
Kim Brunet-Wood ◽  
Robert Bandsma ◽  
Leah Gramlich ◽  
Bonnie Fleming-Carroll ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Care Pathway ◽  
Clinical Care ◽  
Tertiary Care ◽  
Nationwide Survey ◽  
Nutritional Screening ◽  
Pediatric Hospitals ◽  
Adoption And Implementation ◽  
Clinical Care Pathway

Background: Disease-associated malnutrition (DAM) is common in hospitalized children. This survey aimed to assess current in-hospital practices for clinical care of pediatric DAM in Canada. Methods: An electronic survey was sent to all 15 tertiary pediatric hospitals in Canada and addressed all pillars of malnutrition care: screening, assessment, treatment, monitoring and follow-up. Results: Responses of 120 health care professionals were used from all 15 hospitals; 57.5% were medical doctors (MDs), 26.7% registered dietitians (RDs) and 15.8% nurses (RNs). An overarching protocol for prevention, detection and intervention of pediatric malnutrition was present or “a work in progress”, according to 9.6% of respondents. Routine nutritional screening on admission was sometimes or always performed, according to 58.8%, although the modality differed among hospitals and profession. For children with poor nutritional status, lack of nutritional follow-up after discharge was reported by 48.5%. Conclusions: The presence of a standardized protocol for the clinical assessment and management of DAM is uncommon in pediatric tertiary care hospitals in Canada. Routine nutritional screening upon admission has not been widely adopted. Moreover, ongoing nutritional care of malnourished children after discharge seems cumbersome. These findings call for the adoption and implementation of a uniform clinical care pathway for malnutrition among pediatric hospitals.

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