RESUMO
AIMS: To test (1) whether a diabetes scorecard can improve glycaemic control, blood pressure control, LDL cholesterol, aspirin usage and exercise; (2) if the scorecard will motivate and/or educate patients to improve their scores for subsequent visits; and (3) whether the scorecard will improve rates of clinical inertia. METHODS: Five physicians enrolled 103 patients ≥ 40 years old with uncontrolled Type 2 diabetes [HbA(1c) ≥ 64 mmol/mol (8.0%)] to randomly receive either a diabetes scorecard or not during four clinical visits over a 9-month period. The population was predominantly urban with a disproportionately higher percentage of black people than the general population. Our scorecard assigned points to six clinical variables, with a perfect total score of 100 points corresponding to meeting all targets. The primary outcomes were total scores and HbA(1c) in the scorecard and control groups at 9 months. RESULTS: There were no significant differences between the control and scorecard groups at visits 1 and 4 in total score, HbA(1c) , blood pressure, LDL cholesterol, aspirin usage, exercise or knowledge about diabetic targets. By visit 4 both the control and scorecard groups had statistically significant improvements with their mean total score (9 and 7 points, respectively), HbA(1c) [-9 mmol/mol (-0.8%) and -15 mmol/mol (-1.4%), respectively] and aspirin usage (33% increase and 16% increase, respectively). Rates of clinical inertia were low throughout the study. CONCLUSIONS: A diabetes scorecard did not improve glycaemic control, blood pressure control, LDL cholesterol, aspirin usage, exercise or diabetic knowledge in an urban population with uncontrolled Type 2 diabetes.
Assuntos
Aspirina/uso terapêutico , Pressão Sanguínea/fisiologia , LDL-Colesterol/sangue , Diabetes Mellitus Tipo 2/metabolismo , Exercício Físico/fisiologia , Hemoglobinas Glicadas/metabolismo , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto , Idoso , População Negra , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/psicologia , Gerenciamento Clínico , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Motivação/fisiologia , Avaliação de Resultados em Cuidados de Saúde , Método Simples-Cego , População Urbana , População BrancaRESUMO
Because nosocomial pneumonia is difficult to diagnose and the need to treat it is often urgent, particularly in patients on mechanical ventilation, therapy is often empiric. We review the pathogenesis, risk factors, microbiology, diagnosis, and treatment of this disease.
Assuntos
Infecção Hospitalar , Pneumonia , Idoso , Antibacterianos/uso terapêutico , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/etiologia , Infecção Hospitalar/terapia , Humanos , Intubação Intratraqueal/efeitos adversos , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Pneumonia/etiologia , Pneumonia/terapia , Atenção Primária à Saúde , Respiração Artificial/efeitos adversos , Fatores de RiscoRESUMO
Postmenopausal estrogen replacement, with or without progestin therapy, has a generally favorable impact on lipids, improves endothelial function, and has anti-inflammatory and antioxidant effects. These properties should favorably impact coronary risk; indeed, epidemiologic studies have consistently associated hormone replacement therapy with reduced coronary risk. Nonetheless, the Heart & Estrogen/progestin Replacement Study (HERS), a randomized, placebo-controlled, secondary prevention trial of conjugated estrogen with progestin, found no overall reduction in coronary events among women assigned to active hormone treatment. This review explores the role of estrogen replacement among interventions intended to prevent coronary heart disease in the post-HERS era.