The Romanian Society of Internal Medicine's Choosing Wisely Campaign.

Quality of care in medicine is not necessarily proportional to quantity of care and excess is often useless or even more, potentially detrimental to our patients. Adhering to the European Federation of Internal Medicine's initiative, the Romanian Society of Internal Medicine (SRMI) launched the Choosing Wisely in Internal Medicine Campaign, aiming to cut down diagnostic procedures or therapeutics overused in our country. A Working Group was formed and from 200 published recommendations from previous international campaigns, 36 were voted as most important. These were submitted for voting to the members of the SRMI and posted on a social media platform. After the two voting rounds, the top six recommendations were established. These were: 1. Stop medicines when no further benefit is achieved or the potential harms outweigh the potential benefits for the individual patient. 2. Don't use antibiotics in patients with recent C. difficile without convincing evidence of need. 3. Don't regularly prescribe bed rest and inactivity following injury and/or illness unless there is scientific evidence that harm will result from activity. Promote early mobilization. 4. Don't initiate an antibiotic without an identified indication and a predetermined length of treatment or review date. 5. Don't prescribe opioids for treatment of chronic or acute pain for sensitive jobs such as operating motor vehicles, forklifts, cranes or other heavy equipment. 6. Transfuse red cells for anemia only if the hemoglobin concentration is less than 7 g/dL or if the patient is hemodynamically unstable or has significant cardiovascular or respiratory comorbidity. Don't transfuse more units of blood than absolutely necessary.

[Diagnosis and therapeutic aspects of isolated systolic hypertension]. / Particularitati diagnostice si terapeutice ale hipertensiunii sistolice izolate.

UNLABELLED: The isolated systolic hypertension is a distinct entity concerning evolving, pathological, diagnosis and treatment particularities. The present study analyzed the behavior of the blood pressure by continuous ambulatory monitoring of a group of patients diagnosed with isolated systolic hypertension by office measurement. MATERIAL AND METHOD: One hundred and twenty nine patients with isolated systolic hypertension at office were included. They were subjected to continuous ambulatory monitoring of blood pressure, then the treatment was started. After six months the patients were reassessed. RESULTS: Continuous ambulatory monitoring better indicates the increase of systolic tension and the reduction of the diastolic tension by aging. The pulse pressure is significantly higher at the over sixty-five group. The systolic tension is directly correlated with the pulse pressure and indirectly with the diurnal index. (r = 0.36). After six months of treatment the reevaluation shows a statistically significant reduction of the pathological parameters although without achieving tensional control. CONCLUSIONS: The ambulatory monitoring better highlights the values of hypertension and assesses the LOAD and Day Index values. Achieving the therapeutic goal regarding systolic hypertension proves difficult.

[Features of arterial blood pressure in metabolic syndrome]. / Particularitatile hipertensiunii arteriale din sindromul metabolic.

UNLABELLED: The metabolic syndrome has high prevalence in hypertensive patients. Its presence leads to the early appearance of target organ damage, particularly of left ventricular hypertrophy. The 24-hour ambulatory monitoring of arterial blood pressure allows the estimation of the BP Load. The BP Load accomplishes the best correlation between the systolic blood pressure and left ventricular hypertrophy. The purpose of this study is to identify the prevalence of the metabolic syndrome and the particularities of hypertension in hypertensive patients suffering from metabolic syndrome, using 24 hour continuous blood pressure monitoring. MATERIAL AND METHOD: During a three years period (2007-2009), 303 hypertensive patients were assessed at the Internal medicine Section of the County Emergency Hospital in Bacau. RESULTS: The metabolic syndrome occurred in 60.1% of hypertensive patients. The batch with metabolic syndrome contained 181 patients, a female/male ratio of 3,41 to 1, average age: 66.50 +/- 10.28 years, 60.8% coming from urban environment. The monitorised systole-diastolic tension values studies indicate isolated systolic hypertension. No dipper and reverse dipper tensional profiles prevail. CONCLUSIONS: In patients with isolated systolic hypertension, the association of the metabolic syndrome is the main cardiovascular risk and is associated with increase of diastolic blood pressure, presence of left ventricular hypertrophy and increased hypertensive Load values.