Background:Hypertension is a common medical disease, occurring in about one third of young adults and almost two thirds of individuals over the age of 60. With the release of the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment (JNC-8) guidelines, there have been major changes in blood pressure management in the various subgroups.Aim:Optimal blood pressure management and markers of end-organ damage in African-American adult patients were compared between patients who were managed according to the JNC-8 hypertension management guidelines and those who were treated with other regimens.Materials and Methods:African-American patients aged 18 years or older with an established diagnosis of hypertension were included in the study who were followed up in our internal medicine clinic between January 1, 2013 and December 31, 2103; the data on their systolic and diastolic blood pressure readings, heart rate, body mass index (BMI), age, gender, comorbidities, and medications were recorded. Patients were divided into four groups based on the antihypertensive therapy as follows — Group 1: Diuretic only; Group 2: Calcium channel blocker (CCB) only; Group 3: Diuretic and CCB; Group 4: Other antihypertensive agent. Their blood pressure control, comorbidities, and associated target organ damage were analyzed.Results:In all 323 patients, blood pressures were optimally controlled. The majority of the patients (79.6%) were treated with either a diuretic, a CCB, or both. Intergroup comparison analysis showed no statistically significant difference in the mean systolic blood pressure, mean diastolic blood pressure, associated comorbidities, or frequency of target organ damage.Conclusion:Although diuretics or CCBs are recommended as first-line agents in African-American patients, we found no significant difference in the optimal control of blood pressure and frequency of end-organ damage compared to management with other agents.
Overall, GC compliance was relatively low in our study. Interestingly, patients with a strong family history of LS-associated neoplasms were more likely to pursue GC. In the future, assessing and addressing barriers to seeking GC will provide opportunities to improve patient care through increased identification of patients with cancer predisposition syndromes.
Background Implementation of a point of care ultrasound curricula is valuable, but optimal integration for internal medicine residency is unclear. The purpose of this study was to evaluate if a structured ultrasound curriculum vs. structured ultrasound curriculum plus supervised thoracic ultrasounds would improve internal medicine residents’ skill and retention 6 and 12 months from baseline. Methods We conducted a randomized controlled study evaluating internal medical residents’ skill retention of thoracic ultrasound using a structured curriculum (control, n = 14) vs. structured curriculum plus 20 supervised bedside thoracic ultrasounds (intervention, n = 14). We used a stratified randomization based on program year. All subjects attended a half-day course that included 5 lectures and hands-on sessions at baseline. Assessments included written and practical exams at baseline, immediately post-course and at 6 and 12 months. Scores are reported as a percentage for the number of correct responses/number of questions (range 0–100%). The Mann Whitney U and the Friedman tests were used for analyses. Results Twenty-eight residents were enrolled. Two subjects withdrew prior to the 6-month exams. Written exam scores for all subjects improved, baseline median (IQR) 60 (46.47 to 66.67) post-course 80 (65 to 86.67), 6-month 80 (66.67 to 86.67) and 12-month 86.67 (80 to 88.34), p = <0.001. All subjects practical exam scores median (IQR) significantly improved, baseline 18.18 (7.95 to 32.95), post-course 59.09 (45.45 to 70.45), 6 month 71.74 (60.87 to 82.61) and 12-month 76.09 (65.22 to 88.05), p = <0.001. Comparing the control group to the intervention group, there were statistically significant higher scores, median (IQR), in the intervention group on the practical exam at 6 months 63.05 (48.92 to 69.57) vs. 82.61(72.83 to89.13), p = <0.001. Conclusion In this cohort, internal medicine residents participating in a structured thoracic ultrasound course plus 20-supervised ultrasounds achieved higher practical exam scores long-term compared to controls.
Background:Low serum 25-hydroxyvitamin D [25(OH)D] and osteoarthritis (OA) are commonly found in patients followed up in a primary care office. Clear evidence to support the link between 25-hydroxyvitamin D levels and OA is lacking.Aim:To describe the association of serum 25-hydroxyvitamin D status in patients with OA in the primary care office.Materials and Methods:We reviewed the records of 1,455 patients seen in our primary care office between November 2013 and October 2014. All patients were older than 18 years and had a diagnosis of OA. Demographic characteristics as well as 25(OH)D levels and comorbidities were analyzed.Results:Levels of 25(OH)D were available in 1,222 patients with OA. Fifty-one percent of the patients had a low 25(OH)D level. Patients with OA and low 25(OH)D were on an average 5 years younger than patients with OA and normal 25(OH)D (P < 0.001). African Americans (71.7%) and Hispanics (63.1%) had a higher prevalence of low 25(OH)D compared to Whites (42.9%) and other races (49.1%) (P < 0.001). There were significantly more smokers (15.4%) and patients with type 2 diabetes (27.6%) in the group of patients with osteoarthritis and low 25(OH)D (P < 0.001). A lower prevalence of hypothyroidism (18.5% versus 27.4%) and higher body mass index (BMI) were also noted in the group of interest.Conclusion:Patients with low levels of 25(OH)D and OA are younger than their counterparts with low 25(OH)D level. Future studies are needed to clarify the relationship between 25(OH)D level and OA.
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