Adherence to the Mediterranean diet is inversely associated with arterial blood pressure, even though a beneficial component of the Mediterranean diet score-cereal intake-is positively associated with arterial blood pressure. Olive oil intake, per se, is inversely associated with both systolic and diastolic blood pressure.

Aims: To identify factors contributing to laboratory overutilisation in an academic medical department, and to assess the effect of an educational feedback strategy on inappropriate test-ordering behaviour. Methods: The records of 426 patients admitted during a 6-month period were reviewed. The usefulness of 25 investigations (haematology, basic biochemistry and arterial blood gases) was assessed according to implicit criteria. Trainees' acquaintance with investigation costs was assessed via a multiple-choice questionnaire. The medical staff was informed about their test-ordering behaviour, cost awareness and the factors associated with overuse of diagnostic tests. The test-ordering behaviour of the same doctors was reassessed on 214 patients managed during 6 months after the intervention. Results: Overall, 24 482 laboratory tests were ordered before the intervention (mean 2.96 tests/patient/ day). Among those, 67.9% were not considered to have contributed towards management of patients (mean avoidable 2.01 tests/patient/day). Patient age >65 years, hospitalisation beyond 7 days and increased case difficulty (death or inability to establish a diagnosis) were factors independently associated with overuse of laboratory tests. Senior trainees ordered more laboratory examinations, but the percentage of avoidable tests requested by junior trainees was higher. A moderate and disparate level of trainees' awareness about the cost of common laboratory examinations was disclosed. The avoidable tests/patient/day were significantly decreased after the intervention (mean 1.58, p = 0.002), but containment of unnecessary ordering of tests gradually waned during the semester after the intervention. Conclusion: Repeated audit, continuous education and alertness of doctors, on the basis of assessment of factors contributing to laboratory overutilisation, result in restraining the redundant ordering of tests in the hospital setting.T he overuse of laboratory investigations is widely prevalent in hospital practice, including academic departments.1-3 Reasons for excessive ordering of tests by doctors include defensive behaviour and fear or uncertainty, lack of experience, the use of protocols and guidelines, ''routine'' clinical practice, inadequate educational feedback and clinician's unawareness about the cost of examinations. [4][5][6] Inappropriate testing causes unnecessary patient discomfort, entails the risk of generating false-positive results, leads to overloading of the diagnostic services, wastes valuable healthcare resources and is associated with other inefficiencies in healthcare delivery, undermining the quality of health services.1 5 Interventions on inappropriate testing aim to reduce costs, along with improving the quality of care provided. Results, however, are not always consistent, usually owing to inherent limitations of the strategies proposed. In this study, we assessed the appropriateness of routine ordering of laboratory tests of the trainees in an academic internal medicine department, as well as their awa...

Compliance is associated with more effective BP control. Physicians can enhance patient compliance and hypertension control by devoting more time to counselling, avoiding unnecessary changes in drug regimens and restricting the tablet numbers.

Purpose. To develop a simple and reliable diagnostic tool for differentiation of cerebral infarction (CIF) from intracerebral haemorrhage (ICH) in order to aid clinicians to decide about starting antiplatelet therapy in settings where rapid access to computed tomography (CT) is lacking. Methods. Thirty variables regarding each patient admitted with acute stroke were recorded and considered in a logistic regression analysis using ICH as end-point (internal study). CT was used as the golden standard. The score derived was validated with data from the next consecutive stroke patients and was compared with the three preexisting scores (external validation study). Results. Amongst 235 patients (119 males, mean age 70.6 ± 11.2 years) of the internal study, 43 (18.3%) had ICH. Four independent correlates of ICH were identified and used for the derivation of the following integer-based scoring system: number of points ¼ 6 * (neurological deterioration within 3 h from admission) + 4 * (vomiting) + 4 * (WBC > 12 000) + 3 * (decreased level of consciousness). In the external study [168 patients, 85 males, mean age 70.2 ± 10.8 years, 31 (18.5%) with ICH], when the cut-offs £3 points for CIF and ‡11 points for ICH were used, sensitivity, specificity, and positive and negative predictive values of the score for detection of stroke type were 97, 99, 97 and 99%, respectively; exceeding noticeably the three previously proposed systems.Conclusions. The proposed model provides an easy to use tool for sufficiently accurate differentiation between haemorrhagic and nonhaemorrhagic stroke on the basis of information available to all physicians early after admission.

Abstractand interstitial collagen IV (r=0.588, P<0.01). In addition, the number of interstitial a-SMA+ cells and Background. The cellular and humoral factors involved in the pathogenesis of glomerulosclerosis and the extent of immunostain for collagen IV were positively correlated with the final serum creatinine (r= renal fibrosis following a crescentic glomerulonephritis have not been fully elucidated. Myofibroblasts and 0.517, P<0.05 and r=0.612, P<0.01 respectively) and partially predicted functional outcome (R2=26.7% and transforming growth factor-b ( TGF-b) have been implicated in the development of experimental and 37.5% respectively) as well as the response to treatment.An association was observed between periglomerular clinical renal fibrosis. We have attempted to identify these mediators in crescentic glomerulonephritis and myofibroblasts and the generation of fibrotic and fibrocellular crescents. determine their role in the progression of the disease. Patients and methods. We studied retrospectively 21 Conclusion. These observations suggest a causal link between myofibroblasts and fibrotic crescent formapatients with crescentic and necrotizing glomerulonephritis (CNG) with emphasis on the renal expression tion. We also believe that interstitial myofibroblasts are actively involved in the pathogenesis of interstitial (detected by immunohistochemistry) of myofibroblasts (a-smooth muscle actin+ cells), TGF-b and collagen fibrosis in CNG.(III and IV ) as well as their relationship with the clinical outcome of these patients. In situ hybridization Key words: Myofibroblasts; TGF-b; crescentic necrotizhistochemistry was applied to determine the site of ing glomerulonephritis synthesis of TGF-b1 and collagen III. All the patients were treated by immunosuppression and followed up for a median period of 14 months.

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A: Utility of B-type natriuretic peptide (BNP) as a screen for left ventricular dysfunction in patients with diabetes.

Body mass index (BMI) and waist circumference are independently associated with blood pressure, but the dependence of these associations on gender and age has not been clarified. We investigated the associations of BMI and waist circumference with systolic (SBP) and diastolic (DBP) blood pressure and assessed possible interactions with gender and age. Data concerning blood pressure and anthropometric variables were collected at enrollment in a cohort study from 10,928 non-smoking adults, all over Greece, who have never received antihypertensive treatment. Multiple regression-derived standardized coefficients were estimated to compare effects among variables. Among men, waist circumference appears more important than BMI in the prediction of SBP (standardized coefficients 2.26 vs. 1.52 mmHg/SD), and to a lesser extent DBP. In contrast, among women, BMI is more important than waist circumference, in the prediction of SBP (standardized coefficients 3.97 vs. 1.56 mmHg/ SD) and to a lesser extent DBP. The different effects of BMI and waist circumference on blood pressure by gender are evident among older individuals (> 55 years); among younger individuals BMI and waist circumference have comparable effects in both genders. Among younger individuals, BMI and waist circumference are independent and equally important predictors of SBP and DBP in both genders, whereas among older individuals waist circumference is the dominant predictor of blood pressure among men and BMI is the dominant predictor of blood pressure among women. Associations are more evident with respect to SBP than DBP.