Thứ Sáu, 21 tháng 6, 2019

How to Spot and Deal With Attention Deficit Trait

Although ADD and ADHD have become more commonplace to identify and treat, an attention deficient trait (ADT) is one that may present like ADD or ADHD but is not genetically inherited and is typically produced from an overabundance of noise and distractions in the modern workplace. According to psychiatrist Dr. Edward Hallowell the condition may have a negative impact on your overall productivity because your brain is overwhelmed with chatter. “It's sort of like the normal version of attention deficit disorder,” he explains. “But it's a condition induced by modern life, in which you've become so busy attending to so many inputs and outputs that you become increasingly distracted, irritable, impulsive, restless and, over the long term, underachieving. In other words, it costs you efficiency because you're doing so much or trying to do so much, it's as if you're juggling one more ball than you possibly can.” What can you do to spot the signs of ADT and how can you reduce its effects?

Thứ Sáu, 14 tháng 6, 2019

ACC/AHA vs. ESC/ESH on Hypertension Guidelines

The following are key points to remember from this comparison of the blood pressure guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology/European Society of Hypertension (ESC/ESH):
  1. The authors compared the recommendations of the most recent ACC/AHA and ESC/ESH blood pressure guidelines, each of which represented updates and reinforced concepts of prevention regarding elevated blood pressure (BP).
  2. Both guidelines provide general recommendations of a low-sodium diet (<2300 mg of sodium), exercise, body weight reduction, low to moderate alcohol intake, and adequate potassium intake.
  3. The guidelines agree on the importance of proper methods of BP measurement, the use of home BP monitoring and ambulatory monitoring, focusing on detecting and improving adherence, and both support the use of BP telemonitoring and digital health solutions for follow-up.
  4. Both recommend use of absolute cardiovascular (CV) risk estimates computed with risk calculators and that a >10% 10-year risk of atherosclerotic CV disease should be treated more aggressively. And both provide a concise definition of organ damage assessment. The ACC/AHA guideline details guidance for ethnic/racial groups. ESC/ESH emphasizes the importance of environmental and altitude effects on BP.
  5. There are major disagreements with the level of BP defining hypertension, the specific BP targets for treatment, and the use of initial combination therapy. ACC/AHA does not address isolated systolic hypertension, which is detailed in the ESC/ESH guideline, with target systolic BP to <140 mm Hg. ESC/ESH limits BP reduction to no lower than 120/70 mm Hg regardless of baseline, age, and target organ damage.
  6. The initial single-pill combination is strongly recommended in both guidelines with angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker + thiazide or calcium channel blocker. However, ESC/ESH recommends it as initial therapy in patients at ≥140/90 mm Hg and the ACC/AHA recommends a single-pill combination in patients with >20/10 mm Hg above BP goal.
  7. The most important distinction is that ACC/AHA maintains that all people with a BP >130/80 mm Hg have hypertension and BP should be targeted to <130/80 mm Hg. While this implies increased cost, the ACC/AHA guideline stresses lifestyle change for BP for the first 6 months except for those at high risk or with target organ damage.
  8. The ESC/ESH guideline defines hypertension as >140/90 mm Hg with the goal being 130 to <140/70-79 mm Hg for all but targeting to <130/70-79 mm Hg or lower only in those at high cardiovascular risk defined as diabetes, post-stroke, and coronary artery disease.
  9. The authors suggest that a more evidence-based statement for the guideline would be to set the lower BP target for treatment at >15% 10-year CV risk, because all trials had cohorts with >15% CV risk.

Thứ Năm, 13 tháng 6, 2019

Medmastery’s chest x-ray algorithm

Medmastery’s chest x-ray algorithm—a systematic approach for evaluating any chest x-ray

So you're looking at a patient's chest x-ray and you've identified an abnormality–great! But how do you make sure you're not missing something else? In this video, from our Chest X-ray Essentials course, you'll master a powerful step-by-step algorithm that'll make sure you never miss a significant problem again.
This video was taken from our Chest X-ray Essentials course. If you want to watch all the teaching videos that lead up to the algorithm, then take the course and register for the Medmastery membership.