ABSTRACT
AIM: To assess compliance with Joint National Committee 7 (JNC 7) guidelines and evaluate target blood pressure (BP) goals among patients with hypertension. RESULTS: Basic laboratory workup was completed on 75% of patients, and 71% received smoking cessation counseling. Overall BP goal achievement was 45.6%; it was 27.6% and 21.1% among diabetes and chronic kidney disease (CKD) patients, respectively. An average of 2.6 antihypertensive medications were prescribed per patient, with beta-blockers being the most frequently used, followed by thiazide diuretics and angiotensin-converting enzyme inhibitors (ACEIS). ACEIS or angiotensin receptor blockers (ARBs) were not prescribed for 16% of diabetics, 26% of chronic renal failure patients, or 41% of those with history of stroke. Among heart failure patients, 24.1% were not on ACEI or ARBs, and 20.7% were not receiving beta-blockers. CONCLUSIONS: Certain aspects of JNC 7 are not well incorporated into clinical practice, especially among patients with coexisting diabetes and/or CKD.
Subject(s)
Antihypertensive Agents/therapeutic use , Guideline Adherence/statistics & numerical data , Hypertension/drug therapy , Practice Guidelines as Topic , Alcohol Drinking , Blood Pressure , Comorbidity , Female , Hospitals, Teaching , Humans , Hypertension/therapy , Male , Middle Aged , Physical Fitness , Retrospective Studies , Smoking CessationABSTRACT
We report four cases of persistent left superior vena cava (LSVC) incidentally recognized during device implantation. Persistent LSVC is the commonest venous anomaly of the thorax and drains into the right atrium via the coronary sinus. Persistent LSVC demonstrates several congenital variations including variable communication with right-sided superior vena cava (SVC), absence of right-sided SVC, drainage into the left atrium creating a right to left shunt, and association with other congenital anomalies of the heart and great vessels. Abnormal persistent fetal dispersion of specialized pacemaker and conduction tissue, which occurs in some individuals with persistent LSVC, may provide an arrhythmogenic substrate. In this article we discuss embryology, diagnostic approaches, clinical features, technical difficulties in accessing the right ventricle, and a review of literature related to persistent LSVC.
Subject(s)
Cardiac Pacing, Artificial/methods , Electric Countershock/methods , Heart Defects, Congenital/therapy , Vena Cava, Superior/abnormalities , Aged , Aged, 80 and over , Defibrillators, Implantable , Diagnosis, Differential , Electrocardiography , Female , Fluoroscopy , Follow-Up Studies , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/physiopathology , Humans , Male , Middle Aged , Pacemaker, Artificial , Retrospective Studies , Vena Cava, Superior/diagnostic imagingABSTRACT
The rights of patients to make decisions concerning their care have been promoted by ethical guidelines under the banner of respect for autonomy, and by legal statutes that address informed consent requirements and advance directives. Given these trends, this study investigated the opinions of 90 physicians specializing in family practice and internal medicine at the Joan C. Edwards Marshall University School of Medicine and the West Virginia University School of Medicine in relation to physician-patient communication. Beliefs and attitudes of these physicians with respect to the participation of patients and family members in medical decisions were explored, using a survey instrument with closed questions. Although physicians surveyed showed respect for the primary elements of informed consent and supported stronger patients' rights, many respondents reported a willingness to override the explicit directives of patients, based on the requests of surrogates. These results reveal a conflict between current ethical and legal standards and the moral intuitions of many practicing physicians. More research focusing explicitly on the role and authority of surrogate decision-makers is warranted.
