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    3769 results match your criteria Cleveland Clinic Journal of Medicine[Journal]

    1 OF 76

    Kidney transplant: New opportunities and challenges.
    Cleve Clin J Med 2018 Feb;85(2):138-144
    Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH, USA.
    Progress in kidney transplant has improved survival while creating challenges. The pool of eligible patients is increasing, but organ supply remains inadequate. Waiting-list issues, adequate pretransplant assessment, judicious use of potent immunotherapy, and management of infections must be considered. Read More

    PCI for stable angina: A missed opportunity for shared decision-making.
    Cleve Clin J Med 2018 Feb;85(2):105-121
    Vice-Chair for Research, Medicine Institute, and Director, Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.
    Percutaneous coronary intervention (PCI) continues to be frequently performed for patients with stable coronary artery disease, despite clear evidence that it provides minimal benefit over optimal medical therapy and entails small but not inconsequential risks. Many patients and doctors do not fully understand the risks and benefits of PCI, even when presented with the evidence, and this makes informed consent challenging. The best approach is shared decision-making, with doctor and patient together choosing the best treatment option after considering the evidence and the patient's preferences. Read More

    Transient neurologic syndromes: A diagnostic approach.
    Cleve Clin J Med 2018 Feb;85(2):155-163
    Mellen Center for Multiple Sclerosis, Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.
    Clinicians are often confronted with patients who have transient neurologic symptoms lasting seconds to hours. In many of these patients, their symptoms have gone away or returned to baseline by the time of evaluation, making the diagnosis even more challenging. Elements such as correlation of symptoms with vascular territory, prodromes, triggers, motor symptoms, confusion, and sleep behavior can guide the diagnostic workup. Read More

    Medication management in older adults.
    Cleve Clin J Med 2018 Feb;85(2):129-135
    Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
    Managing medications is a major part of providing care to older adults. Polypharmacy is common in the elderly and is fraught with risks. A careful and systematic approach is needed for managing drug therapy in these patients, recognizing the patient's specific goals. Read More

    Detecting and managing device leads inadvertently placed in the left ventricle.
    Cleve Clin J Med 2018 Jan;85(1):69-75
    Electrophysiology, Arrhythmia, and Pacemaker Section, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
    Inadvertent malpositioning of a cardiac implantable electronic device lead into the left ventricle is a rare complication of transvenous pacing and defibrillation. Rapid identification of lead position is critical during implantation and just after the procedure, with immediate correction required if malpositioning is detected. If lead misplacement is discovered late after implantation, the lead should be surgically removed or chronic anticoagulation with warfarin should be instituted. Read More

    Preventing cardiovascular disease in older adults: One size does not fit all.
    Cleve Clin J Med 2018 Jan;85(1):55-64
    VA Boston Healthcare System, Associate Director-Clinical, Geriatric Research, Education, and Clinical Center (GRECC), Boston, MA, USA.
    Frailty and cardiovascular disease are highly interconnected and increase in prevalence with age. Identifying frailty allows for a personalized cardiovascular risk prescription and individualized management of hypertension, hyperlipidemia, diabetes, and lifestyle in the aging population. Read More

    Idiopathic hypercalciuria: Can we prevent stones and protect bones?
    Cleve Clin J Med 2018 Jan;85(1):47-54
    Clinical Associate Professor of Medicine, Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University, Columbus, OH, USA.
    Idiopathic hypercalciuria increases the risk of urinary stones and osteoporosis. The aim of this review is to delineate our current understanding of idiopathic hypercalciuria in the context of bone health, specifically its definition, causes, epidemiology, laboratory evaluation, and potential treatments. Read More

    High users of healthcare: Strategies to improve care, reduce costs.
    Cleve Clin J Med 2018 Jan;85(1):25-31
    Chief of Staff, Medical Director of Care Management, Regions Hospital/HealthPartners, St. Paul, MN, USA.
    A minority of patients consume a disproportionate amount of healthcare, especially in the emergency department. These "high users" are a small but complex group whose expenses are driven largely by low socioeconomic status, mental illness, and drug abuse; lack of social services also contributes. Several promising efforts aimed at improving quality and reducing healthcare costs for high users include care management organizations, patient care plans, and better discharge summaries. Read More

    Aortic replacement in cardiac surgery.
    Cleve Clin J Med 2017 Dec;84(12 Suppl 4):e28-e33
    Department of Thoracic and Cardiovascular Surgery, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
    The number of aorta procedures performed annually in the United States has grown substantially during the past decade. Cleveland Clinic is a leader in research on the risk of aortic dissection in patients with a bicuspid or tricuspid aortic valve and associated aneurysm, which has led to changes in the recommendations of when to operate. Safety and efficacy data support more proactive treatment for most patients with thoracic aortic aneurysm and/or dissection with a growing emphasis on the need to provide life-long care to patients with aortic conditions. Read More

    Improving the safety and efficacy of robotically assisted mitral valve surgery.
    Cleve Clin J Med 2017 Dec;84(12 Suppl 4):e25-e27
    Cardiac Surgeon and Surgical Director, TAVR, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
    To improve outcomes with robotically assisted mitral valve surgery, Cleveland Clinic conducted a study evaluating outcomes in 1,000 consecutive cases. Primary areas of interest were to determine whether increased surgical experience with robotic techniques improved outcomes and to identify opportunities that could improve procedural processes. Results showed that these surgeries were effective and safe in terms of improvements in procedure time, transfusion rates, stroke risk, number of mitral valve replacements, and number of conversions to sternotomy. Read More

    A new generation of drug-eluting stents: Indications and outcomes of bioresorbable vascular scaffolds.
    Cleve Clin J Med 2017 Dec;84(12 Suppl 4):e20-e24
    Director, Cardiovascular Research Advanced Education, MedStar Heart and Vascular Institute, Washington, DC, USA.
    Drug-eluting stents (DES) are increasingly being used as a less invasive alternative to coronary artery bypass grafting. Early generation DES had durable polymers that provided acceptable efficacy outcomes but had high rates of stent thrombosis leading to myocardial infarction and death. Second-generation DES have improved outcomes by reducing stent thrombosis and recurrent stenosis. Read More

    CABG: A continuing evolution.
    Cleve Clin J Med 2017 Dec;84(12 Suppl 4):e15-e19
    Department of Thoracic and Cardiovascular Surgery, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
    Use of coronary artery bypass grafting (CABG) has had a resurgence, as clinical trial data emerged showing that it remains the standard of care for patients with complex lesions. Debate exists regarding various factors, including endoscopic vs open vein-graft harvesting, single vs bilateral mammary artery grafts, radial artery vs saphenous vein grafts, right internal mammary artery vs radial artery grafts, and on-pump vs off-pump surgery. More recent developments include minimally invasive approaches, robotics, and hybrid revascularization, which are changing the risk-benefit ratio for this patient population. Read More

    Expanding indications for TAVR: The preferred procedure in intermediate-risk patients?
    Cleve Clin J Med 2017 Dec;84(12 Suppl 4):e10-e14
    The Heart Hospital Baylor Plano, Baylor Scott & White Health, Plano, TX, USA.
    Transcatheter aortic valve replacement (TAVR) has steadily replaced surgical aortic valve replacement (SAVR) in symptomatic patients with severe aortic stenosis, primarily those at high risk for surgical complications. As TAVR use increases, spurred by technological advances in valve design and patient preferences for the less-invasive procedure, studies have provided data supporting the efficacy and safety of TAVR. Recently, TAVR has expanded to intermediate-risk patients, increasing the potential patient population. Read More

    Trends in cardiovascular risk profiles.
    Cleve Clin J Med 2017 Dec;84(12 Suppl 4):e6-e9
    Director, Sones Catherization Laboratories and Head, Section of Invasive and Interventional Cardiology, Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
    Outcomes for patients with coronary artery disease (CAD) have improved in the past 20 years likely due to advances in clinical care such as angiotensin-converting enzyme inhibitors, antiplatelet agents, and reduced time to cardiac cauterization procedures. But how have the risk factors for CAD changed in the past 2 decades? Analysis of nearly 4,000 patients with ST-elevation myocardial infarction (STEMI) at a tertiary care center found that patients presenting with acute STEMI are younger and more obese than in the past. The prevalence of smoking, hypertension, and diabetes mellitus is also increasing. Read More

    Results of the GLAGOV trial.
    Cleve Clin J Med 2017 Dec;84(12 Suppl 4):e1-e5
    Professor of Cardiology, Theme Leader, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia.
    Statins therapy reduces atheroma in proportion to the reduction of low-density lipoprotein cholesterol (LDL-C). Proprotein convertase subtilisin--kexin type 9 (PCSK9) inhibitors are a new class of injectable human monoclonal antibodies shown to lower LDL-C when added to statin therapy. In a randomized, double-blind, placebo-controlled study, 968 patients with symptomatic coronary artery disease were treated with statins alone or combined with the PCSK9 inhibitor, evolocumab, and assessed for change in percent, total volume, and regression of coronary atheroma. Read More

    Lung transplant: Candidates for referral and the waiting list.
    Cleve Clin J Med 2017 Dec;84(12 Suppl 3):54-58
    Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
    For patients with end-stage lung diseases, lung transplant may significantly extend survival and improve quality of life. Identifying patients that are likely to benefit from a lung transplant is essential to positive outcomes and to maximizing life expectancy for each patient. Prompt referral to and communication with an experienced lung transplant center allows for timely completion of the formal evaluation of candidacy and placement on the organ transplant waiting list. Read More

    Cardiac implantable electronic device infection.
    Cleve Clin J Med 2017 Dec;84(12 Suppl 3):47-53
    Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
    Increasing numbers of patients with cardiac disease have improved quality of life and longevity as a result of cardiac implantable electronic devices (CIEDs). CIED infections can involve the generator pocket, bloodstream, or cardiac structures and occur in about 0.5% of de novo CIED implants and approximately 2% of CIED replacements. Read More

    Update on the management of venous thromboembolism.
    Cleve Clin J Med 2017 Dec;84(12 Suppl 3):39-46
    Section Head, Department of Vascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
    Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism, is a common cardiovascular disease associated with significant morbidity ranging from painful leg swelling, chest pain, shortness of breath, and even death. Long-term complications include recurrent VTE, postpulmonary embolism syndrome, chronic thromboembolic pulmonary hypertension, and postthrombotic syndrome (PTS). Management of VTE requires immediate anticoagulation therapy based on a risk assessment for bleeding. Read More

    Management of coronary chronic total occlusion.
    Cleve Clin J Med 2017 Dec;84(12 Suppl 3):27-38
    Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
    Percutaneous coronary intervention (PCI) for coronary artery chronic total occlusion (CTO) is an important treatment to be used in conjunction with non-CTO PCI, coronary artery bypass grafting, and optimal medical therapy to achieve complete revascularization in patients with coronary artery disease. Read More

    Cardiac amyloidosis: An update on diagnosis and treatment.
    Cleve Clin J Med 2017 Dec;84(12 Suppl 3):12-26
    Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
    Cardiac amyloidosis (CA), once thought to be a rare disease, is increasingly recognized due to enhanced clinical awareness and better diagnostic imaging. CA is becoming of heightened interest to the cardiology community given more effective treatment strategies for light chain amyloidosis (AL), as well as emerging therapies for transthyretin amyloidosis (ATTR). Furthermore, reversing amyloid deposition in affected organs using monoclonal antibodies is actively being tested in clinical trials. Read More

    Pharmacotherapy for obesity: What you need to know.
    Cleve Clin J Med 2017 Dec;84(12):951-958
    Instructor in Medicine, Mayo Clinic College of Medicine and Science, Scottsdale, AZ, USA.
    Weight-loss drugs are being evaluated for their role in obesity management. This article reviews the available weight-loss drugs, their efficacy and side effects, and their best clinical use. Read More

    Diagnostic value of the physical examination in patients with dyspnea.
    Cleve Clin J Med 2017 Dec;84(12):943-950
    Department of Internal Medicine, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, MI, USA.
    We reviewed the evidence for the diagnostic accuracy of the physical examination in diagnosing pneumonia, pleural effusion, chronic obstructive pulmonary disease, and congestive heart failure in patients with dyspnea and found that the physical examination has reliable diagnostic accuracy for these common conditions. Read More

    Diagnosis and treatment of hyperkalemia.
    Cleve Clin J Med 2017 Dec;84(12):934-942
    Professor of Internal Medicine, Biomedical Research Department, Diabetes and Obesity Research Division, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
    Hyperkalemia results either from the shift of potassium out of cells or from abnormal renal potassium excretion. Cell shift leads to transient increases in the plasma potassium concentration, whereas decreased renal excretion of potassium leads to sustained hyperkalemia. Impairments in renal potassium excretion can be the result of reduced sodium delivery to the distal nephron, decreased mineralocorticoid level or activity, or abnormalities in the cortical collecting duct. Read More

    Chronic kidney disease in African Americans: Puzzle pieces are falling into place.
    Cleve Clin J Med 2017 Nov;84(11):855-862
    Former Director, Center for Chronic Kidney Disease, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
    Recent decades have seen great advances in the understanding of chronic kidney disease, spurred by standardizing disease definitions and large-scale patient surveillance. African Americans are disproportionately affected by the disease, and recently discovered genetic variants in APOL1 that protect against sleeping sickness in Africa provide an important explanation for the increased burden. Studies are now under way to determine if genetic testing of African American transplant donors and recipients is advisable. Read More

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