MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Cleveland Clinic Journal of Medicine' source. Wed, 08 Feb 2012 18:50:19 +0100 http://www.medworm.com/index.php?rid=5649711&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F2%2F141%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5649711 Wed, 01 Feb 2012 05:00:00 +0100 5649711 http://www.medworm.com/index.php?rid=5649710&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F2%2F134%3Frss%3D1 Based on data from randomized controlled trials over the past decade, oral mycophenolate (CellCept) now rivals intravenous cyclophosphamide (Cytoxan) as a first-line therapy for lupus nephritis, offering similar efficacy but less toxicity. The roles of rituximab (Rituxan) and new immunomodulatory agents are being explored. Creativity in treating lupus nephritis is needed; one regimen does not fit all. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5649710 Wed, 01 Feb 2012 05:00:00 +0100 5649710 http://www.medworm.com/index.php?rid=5649709&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F2%2F127%3Frss%3D1 Health care disparities have multiple causes; the dynamics of the physician-patient encounter is one of the causes that can be modified. Here, we discuss specific recommendations related to cross-cultural communication and health literacy as practical steps to providing more equitable health care to all patients. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5649709 Wed, 01 Feb 2012 05:00:00 +0100 5649709 http://www.medworm.com/index.php?rid=5649708&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F2%2F121%3Frss%3D1 The fractional excretion of urea (FEU) is a useful index for differentiating the main categories of causes of acute kidney injury, ie, prerenal causes and intrinsic causes. It may be used in preference to the more widely used fractional excretion of sodium (FENa) in situations in which the validity of the latter is limited, such as in patients taking a diuretic. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5649708 Wed, 01 Feb 2012 05:00:00 +0100 5649708 http://www.medworm.com/index.php?rid=5649707&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F2%2F113%3Frss%3D1 Deep brain stimulation has largely replaced ablative procedures for the treatment of advanced Parkinson disease, essential tremor, and dystonia. It is also approved for obsessive-compulsive disorder. Although not curative, it improves symptoms and quality of life. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5649707 Wed, 01 Feb 2012 05:00:00 +0100 5649707 http://www.medworm.com/index.php?rid=5649706&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F2%2F110%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5649706 Wed, 01 Feb 2012 05:00:00 +0100 5649706 http://www.medworm.com/index.php?rid=5649705&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F2%2F102%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5649705 Wed, 01 Feb 2012 05:00:00 +0100 5649705 http://www.medworm.com/index.php?rid=5649704&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F2%2F92%3Frss%3D1 Suicidal behavior is a critical problem in war veterans. Combat veterans are not only more likely to have suicidal ideation, often associated with posttraumatic stress disorder (PTSD) and depression, but they are more likely to act on a suicidal plan. Especially since veterans may be less likely to seek help from a mental health professional, non-mental-health physicians are in a key position to screen for PTSD, depression, and suicidal ideation in these patients. The authors discuss the association of PTSD, depression, and suicide in veterans, keys to assessment of suicide risk, and interventions. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5649704 Wed, 01 Feb 2012 05:00:00 +0100 5649704 http://www.medworm.com/index.php?rid=5649703&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F2%2F90%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5649703 Wed, 01 Feb 2012 05:00:00 +0100 5649703 http://www.medworm.com/index.php?rid=5561699&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F1%2F78%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5561699 Wed, 04 Jan 2012 05:00:00 +0100 5561699 http://www.medworm.com/index.php?rid=5561698&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F1%2F67%3Frss%3D1 The clinical findings of influenza overlap those of community-acquired bacterial pneumonia (CABP), and influenza infection can be complicated by bacterial infections. Reviewed here are the epidemiology, pathophysiology, diagnosis, and management of community-acquired pneumonia (CAP) with special emphasis on considerations during influenza season. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5561698 Wed, 04 Jan 2012 05:00:00 +0100 5561698 http://www.medworm.com/index.php?rid=5561697&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F1%2F57%3Frss%3D1 Skin and soft-tissue infections (SSTIs) are a common presenting problem in both inpatients and outpatients. SSTIs have been broadly classified as complicated or uncomplicated, but specific disease processes and patient characteristics are important in guiding clinical management. Early recognition of the extent of infection, close follow-up, and familiarity with local antibiotic susceptibility data are critical to successful treatment. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5561697 Wed, 04 Jan 2012 05:00:00 +0100 5561697 http://www.medworm.com/index.php?rid=5561696&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F1%2F46%3Frss%3D1 Barriers to blood pressure control exist at the patient, physician, and system levels. We review the current evidence for interventions that target patient- and physician-related barriers, such as patient education, home blood pressure monitoring, and computerized decision-support systems for physicians, and we emphasize the need for more studies that address the effectiveness of these interventions in African American patients. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5561696 Wed, 04 Jan 2012 05:00:00 +0100 5561696 http://www.medworm.com/index.php?rid=5561695&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F1%2F44%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5561695 Wed, 04 Jan 2012 05:00:00 +0100 5561695 http://www.medworm.com/index.php?rid=5561694&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F1%2F38%3Frss%3D1 The AIM-HIGH trial (Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides: Impact on Global Health Outcomes) found, in an interim analysis, no cardiovascular benefit from taking extended-release niacin (Niaspan). In fact, there was a trend toward a greater risk of ischemic stroke, which did not reach statistical significance. But questions remain about this complex trial, which included intensive statin therapy in the active-treatment group and the control group. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5561694 Wed, 04 Jan 2012 05:00:00 +0100 5561694 http://www.medworm.com/index.php?rid=5561693&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F1%2F28%3Frss%3D1 Most, if not all, currently available drugs for Parkinson disease address dopaminergic loss and relieve symptoms. However, their adverse effects can be limiting and they do not address disease progression. Moreover, nonmotor features of Parkinson disease such as depression, dementia, and psychosis are now recognized as important and disabling. A cure remains elusive. However, promising interventions and agents are emerging. As an example, people who exercise regularly are less likely to develop Parkinson disease, and if they develop it, they tend to have slower progression. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5561693 Wed, 04 Jan 2012 05:00:00 +0100 5561693 http://www.medworm.com/index.php?rid=5561692&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F1%2F22%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5561692 Wed, 04 Jan 2012 05:00:00 +0100 5561692 http://www.medworm.com/index.php?rid=5561691&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F1%2F16%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5561691 Wed, 04 Jan 2012 05:00:00 +0100 5561691 http://www.medworm.com/index.php?rid=5561690&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F1%2F12%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5561690 Wed, 04 Jan 2012 05:00:00 +0100 5561690 http://www.medworm.com/index.php?rid=5561689&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F79%2F1%2F10%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5561689 Wed, 04 Jan 2012 05:00:00 +0100 5561689 http://www.medworm.com/index.php?rid=5470112&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F12%2F837%3Frss%3D1 A comprehensive approach is necessary in managing heart failure in frail older adults. To provide optimal care, physicians need to draw on knowledge from the fields of internal medicine, geriatrics, and cardiology. The acronym "MORE" is a mnemonic for what heart failure management should include: multidisciplinary care, attention to other (ie, comorbid) diseases, restrictions (of salt, fluid, and alcohol), and discussion of end-of-life issues. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470112 Thu, 01 Dec 2011 05:00:00 +0100 5470112 http://www.medworm.com/index.php?rid=5470111&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F12%2F829%3Frss%3D1 Many women are turning to bioidentical hormone therapy on the basis of misconceptions and unfounded claims, eg, that this therapy can reverse the aging process and that it is more natural and safe than approved hormone therapy. The aim of this article is to clarify some of the misconceptions. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470111 Thu, 01 Dec 2011 05:00:00 +0100 5470111 http://www.medworm.com/index.php?rid=5470110&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F12%2F821%3Frss%3D1 Essential tremor is a common neurologic problem seen widely at all levels of patient care. It should be differentiated from secondary causes of tremor and Parkinson disease. It can be managed with commonly used drugs. However, severe, resistant, or atypical cases should be referred to a specialist for evaluation and the possible use of botulinum toxin or deep brain stimulation. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470110 Thu, 01 Dec 2011 05:00:00 +0100 5470110 http://www.medworm.com/index.php?rid=5470109&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F12%2F815%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470109 Thu, 01 Dec 2011 05:00:00 +0100 5470109 http://www.medworm.com/index.php?rid=5470108&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F12%2F812%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470108 Thu, 01 Dec 2011 05:00:00 +0100 5470108 http://www.medworm.com/index.php?rid=5470107&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F12%2F801%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470107 Thu, 01 Dec 2011 05:00:00 +0100 5470107 http://www.medworm.com/index.php?rid=5470106&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F12%2F793%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470106 Thu, 01 Dec 2011 05:00:00 +0100 5470106 http://www.medworm.com/index.php?rid=5470105&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F12%2F787-a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470105 Thu, 01 Dec 2011 05:00:00 +0100 5470105 http://www.medworm.com/index.php?rid=5470104&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F12%2F787%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470104 Thu, 01 Dec 2011 05:00:00 +0100 5470104 http://www.medworm.com/index.php?rid=5470103&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F12%2F785%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470103 Thu, 01 Dec 2011 05:00:00 +0100 5470103 http://www.medworm.com/index.php?rid=5470102&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F12%2F777%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470102 Thu, 01 Dec 2011 05:00:00 +0100 5470102 http://www.medworm.com/index.php?rid=5470121&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_2%2FS38%3Frss%3D1 The first step in the management of progressive multifocal leukoencephalopathy (PML) is awareness of the disease. Patients vulnerable to PML are those with immunosuppression, either through their disease or use of immune-modulating therapy. In patients susceptible to PML who exhibit focal neurologic signs and symptoms, brain magnetic resonance imaging can detect the telltale PML brain lesions—subcortical white matter hyperintense areas on T2-weighted images and fluid-attenuated inversion recovery sequences and hypointensity on T1-weighted images, typically without enhancement. Demonstration of JC virus DNA by ultrasensitive polymerase chain reaction in cerebrospinal fluid is diagnostic for PML. Immune restoration whenever possible is the cornerstone of treatment. Highly active antire... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470121 Mon, 28 Nov 2011 05:00:00 +0100 5470121 http://www.medworm.com/index.php?rid=5470120&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_2%2FS33%3Frss%3D1 Progressive multifocal leukoencephalopathy (PML), a rare opportunistic infection of the central nervous system, occurs mainly in the setting of broad-based and selective immunosuppression. The immunomodulatory agent most often implicated in the development of PML is the monoclonal antibody natalizumab. Management of PML begins with risk stratification. Factors that predict the risk of PML are JC virus (JCV) antibody status, history of chemotherapy use, and cumulative exposure to natalizumab. The risk of natalizumab-related PML increases up to a duration of 36 months of therapy, after which the risk appears to level off. If suspicious for PML, the use of a sensitive JCV polymerase chain reaction assay permits early diagnosis. Immune reconstitution represents the mainstay of treatment for PM... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470120 Mon, 28 Nov 2011 05:00:00 +0100 5470120 http://www.medworm.com/index.php?rid=5470119&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_2%2FS28%3Frss%3D1 Progressive multifocal leukoencephalopathy (PML), a rare, typically fatal, opportunistic infection caused by the JC virus, is becoming relevant to physicians in multiple specialties, including those who prescribe biologic agents for the treatment of autoimmune disorders. Reports of PML have led to US Food and Drug Administration alerts and warning letters regarding four immunosuppressive agents in recent years (natalizumab, rituximab, efalizumab, and mycophenolate mofetil). Consequently, informed clinical decision-making requires understanding the risk of PML associated with these therapies. An estimate of the relative frequency of PML associated with specific rheumatic conditions has been generated. Systemic lupus erythematosus appears to be associated with susceptibility to PML that cann... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470119 Mon, 28 Nov 2011 05:00:00 +0100 5470119 http://www.medworm.com/index.php?rid=5470118&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_2%2FS24%3Frss%3D1 Despite the availability of highly active antiretroviral therapy (HAART) for the treatment of human immunodeficiency virus (HIV) infection, there has not been a dramatic decrease in the frequency of progressive multifocal leukoencephalopathy (PML) in the HIV-infected population. Usually a multifocal progressive disease of nonenhancing lesions in white matter, PML can have distinct characteristics in HIV-infected patients, including unifocal static lesions of faint contrast enhancement on imaging and involvement of gray matter. A syndrome of cerebellar degeneration has been described in association with HIV infection in patients positive for JC virus, the papovavirus responsible for PML. The standard of care for HIV-associated PML is HAART to achieve immunologic recovery and optimal HIV vir... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470118 Mon, 28 Nov 2011 05:00:00 +0100 5470118 http://www.medworm.com/index.php?rid=5470117&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_2%2FS18%3Frss%3D1 The treatment benefits of natalizumab in patients with multiple sclerosis (MS) appear to exceed those of other disease-modifying drugs, but progressive multifocal leukoencephalopathy (PML) has been identified as a risk in patients receiving natalizumab. As of August 2011, a total of 150 cases of natalizumab-associated PML had been reported worldwide. The overall risk is estimated at approximately 1.66 in 1,000 patients. Independent risk factors for natalizumab-associated PML are number of infusions beyond 36 and prior use of immunosuppressive drugs. Classifying JC virus antibody status appears to be useful in treatment decision-making for individual MS patients. Patient tolerance for risk plays an important role in the selection of therapy, and the treating physician’s perception and... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470117 Mon, 28 Nov 2011 05:00:00 +0100 5470117 http://www.medworm.com/index.php?rid=5470116&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_2%2FS13%3Frss%3D1 Methods developed by the Southern Network on Adverse Reactions project, the only state-funded pharmacovigilance program in the nation, are invaluable in identifying rare and serious drug events and in disseminating related safety reports quickly throughout the medical community. An important discovery was identification and reporting of an association of rituximab and progressive multifocal leukoencephalopathy (PML) in patients without human immunodeficiency virus (HIV). A recent investigation identified 57 patients with rituximab-associated PML, including bone marrow samples, brain biopsies, and autopsy materials from patients with lymphoma and PML who tested positive for JC virus. The investigation identified an association of rituximab-chemotherapy administration and PML, although a cau... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470116 Mon, 28 Nov 2011 05:00:00 +0100 5470116 http://www.medworm.com/index.php?rid=5470115&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_2%2FS8%3Frss%3D1 The symptoms associated with progressive multifocal leukoencephalopathy (PML) reflect the location of pathologic brain lesions. These symptoms include visual deficits, cognitive impairment, and motor weakness; in patients with acquired immunodeficiency syndrome (AIDS), presenting signs can also include gait disturbance, dysarthria, dysphasia, and ocular palsy. Recently, PML has been observed in patients treated with biologic agents; natalizumab recipients currently represent the second largest group of patients with PML (behind patients with AIDS). Although brain biopsy is the most accurate and reliable method for diagnosing PML, it is rarely used today. Diagnosis is usually based on detection of JC virus in the cerebrospinal fluid by polymerase chain reaction, the clinical presentation, a... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470115 Mon, 28 Nov 2011 05:00:00 +0100 5470115 http://www.medworm.com/index.php?rid=5470114&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_2%2FS3%3Frss%3D1 The JC virus (JCV), first described in 1971, is responsible for initiation of progressive multifocal leukoencephalopathy (PML), a disease characterized by demyelinating plaques and a classic triad of symptoms consisting of cognitive impairment, visual deficits, and motor dysfunction. To establish a diagnosis of PML, evidence of the presence of JCV DNA in pathologic tissue is necessary. The host range for productive infection of JCV is controlled by factors in the cell nucleus that bind to the viral promoter, initiating transcription of mRNA for the coordinated synthesis of viral proteins. Oligodendrocytes, astrocytes, and CD34+ and CD19+ cells of the immune system have the necessary binding proteins in sufficient concentration to allow lytic infection to occur. A strong link between JCV in... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470114 Mon, 28 Nov 2011 05:00:00 +0100 5470114 http://www.medworm.com/index.php?rid=5470113&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_2%2FS2%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5470113 Mon, 28 Nov 2011 05:00:00 +0100 5470113 http://www.medworm.com/index.php?rid=5389510&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F11%2F765%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5389510 Wed, 02 Nov 2011 04:00:00 +0100 5389510 http://www.medworm.com/index.php?rid=5389509&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F11%2F757%3Frss%3D1 Nocturia is a condition that health providers must seek out and address in older adults. Since it adversely affects quality of life and carries a risk of morbidity and of death (often because of falling), this symptom must be elicited during the physician-patient encounter. Understanding its underlying causes, risk factors, and consequences is essential in formulating the most suitable management strategy. Drug and nondrug treatments target the individual disorders that contribute to nocturia. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5389509 Wed, 02 Nov 2011 04:00:00 +0100 5389509 http://www.medworm.com/index.php?rid=5389508&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F11%2F748%3Frss%3D1 Glucocorticoids, commonly used to treat multiple inflammatory processes, can cause hyperglycemia, Cushing syndrome, adrenal suppression, and, when they are discontinued, adrenal insufficiency. Physicians must be aware of these adverse effects and be equipped to manage them. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5389508 Wed, 02 Nov 2011 04:00:00 +0100 5389508 http://www.medworm.com/index.php?rid=5389507&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F11%2F737%3Frss%3D1 In its 2009 recommendations for cervical cancer screening, the American College of Obstetricians and Gynecologists (ACOG) calls for less-frequent but smarter screening that integrates testing for human papillomavirus (HPV) infection with the Papanicolaou (Pap) test. We review the recommendations from this and other organizations and how and why they are evolving. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5389507 Wed, 02 Nov 2011 04:00:00 +0100 5389507 http://www.medworm.com/index.php?rid=5389506&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F11%2F734%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5389506 Wed, 02 Nov 2011 04:00:00 +0100 5389506 http://www.medworm.com/index.php?rid=5389505&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F11%2F728%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5389505 Wed, 02 Nov 2011 04:00:00 +0100 5389505 http://www.medworm.com/index.php?rid=5389504&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F11%2F722%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5389504 Wed, 02 Nov 2011 04:00:00 +0100 5389504 http://www.medworm.com/index.php?rid=5389503&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F11%2F720%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5389503 Wed, 02 Nov 2011 04:00:00 +0100 5389503 http://www.medworm.com/index.php?rid=5389502&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F11%2F709%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5389502 Wed, 02 Nov 2011 04:00:00 +0100 5389502 http://www.medworm.com/index.php?rid=5337831&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS103a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337831 Tue, 04 Oct 2011 04:00:00 +0100 5337831 http://www.medworm.com/index.php?rid=5337830&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS103%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337830 Tue, 04 Oct 2011 04:00:00 +0100 5337830 http://www.medworm.com/index.php?rid=5337829&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS102a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337829 Tue, 04 Oct 2011 04:00:00 +0100 5337829 http://www.medworm.com/index.php?rid=5337828&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS102%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337828 Tue, 04 Oct 2011 04:00:00 +0100 5337828 http://www.medworm.com/index.php?rid=5337827&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS101a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337827 Tue, 04 Oct 2011 04:00:00 +0100 5337827 http://www.medworm.com/index.php?rid=5337826&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS101%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337826 Tue, 04 Oct 2011 04:00:00 +0100 5337826 http://www.medworm.com/index.php?rid=5337825&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS100a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337825 Tue, 04 Oct 2011 04:00:00 +0100 5337825 http://www.medworm.com/index.php?rid=5337824&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS100%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337824 Tue, 04 Oct 2011 04:00:00 +0100 5337824 http://www.medworm.com/index.php?rid=5337823&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS99a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337823 Tue, 04 Oct 2011 04:00:00 +0100 5337823 http://www.medworm.com/index.php?rid=5337822&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS99%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337822 Tue, 04 Oct 2011 04:00:00 +0100 5337822 http://www.medworm.com/index.php?rid=5337821&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS98%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337821 Tue, 04 Oct 2011 04:00:00 +0100 5337821 http://www.medworm.com/index.php?rid=5337820&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS97%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337820 Tue, 04 Oct 2011 04:00:00 +0100 5337820 http://www.medworm.com/index.php?rid=5337819&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS96b%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337819 Tue, 04 Oct 2011 04:00:00 +0100 5337819 http://www.medworm.com/index.php?rid=5337818&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS96a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337818 Tue, 04 Oct 2011 04:00:00 +0100 5337818 http://www.medworm.com/index.php?rid=5337817&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS96%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337817 Tue, 04 Oct 2011 04:00:00 +0100 5337817 http://www.medworm.com/index.php?rid=5337816&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS95a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337816 Tue, 04 Oct 2011 04:00:00 +0100 5337816 http://www.medworm.com/index.php?rid=5337815&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS95%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337815 Tue, 04 Oct 2011 04:00:00 +0100 5337815 http://www.medworm.com/index.php?rid=5337814&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS94a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337814 Tue, 04 Oct 2011 04:00:00 +0100 5337814 http://www.medworm.com/index.php?rid=5337813&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS94%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337813 Tue, 04 Oct 2011 04:00:00 +0100 5337813 http://www.medworm.com/index.php?rid=5337812&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS93a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337812 Tue, 04 Oct 2011 04:00:00 +0100 5337812 http://www.medworm.com/index.php?rid=5337811&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS93%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337811 Tue, 04 Oct 2011 04:00:00 +0100 5337811 http://www.medworm.com/index.php?rid=5337810&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS92%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337810 Tue, 04 Oct 2011 04:00:00 +0100 5337810 http://www.medworm.com/index.php?rid=5337809&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS91a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337809 Tue, 04 Oct 2011 04:00:00 +0100 5337809 http://www.medworm.com/index.php?rid=5337808&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS91%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337808 Tue, 04 Oct 2011 04:00:00 +0100 5337808 http://www.medworm.com/index.php?rid=5337807&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS90a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337807 Tue, 04 Oct 2011 04:00:00 +0100 5337807 http://www.medworm.com/index.php?rid=5337806&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS90%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337806 Tue, 04 Oct 2011 04:00:00 +0100 5337806 http://www.medworm.com/index.php?rid=5337805&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS89a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337805 Tue, 04 Oct 2011 04:00:00 +0100 5337805 http://www.medworm.com/index.php?rid=5337804&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS89%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337804 Tue, 04 Oct 2011 04:00:00 +0100 5337804 http://www.medworm.com/index.php?rid=5337803&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS88a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337803 Tue, 04 Oct 2011 04:00:00 +0100 5337803 http://www.medworm.com/index.php?rid=5337802&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS88%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337802 Tue, 04 Oct 2011 04:00:00 +0100 5337802 http://www.medworm.com/index.php?rid=5337801&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS87a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337801 Tue, 04 Oct 2011 04:00:00 +0100 5337801 http://www.medworm.com/index.php?rid=5337800&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS87%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337800 Tue, 04 Oct 2011 04:00:00 +0100 5337800 http://www.medworm.com/index.php?rid=5337799&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS86%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337799 Tue, 04 Oct 2011 04:00:00 +0100 5337799 http://www.medworm.com/index.php?rid=5337798&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS85a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337798 Tue, 04 Oct 2011 04:00:00 +0100 5337798 http://www.medworm.com/index.php?rid=5337797&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS85%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337797 Tue, 04 Oct 2011 04:00:00 +0100 5337797 http://www.medworm.com/index.php?rid=5337796&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS84a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337796 Tue, 04 Oct 2011 04:00:00 +0100 5337796 http://www.medworm.com/index.php?rid=5337795&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS84%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337795 Tue, 04 Oct 2011 04:00:00 +0100 5337795 http://www.medworm.com/index.php?rid=5337794&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS83a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337794 Tue, 04 Oct 2011 04:00:00 +0100 5337794 http://www.medworm.com/index.php?rid=5337793&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS83%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337793 Tue, 04 Oct 2011 04:00:00 +0100 5337793 http://www.medworm.com/index.php?rid=5337792&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS82a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337792 Tue, 04 Oct 2011 04:00:00 +0100 5337792 http://www.medworm.com/index.php?rid=5337791&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS82%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337791 Tue, 04 Oct 2011 04:00:00 +0100 5337791 http://www.medworm.com/index.php?rid=5337790&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS81a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337790 Tue, 04 Oct 2011 04:00:00 +0100 5337790 http://www.medworm.com/index.php?rid=5337789&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS81%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337789 Tue, 04 Oct 2011 04:00:00 +0100 5337789 http://www.medworm.com/index.php?rid=5337788&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS80a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337788 Tue, 04 Oct 2011 04:00:00 +0100 5337788 http://www.medworm.com/index.php?rid=5337787&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS80%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337787 Tue, 04 Oct 2011 04:00:00 +0100 5337787 http://www.medworm.com/index.php?rid=5337786&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS75%3Frss%3D1 For nearly three decades, starting in the early 1970s, the cardiology research laboratories at the University of Minnesota served as the focal point for the discovery and implementation of much of the information we now apply to the management of heart failure. Director Jay Cohn, building on his expertise in hypertension and hemodynamics, led many creative and committed investigators in the exploration of the mechanisms responsible for increased sensitivity to afterload in heart failure. The neurohormonal hypothesis of heart failure led to the development of several pharmacologic tools, such as angiotensin-converting enzyme inhibitors, β-adrenergic blockers, and, later, angiotensin-receptor blockers. By the late 1990s, it was understood that neurohormonal antagonists could prevent the... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337786 Tue, 04 Oct 2011 04:00:00 +0100 5337786 http://www.medworm.com/index.php?rid=5337785&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS69%3Frss%3D1 Direct visualization of heart-brain interactions is the goal when assessing autonomic nervous system function. Cortical topology relevant to neuroimaging consists of the cingulate, insula, and amygdala, all of which share proximity to the basal ganglia. Significant cardiac effects stemming from brain injury are well known, including alteration of cardiac rhythms, cardiac variability, and blood pressure regulation; in some instances, these effects may correlate with neuroimaging, depending on the region of the brain involved. It is difficult to achieve visualization of areas within the brainstem that govern autonomic responses, although investigators have identified brain correlates of autonomic function with the use of functional magnetic resonance imaging and electrocardiographic data obt... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337785 Tue, 04 Oct 2011 04:00:00 +0100 5337785 http://www.medworm.com/index.php?rid=5337784&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS65%3Frss%3D1 Previous research has demonstrated an association between depression and incident coronary heart disease (CHD); in 2010, well-controlled studies and meta-analyses went beyond depression to include anxiety, anger expression, and negative affect as predictors of incident CHD. Emerging research suggests that positive emotions and resilience (including the ability to self-regulate) offer protection against CHD. New research is elucidating the pathophysiology to explain the effects of emotion and resilience on disease risk; for example, recent work has begun to consider how the relaxation response promotes resilience and found that it induces genomic changes that counter oxidative stress and associated cellular damage. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337784 Tue, 04 Oct 2011 04:00:00 +0100 5337784 http://www.medworm.com/index.php?rid=5337783&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS54%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337783 Tue, 04 Oct 2011 04:00:00 +0100 5337783 http://www.medworm.com/index.php?rid=5337782&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS50%3Frss%3D1 Our laboratory has documented that brain microvessels derived from patients with Alzheimer disease (AD) express or release a myriad of factors that have been implicated in vascular activation and angiogenesis. In addition, we have documented that signaling cascades associated with vascular activation and angiogenesis are upregulated in AD-derived brain microvessels. These results are consistent with emerging data suggesting that factors and processes characteristic of vascular activation and angiogenesis are found in the AD brain. Despite increases in proangiogenic factors and signals in the AD brain, however, evidence for increased vascularity in AD is lacking. Cerebral hypoperfusion/hypoxia, a potent stimulus for vascular activation and angiogenesis, triggers hypometabolic, cognitive, an... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337782 Tue, 04 Oct 2011 04:00:00 +0100 5337782 http://www.medworm.com/index.php?rid=5337781&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS47%3Frss%3D1 To help define the relationships among inflammation, Alzheimer disease, and depression, the Texas Alzheimer’s Research Consortium analyzed an array of inflammatory biomarkers in a cohort of patients with Alzheimer disease and in controls. Inflammation severity was highly correlated with earlier age at onset of Alzheimer disease and was also associated with cognitive decline. The relationship between inflammation and depression was not as clear, and it varied with aspects of depression, gender, and the presence of Alzheimer disease. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337781 Tue, 04 Oct 2011 04:00:00 +0100 5337781 http://www.medworm.com/index.php?rid=5337780&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS44%3Frss%3D1 Depression has been linked to cardiovascular disease and cognitive impairment, including Alzheimer disease, but the exact nature of the relationship is poorly understood. Although depression seems to progress little after the onset of Alzheimer disease, depression in earlier life increases the risk of dementia and cognitive impairment many years in the future. Depression is also associated with reduced vascular function and is a poorly recognized but significant risk factor for stroke. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337780 Tue, 04 Oct 2011 04:00:00 +0100 5337780 http://www.medworm.com/index.php?rid=5337779&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS35%3Frss%3D1 Exercise, considered a mainstay of cardiac rehabilitation, has been shown to reduce cardiac risk factors such as hyperlipidemia and hypertension. Growing evidence also suggests that exercise has beneficial effects on mental health, which is relevant for cardiac patients because of the prognostic significance of depression in patients with coronary heart disease (CHD). Depression has been associated with increased mortality and nonfatal cardiac events in patients with CHD; it is also associated with worse outcomes in patients who undergo coronary artery bypass graft surgery and those who have heart failure. The standard therapy for depression is pharmacologic treatment, often with second-generation antidepressants such as selective serotonin reuptake inhibitors. Despite their widespread use... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337779 Tue, 04 Oct 2011 04:00:00 +0100 5337779 http://www.medworm.com/index.php?rid=5337778&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS30%3Frss%3D1 Implantable medical devices are finding increasing use in the treatment of diseases traditionally targeted with drugs. It is well established that the cholinergic anti-inflammatory pathway serves as a physiological regulator of inflammatory responses, but stimulation of this pathway therapeutically by electrical stimulation of the vagus nerve can also diminish excessive or dysregulated states of inflammation. Recent data from a wide variety of animal models, as well as evidence of reduced vagal tone in rheumatoid arthritis and other inflammatory diseases, support the rationale for, and feasibility of, developing implantable vagal nerve stimulation devices to treat chronic inflammation in humans. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337778 Tue, 04 Oct 2011 04:00:00 +0100 5337778 http://www.medworm.com/index.php?rid=5337777&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS24%3Frss%3D1 Autonomic dysregulation is a feature of chronic heart failure (HF) and is characterized by a sustained increase of sympathetic drive and by withdrawal of parasympathetic activity. Both sympathetic overdrive and increased heart rate are predictors of poor long-term outcome in patients with HF. Pharmacologic agents that partially inhibit sympathetic activity, such as beta-adrenergic receptor blockers, effectively reduce mortality and morbidity in patients with chronic HF. In contrast, modulation of parasympathetic activation as a potential therapy for HF has received only limited attention because of its inherent complex cardiovascular effects. This review examines results of experimental animal studies that provide support for the possible use of electrical vagus nerve stimulation (VNS) as ... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337777 Tue, 04 Oct 2011 04:00:00 +0100 5337777 http://www.medworm.com/index.php?rid=5337776&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS20%3Frss%3D1 Biofeedback is a method of training subjects to regulate their own physiology using feedback from physiologic sensors connected to an output display. Biofeedback-assisted stress management (BFSM) incorporates the physiologic signals with instructions on stress management. The goal of BFSM training is to give subjects the tools to control their own mental and physiologic reactions, leading to improved health and wellness. In cardiovascular disease, overactivation of the sympathetic component of the autonomic nervous system and psychologic stress together negatively affect quality of life and clinical status. BFSM targets both areas. We hypothesize that this intervention can be used in cardiovascular disease to improve clinical status and quality of life, as well as interfere with disease pr... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337776 Tue, 04 Oct 2011 04:00:00 +0100 5337776 http://www.medworm.com/index.php?rid=5337775&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS13%3Frss%3D1 General distress, shared across depression, anxiety and anger, partly accounts for the link between mind and heart. The type D (distressed) personality profile identifies individuals who are particularly vulnerable to the adverse effect of general distress. Type D individuals frequently experience negative emotions and are socially inhibited. This profile is more stable than that associated with episodes of clinical depression and describes the chronic nature of distress in some patients. Type D may also partly account for the effect of emotional distress on cardiac prognosis. Type D is associated with a threefold increased risk of adverse cardiovascular outcomes, even after adjustment for depression. This relationship is less obvious in patients with heart failure. Plausible pathways link... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337775 Tue, 04 Oct 2011 04:00:00 +0100 5337775 http://www.medworm.com/index.php?rid=5337774&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2FSuppl_1%2FS4%3Frss%3D1 This article presents the design and main outcome findings from the National Institutes of Health–funded Bypassing the Blues study, the first trial to examine the impact of a collaborative care strategy for treating depression among patients with cardiac disease, and our efforts to improve upon and expand the model for testing in other cardiac conditions. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5337774 Tue, 04 Oct 2011 04:00:00 +0100 5337774 http://www.medworm.com/index.php?rid=5287148&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F10%2F697%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5287148 Mon, 03 Oct 2011 04:00:00 +0100 5287148 http://www.medworm.com/index.php?rid=5287147&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F10%2F685%3Frss%3D1 Diagnosing aortic dissection requires a high index of suspicion, as it may mimic other more common conditions that cause chest pain. Prompt diagnosis is key, as it requires emergency evaluation and treatment for optimal chances of survival. This paper reviews key clinical features as well as laboratory and imaging tests. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5287147 Mon, 03 Oct 2011 04:00:00 +0100 5287147 http://www.medworm.com/index.php?rid=5287146&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F10%2F675%3Frss%3D1 Jet lag sleep disorder and shift work sleep disorder are the result of dyssynchrony between the internal clock and the external light-dark cycle, brought on by rapid travel across time zones or by working a nonstandard schedule. Symptoms can be minimized by optimizing the sleep environment, by strategic avoidance of and exposure to light, and also with drug and behavioral therapies. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5287146 Mon, 03 Oct 2011 04:00:00 +0100 5287146 http://www.medworm.com/index.php?rid=5287145&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F10%2F665%3Frss%3D1 During the last 5 years, new randomized trials in critically ill patients have challenged a number of traditional treatment strategies in intensive care. The authors review eight studies that helped change their medical practices. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5287145 Mon, 03 Oct 2011 04:00:00 +0100 5287145 http://www.medworm.com/index.php?rid=5287144&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F10%2F657%3Frss%3D1 Dabigatran (Pradaxa) is a new oral anticoagulant approved in the United States for the primary prevention of stroke and systemic embolization in patients with nonvalvular atrial fibrillation. It offers clinicians an alternative to warfarin (Coumadin), and it has received considerable interest because of its convenience of use, clinical efficacy, and safety profile. However, it is more expensive, and this may limit its widespread use. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5287144 Mon, 03 Oct 2011 04:00:00 +0100 5287144 http://www.medworm.com/index.php?rid=5287143&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F10%2F649%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5287143 Mon, 03 Oct 2011 04:00:00 +0100 5287143 http://www.medworm.com/index.php?rid=5287142&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F10%2F646%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5287142 Mon, 03 Oct 2011 04:00:00 +0100 5287142 http://www.medworm.com/index.php?rid=5287141&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F10%2F644%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5287141 Mon, 03 Oct 2011 04:00:00 +0100 5287141 http://www.medworm.com/index.php?rid=5185383&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F9%2F619%3Frss%3D1 It is reasonable to stop bisphosphonates after 5 years of use and then to follow patients with markers of bone turnover. As long as the levels of these markers remain reduced, adding an antiresorptive drug does not make physiologic sense. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5185383 Wed, 31 Aug 2011 23:00:00 +0100 5185383 http://www.medworm.com/index.php?rid=5185382&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F9%2F609%3Frss%3D1 After anticoagulation has been started in patients with venous thromboembolism (VTE), three issues need to be addressed: the length of therapy, measures to help prevent postthrombotic syndrome, and a basic workup for malignancy in patients with idiopathic VTE. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5185382 Wed, 31 Aug 2011 23:00:00 +0100 5185382 http://www.medworm.com/index.php?rid=5185381&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F9%2F606%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5185381 Wed, 31 Aug 2011 23:00:00 +0100 5185381 http://www.medworm.com/index.php?rid=5185380&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F9%2F597%3Frss%3D1 As viral hepatitis and nonalcoholic fatty liver disease continue to increase in prevalence, we will see more cases of hepatic encephalopathy. Primary care physicians are often the first to suspect it, as they are familiar with the patient’s usual mental and physical status. This serious complication typically occurs in patients with severe comorbidities and requires multidisciplinary evaluation and care. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5185380 Wed, 31 Aug 2011 23:00:00 +0100 5185380 http://www.medworm.com/index.php?rid=5185379&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F9%2F594%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5185379 Wed, 31 Aug 2011 23:00:00 +0100 5185379 http://www.medworm.com/index.php?rid=5185378&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F9%2F585%3Frss%3D1 Blood tests are available that measure levels of immunoglobulin E (IgE) against specific allergens such as foods, inhalants, medications, latex, and venoms. These tests can confirm the diagnosis of an allergic disorder, supplementing a clinical history consistent with an immediate allergic reaction. They are particularly useful when skin testing cannot or should not be performed. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5185378 Wed, 31 Aug 2011 23:00:00 +0100 5185378 http://www.medworm.com/index.php?rid=5185377&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F9%2F571%3Frss%3D1 This article reviews these concepts and includes a detailed discussion of the Centers for Medicare and Medicaid Services’ ACO and Shared Savings Proposed Rule. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5185377 Wed, 31 Aug 2011 23:00:00 +0100 5185377 http://www.medworm.com/index.php?rid=5185376&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F9%2F563%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5185376 Wed, 31 Aug 2011 23:00:00 +0100 5185376 http://www.medworm.com/index.php?rid=5081228&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F8%2F549%3Frss%3D1 Several lines of evidence indicate that chronic lack of sleep may contribute to the risk of type 2 diabetes mellitus. Adequate sleep and good sleep hygiene should be included among the goals of a healthy lifestyle, especially for patients with diabetes. We urge clinicians to recommend at least 7 hours of uninterrupted sleep per night as part of a healthy lifestyle. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5081228 Sun, 31 Jul 2011 23:00:00 +0100 5081228 http://www.medworm.com/index.php?rid=5081227&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F8%2F539%3Frss%3D1 Managing small renal masses poses a common and controversial problem. Although radical nephrectomy is still the most common treatment, partial nephrectomy is the new gold standard, and thermal ablation or active surveillance are reasonable for some patients. Renal mass biopsy with molecular profiling will likely allow for more rational treatment in the near future. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5081227 Sun, 31 Jul 2011 23:00:00 +0100 5081227 http://www.medworm.com/index.php?rid=5081226&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F8%2F529%3Frss%3D1 Infection related to cardiovascular implantable electronic devices is a serious complication, necessitating removal of the device and prolonged parenteral antibiotic therapy. Accurate diagnosis and optimal management of these infections are challenging. This review highlights the critical management decisions. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5081226 Sun, 31 Jul 2011 23:00:00 +0100 5081226 http://www.medworm.com/index.php?rid=5081225&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F8%2F521%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5081225 Sun, 31 Jul 2011 23:00:00 +0100 5081225 http://www.medworm.com/index.php?rid=5081224&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F8%2F515%3Frss%3D1 Several new fecal occult blood tests have advantages over older ones when used for colorectal cancer screening. Fecal immunochemical tests can detect antibodies to human globin in the stool and can be used without the dietary restrictions needed with traditional guaiac tests. Although colonoscopy is often considered the gold standard, we hope that these new tests will allow more people to be screened and more cases of colorectal cancer to be detected early. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5081224 Sun, 31 Jul 2011 23:00:00 +0100 5081224 http://www.medworm.com/index.php?rid=5081223&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F8%2F512%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5081223 Sun, 31 Jul 2011 23:00:00 +0100 5081223 http://www.medworm.com/index.php?rid=5081222&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F8%2F505%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5081222 Sun, 31 Jul 2011 23:00:00 +0100 5081222 http://www.medworm.com/index.php?rid=5081221&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F8%2F500%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5081221 Sun, 31 Jul 2011 23:00:00 +0100 5081221 http://www.medworm.com/index.php?rid=5081220&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F8%2F498%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=5081220 Sun, 31 Jul 2011 23:00:00 +0100 5081220 http://www.medworm.com/index.php?rid=4987309&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F7%2F477%3Frss%3D1 This article reviews its indications, evidence of efficacy, and protocols. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4987309 Thu, 30 Jun 2011 23:00:00 +0100 4987309 http://www.medworm.com/index.php?rid=4987308&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F7%2F475%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4987308 Thu, 30 Jun 2011 23:00:00 +0100 4987308 http://www.medworm.com/index.php?rid=4987307&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F7%2F472%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4987307 Thu, 30 Jun 2011 23:00:00 +0100 4987307 http://www.medworm.com/index.php?rid=4987306&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F7%2F465%3Frss%3D1 Because a significant proportion of Staphylococcus aureus strains as well as most coagulase-negative staphylococci are resistant to penicillin and semisynthetic beta-lactam drugs, the need for vancomycin and related antibiotics has never been greater. Effective use of vancomycin requires knowledge of dosing parameters and selection of target trough levels appropriate to the specific infection and to the pathogen being treated. For clinicians, it is vital to remain up-to-date with evolving definitions for vancomycin susceptibility, with new interpretations of efficacy, and with information on toxicity. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4987306 Thu, 30 Jun 2011 23:00:00 +0100 4987306 http://www.medworm.com/index.php?rid=4987305&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F7%2F449%3Frss%3D1 For a variety of reasons, cancer pain is often undertreated, adversely affecting the quality of life for patients and caregivers. To manage cancer pain effectively, physicians need to understand its pathogenesis, how to assess it, how to treat it, and, in particular, how to optimize opioid treatment. We discuss common questions faced by physicians in everyday practice. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4987305 Thu, 30 Jun 2011 23:00:00 +0100 4987305 http://www.medworm.com/index.php?rid=4987304&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F7%2F441%3Frss%3D1 Survivors of cardiac arrest due to ventricular tachycardia or ventricular fibrillation have improved neurologic outcomes if they are cooled to a core body temperature of 32°C to 34°C for 24 hours as soon as possible after reaching the hospital. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4987304 Thu, 30 Jun 2011 23:00:00 +0100 4987304 http://www.medworm.com/index.php?rid=4987303&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F7%2F430%3Frss%3D1 Key points Dabigatran (Pradaxa) will likely start to replace warfarin (Coumadin) both to prevent stroke in patients with atrial fibrillation and to prevent recurrent venous thromboembolism. Using a checklist during insertion of central venous catheters can decrease the rate of catheter-related bloodstream infections in the intensive care unit. The overall survival rate of patients who undergo cardiopulmonary resuscitation in the intensive care unit is approximately 16%; the rate is lower in patients who are receiving pressor drugs and higher in those with ventricular tachycardia or ventricular fibrillation. Patients lacking follow-up with a primary care physician within 30 days of discharge are at high risk of readmission and have a trend for longer length of hospital stay. Preoperative st... Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4987303 Thu, 30 Jun 2011 23:00:00 +0100 4987303 http://www.medworm.com/index.php?rid=4987302&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F7%2F426%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4987302 Thu, 30 Jun 2011 23:00:00 +0100 4987302 http://www.medworm.com/index.php?rid=4886724&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F6%2F404%3Frss%3D1 Heightened awareness of the characteristic patterns of ST-segment depression and T-wave inversion is paramount to quickly identifying life-threatening disorders. This paper reviews how to distinguish the various causes of these abnormalities. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4886724 Tue, 31 May 2011 23:00:00 +0100 4886724 http://www.medworm.com/index.php?rid=4886723&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F6%2F393%3Frss%3D1 Although statins are remarkably effective, they are still underprescribed because of concerns about muscle toxicity. We review the aspects of statin myopathy that are important to the primary care physician and provide a guide for evaluating patients on statins who present with muscle complaints. We outline the differential diagnosis, the risks and benefits of statin therapy in patients with possible toxicity, and the subsequent treatment options. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4886723 Tue, 31 May 2011 23:00:00 +0100 4886723 http://www.medworm.com/index.php?rid=4886722&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F6%2F385%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4886722 Tue, 31 May 2011 23:00:00 +0100 4886722 http://www.medworm.com/index.php?rid=4886721&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F6%2F379%3Frss%3D1 Many patients admitted to the hospital have diabetes mellitus—diagnosed or undiagnosed—and others develop hyperglycemia from the stress of hospitalization. This paper discusses the prevalence, outcomes, and evidence for best management of hyperglycemia and diabetes in hospitalized patients outside the critical care setting. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4886721 Tue, 31 May 2011 23:00:00 +0100 4886721 http://www.medworm.com/index.php?rid=4886720&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F6%2F377%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4886720 Tue, 31 May 2011 23:00:00 +0100 4886720 http://www.medworm.com/index.php?rid=4886719&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F6%2F375%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4886719 Tue, 31 May 2011 23:00:00 +0100 4886719 http://www.medworm.com/index.php?rid=4886718&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F6%2F358%3Frss%3D1 Immune thrombocytopenia (ITP) is a common hematologic disorder. Its pathogenesis involves both accelerated platelet destruction and impaired platelet production. First-line agents are usually effective initially but do not provide long-term responses. Splenectomy remains an effective long-term therapy, as does rituximab (Rituxan) in a subset of patients. Thrombopoietic agents offer a new alternative, although their place in the overall management of ITP remains uncertain. (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4886718 Tue, 31 May 2011 23:00:00 +0100 4886718 http://www.medworm.com/index.php?rid=4886717&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F6%2F356-a%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4886717 Tue, 31 May 2011 23:00:00 +0100 4886717 http://www.medworm.com/index.php?rid=4886716&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F6%2F356%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4886716 Tue, 31 May 2011 23:00:00 +0100 4886716 http://www.medworm.com/index.php?rid=4886715&cid=s_38036_22_f&fid=38036&url=http%3A%2F%2Fwww.ccjm.org%2Fcgi%2Fcontent%2Fshort%2F78%2F6%2F355%3Frss%3D1 (Source: Cleveland Clinic Journal of Medicine) Cleveland Clinic Journal of Medicine journals http://www.medworm.com/rss/comments.php?id=4886715 Tue, 31 May 2011 23:00:00 +0100 4886715