Abstract:
STUDY OBJECTIVES:To compare the safety and efficacy of U.S. Food and Drug Administration (FDA)-recommended doses of labetalol and nicardipine for hypertension (HTN) management in a subset of patients with renal dysfunction (RD). DESIGN:Randomized, open label, multicenter prospective clinical trial. SETTING:Thirteen United States tertiary care emergency departments. PATIENTS OR PARTICIPANTS:Subgroup analysis of the Evaluation of IV Cardene (Nicardipine) and Labetalol Use in the Emergency Department (CLUE) clinical trial. The subjects were 104 patients with RD (i.e., creatinine clearance < 75 mL/min) who presented to the emergency department with a systolic blood pressure (SBP) ≥ 180 mmHg on 2 consecutive readings and for whom the emergency physician felt intravenous antihypertensive therapy was desirable. INTERVENTIONS:The FDA recommended doses of either labetalol or nicardipine for HTN management. MEASUREMENTS:The number of patients achieving the physician's predefined target SBP range within 30 minutes of treatment. RESULTS:Patients treated with nicardipine were within target range more often than those receiving labetalol (92% vs. 78%, P = 0.046). On 6 SBP measures, patients treated with nicardipine were more likely to achieve the target range on either 5 or all 6 readings than were patients treated with labetalol (46% vs. 25%, P = 0.024). Labetalol patients were more likely to require rescue medication (27% vs. 17%, P = 0.020). Adverse events thought to be related to either treatment group were not reported in the 30-minute active study period, and patients had slower heart rates at all time points after 5 minutes (P < 0.01). CONCLUSIONS:In severe HTN with RD, nicardipine-treated patients are more likely to reach a target blood pressure range within 30 minutes than are patients receiving labetalol. CLINICAL IMPLICATIONS:Within 30 minutes of administration, nicardipine is more efficacious than labetalol for acute blood pressure control in patients with RD.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Varon J,Soto-Ruiz KM,Baumann BM,Borczuk P,Cannon CM,Chandra A,Cline DM,Diercks DB,Hiestand B,Hsu A,Jois-Bilowich P,Kaminski B,Levy P,Nowak RM,Schrock JW,Peacock WFdoi
10.3810/pgm.2014.07.2790subject
Has Abstractpub_date
2014-07-01 00:00:00pages
124-30issue
4eissn
0032-5481issn
1941-9260journal_volume
126pub_type
杂志文章,多中心研究,随机对照试验abstract::In the Western world, diabetes is the biggest cause of peripheral neuropathy, usually distal symmetric polyneuropathy but some times another polyneuropathy or a focal neuropathy. In addition, hypothyroidism and acromegaly can cause carpal tunnel syndrome and other sensory complaints. A complete blood cell count, nerve...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1997.09.318
更新日期:1997-09-01 00:00:00
abstract:OBJECTIVE:There is a need to identify safe and effective opioid-sparing multimodal alternative treatment strategies and approaches, including topical analgesics, for opioid-experienced chronic pain patients to mitigate the risk of addiction, misuse, and abuse of opioids. METHODS:This subset analysis from a prospective...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2018.1414551
更新日期:2018-01-01 00:00:00
abstract::Providing medical care for patients with mental disabilities may be challenging and financially unappealing because of the need for extra time and effort. Nonetheless, primary care physicians can meet the medical needs of these patients and benefit from working with a team approach that fosters open communication and ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.1999.11.776
更新日期:1999-11-01 00:00:00
abstract::Although uncommon, hypertensive emergencies require prompt recognition and treatment to reduce very high morbidity and mortality rates. Admission to an intensive care unit for treatment and monitoring is essential for optimal care. A Swan-Ganz catheter is often helpful in management. Intravenous nitroprusside sodium (...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1991.11700894
更新日期:1991-04-01 00:00:00
abstract:INTRODUCTION:The American Academy of Pediatrics and the American Academy of Family Physicians believe that infants, children, and adolescents benefit from having a medical home, characterized by accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care. Several st...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2010.03.2126
更新日期:2010-03-01 00:00:00
abstract::A 29-year-old man had a febrile illness accompanied by chest pain and tachycardia. The ECG suggested either myocarditis or acute ischemia. Heart muscle enzymes were normal, the peripheral blood count showed absolute and relative lymphocytosis, and an echocardiogram disclosed a small pericardial effusion. After deferve...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1989.11700655
更新日期:1989-04-01 00:00:00
abstract::Many medical conditions that clearly have a strong genetic component are not transmitted in a straightforward dominant, recessive, or X-linked pattern. Recent progress in understanding other modes of inheritance, such as imprinting, trinucleotide repeat expansion, mitochondrial inheritance, and mosaicism, has allowed ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2000.09.1.1210
更新日期:2000-09-01 00:00:00
abstract::This article reviews the definition, mechanisms, epidemiology, and clinical sequelae of the metabolic syndrome and explores potential relationships between the metabolic syndrome, type 2 diabetes, and cardiovascular disease. Definitions for the metabolic syndrome proposed by the World Health Organization and the Natio...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.12.2003.suppl31.175
更新日期:2003-12-01 00:00:00
abstract::Physicians must be alert to the possibility of abuse within the family and home. They should be well prepared to help victims begin the transition to a safer environment. An awareness of the prevalence of abuse and a high index of suspicion are the most effective clinical tools for assisting victims of domestic violen...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1996.07.11
更新日期:1996-07-01 00:00:00
abstract:INTRODUCTION:With rising health care costs in the United States, trainees will be increasingly challenged in discussing testing stewardship with patients. OBJECTIVE:We piloted a high-value care (HVC) communication skills curriculum utilizing the Four Habits Model for communication. We hoped residents would 1) learn to...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2020.1807728
更新日期:2020-08-22 00:00:00
abstract::Prescription opioid analgesics are an important treatment option for patients with chronic pain; however, misuse, abuse and diversion of these medications are a major global public health concern. Prescription opioid analgesics can be abused via intended and non-intended routes of administration, both intact or after ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2016.1120642
更新日期:2016-01-01 00:00:00
abstract::Five common conditions and several less common ones cause eyelid dermatitis. Diagnosis and treatment depend on recognizing their characteristics, obtaining a good history, performing a careful skin examination, administering and interpreting patch tests, prescribing the proper medications at the right time, and teachi...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1996.08.61
更新日期:1996-08-01 00:00:00
abstract::Politicians may have written a temporary obituary for healthcare reform, but as anyone in medicine knows, reform is alive and (debatably) well. Mergers, acquisitions, and practice changes are happening all across the land, and many a physician is going from being a small-business owner to being an employee. Difficult ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:
更新日期:1994-11-15 00:00:00
abstract::Granulomatous inflammation of the peritoneal surfaces resulting from exposure to cornstarch granules from surgical gloves produces a syndrome of abdominal pair, adynamic ileus, fever, peritonitis, variable white blood cell count, and inflammatory ascites. Symptoms develop three to four weeks after a routine abdominal ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1976.11716541
更新日期:1976-01-01 00:00:00
abstract::In a series of 123 children with disorders of defecation, constipation was the main problem in 89 and fecal incontinence in 34. All but three of the latter also had constipation. The principal physical findings were abdominal protuberance with palpable stool in the bowel and the presence of a fecal mass in the rectal ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1979.11715223
更新日期:1979-08-01 00:00:00
abstract:BACKGROUND:Binge eating disorder (BED) is now a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). However, post-DSM-5 patient profiles and viewpoints on BED diagnosis and treatment remain unclear. This study used a focus group methodology to examine demographic and cl...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2014.09.2800
更新日期:2014-09-01 00:00:00
abstract::The esophageal obturator airway is a relatively new addition to equipment for emergency resuscitation. It is simple to use after minimal training and can be inserted quickly without laryngoscopic visualization. Problems are uncommon. ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715374
更新日期:1980-02-01 00:00:00
abstract::Nitroglycerin and long-acting nitrates are the pharmacologic mainstays of antianginal therapy, both for acute attacks and for prophylaxis. Propranolol is often effective for prophylaxis in patients incompletely helped by nitrates. A holistic approach is stressed. Appropriate drug use will effect marked improvement in ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1977.11714674
更新日期:1977-11-01 00:00:00
abstract::Objective: Abnormal pro-inflammatory regulation of the immune system might contribute to the pathogenesis of hyperglycemia during pregnancy. We examined the correlations of neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) with disease severity and assessed their predictive values. Methods: This re...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2020.1764235
更新日期:2020-11-01 00:00:00
abstract::Given the present state of the art, any case of apparent pneumonia that is not responding to optimum therapy, or of "viremia" which appears to be progressively deteriorating, should be considered Legionnaires' disease and treated accordingly until proven otherwise. Titers for antibody to the disease in serum obtained ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715346
更新日期:1980-01-01 00:00:00
abstract::Most patients with type 2 diabetes present with comorbid overweight or obesity. Reaching and maintaining acceptable glycemic control is more difficult in overweight and obese patients, and these conditions are associated with increased risk for cardiovascular and other diseases. Glycemic management for these patients ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2010.05.2148
更新日期:2010-05-01 00:00:00
abstract::Women predominate at all ages among patients diagnosed as having primary fibromyalgia. Of 100 patients reviewed, the average age at onset of fibromyalgia was 46. Of 65 patients in whom menopause occurred before diagnosis of fibromyalgia, the average age at menopause was 42, and most of these women had menopause relate...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699544
更新日期:1986-09-15 00:00:00
abstract::Preview The number of cardiac drugs is growing every day, and their indications are changing as more is learned about each one. Choosing the appropriate drug for each patient is made difficult by these complexities, especially when a patient has already had a heart attack. The authors review the latest trials of the m...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1993.11945746
更新日期:1993-11-01 00:00:00
abstract:OBJECTIVE:To evaluate the proportion and the long-term prognostic significance of heart failure (HF) in sarcoidosis patients. METHODS:Data extracted from a large Israeli healthcare provider's database were used to study sarcoidosis patients and matched non-sarcoidosis controls since 2000 to 2016. The proportion of HF ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2020.1832773
更新日期:2020-11-01 00:00:00
abstract::Peripheral neuropathy may be a minor, even unrecognized, clinical problem, or it may be severe and virtually disabling. As in any chronic disorder, the physician's role is to look for treatable disease and to teach patients about the symptoms and natural history of the dysfunction as well as methods for coping with i...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715562
更新日期:1980-10-01 00:00:00
abstract::Exercise-induced asthma can appear as one of many forms of airway hyperreactivity or as a unique clinical entity. Simple spirometry confirms the suspected clinical diagnosis in most instances, although more sensitive measurements of airway obstruction may be required. In general, the asthmatic need not restrict physic...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715395
更新日期:1980-03-01 00:00:00
abstract::Performing office surgery well is an art. You can accomplish this by being attentive to several factors. These include, but are not limited to, providing an office environment that is pleasant, restful, and happy; using proper lighting, instruments, and suture techniques; using gentle techniques for local infiltration...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1983.11698400
更新日期:1983-08-01 00:00:00
abstract::This article on microcytic anemia is the first of several on laboratory investigation of anemia. Microcytic anemia, characterized by a mean corpuscular volume of less than 80 cu mu, is usually due to iron deficiency or chronic disease but may signify thalassemia minor. Exact identification of the cause is important, s...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1979.11715037
更新日期:1979-01-01 00:00:00
abstract::Primary carcinoid tumor of the thymus is a rare, slow-growing neoplasm occurring most commonly in middle-aged men. The usual clinical manifestations are those of a mediastinal mass, although in asymptomatic patients, the diagnosis may be suggested by a routine chest roentgenogram. Excision is the most common treatment...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1984.11698575
更新日期:1984-01-01 00:00:00
abstract::Recognition and appropriate treatment of IBS can be challenging. A rational approach to management focuses on a positive diagnosis based on the characteristic pattern of symptoms and the exclusion of organic disorders. Dietary modification and pharmacologic therapy may be useful for relieving symptoms. Patient educati...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1997.03.184
更新日期:1997-03-01 00:00:00