Hypertension is a common and serious condition that contributes to an estimated 40% of deaths from coronary heart disease and stroke, and is the second leading cause of end-stage renal disease. Because of the importance and frequency of hypertension in primary care practices, we are devoting two issues to the subject. This issue focuses on the definition of blood pressure and current guidelines, risk factors, relationship to cardiovascular disease, blood pressure measurement, patient evaluation, and secondary causes. The next issue will cover treatments (pharmacological and non-pharmacological), initial therapy, relationship to various disease conditions (diabetes, ischemic heart disease, heart failure, chronic kidney disease, cerebrovascular disease, ischemic stroke, stroke prevention, atrial fibrillation, valvular heart disease, aortic regurgitation, sexual dysfunction), resistant hypertension, hypertensive crises and emergencies, preoperative management, and adherence strategies.
The Infectious Diseases Society of America withheld its support for the Surviving Sepsis guidelines. The general concerns included vagueness and inconsistency in definition of sepsis, “one size fits all” prescription of time to administer antibiotics, lack of clarity around drawing blood cultures through IV catheters, recommendation of combination antibiotics, lack of definition around when to use procalcitonin levels, when and how to use pharmacokinetic and pharmacodynamic data effectively, prolonged antibiotic “prophylaxis,” and duration of therapy.
The investigators retrospectively evaluated ESCMIID, IDSA, and Swedish guidelines for neuroimaging in 815 adults with acute bacterial meningitis. Swedish guidelines omit altered mental status and immunosuppression as indications for imaging prior to lumbar puncture. Adherence to Swedish guidelines resulted in decreased mortality and more favorable outcomes.
Research analyzing trends in the nation’s emergency departments indicates low rates of HIV and syphilis screening among teens diagnosed with pelvic inflammatory disease, despite the high risk for such infections. Data also suggest low rates of adherence to national treatment guidelines.
About 820,000 new gonococcal infections occur in the United States each year, with some 570,000 appearing in young people ages 15-24. In an effort to stem the tide of infection, science has identified a potential new treatment, which uses a peptide to disrupt an enzyme the microbe needs to respirate.
In patients with newly diagnosed community-acquired pneumonia, basing the duration of antibiotic treatment on clinical stability criteria led to a significant reduction in duration of antibiotic treatment without an increased risk of adverse outcomes.
The most notable new recommendation of the updated hospital-acquired pneumonia/ventilator-associated pneumonia guideline may be its endorsement of limiting the duration of antibiotic therapy to seven days in most cases.
The American Academy of Pediatrics, with the American Academy of Pediatric Dentistry, has issued updated clinical guidelines for delivering safe sedation to pediatric patients before, during, and after diagnostic and therapeutic procedures.