4965 research outputs found
Sort by
Heart Failure: A Primary Care Provider Review
No full textABSTRACT
Heart failure is a growing concern globally and a leading cause of hospitalizations in the United States, with a projection of 8 million patients diagnosed by 2030. Heart failure (HF) causes debilitating symptoms, including dyspnea, exercise intolerance, fatigue, and edema. Medical therapy and lifestyle modifications, including exercise and fluid restriction, constitute first-line management to reduce hospitalizations and improve quality of life. Heart failure is categorized by left ventricular ejection fraction (LVEF), as measured by echocardiogram. These three main classes are reduced ejection fraction, in which the LVEF is less than 40% (HFrEF), mildly reduced ejection fraction, in which the LVEF is 40-49% (HFmrEF), and preserved ejection fraction, in which the LVEF is greater than 50% (HFpEF). The purpose of this review is to support primary care providers by outlining heart failure classifications, clinical presentations, risk factors, and evidence-based treatment strategies.
Common causes of heart failure include ischemia (decreased blood flow), arrhythmias, obesity, and metabolic syndromes. A comprehensive literature search of databases, including PubMed and Google Scholar, identified review articles on each type of heart failure, comorbidities associated with increased risk of heart failure, and research studies evaluating pharmacological treatment. The clinical application of randomized controlled trials, including the EMPEROR-REDUCED (The Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction) and RALES (Randomized Aldactone Evaluation Study), will be discussed. Despite recent evidence suggesting symptomatic benefit from medical therapy, there remains a need for future research in HFpEF, given the limited options to reduce cardiovascular mortality in this population. In light of the increasing prevalence of heart failure, primary care providers must proactively evaluate and manage these patients to reduce morbidity and mortality
Genetic Adaptations and Malaria Prophylaxis in Sickle Cell Disease: Reducing Morbidity and Mortality
No full textThis study examines the relationship between sickle cell disease (SCD) and malaria, focusing on the benefits and risks of the sickle cell trait, complications associated with SCD, and the impact of malaria infection in endemic regions. The paper emphasizes the importance of antimalarial prophylaxis for patients with SCD living in these areas. Evidence suggests a genetic adaptation in populations exposed to malaria, where a β-globin mutation provides partial protection against infection in individuals with the sickle cell trait. Studies consistently show that heterozygous carriers are largely protected from severe malaria, whereas individuals with homozygous SCD remain highly susceptible, resulting in malaria-related complications and, in severe cases, death. These findings underscore the need for malaria chemoprophylaxis to reduce morbidity and mortality in SCD.
Given malaria’s global health burden, integrating prophylaxis into SCD management is crucial to lowering morbidity and mortality. Sickle cell–related complications, such as painful crises, significantly affect quality of life, and minimizing these through preventive strategies offers a clear benefit. Future research should focus on identifying biomarkers for prophylaxis and vaccine development, predicting malaria severity in SCD, and clarifying the role of malaria parasites in triggering sickling. Further investigation is also warranted to determine whether hydroxyurea—currently the cornerstone of SCD therapy—affects malaria infection rates in individuals affected by SCD.
Keywords: sickle cell trait, sickle cell disease, genetic mutation, malaria, malaria chemoprophylaxi
Antibiotic Stewardship in the Austere Environment: A Narrative Review
No full textAntibiotic stewardship is a critical concern for all clinicians across all practice settings, including remote and austere environments. These settings present unique challenges such as extreme weather patterns due to climate change, resource scarcity, and logistical barriers including delayed resupply, limited climate control for medications, and restricted transportation options. As global conflict and environmental instability rise, more clinicians may find themselves practicing in these constrained environments.
This clinical review examines current antibiotic stewardship strategies in resource-constrained settings, recent advances in dynamic operational environments, and potential new directions for further research to investigate. Although antibiotic resistance was first described in the 1940s, dedicated clinical education covering antibiotic stewardship remains a mainstay of risk mitigation. A narrative review of over 50 studies focused on antibiotic stewardship in the remote primary care setting found that the risk of inappropriate prescribing was substantially higher than that in more urbanized areas.
Core opportunities include more robust institutional policies, surveillance, and decision support tools. Emerging interventions such as infectious disease telehealth consultations, novel antibiotic administration strategies, and abbreviated courses of antibiotics, have shown promise in reducing resistance risk. By adopting a robust yet streamlined antibiotic stewardship approach, remote clinicians can optimize available resources while mitigating risk to their patients
Single Maintenance and Reliever Therapy (SMART) for Pediatric Asthma
Get PDFAsthma is a commonly occurring pediatric condition managed in primary care. In 2020, asthma guidelines changed for treating mild persistent asthma. Now, experts recommend using Single Maintenance and Reliever Therapy (SMART) in children 4 years of age and older. With the SMART approach, patients use one inhaler to maintain and relieve symptoms, as the name implies. The combination inhaler contains budesonide, an inhaled corticosteroid (ICS), and formoterol, a long-acting beta-2 agonist (LABA). The most common brand name associated with this regimen in the United States is Symbicort. While there are various options for ICS therapy, formoterol is currently the sole LABA recommended for use in SMART. SMART is shown to decrease oral steroid use, increase growth rate, reduce emergency department visits and hospitalization, and improve overall asthma control. Although these benefits exist with SMART, there are associated challenges, which include a lack of provider adoption, financial constraints, and a lack of FDA approval for this indication. Despite these challenges, SMART care is efficient and symptom-altering and should be the standard of care for those with persistent asthma
So Much More Than Summer Camp: The Importance of Environmental Education at Nature Centers
Get PDFEducation in the U.S. currently faces a deficit in the promotion and proper teaching of climate change curriculum. Obvious gaps are created by a lack of clear teaching standards for environmental education, the American political machine stirring up controversy over the legitimacy of climate change, or teacher preferences. As climate change is considered one of the greatest threats facing humanity today, there is a need to educate people, especially younger generations, in order to navigate future challenges and make informed decisions. Nature centers offer the ideal location for the promotion of climate change education based on their direct connection to nature and informal curriculum model. This study began with a literature review of current climate education which identified themes in student perceptions and understanding of climate change. A case study of the current environmental education curriculum offered at Camp Kum-Ba-Yah Nature Center was also conducted. It revealed a lack of specific climate-focused activities overall, though there are opportunities to build upon programming and begin to lay the groundwork for further expansion. The need for activities that aid in the development of systems thinking skills was recognized, and therefore lessons were compiled and edited to focus on making connections within a climate system. Educational kits were created for each activity, guided by the insights from the literature review
Mining Medical Data Toward a More Equitable Health System for the Public
Get PDFThe aim of this study is to identify predictors of different sleep disorders which are less studied within the field. With sleep disorders affecting the overall well being of millions of individuals worldwide this is an important examination of potential factors which can lead to the development of such disorders. A relational database was constructed using MySql and Python in order to perform multiple different statistical analyses on data provided by the National Health and Nutrition Examination Survey (NHANES) dataset. Correlations and predictions between described sleep disorders and different physiological factors described within the dataset were found to establish conclusions as to which lesser explored factors are the most related in an individual developing such disorders. The contribution this work has on the field is identifying potential pitfalls of research being conducted in order to potentially provide better care for patients. Such patients can either be those who already hold a sleep disorder diagnosis or those who hold the factors identified within this study that were proven to have strong relations to the development of a sleep disorder
A Comparison of Muscular Strength and Power Development in Unilateral and Bilateral Lower Body Exercises
Get PDFThe purpose of this study was to compare muscle strength and power development following training programs that involved unilateral and bilateral lower-body exercises. A randomized between-groups research design was used in which results from a pretest and posttest were compared across the unilateral and bilateral groups. Sled machine one repetition maximum (1-RM) testing was used as a measure of strength, and countermovement vertical jump (CMVJ) testing was used as a measure of absolute power. Total body bioelectrical impedance analysis testing was used to predict lean body mass in both the left and right legs. Six college-aged female students who were not physically active completed 12 exercise sessions over a four-week training period involving a variation of squats, sled machine pushes, a deadlift, and box step-ups utilizing one or both legs. The specific variation of exercises for each participant was determined by randomized placement into one of the two groups. Sets, repetitions, and loads were determined using percentages of individual 1-RM values that were associated with ACSM recommendations for strength and power development. There were no significant differences in the change in 1-RM values (p=0.18) between the two groups. There were no significant differences in the change in CMVJ values (p=0.15) between the two groups. This study demonstrates a lack of significant differences in muscular strength and power development using unilateral versus bilateral lower body exercises and suggests that other factors of exercise prescription, such as exercise intensity and frequency, may play a larger role in muscular adaptation than the use of one or both limbs
In the Shadow of Sovereignty: A Dark Examination of Hobbes, Sovereign Power, and Genocide
Get PDFThis thesis explores the genocides in Rwanda and Cambodia through the framework of Thomas Hobbes’s political philosophy, focusing on his concepts of the state of nature and absolute sovereignty as articulated in Leviathan. The hypothesis asserts that Hobbes’s state of nature is not merely a hypothetical construct but a tangible reality that can be observed in the actions and failures of authoritarian regimes, such as those of the Hutu government in Rwanda and the Khmer Rouge in Cambodia. These governments, both authoritarian and endowed with seemingly absolute power, paradoxically failed to embody the Leviathan that Hobbes envisioned as the ultimate safeguard against chaos and violence. Through a detailed analysis of historical events, survivor testimonies, and Hobbesian theory, this thesis argues that the genocides orchestrated by these regimes reflect conditions akin to Hobbes’s state of nature. Far from serving as stabilizing sovereigns that provide security and order, the Hutu government and Khmer Rouge exacerbated the very chaos they were meant to suppress, using their absolute authority to foster division, dehumanization, and mass extermination. A study of these regimes reveals that while they did command the respect and authority of a Hobbsian-like sovereign, they failed to adhere to the role Hobbes’s theory idealized of a unifying and protective state. Instead, these regimes abused their authority, and were unchecked by accountability or moral limits, and instead became a tool for oppression rather than protection. This study emphasizes that Hobbes’s state of nature is not confined to theoretical abstraction but emerges as a vivid and recurring phenomenon in real-world political collapses. By comparing Hobbes’s ideal sovereign with the practical failures of these regimes, the thesis acknowledges the dangers of an absolute sovereignty as a solution to the state of nature, highlighting its fragility and potential to morph into chaos. It concludes that while Hobbes’s Dombrovskis 2 framework provides valuable insights into the dynamics of societal breakdown, Hobbes’ advocation for an absolute authority demands full precision and attention to the details written in his work, Leviathan. Furthermore, the genocides in Rwanda and Cambodia underscore the necessity of integrating accountability and ethical governance into sovereign authority to prevent such atrocities and secure enduring stability
