預防ishcemic stroke updated guidelines(american storke association)

Guidelines for Preventing Recurrent Stroke Issued


Updated guidelines on preventing recurrent ischemic stroke have been issued by the American Heart Association and the American Stroke Association.


The document, published in Stroke, offers recommendations in a variety of areas, for example, management of risk factors such as smoking and obesity. The use of antithrombotic therapy after an intracranial hemorrhage also receives much attention.


There are several new strong recommendations, based on high levels of evidence. Among them:


Although the utility of screening patients for metabolic syndrome has not been established, the dyslipidemic and hypertensive features of the syndrome should be singled out for preventive care.
In addressing glycemic control and hypertension in diabetes, targets in existing U.S. guidelines should be used.

https://docs.google.com/fileview?id=0B278nGJMQBk7YTJmOTE5ODQtYTlmOC00ZDUwLTk2ZmUtYzU5YmZmMWQ3ZTk4&hl=zh_TW

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即便是用IGRA, 有時也要等大於三個月才能決定TB contact

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白宮為了掌控醫療費用，傾向大型醫療，個體戶勢必受挫

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early vs late tracheostomy, 早切不會降低死亡率，不會降低VAP，不會降低LOS, wait!

April 27, 2010 — Early vs late tracheotomy (6 - 8 days vs 13 - 15 days after mechanical ventilation) may not significantly lower the risk for ventilator-associated pneumonia in adult patients in the intensive care unit (ICU), according to the results of a randomized controlled trial reported in the April 21 issue of the Journal of the American Medical Association . "Tracheotomy is used to replace endotracheal intubation in patients requiring prolonged ventilation; however, there is considerable variability in the time considered optimal for performing tracheotomy," write Pier Paolo Terragni, MD, from Università di Torino in Turin, Italy, and colleagues. "This is of clinical importance because timing is a key criterion for performing a tracheotomy and patients who receive one require a large amount of health care resources." The goal of this study was to compare early tracheotomy vs late tracheotomy in the incide...
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