10.26.06

Goal Setting and Motivation

Posted in Goal Setting, Motivation at 2:02 pm by Pit

Goal Setting and Motivation The key to successful goal setting is your ability to motivate yourself and stay motivated until you have accomplished your goals. Getting and staying motivated is not as hard as it may seem. It just takes discipline. Let’s look at the thing that you should do in order to [...]

10.25.06

Prioritizing The Time Management

Posted in Time Management at 5:58 am by Pit

Prioritizing The Time Management Self-awareness is vital to manage time efficiently since our goals are the focus we need to put into practice our plans to make them work.Prioritizing your plans can cut down your risks, in addition to help manage your time. Time is precious, since it moves so quickly, we often never know where [...]

10.24.06

A Quiz on Setting Relationship Goals

Posted in Goal Setting, Love & Relationships at 6:44 am by Pit

A Quiz on Setting Relationship Goals How can we best nurture our support for one another? How dependent will we be toward one another and is it healthy? How will we communicate with one another on a daily [...]

10.23.06

ORIGINAL INVESTIGATION: Effectiveness of a Guideline for Venous Thromboembolism Prophylaxis in Elderly Post-Acute Care Patients: A Multicenter Study With Systematic Ultrasonographic Examination

Posted in Aging/ Geriatrics, Thrombolysis, Venous Thromboembolism at 8:00 pm by Pit

Background  Thromboprophylaxis in elderly patients, including post–acute care patients, is at variance with scientific evidence. The purpose of this study was to determine whether a multifaceted intervention was followed by a decrease in deep venous thrombosis (DVT).

Methods  A prospective preintervention-postintervention study was conducted in 1373 patients (preintervention phase, n = 709; postintervention phase, n = 664), aged 65 years or older, enrolled in 33 hospital-based post–acute care facilities in France. An evidence-based guideline addressing pharmacologic and mechanical prophylaxis was implemented through a multifaceted intervention. The main outcome measure was any DVT diagnosed at routine comprehensive ultrasonography performed by registered angiologists.

Results  A DVT was found in 91 patients (12.8%) in the preintervention phase and in 52 patients (7.8%) in the postintervention phase (P = .002). The decrease in DVT involved the calf (7.1% vs 3.6%; P = .005) and the proximal venous segments (5.8% vs 4.2%; P = .18) and remained significant after adjusting for risk factors (adjusted odds ratio of any DVT, 0.58; 95% confidence interval, 0.39-0.86). Pharmacologic prophylaxis with either low-molecular-weight heparin at the high-risk dose, unfractionated heparin, and vitamin K antagonist was similar in the 2 study groups, whereas patients in the postintervention group were more likely to use graduated compression stockings (27.4% vs 34.6%; P = .004) and less likely to receive low-molecular-weight heparin at the low-risk dose (24.7% vs 18.5%; P = .006), which was not recommended by our guideline.

Conclusions  A multifaceted intervention addressing venous thromboembolism prophylaxis in post–acute care patients can be followed by a significant decrease in the rate of any DVT in elderly patients. More active interventions are needed to enforce compliance with evidence-based guidelines.

ORIGINAL INVESTIGATION: High-Sensitivity C-Reactive Protein, Lipoprotein-Associated Phospholipase A2, and Outcome After Ischemic Stroke

Posted in Neurology, Cerebrovascular Disease, Stroke, Neurology, at 8:00 pm by Pit

Background  Inflammatory markers have been associated with ischemic stroke risk and prognosis after cardiac events. Their relationship to prognosis after stroke is unsettled.

Methods  A population-based study of stroke risk factors in 467 patients with first ischemic stroke was undertaken to determine whether levels of high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) predict risk of stroke recurrence, other vascular events, and death.

Results  Levels of Lp-PLA2 and hs-CRP were weakly correlated (r = 0.09; P = .045). High-sensitivity CRP, but not Lp-PLA2, was associated with stroke severity. After adjusting for age, sex, race and ethnicity, history of coronary artery disease, diabetes mellitus, hypertension, hyperlipidemia, atrial fibrillation, smoking, and hs-CRP level, compared with the lowest quartile of Lp-PLA2, those in the highest quartile had an increased risk of recurrent stroke (adjusted hazard ratio, 2.08; 95% confidence interval, 1.04-4.18) and of the combined outcome of recurrent stroke, MI, or vascular death (adjusted hazard ratio, 1.86; 95% confidence interval, 1.01-3.42). After adjusting for confounders, hs-CRP was not associated with risk of recurrent stroke or recurrent stroke, myocardial infarction, or vascular death but was associated with risk of death (adjusted hazard ratio, 2.11; 95% confidence interval, 1.18-3.75).

Conclusions  Inflammatory markers are associated with prognosis after first ischemic stroke and may offer complementary information. Lipoprotein-associated phospholipase A2 may be a stronger predictor of recurrent stroke risk. Levels of hs-CRP, an acute-phase reactant, increase with stroke severity and may be associated with mortality to a greater degree than recurrence.

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