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OBJECTIVE: Implantable loop recorders (ILRs) are increasingly used for long-term rhythm monitoring after ischaemic and cryptogenic stroke, with the goal of detecting atrial fibrillation (AF) and subsequent initiation of oral anticoagulation to reduce risk of adverse clinical outcomes. There is a need to determine the effectiveness of different rhythm monitoring strategies in this context. METHODS: We conducted a retrospective cohort analysis of individuals with commercial and Medicare Advantage insurance in Optum Labs Data Warehouse who had incident ischaemic or cryptogenic stroke and no prior cardiovascular implantable electronic device from 1 January 2016 to 30 June 2021. Patients were stratified by rhythm monitoring strategy: ILR, long-term continuous external cardiac monitor (>48 hours to 30 days) or Holter monitor (≤48 hours). The primary outcome was risk-adjusted all-cause mortality at 12 months. Secondary outcomes included new diagnosis of AF and oral anticoagulation, bleeding, and costs. RESULTS: Among 48 901 patients with ischaemic or cryptogenic stroke, 9235 received an ILR, 29 103 long-term continuous external monitor and 10 563 Holter monitor only. Mean age was 69.9 (SD 11.9) years and 53.5% were female. During the 12-month follow-up period, patients who received ILRs compared with those who received long-term continuous external monitors had a higher odds of new diagnosis of AF and oral anticoagulant initiation (adjusted OR 2.27, 95% CI 2.09 to 2.48). Compared with patients who received long-term continuous external monitors, those who received ILRs had similar 12-month mortality (HR 1.00; 95% CI 0.89 to 1.12), with approximately $13 000 higher costs at baseline (including monitor cost) and $2500 higher costs during 12-month follow-up. CONCLUSIONS: In this large real-world study of patients with ischaemic or cryptogenic stroke, ILR placement resulted in more diagnosis of AF and initiation of oral anticoagulation, but no difference in mortality compar

OBJECTIVE: To explore sleep structure in participants with obstructive sleep apnea (OSA) and comorbid insomnia (COMISA) and participants with OSA without insomnia (OSA-only) using both single-night polysomnography and multi-night wrist-worn photoplethysmography/accelerometry.METHODS: Multi-night 4-class sleep-staging was performed with a validated algorithm based on actigraphy and heart rate variability, in 67 COMISA (23 women, median age: 51 years) and 50 OSA-only (15 women, median age: 51) participants. Sleep statistics were compared using linear regression models and mixed-effects models. Multi-night variability was explored using a clustering approach and between- and within-participant analysis.RESULTS: Polysomnographic parameters showed no significant group differences. Multi-night measurements, during 13.4 ± 5.2 nights per subject, demonstrated a longer sleep onset latency and lower sleep efficiency for the COMISA group. Detailed analysis of wake parameters revealed longer mean durations of awakenings in COMISA, as well as higher numbers of awakenings lasting 5 min and longer (WKN ≥5min) and longer wake after sleep onset containing only awakenings of 5 min or longer. Within-participant variance was significantly larger in COMISA for sleep onset latency, sleep efficiency, mean duration of awakenings and WKN ≥5min. Unsupervised clustering uncovered three clusters; participants with consistently high values for at least one of the wake parameters, participants with consistently low values, and participants displaying higher variability. CONCLUSION: Patients with COMISA more often showed extended, and more variable periods of wakefulness. These observations were not discernible using single night polysomnography, highlighting the relevance of multi-night measurements to assess characteristics indicative for insomnia.

BACKGROUND: Negative interpersonal interactions are associated with acute increases in ambulatory blood pressure (ABP). Yet, the mechanisms underlying this relationship are unclear. PURPOSE: This study tested whether negative interpersonal interactions predict higher ABP both in the moment and during subsequent observations, and whether increases in negative mood mediate these relations. These associations were tested among Black and Hispanic urban adults who may be at higher risk for negative interpersonal interactions as a function of discrimination. Race/ethnicity and lifetime discrimination were tested as moderators. METHODS: Using a 24-hr ecological momentary assessment (EMA) design, 565 Black and Hispanic participants (aged 23-65, M = 39.06, SD = 9.35; 51.68% men) had their ABP assessed every 20 min during daytime accompanied by an assessment of negative interpersonal interactions and mood. This produced 12,171 paired assessments of ABP and self-reports of participants interpersonal interactions, including how much the interaction made them feel left out, harassed, and treated unfairly, as well as how angry, nervous, and sad they felt. RESULTS: Multilevel models revealed that more intense negative interpersonal interactions predicted higher momentary ABP. Mediation analyses revealed that increased negative mood explained the relationship between negative interpersonal interactions and ABP in concurrent and lagged analyses. Discrimination was associated with more negative interpersonal interactions, but neither race/ethnicity nor lifetime discrimination moderated findings. CONCLUSIONS: Results provide a clearer understanding of the psychobiological mechanisms through which interpersonal interactions influence cardiovascular health and may contribute to health disparities. Implications include the potential for just-in-time interventions to provide mood restoring resources after negative interactions.

Objective:Ambulatory blood pressure monitoring (ABPM) plays an important role in the diagnosis of hypertension. However, methodological factors and the measurement conditions affect the results and may lead to incorrect classification of the patient. We performed a pilot study to evaluate the impact of oscillometric measurement artefacts on ABPM-derived variables.Methods:Four classes of artefacts have been detected: motor activity artefacts, cuff errors, cardiovascular arousals, and arrhythmias. The data consisted of uncorrected measurements (all data), corrected measurements (all artefact free data), and artefact affected data.Results:A total of 30 individuals (9 female/21 male), aged between 36 and 86 years, mean: 65.5 (standard deviation: 9.5) were included in the study. The average blood pressure (BP) was higher in artefacts-affected measurements compared the artefact-free measurements both for systolic (4.6 mmHg) and diastolic (1.3 mmHg) measurements. Further, artefact-affected systolic BP (SBP) was 6.4 mmHg higher than artefact-free measurements during daytime. Nocturnal measurements showed no artefact-depended differences. Individual comparisons yielded that 23% of the participants crossed the threshold for BP classification for either 24-h, daytime or nocturnal hypertension when comparing uncorrected and artefact-free measurements. Dipping classification changed within 24% of participants. BP variability was 21 and 12% higher for SPB and DBP, respectively, during daytime. These differences were even higher (27% for SBP and 21% for DPB) during night-time.Conclusion:The study reveals that measurement artefacts are frequently present during cuff-based ABPM and do relevantly affect measurement outcome. Exclusion of measurement artefacts is a promising approach to improving cuff-based ABPM accuracy.

BackgroundBlack adults with chronic kidney disease (CKD) have higher rates of hypertension as compared to White adults with CKD. Little is known of how race and ethnicity associate with the prevalence of hypertension in pediatric CKD patients. The aim was to compare ambulatory blood pressure monitoring (ABPM) results for patients with CKD enrolled in the Chronic Kidney Disease in Children (CKiD) study across racial-ethnic groups.MethodsPatients from the CKiD study who identified as non-Hispanic White, non-Hispanic Black, or Hispanic were included to analyze differences in ABPM results across these racial-ethnic groups. The outcomes were fitted using 3 progressively adjusted models.ResultsThis study included 501 CKiD participants with at least one successful ABPM study. Compared to White participants, Black participants had 4.2 mmHg higher mean sleep systolic blood pressure and 2.7 mmHg higher mean sleep diastolic blood pressure (p = 0.001 and p = 0.004, respectively). Additionally, Black participants had higher odds of abnormal wake systolic load (OR 1.88, 1.21-2.91, p = 0.005), wake diastolic load (OR 1.68, 1.03-2.73, p = 0.04), sleep systolic load (OR 2.19, 1.36-3.5, p = 0.001), sleep diastolic load (OR 2.01, 1.28-3.15, p = 0.002), systolic non-dipping (OR 2.02, 1.31-3.10, p = 0.001), and diastolic non-dipping (OR 2.69, 1.60-4.51, p < 0.001). Compared to White participants, Hispanic participants demonstrated only a lower sleep diastolic load (OR 0.54, 0.31-0.95, p = 0.03).ConclusionsBlack children with CKD have higher absolute nocturnal blood pressures and higher rates of abnormal dipping. Further studies are needed to determine the etiology of these differences and the clinical implications of racial-ethnic differences in ABPM outcomes within the pediatric CKD population. A higher resolution version of the Graphical abstract is available as Supplementary information.

Background Uncontrolled blood pressure (BP) remains a leading cause of death in the United States. The American Medical Association developed a quality improvement program to improve BP control, but it is unclear how to efficiently implement this program at scale across multiple health systems. Methods and Results We conducted BP MAP (Blood Pressure Measure Accurately, Act Rapidly, and Partner With Patients), a comparative effectiveness trial with clinic-level randomization to compare 2 scalable versions of the quality improvement program: Full Support (with support from quality improvement expert) and Self-Guided (using only online materials). Outcomes were clinic-level BP control (<140/90 mm Hg) and other BP-related process metrics calculated using electronic health record data. Difference-in-differences were used to compare changes in outcomes from baseline to 6 months, between intervention arms, and to a nonrandomized Usual Care arm composed of 18 health systems. A total of 24 safety-net clinics in 9 different health systems underwent randomization and then simultaneous implementation. BP control increased from 56.7% to 59.1% in the Full Support arm, and 62.0% to 63.1% in the Self-Guided arm, whereas BP control dropped slightly from 61.3% to 60.9% in the Usual Care arm. The between-group differences-in-differences were not statistically significant (Full Support versus Self-Guided=+1.2% [95% CI, -3.2% to 5.6%], P=0.59; Full Support versus Usual Care=+3.2% [-0.5% to 6.9%], P=0.09; Self-Guided versus Usual Care=+2.0% [-0.4% to 4.5%], P=0.10). Conclusions In this randomized trial, 2 methods of implementing a quality improvement intervention in 24 safety net clinics led to modest improvements in BP control that were not statistically significant. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03818659.

BACKGROUND: Hypertension is a prevalent complication of Chronic Kidney Disease (CKD) and Ambulatory Blood Pressure Monitoring (ABPM) is the gold standard for diagnosis. The aim of our study was to assess the usefulness of obtaining ABPM and to identify barriers to ABPM in this pediatric patient population. METHOD: In this retrospective analysis of patients with CKD stage 3-5 who were seen in one academic medical centers outpatient Pediatric Nephrology clinics between 2018 and 2021, we performed logistic regression to evaluate for associations between demographic factors and odds of having an ABPM. RESULT: Among 96 patients included in the study, 48 patients carried a diagnosis of hypertension. 31 patients had ABPM performed with usable data. In those who had ABPM done, 21 had normotension and 10 had undertreated hypertension. Our study also showed 1 had masked hypertension and 5 had white coat hypertension or effect. We did not find a statistically significant difference in those who did or did not undergo ABPM evaluation based on gender, previous diagnosis of hypertension, distance from clinic, language preference, or racial or ethnic identity. CONCLUSION: ABPM is a useful tool in our CKD population for the diagnosis and management of hypertension. We did not identify specific barriers to ABPM in our CKD population, and there were no differences in patients who obtained ABPM when looking at specific demographic and disease characteristics. Given these findings, we recommend focusing on areas of future improvement in spheres of patient and provider education as well as better quantification using surveys to further illuminate barriers.

BACKGROUND: Coffee is one of the most commonly consumed beverages in the world, but the acute health effects of coffee consumption remain uncertain. METHODS: We conducted a prospective, randomized, case-crossover trial to examine the effects of caffeinated coffee on cardiac ectopy and arrhythmias, daily step counts, sleep minutes, and serum glucose levels. A total of 100 adults were fitted with a continuously recording electrocardiogram device, a wrist-worn accelerometer, and a continuous glucose monitor. Participants downloaded a smartphone application to collect geolocation data. We used daily text messages, sent over a period of 14 days, to randomly instruct participants to consume caffeinated coffee or avoid caffeine. The primary outcome was the mean number of daily premature atrial contractions. Adherence to the randomization assignment was assessed with the use of real-time indicators recorded by the participants, daily surveys, reimbursements for date-stamped receipts for coffee purchases, and virtual monitoring (geofencing) of coffee-shop visits. RESULTS: The mean (±SD) age of the participants was 39±13 years; 51% were women, and 51% were non-Hispanic White. Adherence to the random assignments was assessed to be high. The consumption of caffeinated coffee was associated with 58 daily premature atrial contractions as compared with 53 daily events on days when caffeine was avoided (rate ratio, 1.09; 95% confidence interval [CI], 0.98 to 1.20; P = 0.10). The consumption of caffeinated coffee as compared with no caffeine consumption was associated with 154 and 102 daily premature ventricular contractions, respectively (rate ratio, 1.51; 95% CI, 1.18 to 1.94); 10,646 and 9665 daily steps (mean difference, 1058; 95% CI, 441 to 1675); 397 and 432 minutes of nightly sleep (mean difference, 36; 95% CI, 25 to 47); and serum glucose levels of 95 mg per deciliter and 96 mg per deciliter (mean difference, -0.41; 95% CI, -5.42 to 4.60). CONCLUSIONS: In this randomized tri

Preventive Medicine includes as principles: health care and Medical Care. The training of the doctor was car-ried out caring for the sick in hospitals; The development of Primary Health Care has enabled training in com-munities with the essential objective of providing health care to the population. The methodology used for this research work. The technique for data collection is made up of electronic materials, the latter such as Google Scholar, among others, relying on the use of certified descriptors and endorsed by the UNESCO thesaurus. The information obtained here will be reviewed, summarized and analyzed for its presentation organized in the results. The fundamental aspects of general medicine is that it has the capacity within its vertical action to del-egate incidents to other specialties and health centers that the outpatient clinic does not have the capacity to attend to, therefore the importance of general practitioners and internists in these processes capture and filter at the time of primary care to the population. However, the system in a comprehensive manner cannot function if, in the first instance, there are not the necessary number of health centers per number of inhabitants, as well as doctors and nurses, without ceasing to downplay the importance of medical supplies, La Medicina Preventiva comprende como principios: las atenciones de salud y las de Atención Médica. La formación del médico se realizaba atendiendo a los enfermos en los hospitales; el desarrollo de la Atención Primaria de salud ha posibilitado la formación en las comunidades con el objetivo esencial de la atención a la salud de la población. La metodología utilizada para el presente trabajo de investigación. La técnica para la recolección de datos está constituida por materiales electrónicos, estos últimos como Google Académi-co, entre otros, apoyándose para ello en el uso de descriptores certificados y avalados por el tesauro de la UNESCO. La información aquí obtenida será revisada, resumida y analizada para su exposición organizada en los resultados. Los aspectos fundamentales de la medicina general es que tiene la capacidad dentro de su acción vertical de delegar incidencias a otras especialidades y centros de salud que lo ambulatorio no tiene la capacidad de atender, por ello la importancia de los médicos generales e internistas en estos procesos de captación y filtro a la hora de la atención primaria a la población. Sin embargo, el sistema a manera integral no puede funcionar si en primera instancia no existen la cantidad de centros de salud necesarios por cantidad de habitantes al igual que médicos y enfermeras, sin dejar de restarle importancia a los insumos médicos.

Preventive Medicine includes as principles: health care and Medical Care. The training of the doctor was car-ried out caring for the sick in hospitals; The development of Primary Health Care has enabled training in com-munities with the essential objective of providing health care to the population. The methodology used for this research work. The technique for data collection is made up of electronic materials, the latter such as Google Scholar, among others, relying on the use of certified descriptors and endorsed by the UNESCO thesaurus. The information obtained here will be reviewed, summarized and analyzed for its presentation organized in the results. The fundamental aspects of general medicine is that it has the capacity within its vertical action to del-egate incidents to other specialties and health centers that the outpatient clinic does not have the capacity to attend to, therefore the importance of general practitioners and internists in these processes capture and filter at the time of primary care to the population. However, the system in a comprehensive manner cannot function if, in the first instance, there are not the necessary number of health centers per number of inhabitants, as well as doctors and nurses, without ceasing to downplay the importance of medical supplies, La Medicina Preventiva comprende como principios: las atenciones de salud y las de Atención Médica. La formación del médico se realizaba atendiendo a los enfermos en los hospitales; el desarrollo de la Atención Primaria de salud ha posibilitado la formación en las comunidades con el objetivo esencial de la atención a la salud de la población. La metodología utilizada para el presente trabajo de investigación. La técnica para la recolección de datos está constituida por materiales electrónicos, estos últimos como Google Académi-co, entre otros, apoyándose para ello en el uso de descriptores certificados y avalados por el tesauro de la UNESCO. La información aquí obtenida será revisada, resumida y analizada para su exposición organizada en los resultados. Los aspectos fundamentales de la medicina general es que tiene la capacidad dentro de su acción vertical de delegar incidencias a otras especialidades y centros de salud que lo ambulatorio no tiene la capacidad de atender, por ello la importancia de los médicos generales e internistas en estos procesos de captación y filtro a la hora de la atención primaria a la población. Sin embargo, el sistema a manera integral no puede funcionar si en primera instancia no existen la cantidad de centros de salud necesarios por cantidad de habitantes al igual que médicos y enfermeras, sin dejar de restarle importancia a los insumos médicos.

Preventive Medicine includes as principles: health care and Medical Care. The training of the doctor was car-ried out caring for the sick in hospitals; The development of Primary Health Care has enabled training in com-munities with the essential objective of providing health care to the population. The methodology used for this research work. The technique for data collection is made up of electronic materials, the latter such as Google Scholar, among others, relying on the use of certified descriptors and endorsed by the UNESCO thesaurus. The information obtained here will be reviewed, summarized and analyzed for its presentation organized in the results. The fundamental aspects of general medicine is that it has the capacity within its vertical action to del-egate incidents to other specialties and health centers that the outpatient clinic does not have the capacity to attend to, therefore the importance of general practitioners and internists in these processes capture and filter at the time of primary care to the population. However, the system in a comprehensive manner cannot function if, in the first instance, there are not the necessary number of health centers per number of inhabitants, as well as doctors and nurses, without ceasing to downplay the importance of medical supplies, La Medicina Preventiva comprende como principios: las atenciones de salud y las de Atención Médica. La formación del médico se realizaba atendiendo a los enfermos en los hospitales; el desarrollo de la Atención Primaria de salud ha posibilitado la formación en las comunidades con el objetivo esencial de la atención a la salud de la población. La metodología utilizada para el presente trabajo de investigación. La técnica para la recolección de datos está constituida por materiales electrónicos, estos últimos como Google Académi-co, entre otros, apoyándose para ello en el uso de descriptores certificados y avalados por el tesauro de la UNESCO. La información aquí obtenida será revisada, resumida y analizada para su exposición organizada en los resultados. Los aspectos fundamentales de la medicina general es que tiene la capacidad dentro de su acción vertical de delegar incidencias a otras especialidades y centros de salud que lo ambulatorio no tiene la capacidad de atender, por ello la importancia de los médicos generales e internistas en estos procesos de captación y filtro a la hora de la atención primaria a la población. Sin embargo, el sistema a manera integral no puede funcionar si en primera instancia no existen la cantidad de centros de salud necesarios por cantidad de habitantes al igual que médicos y enfermeras, sin dejar de restarle importancia a los insumos médicos.

Preventive Medicine includes as principles: health care and Medical Care. The training of the doctor was car-ried out caring for the sick in hospitals; The development of Primary Health Care has enabled training in com-munities with the essential objective of providing health care to the population. The methodology used for this research work. The technique for data collection is made up of electronic materials, the latter such as Google Scholar, among others, relying on the use of certified descriptors and endorsed by the UNESCO thesaurus. The information obtained here will be reviewed, summarized and analyzed for its presentation organized in the results. The fundamental aspects of general medicine is that it has the capacity within its vertical action to del-egate incidents to other specialties and health centers that the outpatient clinic does not have the capacity to attend to, therefore the importance of general practitioners and internists in these processes capture and filter at the time of primary care to the population. However, the system in a comprehensive manner cannot function if, in the first instance, there are not the necessary number of health centers per number of inhabitants, as well as doctors and nurses, without ceasing to downplay the importance of medical supplies, La Medicina Preventiva comprende como principios: las atenciones de salud y las de Atención Médica. La formación del médico se realizaba atendiendo a los enfermos en los hospitales; el desarrollo de la Atención Primaria de salud ha posibilitado la formación en las comunidades con el objetivo esencial de la atención a la salud de la población. La metodología utilizada para el presente trabajo de investigación. La técnica para la recolección de datos está constituida por materiales electrónicos, estos últimos como Google Académi-co, entre otros, apoyándose para ello en el uso de descriptores certificados y avalados por el tesauro de la UNESCO. La información aquí obtenida será revisada, resumida y analizada para su exposición organizada en los resultados. Los aspectos fundamentales de la medicina general es que tiene la capacidad dentro de su acción vertical de delegar incidencias a otras especialidades y centros de salud que lo ambulatorio no tiene la capacidad de atender, por ello la importancia de los médicos generales e internistas en estos procesos de captación y filtro a la hora de la atención primaria a la población. Sin embargo, el sistema a manera integral no puede funcionar si en primera instancia no existen la cantidad de centros de salud necesarios por cantidad de habitantes al igual que médicos y enfermeras, sin dejar de restarle importancia a los insumos médicos.

Preventive Medicine includes as principles: health care and Medical Care. The training of the doctor was car-ried out caring for the sick in hospitals; The development of Primary Health Care has enabled training in com-munities with the essential objective of providing health care to the population. The methodology used for this research work. The technique for data collection is made up of electronic materials, the latter such as Google Scholar, among others, relying on the use of certified descriptors and endorsed by the UNESCO thesaurus. The information obtained here will be reviewed, summarized and analyzed for its presentation organized in the results. The fundamental aspects of general medicine is that it has the capacity within its vertical action to del-egate incidents to other specialties and health centers that the outpatient clinic does not have the capacity to attend to, therefore the importance of general practitioners and internists in these processes capture and filter at the time of primary care to the population. However, the system in a comprehensive manner cannot function if, in the first instance, there are not the necessary number of health centers per number of inhabitants, as well as doctors and nurses, without ceasing to downplay the importance of medical supplies, La Medicina Preventiva comprende como principios: las atenciones de salud y las de Atención Médica. La formación del médico se realizaba atendiendo a los enfermos en los hospitales; el desarrollo de la Atención Primaria de salud ha posibilitado la formación en las comunidades con el objetivo esencial de la atención a la salud de la población. La metodología utilizada para el presente trabajo de investigación. La técnica para la recolección de datos está constituida por materiales electrónicos, estos últimos como Google Académi-co, entre otros, apoyándose para ello en el uso de descriptores certificados y avalados por el tesauro de la UNESCO. La información aquí obtenida será revisada, resumida y analizada para su exposición organizada en los resultados. Los aspectos fundamentales de la medicina general es que tiene la capacidad dentro de su acción vertical de delegar incidencias a otras especialidades y centros de salud que lo ambulatorio no tiene la capacidad de atender, por ello la importancia de los médicos generales e internistas en estos procesos de captación y filtro a la hora de la atención primaria a la población. Sin embargo, el sistema a manera integral no puede funcionar si en primera instancia no existen la cantidad de centros de salud necesarios por cantidad de habitantes al igual que médicos y enfermeras, sin dejar de restarle importancia a los insumos médicos.

Preventive Medicine includes as principles: health care and Medical Care. The training of the doctor was car-ried out caring for the sick in hospitals; The development of Primary Health Care has enabled training in com-munities with the essential objective of providing health care to the population. The methodology used for this research work. The technique for data collection is made up of electronic materials, the latter such as Google Scholar, among others, relying on the use of certified descriptors and endorsed by the UNESCO thesaurus. The information obtained here will be reviewed, summarized and analyzed for its presentation organized in the results. The fundamental aspects of general medicine is that it has the capacity within its vertical action to del-egate incidents to other specialties and health centers that the outpatient clinic does not have the capacity to attend to, therefore the importance of general practitioners and internists in these processes capture and filter at the time of primary care to the population. However, the system in a comprehensive manner cannot function if, in the first instance, there are not the necessary number of health centers per number of inhabitants, as well as doctors and nurses, without ceasing to downplay the importance of medical supplies, La Medicina Preventiva comprende como principios: las atenciones de salud y las de Atención Médica. La formación del médico se realizaba atendiendo a los enfermos en los hospitales; el desarrollo de la Atención Primaria de salud ha posibilitado la formación en las comunidades con el objetivo esencial de la atención a la salud de la población. La metodología utilizada para el presente trabajo de investigación. La técnica para la recolección de datos está constituida por materiales electrónicos, estos últimos como Google Académi-co, entre otros, apoyándose para ello en el uso de descriptores certificados y avalados por el tesauro de la UNESCO. La información aquí obtenida será revisada, resumida y analizada para su exposición organizada en los resultados. Los aspectos fundamentales de la medicina general es que tiene la capacidad dentro de su acción vertical de delegar incidencias a otras especialidades y centros de salud que lo ambulatorio no tiene la capacidad de atender, por ello la importancia de los médicos generales e internistas en estos procesos de captación y filtro a la hora de la atención primaria a la población. Sin embargo, el sistema a manera integral no puede funcionar si en primera instancia no existen la cantidad de centros de salud necesarios por cantidad de habitantes al igual que médicos y enfermeras, sin dejar de restarle importancia a los insumos médicos.

Preventive Medicine includes as principles: health care and Medical Care. The training of the doctor was car-ried out caring for the sick in hospitals; The development of Primary Health Care has enabled training in com-munities with the essential objective of providing health care to the population. The methodology used for this research work. The technique for data collection is made up of electronic materials, the latter such as Google Scholar, among others, relying on the use of certified descriptors and endorsed by the UNESCO thesaurus. The information obtained here will be reviewed, summarized and analyzed for its presentation organized in the results. The fundamental aspects of general medicine is that it has the capacity within its vertical action to del-egate incidents to other specialties and health centers that the outpatient clinic does not have the capacity to attend to, therefore the importance of general practitioners and internists in these processes capture and filter at the time of primary care to the population. However, the system in a comprehensive manner cannot function if, in the first instance, there are not the necessary number of health centers per number of inhabitants, as well as doctors and nurses, without ceasing to downplay the importance of medical supplies, La Medicina Preventiva comprende como principios: las atenciones de salud y las de Atención Médica. La formación del médico se realizaba atendiendo a los enfermos en los hospitales; el desarrollo de la Atención Primaria de salud ha posibilitado la formación en las comunidades con el objetivo esencial de la atención a la salud de la población. La metodología utilizada para el presente trabajo de investigación. La técnica para la recolección de datos está constituida por materiales electrónicos, estos últimos como Google Académi-co, entre otros, apoyándose para ello en el uso de descriptores certificados y avalados por el tesauro de la UNESCO. La información aquí obtenida será revisada, resumida y analizada para su exposición organizada en los resultados. Los aspectos fundamentales de la medicina general es que tiene la capacidad dentro de su acción vertical de delegar incidencias a otras especialidades y centros de salud que lo ambulatorio no tiene la capacidad de atender, por ello la importancia de los médicos generales e internistas en estos procesos de captación y filtro a la hora de la atención primaria a la población. Sin embargo, el sistema a manera integral no puede funcionar si en primera instancia no existen la cantidad de centros de salud necesarios por cantidad de habitantes al igual que médicos y enfermeras, sin dejar de restarle importancia a los insumos médicos.

Preventive Medicine includes as principles: health care and Medical Care. The training of the doctor was car-ried out caring for the sick in hospitals; The development of Primary Health Care has enabled training in com-munities with the essential objective of providing health care to the population. The methodology used for this research work. The technique for data collection is made up of electronic materials, the latter such as Google Scholar, among others, relying on the use of certified descriptors and endorsed by the UNESCO thesaurus. The information obtained here will be reviewed, summarized and analyzed for its presentation organized in the results. The fundamental aspects of general medicine is that it has the capacity within its vertical action to del-egate incidents to other specialties and health centers that the outpatient clinic does not have the capacity to attend to, therefore the importance of general practitioners and internists in these processes capture and filter at the time of primary care to the population. However, the system in a comprehensive manner cannot function if, in the first instance, there are not the necessary number of health centers per number of inhabitants, as well as doctors and nurses, without ceasing to downplay the importance of medical supplies, La Medicina Preventiva comprende como principios: las atenciones de salud y las de Atención Médica. La formación del médico se realizaba atendiendo a los enfermos en los hospitales; el desarrollo de la Atención Primaria de salud ha posibilitado la formación en las comunidades con el objetivo esencial de la atención a la salud de la población. La metodología utilizada para el presente trabajo de investigación. La técnica para la recolección de datos está constituida por materiales electrónicos, estos últimos como Google Académi-co, entre otros, apoyándose para ello en el uso de descriptores certificados y avalados por el tesauro de la UNESCO. La información aquí obtenida será revisada, resumida y analizada para su exposición organizada en los resultados. Los aspectos fundamentales de la medicina general es que tiene la capacidad dentro de su acción vertical de delegar incidencias a otras especialidades y centros de salud que lo ambulatorio no tiene la capacidad de atender, por ello la importancia de los médicos generales e internistas en estos procesos de captación y filtro a la hora de la atención primaria a la población. Sin embargo, el sistema a manera integral no puede funcionar si en primera instancia no existen la cantidad de centros de salud necesarios por cantidad de habitantes al igual que médicos y enfermeras, sin dejar de restarle importancia a los insumos médicos.

Preventive Medicine includes as principles: health care and Medical Care. The training of the doctor was car-ried out caring for the sick in hospitals; The development of Primary Health Care has enabled training in com-munities with the essential objective of providing health care to the population. The methodology used for this research work. The technique for data collection is made up of electronic materials, the latter such as Google Scholar, among others, relying on the use of certified descriptors and endorsed by the UNESCO thesaurus. The information obtained here will be reviewed, summarized and analyzed for its presentation organized in the results. The fundamental aspects of general medicine is that it has the capacity within its vertical action to del-egate incidents to other specialties and health centers that the outpatient clinic does not have the capacity to attend to, therefore the importance of general practitioners and internists in these processes capture and filter at the time of primary care to the population. However, the system in a comprehensive manner cannot function if, in the first instance, there are not the necessary number of health centers per number of inhabitants, as well as doctors and nurses, without ceasing to downplay the importance of medical supplies, La Medicina Preventiva comprende como principios: las atenciones de salud y las de Atención Médica. La formación del médico se realizaba atendiendo a los enfermos en los hospitales; el desarrollo de la Atención Primaria de salud ha posibilitado la formación en las comunidades con el objetivo esencial de la atención a la salud de la población. La metodología utilizada para el presente trabajo de investigación. La técnica para la recolección de datos está constituida por materiales electrónicos, estos últimos como Google Académi-co, entre otros, apoyándose para ello en el uso de descriptores certificados y avalados por el tesauro de la UNESCO. La información aquí obtenida será revisada, resumida y analizada para su exposición organizada en los resultados. Los aspectos fundamentales de la medicina general es que tiene la capacidad dentro de su acción vertical de delegar incidencias a otras especialidades y centros de salud que lo ambulatorio no tiene la capacidad de atender, por ello la importancia de los médicos generales e internistas en estos procesos de captación y filtro a la hora de la atención primaria a la población. Sin embargo, el sistema a manera integral no puede funcionar si en primera instancia no existen la cantidad de centros de salud necesarios por cantidad de habitantes al igual que médicos y enfermeras, sin dejar de restarle importancia a los insumos médicos.

Preventive Medicine includes as principles: health care and Medical Care. The training of the doctor was car-ried out caring for the sick in hospitals; The development of Primary Health Care has enabled training in com-munities with the essential objective of providing health care to the population. The methodology used for this research work. The technique for data collection is made up of electronic materials, the latter such as Google Scholar, among others, relying on the use of certified descriptors and endorsed by the UNESCO thesaurus. The information obtained here will be reviewed, summarized and analyzed for its presentation organized in the results. The fundamental aspects of general medicine is that it has the capacity within its vertical action to del-egate incidents to other specialties and health centers that the outpatient clinic does not have the capacity to attend to, therefore the importance of general practitioners and internists in these processes capture and filter at the time of primary care to the population. However, the system in a comprehensive manner cannot function if, in the first instance, there are not the necessary number of health centers per number of inhabitants, as well as doctors and nurses, without ceasing to downplay the importance of medical supplies, La Medicina Preventiva comprende como principios: las atenciones de salud y las de Atención Médica. La formación del médico se realizaba atendiendo a los enfermos en los hospitales; el desarrollo de la Atención Primaria de salud ha posibilitado la formación en las comunidades con el objetivo esencial de la atención a la salud de la población. La metodología utilizada para el presente trabajo de investigación. La técnica para la recolección de datos está constituida por materiales electrónicos, estos últimos como Google Académi-co, entre otros, apoyándose para ello en el uso de descriptores certificados y avalados por el tesauro de la UNESCO. La información aquí obtenida será revisada, resumida y analizada para su exposición organizada en los resultados. Los aspectos fundamentales de la medicina general es que tiene la capacidad dentro de su acción vertical de delegar incidencias a otras especialidades y centros de salud que lo ambulatorio no tiene la capacidad de atender, por ello la importancia de los médicos generales e internistas en estos procesos de captación y filtro a la hora de la atención primaria a la población. Sin embargo, el sistema a manera integral no puede funcionar si en primera instancia no existen la cantidad de centros de salud necesarios por cantidad de habitantes al igual que médicos y enfermeras, sin dejar de restarle importancia a los insumos médicos.

Preventive Medicine includes as principles: health care and Medical Care. The training of the doctor was car-ried out caring for the sick in hospitals; The development of Primary Health Care has enabled training in com-munities with the essential objective of providing health care to the population. The methodology used for this research work. The technique for data collection is made up of electronic materials, the latter such as Google Scholar, among others, relying on the use of certified descriptors and endorsed by the UNESCO thesaurus. The information obtained here will be reviewed, summarized and analyzed for its presentation organized in the results. The fundamental aspects of general medicine is that it has the capacity within its vertical action to del-egate incidents to other specialties and health centers that the outpatient clinic does not have the capacity to attend to, therefore the importance of general practitioners and internists in these processes capture and filter at the time of primary care to the population. However, the system in a comprehensive manner cannot function if, in the first instance, there are not the necessary number of health centers per number of inhabitants, as well as doctors and nurses, without ceasing to downplay the importance of medical supplies, La Medicina Preventiva comprende como principios: las atenciones de salud y las de Atención Médica. La formación del médico se realizaba atendiendo a los enfermos en los hospitales; el desarrollo de la Atención Primaria de salud ha posibilitado la formación en las comunidades con el objetivo esencial de la atención a la salud de la población. La metodología utilizada para el presente trabajo de investigación. La técnica para la recolección de datos está constituida por materiales electrónicos, estos últimos como Google Académi-co, entre otros, apoyándose para ello en el uso de descriptores certificados y avalados por el tesauro de la UNESCO. La información aquí obtenida será revisada, resumida y analizada para su exposición organizada en los resultados. Los aspectos fundamentales de la medicina general es que tiene la capacidad dentro de su acción vertical de delegar incidencias a otras especialidades y centros de salud que lo ambulatorio no tiene la capacidad de atender, por ello la importancia de los médicos generales e internistas en estos procesos de captación y filtro a la hora de la atención primaria a la población. Sin embargo, el sistema a manera integral no puede funcionar si en primera instancia no existen la cantidad de centros de salud necesarios por cantidad de habitantes al igual que médicos y enfermeras, sin dejar de restarle importancia a los insumos médicos.

55 p. -- Bibliogr.: p. 25-27, Fibrosi kistikoa (FK) sendabiderik gabeko herentzia autosomiko errezesiboko gaixotasun genetiko ohikoena da kaukasikoen artean. Gaitzaren aurkezpen klasikoak arnas sistemari eta sistema gastrointestinalari eragiten dioten arren, eragin multisistemikoa duen gaixotasuna da. Alderdi guzti horiek prebenitzeko eta tratatzeko erregimen terapeutiko konplexuak eta denbora asko kontsumitzen dutenak ezartzen dira, oztopo garrantzitsua izan daitekeena erregimenarekiko atxikipena mantentzeko orduan. Ondorioz, urteak aurrera joan ahala pazienteenganako arreta hobetzeko estrategia desberdinak garatzen joan dira, horien artean, gaur egungo gizarteari gehien egokitzen zaionetako bat, telemedikuntza. Beraz, telemedikuntza zerbitzuak FK duten pazienteen atxikipena hobetzeko eta etxeko monitorizazioa egiteko aukera on batean bihurtu daitezke.

The utility of ambulatory electrocardiography (AECG) to evaluate cats with subclinical hypertrophic cardiomyopathy (HCM) for arrhythmias and heart rate variability (HRV) is not well defined but may provide information regarding risk stratification. This prospective study used AECG to evaluate ectopy and HRV in subclinical HCM cats compared to healthy controls and is the first to implement a pharmacologic cardiac stress test. Twenty-three purpose-bred, Maine coon cross cats (16 HCM, 7 control) underwent 48-h of continuous AECG. Terbutaline (0.2-0.3 mg/kg) was administered orally at 24 and 36 h. Heart rate, ectopy frequency and complexity and HRV parameters, including standard deviation of normal R-R intervals (SDNN), were compared pre-terbutaline and post-terbutaline and across phenotype, genotype and sex. Genotype for an HCM-causative mutation was significantly associated with the frequency of supraventricular (P = 0.033) and ventricular (P = 0.026) ectopy across all cats. Seven HCM cats and zero healthy cats had a sinus arrhythmia. Mean heart rate was significantly higher post-terbutaline (p < 0.0001). HCM cats had significantly greater HRV compared to controls (SDNN: p = 0.0006). Male cats had significantly higher HRV (SDNN: p = 0.0001) and lower mean heart rates (p = 0.0001). HRV decreased post-terbutaline (SDNN: p = 0.0008) and changes in HRV observed between sexes were attenuated by terbutaline.

Purpose of reviewTo evaluate how self-measured blood pressure (SMBP) monitoring interventions impact hypertension equity.Recent findingsWhile a growing number of studies have recruited participants from safety-net settings, racial/ethnic minority groups, rural areas, or lower socio-economic backgrounds, few have reported on clinical outcomes with many choosing to evaluate only patient-reported outcomes (e.g., satisfaction, engagement). The studies with clinical outcomes demonstrate that SMBP monitoring (a) can be successfully adopted by historically excluded patient populations and safety-net settings and (b) improves outcomes when paired with clinical support. There are few studies that explicitly evaluate how SMBP monitoring impacts hypertension disparities and among rural, low-income, and some racial/ethnic minority populations. Researchers need to design SMBP monitoring studies that include disparity reduction outcomes and recruit from broader populations that experience worse hypertension outcomes. In addition to assessing effectiveness, studies must also evaluate how to mitigate multi-level barriers to real-world implementation of SMBP monitoring programs.

Cardiac arrhythmias have been observed among patients hospitalised with acute COVID-19 infection, and palpitations remain a common symptom among the much larger outpatient population of COVID-19 survivors in the convalescent stage of the disease. To determine arrhythmia prevalence among outpatients after a COVID-19 diagnosis. Adults with a positive COVID-19 test and without a history of arrhythmia were prospectively evaluated with 14-day ambulatory electrocardiographic monitoring. Participants were instructed to trigger the monitor for palpitations. A total of 51 individuals (mean age 42±11 years, 65% women) underwent monitoring at a median 75 (IQR 34-126) days after a positive COVID-19 test. Median monitoring duration was 13.2 (IQR 10.5-13.8) days. No participant demonstrated atrial fibrillation, atrial flutter, sustained supraventricular tachycardia (SVT), sustained ventricular tachycardia or infranodal atrioventricular block. Nearly all participants (96%) had an ectopic burden of <1%; one participant had a 2.8% supraventricular ectopic burden and one had a 15.4% ventricular ectopic burden. While 47 (92%) participants triggered their monitor for palpitation symptoms, 78% of these triggers were for either sinus rhythm or sinus tachycardia. We did not find evidence of malignant or sustained arrhythmias in outpatients after a positive COVID-19 diagnosis. While palpitations were common, symptoms frequently corresponded to sinus rhythm/sinus tachycardia or non-malignant arrhythmias such as isolated ectopy or non-sustained SVT. While these findings cannot exclude the possibility of serious arrhythmias in select individuals, they do not support a strong or widespread proarrhythmic effect of COVID-19 infection after resolution of acute illness.

Background: 25-hydroxy vitamin D (Vit D)-deficiency is common among patients with chronic kidney disease (CKD) and contributes to cardiovascular disease (CVD). African Americans (AAs) suffer disproportionately from CKD and CVD, and 80% of AAs are Vit D-deficient. The impact of Vit D repletion on cardio-renal biomarkers in AAs is unknown. We examined Vit D repletion on full-length osteopontin (flOPN), c-terminal fibroblast growth factor-23 (FGF-23), and plasminogen activator inhibitor-1 (PAI-1), which are implicated in vascular and kidney pathology. Methods: We performed a randomized, placebo-controlled study of high-risk AAs with Vit D deficiency, treated with 100,000 IU Vit D3 (cholecalciferol; n = 65) or placebo (n = 65) every 4 weeks for 12 weeks. We measured kidney function (CKD-EPI eGFR), protein-to-creatinine ratio, vascular function (pulse wave velocity; PWV), augmentation index, waist circumference, sitting, and 24-h-ambulatory blood pressure (BP), intact parathyroid hormone (iPTH) and serum calcium at baseline and study end, and compared Vit D levels with laboratory variables. We quantified plasma FGF-23, PAI-1, and flOPN by enzyme-linked immunosorbent assay. Multiple regression analyzed the relationship between log flOPN, FGF-23, and PAI-1 with vascular and renal risk factors. Results: Compared to placebo, Vit D3 repletion increased Vit D3 2-fold (p < 0.0001), decreased iPTH by 12% (p < 0.01) and was significantly correlated with PWV (p < 0.009). Log flOPN decreased (p = 0.03), log FGF-23 increased (p = 0.04), but log PAI-1 did not change. Multiple regression indicated association between log flOPN and PWV (p = 0.04) and diastolic BP (p = 0.02), while log FGF-23 was associated with diastolic BP (p = 0.05), and a trend with eGFR (p = 0.06). Conclusion: Vit D3 repletion may reduce flOPN and improve vascular function in high risk AAs with Vit D deficiency.

BackgroundAging is accompanied by an overall dysregulation of many dynamic physiologic processes including those related to blood pressure (BP). While year-to-year BP variability is associated with cardiovascular events and mortality, no studies have examined this trend with more frequent BP assessments. Our study objective is to take the next step to examine week-to-week BP dynamics-pattern, variability, and complexity-before death.MethodsUsing a retrospective study design, we assessed BP dynamics in the 6 months before death in long-term nursing home residents between 1 October 2006 and 30 September 2017. Variability was characterized using SD and mean squared error after adjusting for diurnal variations. Complexity (i.e., amount of novel information in a trend) was examined using Shannon's entropy (bits). Generalized linear models were used to examine factors associated with overall BP variability.ResultsWe identified 17,953 nursing home residents (98.0% male, 82.5% White, mean age 80.2 years, and mean BP 125.7/68.6 mm Hg). Despite a slight trend of decreasing systolic week-to-week BP over time (delta = 7.2 mm Hg), week-to-week complexity did not change in the 6 months before death (delta = 0.02 bits). Average weekly BP variability was stable until the last 3-4 weeks of life, at which point variability increased by 30% for both systolic and diastolic BP. Factors associated with BP variability include average weekly systolic/diastolic BP, days in the nursing home, days in the hospital, and changes to antihypertensive medications.ConclusionsWeek-to-week BP variability increases substantially in the last month of life, but complexity does not change. Changes in care patterns may drive the increase in BP variability as one approaches death.

ObjectiveA higher premature ventricular complex (PVC) frequency is associated with incident congestive heart failure (CHF) and death. While certain PVC characteristics may contribute to that risk, the current literature stems from patients in medical settings and is therefore prone to referral bias. This study aims to identify PVC characteristics associated with incident CHF in a community-based setting.MethodsThe Cardiovascular Health Study is a cohort of community-dwelling individuals who underwent prospective evaluation and follow-up. We analysed 24-hour Holter data to assess PVC characteristics and used multivariable logistic and Cox proportional hazards models to identify predictors of a left ventricular ejection fraction (LVEF) decline and incident CHF, respectively.ResultsOf 871 analysed participants, 316 participants exhibited at least 10 PVCs during the 24-hour recording. For participants with PVCs, the average age was 72±5 years, 41% were women and 93% were white. Over a median follow-up of 11 years, 34% developed CHF. After adjusting for demographics, cardiovascular comorbidities, antiarrhythmic drug use and PVC frequency, a greater heterogeneity of the PVC coupling interval was associated with an increased risk of LVEF decline and incident CHF. Of note, neither PVC duration nor coupling interval duration exhibited a statistically significant relationship with either outcome.ConclusionsIn this first community-based study to identify Holter-based features of PVCs that are associated with LVEF reduction and incident CHF, the fact that coupling interval heterogeneity was an independent risk factor suggests that the mechanism of PVC generation may influence the risk of heart failure.

ObjectiveTo identify the prevalence and characteristics of people living with dementia (PLWD) lost to follow-up (LTFU) from a specialized dementia care clinic and to understand factors influencing patient follow-up status.MethodsWe conducted a retrospective chart review of PLWD seen at a dementia care clinic 2012-2017 who were deceased as of 2018 (n = 746). Participants were evaluated for follow-up status at the time of death. Generalized linear regression was used to analyze demographic and diagnostic characteristics by follow-up status. Text extracted from participant medical records was analyzed using qualitative content analysis to identify reasons patients became LTFU.ResultsAmong PLWD seen at a dementia care clinic, 42% became LTFU before death, 39% of whom had chart documentation describing reasons for loss to follow-up. Increased rates of LTFU were associated with female sex (risk ratio 1.27, [95% confidence interval 1.09-1.49]; p = 0.003), educational attainment of high school or less (1.34, [1.13-1.61]; p = 0.001), and death in a long-term care facility (1.46, [1.19-1.80]; p = 0.003). Commonly documented reasons for not returning for care at the clinic included switching care to another provider (42%), logistical difficulty accessing care (26%), patient-family decision to discontinue care (24%), and functional challenges in accessing care (23%).ConclusionsPLWD are LTFU from specialized memory care at high rates. Attention to care coordination, patient-provider communication, and integrated use of alternative care models such as telehealth are potential strategies to improve care.

The Life's Simple 7 (LS7) metric consists of 7 modifiable health behaviors and measures that are known health factors for cardiovascular wellness. Relatively little is known about the association of LS7 score with cardiac arrhythmias. In the setting of the Multi-Ethnic Study of Atherosclerosis, we studied the LS7 score (range 0 to 14), assessed at the 2010 to 2102 study visit, in relation to cardiac arrhythmias assessed by Zio Patch ambulatory electrocardiographic monitoring in 2016 to 2018. In participants free of clinically recognized cardiovascular disease and atrial fibrillation, we used logistic and linear regression to examine the association of total LS7 score with atrial fibrillation, supraventricular ectopy, and ventricular ectopy. In 1,329 participants in the analysis, the mean (SD) age was 67 (8) years and 48% were men. A more favorable total LS7 score was associated with fewer premature ventricular contractions (PVCs) per hour (ratio of geometric means for optimal [11 to 14] versus inadequate [0 to 7] score 0.52 [95% confidence interval 0.34 to 0.81]). After adjustment for sociodemographic characteristics, the association was attenuated (0.66 [0.43 to 1.01]). =Among the LS7 components, a more favorable body mass index was associated with less ventricular ectopy. We did not detect associations of total LS7 score with atrial arrhythmias. In conclusion, in this longitudinal study of older participants free of clinically recognized cardiovascular disease, there was little evidence of association of the LS7 cardiovascular health score with subclinical cardiac arrhythmias. However, there was a suggestion that a more favorable LS7 score was associated with fewer PVCs and specifically, that a more favorable body mass index was associated with fewer PVCs.

Arterial hypertension is the most important cardiovascular risk factor in the western hemisphere. Masked hypertension (MHT), a missing link in the hypertensive syndrome for many researchers, remains an enigma to be clarified. Scientific evidence in recent years indicates that MHT is a phenomenon that is related to high rates of morbidity and mortality. The aim of this study is to describe the epidemiological profile of patients with MHT diagnosed by ambulatory blood pressure monitoring (ABPM) in the Hypertension Unit of the Centro Occidental Regional Cardiovascular Center, during the period June 2015-2020. A descriptive, cross-sectional, study was carried out which included 85 patients who met the ABPM criteria for MHT. The results show that the female sex (53%) had the highest prevalence and the mean age of the sample was 47 ± 22 years old. In 26% and 80% of patients a history of smoking and sedentary lifestyle was observed. Pathological hypersomnolence was observed in 26% of patients determined by the Epworth scale. The main associated comorbidity was diabetes (28%) followed by dyslipidemia (18%). There was a higher proportion of MHT in women, between the fifth and sixth decade of life, with a higher prevalence in patients with a history of diabetes, dyslipidemia and sedentary habits., La hipertensión arterial constituye el factor de riesgo cardiovascular más importante del hemisferio occidental. La hipertensión enmascarada (HTE), eslabón perdido del síndrome hipertensivo para muchos investigadores, sigue siendo un enigma a esclarecer. La evidencia científica en los últimos años orienta a que la HTE es un fenómeno que se relaciona con altos índices de morbi-mortalidad. El objetivo de este estudio fue describir el perfil epidemiológico de los pacientes con HTE diagnosticada mediante el Monitoreo Ambulatorio de Presión Arterial (MAPA) en la unidad de Hipertensión del Centro Cardiovascular Regional Centro Occidental, durante el periodo Junio 2015-2020. Se realizó un diseño descriptivo, de corte transversal, en donde se incluyeron 85 pacientes que cumplían con criterios por MAPA de HTE. Se observó que el sexo femenino (53%) tuvo la mayor prevalencia con una edad media de 47 ± 22 años. En un 26% y 80% de la muestra estudiada se encontraron antecedentes de tabaquismo y estilo de vida sedentario. Se observó hipersomnolencia patológica en un 26% de los pacientes determinado por la aplicación de la escala de Epworth. La principal enfermedad asociada fue la diabetes (28%) seguida de dislipidemia (18%). Los resultados mostraron una mayor proporción de HTE en mujeres, entre la quinta y sexta década de la vida, con mayor prevalencia en pacientes con antecedentes de diabetes, dislipidemia y hábitos sedentarios.

Gastroesophageal reflux disease (GERD) is a common disease affecting a significant number of adults both globally and in the USA. GERD is clinically diagnosed based on patient-reported symptoms, and the gold standard for diagnosis is ambulatory reflux monitoring, a tool particularly utilized in the common scenario of non-response to therapy or atypical features. Over the past 20 years, there has been a shift toward extending the duration of reflux monitoring, initially from 24 to 48 h and more recently to 96 h, primarily based on a demonstrated increase in diagnostic yield. Further, multiple studies demonstrate clinically relevant variability in day-to-day acid exposure levels in nearly 30% of ambulatory reflux monitoring studies. For these reasons, an ongoing clinical dilemma relates to the optimal activities patients should engage in during prolonged reflux monitoring. Thus, the aims of this review are to detail what is known about variability in daily acid exposure, discuss factors that are known to influence this day-to-day variability (i.e., sleep patterns, dietary/eating habits, stress, exercise, and medications), and finally provide suggestions for patient education and general GERD management to reduce variation in esophageal acid exposure levels.

PURPOSE OF REVIEW: The field of regional anesthesia has evolved tremendously in the last 15 years. New anesthesia protocols for ambulatory surgery and enhanced recovery after surgery have been developed as well. The focus of these techniques and protocols has centered on patient satisfaction and pain control while minimizing the use of opioids. The field of ambulatory surgery and anesthesia continues to evolve, and regional anesthesia and its plane techniques are at the center of these changes. RECENT FINDINGS: Recent research has shown that regional techniques contribute to better pain control and patient experience and may decrease patient readmission rates. The safety of these techniques has been validated when performed by experienced practitioners. New techniques such as the erector spinae block (ESP) have been studied in the setting of laparoscopic surgery with promising results. Regional anesthesia techniques for patients presenting for laparoscopic surgery are safe and seem to provide benefits. Those are related to patient experience, pain control, and readmission rates. Different techniques can be applied to a specific type of intervention. Application of these techniques depend on the clinical picture and patient. Future research may help us clarify how these techniques may improve patient satisfaction and operating room efficiency. New regional blocks may also develop based on what we know today.

Background: Impaired cardiovascular health is a concern for firefighters, with over 50% of line-of-duty deaths having cardiac causes. Many firefighters have hypertension and <25% have their blood pressure (BP) controlled. The alarm response could be an unidentified cardiac risk, but interestingly, the BP response to different calls and on-the-job activity is unknown. Purpose: We aimed to measure the physiological stress resulting from different call types (fire, medical) and job activity (riding apparatus, pre-alert alarms) through ambulatory BP (ABP) monitoring in a population of firefighters. Materials and methods: During 111 12-h work shifts firefighters wore an ABP monitor. BP was measured at 30-min intervals and manual measurements were prompted when the pager went off or whenever they felt stress. Results: Firefighters were hypertensive (124.3 ± 9.9/78.1 ± 6.7 mmHg), overweight (30.2 ± 4.6 kg/m2), middle-aged (40.5 ± 12.6 years) and experienced (17.3 ± 11.7 years). We calculated an average 11% increase in systolic and 10.5% increase in diastolic BP with alarm. Systolic BP (141.9 ± 13.2 mmHg) and diastolic BP (84.9 ± 11.1 mmHg) and the BP surges were higher while firefighters were responding to medical calls compared to fire calls. Between BP groups we found that medical call systolic BP (p = .001, d = 1.2), diastolic BP (p = .017, d = 0.87), and fire call systolic BP (p = .03, d = 0.51) levels were higher in the hypertensive firefighters. Conclusion: This is the first report of BP surge responses to alarms and to occupational activities in firefighters, and medical calls elicited the largest overall responses.PLAIN LANGUAGE SUMMARYCardiovascular disease and impaired cardiovascular health are substantially more prevalent in firefighters, with over 50% of line-of-duty deaths being cardiac related.Many firefighters are diagnosed with high blood pressure (hypertension), which is known to increase the risk of heart attacks, strokes, heart disease, and other serious

Objective: Emerging evidence suggests that various dimensions of sleep health are uniquely associated with cardiovascular health, including through sleep effects on acute blood pressure (BP). Prior work, including work from our lab (Doyle et al., 2019) demonstrates that a poor night’s sleep is associated with higher concurrent nighttime BP and elevations the next day. If experienced chronically, this biobehavioral relationship may be a key pathway in the link between sleep and CV health. The current study sought to better establish this pathway to disease by clarifying and extending methodological approaches to conceptualizing BP, determining the reliability of this relationship through replication, and evaluating its chronicity over time. Methods: The current study sought to address these evidence gaps through analysis of data from in 300 men and women aged 21 to 70 years at baseline and 237 at a 2-year follow-up enrolled in The North Texas Heart Study (NTHS), which included ecologically valid assessment of sleep and blood pressure. Actigraphy-assessed sleep was monitored for two consecutive nights, while ambulatory BP was sampled randomly within 45 minute blocks on the first and second day as well as the second night. This protocol was repeated at the second time point, two years later. Results: The previously reported relationship between sleep and daytime BP largely replicated for sleep efficiency, but not for sleep duration, at Time 2 (unadjusted (systolic: (F(1,190)=7.44, p=.006, R2=0.033), diastolic: (F(1, 190)=5.88, p=0.016, R2=0.025); partial (systolic: (F(6, 180)=4.56, p=0.010, R2=0.10), diastolic: (F(6, 181)=2.83, p=0.025, R2=0.055), fully-adjusted (systolic: (F(8, 150)=8.46, p=0.021, R2=0.27)., diastolic: (F(8, 150)=5.13, p=0.049, R2=0.17). The temporal association between lower sleep efficiency one night and higher BP the next day was a particularly stable trend across time points, BP conceptualizations, and models. The results for sleep and nighttime B

ImportanceHypertension is a prevalent condition that affects approximately 45% of the adult US population and is the most commonly diagnosed condition at outpatient office visits. Hypertension is a major contributing risk factor for heart failure, myocardial infarction, stroke, and chronic kidney disease.ObjectiveTo reaffirm its 2015 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for hypertension in adults, the accuracy of office blood pressure measurement for initial screening, and the accuracy of various confirmatory blood pressure measurement methods.PopulationAdults 18 years or older without known hypertension.Evidence assessmentUsing a reaffirmation deliberation process, the USPSTF concludes with high certainty that screening for hypertension in adults has substantial net benefit.RecommendationThe USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement. The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. (A recommendation).

Background: Dedicated ambulatory training during pulmonary and critical care medicine (PCCM) fellowships is often limited. A novel 2-year longitudinal outpatient pulmonary fellowship curriculum was previously developed, piloted, and studied. The exportability and potential impact of this ambulatory curriculum on PCCM fellowship training nationally is not known. Objective: We aim to understand the current state of ambulatory training in PCCM fellowships and the impact of a standardized outpatient curriculum on fellows' ambulatory knowledge and competency. Methods: Nineteen programs participated in the study from 2017 to 2019. Six programs received the first year of content, seven programs received the entire 2-year curriculum, and seven programs served as a control. Fellows, faculty, and program directors (PDs) completed a series of surveys assessing satisfaction with ambulatory education and the curriculum. Fellows completed a series of medical knowledge inventories, and programs submitted in-training exam scores. Results: A total of 221 fellows (39%) and 17 PDs (89%) completed the precurriculum surveys, and 38 (12%) fellows and 10 (53%) PDs completed postcurriculum surveys. Before curriculum implementation, only 34.4% of fellows rated the quality of their ambulatory education as good or outstanding compared with 57.9% at the end of the study. Eighty-five percent of faculty and 89% of PDs rated the curriculum as good or excellent. Faculty believed that the teaching scripts were easy to use (78.4%), were factually accurate (86.3%), and provided high-yield information (82.1%). The majority of PDs indicated that the curriculum positively impacted patient care (78%) and fulfilled an unmet educational need (100%), and most planned to continue the curriculum after the study (78%). Feedback surrounded the need for updated content based on recently published guidelines and studies. Conclusion: The curriculum is a standardized and feasible way to address a previously unmet n

ObjectiveRecent reports have shown that outpatient shoulder arthroplasty (SA) may be a safe alternative to inpatient management in appropriately selected patients. The purpose was to review the literature reporting on outpatient SA.MethodsA systematic review of publications on outpatient SA was performed. Included publications discussed patients who were discharged on the same calendar day or within 23 hours from surgery. Articles were categorized by discussions on complications, readmissions, and safety, patient selection, pain management strategies, cost effectiveness, and patient and surgeon satisfaction.ResultsTwenty-six articles were included. Patients undergoing outpatient SA were younger and with a lower BMI than those undergoing inpatient SA. Larger database studies reported more medical complications for patients undergoing inpatient compared to outpatient SA. Articles on pain management strategies discussed both single shot and continuous interscalene blocks with similar outcomes. Both patients and surgeons reported high levels of satisfaction following outpatient SA, and cost analysis studies demonstrated significant cost savings for outpatient SA.ConclusionIn appropriately selected patients, outpatient SA can be a safe, cost-saving alternative to inpatient care and may lead to high satisfaction of both patients and physicians, though further studies are needed to clarify appropriate utilization of outpatient SA.

BACKGROUND: The viral pandemic coronavirus disease 2019 (COVID-19) has disrupted cancer patient management around the world. Most reported data relate to incidence, risk factors, and outcome of severe COVID-19. The safety of systemic anti-cancer therapy in oncology patients with non-severe COVID-19 is an important matter in daily practice. METHODS: ONCOSARS-1 was a single-center, academic observational study. Adult patients with solid tumors treated in the oncology day unit with systemic anti-cancer therapy during the initial phase of the COVID-19 pandemic in Belgium were prospectively included. All patients (n = 363) underwent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) serological testing after the first peak of the pandemic in Belgium. Additionally, 141 of these patients also had a SARS-CoV-2 RT-PCR test during the pandemic. The main objective was to retrospectively determine the safety of systemic cancer treatment, measured by the rate of adverse events according to the Common Terminology Criteria for Adverse Events, in SARS-CoV-2-positive patients compared with SARS-CoV-2-negative patients. RESULTS: Twenty-two (6%) of the 363 eligible patients were positive for SARS-CoV-2 by RT-PCR and/or serology. Of these, three required transient oxygen supplementation, but none required admission to the intensive care unit. Hematotoxicity was the only adverse event more frequently observed in SARS-CoV-2 -positive patients than in SARS-CoV-2-negative patients: 73% vs 35% (P < 0.001). This association remained significant (odds ratio (OR) 4.1, P = 0.009) even after adjusting for performance status and type of systemic treatment. Hematological adverse events led to more treatment delays for the SARS-CoV-2-positive group: 55% vs 20% (P < 0.001). Median duration of treatment interruption was similar between the two groups: 14 and 11 days, respectively. Febrile neutropenia, infections unrelated to COVID-19, and bleeding events occurred at a low rate in the SARS-C

ImportanceHypertension is a prevalent condition that affects approximately 45% of the adult US population and is the most commonly diagnosed condition at outpatient office visits. Hypertension is a major contributing risk factor for heart failure, myocardial infarction, stroke, and chronic kidney disease.ObjectiveTo reaffirm its 2015 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for hypertension in adults, the accuracy of office blood pressure measurement for initial screening, and the accuracy of various confirmatory blood pressure measurement methods.PopulationAdults 18 years or older without known hypertension.Evidence assessmentUsing a reaffirmation deliberation process, the USPSTF concludes with high certainty that screening for hypertension in adults has substantial net benefit.RecommendationThe USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement. The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. (A recommendation).

Background: Dedicated ambulatory training during pulmonary and critical care medicine (PCCM) fellowships is often limited. A novel 2-year longitudinal outpatient pulmonary fellowship curriculum was previously developed, piloted, and studied. The exportability and potential impact of this ambulatory curriculum on PCCM fellowship training nationally is not known. Objective: We aim to understand the current state of ambulatory training in PCCM fellowships and the impact of a standardized outpatient curriculum on fellows' ambulatory knowledge and competency. Methods: Nineteen programs participated in the study from 2017 to 2019. Six programs received the first year of content, seven programs received the entire 2-year curriculum, and seven programs served as a control. Fellows, faculty, and program directors (PDs) completed a series of surveys assessing satisfaction with ambulatory education and the curriculum. Fellows completed a series of medical knowledge inventories, and programs submitted in-training exam scores. Results: A total of 221 fellows (39%) and 17 PDs (89%) completed the precurriculum surveys, and 38 (12%) fellows and 10 (53%) PDs completed postcurriculum surveys. Before curriculum implementation, only 34.4% of fellows rated the quality of their ambulatory education as good or outstanding compared with 57.9% at the end of the study. Eighty-five percent of faculty and 89% of PDs rated the curriculum as good or excellent. Faculty believed that the teaching scripts were easy to use (78.4%), were factually accurate (86.3%), and provided high-yield information (82.1%). The majority of PDs indicated that the curriculum positively impacted patient care (78%) and fulfilled an unmet educational need (100%), and most planned to continue the curriculum after the study (78%). Feedback surrounded the need for updated content based on recently published guidelines and studies. Conclusion: The curriculum is a standardized and feasible way to address a previously unmet n

ObjectiveRecent reports have shown that outpatient shoulder arthroplasty (SA) may be a safe alternative to inpatient management in appropriately selected patients. The purpose was to review the literature reporting on outpatient SA.MethodsA systematic review of publications on outpatient SA was performed. Included publications discussed patients who were discharged on the same calendar day or within 23 hours from surgery. Articles were categorized by discussions on complications, readmissions, and safety, patient selection, pain management strategies, cost effectiveness, and patient and surgeon satisfaction.ResultsTwenty-six articles were included. Patients undergoing outpatient SA were younger and with a lower BMI than those undergoing inpatient SA. Larger database studies reported more medical complications for patients undergoing inpatient compared to outpatient SA. Articles on pain management strategies discussed both single shot and continuous interscalene blocks with similar outcomes. Both patients and surgeons reported high levels of satisfaction following outpatient SA, and cost analysis studies demonstrated significant cost savings for outpatient SA.ConclusionIn appropriately selected patients, outpatient SA can be a safe, cost-saving alternative to inpatient care and may lead to high satisfaction of both patients and physicians, though further studies are needed to clarify appropriate utilization of outpatient SA.

Rationale & objectiveObservational studies have reported a U-shaped association between blood pressure (BP) before a hemodialysis session and death. In contrast, because a linear association between out-of-dialysis-unit BP and death has been reported, home BP may be a better target for treatment. To test the feasibility of this approach, we conducted a pilot trial of treating home versus predialysis BP in hemodialysis patients.Study designA 4-month, parallel, randomized, controlled trial.Settings & participants50 prevalent hemodialysis patients in San Francisco and Seattle. Participants were randomly assigned using 1:1 block randomization, stratified by site.InterventionsTo target home systolic BP (SBP) of 100-<140 mm Hg versus predialysis SBP of 100-<140mm Hg. Home and predialysis SBPs were ascertained every 2 weeks. Dry weight and BP medications were adjusted to reach the target SBP.OutcomesPrimary outcomes were feasibility, adherence, safety. and tolerability.Results50 of 70 (71%) patients who were approached agreed to participate. All enrollees completed the study except for 1 who received a kidney transplant. In the home BP treatment group, adherence to obtaining/reporting home BP was 97.4% (and consistent over the 4 months). There was no increased frequency of high (defined as SBP>200mm Hg; 0.2% vs 0%) or low (defined as<90mm Hg; 1.8% vs 1.2%) predialysis BP readings in the home versus predialysis treatment arms, respectively. However, participants in the home BP arm had higher frequency of fatigue (32% vs 16%).LimitationsSmall sample size.ConclusionsThis pilot trial demonstrates feasibility and high adherence to home BP measurement and treatment in hemodialysis patients. Larger trials to test the long-term feasibility, efficacy, and safety of home BP treatment in hemodialysis patients should be conducted.FundersNational Institutes of Health, Satellite Healthcare, and Northwest Kidney Centers.Trial registrationRegistered at Clinic

BackgroundSame-day discharge, defined as discharge from the hospital within 24 h of surgery, has been shown to be safe for joint arthroplasty. We examined demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty in adult patients.MethodsUtilizing data from the American College of Surgeons National Surgical Quality Improvement Program database, we extracted information of all patients that underwent shoulder arthroplasty. The primary and secondary outcome of interest was same-day discharge and 30-day unplanned readmission, respectively. We utilized multivariable logistic regression to identify covariates associated with these outcomes.ResultsThere were 17,011 patients analyzed when identifying predictors for same-day discharge. There was an increase in same-day discharge from 2007 to 2016. The odds of same-day discharge were significantly better for males (P < 0.001). The odds of same-day discharge was significantly decreased for every 10-year increase in age and for patients with insulin dependent diabetes, poor functional status, chronic obstructive pulmonary disease, congestive heart failure, bleeding disorder, and comorbidity burden (all P < 0.001). There were 14,276 patients analyzed for hospital readmission. The odds of unplanned readmission were significantly higher for every 10-year increase in age and for patients with poor functional status, congestive heart failure, bleeding disorder, and higher comorbidity burden (all P < 0.001).ConclusionsThe results of this study show that preoperative comorbidities and advanced age reduce the odds of same-day discharge. Risk stratification, preoperative optimization, and coordinated care after surgery may be helpful to optimize patients for same-day discharge.

Sudden death is the most common mode of mortality in patients with heart failure and preserved ejection fraction (HFpEF). Ventricular arrhythmias (VA) have been suspected as the etiology but the supporting evidence in patients with HFpEF is scarce. We sought to investigate VA prevalence, and to determine if VA are associated with prolonged repolarization, in patients with HFpEF. In a retrospective case-control study design, Cedars-Sinai patients who underwent prolonged ambulatory electrocardiographic monitoring (Zio Patch) between 2016 and 2018 were screened for a clinical diagnosis of HFpEF. Patients with normal diastolic and systolic function who underwent Zio Patch monitoring were also reviewed as controls. Multivariable logistic regression was used to compare the prevalence of rhythm disturbances in patients with and without HFpEF. Ventricular tachycardia (VT) was more prevalent in patients with HFpEF (37% vs. 16% in controls, p = 0.001). Most episodes were non-sustained except for one case of sustained VT in a patient with HFpEF. Covariate-adjusted logistic regression including HFpEF diagnosis, age, sex, body mass index, and the presence of comorbidities revealed that only HFpEF was associated with increased risk of VT (relative risk 2.86, p = 0.023). Subgroup-analyses revealed an association between increased QTc interval and risk of VT (460 ± 38 ms in HFpEF patients with VT vs. 445 ± 28 ms in HFpEF patients without VT, p = 0.03). Non-sustained VT was more prevalent in patients with HFpEF compared to patients without HFpEF, and QTc interval prolongation was associated with VT in HFpEF.

Wearable bioelectronics for continuous and reliable pulse wave monitoring against body motion and perspiration remains a great challenge and highly desired. Here, a low-cost, lightweight, and mechanically durable textile triboelectric sensor that can convert subtle skin deformation caused by arterial pulsatility into electricity for high-fidelity and continuous pulse waveform monitoring in an ambulatory and sweaty setting is developed. The sensor holds a signal-to-noise ratio of 23.3 dB, a response time of 40 ms, and a sensitivity of 0.21 µA kPa-1 . With the assistance of machine learning algorithms, the textile triboelectric sensor can continuously and precisely measure systolic and diastolic pressure, and the accuracy is validated via a commercial blood pressure cuff at the hospital. Additionally, a customized cellphone application (APP) based on built-in algorithm is developed for one-click health data sharing and data-driven cardiovascular diagnosis. The textile triboelectric sensor enabled wireless biomonitoring system is expected to offer a practical paradigm for continuous and personalized cardiovascular system characterization in the era of the Internet of Things.

Soft, skin-integrated electronic sensors can provide continuous measurements of diverse physiological parameters, with broad relevance to the future of human health care. Motion artifacts can, however, corrupt the recorded signals, particularly those associated with mechanical signatures of cardiopulmonary processes. Design strategies introduced here address this limitation through differential operation of a matched, time-synchronized pair of high-bandwidth accelerometers located on parts of the anatomy that exhibit strong spatial gradients in motion characteristics. When mounted at a location that spans the suprasternal notch and the sternal manubrium, these dual-sensing devices allow measurements of heart rate and sounds, respiratory activities, body temperature, body orientation, and activity level, along with swallowing, coughing, talking, and related processes, without sensitivity to ambient conditions during routine daily activities, vigorous exercises, intense manual labor, and even swimming. Deployments on patients with COVID-19 allow clinical-grade ambulatory monitoring of the key symptoms of the disease even during rehabilitation protocols.

BACKGROUND: High normal resting pCO2 is a risk factor for salt sensitivity of blood pressure (BP) in normotensive humans and has been associated with higher resting systolic BP in postmenopausal women. To date, however, no known studies have investigated the effects of regular practice of voluntary mild hypocapnic breathing on BP in hypertensive patients. The objective of the present research was to test the hypothesis that capnometric feedback training can decrease both resting pCO2 and 24-h BP in a series of mildly hypertensive postmenopausal women. METHODS: A small portable end tidal CO2 (etCO2) monitor was constructed and equipped with software that determined the difference between the momentary etCO2 and a pre-programmed criterion range. The monitor enabled auditory feedback for variations in CO2 outside the criterion range. 16 mildly hypertensive postmenopausal women were individually trained to sustain small decreases in etCO2 during six weekly sessions in the clinic and daily sessions at home. 24-h BP monitoring was conducted before and after the intervention, and in 16 prehypertensive postmenopausal women in a control group who did not engage in the capnometric training. RESULTS: Following the intervention, all 16 capnometric training participants showed decreases in resting etCO2 (- 4.3 ± 0.4 mmHg; p < .01) while 15 showed decreases in 24-h systolic BP (- 7.6 ± 2.0 mmHg; p < .01). No significant changes in either measure was observed in the control group. In addition, nighttime (- 9.5 ± 2.6; p < .01) and daytime (- 6.7 ± 0.2 mmHg) systolic BP were both decreased following capnometric training, while no significant changes in nighttime (- 2.8 ± 2.2 mmHg; p = .11) or daytime (- 0.7 ± 1.0 mmHg; p ≤ .247) systolic BP were observed in the control group. CONCLUSIONS: These findings support the hypothesis that regular practice of mild hypocapnic breathing that decreases resting etCO2 reliably decreases 24-h blood press