The American Diabetes Association's (ADA's) Standards of Medical Care in Diabetes is updated and published annually in a supplement to the January issue of Diabetes Care. The ADA's Professional ...Practice Committee, which includes physicians, diabetes educators, registered dietitians (RDs), and public health experts, develops the Standards. The Standards include the most current evidence-based recommendations for diagnosing and treating adults and children with all forms of diabetes. ADA's grading system uses A, B, C, or E to show the evidence level that supports each recommendation.
Background:The purpose of conducting this review was to determine the optimal medical and surgical management of patients in the adult population with foot and ankle tuberculosis from the available ...literature.Methods: A systematic literature search was undertaken through PubMed, Web of Science, Scopus, and the Cochrane Library. The phenomenon of interest was defined as tuberculosis of the foot and/or ankle in patients over 14 years of age. A qualitative data description was performed and reported as per Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines.Results: The median total duration of medical treatment was 12 months (range 6–18). Most studies used a combination of rifampicin, isoniazid, pyrazinamide and ethambutol as intensive phase treatment for a median duration of two to three months. The continuation phase involved two or three agents for up to 16 months. The most common indication for surgery in active disease was failure to respond to medical treatment alone. In quiescent disease, surgery was employed for impending midfoot collapse or painful, deformed joints. It was found that 17% of patients (32 of 184) required arthrodesis.Conclusion: Medical treatment remains a mainstay of management. Evidence supporting surgical management in early disease is limited. No single approach, implant or fixation method for the purpose of arthrodesis has been proven superior to another. Further research is needed, specifically comparative studies to address the lack of consensus surrounding surgical intervention.Level of evidence: Level 5
Hypertension is common in China and its prevalence is rising, yet it remains inadequately controlled. Few studies have the capacity to characterise the epidemiology and management of hypertension ...across many heterogeneous subgroups. We did a study of the prevalence, awareness, treatment, and control of hypertension in China and assessed their variations across many subpopulations.
We made use of data generated in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project from Sept 15, 2014, to June 20, 2017, a population-based screening project that enrolled around 1·7 million community-dwelling adults aged 35–75 years from all 31 provinces in mainland China. In this population, we defined hypertension as systolic blood pressure of at least 140 mm Hg, or diastolic blood pressure of at least 90 mm Hg, or self-reported antihypertensive medication use in the previous 2 weeks. Hypertension awareness, treatment, and control were defined, respectively, among hypertensive adults as a self-reported diagnosis of hypertension, current use of antihypertensive medication, and blood pressure of less than 140/90 mm Hg. We assessed awareness, treatment, and control in 264 475 population subgroups—defined a priori by all possible combinations of 11 demographic and clinical factors (age 35–44, 45–54, 55–64, and 65–75 years, sex men and women, geographical region western, central, and eastern China, urbanity urban vs rural, ethnic origin Han and non-Han, occupation farmer and non-farmer, annual household income < ¥10 000, ¥10 000–50 000, and ≥¥50 000, education primary school and below, middle school, high school, and college and above, previous cardiovascular events yes or no, current smoker yes or no, and diabetes yes or no), and their associations with individual and primary health-care site characteristics, using mixed models.
The sample contained 1 738 886 participants with a mean age of 55·6 years (SD 9·7), 59·5% of whom were women. 44·7% (95% CI 44·6–44·8) of the sample had hypertension, of whom 44·7% (44·6–44·8) were aware of their diagnosis, 30·1% (30·0–30·2) were taking prescribed antihypertensive medications, and 7·2% (7·1–7·2) had achieved control. The age-standardised and sex-standardised rates of hypertension prevalence, awareness, treatment, and control were 37·2% (37·1–37·3), 36·0% (35·8–36·2), 22·9% (22·7–23·0), and 5·7% (5·6–5·7), respectively. The most commonly used medication class was calcium-channel blockers (55·2%, 55·0–55·4). Among individuals whose hypertension was treated but not controlled, 81·5% (81·3–81·6) were using only one medication. The proportion of participants who were aware of their hypertension and were receiving treatment varied significantly across subpopulations; lower likelihoods of awareness and treatment were associated with male sex, younger age, lower income, and an absence of previous cardiovascular events, diabetes, obesity, or alcohol use (all p<0·01). By contrast, control rate was universally low across all subgroups (<30·0%).
Among Chinese adults aged 35–75 years, nearly half have hypertension, fewer than a third are being treated, and fewer than one in twelve are in control of their blood pressure. The low number of people in control is ubiquitous in all subgroups of the Chinese population and warrants broad-based, global strategy, such as greater efforts in prevention, as well as better screening and more effective and affordable treatment.
Ministry of Finance and National Health and Family Planning Commission, China.
Abstract
A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The ...panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion.
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