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  • ISSN: 2379-0547
    Volume 1, Issue 1
    July/August 2013
    Editorial
    Kelley M. Bishop*
    Primary care providers should be able to advise their patients regarding complementary and alternative medicine or CAM. A 2007 study by the National Institute of Health's (NIH) National Center for Complementary and Alternative Medicine (NCCAM) showed that Americans spent $33.9 billion on CAM, with an estimated 38% of adults and 12% of children reported using some form of alternative medicine. According to a recent article/program on Frontline, the recent resurgence of interest in CAM is but the latest of 3 separate cycles of interest within the last 150 years, with the first being in the mid-1800s and the second in the early 1900s.
    Review Article
    Boon-How Chew1* and Sri-Wahyu Taher2
    Abstract: This paper is meant as an overview and updates of fundamental information on cancers. It contains many cancer-related aspects that primary care providers and professionals (PCPP) need to be reminded of and aware in their quest for convincing reason and purpose in dealing with cancer patients. Cancer incidence and prevalence have been alarming in the world. There were about 25 new cancers and 16 cancer deaths every minute in the world in 2008. The causes of cancers are multi-factorial; right from the family history, pathogens, environmental elements, personaldietary choices to exercise. Preventive measures are effective in managing the modifiable factors such as staying away from carcinogenic agents and practising healthy life-styles. There was evidence that lacking confidence in knowledge of cancer and risk assessment were common barriers among the PCPPs for effective cancer care. Many patients with cancer desired more information about life after cancerfrom their PCPPs. Being in the front-line of health systems and functioning as gate-keepers in primary care, essential cancer-related knowledge is important for PCPPs. Thus, this paper aims to provide some update on cancerepidemiology, causes, preventive measures and classification of cancers to PCPPs.
    Michael A Ward*
    Abstract: Atrial Fibrillation (AF) is the most common dysrhythmia seen in primary care. Thrombolic stroke remains one of the most feared complications of this rhythm disturbance. Five landmark trials have demonstrated the efficacy of warfarin and aspirin in reducing this risk. Warfarin use is known to be labor intensive for patients and concerns regarding multiple drug interactions and bleed risk have limited it use in some high-risk populations. Novel oral anti-coagulants come with the promise to lower serious/fatal bleed risk and reduce drug-drug interactions. The new anti-coagulants have fewer drug interactions and do not require regular laboratory monitoring. Here we review trials demonstrating the efficacy of four new oral anticoagulants and summarize their stroke and bleed risk relative the warfarin as a gold standard.
    Research Article
    Vincent Barba*
    Abstract:
    Background: Over three quarters of a million Americans die every year from cardiovascular disease (CVD). Hypertension is a major risk factor for the development of CVD, especially stroke. African American patients have a disproportionate disease burden from stroke.
    Objective: This retrospective cohort study utilizing the University Health System Consortium [UHC] Clinical Database seeks to measure the degree to which appropriate pharmacologic therapy is prescribed to hypertension patients while they are inpatients at a US Academic Medical Center.
    Methods: 2,694,970 adult admissions to 106 academic medical centers were analyzed to evaluate hypertensive patients and an assessment was made to determine whether appropriate therapy for hypertension was prescribed. Mortality rates were measured and compared between and among the groups.
    Results: Of the more than 1.2 million cases with hypertension reviewed, 63.9% were prescribed appropriate pharmacologic therapy for hypertension while inpatients at a US academic medical center. Patients prescribed appropriate pharmacologic hypertension therapy had a statistically significant improvement in their inpatient mortality rates.
    Conclusions: This study concludes that most patients discharged from an academic medical center were prescribed appropriate hypertension pharmacologic therapy. Inpatient mortality rates are improved when hypertensive patients are prescribed appropriate therapy for hypertension during their hospital stay. The group studied was confined to their inpatient stay at an academic medical center. Blood pressure control was not a focus of this study. Outpatient adherence to therapy was not evaluated. More research is needed to elucidate the multifactorial issues that may be behind the increased incidence of stroke in African Americans.
    Gina Agarwal1*, Janusz Kaczorowski2 and Steve Hanna3
    Abstract:
    Introduction: In Canada, family physicians are expected to screen individuals over 40 years of age every 3 years for diabetes. The CHAD (Community Health Awareness of Diabetes) Program assisted family physicians in the diabetes-screening process, by risk-stratifying patients at community pharmacy screening sessions. The paper describes the effectiveness of the program at detecting incident diabetes.
    Methods: Patients of family physicians were invited to attend risk-assessment sessions (diabetes risk questionnaire and capillary blood glucose tests). Results were sent to family physicians and given to attendees. The effect of the program on incident diabetes detection rates was assessed using a retrospective observational chart audit of patients in local family practices, using a before-and-after design.
    Results: Charts of 1030 eligible patients were audited; including 387 charts of CHAD program attendees. The diabetes incidence rate-ratio in program attendees versus non-attendees, comparing one year before-and-after CHAD's implementation, was 1.65 (0.028/0.017), [95% CI = 0.04 - 61.6]. However, the difference between the rates of diabetes diagnosis for the 28 participating physicians before-and-after the program was not significantly different (p= 0.28, df = 27, [95% CI -0.09, 0.03].
    Conclusion: Programs like CHAD may increase the detection of diabetes by family physicians. This may be a useful community program approach, modifiable for different communities by health-services planners.
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