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Insulin Therapy for Type 2 Diabetes: Social, Psychological, and Clinical Factors

The choices for insulin therapy are ever increasing with the development of new products that provide greater flexibility, greater range of effectiveness, lower risk of hypoglycemia, and lower pharmacokinetic and pharmacodynamic variability. These allow for individualization of treatment to match a patient’s daily life but typically at greater cost. This article will review the psychological, social, and clinical factors pertaining to the various insulin products, as well as strategies to initiate and intensify insulin therapy, to help clinicians supplement and enhance their clinical practices in diabetes management.

Noninvasive Mapping and Ablation of Ventricular Tachycardia: Evidence Builds for Novel Approach

In 19 patients with treatment-refractory episodes of ventricular tachycardia or frequent premature ventricular contractions, stereotactic body radiation therapy was highly effective at reducing arrhythmia burden without acute toxicity.

Chronic Kidney Disease Discourages Appropriate Use of Angiography and PCI in NSTEMI

This retrospective study of patients presenting with non-ST-segment elevation myocardial infarction showed higher mortality among patients with chronic kidney disease and lower use of coronary angiography and percutaneous coronary intervention.

Cardiac MRI for Prognosis in Aortic Stenosis

The authors of a consortium observational study of patients with severe aortic stenosis undergoing valve replacement found that a pre-procedure cardiac MRI that detects myocardial fibrosis is predictive of post-procedure mortality and may be useful for making decisions about valve replacement in asymptomatic patients.

Testing Safety, Efficacy of Pharmacotherapy in Hospitalized Heart Failure Patients

In patients hospitalized for acute decompensated heart failure with reduced ejection fraction, administering sacubitril-valsartan led to more improvement in levels of cardiac biomarkers compared to enalapril, with no adverse safety signals.

PCSK9 Inhibitors in Acute Coronary Syndrome Patients

Compared to adding placebo, using the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab in post-acute coronary syndrome patients on maximally tolerated, high-intensity statins with low-density lipoprotein (LDL) cholesterol levels higher than 70 mg/dL lowered LDL and reduced the number of major adverse cardiac events.

Infectious Disease Alert Updates

Circulation of a Novel Vaccinia Virus in Brazilian Equids; Chopin’s Brandied Heart; The Scent of Malaria

Antibiotic Decision-Making Between Medical and Surgical Teams

In an observational study conducted at an academic medical center in London, researchers looked at factors involved in decision-making. The presumptive diagnosis of infection by the emergency department (ED) influenced decision-making by both medical and surgical admitting teams. Medical teams tended to use a multidisciplinary approach to antibiotic decision-making. Surgical teams often delegated antibiotic decision-making to the most junior members of the surgical team.

Acute Flaccid Myelitis 2018

The number of reported cases of acute flaccid myelitis, a paralytic disease of unknown etiology, has increased.

Preventing Clostridioides difficile Infections: Early De-escalation of Antipseudomonal Antibiotics

Early discontinuation of empirically administered antipseudomonal antibiotics may prevent many cases of Clostridioides difficile infection.