Left Ventricular Changes n Isolated Office Hypertension: A Blood Pressure–Matched Comparison With Normotension and Sustained Hypertension
By means of digitized M-mode echocardiography, the authors evaluated left ventricular morphofunctional characteristics in 42 isolated office hypertensive individuals and compared the findings with those for 42 sustained hypertensive individuals and 42 normotensive individuals matched by age, sex, body mass index, mean clinic blood pressure, and daytime blood pressure. Isolated office hypertensives had intermediate left ventricular characteristics between the other 2 groups, having increased left ventricular mass and reduced diastolic function compared with normotensives but lower left ventricular mass and higher diastolic function compared with sustained hypertensives. Comparing blood pressure–matched groups, isolated office hypertensives have left ventricular morphofunctional characteristics significantly different from normotensives and qualitatively similar to sustained hypertensives. The results support the hypothesis that isolated office hypertension should not be considered as simply a benign condition.
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Generalist and Subspecialist Physicians' Knowledge, Attitudes, and Practices Regarding Influenza and Pneumococcal Vaccinations for Elderly and Other High-Risk Patients: A Nationwide Survey
This article presents the results of a survey of 6000 US physicians (2000 family practitioners, 2000 general internists, and 2000 internal medicine subspecialists). There were 1874 physician responders. Generalist physicians were more likely than the subspecialists to very strongly recommend influenza and pneumococcal vaccinations to their elderly and other high-risk patients. Generalists were also more likely to use other effective strategies in their clinical practices, such as standing orders, special clinics, and patient reminders. In both groups, fewer than 30% of physicians used each of these strategies. Physicians seem to be missing many opportunities to ensure that their elderly and other high-risk patients receive influenza and pneumococcal vaccinations. In addition to making strong recommendations to their patients for these immunizations, physicians should also incorporate other effective strategies into their clinical practices. Such efforts will be essential to achieve higher immunization rates in these groups and thereby ensure that the benefits of these safe and effective vaccines are realized.
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Economic Burden of Pneumonia in an Employed Population
The costs of pneumonia cases among beneficiaries of a large corporation were determined by comparing patients with a diagnosis of pneumonia with a 10% random sample of the insured population. Using claims data, the article estimates the overall economic burden of pneumonia from an employer perspective. Total annual, per capita, and employer costs were approximately 5 times higher for pneumonia patients ($11 544) than among typical beneficiaries in the employer overall population ($2368).
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