Seyyed Esmaeil Managheb; Mahmood Soveid; Mohammad Kasaei
Volume 4, Issue 1 , January 2016, , Pages 50-53
Abstract
Cardiovascular disease (CVD) due to atherosclerosis is the foremost cause of premature mortality and of disability-adjusted life years (DALYs) in developed and developing countries (1). The associated mortality is preventable through treatment of dyslipidemia (2). Over half of the first CHD events ...
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Cardiovascular disease (CVD) due to atherosclerosis is the foremost cause of premature mortality and of disability-adjusted life years (DALYs) in developed and developing countries (1). The associated mortality is preventable through treatment of dyslipidemia (2). Over half of the first CHD events and 3/4 of CHD deaths are preventable by controlling the risk factors, including diet, exercise, weight and blood pressure control; prescription of aspirin and tobacco cessation ; and lowering lipids (3). Dyslipidemia covers the broad spectrum of lipid abnormalities (4). However, elevations of the total cholesterol and low density lipoprotein cholesterol (LDL-C) have received the most attention (4). Epidemiologic data revealed that about 70 million Americans had elevated levels of LDL cholesterol between 2005 and 2008 (5). Abnormalities in lipid components are prevalent in Iran and they are more common among men in urban areas. Urbanization, unhealthy diet and sedentary lifestyle are the underlying reasons for the high prevalence of dyslipidemia in Iran (4). Dyslipidemias may be related to other diseases (secondary dyslipidemias); therefore, secondary causes of abnormal lipid levels should be considered first and treated when appropriate (6).The primary target in treating dyslipidemia has been and will probably continue to be LDL cholesterol because it is the most atherogenic lipoprotein which correlates more closely than other lipids with CHD (7). Statin therapy is likely to continue to be emphasized because they are the most effective lipid-lowering agents for reducing LDL cholesterol concentrations, and their efficacy for lowering the risk for cardiovascular events has been proven (8). Every 1.0 mmol/L (40 mg/dL) reduction in LDL-C is associated with a corresponding 22% reduction in CVD mortality and morbidity (9). Patients with an elevated LDL-cholesterol level should begin the Therapeutic Lifestyle Changes program as well as an individualized program of regular exercise. Lifestyle modifications include diet, aerobic exercise, weight control, smoking cessation, evaluation of alcohol consumption; and a nutritional supplement containing sitostanol ester, a saturated derivative of plants’ seed oil (6). Diet and exercise are the cornerstones of treatment for asymptomatic patients with dyslipidemia (6). Smoking cessation reduces coronary event rate by about 50% within one to two years of stopping. Among the benefits of smoking cessation is a 5-10% increase in HDL-C (3). Clinicians should initiate statin therapy regardless of LDL, in patients with established ASCVD. Statins are the drugs of choice for lowering LDL-cholesterol, and aggressive treatment with statins should be pursued (6). Large scale clinical event trials include lovastatin, pravastatin, simvastatin atorvastatin, and rosuvastatin (3). Statin Dose Intensity is shown in Table 1 (3).
Seyed Esmaeil Managheb; Mesbah Shams; Mahmood Soveid; Mohamad Hadi Imanieh; Mohsen Moghadami
Volume 3, Issue 4 , October 2015, , Pages 165-166
Abstract
Compiling clinical guidelines is one of the requirements of family physician plan and classification of health care services.1 The high prevalence of type 2 diabetes can easily be seen in general practice so that 2.5% of referrals to general practitioners are due to diabetes. More than half of the patients ...
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Compiling clinical guidelines is one of the requirements of family physician plan and classification of health care services.1 The high prevalence of type 2 diabetes can easily be seen in general practice so that 2.5% of referrals to general practitioners are due to diabetes. More than half of the patients with Type 2 diabetes are left undiagnosed and most of them suffer from its complications at the time of diagnosis. For example, 6.2% of patients suffer from diabetic retinopathy at the time of diagnosis.2 Most patients diagnosed with diabetes take more than one type of medication to treat the complications; about 60% take only oral medications, and 14 percent take oral medications and insulin.3 Although the principles of care for people with Type 2 diabetes is well known, there is a gap between the quality of care in general practice and optimal care so that up to 50% of patients’ condition are weakly controlled.4 Chronic care model for patients with chronic diseases explains the necessary measures to improve the care of people with chronic diseases. These elements include supporting disease management by the patients themselves, patient care, and support teams. Consultation and training are often done in general practice while it is usually a brief consultation about weight, medication or exercise. There is little evidence that mere printed texts are effective in controlling the disease. Extensive training programs are designed to develop self-management skills for diabetes control.4 The implementation of clinical guidelines in medical practice is a challenging task. But, a number of evidences have been shown to accelerate effective clinical guideline implementation and care improvement.5 Management of diabetes mellitus type 2 is shown in Figure 1.
Seyed Esmaeil Managheb; Mesbah Shams; Mahmood Soveid; Mohamad Hadi Imanieh; Mohsen Moghadami
Volume 3, Issue 4 , October 2015, , Pages 167-168
Abstract
Incidence of diabetes is increasing in developing countries as well as Iran. Half of the patients are not aware of their disease so screening of diabetes is necessary. Lifestyle changes in society, high-saturated fat diet and decreased physical activity are the factors that influence the growing rate ...
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Incidence of diabetes is increasing in developing countries as well as Iran. Half of the patients are not aware of their disease so screening of diabetes is necessary. Lifestyle changes in society, high-saturated fat diet and decreased physical activity are the factors that influence the growing rate of diabetes in Iran.1 The need for addressing type 2 diabetes has been clarified for family physicians.2 Diabetes is a common disease that is associated with significant morbidity and mortality. It has an asymptomatic stage that may be present for up to several years before diagnosis.3 Diabetes is the leading cause of kidney disease.4 In a study among patients over 45 years with type 2 diabetes, these results were reported: 22% suffered from retinopathy, 7% had impaired vision, 6% had kidney diseases, 9% had clinical symptoms, and 19.1% were at risk for foot ulcers.5 Early treatment of type 2 diabetes can reduce or delay complications.6 Optimal glycemia and BP are important in the prevention of diabetic chronic kidney disease (CKD).4 Therapeutic goals in patients with complications, such as CKD, include maintaining renal function and stopping the trend of renal deterioration.5 Progression of diabetic nephropathy can be slowed through the use of some medications.4 How to screen and manage chronic kidney disease in patients with type 2 diabetes is shown in Figure 1.
seyed esmaeil Managheb; Mesbah Shams; Mahmood Soveid; Mohamad Hadi Imanieh; Mohsen Moghadami
Volume 3, Issue 3 , July 2015, , Pages 125-127
Abstract
Health care system is organized to achieve more efficiency as well as developing public equity and providing access to the first, second and third levels of services. Family physician is in the first line of the health care system; in other words, family physician is the health system’s goalkeeper. ...
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Health care system is organized to achieve more efficiency as well as developing public equity and providing access to the first, second and third levels of services. Family physician is in the first line of the health care system; in other words, family physician is the health system’s goalkeeper. According to classification of health services, gaining access to specialized services becomes possible through the referral system.1 Referral system is a system in which the client should primarily refer to the family physician in order to gain access to health care services and be referred to a specialist if necessary. The specialist refers the patient to the family physician for following treatment modalities after doing necessary medical care and advice and recording the results in the feedback form.2 Despite the different levels of service delivery, the boundaries between these levels are not clear enough and have caused problems in the referral system. Certainly, for better implementation of family physician plan, empowering family physicians, clarifying the referral procedure, and localizing its components are of great importance. One of the life long concerns of the Ministry of Health and Medical Education, especially Shiraz University of Medical Sciences, has been developing clinical guidelines to empower family physicians based on clinical referral system and local conditions of the country. Among effective measures in this field is preparing clinical guidelines, according to the level of services and in line with the referral system. The purpose of developing clinical guidelines is improving the quality of health care and increasing the patient’s satisfaction through the following specific objectives: