Aggression management

National and international trends over the past 15 years depict modest improvements in the treatment and/or control of blood pressure (BP) for hypertensive patients. This observation is made despite efforts to promote awareness, treatment, and the means available to aggressively manage high blood pressure. Over 65 million Americans have hypertension, which was listed as the primary cause of death for over 261,000 individuals in the United States in 2002.1 Hypertension is also a significant cause of end-stage renal disease and heart failure. National and international organizations continually refine their recommendations of how... 

Prolonged exposure to elevated growth hormone and insulin-like growth factor I levels can lead to serious complications in patients with acromegaly. Aggressively manage... 

Prolonged exposure to elevated GH and IGP-Is can lead to serious complications in patients with acromegaly. Aggressively manage comorbid conditions such as hypertension, diabetes, arrhythmias, coronary artery disease and heart failure to prevent vascular and neuropathic complications. It is critical to monitor patients indefinitely for management of the comorbidities associated with acromegaly8 (Table 43-4). 

Near-normal glycemia reduces the risk of microvascular disease complications, but aggressive management of traditional cardiovascular risk factors (i.e., smoking cessation, treatment of dyslipidemia, intensive blood pressure control, antiplatelet therapy) is needed to reduce macrovascular disease risk. 

Interventions that may improve prognosis include referrals for vocational testing and training, substance- and alcohol-abuse counseling, and aggressive management of depressive symptoms as they occur. 

I believe that the return on investment from royalties will pay the overall cost of this program eventually in both cases. The final conclusion about intramural programs is that more aggressive management accelerates innovation. There are ways in which institutions can manage these processes that make them more successful and productive. 

One of the continued problems with all chemical researchers is the lack of adequate technician help. Throughout much of my career I was subject to the rule of one, or even half a technician per chemist, which was applied irrespective of how productive a scientist was. There were, of course, exceptions, when I had somewhat more aggressive management, who realized we could make more progress if we could conduct more experimental work. I often wonder how industry would advance if each manager just had one person under him or her ... 

SJ syndrome is life-threatening—drug must be discontinued and patients referred urgently. Immediate (steroids) and possible long-term severe dryness and ocular surface disease wiU require aggressive management. 

Treatment of ginseng exposures is supportive. The use of the herbal preparation is discontinued. Most cases of ginseng overdose do not require aggressive management. Supportive care for symptoms that develop is the mainstay of treatment. 

D in the ACC/AHA classification scheme)."" " The terms decompensated heart failure and exacerbation of heart failure refer to patients with acute worsening of their baseline symptoms that is usually caused by volume overload and/or hypoperfusion. Irrespective of the term used, these forms of severe heart failure may be caused by progression of the underlying disorder or by other intercurrent events that result in worsening of the patient s symptoms. Early identification and aggressive management of patients with advanced heart failure hopefully will reduce morbidity, mortality, and cost of care. 

The cost beneflt ratio associated with more aggressive management of metabolic disorders (e.g., hyperphosphatemia and hypercalcemia) and sHPT has not been formally evaluated. If the associated complications such as vascular and soft tissue calcifications that may increase morbidity and hospitalizations can be significantly reduced, the additional medication costs may ultimately be of minimal consequence. 

A review of additional comorbidities that can negatively impact the prognosis of patients with chronic ischemic heart disease is beyond the scope of this chapter. Nonetheless, aggressive management of comorbid conditions such as hypertension, diabetes, atrial fibrillation, renal insufficiency, and peripheral and cerebrovascular disease remain essential to optimizing the treatment of these patients. 

V. Treatment. Patients who have self-limited mild gastrointestinal symptoms or who remain asymptomatic for 6 hours are unlikely to develop serious intoxication. On the other hand, those few with serious ingestion must be promptly and aggressively managed. 

---