Apr
09

The most sought-after commodity in areas hit by the H7N9 flu outbreak is a 10-yuan ($1.60) herbal remedy, indigowoad roots, or banlangen, which has been selling out in stores across Shanghai and Jiangsu, Zhejiang and Anhui provinces.

Daily supplies at pharmacies are being cleared within hours, and demand is so high the government has imposed strict price restrictions to prevent profiteering.

No one is absolutely certain what the humble herb can do to fight the disease, but Jiangsu provincial health bureau said on April 3 that banlangen can keep the H7N9 virus at bay, something which has eluded most advanced medicines, suggested pharmacists.

“No one knows what might happen with bird flu, so they are buying it,” said a clerk at the Renshoutang Pharmacy in Shanghai.

Xiong Wei, the general manager of LBX Pharmacy in Shanghai, said sales of the herb surged between Thursday and Sunday.

“Demand soared from April 3. We had to order 4,800 packets of banlangen the next day from Hangzhou because some stores in Shanghai reported a shortage.

“By Saturday, almost every city in the Yangtze River Delta had reported a shortage and we have had to order the drug from other parts of the country.”

On usual days, Xiong said LBX sells about 300 packets of banlangen a day. Ever since the bird flu outbreak, sales have been about 10 times that.

More than 3,000 packets were sold on Sunday, Xiong added, although sales had calmed in recent days.

“But we have promised not to raise prices at any of our stores, and hope other drugstores don’t either.”

An employee surnamed Yang at the pharmacy of Shanghai Shuguang Hospital, which is affiliated to Shanghai University of Traditional Chinese Medicine, said: “Banlangen at our hospital is priced at 5.4 yuan a pack.

“So far sales have been steady, with no significant growth.”

Price control officials in Nanjing, Jiangsu province, released a notice on Monday urging that prices of all traditional Chinese medicines sold at drugstores and hospitals should not be allowed to increase during the prevention and control period of bird flu.

Xue Li, a sales representative at Nepstar drugstore in South Huaxia Road in Wuxi, Jiangsu province, said it had been selling banlangen in nine- and 10-yuan packs, ever since the news of the outbreak was reported at the beginning of this month.

“For the cheaper ones, fewer than 10 packets are left at the end of every day.”

Hua Liping, the manager of a drugstore near Wuxi People’s Hospital, said they have been running out of banlangen since Saturday, and was not sure whether they could have the drug restocked until Tuesday.

There are seven major producers of banlangen drugs in China, with Hutchison Whampoa Guangzhou Baiyunshan Chinese Medicine Co the largest, with about 60 percent of the market.

Last year the company’s banlangen sales were worth 336 million yuan.

Apr
05

Hong Kong (CNN) – Chinese authorities have killed more than 20,000 birds from a live-poultry trading zone in Shanghai after an unusual strain of bird flu that has so far killed six people in the country was found in pigeons on sale in the city, state-run media outlet Xinhua reported Friday. Details see…

http://www.cnn.com/2013/04/05/world/asia/china-bird-flu/index.html

 

Apr
04

By Bob Flaws, LAc, FNAAOM (USA), FRCHM (UK)

According to the U.S. Centers for Disease Control and Prevention (CDC), avian influenza is an infection caused by bird flu viruses. These influenza viruses occur naturally among birds and, although wild birds worldwide carry the viruses in their intestines, they do not usually get sick from them.

However, avian influenza is very contagious among birds and can make some domesticated birds, including chickens, ducks and turkeys, very sick and can kill them. Infected birds shed the influenza virus in their saliva, nasal secretions, and feces. Susceptible birds become infected when they come in contact with contaminated secretions or excretions or with surfaces that are contaminated with secretions or excretions from infected birds. Domesticated birds may become infected with avian influenza virus through direct contact with infected waterfowl or other infected poultry; through contact with surfaces such as dirt or cages; or materials, such as water or feed, that have been contaminated with the virus.

 

Infection with avian influenza viruses in domestic poultry causes two main forms of disease that are distinguished by low and high extremes of virulence. The low pathogenic form may go undetected and usually causes only mild symptoms, such as ruffled feathers and a drop in egg production. However, the highly pathogenic form spreads more rapidly through flocks of poultry. This form may cause disease that affects multiple internal organs and has a mortality rate that can reach 90 percent to 100 percent, often within 48 hours.

The risk from bird flu is generally low to most people because the viruses do not usually infect humans. However, confirmed cases of human infection from several subtypes of avian influenza infection have been reported since 1997. Most cases of avian influenza infection in humans have resulted from contact with infected poultry (i.e., domesticated chicken, ducks and turkeys) or surfaces contaminated with secretion/excretions from infected birds. The spread of avian influenza viruses from one ill person to another has been rarely reported, and transmission has not been observed to continue beyond one person.

Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms, such as fever, cough, sore throat, and muscle aches, to eye infections, pneumonia, severe respiratory diseases, such as acute respiratory distress, and other severe and life-threatening complications. The symptoms of bird flu may depend on which virus caused the infection. Studies done in laboratories suggest that some of the prescription medicines approved in the United States for human influenza viruses should also work in treating avian influenza infection in humans. However, influenza viruses can become resistant to these drugs. Therefore, these medications may not always work. Additional studies are needed to demonstrate the effectiveness of these medicines.1

According to the World Health Organization (WHO), there have been a total of 31 cases worldwide of avian influenza and 20 deaths from Jan. 1 to March 8, 2006.2 Also as of March 8, 2006, the Ministry of Health in the People’s Republic of China had reported 10 deaths from H5N1 avian influenza in that country alone.3 Public health officials and organizations around the world remain on high alert because of increasing concerns about the prospect of an influenza pandemic which many experts believe to be inevitable. Moreover, recent problems with the availability and strain-specificity of vaccine for annual flu epidemics in some countries and the rise of pandemic strains of avian flu in disparate geographic regions have alarmed experts about the world’s ability to prevent or contain a human pandemic.4

Because Chinese medicine has a long history of treating various viral conditions successfully and because so many cases of avian influenza in humans have occurred in China, it is only natural for practitioners of Chinese medicine worldwide to ask what our medicine has to offer for the protection and treatment of this condition. On pages 441-443 of issue No. 6, 2005 of Tian Jin Zhong Yi Yao (Tianjin Chinese Medicine & Medicinals), the Tianjin Municipal Group of Experts on the Prevention and Treatment of Avian Influenza With Chinese Medicine and Medicinals published an article titled, “Guidelines for the Diagnosis and Treatment of Human Infection by Highly Pathogenic Avian Influenza with Chinese Medicine and Medicinals.” Therefore, below is an abstract of this article’s discussion of the treatment based on pattern discrimination of the various stages of this disease.

source:  http://www.acupuncturetoday.com/archives2006/oct/10flaws.html

Apr
04

Mainland authorities have made a breakthrough in their investigation of the H7N9 bird flu virus, which has killed two more people, finding it in pigeon samples at a Shanghai market.

Authorities in the city began a cull of poultry following the discovery at the market, Xinhua reported early today.

Leading public health experts warned that more human cases of H7N9 were likely to be detected after health authorities stepped up their monitoring.

The Ministry of Agriculture said yesterday that the virus was found in a sample taken from a pigeon at the Huhuai Agricultural Products Wholesale Market in Shanghai’s Songjiang district. The strain was very similar to the strain detected in the 14 human patients infected to date. Five have died.

Professor Lu Hongzhou, a leading public health expert who has helped treat the cases in Shanghai and was one of the drafters of new national H7N9 flu prevention and control guidelines, said the discovery provided a link between the human flu and birds, although there might be other sources of transmission.

A 48-year-old man from Rugao , Jiangsu , who transported chickens and ducks for a living became the fourth person to die from the virus on Wednesday, Shanghai’s Commission of Health and Family Planning said yesterday. The man went to a private clinic with a cough and fever on Monday and then sought treatment at Tongji Hospital in Shanghai on Wednesday. He died hours later.

The authorities later confirmed a 52 year-old retired woman died of the virus on Wednesday at Huashan Hospital. They said two other local people, including a four-year-old boy, were confirmed infected with H7N9.

Four people in Shanghai have now died of the bird flu in the past month. The other death was in nearby Zhejiang .

Zhejiang’s health department announced the discovery of the province’s third H7N9 flu case yesterday – a 64-year-old farmer from Huzhou – bringing the number of people known to have been infected on the mainland to 14. The man showed symptoms on March 29 and was admitted to a hospital two days later.

Lu Hongzhong, the public health expert, warned more cases would emerge in the coming days as surveillance had been stepped up and it was likely some people had been infected but had not shown strong symptoms.

But even with more cases confirmed it was still a sporadic outbreak because no epidemiological link was found and no cluster outbreak, such as in schools, had been detected.

The outbreak has dealt a major blow to Shanghai’s poultry market, with dealers saying sales had plummeted.

A six-member team of Hong Kong experts set off on a two-day trip to Shanghai yesterday. Led by the Hospital Authority’s chief manager of infection, emergency and contingency, Dr Liu Shao-haei, the team will meet experts in Shanghai to discuss patients’ clinical situations and exchange views on treatment methods.

University of Hong Kong microbiologist Professor Yuen Kwok-yung is one of the team members.

Apr
04

Mainland health officials have been criticised by some doctors for suggesting traditional Chinese medicine and other alternative treatments to help ward off bird flu as the months-long process of creating a new vaccine gets under way.

Gansu’s health commission, for instance, encouraged residents to go outdoors, preferably into wooded areas, for fresh air and sunshine. Listening to music was also deemed an effective way to keep the H7N9 virus at bay.

Massaging the side of one’s nose was also said to help, as was exposing parts of one’s legs and stomach to incense once a day.

Health authorities in the eastern province of Jiangsu suggested a long list of herbal drinks, including the popular ban lan gen, a type of root that is often taken to fight the flu and was prescribed during the Sars outbreak a decade ago.

Dr Fang Shimin , biologist and a popular science writer on the mainland, was among those who questioned the clinical effectiveness of these methods.

In his microblog on Sohu .com he reminded people that Gansu health authorities have promoted the eating of pig’s feet as an effective treatment for various diseases, including Aids and cancer.

“The traditional Chinese medicine industry is trying to cash in,” he wrote.

Professor David Hui Shu-cheong, who teaches respiratory medicine at the Chinese University of Hong Kong, said there was no scientific evidence to show that ban lan gen is effective at preventing influenza.

David Fong Wang-fun, a retired professor of Chinese medicine at Hong Kong’s Baptist University, said Chinese medical theories have long shown that ban lan gen functions as a health supplement, but it is not for emergency treatment.

Traditional Chinese medicine, even when effective, is sometimes greeted with scepticism because much of its purported benefits are not backed by the kind of laboratory evidence for its Western counterparts.

“The biggest headache regarding traditional Chinese medicine is that its effectiveness often cannot be explained,” said Dr Dong Xieliang, president of the Xian Xietong Hospital in Shaanxi . “The curing process can be so sophisticated it may not be simply explained scientifically, physically or chemically.”

Dong said mainland doctors found several herbal therapies helpful in relieving patients’ ailments during the fight against Sars and other flu outbreaks over the past decade.

However, a challenge has been that every herb has a side effect, and prescriptions are often very sophisticated, with more than a dozen herbs needed for maximum effectiveness.

Dong expressed concern that some misleading therapies proposed to fight the new bird flu could further damage the reputation of traditional Chinese medicine on the mainland. “Some advice is obviously wrong, such as going outdoors and eating certain kinds of food or herbs,” he said. “Effective treatment should be much more sophisticated.”

 

DOS AND DOUBTS

Preventive measures advocated by health organisations in China and elsewhere

National Health and Family Planning Commission

Avoid eating raw or half-cooked eggs and birds.

Beijing Centre for Disease Control and Prevention and Centre for Preventive Medical Research

Avoid contact with dead animals and wash hands frequently.

Jiangsu Health Bureau

Consume Chinese medicines ban lan gen (woad root) in granules and radix astragali oral liquid.

Guangxi Centre for Disease Prevention and Control

Avoid consumption of raw chicken and cook animal foodstuffs thoroughly.

Gansu Health Bureau

Massage facial acupuncture points and consume traditional Chinese medicine.

Hong Kong’s Centre for Health Protection

Cover the nose and mouth while sneezing or coughing, hold the spit with tissue and put it into covered dustbins.

World Heath Organisation

Cook food so that it reaches 70°C in all parts (with no pink parts).

 

Apr
04

SHANGHAI, April 4 (Xinhua) — Authorities in Shanghai said Thursday night that another person has died from H7N9 bird flu, bringing the death toll from the new deadly strain to five around the country.

The city has reported six infections to date, and four have died, said the Shanghai Municipal Health and Family Planning Commission.

Of the rest two, there was a four-year-old, the agency said. The baby was recovering from mild illness, it added.

The person died at Huashan Hospital on Wednesday and was confirmed infected with the H7N9 strain on Thursday. The commission gave no further information on the latest case.

 

Also on Thursday, the commission reported the city’s third death from the H7N9 bird flu.

The case involved a 48-year-old man surnamed Chu, a poultry transporter from Rugao in neighboring Jiangsu Province.

He developed symptoms of cough on March 28. After having a fever on Monday, he went to a private clinic for treatment. The man then sought help in the Tongji Hospital in Shanghai in the early hours of Wednesday after his condition worsened.

Chu died three hours after being admitted to the hospital. He was confirmed infected with the H7N9 virus on Thursday. Eight people who had close contact with him have shown no abnormal symptoms.

So far, China has confirmed 14 H7N9 cases — six in Shanghai, four in Jiangsu, three in Zhejiang and one in Anhui, in the first known human infections of the lesser-known strain. Of all, four died in Shanghai and one died in Zhejiang.

China’s Ministry of Agriculture said Thursday the H7N9 avian flu virus has been detected from pigeon samples collected at a marketplace in Songjiang District of Shanghai.

After gene sequence analysis, the national avian flu reference laboratory concluded that the strain of the H7N9 virus found on pigeons was highly congenetic with those found on persons infected with H7N9 virus.

The ministry has ordered beefed-up monitoring of H7N9 bird flu virus in more areas.

China’s health authorities have promised transparency and cooperation to the World Health Organization in regards to human infections of the new strain of bird flu.

The Chinese Center for Disease Control and Prevention said Wednesday that no human-to-human transmission of H7N9 has been discovered and no epidemiological connection between these cases has been found.

WHO confirms five deaths from China bird flu

Apr
04

BEIJING — A middle-aged man who transported poultry for a living and another unidentified person have died from a new strain of bird flu, bringing the death toll to five among 14 confirmed cases in China, the government and state media reported Thursday.

The 48-year-old man, who died in Shanghai, is one of several among the infected believed to have had direct contact with fowl. Until recently, the virus, called H7N9, was not known to infect humans.

The official Xinhua News Agency did not identify the fifth fatality, but said that person also died in Shanghai on Wednesday.

It said the Ministry of Agriculture confirmed on Thursday that the H7N9 virus had been detected in pigeons at a market selling agricultural products in Shanghai.

It is not known how people are becoming sick with the virus, and health officials and scientists caution that there are no indications it can be transmitted from one person to another. Scientists who have studied the virus’s genetic sequence said this week that the virus may have mutated, spreading more easily to other animals and potentially posing a bigger threat to humans.

Guidelines issued Wednesday by the national health agency identify butchers, breeders and sellers of poultry, and those in the meat processing industry as at higher risk.

Experts only identified the first cases on Sunday. Some among the 14 confirmed cases fell ill several weeks ago but only now are being classified as having H7N9.

Xinhua said six cases have been confirmed in Shanghai, four in Jiangsu, three in Zhejiang and one in Anhui.

 

Japan, Hong Kong on guard as China fights new bird flu 

(Reuters) – The death toll from a new strain of bird flu rose to five in China on Thursday as Beijing said it was mobilizing resources nationwide to combat the virus, Japan and Hong Kong stepped up vigilance and Vietnam banned imports of Chinese poultry.

 

 

Apr
03

• Two infections of H7N9 bird flu, involving one death, were reported in east China’s Zhejiang Province.
• The total number of infected people in China has been brought to nine, local authorities said.
• No epidemiological connection between the two cases has been found so far.

(Xinhua) — Two infections of H7N9 bird flu, involving one death, have been reported in east China’s Zhejiang Province, bringing the total number of infected people in the country to nine, local authorities said on Wednesday.

One of the infected has already died, said a statement issued by the provincial health department.

According to the statement, a 38-year-old chef surnamed Hong died on March 27. The man, who worked in Jiangsu Province, where four other cases of H7N9 bird flu have been identified, became ill on March 7 and returned to his home in Jiande, Zhejiang, where he was admitted to a hospital on March 18.

The provincial and national disease control centers confirmed on Monday and Wednesday, respectively, that he was infected with H7N9 avian influenza.

The other patient, a retired Hangzhou man surnamed Yang, was admitted to a hospital on March 25 with a cough and fever. He was transferred to another hospital for better treatment and remains hospitalized, according to the statement.

Provincial and national health authorities confirmed on Tuesday and Wednesday, respectively, that he is infected with the H7N9 avian influenza virus, the statement said.

No epidemiological connection between the two cases has been found so far.

A total of 183 people who came into contact with the two men have so far shown no symptoms of fever or respiratory illness, the statement added.

Zhejiang has initiated an emergency response for epidemics based on regulations of the Ministry of Health, and relevant departments have been asked to take precautionary actions toward disease control.

Seven other H7N9 bird flu cases had been reported previously, two in Shanghai, one in Anhui and four in Jiangsu. The two in Shanghai died and the other five are in critical conditions under treatment in Nanjing, capital of Jiangsu.

Authorities in Chinese regions have ordered health institutions to step up monitoring.

On Wednesday, Pang Xinghuo, spokesman for the Beijing Municipal Disease Control and Prevention Center, said the capital would not rule out the possibility of H7N9 cases popping up.

“With a massive population flow every day, the metropolitan area cannot rule out H7N9 risks. However, with the battle experiences of SARS and H1N1 influenza outbreaks, the city has been well prepared for epidemic control,” according to Pang.

He said the center has ordered hospitals to include H7N9 bird flu testing in routine monitoring and to train hospital staff on how to treat pneumonia caused by unknown factors.

The subtype of H7N9 bird flu virus has not been contracted to human beings before. It shows no signs of being highly contagious among humans, according to the clinical observation on the cases’ close contacts.

However, as few cases of human infection of H7N9 have been found, relatively little research has been done on it. There are no vaccines against the H7N9 bird flu virus either at home or abroad.

China steps up monitoring after more H7N9 bird flu cases

Authorities in Chinese regions have ordered health institutions to step up monitoring of H7N9 bird flu as four more cases were reported Tuesday.

Four people in east China’s Jiangsu Province have been confirmed as being infected with the lesser-known H7N9 bird flu, bringing the total number of infections in the country to seven.

Statistics on pneumonia cases caused by unknown reasons will be reported daily in Shanghai where two people died from the first known human infections of the bird flu strain, the municipal government said in a press briefing Tuesday.

The city government will also set up an expert team to evaluate the severity and risk of the H7N9 bird flu, to step up research on the virus, and to closely watch the infections and people who have been in contact with them, it said.

On Monday, the Shanghai Animal Disease Prevention and Control Center tested 34 samples of pig carcasses pulled from the Huangpu River running through the city and providing it drinking water. It found no bird flu viruses.

Thousands of dead pigs were retrieved from the Huangpu River last month, sparking huge panic as well as satire among the public over tap water safety.

The health authorities in Jiangsu have designated 16 leading hospitals to accept new cases in a bid to offer better treatment and reduce the mortality rate.

The health bureau in Beijing has ordered hospitals to include the testing of H7N9 bird flu in routine monitoring and to train hospital staff on how to treat pneumonia caused by unknown factors.

Health authorities in Shandong Province have ordered morning tests of fever, cough and other respiratory symptoms at schools, nurseries and poultry farms.

The four patients, from four cities in Jiangsu Province, are in critical conditions and under emergency treatment, the Jiangsu provincial health bureau said Tuesday in a statement.

The four were confirmed as human infections with H7N9 avian influenza by an expert team summoned by the provincial health bureau, based on clinical observations, laboratory tests and epidemiological surveys Tuesday afternoon, the statement said. No mutual infections were discovered among them.

A total of 167 people who had come into contact with the four showed no symptoms of fever or respiratory illnesses, it said.

The four included a 45-year-old woman from Nanjing, a 48-year-old woman from Suqian, a 83-year-old man from Suzhou, and a 32-year-old woman from Wuxi, it said.

The woman in Jiangning district of Nanjing, surnamed Xu, fell ill with flu symptoms on March 19. She was transferred to a hospital intensive care unit in Nanjing on March 27 after her condition worsened, the statement said. She is a poultry culler.

The woman from Shuyang county of Suqian City fell ill on March 19 and was transferred to a hospital intensive care unit in Nanjing on March 30.

Tests by the Jiangsu provincial center for disease control and prevention found the two women positive of the H7N9 strain on March 30 and further tests by the Chinese center for disease control and prevention confirmed the results on April 2.

The man from Wujiang district of Suzhou City became ill on March 20 and was admitted to a local hospital on March 29. He was first tested positive of H7N9 bird flu on April 1.

The woman from Binhu district of Wuxi City fell ill on March 21 and was transferred to an intensive care unit of a hospital in Wuxi after her condition worsened on March 28. She was first tested positive of H7N9 bird flu on March 31.

On Sunday, three H7N9 bird flu cases were reported, two in Shanghai and one in Anhui, the first human infections of the bird flu strain. The two in Shanghai died and the one from Anhui is in critical condition and under treatment in Nanjing.

It is unclear how the three got infected, and no mutual infections were discovered among them, said the National Health and Family Planning Commission Sunday. No abnormalities were detected among 88 of their closest contacts.

The subtype of H7N9 bird flu virus has not been contracted to human beings before. The virus shows no signs of being highly contagious among humans, according to the clinical observation on the cases’ close contacts.

 

 

May
30

For over 5,000 years, Traditional Chinese Medicine (TCM) has claimed to be able to predict the state of your inner health simply by looking at your tongue. Now a smartphone app that does it all for us.

The traditional method bases its results on the flow and balance of positive and negative energies in the body.

However, in the modern world (and with technology on our side) gadget geeks have come up with a contemporary way to check our health using the power of the tongue… by creating a smartphone app that does it all for us. Read more…

May
24

Having adopted the American diet, the Chinese now are seeking help from American endocrinologists on ways to manage the negative byproducts of that diet: obesity and diabetes.

A delegation of some two dozen Chinese endocrinologists is here at the annual meeting of the American Association of Clinical Endocrinologists (AACE) to learn tips and tricks on taming the growing metabolic epidemics spreading across their country.

“In 2010, the prevalence of diabetes in China was nearly 10%,” said Guo Xiaohui, MD, from Peking University First Hospital, during a press briefing. “More striking is that 64% of those with diabetes are undiagnosed.”

According to the World Health Organization, the overall percentage of obesity among the Chinese is nearly 6%, but can be as high as 20% in some cities, Xiaohui said.

When asked if the Western diet is partly responsible for the increase in diabetes and obesity, he said, “More specifically, the American diet.”

The Chinese people are eating more food per serving, have more money to buy and eat food — particularly junk food — when they’re not hungry, and engage in less physical activity, Xiaohui said.

He said that many people still eat a traditional Chinese meal, but along with rice and veggies will be more meat, and portions will be bigger as well. In addition, fast-food restaurants such as Kentucky Fried Chicken and McDonald’s are enjoying success at the price of a growing obesity epidemic among children and teens, he said.

One promising initiative is a new network of primary care physicians across the country. These physicians have received training to better deal with diabetes patients. The initiative is mostly focused on rural physicians, whose knowledge of diabetes is lacking.

“The grassroots program trains doctors in the countryside how to diagnose, treat, and manage patients with diabetes,” said Guang Ning, MD, president of the Chinese Society of Endocrinology, at the press conference. “It also teaches them how to properly inject insulin and how to better educate patients to take care of themselves.”

“Perhaps we in the U.S. can also learn from the Chinese,” said Yehuda Handelsman, MD, outgoing president of AACE. “They are to be congratulated for taking a national approach to address this epidemic of diabetes.”

Handelsman and Zachary Bloomgarden, MD, from Mount Sinai School of Medicine in New York City, have been traveling to China the last several years, and it was through their friendship with Ning that the present group of Chinese endocrinologists ended up coming to this meeting to exchange ideas.

A second, related program in China is aimed at educating rural physicians about thyroid disorders, which also are increasing in number, Xiaohui said.

There are six central hospitals in different areas of China where physicians can come for training.

“Unfortunately, the level of knowledge about thyroid disorders among doctors in the countryside is even less than that of diabetes,” Xiaohui said.

“We want to establish a system for fundamental medical care, especially in the countryside, to help improve the health of our country,” he said.

The Chinese delegates are particularly interested in learning about clinical best practices, including guidelines and recommendations for practice.

By Chris Kaiser, Cardiology Editor, MedPage Today