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Dyer C. Trust pays cardiologist £1.22m for unfair dismissal. BMJ 2016; 352:i787. [PMID: 26856762 DOI: 10.1136/bmj.i787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lee NJ, Litt H. Cardiac CT angiography for evaluation of acute chest pain. Int J Cardiovasc Imaging 2015; 32:101-12. [PMID: 26342713 DOI: 10.1007/s10554-015-0763-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/31/2015] [Indexed: 01/23/2023]
Abstract
Chest pain is the second most common emergency department (ED) presentation in the United States. Cardiac computed tomography angiography (CCTA) now plays an important role in the evaluation of patients with suspected acute coronary syndrome in the ED setting. In this article, we review the available techniques focused on the use of CCTA to evaluate patients fosr coronary atherosclerosis for timely triage of acute chest pain.
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Cohen DL, Kearney R, Griffiths M, Nadesalingam V, Bathula R. Around 9% of patients with ischaemic stroke are suitable for thrombectomy. BMJ 2015; 351:h4607. [PMID: 26318160 DOI: 10.1136/bmj.h4607] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Burns PA, Flynn PA, Rennie IM. Importance of location of neurointerventional skills in thrombectomy for acute stroke. BMJ 2015; 351:h4605. [PMID: 26320166 DOI: 10.1136/bmj.h4605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fan G, He S, Chen Z. Musculoskeletal Pain and Cancer Risk of Staff Working With Fluoroscopically Guided Procedures. J Am Coll Cardiol 2015; 66:759-60. [PMID: 26249000 DOI: 10.1016/j.jacc.2015.04.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
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Borghini A, Mercuri A, Turchi S, Chiesa MR, Piccaluga E, Andreassi MG. Increased circulating cell-free DNA levels and mtDNA fragments in interventional cardiologists occupationally exposed to low levels of ionizing radiation. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2015; 56:293-300. [PMID: 25327629 DOI: 10.1002/em.21917] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 09/30/2014] [Indexed: 06/04/2023]
Abstract
Circulating cell-free DNA (ccf-DNA) and mtDNA (ccf-mtDNA) have often been used as indicators of cell death and tissue damage in acute and chronic disorders, but little is known about changes in ccf-DNA and ccf-mtDNA concentrations following radiation exposure. The aim of the study was to investigate the impact of chronic low-dose radiation exposure on serum ccf-DNA levels and ccf-mtDNA fragments (mtDNA-79 and mtDNA-230) of interventional cardiologists working in high-volume cardiac catheterization laboratory to assess their possible role as useful radiation biomarkers. We enrolled 50 interventional cardiologists (26 males; age = 48.4 ± 10 years) and 50 age- and gender-matched unexposed controls (27 males; age = 47.6 ± 8.3 years). Quant-iT™ dsDNA High-Sensitivity assay was used to measure circulating ccf-DNA isolated from serum samples. Quantitative analysis of mtDNA fragments was performed by real-time PCR. No significant relationships were found between ccf-DNA and ccf-mtDNA, and age, gender, smoking, or other clinical parameters. Ccf-DNA levels (44.2 ± 31.1 vs. 30.6 ± 19.2 ng/ml, P = 0.013), ccf-mtDNA-79 (2.6 ± 2.1 vs. 1.1 ± 0.8, P < 0.01), and ccf-mtDNA-230 copies (2.0 ± 1.8 vs. 1.04 ± 0.9, P = 0.02) were significantly higher in interventional cardiologists compared with the non-exposed group. In a subset (n = 15) of interventional cardiologists with a reliable reconstruction of cumulative professional exposure (59.7 ± 48.4 mSv; range: 1.4-182 mS), ccf-DNA (53.2 ± 41.3 vs. 36.4 ± 22.9 and 32.2 ± 20.5, P = 0.08), mtDNA-79 (2.4 ± 2.1 vs. 2.03 ± 1.7 and 1.09 ± 0.82, P = 0.05), and mtDNA-230 (2.0 ± 2.2 vs. 1.5 ± 1.4 and 1.04 ± 0.9, P = 0.09) tended to be significantly increased in high-exposure subjects compared with both low-exposure interventional cardiologists and controls. Our results provide evidence for a possible role of circulating DNA as a relevant biomarker of cellular damage induced by exposure to chronic low-dose radiation.
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Nepovinnykh NV, Lyamina NP, Ptichkina NM. [Assessment of functional food of general version of diet in cardiac hospital]. Vopr Pitan 2015; 84:38-43. [PMID: 26402941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The efficacy of functional food was evaluated in general embodiment diet of cardiological hospital in patients receiving oxygen-containing products (oxygen smoothies) based on protein-carbohydrate raw materials (dairy whey) with dietary fiber. 60 patients were included in local open, prospective, parallel-group study; among them 36 men and 24 women aged 60-75 years, meeting the following criteria: patients with chronic heart failure I-IV functional class, are hospitalized in the cardiology department, have no contraindications to enteral oxygen therapy and sign an informed consent form. The main group comprised 30 patients, which along with standard therapy received enteral oxygen therapy. 30 patients from the control group received standard therapy and aerated non-oxygen mixture (placebo). Standard therapy included cardioprotective drugs, diuretics and concomitant therapy (enzyme preparations) depended upon the clinical status of the patient. Patients received 500 ml of a cocktail within 10-15 minutes daily for 10 days for 1-1,5 hours before the main meal. The studies revealed the most pronounced clinical effect of enteral oxygen therapy in relation to clinical symptoms and side effects caused by drug administrations. After 3-4 procedures patients with chronic heart failure treated with enteral oxygen therapy had a decrease in fatigue, increase physical performance, improve appetite, emotional lability. By the end the positive dynamics of oxygen therapy on the above grounds was detected in 90% of patients. Monitoring pulse oximetry showed a significant increase of oxygen saturation as a result of the course of enteral oxygen therapy: oxygen saturation increased from 98.13 ± 0.13 to 99.17 ± 0.13% (p < 0.001) while in the control group from 98.12 ± 0.20 to 98.19 ± 0.19% (p < 0.01). Physical activity increased from 318 ± 15 to 389 ± 13 m (p < 0.001), in the control group--from 331 ± 17 to 362 ± 15 m (p < 0.05) in the main group on the test results with the 6-minutes walk test. In the main group dyspnea Borg changed from 11 to 7 scores as compared to the control group--from 11 to 9 scores. Analysis of the results showed the advisability of incorporating developed oxygen-containing products in diet therapy of cardiac patients to reduce the severity of side effects from taking of drugs administration to normalize the process of digestion, to improve the overall health of patients.
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Szyszka A, Pajak A, Pohl M, Kaszuba D. [Smoking cessation during hospitalization on cardiology ward]. PRZEGLAD LEKARSKI 2015; 72:152-154. [PMID: 26731874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Among the modifiable risk factors smoking has the most impact on cardiovascular mortality. Among patients with cardiovascular disease benefits of quitting smoking outweigh those associated with commonly prescribed drugs. Hospitalization in the ward seems to be a good time to motivate the patient to take this step. In our paper we present the effectiveness of different methods to achieve this goal.
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Sakai M, Kato A, Kobayashi N, Nakamura R, Okawa S, Sato Y. Improved Lung Cancer Detection in Cardiovascular Outpatients by the Pulmonologist-based Interpretation of Chest Radiographs. Intern Med 2015; 54:2991-7. [PMID: 26631881 DOI: 10.2169/internalmedicine.54.4171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Pulmonologists and cardiologists view chest radiographs differently. Lung cancer may therefore go undetected in patients referred to cardiovascular departments. We aimed to determine the clinical benefit of the additional interpretation of chest radiographs by pulmonologists in study involving cardiovascular outpatients. METHODS A retrospective review of chest radiographs of outpatients attending a Japanese cardiovascular hospital between April 2000 and March 2010 was conducted. Lung cancer patients were categorized into 3 groups: group C, patients in whom tumors were detected by a cardiologist at the first visit; group P, patients in whom tumors were detected by the additional interpretation of a chest radiographs by a pulmonologist after a lesion was missed by a cardiologist; and group H, patients from an earlier period in which chest radiographs were only examined by a cardiologist. RESULTS Cardiologists detected 9 cases of lung cancer in groups C and H from 2,430 and 2,288 radiographs, respectively. Pulmonologists detected 10 cases of lung cancer (group P) and 3 other malignancies that were previously undetected, giving a miss rate of 52.6% for the cardiologists. Tumor diameters were significantly smaller in group P than in group C or H. Furthermore, a significantly higher number of the tumors in group P were of an early stage and resectable, with more superposing structures than in groups C or H. CONCLUSION The additional pulmonologist-based interpretations significantly increased the detection rate of operable tumors that mostly corresponded to the early T1 stage; this serves offers a potential clinical benefit in reducing the period of time from patient presentation to the diagnosis of lung cancer.
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Samadoulougou A, Temoua Naibe D, Mandi G, Yameogo RA, Kabore E, Millogo G, Yameogo NV, Kologo JK, Thiam Tall A, Toguyeni BJY, Zabsonre P. [Evaluation of the level of knowledge of patients on treatment with vitamin K antagonists in Ouagadougou cardiology department]. Pan Afr Med J 2014; 19:286. [PMID: 25870741 PMCID: PMC4391894 DOI: 10.11604/pamj.2014.19.286.5411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/31/2014] [Indexed: 11/28/2022] Open
Abstract
Introduction Les antivitamines K (AVK), traitement anticoagulant oral le plus largement prescrit, posent un réel problème de santé publique du fait de leur risque iatrogène. L'objectif de cette étude était de préciser le niveau de connaissance des patients sur la gestion de leur traitement par les AVK. Méthodes Il s'est agi d'une enquête transversale descriptive réalisée au CHU-Yalgado Ouédraogo, sur une période de 03 mois : du 1er mars au 31 mai 2012. Un questionnaire a été administré aux patients bénéficiant d'un traitement AVK depuis au moins un mois. Résultats Soixante-dix patients ont été inclus dans l'étude dont 30 hommes. L'âge moyen était de 49 ans ± 16 ans. Les cardiopathies et la maladie thromboembolique veineuse justifiant l'institution du traitement AVK étaient retrouvées respectivement dans 58,6% et 41,4% des cas. Le nom de l'AVK et la raison exacte du traitement étaient connus respectivement dans 91,4% et 67,1% des cas. Plus de la moitié des patients (68,6%) savaient que les AVK rendaient le sang plus fluide. Quarante-six patients (65,7%) citaient l'INR comme examen biologique de surveillance du traitement et seulement 28 patients (40%) connaissaient les valeurs cibles. La majorité des patients ne connaissait pas les risques encourus en cas de surdosage (72,8%) et de sous-dosage (71,4%). Une automédication par anti-inflammatoire non stéroïdien était signalée par 18 patients (25,7%). Les choux (74,3%) et la laitue (62,9%), aliments à consommer avec modération, étaient les plus cités. Conclusion Les connaissances des patients sur la gestion des AVK étaient fragmentaires et insuffisantes pour assurer la sécurité et l'efficacité du traitement. La création d'un programme d'éducation thérapeutique sur les AVK s'avère alors nécessaire.
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Timóteo AT, Miranda F, Carmo MM, Ferreira RC. Optimal cut-off value for homeostasis model assessment (HOMA) index of insulin-resistance in a population of patients admitted electively in a Portuguese cardiology ward. ACTA MEDICA PORT 2014; 27:473-9. [PMID: 25203956 DOI: 10.20344/amp.5180] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 07/01/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Insulin resistance is the pathophysiological key to explain metabolic syndrome. Although clearly useful, the Homeostasis Model Assessment index (an insulin resistance measurement) has not been systematically applied in clinical practice. One of the main reasons is the discrepancy in cut-off values reported in different populations. We sought to evaluate in a Portuguese population the ideal cut-off for Homeostasis Model Assessment index and assess its relationship with metabolic syndrome. MATERIAL AND METHODS We selected a cohort of individuals admitted electively in a Cardiology ward with a BMI < 25 Kg/m2 and no abnormalities in glucose metabolism (fasting plasma glucose < 100 mg/dL and no diabetes). The 90th percentile of the Homeostasis Model Assessment index distribution was used to obtain the ideal cut-off for insulin resistance. We also selected a validation cohort of 300 individuals (no exclusion criteria applied). RESULTS From 7 000 individuals, and after the exclusion criteria, there were left 1 784 individuals. The 90th percentile for Homeostasis Model Assessment index was 2.33. In the validation cohort, applying that cut-off, we have 49.3% of individuals with insulin resistance. However, only 69.9% of the metabolic syndrome patients had insulin resistance according to that cut-off. By ROC curve analysis, the ideal cut-off for metabolic syndrome is 2.41. Homeostasis Model Assessment index correlated with BMI (r = 0.371, p < 0.001) and is an independent predictor of the presence of metabolic syndrome (OR 19.4, 95% CI 6.6 - 57.2, p < 0.001). DISCUSSION Our study showed that in a Portuguese population of patients admitted electively in a Cardiology ward, 2.33 is the Homeostasis Model Assessment index cut-off for insulin resistance and 2.41 for metabolic syndrome. CONCLUSION Homeostasis Model Assessment index is directly correlated with BMI and is an independent predictor of metabolic syndrome.
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["Time to laugh e.V." visits children in the LMU Uniclinic on the Grosshadern Campus. With many entertainers the "Time to Laugh" Organization provides variety in the daily clinic routine ]. KINDERKRANKENSCHWESTER : ORGAN DER SEKTION KINDERKRANKENPFLEGE 2014; 33:186. [PMID: 24902352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Ciuraszkiewicz K, Sielski J, Janion-Sadowska A, Stern A, Zychowicz J, Kaziród-Wolski K, Paluchowski M. [Influenza infection in intensive cardiac care unit patients]. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2014; 36:203-205. [PMID: 24779221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Infection with influenza type A virus may cause serious cardiovascular complications, such as myocarditis, heart failure, acute myocardial infarction. Also infection with influenza type AH1N1 may contribute to aggravation of cardiac disorders, i.e. acute coronary syndrome, heart failure, cardiogenic shock, severe ventricular arrythmias. One of the most fatal complication of influenza is pneumonia leading to acute respiratory insufficiency requiring artifitial ventilation. Symptoms of respiratory tract infections durnig influenza epidemy should always be treated with a high index of suspicion. Early diagnosis and adequate antiviral treatment may prevent those complications. A series of four cases of patients hospitalised in intensive cardiac care unit due to suspected cardiac dyspnea and finally diagnosed as a cardiac disease complicated by influenza pneumonia is presented.
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Fischer E, Thieffry E. [Organizing patient education in cardiology]. REVUE DE L'INFIRMIERE 2014; 63:35-37. [PMID: 24654334 DOI: 10.1016/j.revinf.2013.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A central element of the care management of patients with heart failure, therapeutic patient education mobilises caregivers into forming a multi-disciplinary team. In this article, a hospital team shares the different stages in the construction and implementation of a programme for use with hospitalised patients and in consultations. To do this, the nurses undertook training to acquire new educational skills.
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Abstract
Diabetic muscle infarction (DMI) is a rare complication of long-standing diabetes mellitus. This is the first case of DMI reported by cardiologists. A 49-year-old patient with a history of diabetes and hypertension for only two years was admitted to the cardiac ward due to pain in the left thigh with pitting edema in both lower extremities. Magnetic resonance imaging finally confirmed the presence of DMI in the left thigh, which was improved by treatment with anticoagulants, analgesics and rest. However, the typical clinical symptoms of DMI were unrecognizable at the start of treatment, which may be attributed to a lack of awareness of this rare condition among non-endocrinologist physicians.
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Moraes MAPD, Rodrigues J, Cremonesi M, Polanczyk C, Schaan BD. Management of diabetes by a healthcare team in a cardiology unit: a randomized controlled trial. Clinics (Sao Paulo) 2013; 68:1400-7. [PMID: 24270950 PMCID: PMC3812557 DOI: 10.6061/clinics/2013(11)03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 05/30/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of healthcare team guidance in the implementation of a glycemic control protocol in the non-intensive care unit of a cardiology hospital. METHODS This was a randomized clinical trial comparing 9 months of intensive guidance by a healthcare team on a protocol for diabetes care (Intervention Group, n = 95) with 9 months of standard care (Control Group, n = 87). Clinicaltrials.gov: NCT01154413. RESULTS The mean age of the patients was 61.7±10 years, and the mean glycated hemoglobin level was 71±23 mmol/mol (8.7±2.1%). The mean capillary glycemia during hospitalization was similar between the groups (9.8±2.9 and 9.1±2.4 mmol/l for the Intervention Group and Control Group, respectively, p = 0.078). The number of hypoglycemic episodes (p = 0.77), hyperglycemic episodes (47 vs. 50 in the Intervention Group and Control Group, p = 0.35, respectively), and the length of stay in the hospital were similar between the groups (p = 0.64). The amount of regular insulin administered was 0 (0-10) IU in the Intervention Group and 28 (7-56) IU in the Control Group (p<0.001), and the amount of NPH insulin administered was similar between the groups (p = 0.16). CONCLUSIONS While guidance on a glycemic control protocol given by a healthcare team resulted in a modification of the therapeutic strategy, no changes in glycemic control, frequency of episodes of hypoglycemia and hyperglycemia, or hospitalization duration were observed.
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Barnes GD, Katz A, Desmond JS, Kronick SL, Beach J, Chetcuti SJ, Bates ER, Gurm HS. False activation of the cardiac catheterization laboratory for primary PCI. THE AMERICAN JOURNAL OF MANAGED CARE 2013; 19:671-675. [PMID: 24304215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES We sought to evaluate trends in door-to-balloon (D2B) times and false activation rates for the cardiac catheterization laboratory (CCL) in patients presenting to the emergency department (ED) with acute ST-elevation myocardial infarction (STEMI). In patients with STEMI, national efforts have focused on reducing D2B times for primary percutaneous coronary intervention (P-PCI). This emphasis on time-to-treatment may increase the rate of false CCL activations and unnecessary healthcare utilization. STUDY DESIGN Retrospective quality improvement chart review. METHODS We examined all emergent CCL activations for P-PCI between 2007 and 2011 at the University of Michigan Hospital. False activation was defined as emergent CCL activation when the patient did not require CCL care or emergent cardiology evaluation in the ED. Pre-hospital or ED false activation rates and mean D2B time were retrospectively determined by chart review. RESULTS The CCL was activated 717 times for suspected STEMI. The number of CCL activations increased from 96 in 2007 to 190 in 2011. False CCL activations accounted for 28% of all prehospital and 29% of all ED activations. The false activation rate increased from 15% of all cases in 2007 to 40% of all cases in 2011. The median D2B time decreased from 67 minutes in 2007 to 55 minutes in 2011. CONCLUSIONS Over a 5-year period with a strong emphasis on reducing D2B times, there has been an increased CCL false activation rate for P-PCI.
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Carlson J. Under scrutiny: cardiologists feeling pressure over 70% criterion. MODERN HEALTHCARE 2013; 43:12-13. [PMID: 23878918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Bagger H. [PCI should be decentralized. The National Board of Health and the Danish Society of Cardiology ought to take the debate]. Ugeskr Laeger 2013; 175:380. [PMID: 23530280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Heathfield E, Hussain T, Qureshi S, Valverde I, Witter T, Douiri A, Bell A, Beerbaum P, Razavi R, Greil GF. Cardiovascular magnetic resonance imaging in congenital heart disease as an alternative to diagnostic invasive cardiac catheterization: a single center experience. CONGENIT HEART DIS 2013; 8:322-7. [PMID: 23331640 DOI: 10.1111/chd.12032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study aims to assess whether the increasing use of cardiovascular magnetic resonance imaging in place of diagnostic cardiac catheterization in the management of pediatric patients with congenital heart disease has had an impact on pediatric cardiac care. DESIGN Retrospective analysis of data was used. SETTING The study was performed at the Evelina Children's Hospital Cardiology Department. PATIENTS. : Elective diagnostic cardiac catheterization or magnetic resonance imaging (MRI) from 2005-2010 are included (n = 896). OUTCOME MEASURES Indication, length of stay, and incidence of complications were recorded. In cases used to plan surgery, 30-day survival following the procedure was recorded. Surgical outcomes were compared between the two groups. Surgical outcomes planned using MRI were compared with national outcomes from Congenital Cardiac Audit Database. RESULTS For catheterizations (50 patients, [31 male, median age 3 years, interquartile range 1 to 12]), median hospital stay was 1 day (interquartile range 0 to 3), and complications occurred in 11 (22%). Median hospital stay for MRI (846 patients [517 male, median age 3 years, interquartile range 0 to 9]) was significantly shorter: 0 days (interquartile range 0 to 1, P <.001), with fewer complications (16 [1.9%], P <.0001). Twenty-four catheter and 283 MRI patients underwent surgery within 18 months. One catheter patient (2.0%) and four MRI patients (1.4%) died within 30 days (P =.48). CONCLUSION Replacing catheterization with cardiovascular magnetic resonance imaging has resulted in reduced rates of complication and shorter hospital stays without a significant impact on surgical outcome.
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Martine Bonhôte B, Mülhauser S, Shaha M. [Impetus for a change in life style]. KRANKENPFLEGE. SOINS INFIRMIERS 2013; 106:13-15. [PMID: 23802355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Dalloul G, Feldman D, Haddad N, Amruthlal Jain SK, Zarghami J, Zughaib M. Carotid artery stenting in a community hospital: a success story. THE JOURNAL OF INVASIVE CARDIOLOGY 2013; 25:3-6. [PMID: 23293167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Carotid endarterectomy (CEA) is an effective procedure for reducing the risk of stroke in patients with carotid artery atherosclerosis. The evolution of carotid artery stenting (CAS) has made this a viable alternative to CEA in appropriate patient populations. We sought to evaluate the safety and efficacy of CAS in a high-risk population, in an effort to report such results in a medium-size community hospital. The data were then compared with the results published in the CREST and SAPPHIRE trials. METHODS The records of 280 consecutive patients undergoing carotid artery stenting between January 2005 and December 2011 were reviewed. A total of 271 patients were included in the final analysis. The clinical endpoints included cerebrovascular accident, myocardial infarction, and death in the perioperative period. RESULTS A total of 155 men (57.2%) and 116 women (42.8%) underwent CAS. A total of 259 carotid interventions (95.6%) were successful. Two of 271 patients (0.7%) experienced a minor neurologic event post procedure, with 1 patient death (0.35%) recorded. No perioperative myocardial infarctions were encountered. CONCLUSION Our findings indicate that our institution has been able to safely and effectively introduce and carry out CAS as a substitute to CEA in patients that are at high risk for surgery with results comparable to those published in large-scale clinical trials. Further studies are needed to verify whether these results can be generalized to other community hospitals, as well as to refine qualification criteria for performing physicians. Furthermore, the applicability of these results to normal-risk patients is currently being investigated.
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Molden MM, Brown CL, Griffith BE. At the heart of integration: aligning physicians and administrators to create new value. Front Health Serv Manage 2013; 29:3-16. [PMID: 23858984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Because of its ability to create real incremental value for patients and providers, physician-hospital integration will continue to play a major role in transforming the way healthcare is delivered. Integration is more than a transaction, and without developing the right culture, new integrated organizations will struggle to transform their current model of care. Confronted with regulatory and specialty-specific environmental forces, cardiovascular physicians have integrated with health systems at a higher rate than other specialties have. In 2007, Piedmont Healthcare launched Piedmont Heart as the first integrated cardiovascular care delivery program affiliated with a community healthcare system in greater Atlanta. Piedmont Healthcare had successfully brought together hospitals and cardiovascular physicians in an organizational structure that allowed for the right culture, resulting in true integration and patient-centered care. Today, Piedmont Heart is one of the largest physician groups in the United States focused on delivering high-quality outcomes, aligning multidisciplinary cardiovascular initiatives, and allowing for smart, strategic growth. It has taken Piedmont Heart nearly five years to create new, incremental value from its center-of-excellence organizational structure, clinical pathways development, and Patient First program. Piedmont Heart had the advantage of starting earlier than many other physician-hospital integrated structures. As US healthcare moves from an industry driven by volume to one focused on value, it is organizations like Piedmont Heart that continue to drive smart integration forward and focus on innovation, despite potential disruption, that will be successful.
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