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<1>
Accession Number
2011462989
Authors
Muttaiyah S. Best E.J. Freeman J.T. Taylor S.L. Morris A.J. Roberts S.A.
Institution
(Muttaiyah, Freeman, Morris, Roberts) Department of Microbiology, Auckland
City Hospital, Private Bag 92026, Grafton, Auckland, New Zealand
(Best) Department of Paediatric Infectious Diseases, Auckland City
Hospital, Auckland, New Zealand
(Taylor) Department of Microbiology, Middlemore Hospital, Auckland, New
Zealand
Title
Corynebacterium diphtheriae endocarditis: A case series and review of the
treatment approach.
Source
International Journal of Infectious Diseases. 15 (9) (pp e584-e588),
2011. Date of Publication: September 2011.
Publisher
Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands)
Abstract
Objectives: Infective endocarditis due to non-toxigenic Corynebacterium
diphtheriae is uncommon; we report 10 cases occurring over a 14-year
period in Auckland, New Zealand and review the approach for treatment.
Case series: Eight of the 10 patients had known prosthetic valves or
homografts in situ. Three patients required surgical intervention for
infective endocarditis. Seven patients were treated with a combination of
beta-lactam and aminoglycoside, and one each was treated with a
combination of vancomycin and an aminoglycoside, a beta-lactam alone, and
vancomycin alone. All patients survived and none relapsed. Review of
literature: The antibiotic treatment of 46 previously reported cases was
reviewed; patients treated with a beta-lactam and aminoglycoside (n=25),
and without the addition of an aminoglycoside (n=11) were compared. The
differences in length of treatment within each group make the comparison
of outcome (mortality, need for surgical intervention, disease and
treatment complications) difficult. However, regardless of the length of
treatment, there was no difference in mortality or need for surgical
intervention between the two groups in the currently published cases.
Conclusions: Current evidence suggests that endocarditis of either native
or prosthetic valves, caused by penicillin-susceptible C. diphtheriae,
demonstrates a favorable outcome when treated with either a beta-lactam
alone or in combination with an aminoglycoside. Patient-specific factors
will determine which approach is more appropriate for each individual
patient. 2011 International Society for Infectious Diseases.

<2>
Accession Number
2011460900
Authors
Hindoyan A. Cao M. Cesario D.A. Shinbane J.S. Saxon L.A.
Institution
(Hindoyan, Cao, Cesario, Shinbane, Saxon) Keck School of Medicine,
University of Southern California, 1510 San Pablo Street, Los Angeles, CA
90033, United States
Title
Impact of relaxation training on patient-perceived measures of anxiety,
pain, and outcomes after interventional electrophysiology procedures.
Source
PACE - Pacing and Clinical Electrophysiology. 34 (7) (pp 821-826), 2011.
Date of Publication: July 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Electrophysiology procedures vary in invasiveness, duration,
and anesthesia utilized. While complications are low and efficacy high,
cases are elective and patient experiences related to anxiety, pain, and
perceived outcomes are not well studied. We sought to determine if a
30-minute audio compact disc (CD) that teaches relaxation techniques and
wellness perception prior to an elective procedure impacts validated
measures of anxiety, pain, and procedural outcomes. Methods: Sixty-one
patients were randomly assigned to a control group (CG) (N_CG =
31) or interventional group (IG) (N _IG = 30). Both groups
answered a baseline Hospital Anxiety and Depression Scale (HADS-A) survey
consisting only of anxiety assessment questions. The IG listened to the CD
the night prior to their procedure. Heart rate and blood pressure were
monitored on admission and prior to the procedure. Postprocedure, both
groups completed two HADS-A surveys as well as two Patient Experience
Surveys (PES). There was no statistical difference in the demographics and
the rate of procedural complications between the groups. The statistical
significance of our data was determined using a Student's t-test and
chi² test. Results: At baseline, both groups had equal amounts
of anxiety prior to their procedures (P = 0.2). The patients in the IG had
lower systolic blood pressures during admission and prior the
administration of analgesics in comparison to the CG. Postprocedure,
results from administering the HADS-A demonstrated that the IG had 33%
lower anxiety (P = 0.02) than CG patients. Conclusion: The implementation
of basic relaxation teaching techniques prior to planned electrophysiology
procedures lowers systolic blood pressure and postprocedural anxiety.
2011 Wiley Periodicals, Inc.

<3>
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Accession Number
2011463633
Authors
Witzenbichler B. Wohrle J. Guagliumi G. Peruga J.Z. Brodie B.R. Dudek D.
Kornowski R. Hartmann F. Hood K.L. Parise H. Lansky A.J. Nikolsky E.
Mehran R. Stone G.W.
Institution
(Witzenbichler) Charite Campus Benjamin Franklin, Berlin, Germany
(Wohrle) University of Ulm, Ulm, Germany
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Peruga) Medical University, Lodz, Poland
(Brodie) LeBauer Cardiovascular Research Foundation, Moses Cone Heart and
Vascular Center, Greensboro, NC, United States
(Dudek) Jagiellonian University, Krakow, Poland
(Kornowski) Rabin Medical Center, Petach-Tikva, Israel
(Hartmann) Universitatsklinikum Schleswig-Holstein, Lubeck, Germany
(Hood) Boston Scientific Corporation, Marlborough, MA, United States
(Parise, Lansky, Nikolsky, Mehran, Stone) Columbia University Medical
Center, Cardiovascular Research Foundation, 111 E 59th St, New York, NY
10022, United States
Title
Paclitaxel-eluting stents compared with bare metal stents in diabetic
patients with acute myocardial infarction: The harmonizing outcomes with
revascularization and stents in acute myocardial infarction (HORIZONS-AMI)
trial.
Source
Circulation: Cardiovascular Interventions. 4 (2) (pp 130-138), 2011.
Date of Publication: April 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-In the prospective, randomized Harmonizing Outcomes with
Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI)
trial, implantation of paclitaxel-eluting stents (PES) safely reduced the
rates of ischemic target lesion revascularization (TLR) compared with bare
metal stents (BMS) in patients with ST-segment elevation myocardial
infarction (STEMI) undergoing primary percutaneous intervention. Diabetes
mellitus is a known predictor of adverse outcomes after percutaneous
intervention in STEMI. We therefore sought to assess the impact of PES in
diabetic patients with STEMI from the HORIZONS-AMI trial. Methods and
Results-A total of 478 patients with diabetes and 2527 without diabetes
were randomly assigned to receive PES versus BMS. The 12-month rates of
ischemic TLR were significantly reduced by PES compared with BMS in both
diabetic (11.2% versus 5.2%; hazard ratio [95% confidence interval]=0.45
[0.21 to 0.93]; P=0.03) and nondiabetic (6.8% versus 4.3%, hazard ratio
[95% confidence interval]=0.63 [0.44 to 0.92]; P=0.02) patients. In
patients with insulin-treated diabetes, PES compared with BMS reduced the
12-month TLR rate from 21.4% to 7.3% (hazard ratio [95% confidence
interval]=0.35 [0.12 to 1.03]; P=0.046). Angiographic late loss and binary
restenosis at 13 months were also significantly reduced in PES-treated
diabetic patients. There were no significant differences between the BMS
and PES groups in the 12-month rates of death, reinfarction, stroke, or
stent thrombosis in either diabetic or nondiabetic patients.
Conclusions-In the large-scale, prospective, randomized HORIZONS-AMI
trial, implantation of PES compared with BMS in patients with STEMI and
diabetes mellitus resulted in significant reductions in ischemia-driven
TLR and angiographic restenosis at 1 year, with comparable safety
outcomes, including stent thrombosis. These results suggest that PES can
safely be used to reduce restenosis in high-risk diabetic patients
presenting with STEMI. Copyright 2011 American Heart Association. All
rights reserved.

<4>
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Accession Number
2011463632
Authors
Briguori C. Airoldi F. Visconti G. Focaccio A. Caiazzo G. Golia B.
Biondi-Zoccai G. Ricciardelli B. Condorelli G.
Institution
(Briguori, Visconti, Focaccio, Caiazzo, Golia, Ricciardelli) Laboratory of
Interventional Cardiology, Department of Cardiology, Clinica Mediterranea,
Via Orazio, 2, I-80121, Naples, Italy
(Airoldi) Laboratory of Interventional Cardiology IRCCS Multimedica,
Milan, Italy
(Biondi-Zoccai) Division of Cardiology, University of Modena e Reggio
Emilia, Modena, Italy
(Condorelli) Dipartimento di Biologia e Patologia Cellulare e Molecolare,
Federico II University, Naples, Italy
Title
Novel approaches for preventing or limiting events in diabetic patients
(naples-diabetes) trial: A randomized comparison of 3 drug-eluting stents
in diabetic patients.
Source
Circulation: Cardiovascular Interventions. 4 (2) (pp 121-129), 2011.
Date of Publication: April 2011.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background-To expand the paucity of data on the efficacy of various
drug-eluting stents in diabetic patients. Methods and Results-Type 2
diabetic patients treated in our institution from October 2005 to January
2007 presenting with of de novo lesions in native coronary arteries were
randomly assigned to sirolimus-eluting stents (Cypher group; n=76);
paclitaxel-eluting stents (Taxus group; n=75); and everolimus-eluting
stents (Endeavor group; n=75). Poor metabolic control (HbA1c >7% and
low-density lipoprotein cholesterol >100 mg/dL) and microvascular
complications (retinopathy and/or nephropathy) were assessed. The primary
end point was the 3-year composite of major adverse cardiac events (MACE),
including death of any cause, myocardial infarction, and clinically driven
target vessel revascularization. MACE-free survival was 86.8% in the
Cypher group, 82.5% in the Taxus group, and 64.4% in the Endeavor group
(P=0.006 by log-rank test). The post hoc comparisons showed no significant
difference between Cypher versus Taxus groups (adjusted P=1.0) but a
higher MACE rate in the Endeavor group versus both the Cypher group
(adjusted P=0.012) and the Taxus group (adjusted P=0.075). Independent
predictors of 3-year MACE at Cox analysis were treatment by Endeavor
versus Cypher stent (2.35 [95% confidence interval, 1.07 to 5.41];
P=0.030), multivessel disease (hazard ratio, 1.78 [95% confidence
interval, 1.06 to 2.66]; P=0.031), diabetic retinopathy (hazard ratio,
1.60; [95% confidence interval, 1.03 to 2.76]; P=0.038), and poor
metabolic control (hazard ratio, 1.60; [95% confidence interval, 1.02 to
2.52]; P=0.048). Conclusions-The present pilot study suggests that in
diabetic patients, the Endeavor stent is associated with a higher 3-year
MACE rate when compared with Cypher and Taxus stents. Copyright 2011
American Heart Association. All rights reserved.

<5>
Accession Number
2011461729
Authors
Klauss V. Serruys P.W. Pilgrim T. Buszman P. Linke A. Ischinger T. Eberli
F. Corti R. Wijns W. Morice M.-C. Di Mario C. Van Geuns R.J. Van Es G.-A.
Kalesan B. Wenaweser P. Jni P. Windecker S.
Institution
(Klauss) Department of Cardiology, University Hospital Munich
(Innenstadt), Munich, Germany
(Ischinger) Department of Cardiology, Hospital Bogenhausen, Munich,
Germany
(Linke) Herzzentrum Leipzig, Leipzig, Germany
(Serruys, Van Geuns) Thoraxcenter, Erasmus University, Rotterdam,
Netherlands
(Van Es) Cardialysis, Rotterdam, Netherlands
(Pilgrim, Kalesan, Wenaweser, Windecker) Department of Cardiology, Bern
University Hospital, Freiburgstrasse 10, 3010 Bern, Switzerland
(Kalesan, Jni) Institute of Social and Preventive Medicine, University of
Bern, Bern, Switzerland
(Jni, Windecker) Clinical Trials Unit Bern, Bern University Hospital,
Bern, Switzerland
(Eberli) Department of Cardiology, Triemli Spital, Zurich, Switzerland
(Corti) Department of Cardiology, University Hospital, Zurich, Switzerland
(Buszman) Department of Cardiology, Medical University of Silesia,
Katowice, Poland
(Wijns) Department of Cardiology, Onze Lieve Vrouw Ziekenhuis, Aalst,
Belgium
(Morice) Department of Cardiology, Institut Cardiovasculaire Paris-Sud,
Paris, France
(Di Mario) Department of Cardiology, Royal Brompton Hospital, London,
United Kingdom
Title
2-Year clinical follow-up from the randomized comparison of
biolimus-eluting stents with biodegradable polymer and sirolimus-eluting
stents with durable polymer in routine clinical practice.
Source
JACC: Cardiovascular Interventions. 4 (8) (pp 887-895), 2011. Date of
Publication: August 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: This study sought to investigate safety and efficacy of
biolimus-eluting stents (BES) with biodegradable polymer as compared with
sirolimus-eluting stents (SES) with durable polymer through 2 years of
follow-up. Background: BES with a biodegradable polymer provide similar
efficacy and safety as SES with a durable polymer at 9 months. Clinical
outcomes beyond the period of biodegradation of the polymer used for drug
release and after discontinuation of dual antiplatelet therapy are of
particular interest. Methods: A total of 1,707 patients were randomized to
unrestricted use of BES (n = 857) or SES (n = 850) in an all-comers
patient population. Results: At 2 years, BES remained noninferior compared
with SES for the primary endpoint, which was a composite of cardiac death,
myocardial infarction, or clinically indicated target vessel
revascularization (BES 12.8% vs. SES 15.2%, hazard ratio [HR]: 0.84, 95%
confidence interval [CI]: 0.65 to 1.08, p _{noninferiority} <
0.0001, p_superiority = 0.18). Rates of cardiac death (3.2% vs.
3.9%, HR: 0.81, 95% CI: 0.49 to 1.35, p = 0.42), myocardial infarction
(6.3% vs. 5.6%, HR: 1.12, 95% CI: 0.76 to 1.65, p = 0.56), and clinically
indicated target vessel revascularization (7.5% vs. 8.6%, HR: 0.86, 95%
CI: 0.62 to 1.20, p = 0.38) were similar for BES and SES. The rate of
definite stent thrombosis through 2 years was 2.2% for BES and 2.5% for
SES (p = 0.73). For the period between 1 and 2 years, event rates for
definite stent thrombosis were 0.2% for BES and 0.5% for SES (p = 0.42).
After discontinuation of dual antiplatelet therapy, no very late definite
stent thrombosis occurred in the BES group. Conclusions: At 2 years of
follow-up, the unrestricted use of BES with a biodegradable polymer
maintained a similar safety and efficacy profile as SES with a durable
polymer. (Limus Eluted From a Durable Versus Erodable Stent Coating
[LEADERS]; NCT00389220) 2011 American College of Cardiology Foundation.

<6>
Accession Number
2011461726
Authors
Klomp M. Beijk M.A. Varma C. Koolen J.J. Teiger E. Richardt G. Bea F. Van
Geloven N. Verouden N.J. Chan Y.K. Woudstra P. Damman P. Tijssen J.G. De
Winter R.J.
Institution
(Klomp, Beijk, Van Geloven, Verouden, Chan, Woudstra, Damman, Tijssen, De
Winter) Academic Medical CenterUniversity of Amsterdam, Department of
Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
(Koolen) Catharina Ziekenhuis, Eindhoven, Netherlands
(Varma) City Hospital Birmingham, Birmingham, United Kingdom
(Teiger) Henri Mondor Hospital, Creteil, France
(Richardt) Segeberger Kliniken, Bad Segeberg, Germany
(Bea) Universittsklinikum Heidelberg, Heidelberg, Germany
Title
1-Year outcome of TRIAS HR (TRI-stent Adjudication Study-High Risk of
restenosis): A multicenter, randomized trial comparing genous endothelial
progenitor cell capturing stents with drug-eluting stents.
Source
JACC: Cardiovascular Interventions. 4 (8) (pp 896-904), 2011. Date of
Publication: August 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objectives: This study sought to demonstrate the noninferiority of
endothelial progenitor cell capturing stents (ECS) relative to
drug-eluting stents (DES) regarding target lesion failure (TLF) and the
composite of cardiac death, myocardial infarction, and target lesion
repeat revascularization within 1 year. Background: A "pro-healing"
approach for prevention of in-stent restenosis is theoretically favorable
over the use of cytotoxic/cytostatic drugs released from DES to treat
coronary artery disease. Promoting accelerated endothelialization of the
stent, ECS have shown promising results in studies with patients carrying
noncomplex lesions. Methods: We undertook an international, clinical trial
in 26 centers planning to randomize 1,300 patients with stable coronary
artery disease and with a high risk of restenosis between treatment, with
either ECS or DES. After a routine review with 50% of the patients
enrolled, early cessation of the trial was recommended by the data and
safety monitoring board when TLF in the ECS population was higher and
treatment of new patients with an ECS would be unreasonable. Results: At 1
year evaluating 304 patients receiving ECS and 318 receiving DES, TLF
occurred in 17.4% of the ECS-treated patients and in 7.0% of the
DES-treated patients (p = 0.98 for noninferiority). Conclusions: Within 1
year, inhibition of intimal hyperplasia by the ECS is not sufficiently
strong to compete with DES in terms of restenosis prevention in
patients/lesions with a high risk of restenosis. Furthermore, long-term
follow-up is pivotal to fully appreciate the clinical value of ECS,
including the effect on late intimal hyperplasia regression. 2011
American College of Cardiology Foundation.

<7>
Accession Number
2011452618
Authors
Torp-Pedersen C. Crijns H.J.G.M. Gaudin C. Page R.L. Connolly S.J.
Hohnloser S.H.
Institution
(Torp-Pedersen) Department of Cardiology, Gentofte Hospital, University of
Copenhagen, 2009 Hellerup, Denmark
(Crijns) Department of Cardiology, University Hospital Maastricht,
Maastricht, Netherlands
(Gaudin) Sanofi-aventis RandD, Frankfurt, Germany
(Page) Department of Medicine, University of Wisconsin, Madison, WI,
United States
(Connolly) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
(Hohnloser) Department of Cardiology, J. W. Goethe University, Frankfurt,
Germany
Title
Impact of dronedarone on hospitalization burden in patients with atrial
fibrillation: Results from the ATHENA study.
Source
Europace. 13 (8) (pp 1118-1126), 2011. Date of Publication: August 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims: Cardiovascular (CV) hospitalization is a predictor of CV mortality
and has a negative impact on patients' quality of life. The primary
endpoint of A placebo-controlled, double-blind, parallel-arm Trial to
assess the efficacy of dronedarone 400 mg bid for the prevention of
cardiovascular Hospitalization or death from any cause in patiENTs with
Atrial fibrillation/atrial flutter (ATHENA), a composite of first CV
hospitalization or death from any cause, was significantly reduced by
dronedarone. This post hoc analysis evaluated the secondary endpoint of CV
hospitalization and the clinical benefit of dronedarone on the number and
duration of CV hospitalizations in patients with atrial fibrillation (AF).
Methods and results: ATHENA was a double-blind, parallel group study in
4628 patients with a history of paroxysmal/persistent AF and additional
risk factors, treated with placebo or dronedarone. Dronedarone treatment
significantly reduced the risk of first CV hospitalization (P < 0.0001 vs.
placebo), while the risk of first non-CV hospitalization was similar in
both groups (P=0.77). About half of the CV hospitalizations were
AF-related, with a median duration of hospital stay of four nights. The
risk of any hospitalization for AF [hazard ratio (95 confidence interval)
0.626 (0.546-0.719)] and duration of hospital stay were significantly
reduced by dronedarone (P < 0.0001 vs. placebo). Dronedarone treatment
reduced total hospitalizations for acute coronary syndrome (P=0.0105) and
the time between the first AF/atrial flutter recurrence and CV
hospitalization/death (P=0.0048). Hospitalization burden was significantly
reduced across all levels of care (P < 0.05). Cumulative incidence data
indicated that the effects of dronedarone persisted for at least 24
months. Conclusions: Dronedarone reduced the risk for CV hospitalization
and the total hospitalization burden in this patient group.The trial is
registered under ClinicalTrials.#gov NCT 00174785. 2011 The Author.

<8>
Accession Number
2011451409
Authors
Sanchez-Lazaro I.J. Almenar L. Martinez-Dolz L. Buendia-Fuentes F. Aguero
J. Navarro-Manchon J. Vicente J.-L. Salvador A.
Institution
(Sanchez-Lazaro, Almenar, Martinez-Dolz, Buendia-Fuentes, Aguero,
Navarro-Manchon, Salvador) Heart Failure and Transplantation Unit,
Cardiology Department, Hospital Universitario La Fe, Valencia, Spain
(Vicente) Anesthesiology Department, Hospital Universitario La Fe,
Valencia, Spain
Title
A prospective randomized study comparing cyclosporine versus tacrolimus
combined with daclizumab, mycophenolate mofetil, and steroids in heart
transplantation.
Source
Clinical Transplantation. 25 (4) (pp 606-613), 2011. Date of
Publication: July/August 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Background: Cyclosporine (CsA) and tacrolimus (Tac) in heart
transplantation (HTx) have been compared but with certain drawbacks. We
compared both drugs in a prospective analysis with medium-term follow-up.
Methods: Hundred and six patients were randomized to receive CsA or Tac
(53 per group). Target levels of CsA were 200-300ng/mL in the first six
months and 100-200ng/mL thereafter. Tac levels were 10-15 and 5-10ng/mL,
respectively. We also used daclizumab as induction and mycophenolate
mofetil (MMF) and steroids as maintenance therapy. Results: Baseline
characteristics were similar. Survival (CsA 88.7% vs. Tac 81.1%; p=0.493)
was similar. There was a tendency for longer time to first rejection with
CsA (93+/-110 vs. 55+/-81d; p=0.122). There were more rejection-free
patients with Tac (39 vs. 28%; p=0.233). CsA patients suffered more viral
infections (0.41+/-0.58 vs. 0.11+/-0.31; p=0.003). CsA patients developed
hypertension often (64 vs. 43%; p=0.032). Tac patients suffered more
gastrointestinal complications (16 vs. 6%; p=0.042). Renal function and
the development of diabetes, dyslipidemia, or neurological complications
was similar. Conclusions: Tac patients showed a tendency for longer time
to first rejection, and there were more rejection-free patients with Tac
and suffered fewer viral infections. Tac patients developed less
hypertension and needed less drugs for its control. Renal function was
similar in both groups. 2010 John Wiley & Sons A/S.

<9>
Accession Number
21385466
Authors
Rosenfeldt F. Braun L. Spitzer O. Bradley S. Shepherd J. Bailey M. van der
Merwe J. Leong J.Y. Esmore D.
Institution
(Rosenfeldt) Cardiac Surgical Research Unit, Alfred Hospital, Department
of Surgery, Monash University, Baker IDI Institute Melbourne, Australia.
Title
Physical conditioning and mental stress reduction--a randomised trial in
patients undergoing cardiac surgery.
Source
BMC complementary and alternative medicine. 11 (pp 20), 2011. Date of
Publication: 2011.
Abstract
Preoperative anxiety and physical unfitness have been shown to have
adverse effects on recovery from cardiac surgery. This study involving
cardiac surgery patients was primarily aimed at assessing the feasibility
of delivering physical conditioning and stress reduction programs within
the public hospital setting. Secondary aims were to evaluate the effect of
these programs on quality of life (QOL), rates of postoperative atrial
fibrillation (AF) and length of stay (LOS) in hospital. Elective patients
scheduled for coronary artery bypass graft and/or valve surgery at a
public hospital in Melbourne, Australia were enrolled. Patients were
randomized to receive either holistic therapy (HT) or usual care (UC). HT
consisted of a series of light physical exercise sessions together with a
mental stress reduction program administered in an outpatient setting for
the first two weeks after placement on the waiting list for surgery. A
self-administered SF-36 questionnaire was used to measure QOL and hospital
records to collect data on LOS and rate of postoperative AF. The study
population comprised 117 patients of whom 60 received HT and 57 received
UC. Both programs were able to be delivered within the hospital setting
but ongoing therapy beyond the two week duration of the program was not
carried out due to long waiting periods and insufficient resources. HT, as
delivered in this study, compared to UC did not result in significant
changes in QOL, LOS or AF incidence. Preoperative holistic therapy can be
delivered in the hospital setting, although two weeks is insufficient to
provide benefits beyond usual care on QOL, LOS or postoperative AF.
Further research is now required to determine whether a similar program of
longer duration, or targeted to high risk patients can provide measurable
benefits. This trial was conducted as part of a larger study and according
to the principles contained in the CONSORT statement 2001.

<10>
Accession Number
21678362
Authors
Vale N. Nordmann A.J. Schwartz G.G. de Lemos J. Colivicchi F. den Hartog
F. Ostadal P. Macin S.M. Liem A.H. Mills E. Bhatnagar N. Bucher H.C. Briel
M.
Institution
(Vale) Family Medicine, St Mary's Hospital, McGill University, 377 Rue
Jean Brilliant, Montreal, Quebec, Canada, H3T 1M5.
Title
Statins for acute coronary syndrome.
Source
Cochrane database of systematic reviews (Online). (6) (pp CD006870),
2011. Date of Publication: 2011.
Abstract
The early period following the onset of acute coronary syndromes (ACS)
represents a critical stage of coronary heart disease with a high risk for
recurrent events and deaths. The short-term effects of early treatment
with statins in patients suffering from ACS on patient-relevant outcomes
are unclear. To assess the benefits and harms of early administered
statins in patients with ACS from randomized controlled trials (RCTs). We
searched CENTRAL, MEDLINE, EMBASE, and CINAHL (to 1 February 2010). No
language restrictions were applied. We supplemented the search by
contacting experts in the field, by reviewing reference lists of reviews
and editorials on the topic, and by searching trial registries. RCTs
comparing statins with placebo or usual care, initiation of statin therapy
within 14 days following the onset of ACS, and follow-up of at least 30
days reporting at least one clinical outcome. Two authors independently
assessed study quality and extracted data. We pooled treatment effects and
calculated risk ratios (RRs) for all outcomes in the treatment and control
groups using a random effects model. Eighteen studies (14,303 patients)
compared early statin treatment versus placebo or usual care in patients
with ACS. Compared to placebo or usual care, early statin therapy did not
decrease the combined primary outcome of death, non-fatal myocardial
infarction (MI), and stroke at one month (risk ratio (RR) 0.93, 95%
confidence interval (CI) 0.80 to 1.08) and four months (RR 0.93, 95% CI
0.81 to 1.06) of follow-up. There were no statistically significant risk
reductions from statins for total death, total MI, total stroke,
cardiovascular death, revascularization procedures, and acute heart
failure at one month and at four months, although there were favorable
trends related to statin use for each of these endpoints. The incidence of
episodes of unstable angina was significantly reduced at four months
following ACS (RR 0.76, 95% CI 0.59 to 0.96). There were nine individuals
with myopathy (elevated creatinine kinase levels > 10 times the upper
limit of normal) in statin treated patients (0.13%) versus one (0.015%) in
the control groups. Serious muscle toxicity was mostly limited to patients
treated with simvastatin 80 mg. Based on available evidence, initiation of
statin therapy within 14 days following ACS does not reduce death,
myocardial infarction, or stroke up to four months, but reduces the
occurrence of unstable angina at four months following ACS.

<11>
Accession Number
2011469525
Authors
Kerin N.Z. Jacob S.
Institution
(Kerin, Jacob) Department of Medicine, Medical School, Wayne State
University, Detroit, MI, United States
Title
The efficacy of sotalol in preventing postoperative atrial fibrillation: A
meta-analysis.
Source
American Journal of Medicine. 124 (9) (pp 875.e1-875.e9), 2011. Date of
Publication: September 2011.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Objective: Supraventricular tachyarrhythmias including atrial fibrillation
are common and troubling complications after cardiac surgery, and thus
considerable interest in pharmacologic prophylaxis has developed. The aim
of this study was to evaluate the efficacy of sotalol in the prevention of
postoperative supraventricular tachyarrhythmias. Methods: Standard methods
of meta-analysis were used. Randomized clinical trials published in
English language were eligible for the meta-analysis. Results: A
systematic review revealed 15 eligible publications that provided 20
comparisons of sotalol with a control group. The incidence and relative
risk (RR) with 95% confidence interval (CI) of developing postoperative
supraventricular tachyarrhythmias while taking sotalol were sotalol (n =
489) versus placebo (n = 499): 22.5% versus 41.5%, RR = 0.55 (CI,
0.454-0.667, P <.001); sotalol (n = 304) versus no treatment (n = 311):
12% versus 39%, RR = 0.329 (CI, 0.236-0.459, P <.001); sotalol (n = 488)
versus beta-blocker (n = 555): 14% versus 23%, RR = 0.644 (CI,
0.495-0.838, P <.001); sotalol (n = 139) versus amiodarone (n = 146): no
significant differences in supraventricular tachyarrhythmia prevention;
and sotalol (n = 51) versus magnesium (n = 54): no significant differences
in supraventricular tachyarrhythmia prevention. Initiating sotalol orally
or intravenously had no significant effect on efficacy. Initiating sotalol
after surgery showed a trend toward less adverse events (before: RR =
1.700 [CI, 0.903-3.200] and after: RR = 0.767 [CI, 0.391-1.505]).
Conclusion: Sotalol is more effective in the prevention of
supraventricular tachyarrhythmia than placebo or beta-blockers. Initiating
sotalol before cardiac surgery has no advantage compared with initiating
sotalol shortly after surgery. Starting sotalol intravenously after
surgery may be a more reliable method than administering via a nasogastric
tube or delaying treatment until the patient can take oral medication.
2011 Elsevier Inc.

<12>
Accession Number
2011466682
Authors
Shah A.M. Lam C.S.P. Cheng S. Verma A. Desai A.S. Rocha R.A. Hilkert R.
Izzo J. Oparil S. Pitt B. Thomas J.D. Zile M.R. Aurigemma G.P. Solomon
S.D.
Institution
(Shah, Cheng, Verma, Desai, Solomon) Brigham and Women's Hospital, United
States
(Lam) National University Health System, Singapore and Boston University
School of Medicine, Boston, MA, United States
(Rocha, Hilkert) Novartis Pharmaceutical, East Hanover, NJ, United States
(Izzo) SUNY-Buffalo, Buffalo, NY, United States
(Oparil) University of Alabama School of Medicine, Birmingham, AL, United
States
(Pitt) University of Michigan, Ann Arbor, MI, United States
(Thomas) Cleveland Clinic Foundation, Cleveland, OH, United States
(Zile) RHJ Department of Veterans Affairs Medical Center, Medical
University of South Carolina, Charleston, SC, United States
(Aurigemma) University of Massachusetts Medical Center, Worcester, MA,
United States
Title
The relationship between renal impairment and left ventricular structure,
function, and ventricular-arterial interaction in hypertension.
Source
Journal of Hypertension. 29 (9) (pp 1829-1836), 2011. Date of
Publication: September 2011.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Objectives: Our objective was to define the relationship between renal
dysfunction-both albuminuria and reduced estimated glomerular filtration
rate (eGFR)-and cardiac structure and diastolic dysfunction among patients
with chronic hypertension. Methods: Both albuminuria and eGFR were
measured in 540 asymptomatic patients with hypertension and diastolic
dysfunction assessed by reduced early mitral annular relaxation velocity
(E'). The majority of patients were white, mean age was 60+/-10 years,
mean SBP was 149+/-18 mmHg, and there was a low prevalence comorbid
conditions. Albuminuria was undetectable in 148 (27%), within the normal
to low range [urine albumin-to-creatinine ratio (UACR) 1-25mg/g for men,
1-17mg/g for women] in 292 (54%), and high or very high (UACR >25mg/g for
men, >17mg/g for women) in 100 (19%). Estimated GFR was 60ml/min per 1.73m
or less in 75 (14%), 61-90ml/min per 1.73m in 244 (45%), and more than
90ml/min per 1.73m in 221 (41%). Results: Albuminuria, even within the
normal range, was associated with greater left ventricular wall thickness
(P=0.01), higher relative wall thickness (P=0.004), worse diastolic
function reflected in lower E' (P=0.01), greater arterial and left
ventricular end-systolic stiffness (P<0.0001 and P=0.003, respectively),
and higher N-terminal pro-brain natriuretic peptide (NT-proBNP) level
(P=0.0025), even after adjustment for differences in baseline
characteristics. In contrast, no independent relationship was observed
between eGFR and parameters of cardiac structure or function. Conclusion::
Among asymptomatic hypertensive patients with evidence of diastolic
dysfunction, the presence of albuminuria, even within the normal range, is
associated with greater concentric remodeling, greater left ventricular
end-systolic stiffness, and worse diastolic function. 2011 Wolters Kluwer
Health | Lippincott Williams & Wilkins.

<13>
Accession Number
2011466888
Authors
Shlipak M.G. Coca S.G. Wang Z. Devarajan P. Koyner J.L. Patel U.D.
Thiessen-Philbrook H. Garg A.X. Parikh C.R.
Institution
(Shlipak) Department of Medicine, San Francisco VA Medical Center,
University of California, San Francisco, San Francisco, CA, United States
(Shlipak) Department of Epidemiology and Biostatistics, University of
California, San Francisco, San Francisco, CA, United States
(Coca, Wang, Parikh) Section of Nephrology, Yale University, VAMC, 950
Campbell Ave, West Haven, CT 06516, United States
(Devarajan) Department of Pediatrics, Cincinnati Children's Hospital
Medical Center, University of Cincinnati, Cincinnati, OH, United States
(Koyner) Department of Medicine, University of Chicago, Pritzker School of
Medicine, Chicago, IL, United States
(Patel) Duke Clinical Research Institute, Duke University, School of
Medicine, Durham, NC, United States
(Thiessen-Philbrook, Garg) Division of Nephrology, Departments of
Medicine, Epidemiology, and Biostatistics, University of Western Ontario,
London, ON, Canada
Title
Presurgical serum cystatin C and risk of acute kidney injury after cardiac
surgery.
Source
American Journal of Kidney Diseases. 58 (3) (pp 366-373), 2011. Date of
Publication: September 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Background: Acute kidney injury (AKI) after cardiac surgery is associated
with poor outcomes, but is challenging to predict from information
available before surgery. Study Design: Prospective cohort study. Setting
& Participants: The TRIBE-AKI (Translational Research Investigating
Biomarker Endpoints in Acute Kidney Injury) Consortium enrolled 1,147
adults undergoing cardiac surgery at 6 hospitals from 2007-2009;
participants were selected for high AKI risk. Predictors: Presurgical
values for cystatin C, creatinine, and creatinine-based estimated
glomerular filtration rate (eGFR) were categorized into quintiles and
grouped as "best" (quintiles 1-2), "intermediate" (quintiles 3-4), and
"worst" (quintile 5) kidney function. Outcomes: The primary outcome was
AKI Network (AKIN) stage 1 or higher; <0.3 mg/dL or 50% increase in
creatinine level. Measurements: Analyses were adjusted for characteristics
used clinically for presurgical risk stratification. Results: Average age
was 71 +/- 10 years (mean +/- standard deviation); serum creatinine, 1.1
+/- 0.3 mg/dL; eGFR-Cr, 74 +/- 9 mL/min/1.73 m²; and cystatin
C, 0.9 +/- 0.3 mg/L. 407 (36%) participants developed AKI during
hospitalization. Adjusted odds ratios for intermediate and worst kidney
function by cystatin C were 1.9 (95% CI, 1.4-2.7) and 4.8 (95% CI,
2.9-7.7) compared with 1.2 (95% CI, 0.9-1.7) and 1.8 (95% CI, 1.2-2.6) for
creatinine and 1.0 (95% CI, 0.7-1.4) and 1.7 (95% CI, 1.1-2.3) for eGFR-Cr
categories, respectively. After adjustment for clinical predictors, the C
statistic to predict AKI was 0.70 without kidney markers, 0.69 with
creatinine, and 0.72 with cystatin C. Cystatin C also substantially
improved AKI risk classification compared with creatinine, based on a net
reclassification index of 0.21 (P < 0.001). Limitations: The ability of
these kidney biomarkers to predict risk of dialysis-requiring AKI or death
could not be assessed reliably in our study because of a small number of
patients with either outcome. Conclusions: Presurgical cystatin C is
better than creatinine or creatinine-based eGFR at forecasting the risk of
AKI after cardiac surgery.

<14>
Accession Number
2011466887
Authors
Zhang Z. Lu B. Sheng X. Jin N.
Institution
(Zhang, Lu, Sheng, Jin) Department of Critical Care Medicine, Jinhua
Municipal Central Hospital, Zhejiang, China
Title
Cystatin C in prediction of acute kidney injury: A systemic review and
meta-analysis.
Source
American Journal of Kidney Diseases. 58 (3) (pp 356-365), 2011. Date of
Publication: September 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Background: Cystatin C (CysC) has been proposed as a filtration marker for
the early detection of acute kidney injury (AKI); however, a wide range of
its predictive accuracy has been reported. Study Design: Meta-analysis of
diagnostic test studies. Setting & Population: Various clinical settings
of AKI, including patients after cardiac surgery, pediatric patients, and
critically ill patients. Selection Criteria: Computerized search of
PubMed, Current Contents, CINAHL, and EMBASE from inception until November
15, 2010, was performed to identify potentially relevant articles.
Inclusion criteria were studies investigating the diagnostic accuracy of
CysC level to predict AKI. There were no language restrictions in the
search. Index Tests: Increasing or increased serum CysC level or urinary
CysC excretion. Reference Tests: The outcome was the development of AKI,
primarily based on serum creatinine level (definition varied across
studies). Results: We analyzed data from 19 studies and 11 countries
involving 3,336 patients. Of these studies, 13 could be included in the
meta-analysis. Across all settings, the diagnostic OR for serum CysC level
to predict AKI was 23.5 (95% CI, 14.2-38.9), with sensitivity and
specificity of 0.84 and 0.82, respectively. The area under the receiver
operating characteristic curve (AUROC) of serum CysC level to predict AKI
was 0.96 (95% CI, 0.95-0.97). Subgroup analysis showed that serum CysC was
of diagnostic value when measured early (within 24 hours after renal
insult or intensive care unit admission). For the diagnostic value of
urinary CysC excretion, the diagnostic OR was 2.60 (95% CI, 2.01-3.35),
with sensitivity and specificity of 0.52 and 0.70, respectively. The AUROC
of urinary CysC excretion to predict AKI was 0.64 (95% CI, 0.62-0.66).
Limitations: Variation in criteria for definitions of index and reference
tests, absence of measured glomerular filtration rate in most studies.
Conclusion: Serum CysC appears to be a good biomarker in the prediction of
AKI, whereas urinary CysC excretion has only moderate diagnostic value.
2011 National Kidney Foundation, Inc.

<15>
Accession Number
21266906
Authors
Harling L. Warren O.J. Martin A. Kemp P.R. Evans P.C. Darzi A. Athanasiou
T.
Institution
(Harling) Department of Surgery and Cancer, Imperial College London,
London, UK.
Title
Do miniaturized extracorporeal circuits confer significant clinical
benefit without compromising safety? A meta-analysis of randomized
controlled trials.
Source
ASAIO journal (American Society for Artificial Internal Organs : 1992).
57 (3) (pp 141-151), 2011. Date of Publication: 2011 May-Jun.
Abstract
Miniaturized extracorporeal circulation (mECC) attempts to reduce the
adverse effects of conventional extracorporeal circulation (CECC) bypass.
However, the potential benefits remain unclear and safety concerns
persist. A systematic literature review identified 29 studies
incorporating 2,355 patients: 1,181 (50.1%) who underwent cardiac surgery
with CECC and 1,174 (49.9%) with mECC. These were meta-analyzed using
random effects modeling. Heterogeneity, subgroup analysis, and risk of
bias were assessed. Primary endpoints were 30-day mortality, neurovascular
compromise, and end organ dysfunction. Secondary endpoints were length of
stay and transfusion burden. Miniaturized extracorporeal circulation
significantly reduced postoperative arrhythmias (p = 0.03), but no
significant difference in 30-day mortality, neurocognitive disturbance,
cerebrovascular events, renal failure, or myocardial infarction was
identified. Miniaturized extracorporeal circulation also significantly
reduced mean blood loss (p < 0.00001) and number of patients transfused (p
< 0.00001); however, duration of hospitalization, units transfused per
patient, chest tube drainage, and revision for rebleeding remained
unchanged. Subgroup analysis of larger studies (10 studies, n >= 31)
showed mECC to significantly reduce ventilation period, hospital stay, and
intensive care unit (ICU) stay. Similarly, a significant reduction in
neurocognitive disturbance was seen in studies with closely matched
demographic groups. Miniaturized extracorporeal circulation is not
associated with increased cerebrovascular injury and may confer an
advantage, reducing postoperative arrhythmia, blood loss, and transfusion
burden.

<16>
Accession Number
19709054
Authors
Staffieri F. Driessen B. Lacitignola L. Crovace A.
Institution
(Staffieri) Universita di Bari, D.E.T.O., Sezione di Chirurgia
Veterinaria, Strada Provinciale per Casamassima Km 3, 70010 Valenzano
(Bari), Italy
(Staffieri, Crovace) Dipartimento dell'Emergenza e Dei Trapianti di Organi
(D.E.T.O.), Sezione di Chirurgia Veterinaria, Universita Degli Studi di
Bari, Valenzano (Bari), Italy
(Staffieri, Driessen) Department of Clinical Studies, New Bolton Center,
University of Pennsylvania, Kennett Square, PA, United States
(Driessen) Department of Anesthesiology, University of California-Los
Angeles, David Geffen School of Medicine, Los Angeles, CA, United States
(Lacitignola) Dipartimento Dell' Scienze Cliniche Veterinarie, Sezione di
Chirurgia Veterinaria, Universita Degli Studi di Teramo, Teramo, Italy
Title
A comparison of subarachnoid buprenorphine or xylazine as an adjunct to
lidocaine for analgesia in goats.
Source
Veterinary Anaesthesia and Analgesia. 36 (5) (pp 502-511), 2009. Date of
Publication: September 2009.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Objective To test the hypothesis that subarachnoid administration of
buprenorphine and lidocaine provides more intense and longer lasting
perioperative analgesia with less side effects than xylazine and lidocaine
in goats. Study design Randomized, blinded, controlled study. Study
animals Ten healthy female goats randomly assigned to two groups of five
animals each. Methods After sedation with acepromazine (0.1 mg
kg^-1) intravenously (IV), lidocaine 2% (0.1 mL kg^-1)
combined with either xylazine (0.05 mg kg^-1; Group X) or
buprenorphine (0.005 mg kg^-1; Group B) were injected
intrathecally at the lumbo-sacral junction prior to stifle surgery.
Electrocardiogram, heart rate, direct systolic, mean, and diastolic
arterial blood pressures, rectal temperature and arterial blood gases were
recorded as were post-operative sedation and pain scores using a visual
analogue and numeric rating scale, respectively. Data were analyzed with
one-way anova for repeated measures, one-way anova, Friedman's and
Kruskal-Wallis tests as necessary (p < 0.05). Results Surgery was
successfully performed under both analgesia protocols. Total pain and
sedation scores were significantly lower in the B as compared with X group
from 3-24 hours and 30-120 minutes, respectively after subarachnoid drug
administration (SDA). Heart rate and arterial blood pressures decreased
post SDA and were consistently lower in X versus B (p < 0.05). In B
arterial blood gas parameters did not change post SDA, but in group X
PaCO₂ increased slightly within 15 minutes of SDA and remained
elevated for at least 3 hours (p < 0.05). Conclusion In these goats
intrathecal administration of buprenorphine and lidocaine produced more
profound and longer lasting analgesia with less sedation and hemodynamic
and respiratory impairment than xylazine with lidocaine. Clinical
relevance In these goats undergoing hind limb surgery, subarachnoid
buprenorphine/lidocaine offered more intense and longer lasting analgesia
than a xylazine/lidocaine combination, with less sedation and impairment
of cardiopulmonary function. 2009 Association of Veterinary
Anaesthetists.

<17>
Accession Number
70508760
Authors
Wray J. Orrells C. Latch H. Burch M.
Institution
(Wray, Orrells, Latch, Burch) Cardiorespiratory, Great Ormond Street
Hospital, London, United Kingdom
Title
The impact of dietary and exercise education on quality of life
post-transplant - A randomised controlled trial.
Source
Pediatric Transplantation. Conference: 6th Congress of the International
Pediatric Transplant Association, IPTA 2011 Montreal, QC Canada.
Conference Start: 20110625 Conference End: 20110628. Conference
Publication: (var.pagings). 15 (pp 100), 2011. Date of Publication:
August 2011.
Publisher
Blackwell Publishing Ltd
Abstract
PURPOSE: To assess whether an intervention (information and advice about
exercise and diet) resulted in improvements in perceived quality of life
and physical wellbeing for children and teenagers who had undergone heart
transplantation. METHOD: Seventy children and teenagers (median age: 8.7
years) with no significant co-morbidities who had undergone heart
transplantation at least 12 months previously were randomized to either an
intervention (IG) or control (CG) group using minimization to stratify for
age, gender, pre-transplant diagnosis and body-mass index. Questionnaires
assessing quality of life, knowledge about diet and exercise, eating
behaviours and physical activity levels were completed by parents and
older children/teenagers at baseline and 12 months later. Children and
teenagers in the IG and their parents received individually tailored
information about diet and exercise, delivered during 4 separate sessions
over a 12 month period using an approach based on the Theory of Planned
Behaviour. Those in the CG received usual care. RESULTS: The groups did
not differ at baseline on any medical or demographic parameters. All
children and teenagers in the IG completed the intervention
satisfactorily. At follow-up the change in each of the quality of life
domains (physical, emotional, social and school) was more positive in the
IG compared to the CG and the difference was significant on the child
ratings of school quality of life (t=2.177; p=.036). There were also
improvements in reported exercise and healthy eating behaviours in the IG
relative to the CG. CONCLUSION: The diet and exercise intervention had a
positive impact on quality of life and on reported levels of physical
activity and healthy eating behaviours in the short term. Lack of
knowledge of both young people and their parents about the benefits and
importance of a healthy life-style after transplant needs to be addressed
routinely.

<18>
Accession Number
70513991
Authors
Coleman K. Tan J.T. Norris S. Hardy K. Berg T. Metz L.
Institution
(Coleman, Tan, Norris) Health Technology Analysts Pty Ltd, Sydney, NSW,
Australia
(Hardy, Berg) Johnson and Johnson Medical Australia, Sydney, NSW,
Australia
(Metz) Johnson and Johnson Medical Asia-Pacific, Singapore, Singapore
Title
Surgical site infection in Australia: A systematic review of the incidence
and economic burden.
Source
Value in Health. Conference: ISPOR 4th Asia-Pacific Conference Phuket
Thailand. Conference Start: 20100905 Conference End: 20100907. Conference
Publication: (var.pagings). 13 (7) (pp A547), 2010. Date of Publication:
November 2010.
Publisher
Elsevier Ltd
Abstract
OBJECTIVES: To conduct a systematic review of literature on the
epidemiological and economic burden of surgical site infection (SSI) in
Australia. METHODS: A literature search of the EMBASE and Medline
databases was conducted. The search was limited to 1995-2010 to ensure the
pertinence of the data. Searches to identify epidemiological and economic
studies were conducted separately. Relevant studies were identified using
pre-defined criteria (i.e., reports the rate, risk factors, cost of SSI;
conducted in a hospital setting; not an intervention study). RESULTS:
Thirty-five studies were included in this review. Differences in study
design (surveillance period, data collection method, surgical procedure)
made it difficult to synthesise data to derive a single estimate of SSI in
Australia. The overall incidence of SSI in Australia is approximately
5-10%. However, the rate of SSI varied across different procedures: higher
rates were seen following gastrointestinal (~11%) and cardiovascular
(6-13%) surgery, while the rates for orthopedic (4.7-8%) and gynecological
surgery (2.3-10%) appeared lower. Risk factors identified include diabetes
and obesity, which increased the risk of SSI by 60-180%. The National
Nosocomial Infections Surveillance (NNIS) risk index was positively
correlated with the risk of developing an SSI. The most common organisms
identified in SSIs were Staphylococcus aureus and Pseudomonas aeruginosa.
The hospitalization cost attributable to SSI is estimated at approximately
AUD$54 million annually. With a large proportion of SSIs occurring after
discharge from hospital, the incidence of SSI is likely underestimated.
Post-discharge SSI, in turn, increases the burden to community health
services. Indirect costs, such as loss of productivity, further add to the
economic burden of SSI. CONCLUSIONS: The incidence and cost estimates
demonstrate that SSI represents a significant burden to the Australian
health-care system. Interventions aimed at reducing SSI would provide
cost-savings and improve the efficiency of the health-care system.

<19>
Accession Number
70513989
Authors
Tan J.T. Coleman K. Norris S. Metz L.
Institution
(Tan, Coleman, Norris) Health Technology Analysts Pty Ltd, Sydney, NSW,
Australia
(Metz) Johnson and Johnson Medical Asia-Pacific, Singapore, Singapore
Title
Surgical site infection in China: A systematic review of the incidence and
economic burden.
Source
Value in Health. Conference: ISPOR 4th Asia-Pacific Conference Phuket
Thailand. Conference Start: 20100905 Conference End: 20100907. Conference
Publication: (var.pagings). 13 (7) (pp A546), 2010. Date of Publication:
November 2010.
Publisher
Elsevier Ltd
Abstract
OBJECTIVES: To conduct a systematic review of literature on the
epidemiological and economic burden of surgical site infection (SSI) in
China. METHODS: A literature search of the EMBASE and Medline databases
was conducted. The search was limited to 1995-2010 to ensure the
pertinence of the data. Relevant studies were identified using pre-defined
inclusion criteria (i.e., reports the rate, risk factors, cost of SSI;
conducted in a hospital setting; not an intervention study). Data on the
prevalence, incidence, risk factors and cost of SSI were extracted.
Searches to identify epidemiological and economic studies were conducted
separately. RESULTS: The literature search identified six publications,
comprising three studies conducted in Beijing (N = 95 to 196), one in
Shandong (N = 2126), and two in Guangdong (N = 13,798). The incidence of
SSI varied with surgical procedure. High incidence rates of SSI were
reported for laryngectomy (21.1%), general surgery (18.8%), thoracic
surgery (13.9%) and bone surgery (11.2%); while the rates for pancreas
surgery (7.1%), neurosurgery (3%) and caesarean section (0.7%) appeared
lower. The included studies found that risk factors such as wound
classification, BMI and use of antibiotics significantly increased the
risk of SSI. SSI was associated with a significant increase in neoplasm
recurrence following laryngectomy (35% vs. 5.3%, P < 0.001), and extended
postoperative hospital stay by an average of 33.6 days. The additional
cost experienced by patients who developed a SSI was estimated at RMB
17,332/patient. CONCLUSIONS: SSI has the potential to represent a
substantial burden on the healthcare system and patients in China, mainly
attributable to the extended length of stay in hospital and additional
cost of treatment required. Interventions aimed at reducing SSI would
provide cost-savings to the health-care system and improve its efficiency.

<20>
Accession Number
70511498
Authors
Hess E. Agarwal D. Chandra S. Murad M.H. Erwin P.J. Hollander J.E. Montori
V.M. Stiell I.G.
Institution
(Hess, Agarwal, Chandra, Murad, Erwin, Hollander, Montori, Stiell) Mayo
Clinic, Rochester, MN, United States
Title
ACCURACY of the TTMI risk score in emergency department patients with
potential acute coronary syndromes: A systematic review and meta-analysis.
Source
Canadian Journal of Emergency Medicine. Conference: 2010 CAEP/ACMU
Montreal, QC Canada. Conference Start: 20100529 Conference End: 20100602.
Conference Publication: (var.pagings). 12 (3) (pp 242), 2010. Date of
Publication: May 2010.
Publisher
BC Decker Inc.
Abstract
Introduction: The thrombolysis in myocardial infarction (TTMI) risk score
uses clinical data to predict the short-term risk of acute myocardial
infarction, coronary revascularization and death from any cause. We sought
to determine the prognostic accuracy of the TTMI risk score in emergency
department patients with potential acute coronary syndromes. Methods: We
searched 5 electronic databases, hand- searched reference lists of
included studies, and contacted content experts to identify articles for
review. We included prospective cohort studies that validated the TTMI
risk score in emergency department patients. We performed metaregression
to determine whether a linear relationship exists between TIMI risk score
and the cumulative incidence of cardiac events. Results: We included 9
prospective cohort studies (with a total of 16 054 patients) in our
systematic review. Data were available for meta-analysis in 7 of 9
studies. Of patients with a score of zero, 1.9% had a cardiac event within
30 days (sensitivity 97.2%, 95% CI 96.4-97.9; specificity 24.8%, 95% CI
24.1-25.6; positive likelihood ratio 1.29,95% CI 1.28-1.31; negative
likelihood ratio 0.11, 95% CI 0.09-0.15). Metaregression analysis revealed
a strong linear relationship between TTMI risk score (p < 0.001) and the
cumulative incidence of cardiac events. Conclusion: Evidence supports use
of the TTMI risk score to risk stratify emergency department patients with
potential acute coronary syndromes. The lowest risk category (TIMI 0)
missed 1.9% of cardiac events. Though the TTMI risk score is an effective
risk stratification tool it should not be used as the sole means of
detenriining patient disposition.