Results Generated From:
Embase <1980 to 2012 Week 26>
Embase (updates since 2012-06-21)
<1>
Accession Number
2012350667
Authors
Reinhart K. Perner A. Sprung C.L. Jaeschke R. Schortgen F. Groeneveld
A.B.J. Beale R. Hartog C.S.
Institution
(Reinhart, Hartog) Department for Anesthesiology and Intensive Care
Medicine, Jena University Hospital, Friedrich-Schiller University,
Erlanger Allee 101, 07747 Jena, Germany
(Perner) Department of Intensive Care, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
(Sprung) Department of Anesthesiology and Critical Care Medicine, Hadassah
Hebrew University Medical Center, Jerusalem, Israel
(Jaeschke) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Jaeschke) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, ON, Canada
(Schortgen) Reanimation Medicale, AP-HP, Groupe Hospitalier Albert
Chenevier, Henri Mondor, Creteil, France
(Groeneveld) Erasmus Medical Centre, Rotterdam, Netherlands
(Beale) Department of Adult Critical Care, Guy's and St Thomas' NHS
Foundation Trust, London, United Kingdom
Title
Consensus statement of the ESICM task force on colloid volume therapy in
critically ill patients.
Source
Intensive Care Medicine. 38 (3) (pp 368-383), 2012. Date of Publication:
March 2012.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Purpose: Colloids are administered to more patients than crystalloids,
although recent evidence suggests that colloids may possibly be harmful in
some patients. The European Society of Intensive Care Medicine therefore
assembled a task force to compile consensus recommendations based on the
current best evidence for the safety and efficacy of the currently most
frequently used colloids-hydroxyethyl starches (HES), gelatins and human
albumin. Methods: Meta-analyses, systematic reviews and clinical studies
of colloid use were evaluated for the treatment of volume depletion in
mixed intensive care unit (ICU), cardiac surgery, head injury, sepsis and
organ donor patients. Clinical endpoints included mortality, kidney
function and bleeding. The relevance of concentration and dosage was also
assessed. Publications from 1960 until May 2011 were included. The quality
of available evidence and strength of recommendations were based on the
Grading of Recommendations Assessment, Development, and Evaluation (GRADE)
approach. Recommendations and conclusions: We recommend not to use HES
with molecular weight >=200 kDa and/or degree of substitution >0.4 in
patients with severe sepsis or risk of acute kidney injury and suggest not
to use 6% HES 130/0.4 or gelatin in these populations. We recommend not to
use colloids in patients with head injury and not to administer gelatins
and HES in organ donors. We suggest not to use hyperoncotic solutions for
fluid resuscitation. We conclude and recommend that any new colloid should
be introduced into clinical practice only after its patient-important
safety parameters are established. Copyright jointly held by Springer and
ESICM 2012.
<2>
Accession Number
2012344433
Authors
Lance M.D. Ninivaggi M. Schols S.E.M. Feijge M.A.H. Oehrl S.K. Kuiper
G.J.A.J.M. Nikiforou M. Marcus M.A.E. Hamulyak K. van Pampus E.C.M. ten
Cate H. Heemskerk J.W.M.
Institution
(Lance, Kuiper, Marcus) Department of Anesthesiology, CARIM, Maastricht
University Medical Center, Maastricht, Netherlands
(Ninivaggi, Schols, Feijge, Oehrl, Kuiper, Nikiforou, Heemskerk)
Department of Biochemistry, CARIM, Maastricht University Medical Center,
Maastricht, Netherlands
(Schols, Hamulyak, ten Cate) Department of Internal Medicine, CARIM,
Maastricht University Medical Center, Maastricht, Netherlands
(van Pampus) Laboratory of Medical Immunology, Radboud University Medical
Center, Nijmegen, Netherlands
Title
Perioperative dilutional coagulopathy treated with fresh frozen plasma and
fibrinogen concentrate: A prospective randomized intervention trial.
Source
Vox Sanguinis. 103 (1) (pp 25-34), 2012. Date of Publication: July 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Background and objectives Treatment of dilutional coagulopathy by
transfusing fresh frozen plasma (FFP) remains sub-optimal. We hypothesized
that partial replacement of transfused FFP by fibrinogen concentrate
results in improved coagulant activity and haemostasis. This was tested in
a controlled clinical intervention trial with patients experiencing
massive bleeding during major surgery. Methods Patients undergoing major
elective surgery were treated according to current protocols. When
transfusion with FFP was required, patients were randomized as follows:
group A received 4units FFP and group B received 2units FFP plus 2g
fibrinogen concentrate. Blood samples were taken before and after the
intervention. Analysts were blinded to the treatment type. Results Group A
(B) consisted of 21 (22) patients, in 16 (17) of whom bleeding stopped
after intervention. Plasma fibrinogen increased significantly more in
group B (057g/l) than in group A (005g/l). However, levels of prothrombin
and factors VIII, IX and X increased more in group A than in group B.
Rotational thromboelastometry (ROTEM) of whole blood and plasma revealed
improved fibrin clot formation in group B but not in group A. Thrombin
generation [calibrated automated thrombogram (CAT)] in plasma increased
more in group A. Principal parameters determining whole-blood
thromboelastometry were the fibrinogen level and platelet count. In vitro
addition of fibrinogen and prothrombin complex concentrate to
pre-intervention samples restored both ROTEM and CAT parameters.
Conclusions Partial replacement of transfused FFP by fibrinogen increases
fibrin clot formation at the expense of less improved thrombin generation.
Coagulation factors other than fibrinogen alone are required for full
restoration of haemostasis. 2011 International Society of Blood
Transfusion.
<3>
Accession Number
2012350852
Authors
Sequist T.D. Morong S.M. Marston A. Keohane C.A. Cook E.F. Orav E.J. Lee
T.H.
Institution
(Sequist, Morong, Keohane, Cook, Orav, Lee) Division of General Medicine
and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street,
Boston, MA 02120, United States
(Sequist) Department of Health Care Policy, Harvard Medical School,
Boston, MA, United States
(Sequist, Marston) Harvard Vanguard Medical Associates, Boston, MA, United
States
(Lee) Partners Healthcare System, Boston, MA, United States
Title
Electronic risk alerts to improve primary care management of chest pain: A
randomized, controlled trial.
Source
Journal of General Internal Medicine. 27 (4) (pp 438-444), 2012. Date of
Publication: April 2012.
Publisher
Springer New York (233 Springer Street, New York NY 10013-1578, United
States)
Abstract
BACKGROUND: The primary care evaluation of chest pain represents a
significant diagnostic challenge. OBJECTIVE: To determine if electronic
alerts to physicians can improve the quality and safety of chest pain
evaluations. DESIGN AND PARTICIPANTS: Randomized, controlled trial
conducted between November 2008 and January 2010 among 292 primary care
clinicians caring for 7,083 adult patients with chest pain and no history
of cardiovascular disease. INTERVENTION: Clinicians received alerts within
the electronic health record during office visits for chest pain. One
alert recommended performance of an electrocardiogram and administration
of aspirin for high risk patients (FraminghamRisk Score (FRS)=10%), and a
second alert recommended against performance of cardiac stress testing for
low risk patients (FRS<10%). MAIN MEASURES: The primary outcomes included
performance of an electrocardiogram and administration of aspirin therapy
for high risk patients; and avoidance of cardiac stress testing for low
risk patients. KEY RESULTS: The majority (81%) of patients with chest pain
were classified as low risk. High risk patients were more likely than low
risk patients to be evaluated in the emergency department (11% versus 5%,
p<0.01) and to be hospitalized (7% versus 3%, p<0.01). Acute myocardial
infarction occurred among 26 (0.4%) patients, more commonly among high
risk compared to low risk patients (1.1% versus 0.2%, p<0.01). Among high
risk patients, there was no difference between the intervention and
control groups in rates of performing electrocardiograms (51% versus 48%,
p=0.33) or administering aspirin (20% versus 18%, p=0.43). Among low risk
patients, there was no difference between intervention and control groups
in rates of cardiac stress testing (10% versus 9%, p=0.40). CONCLUSIONS:
Primary care management of chest pain is suboptimal for both high and low
risk patients. Electronic alerts do not increase risk-appropriate care for
these patients. Society of General Internal Medicine 2011.
<4>
Accession Number
2012342458
Authors
Alazzoni A. Al-Saleh A. Jolly S.S.
Institution
(Alazzoni, Al-Saleh, Jolly) Department of Medine and Cardiology, Hamilton
Health Sciences, McMaster University, Hamilton, ON L8L 2X2, Canada
Title
Everolimus-eluting versus paclitaxel-eluting stents in percutaneous
coronary intervention: Meta-analysis of randomized trials.
Source
Thrombosis. , 2012. Article Number: 126369. Date of Publication: 2012.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. Individual randomized trials have suggested that
everolimus-eluting stents may have improved clinical outcomes compared to
paclitaxel-eluting stents, but individual trials are underpowered to
examine outcomes such as mortality and very late stent thrombosis.
Methods. Medline, Cochrane, and conference proceedings were searched for
randomized trials comparing everolimus versus paclitaxel-eluting stents
for percutaneous coronary intervention. Results. 6792 patients were
included from 4 randomized controlled trials. Stent thrombosis was reduced
with everolimus stents versus paclitaxel stents (0.7% versus 2.3%; OR:
0.32; CI: 0.20-0.51; P<0.00001). The reductions in stent thrombosis were
observed in (i) early stent thrombosis (within 30 days) (0.2% versus 0.9%;
OR: 0.24; P=0.0005), (ii) late (day 31-365) (0.2% versus 0.6%; OR: 0.32;
P=0.01), and (iii) very late stent thrombosis (365 days) (0.2% versus
0.8%; OR: 0.34; P=0.009). The rates of cardiovascular mortality were 1.2%
in everolimus group and 1.6% in paclitaxel group (OR: 0.85; P=0.43).
Patients receiving everolimus-eluting stents had significantly lower
myocardial infarction events and target vessel revascularization as
compared to paclitaxel-eluting stents. Interpretation. Everolimus compared
to paclitaxel-eluting stents reduced the incidence of early, late, and
very late stent thrombosis as well as target vessel revascularization.
2012 Ashraf Alazzoni et al.
<5>
Accession Number
2012334507
Authors
Lin W. Li H. Liu W. Cao L. Tan H. Zhong Z.
Institution
(Lin, Li, Liu, Cao, Tan, Zhong) Department of Anesthesiology, Sun Yat-Sen
University Cancer Centre, State Key Laboratory of Oncology of South China,
Guangzhou, China
Title
A randomised trial comparing the CEL-100 videolaryngoscope with the
Macintosh laryngoscope blade for insertion of double-lumen tubes.
Source
Anaesthesia. 67 (7) (pp 771-776), 2012. Date of Publication: July 2012.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
We performed a randomised trial comparing the CEL-100 videolaryngoscope
with the Macintosh laryngoscope blade in 170 patients undergoing
double-lumen tube placement for thoracic surgery. Compared with the
Macintosh laryngoscope blade, use of the CEL-100 resulted in significantly
more patients with a Cormack and Lehane Grade-1 laryngeal view (90.4% vs
61.0%, p < 0.001), a higher rate of successful intubation on the first
attempt (92.8% vs 79.3%, p = 0.012), a lower median (IQR [range])
intubation difficulty score (0 (0-0 [0-60]) vs 15 (0-30 [0-80]), p <
0.001), a higher incidence of correct positioning of the tube (90.3% vs
79.2%, p = 0.041) and significantly fewer patients requiring external
laryngeal pressure (19.3% vs 32.9%, p = 0.046). Median (IQR [range]) time
to successful intubation was 45 (38-55 [22-132]) s with the CEL-100
compared with 51 (40-61 [30-160] s using the Macintosh laryngoscope blade.
We conclude that the CEL-100 videolaryngoscope is superior to the
Macintosh laryngoscope blade for double-lumen tube insertion. 2012 The
Association of Anaesthetists of Great Britain and Ireland.
<6>
Accession Number
2012336167
Authors
Genereux P. Head S.J. Van Mieghem N.M. Kodali S. Kirtane A.J. Xu K. Smith
C. Serruys P.W. Kappetein A.P. Leon M.B.
Institution
(Genereux, Kodali, Kirtane, Xu, Smith, Leon) Columbia University Medical
Center, New York-Presbyterian Hospital, Cardiovascular Research
Foundation, 177 Fort Washington Avenue, New York, NY 10032, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Universite de Montreal,
Montreal, QC, Canada
(Head, Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Van Mieghem, Serruys) Department of Cardiology, Erasmus University
Medical Center, Rotterdam, Netherlands
Title
Clinical outcomes after transcatheter aortic valve replacement using valve
Academic Research Consortium definitions: A weighted meta-analysis of
3,519 patients from 16 studies.
Source
Journal of the American College of Cardiology. 59 (25) (pp 2317-2326),
2012. Date of Publication: 19 Jun 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Objectives: This study sought to perform a weighted meta-analysis to
determine the rates of major outcomes after transcatheter aortic valve
replacement (TAVR) using Valve Academic Research Consortium (VARC)
definitions and to evaluate their current use in the literature.
Background: Recently, the published VARC definitions have helped to add
uniformity to reporting outcomes after TAVR. Methods: A comprehensive
search of multiple electronic databases from January 1, 2011, through
October 12, 2011, was conducted using predefined criteria. We included
studies reporting at least 1 outcome using VARC definitions. Results: A
total of 16 studies including 3,519 patients met inclusion criteria and
were included in the analysis. The pooled estimate rates of outcomes were
determined according to VARC's definitions: device success, 92.1% (95%
confidence interval [CI]: 88.7% to 95.5%); all-cause 30-day mortality,
7.8% (95% CI: 5.5% to 11.1%); myocardial infarction, 1.1% (95% CI: 0.2% to
2.0%); acute kidney injury stage II/III, 7.5% (95% CI: 5.1% to 11.4%);
life-threatening bleeding, 15.6% (95% CI: 11.7% to 20.7%); major vascular
complications, 11.9% (95% CI: 8.6% to 16.4%); major stroke, 3.2% (95% CI:
2.1% to 4.8%); and new permanent pacemaker implantation, 13.9% (95% CI:
10.6% to 18.9%). Medtronic CoreValve prosthesis use was associated with a
significant higher rate of new permanent pacemaker implantation compared
with the Edwards prosthesis (28.9% [95% CI: 23.0% to 36.0%] vs. 4.9% [95%
CI: 3.9% to 6.2%], p < 0.0001). The 30-day safety composite endpoint rate
was 32.7% (95% CI: 27.5% to 38.8%) and the 1-year total mortality rate was
22.1% (95% CI: 17.9% to 26.9%). Conclusions: VARC definitions have already
been used by the TAVR clinical research community, establishing a new
standard for reporting clinical outcomes. Future revisions of the VARC
definitions are needed based on evolving TAVR clinical experiences. 2012
American College of Cardiology Foundation.
<7>
Accession Number
2012342409
Authors
Lansky A.J. Brar S.S. Yaqub M. Sood P. Applegate R.J. Lazar D. Jankovic I.
Hermiller J.B. Koo K. Sudhir K. Stone G.W.
Institution
(Lansky, Lazar, Jankovic) Yale University School of Medicine, New Haven,
CT, United States
(Brar) Kaiser Permanente Medical Center, Los Angeles, CA, United States
(Yaqub, Sood, Koo, Sudhir) Abbott Vascular, Santa Clara, CA, United States
(Applegate) Wake Forest University Health Sciences, Winston-Salem, NC,
United States
(Hermiller) St. Vincent s Heart Center of Indiana, Indianapolis, IN,
United States
(Stone) Columbia University Medical Center, Cardiovascular Research
Foundation, New York, NY, United States
Title
Impact of routine angiographic follow-up after percutaneous coronary
intervention with drug-eluting stents in the SPIRIT III randomized trial
at three years.
Source
American Journal of Cardiology. 110 (1) (pp 21-29), 2012. Date of
Publication: 01 Jul 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Routine angiographic follow-up after bare-metal stent implantation has
been associated with an increase in coronary revascularization. The impact
of angiographic follow-up after drug-eluting stent placement remains
poorly characterized. The prospective, randomized, single-blinded SPIRIT
III trial assigned patients to the everolimus-eluting stent or the
paclitaxel-eluting stent (PES). Major adverse cardiovascular events
(cardiac death, myocardial infarction, and ischemia-driven target lesion
revascularization [ID-TLR]) at 3 years were assessed by angiographic
versus clinical-only follow-up at 8 months +/- 28 days and a landmark
survival analysis from 9 months to 3 years. Of 1,002 patients, 564
patients were assigned to angiographic follow-up at 8 months +/- 28 days
and 438 patients underwent clinical follow-up alone. Three-year major
adverse cardiovascular event rates were 10.6% in the angiographic group
and 12.0% in the clinical follow-up group (p = 0.64). Ischemia-driven
revascularization increased twofold at 9 months, but no difference was
noted in ID-TLR for either device. Non-ID-TLR was significantly higher in
patients in the angiographic group (4.5% vs 1.0%, p = 0.002), a difference
resulting from PES (9.1% vs 0.7%, p = 0.0007) rather than
everolimus-eluting stent (2.2% vs 1.1%, p = 0.36) treatment. The landmark
analysis showed no significant differences between the angiographic and
clinical follow-up groups from 9 months to 3 years of major clinical
outcomes. In conclusion, routine angiographic follow-up in SPIRIT III did
not increase rates of ID-TLR compared to clinical follow-up alone. Despite
higher nonischemia-driven revascularization rates with angiographic
follow-up of patients with PESs, none of the safety end points were
adversely affected. 2012 Elsevier Inc. All rights reserved.
<8>
Accession Number
2012334542
Authors
Hendel R.C. Ruthazer R. Chaparro S. Martinez C. Selker H.P. Beshansky J.R.
Udelson J.E.
Institution
(Hendel, Chaparro, Martinez) Division of Cardiovascular Medicine,
Department of Medicine, University of Miami Miller School of Medicine,
1120 14th Street, CRB #1123, Miami, FL 33136, United States
(Ruthazer, Selker, Beshansky, Udelson) Department of Medicine, Tufts
Medical Center, Boston, MA, United States
Title
Cocaine-using patients with a normal or nondiagnostic electrocardiogram:
Single-photon emission computed tomography myocardial perfusion imaging
and outcome.
Source
Clinical Cardiology. 35 (6) (pp 354-358), 2012. Date of Publication: 2012.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
Background: Few trials have examined the outcomes of patients who use
cocaine with chest pain and who have a normal or nondiagnostic
electrocardiogram (ECG) and the use of single-photon emission computed
tomography (SPECT) myocardial perfusion imaging (MPI). Hypothesis: We
sought to compare the characteristics and overall outcomes in cocaine
users vs non-cocaine users presenting to the emergency department with a
normal/nondiagnostic ECG and to assess the value of rest MPI in both of
these populations. Methods: Patients with symptoms compatible with
myocardial ischemia, suspected acute coronary syndrome (ACS), and a
normal/nondiagnostic ECG were enrolled in the Emergency Room Assessment of
Sestamibi for Evaluation of Chest Pain (ERASE Chest Pain) trial, a
randomized controlled trial designed to evaluate the impact of rest MPI on
triage decisions. Cocaine users (n = 294) were compared to non-cocaine
users (n = 2180). Cocaine users were younger than non-cocaine users, and
72% were male. Results: Among the cocaine users, 2.4% had a myocardial
infarction, 1.4% required percutaneous coronary intervention, and none of
the patients underwent coronary artery bypass graft surgery. Among cocaine
users with a final diagnosis of not ACS, randomization of patients to rest
SPECT MPI resulted in an appropriate reduction in hospital admissions in
both the cocaine users (P = 0.011) and the non-cocaine users (P < 0.001),
suggesting improved triage when MPI was used. Conclusions: Cocaine users
with a normal/nondiagnostic ECG are at low risk of cardiac events. Even
though cocaine users are at low risk of cardiac events, SPECT MPI remains
effective in the risk stratification and improves triage management
decisions resulting in lower admission rates and more discharges to home.
2012 Wiley Periodicals, Inc.
<9>
Accession Number
2012340074
Authors
Wang D. Sun J. Solomon S.B. Klein H.G. Natanson C.
Institution
(Wang, Sun, Solomon, Klein, Natanson) Critical Care Medicine Department,
Clinical Center, National Institutes of Health, 9000 Rockville Pike,
Bethesda, MD 20892, United States
(Wang, Sun, Solomon, Klein, Natanson) Department of Transfusion Medicine,
National Institutes of Health, Bethesda, MD, United States
(Wang, Sun, Solomon, Klein, Natanson) Anesthesia and Critical Care
Medicine Department, West China Hospital, Sichuan University, Cheng Du,
China
Title
Transfusion of older stored blood and risk of death: A meta-analysis.
Source
Transfusion. 52 (6) (pp 1184-1195), 2012. Date of Publication: June 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
BACKGROUND: Blood for transfusion is stored for up to 42 days. Older blood
develops lesions and accumulates potentially injurious substances. Some
studies report increasing toxicity as blood ages. We assessed the safety
of transfused older versus newer stored blood. STUDY DESIGN AND METHODS:
PubMed, Scopus, and Embase were searched using terms new and old and red
blood cell and storage through May 6, 2011, for observational and
randomized controlled studies comparing outcomes using transfused blood
having longer and shorter storage times. Death was the outcome of
interest. RESULTS: Twenty-one studies were identified, predominantly in
cardiac surgery (n = 6) and trauma (n = 6) patients, including 409,966
patients. A test for heterogeneity of these studies' results was not
significant for mortality (I<sup>2</sup> = 3.7%, p = 0.41). Older blood
was associated with a significantly increased risk of death (odds ratio,
1.16; 95% confidence interval [CI], 1.07-1.24). Using available mortality
data, 97 (95% CI, 63-199) patients need to be treated with only new blood
to save one life. Subgroup analysis of these trials indicated that the
increased risk was not restricted to a particular type of patient, size of
trial, or amount of blood transfused. CONCLUSION: Based on available data,
use of older stored blood is associated with a significantly increased
risk of death.
<10>
Accession Number
2012335378
Authors
Neyt M. Van Brabandt H. Devriese S. Van De Sande S.
Institution
(Neyt, Van Brabandt, Devriese, Van De Sande) Belgian Health Care Knowledge
Centre (KCE), Brussels, Belgium
Title
A cost-utility analysis of transcatheter aortic valve implantation in
Belgium: Focusing on a well-defined and identifiable population.
Source
BMJ Open. 2 (3) , 2012. Article Number: e001032. Date of Publication:
2012.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Background: Patients with severe aortic stenosis and coexisting
non-cardiac conditions may be at high risk for surgical replacement of the
aortic valve or even be no candidates for surgery. In these patients,
transcatheter aortic valve implantation (TAVI) is suggested as an
alternative. Results of the PARTNER (Placement of AoRTic TraNscathetER
Valve) trial comparing the clinical effectiveness of TAVI with surgical
valve replacement and standard therapy were published. The authors
assessed the cost-effectiveness of TAVI in Belgium. Methods: A Markov
model of incremental costs, effects (survival and quality of life) and
incremental cost-effectiveness of TAVI was developed. The impact on
survival, number of events and quality of life was based on the PARTNER
trial. Costs per event were context specific. Results: In high-risk
operable patients, even if the minor differences in 30-day and 1-year
mortality are taken into account, the incremental cost-effectiveness ratio
(ICER) remains on average above 750 000 per quality-adjusted life-year
(QALY) gained (incremental cost: 20 400; incremental effect: 0.03 QALYs).
In inoperable patients, an ICER of 44 900 per QALY (incremental cost: 33
200; incremental effect: 0.74 QALYs) is calculated, including a life-long
extrapolation of the mortality benefit. This result was sensitive to the
assumed time horizon. The subgroup of anatomically inoperable patients had
better outcomes than medically inoperable patients, with ICERs decreasing
more than 10 000/QALY. Conclusions: It is inappropriate to consider
reimbursement of TAVI for high-risk operable patients. Reimbursing TAVI in
inoperable patients in essence is a political decision. From an economic
perspective, it would be prudent to first target patients that are
inoperable because of anatomical prohibitive conditions. In the search for
evidence, the authors identified non-published negative results from a
randomised controlled TAVI trial. The study sponsor should be more willing
to share this information to allow balanced evaluations and policy
recommendations. Payers should require these data before taking
reimbursement decisions.
<11>
Accession Number
2012334249
Authors
Zhou H.-B. Wu Y. Wang L.-Q. Zou S.-L. Qiao Y.-Z. Wang L.-X.
Institution
(Zhou, Wu, Wang, Zou, Qiao) Department of Thoracic Medicine, Liaocheng
People's Hospital, Taishan Medical University, Liaocheng, China
(Wang) School of Biomedical Sciences, Charles Sturt University, Wagga
Wagga, NSW 2678, Australia
Title
Feasibility and safety of early removal of incisional dressings following
thoracic surgery.
Source
Medical Principles and Practice. 21 (4) (pp 379-382), 2012. Date of
Publication: June 2012.
Publisher
S. Karger AG (Allschwilerstrasse 10, P.O. Box, Basel CH-4009, Switzerland)
Abstract
Objective: To investigate the feasibility and safety of early dressing
removal of clean wounds following thoracotomy. Subjects and Methods: A
total of 230 patients (127 males, mean age 55.6 +/- 16.7 years) were
randomly divided into study and control groups. In the study group the
cotton gauze dressing was removed 48 h after the surgery, whereas in the
control group the dressing was kept on for 7-8 days until the removal of
skin sutures. The infection and healing of the wounds were examined, and
patients were followed up for 30 days. Results: There was no statistically
significant difference in age, sex, smoking rates, concurrent illnesses
and operational characteristics between the study and control groups (p >
0.05). The wound infection rate in the study and control groups was 6
(5.2%) and 7 patients (6.1%), respectively (p = 0.775). Two patients
(1.7%) from the study group and 1 (0.9%, p = 0.561) from the control group
had partial wound approximation by day 7. Surrounding skin integrity was
normal in 106 (92.2%) of the study group and 107 (93.0%) of the control
group patients by postoperative day 7 (p = 0.801). Conclusion: Removal of
wound dressing 48 h after thoracic surgery was not associated with an
increased risk of surgical site infection. Hence the early removal of
wound dressing did not appear to have an adverse impact on wound healing.
Copyright 2012 S. Karger AG.
<12>
Accession Number
2012317190
Authors
Faleh H.F.A. Alsuwaida A.O. Hersi A.S. Ullah A. Alshahrani A.M. Al-Nemer
K.A. Al-Saif S.M. Taraben A.M. Kashour T.S. Ahmed W.H. Balghith M.A.
Al-Habib K.F.
Institution
(Faleh, Hersi, Alshahrani, Al-Habib) Departments of Cardiac Sciences, King
Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
(Alsuwaida) Departments of Medicine, King Fahad Armed Forces Hospital,
Jeddah, Saudi Arabia
(Ullah, Al-Nemer) College of Medicine, King Khalid University Hospital,
Medicine Department, Jeddah, Saudi Arabia
(Kashour) Security Forces Hospital, Cardiology Section, King Fahad Armed
Forces Hospital, Jeddah, Saudi Arabia
(Al-Saif) Prince Salman Medical Center, Cardiology Section, King Fahad
Medical City, Saudi Arabia
(Balghith) National Guard Hospital, Cardiology Unit, King Fahad Armed
Forces Hospital, King Abdul Aziz Medical City, Saudi Arabia
(Taraben) Saud Al Babtain Cardiac Center, Cardiac Department, King Fahad
Armed Forces Hospital, Jeddah, Saudi Arabia
(Ahmed) Faisal Specialist Hospital and Research Center, Cardiac
Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
Title
In-hospital adverse clinical outcomes of ST elevation myocardial
infarction patients with renal dysfunction: Insights from the Saudi
project for assessment of coronary events.
Source
Saudi Medical Journal. 32 (8) (pp 806-812), 2011. Date of Publication:
August 2011.
Publisher
Saudi Arabian Armed Forces Hospital (P.O. Box 7897, Riyadh 11159, Saudi
Arabia)
Abstract
Objectives: To explore the prognostic value of baseline estimated
glomerular filtration rate (eGFR) in Saudi patients presenting with ST
elevation myocardial infarction (STEMI), and its impact on hospital
therapies. Methods: The STEMI patients with a baseline serum Creatinine
enrolled in the SPACE (Saudi Project for Assessment of Coronary Events)
registry were analyzed. This study was performed in several regions in
Saudi Arabia between December 2005 to December 2007. Based on eGFR levels,
patients were classified into: more than 90.1 ml/min (normal renal
function), 90-60.1 (borderline/mildly impaired renal function), 60-30
(moderate renal dysfunction), and less than 30 ml/ min/1.73 m<sup>2</sup>
(severe renal dysfunction). Results: Two thousand and fifty eight patients
qualified for this study. Of these, 1058 patients had renal dysfunction.
Patients with renal dysfunction were older, and had a higher prevalence of
risk factors for atherosclerosis. Patients with moderate or severe renal
dysfunction were less likely to be treated with beta blockers, angiotensin
converting enzymes inhibitors, statins, or reperfusion therapies.
Significantly worse outcomes were seen with lower eGFR in a stepwise
fashion. The adjusted odds ratio of in-hospital death in patients with
eGFR less than 30ml/min was 5.3 (95% CI, 1.15-25.51, p=0.0383).
Conclusion: A low baseline eGFR in STEMI patients is an independent
predictor of all major adverse cardiovascular outcomes, and a marker for
less aggressive in-hospital therapy.
<13>
Accession Number
2012329810
Authors
Mann C.D. McCarthy M. Nasim A. Bown M. Dennis M. Sayers R. London N.
Naylor A.R.
Institution
(Mann, McCarthy, Nasim, Bown, Dennis, Sayers, London, Naylor) Department
of Vascular Surgery, Leicester Royal Infirmary, Infirmary Square,
Leicester LE1 5WW, United Kingdom
Title
Management and outcome of prosthetic patch infection after carotid
endarterectomy: A single-centre series and systematic review of the
literature.
Source
European Journal of Vascular and Endovascular Surgery. 44 (1) (pp 20-26),
2012. Date of Publication: July 2012.
Publisher
W.B. Saunders Ltd (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Objectives: Outcomes following prosthetic patch infection after carotid
endarterectomy (CEA). Methods: Retrospective audit and systematic review.
Results: 22 patients were treated between January 1992 and April 2012, 5
having undergone their original CEA at another institution. The commonest
infecting organism was Staphylococcus. One patient was treated by
antibiotic irrigation, one was stented, while 20 underwent debridement and
patch excision plus; carotid ligation (n = 3), vein patching (n = 3) or
vein bypass (n = 14). There was one peri-operative stroke, but no
peri-operative deaths. There were no reinfections at a median follow-up of
54 months. A systematic review identified 123 patients with prosthetic
patch infection in the world literature. Thirty-six (29%) presented <2
months, 78 (63%) presented >6 months after the original CEA. Seventy-nine
of/87 patients (91%) with a positive culture yielded Staphylococci or
Streptococci. Seventy-four patients were treated by patch excision and
autologous reconstruction. Four (5%) developed reinfection <30 days, but
later reinfections have been reported. Seven of nine patients (78%)
undergoing prosthetic reconstruction either died or suffered reinfection.
Five patients were treated with a covered stent, none developing
reinfection (median followup 12 months). Conclusion: Patch infection
following CEA is rare. Few have undergone stenting and long term data are
awaited. For now, patch excision and autologous reconstruction remains the
'gold standard'. 2012 European Society for Vascular Surgery. Published by
Elsevier Ltd. All rights reserved.
<14>
Accession Number
22364379
Authors
Gu W.J. Wu Z.J. Wang P.F. Aung L.H. Yin R.X.
Institution
(Gu) Department of Cardiology, Institute of Cardiovascular Diseases, the
First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road,
Nanning 530021, Guangxi, People's Republic of China.
Title
N-Acetylcysteine supplementation for the prevention of atrial fibrillation
after cardiac surgery: a meta-analysis of eight randomized controlled
trials.
Source
BMC cardiovascular disorders. 12 (pp 10), 2012. Date of Publication:
2012.
Abstract
Atrial fibrillation is the most common type of arrhythmia after cardiac
surgery. An increasing body of evidence demonstrates that oxidative stress
plays a pivotal role in the pathophysiology of atrial fibrillation.
N-acetylcysteine (NAC) is a free radical scavenger, and may attenuate this
pathophysiologic response and reduce the incidence of postoperative AF
(POAF). However, it is unclear whether NAC could effectively prevent POAF.
Therefore, this meta-analysis aims to assess the efficacy of NAC
supplementation on the prevention of POAF. Medline and Embase were
systematically reviewed for studies published up to November 2011, in
which NAC was compared with controls for adult patients undergoing cardiac
surgery. Outcome measures comprised the incidence of POAF and hospital
length of stay (LOS). The meta-analysis was performed with the
fixed-effect model or random-effect model according to the heterogeneity.
Eight randomized trials incorporating 578 patients provided the best
evidence and were included in this meta-analysis. NAC supplementation
significantly reduced the incidence of POAF (OR 0.62, 95% CI 0.41 to 0.93;
P = 0.021) compared with controls, but had no effect on LOS (WMD -0.07,
95% CI -0.42 to 0.28; P = 0.703). The prophylactic NAC supplementation may
effectively reduce the incidence of POAF. However, the overall quality of
current studies is poor and further research should focus on adequately
powered randomized controlled trials with POAF incidence as a primary
outcome measure. 2012 Gu et al; licensee BioMed Central Ltd
<15>
Accession Number
70786904
Authors
Liao K.P. Kurreeman F. Guzman R.N.P. Zhang J. Cai T. Li G. Duclos G.
Institution
(Liao, Kurreeman, Guzman, Zhang, Cai, Li, Duclos) Brigham and Women's
Hospital, Boston, MA, United States
(Liao, Kurreeman, Guzman, Zhang, Cai, Li, Duclos) Information Systems,
Boston, MA, United States
(Liao, Kurreeman, Guzman, Zhang, Cai, Li, Duclos) Harvard School of Public
Health, Boston, MA, United States
(Liao, Kurreeman, Guzman, Zhang, Cai, Li, Duclos) Broad Institute,
Cambridge, United States
(Liao, Kurreeman, Guzman, Zhang, Cai, Li, Duclos) Partners Healthcare
Systems, Boston, MA, United States
Title
The burden of autoimmunity and risk for coronary artery disease in
rheumatoid arthritis.
Source
Arthritis and Rheumatism. Conference: Annual Scientific Meeting of the
American College of Rheumatology and Association of Rheumatology Health
Professionals 2011 Chicago, IL United States. Conference Start: 20111104
Conference End: 20111109. Conference Publication: (var.pagings). 63 (10
SUPPL. 1) , 2011. Date of Publication: October 2011.
Publisher
John Wiley and Sons Inc.
Abstract
Background/Purpose: RA patients are at a 2-fold risk of coronary artery
disease (CAD) compared with the general population. Immune dysregulation
is thought to contribute to this elevated risk of CAD, but the precise
mechanisms are unknown. We hypothesized that the burden of autoimmunity,
represented by the presence of autoantibodies, or autoimmune risk alleles
are associated with increased risk of CAD in RA. We tested this hypothesis
in RA and 2 diseases with pathognomonic autoantibodies and published
genetic risk alleles, systemic lupus erythematosus (SLE) and celiac sprue.
Both SLE and celiac also share genetic risk alleles with RA. Methods: This
study was conducted in a cohort of 1335 RA subjects identified from the
electronic medical records of a large academic institution using our
published algorithm. We identified RA subjects with prevalent CAD through
medical record review. Subjects were identified with CAD if they had a CAD
diagnosis by their treating physician and documentation of CAD after
cardiac catheterization, stress test, EKG or if they underwent
angioplasty, stent placement, or a coronary artery bypass graft. We
measured anti-nuclear antibodies (ANA), antibodies to tissue
transglutaminase (tTG), and antibodies to cyclic citrullinated peptide
(CCP) in all RA cases using commercial ELISA kits. We genotyped subjects
for 34 SLE, 17 celiac, 29 RA validated risk alleles based on GWAS and
meta-analyses, and 182 ancestry informative markers (AIMs). We conducted
our analysis in European American (EU) subjects to minimize population
stratification. We calculated a SLE, celiac, and RA count genetic risk
score (GRS) by adding the number of disease specific risk alleles for each
individual. We tested the association between ANA, tTG, CCP titers and CAD
outcome using logistic regression in 3 separate models. The association
between CAD outcome and disease-specific GRS was conducted using a
student's t-test separately for SLE, celiac and RA. Results: Among 1335 RA
cases, 81% were female, 70% were CCP positive, 76% had bone erosions, and
8% (n=111) had CAD; 84% (n=1124) were EU by AIMs of which 9% (n=100) had
CAD. In EU RA cases we observed an association between the celiac GRS and
CAD outcome (p=0.03). There was a suggestive trend of higher tTG titers
associated with increased risk of CAD (p=0.06). No association was
observed between the SLE and RA GRS and CAD outcome. Similarly we found no
association between ANA and CCP titers and CAD outcome in RA cases.
Conclusion: The unexplained risk for CAD in RA patients may be partially
explained by the burden of autoimmunity, in particular genetic
predisposition for celiac disease.
<16>
Accession Number
70781429
Authors
Del Rey Hurtado de Mendoza B. Escudero Huedo V. Vazquez Rodriguez M.
Jimenez Figueroa L. Medina Malagon L. Iglesias Fernandez B. Marin Gabriel
M.A.
Institution
(Del Rey Hurtado de Mendoza, Escudero Huedo, Vazquez Rodriguez, Jimenez
Figueroa, Medina Malagon, Iglesias Fernandez, Marin Gabriel) Hospital
Universitario Puerta de Hierro-Majadahonda, Pediatrics/ Neonates, Spain
Title
Non-pharmacological analgesia in procedural pain in healthy term neonates:
A randomized controlled trial.
Source
Journal of Maternal-Fetal and Neonatal Medicine. Conference: 23rd European
Congress of Perinatal Medicine Paris France. Conference Start: 20120613
Conference End: 20120616. Conference Publication: (var.pagings). 25 (pp
39-40), 2012. Date of Publication: June 2012.
Publisher
Informa Healthcare
Abstract
Introduction-objective: Non-pharmacological interventions are important
alternatives for pain relief during minor procedures in neonates. The
purpose of this study was to compare the efficacy of different
non-pharmacological procedures in reducing pain response during blood
sampling through heel lance. Methods: In this randomised controlled trial,
136 healthy term newborn infants at Tertiary Public Hospital (Madrid) were
randomly assigned to four groups: (i) being breastfed with skinto- skin
contact (group 1, n = 35), (ii) receiving 2 mL oral 24% sucrose with
skin-to-skin contact with the mother (group 2, n = 35), (iii) being held
in skin-to-skin contact with the mother (group 3, n = 33) or (iv)
receiving 2 mL oral 24% sucrose (group 4, n = 33). Randomisation was by
closed envelopes and nurses and parents were masked to the randomization
group. All neonates were videotaped during the painful procedure (heel
lance). Heel lance was made with an automated piercing device for routine
neonatal screening for congenital disorders at 48 h of life. Patients were
excluded if previous capillar or venous sampling were made. Breastfeeding
was initiated at least 5 min before the procedure. Sucrose was given 2 min
before the procedure. Skin to skin contact was initiated at least 5 min
before the sample. Two observers watched the videos and measured pain by
Neonatal Infant Pain Scale. Duration of crying, % of crying while making
the procedure, heart rate and duration of sampling were also measured. A
inform consent was given to parents before including in the study. Data
were analysed per intention to treat. This study was approved by Local
Ethical Committee. Results: Coincidence between observers was 90.8% (95%
CI 87.8-93.8). There were no differences between groups in gestational
age, birthweight, Apgar score and gender. Mean NIPS score was 1.6 +/- 1.6
(group 1), 2.9 +/- 1.7 (group 2); 3.8 +/- 2 (group 3); and 3.5 +/- 1.8
(group 4) (p < 0.01 between group 1 and other groups). Length of crying
was significantly reduced in groups 1 and 2 versus groups 3 and 4 (p =
0.01). Percent of crying was lower in group 1 (p = 0.01). There were no
differences in heart rate not in the duration of sampling between groups.
(See Table 1). Conclusion: This study suggests that breastfeeding
associated with skin-to-skin contact provides superior analgesia for heel
lance in healthy term newborns compared with other kinds of
nonpharmacological analgesia. (Table presented) .
