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<1>
Accession Number
2014101198
Authors
Tanaka M. Sagawa M. Usuda K. Machida Y. Ueno M. Motono N. Sakuma T.
Institution
(Tanaka, Sagawa, Usuda, Machida, Ueno, Motono, Sakuma) Department of
Thoracic Surgery, Kanazawa Medical University, Uchinada, Kahoku, Ishikawa,
Japan
Title
Postoperative drainage with one chest tube is appropriate for pulmonary
lobectomy: A randomized trial.
Source
Tohoku Journal of Experimental Medicine. 232 (1) (pp 55-61), 2014. Date of
Publication: 2014.
Publisher
Tohoku University Medical Press (2-1 Seiryomachi, Aoba-ku, Sendai
980-8575, Japan)
Abstract
To expand postoperative residual lungs after pulmonary lobectomy, thoracic
drainage with two chest tubes has been recommended. Several studies
recently demonstrated that postoperative drainage with one chest tube
(PD1) was as safe as that with two chest tubes (PD2). However, most of the
patients in those studies underwent lobectomy by standard thoracotomy.
Although the number of pulmonary lobectomies by video-assisted thoracic
surgery (VATS) has been increasing in recent years, there have been no
reports that compared PD1 with PD2 after pulmonary lobectomy, including
that by VATS. To elucidate whether postoperative management with PD1 is as
safe as that with PD2, we conducted a randomized controlled trial. Lung
cancer patients who underwent lobectomies with mediastinal nodal
dissection in our hospital were assigned to one of two groups: one chest
tube placed in PD1 group and two chest tubes placed in PD2 group. A total
of 108 patients were registered in the study. There were no signifcant
differences in the age, gender, pathological stage or histological type
between two groups. Since the residual lung expansion was good in both
groups, there were no patients who needed thoracentesis. There were no
signifcant differences in the number of cases with pleurodesis, the
amount/duration of drainage or the pain of the patients between two
groups. In conclusion, since PD1 has advantages in saving cost and time
and in low risk of transcutaneous infection, PD1 is appropriate after
pulmonary lobectomy by VATS and by open thoracotomy. 2014 Tohoku
University Medical Press.
<2>
Accession Number
2014115123
Authors
Ozaydin M. Peker T. Akcay S. Uysal B.A. Yucel H. Icli A. Erdogan D. Varol
E. Dogan A. Okutan H.
Institution
(Ozaydin, Akcay, Uysal, Icli, Erdogan, Varol, Dogan) Department of
Cardiology, Suleyman Demirel University, 122 Hatice Halici No. 126, 32040
Isparta, Turkey
(Peker) Department of Anesthesiology, Suleyman Demirel University,
Isparta, Turkey
(Okutan) Department of Cardiovascular Surgery, Suleyman Demirel
University, Isparta, Turkey
Title
Addition of N-acetyl cysteine to carvedilol decreases the incidence of
acute renal injury after cardiac surgery.
Source
Clinical Cardiology. 37 (2) (pp 108-114), 2014. Date of Publication:
February 2014.
Publisher
John Wiley and Sons Inc. (111 River Street, Hoboken NJ 07030-5774, United
States)
Abstract
Background Oxidative stress and inflammation during cardiac surgery may be
associated with acute renal injury (ARI). N-acetyl cysteine (NAC) and
carvedilol have antioxidant and anti-inflammatory properties. Hypothesis A
combination of carvedilol and NAC should decrease the incidence of ARI
more than metoprolol or carvedilol. Methods Patients undergoing cardiac
surgery were randomized to metoprolol, carvedilol, or carvedilol plus NAC.
End points were occurrence of ARI and change in preoperative to
postoperative peak creatinine levels. Results ARI incidence was lower in
the carvedilol plus NAC group compared with the metoprolol (21.0% vs
42.1%; P = 0.002) or carvedilol (21.0% vs 38.6%; P = 0.006) groups, but
was similar between the metoprolol and carvedilol groups (P = 0.62).
Preoperative and postoperative day 1 creatinine levels were similar among
the metoprolol (1.02 [0.9-1.2] and 1.2 [0.92-1.45]) the carvedilol (1.0
[0.88-1.08] and 1.2 [0.9-1.5]) and the carvedilol plus NAC groups (1.06
[0.9-1.18] and 1.1 [1.0-1.21] mg/dL; all P values >0.05). Postoperative
day 3, day 5, and peak creatinine levels were lower in the carvedilol plus
NAC group (1.11 [1.0-1.23], 1.14 [1.0-1.25] and 1.15 [1.0-1.25]) as
compared with the metoprolol (1.4 [1.3-1.49], 1.3 [1.0-1.54] and 1.3
[1.0-1.54]) or carvedilol groups (1.2 [1.0-1.52], 1.25 [1.0-1.52] and 1.25
[1.0-1.55] mg/dL; all P values <0.05), but were similar between the
metoprolol and carvedilol groups (all P values >0.05). Conclusions
Combined carvedilol and NAC decreased ARI incidence as compared with
carvedilol or metoprolol. No difference was detected between carvedilol
and metoprolol. 2013 Wiley Periodicals, Inc.
<3>
Accession Number
2014095808
Authors
Harsoor S. Rani D. Lathashree S. Nethra S. Sudheesh K.
Institution
(Harsoor, Rani, Lathashree, Nethra, Sudheesh) Department of Anaesthesia,
Bangalore Medical College and Research Institute, Bangalore, Karnataka,
India
Title
Effect of intraoperative Dexmedetomidine infusion on Sevoflurane
requirement and blood glucose levels during entropy-guided general
anesthesia.
Source
Journal of Anaesthesiology Clinical Pharmacology. 30 (1) (pp 25-30), 2014.
Date of Publication: January-March 2014.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Background: Dexmedetomidine has been shown to blunt the stress response to
surgery. Hence a study was designed to evaluate the effect of intravenous
(IV) Dexmedetomidine infusion during general anesthesia for abdominal
surgeries on blood glucose levels and on Sevoflurane requirements during
anesthesia. Materials and Methods: Forty patients scheduled for abdominal
surgery under general anesthesia were divided into Dexmedetomidine (D)
group and Placebo (P) group of 20 each. Group D received a loading dose of
Inj. Dexmedetomidine at 1 mug/kg/10 min diluted to 20 mL, followed by
maintenance with 0.5 mug/kg/h., till the end of surgery. Group P received
similar volume of IV normal saline. Anesthesia was maintained with nitrous
oxide in oxygen and Sevoflurane keeping entropy between 40 and 60. Data
were analyzed using students t test, chi square test and Fisher Exact test
as applicable. Results: During the first postoperative hour,
Dexmedetomidine group showed blood glucose levels of 118.2 + 16.24 mg/dL,
compared to placebo group which was 136.95 + 19.76 mg/dL and it was
statistically significant (P < 0.01). Mean hourly Sevoflurane requirement
in Group D was 11.10 + 2.17 mL, compared to 15.45 + 3.97 mL in placebo
group. In peri-operative period, the heart rate and MAP were significantly
lower in Group D, when compared to placebo. Patients in Group D were
better sedated and post-operative pain score was better in Group D
compared to Group P. Conclusion: IV Dexmedetomidine was effective in
blunting stress response to surgical trauma as indicated by lower blood
glucose levels, and reduces Sevoflurane requirements during entropy guided
general anesthesia without affecting time for extubation.
<4>
Accession Number
2014115798
Authors
Garikipati N.V. Mittal S. Chaudhry F. Musat D.L. Sichrovsky T. Preminger
M. Arshad A. Steinberg J.S.
Institution
(Garikipati) Division of Cardiology, Wright State University Boonshoft
School of Medicine, Dayton, OH, United States
(Mittal, Musat, Sichrovsky, Preminger, Arshad, Steinberg) Arrhythmia
Institute, Valley Health System, Ridgewood, NJ, United States
(Mittal, Musat, Sichrovsky, Preminger, Arshad, Steinberg) Columbia
University, College of Physicians and Surgeons, New York, NY, United
States
(Chaudhry) Division of Cardiology, Mount Sinai Hospital, New York, NY,
United States
Title
Comparison of endovascular versus epicardial lead placement for
resynchronization therapy.
Source
American Journal of Cardiology. 113 (5) (pp 840-844), 2014. Date of
Publication: 01 Mar 2014.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Cardiac resynchronization therapy (CRT) has been shown to improve survival
and symptoms in patients with severe left ventricular (LV) dysfunction,
congestive heart failure, and prolonged QRS duration. LV lead placement is
achieved by placing the lead in the coronary sinus, an endovascular
approach, or by a minimally invasive robotic-assisted thoracoscopic
epicardial approach. There are no data directly comparing the 2 methods.
Patients eligible for CRT were randomized to the endovascular and
epicardial arms. Coronary sinus lead placement was achieved using the
standard technique, and epicardial leads were placed using a minimally
invasive robotic-assisted thoracoscopic approach. The primary end point
was a decrease in LV end-systolic volume index at 6 months. The secondary
end points included 30-day mortality rate, measures of clinical
improvement, 1-year electrical lead performance, and 1-year survival rate.
The relative improvement of LV end-systolic volume index from baseline to
6 months was similar between the arms (28.8% for the transvenous [n = 12]
vs 30.5% for the epicardial (n = 9) arm, p = 0.93). There were no
significant differences in the secondary end points between the 2 groups.
In conclusion, there were no differences in echocardiographic and clinical
outcomes comparing a conventional endovascular approach versus
robotic-assisted surgical epicardial LV lead placement for CRT in patients
with heart failure. Surgical approaches are still a viable alternative
when a transvenous procedure has failed or is not technically feasible.
2014 Elsevier Inc. All rights reserved.
<5>
Accession Number
2014111390
Authors
Lorut C. Lefebvre A. Planquette B. Quinquis L. Clavier H. Santelmo N.
Hanna H.A. Bellenot F. Regnard J.-F. Riquet M. Magdeleinat P. Meyer G.
Roche N. Huchon G. Coste J. Rabbat A.
Institution
(Lorut, Lefebvre, Roche, Huchon, Rabbat) Department of Respiratory and
Intensive Care Medicine, Cochin-Broca-Hotel, University Paris5, 27 rue du
Faubourg Saint Jacques, 75679 Paris cedex 14, France
(Regnard) Department of Thoracic Surgery, Cochin-Broca-Hotel-Dieu Hospital
Group, University Paris5, Paris, France
(Quinquis, Coste) Department of Biostatistics and Epidemiology, Hotel-Dieu
Hospital, University Paris5, Paris, France
(Planquette, Meyer) Department of Respiratory and Intensive Care Medicine,
European Georges Pompidou Hospital, University Paris5, Paris, France
(Riquet) Department of Thoracic Surgery, European Georges Pompidou
Hospital, University Paris5, Paris, France
(Clavier) Department of Intensive Care Medicine, Institut Montsouris
Hospital, Paris, France
(Magdeleinat) Department of Thoracic Surgery, Institut Montsouris
Hospital, Paris, France
(Santelmo) Department of Thoracic Surgery, University Hospital,
Strasbourg, France
(Hanna) Department of Thoracic Surgery, University Hospital, Dijon, France
(Bellenot) Department of Thoracic Surgery, University Hospital, Pontoise,
France
Title
Early postoperative prophylactic noninvasive ventilation after major lung
resection in COPD patients: A randomized controlled trial.
Source
Intensive Care Medicine. 40 (2) (pp 220-227), 2014. Date of Publication:
February 2014.
Publisher
Springer Verlag (Tiergartenstrasse 17, Heidelberg D-69121, Germany)
Abstract
Objectives: To investigate whether prophylactic postoperative NIV prevents
respiratory complications following lung resection surgery in COPD
patients. Methods: In seven thoracic surgery departments, 360 COPD
patients undergoing lung resection surgery were randomly assigned to two
groups: conventional postoperative treatment without (n = 179) or with (n
= 181) prophylactic NIV, applied intermittently during 6 h per day for 48
h following surgery. The primary endpoint was the rate of acute
respiratory events (ARE) at 30 days postoperatively (ITT analysis).
Secondary endpoints were acute respiratory failure (ARF), intubation rate,
mortality rate, infectious and non-infectious complications, and duration
of ICU and hospital stay. Measurements and main results: ARE rates did not
differ between the prophylactic NIV and control groups (57/181, 31.5 vs.
55/179, 30.7 %, p = 0.93). ARF rate was 18.8 % in the prophylactic NIV
group and 24.5 % in controls (p = 0.20). Re-intubation rates were similar
in the prophylactic NIV and control group [10/181 (5.5 %) and 13/179 (7.2
%), respectively, p = 0.53]. Mortality rates were 5 and 2.2 % in the
control and prophylactic NIV groups, respectively (p = 0.16). Infectious
and non-infectious complication rates, and duration of ICU and hospital
stays were similar between groups. Conclusions: Prophylactic postoperative
NIV did not reduce the rate of ARE in COPD patients undergoing lung
resection surgery and did not influence other postoperative complications
rates, mortality rates, and duration of ICU and hospital stay. 2013
Springer-Verlag Berlin Heidelberg and ESICM.
<6>
Accession Number
2014096131
Authors
Holper E.M. Kim R.J. Mack M. Brown D. Brinkman W. Herbert M. Stewart W.
Vance K. Bowers B. Dewey T.
Institution
(Holper, Herbert, Bowers, Dewey) Division of Cardiology, Medical City
Hospital, Dallas, TX, United States
(Kim, Stewart, Vance) Cardiopulmonary Research Science and Technology
Institute, Baylor, Plano, TX, United States
(Mack, Brown, Brinkman) Heart Hospital, Baylor, Plano, TX, United States
Title
Randomized trial of surgical cutdown versus percutaneous access in
transfemoral TAVR.
Source
Catheterization and Cardiovascular Interventions. 83 (3) (pp 457-464),
2014. Date of Publication: 15 Feb 2014.
Publisher
Wiley-Liss Inc. (111 River Street, Hoboken NJ 07030-5774, United States)
Abstract
Objectives To compare iliofemoral arterial complications with transfemoral
transcatheter aortic valve replacement (TF-TAVR) utilizing surgical
cutdown versus percutaneous access with closure devices in a randomized
trial. Background Major vascular complications following TAVR are a
significant risk of the procedure. There are no randomized data comparing
whether access method in TF-TAVR influences the risk of such
complications. Methods From June to December 2011, 30 consecutive patients
undergoing TF-TAVR were randomized to either surgical cutdown (C) or
percutaneous (P) access. Subjects underwent preoperative CT scans, pre-
and post-operative bilateral femoral arterial ultrasound and angiography.
The primary endpoint was the composite of major and minor vascular
complications at 30 days, as defined by the Valve Academic Research
Consortium-2. Multivariate predictors of vascular complications were
identified. Results Of the 30 subjects enrolled, 27 were treated with the
randomized method of access as randomized. Iliofemoral complications were
observed in eight patients (26.7%; C = 4, P = 4), all of which were
dissections and/or stenoses that required percutaneous and/or surgical
intervention. There were two (13.3%) major and two (13.3%) minor
complications in each group. Two covariates that were significantly
associated with vascular complications included female sex and baseline
femoral arterial velocity on ultrasound. Conclusions While surgical
cutdown in TF-TAVR is the recommended access for new centers initiating a
TAVR program, this small randomized pilot study suggests the lesser
invasive percutaneous method in an experienced center is equivalent in
safety to the surgical method. Doppler ultrasound may be useful in
predicting complications prior to the procedure. 2013 Wiley Periodicals,
Inc. Copyright 2013 Wiley Periodicals, Inc.
<7>
Accession Number
2014111137
Authors
Mcconnachie A. Walker A. Robertson M. Marchbank L. Peacock J. Packard C.J.
Cobbe S.M. Ford I.
Institution
(Mcconnachie, Walker, Robertson, Ford) Robertson Centre for Biostatistics,
University of Glasgow, Glasgow G12 8QQ, United Kingdom
(Marchbank) Information Services Division (ISD), NHS National Services
Scotland, Paisley PA3 2SJ, United Kingdom
(Peacock) Information Services Division (ISD), NHS National Services
Scotland, Edinburgh EH12 9EB, United Kingdom
(Packard) Tennent Building, Western Infirmary, Glasgow G11 6NT, United
Kingdom
(Cobbe) Department of Medical Cardiology, Glasgow Royal Infirmary, Glasgow
G4 0SF, United Kingdom
Title
Long-term impact on healthcare resource utilization of statin treatment,
and its cost effectiveness in the primary prevention of cardiovascular
disease: A record linkage study.
Source
European Heart Journal. 35 (5) (pp 290-298), 2014. Date of Publication: 01
Feb 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
AimsTo assess the impact on healthcare resource utilization, costs, and
quality of life over 15 years from 5 years of statin use in men without a
history of myocardial infarction in the West of Scotland Coronary
Prevention Study (WOSCOPS).MethodsSix thousand five hundred and
ninety-five participants aged 45-54 years were randomized to 5 years
treatment with pravastatin (40 mg) or placebo. Linkage to routinely
collected health records extended follow-up for secondary healthcare
resource utilization to 15 years. The following new results are reported:
cause-specific first and recurrent cardiovascular hospital admissions
including myocardial infarction, heart failure, stroke, coronary
revascularization and angiography; non-cardiovascular hospitalization;
days in hospital; quality-adjusted life years (QALYs); costs of
pravastatin treatment, treatment safety monitoring, and hospital
admissions.ResultsFive years treatment of 1000 patients with pravastatin
(40 mg/day) saved the NHS 710 000 (P < 0.001), including the cost of
pravastatin and lipid and safety monitoring, and gained 136 QALYs (P =
0.017) over the 15-year period. Benefits per 1000 subjects, attributable
to prevention of cardiovascular events, included 163 fewer admissions and
a saving of 1836 days in hospital, with fewer admissions for myocardial
infarction, stroke, heart failure and coronary revascularization. There
was no excess in non-cardiovascular admissions or costs (or in admissions
associated with diabetes or its complications) and no evidence of
heterogeneity of effect over sub-groups defined by baseline cardiovascular
risk.ConclusionFive years' primary prevention treatment of middle-aged men
with a statin significantly reduces healthcare resource utilization, is
cost saving, and increases QALYs. Treatment of even younger, lower risk
individuals is likely to be cost-effective. The Author 2013.
<8>
Accession Number
2014115791
Authors
Rodriguez A.E. Palacios I. Rodriguez-Granillo A.M. Mieres J.R. Tarragona
S. Fernandez-Pereira C. Solorzano L. Pauletto R. Serruys P.W. Antoniucci
D.
Institution
(Rodriguez, Rodriguez-Granillo) Centro de Estudios en Cardiologia
Intervencionista, Buenos Aires, Argentina
(Rodriguez, Mieres, Solorzano, Pauletto) Department of Cardiology,
Sanatorio Otamendi y Miroli, Buenos Aires, Argentina
(Rodriguez, Mieres, Pauletto) Department of Cardiology, Sanatorio Las
Lomas, Buenos Aires, Argentina
(Palacios) Department of Cardiology, Massachusetts General Hospital,
Boston, MA, United States
(Tarragona) Argentina Association in Health and Economics, Buenos Aires,
Argentina
(Fernandez-Pereira, Solorzano) Department of Cardiology, Clinica IMA,
Buenos Aires, Argentina
(Serruys) Department of Cardiology, Erasmus Thoraxcenter, Rotterdam,
Netherlands
(Antoniucci) Department of Cardiology, Careggi Hospital, Florence, Italy
Title
Comparison of cost-effectiveness of oral rapamycin plus bare-metal stents
versus first generation of drug-eluting stents (from the Randomized Oral
Rapamycin in Argentina [ORAR] 3 Trial).
Source
American Journal of Cardiology. 113 (5) (pp 815-821), 2014. Date of
Publication: 01 Mar 2014.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The aim of this study was to compare 5-year cost-effectiveness and
clinical outcomes of patients with oral rapamycin (OR) plus bare-metal
stent versus the drug-eluting stent (DES) strategy. During 2006 to 2007, a
total of 200 patients were randomized to OR (n = 100) and DES (n = 100).
Primary end point was to compare costs of initial procedure and
cost-effectiveness of both revascularization strategies. Safety was
evaluated by the composite of death, myocardial infarction, and
cerebrovascular accident. Efficacy was assessed by target vessel and
target lesion revascularizations. The 2 groups had similar baseline
demographic, clinical, and angiographic characteristics. In the DES group,
paclitaxel-, zotarolimus-, and sirolimus-eluting stents were used.
Five-year clinical follow-up was accomplished in 99% patients. The DES
group had significantly higher procedural (p <0.001), discharge to
first-year (p = 0.02), and 1- to 5-year costs (p <0.001) compared with the
OR group. At 5 years, the composite end point of death, myocardial
infarction, and cerebrovascular accident (12% in the OR group vs 25% in
the DES group, p = 0.01) was significantly less in the OR group. Target
vessel revascularization (14.5% in the OR group vs 21% in the DES group, p
= 0.16) and target lesion revascularization (10% in the OR group vs 17.6%
in the DES group, p = 0.05) were not significantly different. In
conclusion, a strategy of OR plus bare-metal stent was cost saving than a
first-generation DES. 2014 Elsevier Inc. All rights reserved.
<9>
Accession Number
2014115782
Authors
Shimony A. Grandi S.M. Pilote L. Joseph L. O'Loughlin J. Paradis G.
Rinfret S. Sarrafzadegan N. Adamjee N. Yadav R. Gamra H. Diodati J.G.
Eisenberg M.J.
Institution
(Shimony, Grandi, Eisenberg) Divisions of Cardiology and Clinical
Epidemiology, Jewish General Hospital, McGill University, Montreal, QC,
Canada
(Grandi, Pilote, Joseph, Paradis, Eisenberg) Department of Epidemiology,
Biostatistics and Occupational Health, McGill University, Montreal, QC,
Canada
(Pilote, Joseph) Division of Clinical Epidemiology, McGill University
Health Centre, Montreal, QC, Canada
(Pilote) Division of General Internal Medicine, McGill University Health
Centre, Montreal, QC, Canada
(O'Loughlin) Department of Social and Preventive Medicine, Universite de
Montreal, Montreal, QC, Canada
(Rinfret) Multidisciplinary Cardiology Department, Quebec Heart-Lung
Institute, Quebec City, QC, Canada
(Sarrafzadegan) Isfahan Cardiovascular Research Center, Isfahan University
of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Adamjee) Interactive Research and Development Center, Karachi, Pakistan
(Yadav) Department of Cardiology, All India Institute of Medical Sciences,
New Delhi, India
(Gamra) Cardiac Thrombosis Research Unit, Department of Cardiology A,
Fattouma Bourguiba University Hospital, Monastir, Tunisia
(Diodati) Division of Cardiology, Hopital du Sacre-Coeur de Montreal,
Montreal, QC, Canada
Title
Utilization of evidence-based therapy for acute coronary syndrome in
high-income and low/middle-income countries.
Source
American Journal of Cardiology. 113 (5) (pp 793-797), 2014. Date of
Publication: 01 Mar 2014.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
Limited data exist regarding the management of patients with acute
coronary syndrome (ACS) in high-income countries compared with
low/middle-income countries. We aimed to compare in-hospital trends of
revascularization and prescription of medications at discharge in patients
with ACS from high-income (Canada and United States) and low/middle-income
(India, Iran, Pakistan, and Tunisia) countries. Data from a double-blind,
placebo-controlled, randomized trial investigating the effect of bupropion
on smoking cessation in patients after an enzyme-positive ACS was used for
our study. A total of 392 patients, 265 and 127 from high-income and from
low/middle-income countries, respectively, were enrolled. Patients from
high-income countries were older, and were more likely to have diagnosed
hypertension and dyslipidemia. During the index hospitalization, patients
from high-income countries were more likely to be treated by percutaneous
coronary intervention (odds ratio [OR] 19.7, 95% confidence interval [CI]
10.5 to 37.0). Patients with ST elevation myocardial infarction from
high-income countries were more often treated by primary percutaneous
coronary intervention (OR 16.3, 95% CI 6.3 to 42.3) in contrast with
thrombolytic therapy (OR 0.24, 95% CI 0.14 to 0.41). Patients from
high-income countries were also more likely to receive evidence-based
medications at discharge (OR 2.32, 95% CI 1.19 to 4.52, a composite of
aspirin, clopidogrel, and statin). In conclusion, patients with ACS in
low/middle-income countries were less likely to be revascularized and to
receive evidence-based medications at discharge. Further studies are
needed to understand the underutilization of procedures and evidence-based
medications in low/middle-income countries. 2014 Elsevier Inc. All rights
reserved.
<10>
[Use Link to view the full text]
Accession Number
23934169
Authors
Van der Linden P. De Ville A. Hofer A. Heschl M. Gombotz H.
Institution
(Van der Linden) * Professor, Department of Anesthesia, Centre hospitalier
Universi taire Brugmann, Hopital Universitaire des Enfants Reine Fabiola,
Brussels, Belgium. + Staff Member, ++ Professor, Department of Anesthesia
and Intensive Care, Algemeines Krankenhaus der Stadt Linz, Linz, Austria.
Title
Six percent hydroxyethyl starch 130/0.4 (Voluven) versus 5% human serum
albumin for volume replacement therapy during elective open-heart surgery
in pediatric patients.
Source
Anesthesiology. 119 (6) (pp 1296-1309), 2013. Date of Publication: Dec
2013.
Abstract
Although 5% albumin (human serum albumin [HSA]) is widely used in cardiac
surgery children, synthetic colloids may provide a valuable alternative.
This study compared 6% hydroxyethyl starch (HES) 130/0.4 with HSA for
volume replacement in this population. The study was a two-center,
randomized, controlled, parallel-group, double-blind trial performed in
children aged 2-12 yr undergoing elective surgery for congenital heart
disease under extracorporeal circulation. The primary objective was to
demonstrate equivalence between HES and HSA with regard to the total
volume of colloid infusion for intraoperative volume replacement including
priming of the extracorporeal circuitery. In the per-protocol population,
mean volume of colloid required until end of surgery was (mean + SD) 36.6
+ 11.8 ml/kg body weight in the HES group (N = 29) and 37.0 + 11.9 ml/kg
body weight in the HSA group (N = 26; ratio of means HES/HSA = 0.98 [95%
CI, 0.84-1.16]). Intraoperative fluid balance was less positive in the HES
group (P = 0.047). No difference was found regarding hemodynamics, the use
of vasoactive and inotropic drugs. Blood loss, erythrocytes transfusion,
and renal function were not different between groups. The incidence of
adverse events up to postoperative day 28 did not differ between the
groups. In pediatric cardiac surgery, HES showed equivalence to HSA with
regard to volume replacement therapy in children aged from 2 to 12 yr.
Although there was no suggestion of an imbalance of safety measures
between HES and HSA, the study was not powered to provide any firm
conclusions about safety of tetrastarch in this population.
<11>
Accession Number
23716291
Authors
Malago R. Pezzato A. Barbiani C. Tezza M. Sala G. Alfonsi U. Mucelli R.P.
Institution
(Malago) Istituto di Radiologia, Azienda Ospedaliero Universitaria
Integrata di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134,
Verona, Italy,
Title
Learning curve in multidetector CT coronary angiography (MDCT-CA).
Source
La Radiologia medica. 118 (8) (pp 1281-1293), 2013. Date of Publication:
Dec 2013.
Abstract
Coronary angiography using multidetector computed tomography (MDCT-CA) is
a recent technique for the nonivasive study of coronary arteries. This
study assessed the diagnostic accuracy of coronary artery stenosis
evaluation obtained by three readers at different levels of training or at
different points of the learning curve proposed by the international
guidelines. Three radiologists in training with different levels of
experience in MDCT-CA scored 50 cases at various time points of the
learning curve: baseline, 4 weeks, 8 weeks and 6 months. The trainee
radiologists evaluated the degree of stenosis on each coronary segment,
and overall accuracy was calculated on a per-segment, pervessel and
per-patient basis. All readers improved analysis accuracy per segment
(range, 73-90%); sensitivity reached 45% per segment, 84% per vessel and
93% per patient; specificity was 99% per segment and vessel and 98% per
patient. Positive and negative predictive values increased to 94% and 92%,
respectively. Although all readers improved in diagnostic performance with
growing experience with MDCT-CA, a longer training period may be necessary
to achieve adequate levels of expertise in MDCT-CA to be able to perform
as independent readers.
<12>
Accession Number
2013422453
Authors
Abid Shah M. Suleman S. Hussain Munir A.
Institution
(Abid Shah, Suleman) Department of Pharmacology, Khyber Medical College,
Peshawar, Pakistan
(Hussain Munir) Department of Pathology, Khyber Medical College, Peshawar,
Pakistan
Title
Comparative efficacy and safety profile of 5 MG rosuvastatin versus 10 MG
rosuvastatin in patients with ischemic heart disease.
Source
Journal of Medical Sciences (Peshawar). 21 (1) (pp 35-39), 2013. Date of
Publication: January 2013.
Publisher
Khyber Medical College (PeshawarPakistan)
Abstract
Objectives: To compare the efficacy and clinical profile of 5 mg
rosuvastatin versus 10 mg rosuvastatin in improving the management of
patients with IHD. Material and Methods: This study was jointly conducted
by Department of Pharmacology, Khyber Medical College, and Cardiology
Department of Khyber Teaching Hospital from January 2011 to August 2011.
The patients presenting to coronary care unit and cardiology OPD were
randomized into a two groups; Group A and Group B each comprising 50
patients. Group A recieved 5 mg of rosuvastatin and Group B received 10 mg
of resovuastatin for three months. National cholesterol Education
programme adult treat panel III (NCEP ATP III) guideline for LDL-C was
chosen as the primary objective while assessing the safety profile and
toxicity was considered the secondary end point. A rise in HDL-C was also
anticipated. Results: Thirty-four (68%) patients in group A and 41 (82%)
patients in group B were male. All the patients were resident of Peshawar.
Their mean ages were 51.4 + 7.6 and 49.35 + 5.65 years respectively in
group A and B. The LDL-C dropped to NCEP ATP III value of < 100 mg% in 3
(26%) patients in group A compared to 4 (88%) in group B P < 0.0004. LDL-C
levels after the 3 month treatment showed a mean reduction of 66.2 + 3.8
and 84.1 + 4.3 in group A and B respectively implying 39.02% and 48.38 %
reduction with a P value < 0.0001. The reduction to total cholesterol
(TLC) was 31.69% (mean 83.2 + 7.5) and 41.28% (mean 107.0 + 3.3) in the
respective groups with a P value of < 0.0001. The significant value for
triglycerids was a P < 0.04 for group B while the HDL-C improvement was
0.0006 in group B (receiving 10 mg rosuvastatin). The reported increased
in the incidence of myalgia and muscle weakness was statistically
insignificant P < 0.06. Conclusion: Rosuvastatin; clinically proven
antilipidemic agent for the management of IHD has a better efficacy with
almost identical adverse effects in 10 mg doses as compared with 5 mg
doses and this satisfies the NCEPATP III guidelines.
<13>
Accession Number
2014100864
Authors
Borji R. Reza Khatami M. Reza Abbasi M. Meysamie A. Barkhordari K.
Ayatollah Esfahani F. Pashang M. Ghadirian L.
Institution
(Borji) Department of Internal Medicine, Imam Khomeini Hospital, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Reza Khatami, Reza Abbasi) Department of Nephrology, Nephrology Research
Center, Imam Khomeini hospital, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Meysamie) Department of Community Community Medicine, Tehran University
of Medical Sciences, Tehran, Iran, Islamic Republic of
(Barkhordari) Department of Anesthesiology and Critical Care Medicine,
Tehran heart center, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Ayatollah Esfahani, Pashang) Nurse, Cardiovascular Research Department,
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Ghadirian) Community Based Participatory Research Centre, Center for
Academic and Health Policy, Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Title
Prophylactic dialysis in non-dialysis-dependent patients with renal
failure after CABG.
Source
Tehran University Medical Journal. 71 (12) (pp 800-806), 2014. Date of
Publication: 2014.
Publisher
Tehran University of Medical Sciences (202 Amouzesh Building, Poursina
Ave., Ghods St, Keshavarz Blvd, Tehran, Iran, Islamic Republic of)
Abstract
Background: The mortality due to Coronary Artery Bypass Graft (CABG) in
patients with chronic renal failure is more common than normal population.
This study evaluates the impacts of prophylactic dialysis on decreasing
mortality and morbidity of nondialysis- dependent patients with renal
failure after CABG surgery. Methods: In this study, fifty
non-dialysis-dependent patients who were suffering from renal failure and
needed to CABG, were selected by convenience sampling method.
Sequentially, they were allocated to prophylactic dialysis (n=20) and no
prophylactic dialysis (n=30) groups, using a randomized block design.
Exclusion criteria were under 18 year old patients and doing CABG for
second time. Mortality rate and some complications such as acute renal
failure, brain accident and atrial arrhythmias were compared between two
groups after CABG. All cardiac surgeries were performed in a single centre
and through a median sternotomy. P value less than 0.05 was considered as
significant. Results: The mean age of patients was (65.3+9.9). The
patients included %16 (n.8) of women and %84 (n.42) of men. There were 20
patients in intervention and 30 patients in control groups. Baseline
characteristics were similar in two groups. Comparison between
intervention and control groups after surgery did not show any difference
in mortality (P=0.14), acute renal failure (P=0.4), cerebrovascular
accidents (P=1) and atrial arrhythmias (P=0.3), need to second surgery due
to bleeding (P=1), need to dialysis (P=0.14), need to rehospitalization
(P=1), duration of ventilator use (P=0.4), duration of need to
hospitalization (P=0.11), duration of a patients stay in the Intensive
Care Unit (P=0.4) and deep sternal infection (P=0.7) rates. Conclusion:
According the results of this study, prophylactic dialysis, before
conducting CABG, does not have any significant effect on mortality and
other complications. The only exception is lung complications in
non-dialysis-dependent patients with renal failure.
<14>
Accession Number
2014100862
Authors
Sarzaeem M. Shayan N.
Institution
(Sarzaeem) Department of Cardiovascular Surgery, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Shayan) Transplantation Research Center, Dr. Shariati Hospital, Tehran,
Iran, Islamic Republic of
Title
Vitamin C in prevention of atrial fibrillation after coronary artery
bypass graft: Double blind randomized clinical trial.
Source
Tehran University Medical Journal. 71 (12) (pp 787-793), 2014. Date of
Publication: 2014.
Publisher
Tehran University of Medical Sciences (202 Amouzesh Building, Poursina
Ave., Ghods St, Keshavarz Blvd, Tehran, Iran, Islamic Republic of)
Abstract
Background: Atrial fibrillation is the most common arrhythmia after
cardiac surgery. Vitamin C as an antioxidant has an important role in
reducing the incidence of postoperative atrial fibrillation. The present
study aimed at administrating vitamin C as a way to reduce the incidence
of post-CABG atrial fibrillation. Methods: In this double-blind, parallel
clinical trial, 170 patients with coronary artery disease who underwent
CABG surgery, by using a table of random numbers are divided into
intervention and control groups to receive placebo or vitamin C. The
clinical and surgical characteristics of the patients in the two groups
were similar. The intervention group received 2 mg of vitamin C
intravenously, the night before surgery. This drug followed by 500 mg,
twice a day for five days after surgery. On the other hand patients in the
control group received placebo (normal saline intravenously). After
operation two groups were compared regarding Important outcomes such as
postoperative arrhythmia, ICU stay and hospital stay. Results: One hundred
eighteen men and fifty two women with a mean age of 59.1+9.8 years were
enrolled in the study in two vitamin C and placebo groups (each consisting
of 85 patients). The incidence of postoperative atrial fibrillation was
12.9% in the vitamin C group and 29.4% in the control group (P=0.009). ICU
stay in the vitamin C group were 2.5+1.4 days versus 3.0+1.6 days in
controls (P=0.035) and hospital stay in the vitamin C group were 6.6+1.5
days versus 8.2+2.3 days in controls (P<0.001). Conclusion: Vitamin C is
relatively safe, inexpensive, well tolerated and has a low complication.
According to the 44% reduction in the incidence of atrial fibrillation in
vitamin C patients undergoing coronary artery bypass grafting surgery,
this drug can be prescribed as a prophylaxis for prevention of post-CABG
atrial fibrillation.
<15>
Accession Number
2014095932
Authors
Turner A. Murphy B.M. Higgins R.O. Elliott P.C. Le Grande M.R. Goble A.J.
Worcester M.U.C.
Institution
(Turner, Murphy, Higgins, Elliott, Le Grande, Goble, Worcester) Heart
Research Centre, Royal Melbourne Hospital, PO Box 2137, VIC 3050,
Australia
(Turner, Murphy, Elliott, Worcester) University of Melbourne, VIC,
Australia
Title
An integrated secondary prevention group programme reduces depression in
cardiac patients.
Source
European Journal of Preventive Cardiology. 21 (2) (pp 153-162), 2014. Date
of Publication: February 2014.
Publisher
SAGE Publications Inc. (2455 Teller Road, Thousand Oaks CA 91320, United
States)
Abstract
Objective: Depression is common following an acute cardiac event and can
occur at a time when behaviour change is strongly recommended to reduce
the risk of further cardiovascular events. The 'Beating Heart Problems'
programme was designed to support cardiac patients in behaviour change and
mood management. Methods: The programme was based on cognitive behaviour
therapy and motivational interviewing. A randomized controlled trial (RCT)
comparing the 8-week group programme with usual care was undertaken
between 2007 and 2010. All patients attended a hospital-based clinic for
assessment of physiological risk factors at baseline (6 weeks after their
acute event), and at 4- and 12-month follow up. Psychological and
behavioural indicators were assessed by self-report questionnaires. Of the
275 patients enrolled into the RCT, 42 (15%) had Beck Depression
Inventory-II scores >13 at baseline. Treatment and control group
comparisons were undertaken for this subgroup, using growth curve
modelling and testing for group differences over time in psychological,
physiological, health behaviour, and self-efficacy measures. Results:
Significantly greater improvements (p<0.01) in depression symptoms and
self-rated health were reported for the intervention group, as well as
significantly larger gains in confidence in managing depression (p<0.05)
and anger (p<0.01). Trends (0.05<p<0.10) for larger treatment group
improvements were also seen for anxiety symptoms and confidence in
managing anxiety. Conclusion: A group secondary-prevention programme that
integrates behavioural and mood management strategies leads to decreased
depression, increased confidence, and improved health perceptions in
depressed cardiac patients. The European Society of Cardiology 2012.
<16>
Accession Number
2014106052
Authors
Migliore A. Jefferson T. Cerbo M. Abraha I. Montedori A.
Institution
(Migliore, Jefferson, Cerbo, Abraha) Agenas Sperimentazione e Sviluppo,
Agenzia Nazionale per i Servizi Sanitari Regionali, ISS-Innovazione, via
Puglie, 23-00187 Rome, Italy
(Abraha, Montedori) Office of Regional Health Planning, Regional Health
Authority of Umbria, via M. Angeloni, 61-06124 Perugia, Italy
Title
Implantable devices for the closure of patent foramen ovale in adults: An
Italian rapid health technology assessment.
Source
Expert Review of Medical Devices. 11 (2) (pp 151-161), 2014. Date of
Publication: March 2014.
Publisher
Expert Reviews Ltd. (2 Albert Place, London N3 1QB, United Kingdom)
Abstract
Percutaneous closure of patent foramen ovale (PFO) is offered to patients
suffering from cryptogenic stroke, transient ischemic attack or persistent
migraine. Several PFO closure devices are CE marked but none have yet been
approved by the FDA. On the Italian market 11 different PFO closure
devices are available and more than 2500 PFO procedures were reported in
2012. We report findings of a systematic review and meta-analysis of
studies in which patients with PFO and transient ischemic attacks,
cryptogenic stroke or persistent migraine who underwent PFO closure were
compared to patients treated by usual care. We included five controlled
clinical trials and one randomized controlled trial. Included studies had
poor methodological quality and heterogeneity. In the included randomized
controlled trial, 4.7% of procedure-related serious adverse events were
observed. Large multicenter, sufficiently powered, and properly randomized
trials need to be conducted in Europe with particular attention to patient
selection. 2014 Informa UK Ltd.
<17>
Accession Number
71331366
Authors
Gough A. O'Sullivan K. Barry M. Hurley J. Sugrue D.
Institution
(Gough, O'Sullivan, Barry, Hurley, Sugrue) Mater Misericordiae University
Hospital, Dublin, Ireland
Title
Is valve choice the main determinant of paravalvular leak post
transcatheter aortic valve implantation?.
Source
Irish Journal of Medical Science. Conference: 64th Irish Cardiac Society
Annual Scientific Meeting Co. Kerry Ireland. Conference Start: 20131004
Conference End: 20131005. Conference Publication: (var.pagings). 182 (pp
S376), 2013. Date of Publication: October 2013.
Publisher
Springer London
Abstract
Background: Significant paravalvular regurgitation (PVR) following
transcatheter aortic valve implantation (TAVI) is associated with poor
survival. Unfavourable anatomic and pathological factors contribute. There
is considerable variability in PVR rates reported. The two most popular
valve delivery systems,MedtronicCorevalve (MCV)and Edwards Sapien (ES),
differ significantly in structure and deployment technique. Methods: A
systematic review of literature looking at PVR at timepoints up to 1 year,
using different valve types was performed through Pubmed and bibliographic
searches from 2008-2013. One analysis consisted of immediate,
post-procedure and 30 day rates of PVR with 6 months and 1 year separately
reviewed. A systematic review and meta-analysis of studies of PVR in MCV
and ES was performed. Results: Over 8000 patients from over 20 studies
looking at PVR up to 1 year were examined; focusing on 9 studies comparing
MCV versus ES outcomes, and other factors predisposing to PVR to ascertain
if valve choice is the main determinant of PVR. Pooled rate of significant
PVR was 9.0 % (95 % confidence interval: 5.5, 13.0). Rates at 6 months and
1 year were 10.2 %(95 %CI: 1.5, 24.9) and 7.0 %(95 % CI: 0, 26.5)
respectively. Examining valve types; MCV displayed more PVR; 15.75 % >95 %
CI 12.48-19.32] versus ES 3.93 % >95 % CI 1.05-8.38]. Comparing PVR rates
by mixed-effects meta-regression with fixed-effect moderator variable for
valve type, suggesting statistically significant difference inPVRrates
between valves (p = 0.0002). Conclusion: Approximately 10 % of patients
develop PVR post TAVI, impacting on survival. There's no universally
accepted method of reporting rates of PVR between studies which would be
useful to ensure consistency in reporting. Numerous factors including
valve choice impact on PVR. Evidence suggests that valve choice remains
the most modifiable factor in reducing PVR post TAVI.
<18>
Accession Number
71331345
Authors
McKavanagh P. Lusk L. Ball P.A. Trinick T.R. Duly E. Verghis R M. Agus
A.M. Walls G.M. McCusker S. Orr C. Hamilton A. Harbinson M.T. Donnelly
P.M.
Institution
(McKavanagh, Lusk, Ball, Trinick, Duly, Verghis R, Agus, Walls, McCusker,
Orr, Hamilton, Harbinson, Donnelly) Ulster Hospital, Dundonald, Belfast,
United Kingdom
Title
One year follow up of the CAPP study: A randomised controlled trial
comparing EST to cardiac CT.
Source
Irish Journal of Medical Science. Conference: 64th Irish Cardiac Society
Annual Scientific Meeting Co. Kerry Ireland. Conference Start: 20131004
Conference End: 20131005. Conference Publication: (var.pagings). 182 (pp
S368), 2013. Date of Publication: October 2013.
Publisher
Springer London
Abstract
Purpose: This is the 1 year follow-up of The Cardiac Computerised
Tomography (CT) for the Assessment of Pain and Plaque (CAPP) study.
[ISRCTN52480460]. The study compared the economic and clinical outcomes of
using cardiac CT compared to Exercise Stress Test (EST) in stable troponin
negative chest pain. Method: CAPP is a cost-utilisation analysis
randomised controlled trial. 500 patients without known coronary artery
disease received either EST or cardiac CT. All patients were followed up
for re-hospitalisations rates and adverse events and for angina symptoms
with the well established Seattle Angina Questionnaires (SAQ). Results: Of
the 500 patients randomised 12 withdrew over the year, resulting in 245 in
the EST arm and 243 in CT arm receiving follow up. The mean age was 58.3
years and a mean Diamond Forrester score of 46.4 %. There were with no
significant differences in the pretest probabilities, age, sex or risk
factors. Over the 1 year follow up period there were 29 Emergency
Department (ED) chest pain attendances in the EST arm, with 13 unplanned
admissions, compared to 8 ED attendances with 2 unplanned admissions in
the CT arm. There were also more cardiology outpatient attendances in the
EST arm. In the EST arm there were 7 patients who underwent Coronary
Artery Bypass Grafting (CABG) and 12 who had Percutaneous Coronary
Intervention (PCI), compared to 9 CABG and 29 PCI in the CT arm. At 1 year
408 (81.6 %) patients had returned the SAQ, 210 in the CT arm and 198 in
the EST. There were significant improvements in the SAQ angina stability
and quality of life scores at 1 year in the CT arm (p B 0.05).
Conclusions: Cardiac CT as an index investigation for stable chest pain
improved angina stability and quality of life, resulting in fewer planned
and unplanned hospital attendances.
<19>
Accession Number
71326247
Authors
Healy D.A. Boyle E.M. McCartan D. Bourke M. Dowdall J. Cross S. Manning B.
Fulton G. Kavanagh E. Burke P. Grace P.A. Clarke Moloney M. Walsh S.R.
Institution
(Healy, Kavanagh, Burke, Grace, Clarke Moloney, Walsh) Department of
Vascular Surgery, University Hospital Limerick, Limerick, Ireland
(Boyle, Manning, Fulton) Department of Vascular Surgery, Cork University
Hospital, Cork, Ireland
(McCartan, Bourke, Dowdall, Cross) Department of Vascular Surgery,
Waterford Regional Hospital, Waterford, Ireland
Title
Preconditioning shields against vascular events in surgery
(preconditioning-SAVES): Pilot results.
Source
Irish Journal of Medical Science. Conference: 21st Sylvester O'Halloran
Meeting Co. Limerick Ireland. Conference Start: 20130301 Conference End:
20130302. Conference Publication: (var.pagings). 182 (pp S32), 2013. Date
of Publication: March 2013.
Publisher
Springer London
Abstract
Strategies are needed to reduce cardiovascular complications following
major arterial surgery. Remote ischaemic preconditioning (RIPC) has been
shown to reduce myocardial damage in cardiac surgery. Whether RIPC can
improve clinical outcomes in vascular surgery is unclear. Preconditioning
SAVES is a multi-centre randomized controlled trial, aiming to evaluate
the effect of RIPC on patients who are undergoing open abdominal aortic
aneurysm (AAA) repair, endovascular aneurysm repair (EVAR), lower limb
revascularization or carotid endarterectomy procedures. Patients are
randomized to either a period of tourniquet-induced upper limb
ischaemia/reperfusion (RIPC arm) or no intervention (control arm).
Recruitment to the pilot phase of the trial began in January 2012. The
primary endpoint combines death, cardiac arrest, myocardial infarction,
new arrhythmia, unstable angina, congestive cardiac failure, transient
ischaemic attack, renal failure requiring dialysis, mesenteric ischaemia
and respiratory failure. For the pilot trial, perioperative troponin leak
is a surrogate primary outcome. Secondary endpoints include duration of
hospital and intensive care unit stay and several other perioperative
complications. Outcomes are assessed 1 month following surgery. The
results of the first 50 patients are presented. Primary clinical outcomes
incidences were 4/26 (15.4 %) in the RIPC arm and 4/24 (16.7 %) in the
control arm. Secondary clinical outcome incidences were 10/26 (38.5 %) and
10/24 (41.7 %), respectively. There were no significant differences in
clinical outcomes or troponin values. Preconditioning SAVES aims to
establish whether RIPC confers a clinical benefit when used in major
vascular surgery. Our initial results confirm the feasibility of
conducting a large trial to establish the role of RIPC.
<20>
Accession Number
71326050
Authors
Fitzmaurice G. McWilliams B. Nolke L. Redmond M. McGuinness J. O'Donnell
M.
Institution
(Fitzmaurice, Nolke, Redmond, McGuinness) Department of Cardiothoracic
Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
(McWilliams) Department of Anaesthetics and Intensive Care Medicine,
Cardiff University, Heath Park, Cardiff, United Kingdom
(O'Donnell) Department of Life and Health Sciences, University of Ulster,
Jordanstown, Ireland
Title
Do statins have a role in the promotion of post-operative wound healing
amongst cardiac surgical patients?.
Source
Irish Journal of Medical Science. Conference: 37th Sir Peter Freyer
Memorial Lecture and Surgical Symposium 2012 Galway Ireland. Conference
Start: 20120907 Conference End: 20120908. Conference Publication:
(var.pagings). 181 (pp S184-S185), 2012. Date of Publication: September
2012.
Publisher
Springer London
Abstract
Introduction: Statins are amongst the most widely prescribed medications
in the world and they may have a number of potential pleiotropic effects
including a possible role in the promotion of wound healing. Cardiac
surgical patients represent a patient population with significant
associated co-morbidities that can impede normal wound healing. Aim: To
evaluate statins in the promotion of post-operative wound healing with the
aim of consolidating the current evidence base, to elucidate an underlying
mechanism of action, and assess whether further investigations would be
appropriate. Methods: A systematic review was conducted using MEDLINE, The
Cochrane Library, and Embase with the keywords "statins", "wound", and
"neutrophil migration". A total of 326 articles were identified and
following review, twenty articles were deemed relevant for inclusion.
Results: Given the infancy of the topic, the majority of studies related
to animal research, however a number of significant findings could be
reported. Statins improved wound healing (32 % faster rate of
epithelialisation) and tensile strength (33 % greater wound breaking
strength) while modulating the various inflammatory mediators involved.
Topical statins appeared to provide enhanced outcomes in comparison to
systemic statin use, with an optimal timeframe for treatment benefit of
14-days, and that benefit related to the duration of treatment rather than
dosage. In addition the evidence would suggest that inhibition of Farnesyl
Pyrophosphate formation may underpin the overall pleiotropic effects of
statins on wound healing. Conclusion: Topical statins may provide a
valuable adjunct to cardiac surgeons in the augmentation of wound healing
and further evaluation would be appropriate.
<21>
Accession Number
71323214
Authors
Berczi V.
Institution
(Berczi) Department of Radiology and Oncotherapy, Semmelweis University,
Budapest, Hungary
Title
Upper limb DVT-which patients should we treat and how?.
Source
CardioVascular and Interventional Radiology. Conference: Cardiovascular
and Interventional Radiological Society of Europe, CIRSE 2013 Barcelona
Spain. Conference Start: 20130914 Conference End: 20130918. Conference
Publication: (var.pagings). 36 (pp S182-S183), 2013. Date of Publication:
September 2013.
Publisher
Springer New York
Abstract
INTRODUCTION, BACKGROUND Primary upper extremity deep-vein thrombosis
(UEDVT) is defined as spontaneously developed thrombosis without any
clinically apparent risk factors or after strenuous exercise (effort
thrombosis). Screening for occult cancer should be performed in idiopathic
thrombosis, while effort thrombosis (Paget-Schrotter syndrome) typically
occurs in young and physically active patients because of repetitive
injury to the vein due to a tight thoracic outlet. Repetitive use of the
arms above the shoulder level is frequent. Primary UEDVT is responsible
for approximately 20%-30% UEDVTs. Secondary UEDVT develops in the setting
of central venous catheter, pregnancy, malignancy, recent surgery or
recent trauma. The main complication of effort UEDVT is post-thrombotic
syndrome (venous distension, swelling of the arm, blue discoloration, pain
with exercise). UEDVT, particularly secondary UEDVT, carries a substantial
risk of pulmonary embolism (3%-12%). Symptomatic PE with lower limb DVT
was three times more frequent than that for UEDVT in the RIETE registry
(29% vs. 9%); however, three-month mortality rate was higher in the UEDVT
group (11% vs. 7%). Recurrence rate is smaller in UEDVT than in lower limb
DVT. DIAGNOSIS Clinical presentation: The most common signs and syndromes
include unilateral arm swelling, erythema, discomfort, dilated superficial
veins, superior vena cava syndrome, low-grade fever, dyspnea. Clinical
evaluation has low specificity (30%-60%). The D-dimer test has only
limited usefulness in suspected UEDVT, probably being more efficient in
outpatients compared with in-hospital patients. Therefore, imaging studies
are required. Ultrasound: On B-mode imaging, echogenicity may vary in
acute thrombosis. As usual, non-compressibility defines the presence of
DVT. This evaluation technique cannot be used for the centrallysituated
veins (i.e. brachiocephalic veins and superior vena cava) or for the
medial segment of the subclavian veins near the clavicle. Absence of flow
and of the normal biphasic pattern on pulsed-wave Doppler can also suggest
DVT (75% sensitivity, 100% specificity). A recent guideline suggested the
use of compressions and Doppler US ('combined modality US') as an initial
diagnostic test. Contrast venography (CV): Earlier, CV has been the
reference standard for suspected lower limb DVT. Contrast medium is
injected into a distal vein of the upper extremity. A thrombus is
identified as a filling defect present in more than one view. However,
interobserver agreement on venogram interpretation in suspected DVT is
only 70%-80%. This technique is reserved when initial non-invasive imaging
is insufficient for a conclusive diagnosis or is negative in case of high
clinical suspicion of DVT. CV visualises veins at the thoracic outlet.
However, it requires radiation exposure and intravenous contrast and is
technically demanding. CO<sub>2</sub> venography has been used in small
studies with acceptable results (97% sensitivity and 85% specificity
against standard contrast venography). Computed tomography venography
(CTV): Pooled sensitivity of 96% and specificity of 95% was found in a
recent study against US or CV in lower limb studies; upper extremity
investigations are scarce. Obvious disadvantages of CTV include ionising
radiation and the risk associated with intravenous iodinated contrast
medium. Magnetic resonance venography (MRV): There are very few studies on
MR diagnosis of UEDVT; most of our current experience is from lower
extremity publications. Pooled sensitivity and specificity of CE-MRV was
91% and 95%, respectively, against CV as a reference standard in the lower
limb veins. TOF MRV is also promising. Magnetic resonance direct thrombus
imaging (MRDTI) can distinguish recent from chronic thrombus in case of
recurrent DVT in the lower extremity. TREATMENT POSSIBILITIES
Anticoagulation The mainstay therapy is therapeutically-dosed parenteral
anticoagulant bridged to an oral anticoagulant. INR should reach 2.0 or
higher on two measurements with a difference in time of at least 24 h.
Acute phase therapy is for three months. Complication rate of
anticoagulation therapy includes 2%-4% major bleeding. No
randomised-controlled trials exist for the anticoagulation treatment of
UEDVT. However, a retrospective analysis reported increased symptomatic
resolution (48% vs. 70%). Indications of anticoagulation therapy beyond
three months are uncertain; provoked situations (e.g. cancer, central
venous catheter) or UEDVT with tight thoracic outlet (surgically not
corrected) may justify long-term anticoagulation treatment. Endovascular
therapies Thrombolysis Systemic thrombolysis has been largely replaced by
catheter-directed thrombolysis in lower limb DVT because of smaller number
of bleeding complications and better rates of valvular competence.
Catheter-directed thrombolysis uses a multiport catheter placed directly
into the thrombus using image guidance. For lower limb treatment, typical
regimen consists of continuous high-volume drip regimen with dilute
thrombolytics and concomitant unfractionated heparin. Clearance rates are
70%-90%. Clots older than two weeks are generally less susceptible for
thrombolysis. No published guidelines are available for UEDVT. Most common
complications are typically access site bleeding (major bleeding rate is
approximately 10%). Appropriate case selection is challenging. High level
evidence showed benefit for low-dose thrombolytic treatment of
catheter-dysfunction due to thrombotic luminal occlusion with negligible
bleeding risk. Percutaneous mechanical thrombectomy The next, separate
lecture of this session will address this question in details. Angioplasty
and stenting Limited data are available in literature. Stent placement for
central and peripheral limb obstruction in 65 patients showed a clinical
success rate of 75% and 42% at 12 and 24 months, respectively, with a high
rate of reintervention. A smaller study (22 patients) reported occlusion
of the stents in patients with Paget-Schrotter syndrome. Indications for
these interventions are uncertain and long-term data are lacking. Unless
contraindicated, anticoagulation should follow all interventional
treatments. Superior vena cava filter A recent systematic review analysis
on 209 SVC filter placements showed a complication rate of 3.8% (mainly
filter strut perforation causing cardiac tamponade, pneumothorax and
aortic perforation). The benefit is yet uncertain. SCV filter has
currently a small role in the management of UEDVT. CONCLUSIONS Clinical
prediction score and D-dimer assays are of limited use in UEDVT;
therefore, diagnosis is based on imaging methods, primarily
ultrasonography. The cornerstone of UEDVT treatment is anticoagulation.
Because severe post-thrombotic syndrome is rarely observed after
conservative treatment of UEDVT, the long-term benefit of thrombolysis is
currently unclear. Selective patients with acute thrombosis having severe
syndromes and low bleeding risk may be considered. Placement of the
superior vena cava filter may only be considered in patients with
contraindications for anticoagulation therapy and pulmonary embolism.
Clear indications for endovascular therapies warrants more randomised
trials.
<22>
Accession Number
71322786
Authors
Backes A. Rizos A. Pricor L.
Institution
(Backes, Rizos, Pricor) Sharp HealthCare, United States
Title
Primary medication adherence among patients transitioning from hospital to
home care.
Source
Journal of the American Pharmacists Association. Conference: APhA2012 New
Orleans, LA United States. Conference Start: 20120309 Conference End:
20120312. Conference Publication: (var.pagings). 52 (2) (pp 205-206),
2012. Date of Publication: March-April 2012.
Publisher
American Pharmacists Association
Abstract
Objective: The objective is to determine the effect of a pharmacy
resident- led intervention on primary medication adherence among patients
transitioning from hospital to home care (HC). Methods: This is a
randomized, controlled trial. Patients discharged from the hospital and
admitted to HC will be eligible if they have congestive heart failure or
take >10 medications. Patients being evaluated for heart transplants will
be excluded. Eligible patients will be visited by the pharmacy resident
prior to discharge. Written informed consent and pharmacy information will
be obtained. The control group will receive usual care, which consists of
discharge medication counseling by a nurse and medication reconciliation
by a HC clinician. The intervention group will be visited by the pharmacy
resident prior to discharge (phase I) and at home within 5 days after
discharge (phase II). Phase I will consist of reviewing the discharge
medication list for drugrelated problems (DRPs), discussing DRPs with
hospitalist, and medication counseling. Phase II will consist of comparing
medication bottles to discharge medication list and identifying DRPs to
address with the primary care provider. The primary outcome will be
primary medication adherence within 5 days of discharge. The pharmacy
resident will call patients' pharmacies to determine whether newly
prescribed medications were picked up by the patients. For intervention
patients, this will be physically confirmed during the home visit. For
control patients, this will be electronically confirmed by the assessment
done by the HC clinician. Secondary outcomes will be frequency of 30-day
readmissions and 30-day emergency department visits. All data analyses
will be performed using Stata. Continuous variables will be compared using
the student's t test, and categorical data will be compared using
chi-square test. Data analyses will include descriptive analyses of
patient demographics, rate of primary medication non-adherence, and
factors associated with primary medication non-adherence.
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