Results Generated From:
Embase <1980 to 2014 Week 37>
Embase (updates since 2014-09-05)
<1>
Accession Number
23911209
Authors
Harilall Y. Adam J.K. Biccard B.M. Reddi A.
Institution
(Harilall, Reddi) Dept of Cardiothoracic Surgery, Inkosi Albert Luthuli
Central Hospital, KZN, South Africa.
(Adam) Department of Biomedical and Clinical Technology, Durban University
of Technology, South Africa. Electronic address:
(Biccard) College of Health Sciences, University of Kwazulu Natal, South
Africa; Department of Anaesthesia, Inkosi Albert Luthuli Central Hospital,
South Africa.
Title
The effect of optimising cerebral tissue oxygen saturation on markers of
neurological injury during coronary artery bypass graft surgery.
Source
Heart, lung & circulation. 23 (1) (pp 68-74), 2014. Date of Publication:
Jan 2014.
Abstract
Surgical revascularisation of the coronary arteries is a cornerstone of
cardiothoracic surgery. Advanced age and the incidence of preoperative
co-morbidity in patients presenting for coronary artery bypass graft
surgery increases the potential for stroke and other perioperative
outcomes. It is hypothesised that by using interventions during cardiac
surgery to improve cerebral oxygenation, the risk of patients enduring
adverse neurological outcomes would be reduced. Forty patients (mean age
55.3, standard deviation 9.74 and range from 39 to 72 years) undergoing
on-pump coronary artery bypass graft surgery were recruited at Inkosi
Albert Luthuli Central Hospital, South Africa. Patients were randomised
into a control group (n=20) and interventional group (n=20).
Intraoperative regional cerebral oxygen saturation (rSO2) monitoring with
active display and Murkin treatment intervention protocol was administered
for the interventional group. Arterial blood samples for the measurement
of serum S100B were taken pre and postoperatively. An enzyme immunoassay
(ELISA) was used for the quantitative and comparative measurement of human
S100B concentrations for both groups. A prioritised intraoperative
management protocol to maintain rSO2 values above 75% of the baseline
threshold during cardiopulmonary bypass was followed. There was a highly
significant difference in the change in S100B concentrations post surgery
between the interventional (37.3picograms per millilitre) and control
groups (139.3pg/ml). The control group showed a significantly higher
increase in S100B concentration over time than the intervention group
(p<0.001). There was a significant difference in cerebral desaturation
time (p<0.001) between the groups. The mean desaturation time for the
control group was 63.85min as compared to 24.7min in the interventional
group. Cerebral desaturation occurred predominantly during aortic cross
clamping, distal anastomosis of coronary arteries and aortic cross clamp
release. Predictors of cerebral oxygen desaturation included, partial
pressure of carbon dioxide (pCO2), temperature, pump flow rate (LMP), mean
arterial pressure (MAP), haematocrit, heart rate (HR) and patient oxygen
saturation (SpO2). Monitoring brain oxygen saturation during on-pump CABG
together with an effective treatment protocol to deal with cerebral
desaturation must be advocated. Copyright 2013. Published by Elsevier
B.V.
<2>
Accession Number
2014571101
Authors
Pin T.W.
Institution
(Pin) Department of Rehabilitation Science, Hong Kong Polytechnic
University, Hung Hom, Kowloon, Hong Kong
Title
Psychometric properties of 2-minute walk test: A systematic review.
Source
Archives of Physical Medicine and Rehabilitation. 95 (9) (pp 1759-1775),
2014. Date of Publication: September 2014.
Abstract
Objective To systematically review the psychometric evidence on the
2-minute walk test (2MWT). Data Sources Electronic searches of databases
including MEDLINE, CINAHL, Academic Search Premier, SPORTDiscus, PsycINFO,
EMBASE, the Cochrane Library, and DARE were done until February 2014 using
a combination of subject headings and free texts. Study Selection Studies
were included if psychometric properties of the 2MWT were (1) evaluated;
(2) written as full reports; and (3) published in English language
peer-reviewed journals. Data Extraction A modified consensus-based
standard for the selection of health measurement instruments checklist was
used to rate the methodological quality of the included studies. A quality
assessment for statistical outcomes was used to assess the measurement
properties of the 2MWT. Data Synthesis Best-evidence synthesis was
collated from 25 studies of 14 patient groups. Only 1 study was found that
examined the 2MWT in the pediatric population. The testing procedures of
the 2MWT varied across the included studies. Reliability, validity
(construct and criterion), and responsiveness of the 2MWT also varied
across different patient groups. Moderate to strong evidence was found for
reliability, convergent validity, discriminative validity, and
responsiveness of the 2MWT in frail elderly patients. Moderate to strong
evidence for reliability, convergent validity, and responsiveness was
found in adults with lower limb amputations. Moderate to strong evidence
for validity (convergent and discriminative) was found in adults who
received rehabilitation after hip fractures or cardiac surgery. Limited
evidence for the psychometric properties of the 2MWT was found in other
population groups because of methodological flaws. Conclusions There is
inadequate breadth and depth of psychometric evidence of the 2MWT for
clinical and research purposes - specifically, minimal clinically
important changes and responsiveness. More good-quality studies are
needed, especially in the pediatric population. Consensus on standardized
testing procedures of the 2MWT is also required. 2014 by the American
Congress of Rehabilitation Medicine.
<3>
Accession Number
2014571057
Authors
Pilgrim T. Roffi M. Tuller D. Muller O. Vuilliomenet A. Cook S. Weilenmann
D. Kaiser C. Jamshidi P. Heg D. Juni P. Windecker S.
Institution
(Pilgrim, Windecker) Department of Cardiology, Swiss Cardiovascular
Center, University Hospital, 3010 Bern, Switzerland
(Roffi) Department of Cardiology, University Hospital, Geneva, Switzerland
(Tuller) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Muller) Department of Cardiology, University Hospital, Lausanne,
Switzerland
(Vuilliomenet) Department of Cardiology, Kantonsspital, Aarau, Switzerland
(Cook) Department of Cardiology, University Hospital, Fribourg,
Switzerland
(Weilenmann) Department of Cardiology, Kantonsspital, St Gallen,
Switzerland
(Kaiser) Department of Cardiology, University Hospital, Basel, Switzerland
(Jamshidi) Department of Cardiology, Kantonsspital, Luzern, Switzerland
(Heg, Juni) Institute of Social and Preventive Medicine, Clinical Trials
Unit, Bern University Hospital, Bern, Switzerland
Title
Randomized comparison of biodegradable polymer sirolimus-eluting stents
versus durable polymer everolimus-eluting stents for percutaneous coronary
revascularization: Rationale and design of the BIOSCIENCE trial.
Source
American Heart Journal. 168 (3) (pp 256-261), 2014. Date of Publication:
September 2014.
Abstract
Background Biodegradable polymers for release of antiproliferative drugs
from metallic drug-eluting stents aim to improve long-term vascular
healing and efficacy. We designed a large scale clinical trial to compare
a novel thin strut, cobalt-chromium drug-eluting stent with silicon
carbide-coating releasing sirolimus from a biodegradable polymer (O-SES,
Orsiro; Biotronik, Bulach, Switzerland) with the durable polymer-based
Xience Prime/Xpedition everolimus-eluting stent (EES) (Xience
Prime/Xpedition stent, Abbott Vascular, IL) in an all-comers patient
population. Design The multicenter BIOSCIENCE trial (NCT01443104) randomly
assigned 2,119 patients to treatment with biodegradable polymer
sirolimus-eluting stents (SES) or durable polymer EES at 9 sites in
Switzerland. Patients with chronic stable coronary artery disease or acute
coronary syndromes, including non-ST-elevation and ST-elevation myocardial
infarction, were eligible for the trial if they had at least 1 lesion with
a diameter stenosis >50% appropriate for coronary stent implantation. The
primary end point target lesion failure (TLF) is a composite of cardiac
death, target vessel myocardial infarction, and clinically driven target
lesion revascularization within 12 months. Assuming a TLF rate of 8% at 12
months in both treatment arms and accepting 3.5% as a margin for
noninferiority, inclusion of 2,060 patients would provide more than 80%
power to detect noninferiority of the biodegradable polymer SES compared
with the durable polymer EES at a 1-sided type I error of 0.05. Clinical
follow-up will be continued through 5 years. Conclusion The BIOSCIENCE
trial will determine whether the biodegradable polymer SES is noninferior
to the durable polymer EES with respect to TLF. 2014 Mosby, Inc.
<4>
Accession Number
2014568351
Authors
Ren X. Liu W. Peng Y. Li Q. Chai H. Zhao Z.-G. Meng Q.-T. Chen C. Zhang C.
Luo X.-L. Chen M. Huang D.-J.
Institution
(Ren, Liu, Peng, Li, Chai, Zhao, Meng, Chen, Zhang, Luo, Chen, Huang)
Department of Cardiology, West China Hospital, Sichuan University, No. 37
Guoxue Alley, Chengdu, Sichuan 610041, China
Title
Percutaneous coronary intervention compared with coronary artery bypass
graft in coronary artery disease patients with chronic kidney disease: A
systematic review and meta-analysis.
Source
Renal Failure. 36 (8) (pp 1177-1186), 2014. Date of Publication: September
2014.
Publisher
Informa Healthcare
Abstract
Previous reports of percutaneous coronary intervention versus coronary
artery bypass graft outcomes in coronary artery disease patients with
chronic kidney disease (CKD) were inconsistent. We evaluated the optimal
revascularization strategy for CKD patients. We searched Pub Med, EMBASE,
and the Cochrane Central Register of Controlled Trials and scanned the
references of relevant articles and reviews. All studies that compared
relevant clinical outcomes between percutaneous coronary intervention and
coronary artery bypass graft in CKD patients were selected. We defined
short-term and long-term all-cause mortality as primary outcome, and
long-term incidences of myocardial infarction and revascularization as
secondary outcomes. A total of 2235 citations were retrieved, and 31
studies involving 99,054 patients, with 55,383 receiving percutaneous
coronary intervention and 43,671 receiving coronary artery bypass graft,
were included. In subgroup analyses of dialysis patients receiving
percutaneous coronary intervention with stents versus coronary artery
bypass graft, CKD patients with multivessel coronary disease, and CKD
patients receiving drug-eluting stent versus coronary artery bypass graft,
the pooled outcomes revealed that percutaneous coronary intervention
possessed lower short-term mortality, but higher late revascularization
risk. No significant differences in long-term mortality were observed
between the two strategies in these subgroup analyses. In conclusion, in
some specific clinical circumstances, CKD patients receiving percutaneous
coronary intervention possessed lower short-term all-cause mortality, but
higher long-term revascularization risk, than coronary artery bypass
graft; long-term all-cause mortality was not different between the two
strategies. 2014 Informa Healthcare USA, Inc. All rights reserved.
<5>
Accession Number
2014568016
Authors
Canale L. Mick S. Nair R. Mihaljevic T. Bonatti J.
Institution
(Canale, Mick) Cleveland Clinic, Heart and Vascular Institute, 9500 Euclid
Avenue, J 4-133, Cleveland, OH 44195, United States
(Nair, Mihaljevic, Bonatti) Cleveland Clinic Abu Dhabi, Abu Dhabi, United
Arab Emirates
Title
Atrial fibrillation after robotic cardiac surgery.
Source
Journal of Atrial Fibrillation. 7 (1) (pp 99-103), 2014. Date of
Publication: June-July 2014.
Publisher
CardioFront LLC
Abstract
Atrial fibrillation is one of the commonest complications after cardiac
surgery and it is associated with considerable morbidity and increase in
mortality. Recently, robotic approach to many heart operations has become
feasible and reproducible. We here investigate and review the incidence of
atrial fibrillation after robotic cardiac surgery. We found that its
incidence is overall low and less than in conventional heart surgery.
<6>
Accession Number
2014566237
Authors
Saito S. Valdes-Chavarri M. Richardt G. Moreno R. Romo A.I. Barbato E.
Carrie D. Ando K. Merkely B. Kornowski R. Eltchaninoff H. James S. Wijns
W.
Institution
(Saito) Shonan Kamakura General Hospital, Kanagawa, Japan
(Valdes-Chavarri) Hospital Universitaria V. Arrixaca, Murcia, Spain
(Richardt) Segeberger Kliniken GmbH, Bad Segeberg, Germany
(Moreno) Hospital la Paz, Madrid, Spain
(Romo) Hospital Meixoeiro Galaria, Vigo, Spain
(Barbato, Wijns) Cardiovascular Centre Aalst, OLV Hospital, Aalst, Belgium
(Carrie) CHU Toulouse Rangeuil, Toulouse, France
(Ando) Kokura Memorial Hospital, Fukuoka, Japan
(Merkely) Semmelweis University Hospital, Budapest, Hungary
(Kornowski) Rabin Medical Centre, Petach-Tikva, Israel
(Eltchaninoff) CHUCharles Nicolle Rouen, Rouen, France
(James) Uppsala Akademiska Sjukhus, Uppsala, Sweden
(Wijns) Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 165, 9301
Aalst, Belgium
Title
A randomized, prospective, intercontinental evaluation of a bioresorbable
polymer sirolimus-eluting coronary stent system: The CENTURY II (Clinical
Evaluation of New Terumo Drug-Eluting Coronary Stent System in the
Treatment of Patients with Coronary Artery Disease) trial.
Source
European Heart Journal. 35 (30) (pp 2021-2031), 2014. Date of Publication:
07 Aug 2014.
Publisher
Oxford University Press
Abstract
Aim: The aim of this study was to establish safety and efficacy of a new
sirolimus-eluting stent with bioresorbable polymer, Ultimaster (BP-SES).
Sirolimus-eluting stent with bioresorbable polymer was compared with
everolimus-eluting, permanent polymer, Xience stent (PP-EES) in the frame
of a CENTURY II clinical trial designed to make global clinical data
compliant with regulatory requirements in Europe and Japan. Methods and
results: The CENTURY II is a prospective, multicentre, randomized (1: 1),
single blind, controlled, non-inferiority clinical trial conducted at 58
study sites in Japan, Europe, and Korea. A total of 1123 patients
requiring a percutaneous coronary intervention (PCI) procedure, with
implantation of drug-eluting stent (DES), were enrolled [total population
(TP)]. Randomization of patients was stratified for the subset of patients
matching requirements for DES in Japan (Cohort JR, n = 722). Baseline
patient demographic and angiographic characteristics were similar in both
study arms, with minimal differences between the TP and Cohort JR. The
primary endpoint, freedom from target lesion failure (TLF) at 9 months -
TLF [composite of cardiac death, target-vessel-related myocardial
infarction (MI) and target lesion revascularization] - was 95.6% with
BP-SES and 95.1% with PP-EES (P<sub>non-inferiority</sub><0.0001).
Composite of cardiac death and MI rate was 2.9 and 3.8% (P = 0.40) and
target vessel revascularization was 4.5% with BP-SES and 4.2% with PP-EES
(P = 0.77). The stent thrombosis rate was 0.9% in both arms. InCohort JR,
freedom fromTLFwas 95.9 and 94.6% (P <sub>non-inferiority</sub> < 0.0005)
with BP-SES and PP-EES, respectively. Conclusion: The new bioresorbable
polymer sirolimus-eluting stent showed safety and efficacy profiles
similar to durable polymer everolimus-eluting stent at 9-month follow-up.
The Author 2014.
<7>
Accession Number
2014569984
Authors
Washam J.B. Dolor R.J. Jones W.S. Halim S.A. Hasselblad V. Mayer S.B.
Heidenfelder B.L. Melloni C.
Institution
(Washam) Duke Heart Center, Duke University Medical Center, DUMC 3943,
Durham, NC 27710, United States
(Dolor, Jones, Halim, Hasselblad, Heidenfelder, Melloni) Duke Clinical
Research Institute, Duke University Medical Center, Durham, NC, United
States
(Mayer) Division of Endocrinology and Metabolism, Department of Medicine,
Virginia Commonwealth University, Richmond, VA, United States
Title
Dual antiplatelet therapy with or without oral anticoagulation in the
postdischarge management of acute coronary syndrome patients with an
indication for long term anticoagulation: A systematic review.
Source
Journal of Thrombosis and Thrombolysis. 38 (3) (pp 285-298), 2014. Date of
Publication: October 2014.
Publisher
Kluwer Academic Publishers
Abstract
Currently, there is a lack of consensus among guidelines for the
postdischarge treatment of patients presenting with acute coronary
syndrome (ACS) who have a long-term indication for anticoagulation. We
conducted a systematic review comparing the safety and effectiveness of
dual antiplatelet therapy (DAPT) and triple therapy (TT; defined as DAPT
plus an oral anticoagulant) in patients with ACS and a long-term
indication for anticoagulation. We searched for clinical studies in
MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews published
between January 1995 and September 2013. Each investigator screened and
abstracted data, assessed applicability and quality, and graded the
strength of evidence. Meta-analysis of direct comparison was performed
when outcomes and follow-up periods were comparable. Fourteen
observational studies were identified that contained comparative
effectiveness data on DAPT versus TT. No difference in the odds of
mortality (OR 1.04, 95 % CI 0.59-1.83) or stroke (OR 1.01, 95 % CI
0.38-2.67) at 1-5 years was found between TT and DAPT. Major bleeding at
1-5 years (OR 1.46, 95 % CI 1.07-2.00) and nonfatal MI at 1-5 years (OR
1.85, 95 % CI 1.13-3.02) occurred more frequently in patients receiving
TT. The results of this systematic review demonstrate that treatment with
TT was associated with increased rates of nonfatal MI and major bleeding
when compared with treatment with DAPT in the postdischarge management of
ACS patients with an indication for oral anticoagulation. Until results of
ongoing randomized trials assessing antithrombotic therapies define
optimal management strategies, the current analysis suggests using caution
when prescribing TT to these patients. 2014 Springer Science+Business
Media.
<8>
Accession Number
2014566099
Authors
Harskamp R.E. Alexander J.H. Schulte P.J. Brophy C.M. Mack M.J. Peterson
E.D. Williams J.B. Gibson C.M. Califf R.M. Kouchoukos N.T. Harrington R.A.
Ferguson Jr. T.B. Lopes R.D.
Institution
(Harskamp, Alexander, Schulte, Peterson, Williams, Lopes) Department of
Medicine, Duke Clinical Research Institute, Duke University, 2400 Pratt
St, Durham, NC 27705, United States
(Harskamp) Heart Center, Academic Medical Center, University of Amsterdam,
Amsterdam, Netherlands
(Brophy) Division of Vascular Surgery, Vanderbilt University, Nashville,
TN, United States
(Mack) Cardiopulmonary Research Science and Technology Institute, Dallas,
TX, United States
(Gibson) PERFUSE Angiographic Laboratory, Boston, MA, United States
(Califf) Department of Medicine, Duke Translational Medicine Institute,
Duke University, Durham, NC, United States
(Kouchoukos) Heart Center, Missouri Baptist Medical Center, St Louis, MO,
United States
(Harrington) Department of Medicine, Stanford University, Stanford, CA,
United States
(Ferguson Jr.) Department of Cardiovascular Sciences, East Carolina
University, Greenville, NC, United States
Title
Vein graft preservation solutions, patency, and outcomes after coronary
artery bypass graft surgery: Follow-up from PREVENT IV randomized clinical
trail.
Source
JAMA Surgery. 149 (8) (pp 798-805), 2014. Date of Publication: August
2014.
Publisher
American Medical Association
Abstract
IMPORTANCE In vitro and animal model data suggest that intraoperative
preservation solutions may influence endothelial function and vein graft
failure (VGF) after coronary artery bypass graft (CABG) surgery. Clinical
studies to validate these findings are lacking. OBJECTIVE To evaluate the
effect of vein graft preservation solutions on VGF and clinical outcomes
in patients undergoing CABG surgery. DESIGN, SETTING, AND PARTICIPANTS
Data from the Project of Ex-Vivo Vein Graft Engineering via Transfection
IV (PREVENT IV) study, a phase 3, multicenter, randomized, double-blind,
placebo-controlled trial that enrolled 3014 patients at 107 US sites from
August 1, 2002, through October 22, 2003, were used. Eligibility criteria
for the trial included CABG surgery for coronary artery disease with at
least 2 planned vein grafts. INTERVENTIONS Preservation of vein grafts in
saline, blood, or buffered saline solutions. MAIN OUTCOMES AND MEASURES
One-year angiographic VGF and 5-year rates of death, myocardial
infarction, and subsequent revascularization. RESULTS Most patients had
grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%])
and buffered saline (507 [16.8%]). Baseline characteristics were similar
among groups. One-year VGF rates were much lower in the buffered saline
group than in the saline group (patient-level odds ratio [OR], 0.59
[95%CI, 0.45-0.78; P < .001]; graft-level OR, 0.63 [95%CI, 0.49-0.79; P <
.001]) or the blood group (patient-level OR, 0.62 [95%CI, 0.46-0.83; P =
.001]; graft-level OR, 0.63 [95%CI, 0.48-0.81; P < .001]). Use of buffered
saline solution also tended to be associated with a lower 5-year risk for
death,myocardial infarction, or subsequent revascularization compared with
saline (hazard ratio, 0.81 [95%CI, 0.64-1.02; P = .08]) and blood (0.81
[0.63-1.03; P = .09]) solutions. CONCLUSIONS AND RELEVANCE Patients
undergoing CABG whose vein grafts were preserved in a buffered saline
solution had lower VGF rates and trends toward better long-term clinical
outcomes compared with patients whose grafts were preserved in saline-or
blood-based solutions. Copyright 2014 American Medical Association. All
rights reserved.
<9>
Accession Number
2014702098
Authors
Mailhot T. Cossette S. Bourbonnais A. Cote J. Denault A. Cote M.-C.
Lamarche Y. Guertin M.-C.
Institution
(Mailhot, Cossette, Bourbonnais, Cote') Faculty of Nursing, University of
Montreal, C.P. 6128 succ. Centre-ville, Montreal, QC H3C 3J7, Canada
(Mailhot, Cossette) Montreal Heart Institute Research Center S-2490, 5000
Belanger Street, Montreal, QC H1T 1C8, Canada
(Bourbonnais) Centre de recherche de l'Institut Universitaire de
Ge'riatrie de Montre'al, 4545 chemin Queen-Mary, Montre'al, QC H3W 1W4,
Canada
(Bourbonnais) Centre Ge'ratrique Maimonides Donald Berman, 5795 Caldwell
ave, Montreal, QC H4W 1W3, Canada
(Cote') Centre de Recherche du Centre Hospitalier de l'Universite' de
Montre'al, 900 Saint-Denis Street, Montreal, QC H2X 0A9, Canada
(Denault) Department of Anesthesiology, Montreal Heart Institute, 5000
Belanger Street, Montreal, QC H1T 1C8, Canada
(Cote') Department of Psychosomatics, Montreal Heart Institute, 5000
Belanger Street, Montreal, QC H1T 1C8, Canada
(Lamarche) Department of Cardiac Surgery, Montreal Heart Institute, 5000
Belanger Street, Montreal, QC H1T 1C8, Canada
(Guertin) Montreal Health Innovations Coordinating Center, 4100 Molson
street suite 400, Montre'al, QC H1Y 3N1, Canada
Title
Evaluation of a nurse mentoring intervention to family caregivers in the
management of delirium after cardiac surgery (MENTOR_D): A study protocol
for a randomized controlled pilot trial.
Source
Trials. 15 (1) , 2014. Article Number: 306. Date of Publication: July 30,
2014.
Publisher
BioMed Central Ltd.
Abstract
Background: Despite the use of evidence-based preventive measures,
delirium affects about 40% of patients following cardiac surgery with the
potential for serious clinical complications and anxiety for caregivers.
There is some evidence that family involvement as a core component of
delirium management may be beneficial since familiarity helps patients
stay in contact with reality, however, this merits further investigation.
There is also currently a gap in the scientific literature regarding
objective indicators that could enhance early detection and monitoring of
delirium. Therefore, this randomized pilot trial examines the
acceptability, feasibility, and preliminary efficacy of an experimental
nursing intervention to help family caregivers manage post-cardiac surgery
delirium in their relatives. It also explores the validity of a new and
innovative measure that has potential as an indicator for
delirium.Methods/Design: In this two-group randomized pilot study (n =
30), the control group will receive usual care and the intervention group
will receive the experimental intervention aimed at reducing delirium
severity. The intervention nurse's objective will be to foster the family
caregiver's self-efficacy in behaving in a supportive manner during
delirium episodes. Data will be collected from standard delirium
assessment scales and a novel measure of delirium, i.e., cerebral oximetry
obtained using near infrared spectroscopy, as well as medical records and
participants' responses to questionnaires.Discussion: New strategies for
early detection, monitoring, and management of delirium are needed in
order to improve outcomes for both patients and families. The present
article exposes feasibility issues based on the first few months of the
empirical phase of the study that may be useful to the scientific
community interested in improving the care of patients with delirium.
Another potentially important contribution is in the exploration of
cerebral oximetry, a promising measure as an objective indicator for early
detection and continuous monitoring of delirium. The proposed pilot study
will build towards a larger trial with the potential to improve knowledge
about delirium management and monitoring.
<10>
Accession Number
2014563451
Authors
Rauch B. Riemer T. Schwaab B. Schneider S. Diller F. Gohlke H. Schiele R.
Katus H. Gitt A. Senges J.
Institution
(Rauch) Zentrum fur Ambulante Rehabilitation, Klinikum der Stadt
Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen am Rhein, Germany
(Riemer, Schneider, Diller, Senges) Institut fur Herzinfarktforschung,
Ludwigshafen, Germany
(Schwaab) Curschmann Klinik, Timmendorfer Strand, Germany
(Gohlke) Herzzentrum Bad Krozingen, Bad Krozingen, Germany
(Schiele) Klinikum Friedrichshafen, Friedrichshafen, Germany
(Katus) Klinikum der Universitat Heidelberg, Heidelberg, Germany
(Gitt) Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
Title
Short-term comprehensive cardiac rehabilitation after AMI is associated
with reduced 1-year mortality: Results from the OMEGA study.
Source
European Journal of Preventive Cardiology. 21 (9) (pp 1060-1069), 2014.
Date of Publication: September 2014.
Publisher
SAGE Publications Inc.
Abstract
Background: The prognostic effect of early, comprehensive short-term
cardiac rehabilitation on top of current, guideline- adjusted treatment of
acute myocardial infarction has not sufficiently been evaluated. Design:
Prospective cohort study. Methods: Within the OMEGA study population, the
clinical course of 3560 patients still alive 3 months after acute
myocardial infarction were evaluated by comparing patients who had
attended to cardiac rehabilitation (70.6%) with those who did not. Total
mortality and major adverse cerebrovascular and cardiovascular events, as
well as non-fatal events, were evaluated within the time period of 4-12
months after hospital admission for acute myocardial infarction. The
effect of cardiac rehabilitation on clinical events was estimated by using
the propensity score method to adjust for confounding parameters in
multivariate analysis. Results: Patients participating in cardiac
rehabilitation were younger, more often had acute revascularization, less
often experienced non-ST-elevation myocardial infarction, and less often
had a history of diabetes or cardiovascular events. Total mortality (OR
0.46, 95% CI 0.27-0.77) and major adverse cerebrovascular and
cardiovascular events (OR 0.53, 95% CI 0.38-0.75) were significantly lower
in the rehabilitation group. Subgroup analysis including major clinical
characteristics also revealed significantly reduced rates of total death
and major adverse cerebrovascular and cardiovascular events in the
rehabilitation group. Conclusions: Attendance to early, comprehensive
short-term cardiac rehabilitation programmes on top of current
guideline-adjusted treatment of acute myocardial infarction is associated
with a significantly improved 1-year prognosis. 2013 The European Society
of Cardiology.
<11>
Accession Number
2014562902
Authors
Tackett S.M. Sugarman R. Kreuwel H.T.C. Alvarez P. Nasso G.
Institution
(Tackett, Kreuwel) Baxter Healthcare Corporation, Westlake Village, CA,
United States
(Sugarman, Alvarez) Evidera, Lexington, MA, United States
(Nasso) Department of Cardiac Surgery, Anthea Hospital, GVM Care and
Research, Bari, Italy
Title
Hospital economic impact from hemostatic matrix usage in cardiac surgery.
Source
Journal of Medical Economics. 17 (9) (pp 670-676), 2014. Date of
Publication: September 2014.
Publisher
Informa Healthcare
Abstract
Objective: Improved health outcomes can result in economic savings for
hospitals and payers. While effectiveness of topical hemostatic agents in
cardiac surgery has been demonstrated, evaluations of their economic
benefit are limited. This study quantifies the cost consequences to
hospitals, based on clinical outcomes, from using a flowable hemostatic
matrix vs non-flowable topical hemostatic agents in cardiac surgery.
Research design and methods: Applying clinical outcomes from a prospective
randomized clinical trial, a cost consequence framework was utilized to
model the economic impact of comparator groups. From that study, clinical
outcomes were obtained and analyzed for a flowable hemostatic matrix
(FLOSEAL, Baxter Healthcare Corporation) vs non-flowable topical hemostats
(SURGICEL Nu-Knit, Ethicon-Johnson & Johnson; GELFOAM, Pfizer). Costing
analyses focused on the following outcomes: complications, blood
transfusions, surgical revisions, and operating room (OR) time. Cardiac
surgery costs were analyzed and expressed in 2012 US dollars based on
available literature searches and US data. Comparator group variability in
cost consequences (i.e., cost savings) was calculated based on annualized
impact and scenario testing. Results: Results suggest that if a flowable
hemostatic matrix (rather than a non-flowable hemostat) was utilized
exclusively in 600 mixed cardiac surgeries annually, a hospital could
improve patient outcomes by a reduction of 33 major complications, 76
minor complications, 54 surgical revisions, 194 transfusions, and 242 h of
OR time. These outcomes correspond to a net annualized cost consequence
savings of $5.38 million, with complication avoidance as the largest
contributor. Conclusions: This cost consequence framework and supportive
modeling was used to evaluate the hospital economic impact of outcomes
resulting from the usage of various hemostatic agents. These analyses
support that cost savings can be achieved from routine use of a flowable
hemostatic matrix, rather than a non-flowable topical hemostat, in cardiac
surgery. 2014 Informa UK Ltd.
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Accession Number
71607044
Authors
Boitor M. Martorella G. Arbour C. Michaud C. Gelinas C.
Institution
(Boitor, Martorella, Arbour, Gelinas) Ingram School of Nursing, McGill
University, Montreal, Canada
(Martorella) Faculty of Nursing, Universite de Montreal, Montreal, Canada
(Martorella, Arbour, Michaud, Gelinas) Quebec Nursing Interventions
Research Network (RRISIQ), McGill University, Montreal, Canada
(Arbour, Gelinas) Alan Edwards Centre for Research on Pain, McGill
University, Montreal, Canada
(Michaud) School of Nursing, Universite de Sherbrooke, Sherbrooke, Canada
(Gelinas) Centre for Nursing Research and Lady Davis Institute, Jewish
General Hospital, Montreal, QC, Canada
Title
Evaluation of the preliminary effectiveness of hand-massage therapy on
postoperative pain of cardiac surgery adults in the intensive care unit.
Source
Pain Research and Management. Conference: 35th Annual Scientific Meeting
of the Canadian Pain Society Quebec City, QC Canada. Conference Start:
20140520 Conference End: 20140523. Conference Publication: (var.pagings).
19 (3) (pp e64), 2014. Date of Publication: May-June 2014.
Publisher
Pulsus Group Inc.
Abstract
AIM: This study aimed to evaluate the preliminary effectiveness of hand
massage on postoperative pain in the ICU. METHODS: A pilot randomized
controlled trial (RCT) was conducted with 40 adult ICU patients post
cardiac surgery. Patients were randomized to either experimental (EG)
(n=21) or control group (CG) (n=19). The EG received a 15 min hand-massage
with lavender cream followed by a 30 min rest period. The CG had the cream
applied to their hands without massage followed by the rest period. All
participants received at least two interventions (massage or control), and
12 of them, a third one from a trained nurse within the first 24 h
postoperative period. Pain variables (0 to 10 intensity, 0 to 8
Critical-Care Pain Observation Tool for behaviors) were collected before
and after each intervention. Participants were also interviewed within 24
h post-ICU discharge with the Brief Pain Inventory (BPI). RESULTS: A trend
towards significance for the second intervention (P=0.088), and a
treatment effect for the third intervention (F[2, 20]=6.30; P=0.008) were
found for the EG who reported a greater decrease in pain intensity
post-massage. Significantly less pain behaviors (ie, lower CPOT scores)
post-massage were found for the EG for the first intervention (Mann
Whitney=83.5; P=0.047). No significant results were obtained using the
BPI. CONCLUSIONS: This pilot RCT showed promising results supporting
potential benefits of hand-massage as a non-pharmacological intervention
for pain management in postoperative ICU patients. A larger RCT is
warranted to further explore its effects on pain, but until then, this
low-cost intervention can be safely administered.
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