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Embase <1980 to 2015 Week 47>
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<1>
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Accession Number
2015876424
Authors
Lu M. Sajobi T. Lucyk K. Lorenzetti D. Quan H.
Institution
(Lu) Department of Economics and Community Health Sciences, Centre for
Health and Policy Studies, University of Calgary, Calgary, AB, Canada
(Sajobi, Lucyk, Lorenzetti, Quan) Department of Community Health Sciences,
Centre for Health and Policy Studies, University of Calgary, Calgary, AB,
Canada
Title
Systematic review of risk adjustment models of hospital Length of Stay
(LOS).
Source
Medical Care. 53 (4) (pp 355-365), 2015. Date of Publication: 30 Mar 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Policy decisions in health care, such as hospital performance
evaluation and performance-based budgeting, require an accurate prediction
of hospital length of stay (LOS). This paper provides a systematic review
of risk adjustment models for hospital LOS, and focuses primarily on
studies that use administrative data. Methods: MEDLINE, EMBASE, Cochrane,
PubMed, and EconLit were searched for studies that tested the performance
of risk adjustment models in predicting hospital LOS. We included studies
that tested models developed for the general inpatient population, and
excluded those that analyzed risk factors only correlated with LOS, impact
analyses, or those that used disease-specific scales and indexes to
predict LOS. Results: Our search yielded 3973 abstracts, of which 37 were
included. These studies used various disease groupers and severity/
morbidity indexes to predict LOS. Few models were developed specifically
for explaining hospital LOS; most focused primarily on explaining resource
spending and the costs associated with hospital LOS, and applied these
models to hospital LOS. We found a large variation in predictive power
across different LOS predictive models. The best model performance for
most studies fell in the range of 0.30-0.60, approximately. Conclusions:
The current risk adjustment methodologies for predicting LOS are still
limited in terms of models, predictors, and predictive power. One possible
approach to improving the performance of LOS risk adjustment models is to
include more diseasespecific variables, such as disease-specific or
condition-specific measures, and functional measures. For this approach,
however, more comprehensive and standardized data are urgently needed. In
addition, statistical methods and evaluation tools more appropriate to LOS
should be tested and adopted.
<2>
Accession Number
2013233359
Authors
Weltert L. Nardella S. Rondinelli M.B. Pierelli L. De Paulis R.
Institution
(Weltert, Nardella, Rondinelli, Pierelli, De Paulis) not available, Italy
Title
Reduction of allogeneic red blood cell usage during cardiac surgery by an
integrated intra- and postoperative blood salvage strategy: Results of a
randomized comparison.
Source
Transfusion. 53 (4) (pp 790-797), 2013. Date of Publication: April 2013.
Publisher
Blackwell Publishing Inc.
Abstract
BACKGROUND: The amount of allogeneic blood transfusion may relate to worse
outcome in cardiac surgery. The reinfusion of red blood cells (RBCs) lost
by patients, including those of chest drains, is a promising strategy to
minimize allogeneic transfusions. STUDY DESIGN AND METHODS: To verify this
hypotheis, 1047 cardiac surgery patients were randomly assigned to either
traditional intraoperative blood salvage followed by chest drain insertion
or intra- and postoperative strategy with the Haemonetics cardioPAT
system. Allogeneic RBC transfusion rate (primary endpoint) and
postoperative complications (secondary endpoint) were recorded at the time
of discharge from the hospital and at first month follow-up visit,
respectively. RESULTS: The cardioPAT arm received 1.20 units of allogeneic
RBCs per patient, whereas the control group required 2.11 units per
patient, and this difference proved to be highly significant (p = 0.02).
We observed a comparable 45-day mortality rate but a lower rate of deep
vein thrombosis (p = 0.04) and atrial fibrillation (p = 0.04) in the
cardioPAT arm. DISCUSSION: A significant reduction in patient exposure to
allogeneic RBCs was observed in the cardioPAT system arm. Complications
were slightly less frequent in the cardioPAT group. The use of the
cardioPAT is a safe and effective strategy to reduce allogeneic RBC
transfusions in cardiac surgery. © 2012 American Association of Blood
Banks.
<3>
Accession Number
2015508289
Authors
Deuse T. Bara C. Barten M.J. Hirt S.W. Doesch A.O. Knosalla C. Grinninger
C. Stypmann J. Garbade J. Wimmer P. May C. Porstner M. Schulz U.
Institution
(Deuse, Barten) Department of Cardiovascular Surgery, University Heart
Center Hamburg, Martinistr 52, Hamburg 20246, Germany
(Bara) Division of Cardiovascular, Thoracic and Transplantation Surgery,
Hannover Medical School, Carl-Neuberg-Strase 1, Hannover 30625, Germany
(Barten, Garbade) Department of Cardiac Surgery, University Hospital
Leipzig, Heart Center, Strumpellstrase 39, Leipzig, Germany
(Hirt) Department of Cardiothoracic Surgery, University Hospital
Regensburg, Franz-Josef-Straus-Allee 11, Regensburg 93053, Germany
(Doesch) Department of Cardiology, University Hospital Heidelberg, Im
Neuenheimer Feld 400, Heidelberg 69120, Germany
(Knosalla) Department of Cardiovascular and Thoracic Surgery, German Heart
Institute Berlin, Augustenburger Platz 1, Berlin 13353, Germany
(Grinninger) Department of Cardiac Surgery, Munich Transplantation Center,
Klinikum Groshadern LMU, Marchioninistrase 15, Munich 81377, Germany
(Stypmann) Department of Cardiovascular Medicine, Division of Cardiology,
University Hospital Munster, Albert-Schweitzer-Strase 33, Munster 48149,
Germany
(Wimmer, May, Porstner) Novartis Pharma GmbH, Roonstrase 25, Nuremberg
90429, Germany
(Schulz) Department of Thoracic and Cardiovascular Surgery, Heart and
Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, Bad
Oeynhausen 32545, Germany
Title
The MANDELA study: A multicenter, randomized, open-label, parallel group
trial to refine the use of everolimus after heart transplantation.
Source
Contemporary Clinical Trials. 45 (pp 356-363), 2015. Date of Publication:
November 01, 2015.
Publisher
Elsevier Inc.
Abstract
In recent years a series of trials has sought to define the optimal
protocol for everolimus-based immunosuppression in heart transplantation,
with the goal of minimizing exposure to calcineurin inhibitors (CNIs) and
harnessing the non-immunosuppressive benefits of everolimus. Randomized
studies have demonstrated that immunosuppressive potency can be maintained
in heart transplant patients receiving everolimus despite marked CNI
reduction, although very early CNI withdrawal may be inadvisable. A
potential renal advantage has been shown for everolimus, but the optimal
time for conversion and the adequate reduction in CNI exposure remain to
be defined. Other reasons for use of everolimus include a substantial
reduction in the risk of cytomegalovirus infection, and evidence for
inhibition of cardiac allograft vasculopathy, a major cause of graft loss.
The ongoing MANDELA study is a 12-month multicenter, randomized,
open-label, parallel-group study in which efficacy, renal function and
safety are compared in approximately 200 heart transplant patients.
Patients receive CNI therapy, steroids and everolimus or mycophenolic acid
during months 3 to 6 post-transplant, and are then randomized at month 6
post-transplant (i) to convert to CNI-free immunosuppression with
everolimus and mycophenolic acid or (ii) to continue reduced-exposure CNI,
with concomitant everolimus. Patients are then followed to month 18
post-transplant The rationale and expectations for the trial and its
methodology are described herein.
<4>
Accession Number
2015296408
Authors
Saurav A. Kaushik M. Mahesh Alla V. White M.D. Satpathy R. Lanspa T. Mooss
A.N. Delcore M.G.
Institution
(Saurav, Mahesh Alla, White, Lanspa, Mooss, Delcore) Division of
Cardiology, Creighton University Medical Center, 3006 Webster St. 68131,
United States
(Kaushik) Division of Cardiology, VA Nebraska-Western Iowa Health System,
Omaha, NE, United States
(Satpathy) Division of Cardiology, Alegent Creighton Heart and Vascular
Institute, Omaha, NE, United States
Title
Comparison of percutaneous device closure versus surgical closure of
peri-membranous ventricular septal defects: A systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 86 (6) (pp 1048-1056),
2015. Date of Publication: 15 Nov 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background While percutaneous device closure (PDC) is a first-line therapy
for isolated muscular ventricular septal defects (mVSD), surgery is still
the preferred approach for peri-membranous ventricular septal defects
(pmVSD). Objective We sought to compare the outcomes of percutaneous
versus open surgical closure of pmVSDs. Methods PubMed, Cochrane Library,
and Web of Science databases were searched through October 15, 2014 for
English language studies comparing outcomes of PDC with surgical closure
of pmVSDs. Study quality, publication bias, and heterogeneity were
assessed. A meta-analysis of selected studies was performed using a random
effects model. Comparison was done for early (<1 month) safety and
efficacy outcomes. Results Seven studies with a total of 3,134 patients
(PDC = 1,312, surgery = 1,822) were identified. Patients in the PDC group
were older than those treated surgically (mean age 12.2 vs. 5.5 years,
respectively). In six out of seven studies, the mean VSD size was found to
be comparable between the treatment arms (PDC 4.9 mm vs. surgery 6.0 mm).
Males represented 52% of patients in either group. Follow-up ranged from 5
to 42 months. No significant differences were observed between PDC vs.
surgery in terms of procedural success rate [relative risk (RR): 1.00,
confidence interval (CI): 0.99-1.00; P = 0.67]. Combined safety end points
for major complications (early death/reoperation/permanent pacemaker) were
similar in both groups (RR: 0.55, CI: 0.23-1.35; P = 0.19) as were as
other outcomes like post-procedure significant residual shunt (RR: 0.69,
CI: 0.29-1.68; P = 0.41), significant valvular (aortic/tricuspid)
regurgitation (RR: 0.70, CI: 0.26-1.86; P = 0.47), and advanced heart
block (RR: 0.99, CI: 0.46-2.14; P = 0.98). The need for blood transfusion
(RR: 0.02, CI: 0.00-0.05; P < 0.001) and duration of hospital stay
[standard mean difference (SMD) -2.17 days, CI: -3.12 to -1.23; P < 0.001]
were significantly reduced in the PDC group. Conclusion Percutaneous
closure of pmVSD when performed in a selected subgroup of patients is
associated with similar procedural success rate without increased risk of
significant valvular regurgitation or heart block when compared with
surgical closure.
<5>
Accession Number
2015025093
Authors
Campos C.M. Stanetic B.M. Farooq V. Walsh S. Ishibashi Y. Onuma Y.
Garcia-Garcia H.M. Escaned J. Banning A. Serruys P.W.
Institution
(Campos, Stanetic, Ishibashi, Onuma, Garcia-Garcia) Department of
Interventional Cardiology, Thoraxcenter, Erasmus University Medical
Centre, Rotterdam, Netherlands
(Campos) Department of Interventional Cardiology, Heart Institute, Medical
School, University of Sao Paulo, Sao Paulo, Brazil
(Stanetic) Department of Interventonal Cardiology, University Hospital
Clinical Centre Banja Luka, Banja Luka, Bosnia and Herzegovina
(Farooq) Department of Intervenional Cardiology, Manchester Heart Centre,
Manchester Royal Infirmary, Central Manchester University Hospitals NHS
Trust, Manchester, United Kingdom
(Walsh) Belfast Health and Social Care Trust, Belfast, United Kingdom
(Escaned) Cardiovascular Institute, Hospital Clinico San Carlos, Centro
Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid,
Spain
(Banning) Department of Interventional Cardiology, Oxford University
Hospitals, Oxford, United Kingdom
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
Title
Risk stratification in 3-vessel coronary artery disease: Applying the
SYNTAX Score II in the Heart Team Discussion of the SYNTAX II trial.
Source
Catheterization and Cardiovascular Interventions. 86 (6) (pp E229-E238),
2015. Date of Publication: 15 Nov 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background Heart Team (HT) and the SYNTAX Score II (SSII) have been
integrated to the contemporary guidelines with the aim to provide a
multidisciplinary decision-making process between coronary artery bypass
surgery (CABG) and percutaneous coronary intervention (PCI). Aims To
prospectively assess the agreement between the HT decision and the SSII
recommendation regarding the revascularization strategy in patients with
3-vessel coronary artery disease (CAD) of the SYNTAX II trial. Methods The
SSII predicts the 4-year mortality of an individual patient both after PCI
and after CABG. Patients were treated by PCI when the SSII predicted a
mortality risk favoring PCI or when risk predictions were equipoise
between PCI and CABG. However, the HT could overrule the SSII and
recommend either CABG or PCI. Results A total of 202 patients have been
screened and 24 did not fulfill inclusion criteria. The median age was
67.0 (IQR 59.0-73.3), and 167 (82.7%) were male. The HT endorsed SSII
treatment recommendation, for CABG or PCI, in 152 patients (85.4%). Three
patients had preference for PCI, irrespective of the HT decision. The main
reason for the HT to overrule the SSII and recommend CABG was the prospect
of a more complete revascularization (21 of 25 patients). Patients
recommended for CABG by the HT had significantly higher anatomical SYNTAX
score (P = 0.03) and higher predicted mortality risk for PCI (P = 0.04)
when compared with patients that were enrolled in the trial. Conclusion
The SYNTAX score II showed to be a suitable tool for guiding treatment
decisions of patients with 3-vessel coronary artery disease being endorsed
by the HT in the vast majority of the patients that have been enrolled in
the SYNTAX II trial.
<6>
Accession Number
2015969594
Authors
Arnous S. Shakhshir N. Wiper A. Ordoubadi F.-F. Williams P. Clarke B.
Mahadavan V. El-Omar M. Mamas M. Fraser D.
Institution
(Arnous, Shakhshir, Wiper, Ordoubadi, Williams, Clarke, Mahadavan,
El-Omar, Mamas, Fraser) Manchester Heart Centre, Manchester Royal
Infirmary, Manchester M139WL, United Kingdom
(Arnous) Cardiovascular Institute, University of Manchester, Manchester
M13 9PT, United Kingdom
Title
Incidence and mechanisms of longitudinal stent deformation associated with
Biomatrix, Resolute, Element, and Xience stents: Angiographic and
case-by-case review of 1,800 PCIs.
Source
Catheterization and Cardiovascular Interventions. 86 (6) (pp 1002-1011),
2015. Date of Publication: 15 Nov 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background There is conflicting evidence regarding the incidence of
longitudinal stent deformation (LSD) in contemporary practice. Methods and
results To assess the incidence and mechanism of LSD across commonly used
DES platforms, we performed a case-by-case review of 1,800 PCI cases
involving 450 consecutive procedures using Biomatrix Flex, Resolute
Integrity, Promus Element, and Xience V stents, respectively, between
January 2009 and December 2011. LSD was detected in a higher proportion
with Promus Element [15 (3.1%)] compared with other platforms (Xience V [4
(0.9%)], Biomatrix [3 (0.7%)], Resolute [3 (0.7%)]; P = 0.002). LSD was
characterized as guide catheter/guide extension induced, or as impact from
secondary devices such as postdilatation balloons or IVUS catheters. The
incidence of guide catheter/guide extension LSD was similar across
platforms; (Promus Element [5 (1.1%)], Xience V [4 (0.9%)], Biomatrix [3
(0.7%)], Resolute [3 (0.7%)]; P = 0.85). Secondary device LSD occurred
exclusively with Promus Element (9/450 cases [2%] (P < 0.0001).
Re-entering the deformed stent was more difficult in cases of secondary
device LSD (6/9 compared with 0/12 treated cases; P < 0.001). Univariate
predictors of LSD were previous CABG, culprit vessel, ostial involvement,
and lesion tortuosity. Multivariate predictors of LSD were the Promus
Element stent (OR 5.53 CI[1.54-19.85]), Guideliner use (OR 22.09
CI[4.73-103]), postdilation balloons (OR 5.47 CI[1.31-22.81]) and number
of stents deployed (OR 2.06 CI[1.45-2.9]. Conclusion LSD is more common
than previously reported. LSD by a guide catheter/guide extension occurred
equally with all platforms, however, LSD associated with secondary devices
only occurred with the Element stent. These findings have important
implications regarding current and future stent designs.
<7>
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Accession Number
2015501120
Authors
Tie H.-T. Luo M.-Z. Li Z.-H. Wang Q. Wu Q.-C. Li Q. Zhang M.
Institution
(Tie, Wang, Li, Zhang) Department of Cardiothoracic Surgery, First
Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
(Luo) First Affiliated Hospital, Chongqing Medical University, Division of
Immunology, Children's Hospital, Chongqing Medical University, Chongqing,
China
(Li, Wu) First College of Clinical Medicine, Chongqing Medical University,
Chongqing, China
Title
Remote ischemic preconditioning fails to benefit pediatric patients
undergoing congenital cardiac surgery: A meta-analysis of randomized
controlled trials.
Source
Medicine (United States). 94 (43) , 2015. Article Number: e1895. Date of
Publication: 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Remote ischemic preconditioning (RIPC) has been proven to reduce the
ischemia-reperfusion injury. However, its effect on children receiving
congenital cardiac surgery (CCS) was inconsistent. We therefore performed
the current meta-analysis of randomized controlled trials (RCTs) to
comprehensively evaluate the effect of RIPC in pediatric patients
undergoing CCS. PubMed, Embase, and Cochrane library were searched to
identify RCTs assessing the effect of RIPC in pediatric patients
undergoing CCS. The outcomes included the duration of mechanical
ventilation (MV), intensive care unit (ICU) length of stay, postoperative
cardiac troponin (cTnI) level, hospital length of stay (HLOS),
postoperative inotropic score, and mortality. Subgroup and sensitivity
analysis were also performed as predesigned. The meta-analysis was
performed with randomeffects model despite of heterogeneity. Sensitivity
and subgroup analysis were predesigned to identify the robustness of the
pooled estimate. Nine RCTs with 697 pediatric patients were included in
the metaanalysis. Overall, RIPC failed to alter clinical outcomes of
duration of MV(standardmeandifference[SMD]-0.03,95%confidenceinterval
[CI]-0.23-0.17), ICU length of stay (SMD-0.22, 95% CI-0.47-0.04), or HLOS
(SMD-0.14, 95%CI-0.55-0.26).Additionally, RIPC could not
reducepostoperativecTnI(at4-6 hours: SMD-0.25,95%CI-0.73-0.23; P=0.311; at
20-24 hours: SMD0.09, 95%CI-0.51-0.68;P=0.778) or postoperative inotropic
score (at 4-6 hours: SMD-0.19, 95%CI-0.51-0.14;P=0.264;at24 hours:
SMD-0.15,95%CI-0.49-0.18;P=0.365). RIPC may have no beneficial effects in
children undergoing CCS. However, this finding should be interpreted with
caution because of heterogeneity and large-scale RCTs are still needed.
<8>
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Accession Number
2015506409
Authors
Kanthimathinathan H.K. Sundararajan S.B. Laker S. Scholefield B.R. Morris
K.P.
Institution
(Kanthimathinathan, Laker, Scholefield, Morris) PICU, Birmingham
Children's Hospital, Birmingham, United Kingdom
(Sundararajan) PICU, Leeds Children's Hospital, Leeds, United Kingdom
(Scholefield) University of Birmingham, Birmingham, United Kingdom
Title
Targeting glycemic control after pediatric cardiac surgery: The influence
of age on insulin requirement.
Source
Pediatric Critical Care Medicine. 16 (9) (pp 853-858), 2015. Date of
Publication: 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Factors influencing the development of hyperglycemia and
pattern of insulin requirement in children undergoing cardiac surgery are
poorly understood. This study investigated the impact of age on the
pattern of hyperglycemia and insulin requirement in children after cardiac
surgery. Design: Cohort study, based on a prospectively collected dataset
for patients enrolled into the Control of Hyperglycemia in Pediatric
Intensive Care trial. Setting: A 24-bedded multidisciplinary PICU.
Patients: Children randomized to the tight glycemic control arm (target
blood glucose, 4-7 mmol/L [72-126 mg/dL]) of the Control of Hyperglycemia
in Pediatric Intensive Care trial following cardiac surgery. Children were
categorized into four age groups (neonate, 1-30 d; infant, 31-365 d; young
child, 1-5 yr; older child, 5-16 yr) for analyses of patterns of
hyperglycemia and insulin requirement over the 12-hour period following
initiation of insulin. Interventions: Insulin titration was performed
based on blood glucose value and rate of change of blood glucose using an
algorithm developed for the Control of Hyperglycemia in Pediatric
Intensive Care trial. Measurements and Main Results: Of 92 children, 72
children (78%) randomized to the tight glycemic control group developed
hyperglycemia (blood glucose, > 7 mmol/L [126 mg/dL]) and received
insulin. Older age was associated with higher blood glucose and a higher
insulin dose per kilogram over the first 3 hours of the study period (p ?
0.02). Cumulative insulin dose was significantly higher in older children
(median, 1.3 U/kg [range, 0.2-5.75]) compared with other age groups
(neonate, 0.37 [0.05-2.2]; infant, 0.45 [0.05-2.2]; young child, 0.35
[0.05-0.81]) (p = 0.004). Age group, rather than body mass index,
carbohydrate intake, or cardiac surgery variables, was the only variable
(coefficient: 1.14 0.3; p < 0.001) associated with cumulative insulin dose
on multivariate analysis. Conclusions: When tight glycemic control is
targeted in children who have undergone cardiac surgery, children in the
older child age group (5-16 yr) require insulin at significantly higher
doses. Further study is needed to understand the mechanisms involved.
<9>
Accession Number
2015504807
Authors
Bolzan D.W. Gomes W.J. Peixoto T.C.A. Faresin S.M. Carvalho A.C.C. De
Paola A.A.V. Guizilini S.
Institution
(Bolzan, Gomes, Peixoto, Carvalho, De Paola, Guizilini) Cardiology
Division, Federal University of Sao Paulo, Sao Paulo, Brazil
(Faresin) Pneumology Division, Escola Paulista de Medicina, Federal
University of Sao Paulo, Sao Paulo, Brazil
(Gomes) Cardiovascular Surgery Discipline, Pirajussara and Sa~o Paulo
Hospitals, Federal University of Sao Paulo, Sao Paulo, Brazil
(Guizilini) Department of Human Movement Sciences, Physical Therapy School
of the Federal University of Sao Paulo, Santos, Sao Paulo, Brazil
Title
Clinical use of the volume-time curve for endotracheal tube cuff
management.
Source
Respiratory Care. 59 (11) (pp 1628-1635), 2014. Date of Publication:
November 2014.
Publisher
American Association for Respiratory Care
Abstract
BACKGROUND: Previous investigation showed that the volume-time curve
technique could be an alternative for endotracheal tube (ETT) cuff
management. However, the clinical impact of the volume-time curve
application has not been documented. The purpose of this study was to
compare the occurrence and intensity of a sore throat, cough, thoracic
pain, and pulmonary function between these 2 techniques for ETT cuff
management: volume-time curve technique versus minimal occlusive volume
(MOV) technique after coronary artery bypass grafting. METHODS: A total of
450 subjects were randomized into 2 groups for cuff management after
intubation:MOVgroup (n=222) and volume-time curve group (n = 228). We
measured cuff pressure before extubation. We performed spirometry 24 h
before and after surgery. We graded sore throat and cough according to a
4-point scale at 1, 24, 72, and 120 h after extubation and assessed
thoracic pain at 24 h after extubation and quantified the level of pain by
a 10-point scale. RESULTS: The volume-time curve group presented
significantly lower cuff pressure (30.9 +/- 2.8 vs 37.7 +/- 3.4 cm
H<sub>2</sub>O), less incidence and intensity of sore throat (1 h, 23.7 vs
51.4%; and 24 h, 18.9 vs 40.5%, P <.001), cough (1 h, 19.3 vs 48.6%; and
24 h, 18.4 vs 42.3%, P <.001), thoracic pain (5.2 +/- 1.8 vs 7.1 +/- 1.7),
better preservation of FVC (49.5 +/- 9.9 vs 41.8 +/- 12.9%, P =.005), and
FEV<sub>1</sub> (46.6 +/- 1.8 vs 38.6 +/- 1.4%, P =.005) compared with the
MOV group. CONCLUSIONS: The subjects who received the volumetime curve
technique for ETT cuff management presented a significantly lower
incidence and severity of sore throat and cough, less thoracic pain, and
minimally impaired pulmonary function than those subjects who received the
MOV technique during the first 24 h after coronary artery bypass grafting.
<10>
[Use Link to view the full text]
Accession Number
2015447794
Authors
Pack Q.R. Squires R.W. Valdez-Lowe C. Mansour M. Thomas R.J. Keteyian S.J.
Institution
(Pack, Valdez-Lowe, Mansour, Keteyian) Division of Cardiovascular
Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit,
MI, United States
(Pack, Squires, Thomas) Division of Cardiovascular Diseases, Department of
Internal Medicine, Mayo Clinic, Rochester, MN, United States
(Pack) Department of Cardiovascular Medicine, Baystate Medical Group, 759
Chestnut St, Springfield, MA 01089, United States
(Pack) Tufts University School of Medicine, Boston, MA, United States
Title
Employment status and participation in cardiac rehabilitation: Does
encouraging earlier enrollment improve attendance?.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 35 (6) (pp
390-398), 2015. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins
Abstract
PURPOSE: For patients hospitalized for a cardiac event, an earlier
appointment to outpatient cardiac rehabilitation (CR) increases
participation. However, it is unknown what effect hastening CR enrollment
might have among employed patients planning to return to work (RTW).
METHODS: Using 2 complementary data sets from Henry Ford Hospital (HFH)
and Mayo Clinic, we assessed when employed patients eligible for CR
anticipated a RTW, the impact of an earlier appointment on CR enrollment,
and the effect of employment status on the number of CR sessions attended.
Patients at HFH attended CR at either 8 or 42 days (through
randomization), whereas Mayo Clinic patients attended 10 days after
hospital discharge per standard routines. RESULTS: Among 148 patients at
HFH, 65 (44%) were employed and planned to RTW. Of these, 67% desired to
RTW within 1 to 2 weeks, whereas 28% anticipated an RTW within 1 to 3
days. Home financial strain predicted nonparticipation in CR ( P .001) and
was associated with an earlier planned RTW. Among 1030 patients at Mayo
Clinic, 393 (38%) were employed. Employed (vs nonemployed) patients
enrolled in CR 3.3 days sooner ( P .001), but attended 1.6 fewer CR
sessions ( P = .04). In employed patients from both health systems, an
earlier (vs later) appointment to CR did not result in additional exercise
sessions of CR. CONCLUSIONS: Employed patients plan to RTW quickly, in
part because of home finances. They also enroll earlier into CR than
nonemployed patients. Despite these findings, earlier appointments do not
seem to favorably impact overall CR participation.
<11>
Accession Number
20499017
Authors
Caroleo S. Bisurgi G. Onorati F. Rubino A. Calandese F. De Munda C.
Renzulli A. Santangelo E. Verre M. Amantea B.
Institution
(Caroleo, Bisurgi, Onorati, Rubino, Calandese, De Munda, Renzulli,
Santangelo, Verre, Amantea) Intensive Care Unit, University Hospital Mater
Domini, Magna Graecia University, Catanzaro, Italy
Title
Intensive versus conventional insulinotherapy after elective and on-pump
myocardial revascularization: a prospective and randomized study.
Source
La Clinica terapeutica. 161 (2) (pp e33-e37), 2010. Date of Publication:
2010.
Abstract
OBJECTIVES: Strict glycemic control is increasingly recognized as an
important goal in a broad spectrum of critically ill patients. We analyzed
the inflammatory and clinical response of patients submitted to intensive
or conventional insulinotherapy in a specific clinical context.
MATERIALS AND METHODS: We analyzed a prospective and randomized collected
database of an Intensive Care Unit (ICU) in a University Hospital. The
database comprised a total of 50 patients aged 30 to 80 (ASA II-III) who
underwent elective and on-pump myocardial revascularization from September
2006 to June 2008. On ICU admission, patients were randomly assigned to
Group 1 (intensive insulinotherapy) or Group 2 (conventional
insulinotherapy). Data collected included glucose and lactate blood
levels, haemodynamic parameters, cytokines (TNFalpha, IL-6, IL-8, IL-10),
C-Reactive Protein, white blood cells and platelets blood levels, body
temperature, Sequential Organ Failure Assessment (SOFA) score, Infection
Probability Score (IPS) and ICU length of stay (LOS). Within-between group
analysis, one-way ANOVA and unpaired t-test were used when appropriate.
RESULTS: Pre- and perioperative variables were comparable between the two
groups (p=NS for all measurements). Glucose and lactate blood levels were
lower in Group 1 (p less than 0.0001). Stroke Volume Index was higher in
Group 1 (p less than 0.05). Moreover, we observed statistically
significant differences between groups in terms of inflammatory parameters
and severity scores. No difference was observed in ICU LOS.
CONCLUSIONS: Intensive insulinotherapy after elective on-pump myocardial
revascularization significantly modulates the inflammatory response.
Different inflammatory patterns could correlate with different clinical
response as suggested by SOFA and IP score analysis.
<12>
Accession Number
24787892
Authors
Lim C.-H. Nam M.-J. Lee J.-S. Kim H.-J. Kim J.-Y. Shin H.-W. Lee H.-W. Sun
K.
Institution
(Lim, Nam, Lee, Kim, Kim, Shin, Lee, Sun) Department of Anesthesiology and
Pain Medicine, Korea University Medical Center, Seoul, Korea
Title
A meta-analysis of pulmonary function with pulsatile perfusion in cardiac
surgery.
Source
Artificial organs. 39 (2) (pp 110-117), 2015. Date of Publication: 01 Feb
2015.
Abstract
The aim of this study was to determine whether pulsatile or nonpulsatile
perfusion had a greater effect on pulmonary dysfunction in randomized
controlled trials. MEDLINE, EMBASE, and the Cochrane Central Register of
Controlled Trials were used to identify available articles published
before April 13, 2013. A meta-analysis was conducted on the effects of
pulsatile perfusion on postoperative pulmonary function, intubation time,
and the lengths of intensive care unit (ICU) and hospital stays. Eight
studies involving 474 patients who received pulsatile perfusion and 496
patients who received nonpulsatile perfusion during cardiopulmonary bypass
(CPB) were considered in the meta-analysis. Patients receiving pulsatile
perfusion had a significantly greater PaO2 /FiO2 ratio 24h and 48h
post-operation (P<0.00001, both) and significantly lower chest radiograph
scores at 24h and 48h post-operation (P<0.00001 and P=0.001, respectively)
compared with patients receiving nonpulsatile perfusion. The incidence of
noninvasive ventilation for acute respiratory insufficiency was
significantly lower (P<0.00001), and intubation time and ICU and hospital
stays were shorter (P=0.004, P<0.00001, and P<0.00001, respectively) in
patients receiving pulsatile perfusion during CPB compared with patients
receiving nonpulsatile perfusion. In conclusion, our meta-analysis
suggests that the use of pulsatile flow during CPB results in better
postoperative pulmonary function and shorter ICU and hospital stays.
<13>
Accession Number
25287767
Authors
Fengler K. Fuernau G. Desch S. Eitel I. Neumann F.-J. Olbrich H.-G. de
Waha A. de Waha S. Richardt G. Hennersdorf M. Empen K. Hambrecht R.
Fuhrmann J. Bohm M. Poess J. Strasser R. Schneider S. Schuler G. Werdan K.
Zeymer U. Thiele H.
Institution
(Fengler, Fuernau, Desch, Eitel, Neumann, Olbrich, de Waha, de Waha,
Richardt, Hennersdorf, Empen, Hambrecht, Fuhrmann, Bohm, Poess, Strasser,
Schneider, Schuler, Werdan, Zeymer, Thiele) Department of Internal
Medicine, Cardiology, University of Leipzig, Heart Center, Strumpellstrase
39, 04289, Leipzig, Germany
Title
Gender differences in patients with cardiogenic shock complicating
myocardial infarction: a substudy of the IABP-SHOCK II-trial.
Source
Clinical research in cardiology : official journal of the German Cardiac
Society. 104 (1) (pp 71-78), 2015. Date of Publication: 01 Jan 2015.
Abstract
BACKGROUND: Cardiogenic shock (CS) complicating acute myocardial
infarction (AMI) is associated with high mortality. Previous studies
regarding gender-specific differences in CS are conflicting and there are
insufficient data for the presence of gender-associated differences in the
contemporary percutaneous coronary intervention era. Aim of this study was
therefore to investigate gender-specific differences in a large cohort of
AMI patients with CS undergoing contemporary treatment.
METHODS: In the randomized Intra-aortic Balloon Pump in Cardiogenic Shock
II (IABP-SHOCK II) trial, 600 patients with CS complicating AMI undergoing
early revascularization were assigned to therapy with or without
intra-aortic balloon pump. We compared sex-specific differences in these
patients with regard to baseline and procedural characteristics as well as
short- and long-term clinical outcome.
RESULTS: Of 600 patients 187 (31%) were female. Women were significantly
older than men and had a significantly lower systolic and diastolic blood
pressure at presentation (p < 0.05 for all). Diabetes mellitus and
hypertension were more frequent in women, whereas smoking was more
frequent in men (p < 0.05 for all). Women showed a higher mortality within
the first day after randomization (p = 0.004). However, after
multivariable adjustment this numerical difference was no longer
statistically significant. No gender-related differences in clinical
outcome were observed after 1, 6 and 12 months of follow-up.
CONCLUSION: In this large-scale multicenter study in patients with CS
complicating AMI, women had a worse-risk profile in comparison to men. No
significant gender-related differences in treatment as well as short- and
long-term outcome were observed.
<14>
[Use Link to view the full text]
Accession Number
26152708
Authors
Lee J.M. Hwang D. Park J. Kim K.-J. Ahn C. Koo B.-K.
Institution
(Lee) From Department of Internal Medicine and Cardiovascular Center,
Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K.,
B.-K.K.); Division of Biostatistics, Center for Devices and Radiological
Health, Food and Drug Administration, Silver Spring, MD (C.A.); and
Institute of Aging, Seoul National University, Korea (B.-K.K.)
(Hwang) From Department of Internal Medicine and Cardiovascular Center,
Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K.,
B.-K.K.); Division of Biostatistics, Center for Devices and Radiological
Health, Food and Drug Administration, Silver Spring, MD (C.A.); and
Institute of Aging, Seoul National University, Korea (B.-K.K.)
(Park) From Department of Internal Medicine and Cardiovascular Center,
Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K.,
B.-K.K.); Division of Biostatistics, Center for Devices and Radiological
Health, Food and Drug Administration, Silver Spring, MD (C.A.); and
Institute of Aging, Seoul National University, Korea (B.-K.K.)
(Kim) From Department of Internal Medicine and Cardiovascular Center,
Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K.,
B.-K.K.); Division of Biostatistics, Center for Devices and Radiological
Health, Food and Drug Administration, Silver Spring, MD (C.A.); and
Institute of Aging, Seoul National University, Korea (B.-K.K.)
(Ahn) From Department of Internal Medicine and Cardiovascular Center,
Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K.,
B.-K.K.); Division of Biostatistics, Center for Devices and Radiological
Health, Food and Drug Administration, Silver Spring, MD (C.A.); and
Institute of Aging, Seoul National University, Korea (B.-K.K.)
(Koo) From Department of Internal Medicine and Cardiovascular Center,
Seoul National University Hospital, Korea (J.M.L., D.H., J.P., K.-J.K.,
B.-K.K.); Division of Biostatistics, Center for Devices and Radiological
Health, Food and Drug Administration, Silver Spring, MD (C.A.); and
Institute of Aging, Seoul National University, Korea (B.-K.K.).
bkkoo@snu.ac.kr
Title
Percutaneous Coronary Intervention at Centers With and Without On-Site
Surgical Backup: An Updated Meta-Analysis of 23 Studies.
Source
Circulation. 132 (5) (pp 388-401), 2015. Date of Publication: 04 Aug 2015.
Abstract
BACKGROUND: Emergency coronary artery bypass grafting for unsuccessful
percutaneous coronary intervention (PCI) is now rare. We aimed to evaluate
the current safety and outcomes of primary PCI and nonprimary PCI at
centers with and without on-site surgical backup.
METHODS AND RESULTS: We performed an updated systematic review and
meta-analysis by using mixed-effects models. We included 23 high-quality
studies that compared clinical outcomes and complication rates of 1 101
123 patients after PCI at centers with or without on-site surgery. For
primary PCI for ST-segment-elevation myocardial infarction (133 574
patients), all-cause mortality (without on-site surgery versus with
on-site surgery: observed rates, 4.8% versus 7.2%; pooled odds ratio [OR],
0.99; 95% confidence interval, 0.91-1.07; P=0.729; I(2)=3.4%) or emergency
coronary artery bypass grafting rates (observed rates, 1.5% versus 2.4%;
pooled OR, 0.76; 95% confidence interval, 0.56-1.01; P=0.062; I(2)=42.5%)
did not differ by presence of on-site surgery. For nonprimary PCI (967 549
patients), all-cause mortality (observed rates, 1.6% versus 2.1%; pooled
OR, 1.15; 95% confidence interval, 0.94-1.41; P=0.172; I(2)=67.5%) and
emergency coronary artery bypass grafting rates (observed rates, 0.5%
versus 0.8%; pooled OR, 1.14; 95% confidence interval, 0.62-2.13; P=0.669;
I(2)=81.7%) were not significantly different. PCI complication rates
(cardiogenic shock, stroke, aortic dissection, tamponade, recurrent
infarction) also did not differ by on-site surgical capability. Cumulative
meta-analysis of nonprimary PCI showed a temporal decrease of the effect
size (OR) for all-cause mortality after 2007.
CONCLUSIONS: Clinical outcomes and complication rates of PCI at centers
without on-site surgery did not differ from those with on-site surgery,
for both primary and nonprimary PCI. Temporal trends indicated improving
clinical outcomes in nonprimary PCI at centers without on-site surgery.
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