Results Generated From:
Embase <1980 to 2016 Week 36>
Embase (updates since 2016-08-26)
<1>
Accession Number
26433523
Author
Conte J.V.; Gleason T.G.; Resar J.R.; Adams D.H.; Deeb G.M.; Popma J.J.;
Hughes G.C.; Zorn G.L.; Reardon M.J.
Institution
(Conte) Department of Surgery, The Johns Hopkins University, Baltimore,
Maryland. Electronic address: jconte@jhmi.edu
(Gleason) Department of Surgery, University of Pittsburgh Medical Center,
Pittsburgh, Pennsylvania
(Resar) Department of Medicine, The Johns Hopkins University, Baltimore,
Maryland
(Adams) Department of Surgery, Mount Sinai Medical Center, New York, New
York
(Deeb) Department of Surgery, University of Michigan, Ann Arbor, Michigan
(Popma) Department of Medicine, Beth Israel Deaconess Medical Center,
Boston, Massachusetts
(Hughes) Department of Surgery, Duke University, Durham, North Carolina
(Zorn) Department of Surgery, University of Kansas, Lawrence, Kansas
(Reardon) Department of Surgery, Houston-Methodist DeBakey Heart and
Vascular Center, Houston, Texas
Title
Transcatheter or Surgical Aortic Valve Replacement in Patients With Prior
Coronary Artery Bypass Grafting.
Source
The Annals of thoracic surgery. 101 (1) (pp 72-79), 2016. Date of
Publication: 01 Jan 2016.
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) and surgical
aortic valve replacement (SAVR) are treatment options for aortic stenosis
in patients with prior coronary artery bypass graft surgery. We assessed
the major clinical outcomes of such patients enrolled in the CoreValve
High Risk (CHR) study.
METHODS: Of the 795 CHR study patients, 226 had prior coronary artery
bypass graft surgery; 115 underwent TAVR and 111 underwent SAVR. The
primary endpoint was a comparison of all-cause mortality at 1 year.
Important secondary clinical endpoints were assessed.
RESULTS: At 1 year, all-cause mortality was 9.6% for TAVR versus 18.1% for
SAVR (p = 0.06); cardiovascular mortality was 7.0% for TAVR versus 13.8%
for SAVR (p = 0.09). A combination of The Society of Thoracic Surgeons
risk score greater than 7 and age greater than 80 years was a significant
predictor of mortality, with TAVR demonstrating a survival advantage (p =
0.03). No differences were seen for stroke. The SAVR group had longer
intensive care unit and hospital stays, increased incidence of acute
kidney injury, life-threatening or disabling bleeding, and major adverse
cardiac and cerebrovascular events (p < 0.05). Pacemaker implantation and
paravalvular regurgitation were greater with TAVR at all timepoints.
CONCLUSIONS: For patients with prior coronary artery bypass graft surgery
and aortic stenosis, TAVR offers a significant morbidity advantage and a
strong trend toward improved survival over SAVR at 1 year.
<2>
Accession Number
26303634
Author
Johnson J.T.; Sleeper L.A.; Chen S.; Ohye R.G.; Gaies M.G.; Williams I.A.;
Sachdeva R.; Pruetz J.D.; Tatum G.H.; Thacker D.; Brunetti M.A.; Frommelt
M.A.; Jacobs J.P.; Kirsh J.A.; Lambert L.M.; Newburger J.W.; Pemberton
V.L.; Zyblewski S.C.; Divanovic A.A.; Pinto N.M.
Institution
(Johnson) Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago,
Illinois. Electronic address: jtjohnson@luriechildrens.org
(Sleeper) New England Research Institutes, Inc., Watertown, Massachusetts
(Chen) New England Research Institutes, Inc., Watertown, Massachusetts
(Ohye) University of Michigan Health System, Ann Arbor, Michigan
(Gaies) University of Michigan Health System, Ann Arbor, Michigan
(Williams) Columbia University Medical Center, New York City, New York
(Sachdeva) Children's Healthcare of Atlanta, Emory University, Atlanta,
Georgia
(Pruetz) Children's Hospital Los Angeles, Los Angeles, California
(Tatum) Duke Children's Hospital and Health Center, Durham, North Carolina
(Thacker) Nemours/Alfred L. DuPont Hospital for Children, Wilmington,
Delaware
(Brunetti) Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
(Frommelt) Children's Hospital Wisconsin, Milwaukee, Wisconsin
(Jacobs) All Children's Hospital, St. Petersburg, Florida
(Kirsh) The Hospital for Sick Children, Toronto, Canada
(Lambert) University of Utah at Primary Children's Hospital, Salt Lake
City, Utah
(Newburger) Boston Children's Hospital, Boston, Massachusetts
(Pemberton) National Heart, Lung and Blood Institute, Bethesda, Maryland
(Zyblewski) Medical University of South Carolina, Charleston, South
Carolina
(Divanovic) Cincinnati Children's Hospital, Cincinnati, Ohio
(Pinto) University of Utah at Primary Children's Hospital, Salt Lake City,
Utah
Title
Associations Between Day of Admission and Day of Surgery on Outcome and
Resource Utilization in Infants With Hypoplastic Left Heart Syndrome Who
Underwent Stage I Palliation (from the Single Ventricle Reconstruction
Trial).
Source
The American journal of cardiology. 116 (8) (pp 1263-1269), 2015. Date of
Publication: 15 Oct 2015.
Abstract
Newborns with hypoplastic left heart syndrome and other single right
ventricular variants require substantial health care resources. Weekend
acute care has been associated with worse outcomes and increased resource
use in other populations but has not been studied in patients with single
ventricle. Subjects of the Single Ventricle Reconstruction trial were
classified by whether they had a weekend admission and by day of the week
of Norwood procedure. The primary outcome was hospital length of stay
(LOS); secondary outcomes included transplant-free survival, intensive
care unit (ICU) LOS, and days of mechanical ventilation. The Student's t
test with log transformation and the Wilcoxon rank-sum test were used to
analyze associations. Admission day was categorized for 533 of 549
subjects (13% weekend). The day of the Norwood was Thursday/Friday in 39%.
There was no difference in median hospital LOS, transplant-free survival,
ICU LOS, or days ventilated for weekend versus non-weekend admissions. Day
of the Norwood procedure was not associated with a difference in hospital
LOS, transplant-free survival, ICU LOS, or days ventilated. Prenatally
diagnosed infants born on the weekend had lower mean birth weight, younger
gestational age, and were more likely to be intubated but did not have a
difference in measured outcomes. In conclusion, in this cohort of patients
with single right ventricle, neither weekend admission nor end-of-the-week
Norwood procedure was associated with increased use of hospital resources
or poorer outcomes. We speculate that the complex postoperative course
following the Norwood procedure outweighs any impact that day of admission
or operation may have on these outcomes.
<3>
Accession Number
26310979
Author
Maru S.; Byrnes J.; Carrington M.J.; Chan Y.-K.; Thompson D.R.; Stewart
S.; Scuffham P.A.
Institution
(Maru) Centre for Applied Health Economics, School of Medicine, Population
& Social Health Research, Menzies Health Institute Queensland, Griffith
University, Australia. Electronic address:
(Byrnes) Centre for Applied Health Economics, School of Medicine,
Population & Social Health Research, Menzies Health Institute Queensland,
Griffith University, Australia
(Carrington) Centre for Primary Care and Prevention, Mary MacKillop
Institute for Health Research, Australian Catholic University, Melbourne,
VIC, Australia
(Chan) Centre for Primary Care and Prevention, Mary MacKillop Institute
for Health Research, Australian Catholic University, Melbourne, VIC,
Australia
(Thompson) Centre for Primary Care and Prevention, Mary MacKillop
Institute for Health Research, Australian Catholic University, Melbourne,
VIC, Australia
(Stewart) Centre for Research Excellence to Reduce Inequality in Heart
Disease, Mary MacKillop Institute for Health Research, Australian Catholic
University, Melbourne, VIC, Australia
(Scuffham) Centre for Applied Health Economics, School of Medicine,
Population & Social Health Research, Menzies Health Institute Queensland,
Griffith University, Australia
Title
Cost-effectiveness of home versus clinic-based management of chronic heart
failure: Extended follow-up of a pragmatic, multicentre randomized trial
cohort - The WHICH? study (Which Heart Failure Intervention Is Most
Cost-Effective & Consumer Friendly in Reducing Hospital Care).
Source
International journal of cardiology. 201 (pp 368-375), 2015. Date of
Publication: 15 Dec 2015.
Abstract
OBJECTIVE: To assess the long-term cost-effectiveness of two
multidisciplinary management programs for elderly patients hospitalized
with chronic heart failure (CHF) and how it is influenced by patient
characteristics.
METHODS: A trial-based analysis was conducted alongside a randomized
controlled trial of 280 elderly patients with CHF discharged to home from
three Australian tertiary hospitals. Two interventions were compared:
home-based intervention (HBI) that involved home visiting with
community-based care versus specialized clinic-based intervention (CBI).
Bootstrapped incremental cost-utility ratios were computed based on
quality-adjusted life-years (QALYs) and total healthcare costs.
Cost-effectiveness acceptability curves were constructed based on
incremental net monetary benefit (NMB). We performed multiple linear
regression to explore which patient characteristics may impact
patient-level NMB.
RESULTS: During median follow-up of 3.2 years, HBI was associated with
slightly higher QALYs (+0.26 years per person; p=0.078) and lower total
healthcare costs (AU$ -13,100 per person; p=0.025) mainly driven by
significantly reduced duration of all-cause hospital stay (-10 days;
p=0.006). At a willingness-to-pay threshold of AU$ 50,000 per additional
QALY, the probability of HBI being better-valued was 96% and the
incremental NMB of HBI was AU$ 24,342 (discounted, 5%). The variables
associated with increased NMB were HBI (vs. CBI), lower Charlson
Comorbidity Index, no hyponatremia, fewer months of HF, fewer prior HF
admissions <1 year and a higher patient's self-care confidence. HBI's net
benefit further increased in those with fewer comorbidities, a lower
self-care confidence or no hyponatremia.
CONCLUSIONS: Compared with CBI, HBI is likely to be cost-effective in
elderly CHF patients with significant comorbidity.
<4>
Accession Number
25493460
Author
Emery R.W.; Solien E.; Klima U.
Institution
(Emery, Solien, Klima) From the *St. Josephs Hospital, St. Paul, MN +Kips
Bay Medical Inc., Minneapolis, MN; and ++Burjeel Hospital Abu Dhabi, Abu
Dhabi, United Arab Emirates
Title
Clinical evaluation of the eSVS Mesh: First-in-Man trial outcomes.
Source
ASAIO journal (American Society for Artificial Internal Organs : 1992). 61
(2) (pp 178-183), 2015. Date of Publication: 01 Mar 2015.
Abstract
In coronary artery bypass graft surgery, saphenous vein graft (SVG)
patency is much lower than that of the internal mammary artery (IMA). To
address this problem, an external support device, the eSVS Mesh was
developed. A prospective randomized First-in-Man feasibility trial was
conducted in 90 patients after institutional ethics committee approval at
seven international centers. The left IMA was used to bypass the anterior
descending artery. A mesh-supported (treated) saphenous vein was
randomized to either the right or the circumflex coronary system, and an
unsupported (control) vein was grafted to the opposing territory. Device
diameters available for use were 3.0, 3.5, 4.0, and 4.5 mm. Primary
end-points were 30 day adverse cardiac and cerebral events and
angiographic patency at 9-12 months. Eighty-five of 90 patients returned
for 30 day clinical follow-up (94%). Five patients refused to return, but
by telephone contacts were asymptomatic. There was one late noncardiac
death and 73 patients returned for angiography (82%), thus 12 additional
patients were lost to follow-up at 1 year. Overall patency rate was 49%
for the treated versus 81% for controls (p < 0.001). Subset analysis
revealed significantly lower patency at one center and with use of the 3.0
mm device (p < 0.05). Removing these data, patency was 72% vs. 81% (p =
NS). Sternal wound infection was higher than expected at 5.0%, but this
was center specific. The eSVS Mesh is safe, but at up to 1 year, patency
is equivalent to untreated vein grafts after removal of outlying data.
This study provides insight into operative events and parameters that may
optimize outcomes and point to potential improvements in the external SVG
support device. Furthermore, longer term studies are pending.
<5>
Accession Number
26749228
Author
Marashi S.M.; Saeedinia S.M.; Sadeghi M.; Movafegh A.; Marashi S.
Institution
(Marashi) Department of Anesthesiology, Shariati Hospital, Tehran
University of Medical Sciences, Tehran, Iran
(Saeedinia) Department of Anesthesiology, Shariati Hospital, Tehran
University of Medical Sciences, Tehran, Iran
(Sadeghi) Department of Anesthesiology, Shariati Hospital, Tehran
University of Medical Sciences, Tehran, Iran
(Movafegh) Department of Anesthesiology, Shariati Hospital, Tehran
University of Medical Sciences, Tehran, Iran
(Marashi) Department of Anesthesiology, Shariati Hospital, Tehran
University of Medical Sciences, Tehran, Iran
Title
Attenuation of Hemodynamic Responses to Intubation by Gabapentin in
Coronary Artery Bypass Surgery: a Randomized Clinical Trial.
Source
Acta medica Iranica. 53 (12) (pp 733-737), 2015. Date of Publication: 01
Dec 2015.
Abstract
A varieties of medications have been suggested to prevent hemodynamic
instabilities following laryngoscopy and endotracheal intubation. This
study was conducted to determine the beneficial effects of gabapentin on
preventing hemodynamic instabilities associated with intubation in
patients who were a candidate for coronary artery bypass surgery (CABG).
This double blinded randomized, parallel group clinical trial was carried
out on 58 normotensive patients scheduled for elective CABG under general
anesthesia with endotracheal intubation in Shariati Hospital. Patients
were randomly allocated to two groups of 29 patients that received 1200 mg
of gabapentin in two dosages (600 mg, 8 hours before anesthesia induction
and 600 mg, 2 hours before anesthesia induction) as gabapentin group or
received talc powder as placebo (placebo group). Heart rate, mean arterial
pressure, systolic and diastolic blood pressure were measured immediately
before intubation, during intubation, immediately after intubation, 1 and
2 minutes after tracheal intubation. Inter-group comparisons significantly
showed higher systolic and diastolic blood pressure, mean arterial
pressure and heart rate immediately before intubation, during intubation,
immediately after intubation, 1 and 2 minutes after tracheal intubation in
the placebo group in comparison to gabapentin group. The median of anxiety
verbal analog scale (VAS) at the pre-induction room in gabapentin and
placebo groups were 2 and 4, respectively that was significantly lower in
the former group (P. value =0.04 ); however, regarding median of pain
score no difference was observed between them (P. value =0.07). Gabapentin
(1200 mg) given preoperatively can effectively attenuate the hemodynamic
response to laryngoscopy, intubation and also reduce preoperative related
anxiety in patients who were a candidate for CABG.
<6>
Accession Number
26278425
Author
Ozguler I.M.; Burma O.; Uysal A.; Akbulut H.
Institution
(Ozguler, Burma, Uysal, Akbulut) . drmuratozg@hotmail.com
Title
Rosuvastatin Lowers Systemic Inflammatory Response in Coronary Artery
Bypass Graft Accompanied by Cardiopulmonary Bypass Surgery: A Randomized
Controlled Study.
Source
Clinical and investigative medicine. Medecine clinique et experimentale.
38 (4) (pp E154-E163), 2015. Date of Publication: 2015.
Abstract
PURPOSE: Cardiopulmonary bypass (CPB) is commonly associated with a
systemic inflammatory response that may lead to severe complications.
Classic signs of systemic inflammatory response syndrome are complement
activation and changes in cytokine and acute phase reactant levels. The
effects of rosuvastatin after CPB on interleukin-6 (IL-6), interleukin-10
(IL-10), interleukin-18 (IL-18) and High Sensitivity C-Reactive Protein
(hs-CRP) levels were investigated.
METHODS: Thirty-seven male and thirteen female patients (total=50) aged 42
to 78 years, who had coronary bypass surgery due to coronary artery
disease were randomly divided into two groups. The 25 patients in the
control group were administered placebos. The 25 in the treatment group
were administered 20 mg rosuvastatin tablets daily between preoperative
day 7 and postoperative day 28. Blood samples were taken at six time
points; before induction of anesthesia (T1), during CPB (T2), five minutes
after removal of cross clamp (T3), after protamine infusion (T4),
postoperative day three (T5) and postoperative day 28 (T6). Data points
were expressed as mean +/- standard deviation (SD).
RESULTS: Rosuvastatin lowered IL-6 levels at T4, T5 and T6 time points
(T4, T5, T6 p < 0.05), and elevated IL-10 levels at T3 and T4 (T3, T4 p <
0.05). IL-18 levels were also elevated at multiple time points.
Rosuvastatin also lowered hs-CRP levels and cholesterol levels at T6 (p <
0.05).
CONCLUSION: Administering 20 mg/day of rosuvastatin between preoperative
day 7 and postoperative day 28 may result in fewer complications in
certain (especially intraoperative) cases of systemic inflammatory
response caused by the CPB technique used in coronary bypass surgery.
<7>
Accession Number
20160613308
Author
Polistena A.; Di Lorenzo P.; Sanguinetti A.; Buccelli C.; Conzo G.; Conti
A.; Niola M.; Avenia N.
Institution
(Di Lorenzo, Buccelli, Niola) Department of Advanced Biomedical Sciences,
University of Naples Federico II, Naples, Italy
(Polistena, Sanguinetti, Avenia) University of Perugia, Medical School,
Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy
(Conzo) Department of Anesthesiological, Surgical and Emergency Sciences,
Second University of Naples, Naples, Italy
(Conti) Department of Surgery, Radiology and Public Health, Public Health
and Humanities Section, University of Brescia, Centre of Bioethics
Research, Brescia, Italy
Title
Medicolegal implications of surgical errors and complications in neck
surgery: A review based on the Italian current legislation.
Source
Open Medicine (Poland). 11 (1) (pp 298-306), 2016. Date of Publication: 01
Aug 2016.
Publisher
De Gruyter Open Ltd
Abstract
Aim of the present paper is the review of the principal complications
associated to endocrine neck surgery considering how expertise, full
adoption of guidelines, appropriate technology and proper informed consent
may limit the medicolegal claims at the light of the incoming new
regulation of the medical professional legal responsibility. A literature
search, using the Medline/PubMed database for full-length papers, was
used. Postoperative recurrent laryngeal nerve (RLN) palsy and
hypoparathy-roidism remain the principal causes of surgical malpractice
claims. In the procedure of neck lymphadenctomy intra-operative
haemorrhage, thoracic duct injury, injuries to loco-regional nerves can be
observed and can be source of claims. After many years of increased
medicolegal litigations, the Italian government is proposing a drastic
change in the regulations of supposed medical malpractice in order to
guarantee the patient's right to a safe treatment and in the meantime to
defend clinicians from often unmotivated and prejudicial legal cases.
Surgical errors and complications in neck surgery are a relevant clinical
issue. Only the combination of surgical and clinical expertise,
application of guidelines, appropriate technology and a routinely use of
specific informed consent can contain potential medicolegal implications.
<8>
Accession Number
20160589767
Author
Park K.; Lai D.; Handberg E.M.; Moye L.; Perin E.C.; Pepine C.J.; David
Anderson R.
Institution
(Park, Handberg, Pepine, David Anderson) Division of Cardiovascular
Medicine, Houston, TX 77030, United States
(Lai, Moye) Department of Medicine, University of Florida College of
Medicine, Gainesville, FL 32610, United States
(Moye) Coordinating Center for Clinical Trials, Houston, TX 77030, United
States
(Perin) School of Public Health, University of Texas Health Science Center
at Houston, United States
(Perin) Stem Cell Center, Houston, TX 77030, United States
(Lai, Handberg, Moye, Perin, Pepine, David Anderson) Texas Heart
Institute, Houston, TX 77030, United States
Title
Association between high endocardial unipolar voltage and improved left
ventricular function: In patients with ischemic cardiomyopathy.
Source
Texas Heart Institute Journal. 43 (4) (pp 291-296), 2016. Date of
Publication: August 2016.
Publisher
Texas Heart Institute
Abstract
We know that endocardial mapping reports left ventricular electrical
activity (voltage) and that these data can predict outcomes in patients
undergoing traditional revascularization. Because the mapping data from
experimental models have also been linked with myocardial viability, we
hypothesized an association between increased unipolar voltage in patients
undergoing intramyocardial injections and their subsequent improvement in
left ventricular performance. For this exploratory analysis, we evaluated
86 patients with left ventricular dysfunction, heart-failure symptoms,
possible angina, and no revascularization options, who were undergoing
endocardial mapping. Fifty-seven patients received bone marrow mononuclear
cell (BMC) injections and 29 patients received cell-free injections of a
placebo. The average mapping site voltage was 9.7 +/- 2 mV, and sites with
voltage of >6.9 mV were engaged by needle and injected (with BMC or
placebo). For all patients, at 6 months, left ventricular ejection
fraction (LVEF) improved, and after covariate adjustment this improvement
was best predicted by injection-site voltage. For every 2-mV increase in
baseline voltage, we detected a 1.3 increase in absolute LVEF units for
all patients (P=0.038). Multiple linear regression analyses confirmed that
voltage and the CD34+ count present in bone marrow (but not treatment
assignment) were associated with improved LVEF (P=0.03 and P=0.014,
respectively). In an exploratory analysis, higher endocardial voltage and
bone marrow CD34<sup>+</sup>levels were associated with improved left
ventricular function among ischemic cardiomyopathy patients.
Intramyocardial needle injections, possibly through stimulation of
angiogenesis, might serve as a future therapy in patients with reduced
left ventricular function and warrants investigation.
<9>
Accession Number
20160611389
Author
Van Mieghem N.M.; Van Gils L.; Ahmad H.; Van Kesteren F.; Van Der Werf
H.W.; Brueren G.; Storm M.; Lenzen M.; Daemen J.; Van Den Heuvel A.F.M.;
Tonino P.; Baan J.; Koudstaal P.J.; Schipper M.E.I.; Lugt A.V.D.; De
Jaegere P.P.T.
Institution
(Van Mieghem, Van Gils, Lenzen, Daemen, De Jaegere) Department of
Cardiology, Erasmus Medical Center, Gravendijkwal 230, Rotterdam 3015 CE,
Netherlands
(Ahmad, Lugt) Department of Radiology, Erasmus Medical Center, Rotterdam,
Netherlands
(Van Kesteren, Baan) Department of Cardiology, Academic Medical Center,
Amsterdam, Netherlands
(Van Der Werf, Van Den Heuvel) Department of Cardiology, University
Medical Center Groningen, Groningen, Netherlands
(Brueren, Tonino) Department of Cardiology, Catharina Ziekenhuis,
Eindhoven, Netherlands
(Storm, Koudstaal) Department of Neurology, Erasmus Medical Center,
Rotterdam, Netherlands
(Schipper) Department of Pathology, Erasmus Medical Center, Rotterdam,
Netherlands
Title
Filter-based cerebral embolic protection with transcatheter aortic valve
implantation: The randomised MISTRAL-C trial.
Source
EuroIntervention. 12 (4) (pp 499-507), 2016. Date of Publication: July
2016.
Publisher
EuroPCR
Abstract
Aims: Our aim was to determine whether use of the filter-based Sentinel
Cerebral Protection System (CPS) during transcatheter aortic valve
implantation (TAVI) can affect the early incidence of new brain lesions,
as assessed by diffusion-weighted magnetic resonance imaging (DW-MRI), and
neurocognitive performance. Methods and results: From January 2013 to July
2015, 65 patients were randomised 1:1 to transfemoral TAVI with or without
the Sentinel CPS. Patients underwent DW-MRI and extensive neurological
examination, including neurocognitive testing one day before and five to
seven days after TAVI. Follow-up DW-MRI and neurocognitive testing was
completed in 57% and 80%, respectively. New brain lesions were found in
78% of patients with follow-up MRI. Patients with the Sentinel CPS had
numerically fewer new lesions and a smaller total lesion volume (95 mm3
[IQR 10-257] vs. 197 mm3 [95-525]). Overall, 27% of Sentinel CPS patients
and 13% of control patients had no new lesions. Ten or more new brain
lesions were found only in the control cohort (in 20% vs. 0% in the
Sentinel CPS cohort, p=0.03). Neurocognitive deterioration was present in
4% of patients with Sentinel CPS vs. 27% of patients without (p=0.017).
The filters captured debris in all patients with Sentinel CPS protection.
Conclusions: Filter-based embolic protection captures debris en route to
the brain in all patients undergoing TAVI. This study suggests that its
use can lead to fewer and overall smaller new brain lesions, as assessed
by MRI, and preservation of neurocognitive performance early after TAVI.
<10>
Accession Number
20160403503
Author
Phibbs C.S.; Love S.R.; Jacobson A.K.; Edson R.; Su P.; Uyeda L.; Matchar
D.B.; writing for the THINRS Executive Committee and Site Investigators
Institution
(Phibbs, Su) Health Economics Resource Center, VA Palo Alto Health Care
System, Palo Alto, CA, United States
(Phibbs) Department of Pediatrics and Center for Primary Care and Outcomes
Research, Stanford University School of Medicine, Stanford, CA, United
States
(Phibbs) Health Economist, VA Health Economics Resource Center, 795 Willow
Road (152MPD), Menlo Park, CA 94025, United States
(Love, Matchar) Health Services and Systems Research Program,
Duke-National University of Singapore Graduate Medical School, Singapore,
Singapore
(Love) Warren Alpert Medical School of Brown University, Providence, RI,
United States
(Jacobson) Jerry L. Pettis VA Medical Center, Research and Development
Service (151), Loma Linda, CA, United States
(Jacobson) Department of Internal Medicine, Loma Linda University, Loma
Linda, CA, United States
(Edson, Uyeda) VA Palo Alto Health Care System, Cooperative Studies
Program Coordinating Center (151 K), Palo Alto, CA, United States
(Matchar) Durham VA Medical Center, Durham, NC, United States
(Matchar) Division of General Medicine, Department of Medicine, and Center
for Clinical Health Policy Research, Duke University Medical Center,
Durham, NC, United States
Title
At-Home Versus In-Clinic INR Monitoring: A Cost-Utility Analysis from The
Home INR Study (THINRS).
Source
Journal of General Internal Medicine. 31 (9) (pp 1061-1067), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Springer New York LLC
Abstract
Background: Effective management of patients using warfarin is
resource-intensive, requiring frequent in-clinic testing of the
international normalized ratio (INR). Patient self-testing (PST) using
portable at-home INR monitoring devices has emerged as a convenient
alternative. As revealed by The Home INR Study (THINRS), event rates for
PST were not significantly different from those for in-clinic high-quality
anticoagulation management (HQACM), and a cumulative gain in quality of
life was observed for patients undergoing PST. Objective: To perform a
cost-utility analysis of weekly PST versus monthly HQACM and to examine
the sensitivity of these results to testing frequency.
Patients/Interventions: In this study, 2922 patients taking warfarin for
atrial fibrillation or mechanical heart valve, and who demonstrated PST
competence, were randomized to either weekly PST (n = 1465) or monthly
in-clinic testing (n = 1457). In a sub-study, 234 additional patients were
randomized to PST once every 4 weeks (n = 116) or PST twice weekly (n =
118). The endpoints were quality of life (measured by the Health Utilities
Index), health care utilization, and costs over 2 years of follow-up.
Results: PST and HQACM participants were similar with regard to gender,
age, and CHADS<inf>2</inf>score. The total cost per patient over 2 years
of follow-up was $32,484 for HQACM and $33,460 for weekly PST,
representing a difference of $976. The incremental cost per
quality-adjusted life year gained with PST once weekly was $5566 (95 % CI,
-$11,490 to $25,142). The incremental cost-effectiveness ratio (ICER) was
sensitive to testing frequency: weekly PST dominated PST twice weekly and
once every 4 weeks. Compared to HQACM, weekly PST was associated with
statistically significant and clinically meaningful improvements in
quality of life. The ICER for weekly PST versus HQACM was well within
accepted standards for cost-effectiveness, and was preferred over more or
less frequent PST. These results were robust to sensitivity analyses of
key assumptions. Conclusion: Weekly PST is a cost-effective alternative to
monthly HQACM and a preferred testing frequency compared to twice weekly
or monthly PST.
<11>
Accession Number
20160608770
Author
Zaman S.; Gooley R.; Cheng V.; McCormick L.; Meredith I.T.
Institution
(Zaman, Gooley, Cheng, McCormick, Meredith) MonashHEART, Monash Health,
Melbourne, VIC, Australia
(Gooley, Meredith) Monash University, Melbourne, VIC, Australia
Title
Impact of routine crossover balloon occlusion technique on access-related
vascular complications following transfemoral transcatheter aortic valve
replacement.
Source
Catheterization and Cardiovascular Interventions. 88 (2) (pp 276-284),
2016. Date of Publication: 01 Aug 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To determine the impact of incorporating routine crossover
balloon occlusion technique (CBOT) for vascular access closure following
transcatheter aortic valve replacement (TAVR) on major access-site-related
complications. Background: Vascular complications are associated with
increased mortality following TAVR. The CBOT involves passage of a balloon
catheter from the contralateral femoral artery to enable controlled
closure of large-sheath access-sites. Methods: Consecutive patients who
underwent transfemoral TAVR as part of three clinical trials were
prospectively recruited. Patients who had routine CBOT (CBOT group, n =
55) were compared to preceding patients who did not undergo CBOT (control
group, n = 43). The primary endpoint was 30-day occurrence of
access-site-related Valve Academic Research Consortium (VARC)-2 defined
major vascular and/or bleeding complications. Results: CBOT was
successfully performed in 96% with 2% occurrence of a minor CBOT-related
complication. At 30-days access-site-related major vascular and/or
bleeding occurred in 5.5% and 18.6% of the CBOT and control group,
respectively (P = 0.042). This consisted of VARC-2 major vascular events
in 3.6% and 16.3% (P = 0.036) and VARC-2 major/life-threatening bleeding
events in 5.5% and 14.0% (P = 0.137) of the CBOT and control group,
respectively. Transfusion of >2 units of packed red blood cells were
required in 10.9% and 30.2% of the CBOT and control group, respectively (P
= 0.016). There was no significant difference in contrast load, procedure
time, and kidney injury between the two groups. Conclusions: Routine CBOT
for TAVR access-site closure has a high success rate and is associated
with a significant reduction in VARC-2 major vascular and bleeding
complications compared to TAVR performed without CBOT. © 2016 Wiley
Periodicals, Inc.
<12>
Accession Number
20160608769
Author
Dery J.-P.; Mahaffey K.W.; Tricoci P.; White H.D.; Podder M.; Westerhout
C.M.; Moliterno D.J.; Harrington R.A.; Chen E.; Strony J.; Van de Werf F.;
Ziada K.M.; Held C.; Aylward P.E.; Armstrong P.W.; Rao S.V.
Institution
(Dery) Department of Cardiology and Cardiovascular Surgery, Institut
Universitaire De Cardiologie Et De Pneumologie De Quebec, Laval
University, Quebec City, Canada
(Mahaffey, Harrington) Department of Medicine, Department of Medicine,
Stanford University, Stanford, CA, United States
(Tricoci, Rao) Department of Medicine, Duke Clinical Research Institute,
Durham, NC, United States
(White) Department of Cardiology, Green Lane Cardiovascular Service,
Auckland, New Zealand
(Podder, Westerhout, Armstrong) Department of Economics, Canadian VIGOUR
Centre, University of Alberta, Edmonton, AB, Canada
(Moliterno, Ziada) Department of Internal Medicine, Gill Heart Institute
and Division of Cardiovascular Medicine, University of Kentucky,
Lexington, KY, United States
(Chen) Bayer HealthCare Pharmaceuticals, Department of Internal Medicine,
Bayer HealthCare Pharmaceuticals, Whippany, NJ, United States
(Strony) Merck, Whitehouse Station, NJ, United States
(Van de Werf) Department of Cardiovascular Sciences, University Hospitals
Leuven, Belgium
(Held) Department of Medical Sciences, Uppsala Clinical Research Center,
Uppsala University, Sweden
(Aylward) Division of Medicine, SAHMRI, Flinders University and Medical
Center, Adelaide, Australia
Title
Arterial access site and outcomes in patients undergoing percutaneous
coronary intervention with and without vorapaxar.
Source
Catheterization and Cardiovascular Interventions. 88 (2) (pp 163-173),
2016. Date of Publication: 01 Aug 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We evaluated outcomes associated with transradial vs.
transfemoral approaches and vorapaxar in acute coronary syndrome (ACS)
patients undergoing percutaneous coronary intervention (PCI) in the TRACER
trial. Background: Vorapaxar reduces ischemic events but increases the
risk of major bleeding. Methods: We compared 30-day and 2-year major
adverse cardiac events (MACE: cardiovascular death, myocardial infarction,
stroke, recurrent ischemia with rehospitalization, and urgent coronary
revascularization) and noncoronary artery bypass graft (CABG)-related
bleedings in 2,192 transradial and 4,880 transfemoral patients undergoing
PCI after adjusting for confounding variables, including propensity for
transradial access. Results: Overall, 30-day GUSTO moderate/severe and
non-CABG TIMI major/minor bleeding occurred less frequently in transradial
(0.9% vs. 2.0%, P = 0.001) vs. transfemoral (1.1% vs. 2.5%, P = 0.005)
patients. A similar reduction was seen at 2 years (3.3% vs. 4.7%, P =
0.008; 3.3% vs. 4.9%, P < 0.001, respectively). Transradial was associated
with an increased risk of ischemic events at 30 days (OR 1.38, 95% CI
1.11-1.72; P = 0.004), driven primarily by increased periprocedural
myocardial infarctions. At 2 years, rates of MACE were comparable (HR
1.14, 95% CI 0.98-1.33; P = 0.096). Although bleeding rates were higher
with vorapaxar in transfemoral vs. transradial patients, there was no
significant treatment interaction. Also, the access site did not modulate
the association between vorapaxar and MACE. Conclusions: Transradial
access was associated with lower bleeding rates and similar long-term
ischemic outcomes, suggesting transradial access is safer than
transfemoral access among ACS patients receiving potent antiplatelet
therapies. Because of the nonrandomized allocation of arterial access,
these results should be considered exploratory. © 2015 Wiley
Periodicals, Inc.
<13>
Accession Number
20160608765
Author
Ndrepepa G.; Groha P.; Lahmann A.L.; Lohaus R.; Cassese S.; Schulz-Schupke
S.; Kufner S.; Mayer K.; Bernlochner I.; Byrne R.A.; Fusaro M.; Laugwitz
K.-L.; Schunkert H.; Kastrati A.
Institution
(Ndrepepa, Groha, Lahmann, Lohaus, Cassese, Schulz-Schupke, Kufner, Mayer,
Byrne, Fusaro, Schunkert, Kastrati) Deutsches Herzzentrum Munchen,
Technische Universitat, Munich, Germany
(Bernlochner, Laugwitz) 1.Medizinische Klinik, Klinikum rechts der Isar,
Technische Universitat, Munich, Germany
(Laugwitz, Schunkert, Kastrati) DZHK (German Centre for Cardiovascular
Research), Partner Site Munich Heart Alliance, Munich, Germany
Title
Increased bleeding risk during percutaneous coronary interventions by
arterial hypertension.
Source
Catheterization and Cardiovascular Interventions. 88 (2) (pp 184-190),
2016. Date of Publication: 01 Aug 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We aimed to assess the association between arterial
hypertension and bleeding in patients undergoing percutaneous coronary
intervention (PCI). Background: The impact of arterial hypertension on
bleeding risk of patients with coronary artery disease undergoing PCI is
unknown. Methods: This study included 14,180 patients who underwent PCI.
Bleeding was defined using the Bleeding Academic Research Consortium
(BARC) criteria. Arterial hypertension was defined as treatment with
antihypertensive drugs or a systolic blood pressure >140 mm Hg and/or
diastolic blood pressure value >90 mm Hg documented on at least 2
occasions. The primary outcome was bleeding rate within 30 days of PCI.
Results: Overall, 11,066 patients (78.0%) had arterial hypertension.
Bleeding events occurred in 1,232 patients with arterial hypertension and
278 patients without arterial hypertension (11.1% vs 8.9%; odds ratio [OR]
= 1.28, 95% confidence interval [CI] 1.11-1.46, P < 0.001). Access-site
bleeding occurred in 730 patients with arterial hypertension and 175
patients without arterial hypertension (6.6% vs 5.6%: OR = 1.19
[1.01-1.41], P = 0.049). Non-access-site bleeding occurred in 502 patients
with and 103 patients without arterial hypertension (4.5% vs 3.3%; OR =
1.39 [1.12-1.72], P = 0.003). After adjustment, arterial hypertension was
significantly associated with any bleeding (adjusted OR = 1.41
[1.19-1.67], P < 0.001), access-site bleeding (adjusted OR = 1.36
[1.10-1.68], P = 0.005) and non-access-site bleeding (adjusted OR = 1.42
[1.09-1.83], P = 0.008). A history of arterial hypertension increased the
risk of non-access-site bleeding (P = 0.002), whereas systolic blood
pressure at the time of PCI increased the risk of access site bleeding (P
= 0.018). Conclusions: Arterial hypertension is associated with increased
risk of bleeding during PCI procedures. © 2015 Wiley Periodicals,
Inc.
<14>
Accession Number
20160605734
Author
Patel J.; Thosani R.; Kothari J.; Garg P.; Pandya H.
Institution
(Patel, Thosani) Department of Cardiac Anesthesia, UN Mehta Institute of
Cardiology and Research Center (Affiliated to BJ Medical College), New
Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016, India
(Kothari, Garg) Department of Cardiovascular and Thoracic Surgery, UN
Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad,
India
(Pandya) Department of Research, UN Mehta Institute of Cardiology and
Research Center, Asarwa, Ahmedabad, India
Title
Clonidine and ketamine for stable hemodynamics in off-pump coronary artery
bypass.
Source
Asian Cardiovascular and Thoracic Annals. 24 (7) (pp 638-646), 2016. Date
of Publication: 01 Sep 2016.
Publisher
SAGE Publications Inc.
Abstract
Background The current era of fast-track extubation and faster recovery
after cardiac surgery requires agents that provide perioperative sedation,
suppress sympathetic response, reduce opioid requirement, and maintain
hemodynamic stability. Methods In a prospective randomized double-blind
study, 75 off-pump coronary artery bypass patients were divided into 3
groups of 25 each: group A had clonidine 1 mug.kg<sup>-1</sup>, group B
had clonidine 1 mug.kg<sup>-1</sup> and ketamine 1 mg.kg<sup>-1</sup>, and
group C had a saline placebo. Perioperative changes in heart rate,
systolic and diastolic blood pressure, sedation score, pain score, and
requirement of analgesics, beta blockers, fentanyl, propofol, and
inotropes were recorded, as well time to extubation, intensive care unit
stay, and 30-day mortality. Results The combination of clonidine and
ketamine led to stable hemodynamics and reduced beta-blocker dosage. The
sedation score was highest in groups A and B up to 24 h postoperatively.
The pain score was lowest in group B in the first 24 h, and the total dose
of analgesics was highest in group C. Clonidine and ketamine or clonidine
alone reduced extubation time, but intensive care unit stay was unchanged
Conclusions Combined low-dose clonidine and ketamine produced
perioperative sedation and effective suppression of sympathetic response
with stable hemodynamics. Intraoperative beta-blocker use was reduced
without increasing inotrope requirement. This combination prolonged the
analgesic effect of opioids, reducing postoperative pain score and
analgesic requirement. Low-dose clonidine alone produced sedation but did
not completely block sympathetic response. Intensive care unit stay and
patient outcome were not affected by clonidine or ketamine.
<15>
Accession Number
20160605723
Author
Srivastava V.; Purohit M.; Bose A.; Bittar M.N.; Rogers S.; Zacharias J.
Institution
(Srivastava, Purohit, Bose, Bittar, Rogers, Zacharias) Department of
Cardiothoracic Surgery, Victoria Hospital, Blackpool FY3 8NR, United
Kingdom
Title
Single crossclamp: Safe training tool for coronary artery bypass grafting.
Source
Asian Cardiovascular and Thoracic Annals. 24 (7) (pp 633-637), 2016. Date
of Publication: 01 Sep 2016.
Publisher
SAGE Publications Inc.
Abstract
Objective The single-crossclamp technique for coronary artery bypass
grafting is recognized to reduce manipulation of the ascending aorta, and
thereby improve neurological outcomes. However, there is a perceived
disadvantage of long cardiopulmonary bypass and crossclamp times. Our
objective was to evaluate outcomes with this technique and determine
whether it is safe for training. Methods Patients undergoing coronary
artery bypass between October 2005 and February 2014 with use of the
single-crossclamp method were divided into 2 groups: a consultant group (n
= 1024), and a trainee group (n = 504), depending on the primary surgeon.
Their outcomes were compared. Results The consultants operated on more
nonelective patients who had a higher risk profile (mean additive
EuroSCORE I 4.05 vs. 3.80, p = 0.085; logistic EuroSCORE I 4.36 vs. 3.64,
p = 0.002). There were 9 (0.9%) deaths in the consultant group and 5 (1%)
in the trainee group. The mean number of grafts in the consultant group
was greater, but the crossclamp time was similar and cardiopulmonary
bypass time was shorter. There were 4 (0.4%) cerebrovascular events in the
consultant group and 3 (0.6%) in the trainee group. Postoperative stay was
shorter in the trainee group (7.19 vs. 7.97 days, p = 0.033). Other
complication rates were similar. Conclusions The technique has excellent
outcomes, especially neurological, and is safe for training junior
surgeons.
<16>
Accession Number
20160581933
Author
Lund M.; Tsai J.A.; Nilsson M.; Winter R.; Lundell L.; Kalman S.
Institution
(Lund, Kalman) Department of Anaesthesiology and Intensive Care,
Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm
141 86, Sweden
(Tsai, Nilsson, Lundell) Centre for Digestive Diseases, Karolinska
Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
(Winter) Department of Medicine, School of Technology and Health,
Karolinska University Hospital, Huddinge, Stockholm, Sweden
Title
Effects of neoadjuvant chemo or chemoradiotherapy for oesophageal cancer
on perioperative haemodynamics.
Source
European Journal of Anaesthesiology. 33 (9) (pp 653-661), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy might improve oncological outcome
compared with chemotherapy after surgery for oesophagus or
gastrooesophageal junction cancer. However, radiotherapy may induce
cardiovascular side-effects that could increase the risk of perioperative
adverse effects and postoperative morbidity. OBJECTIVES The aim of this
study was to compare the perioperative haemodynamics in patients
undergoing oesophagectomy following neoadjuvant chemotherapy or
chemoradiotherapy for cancer. DESIGN A prospective single-centre cohort
study within a randomised multi-centre trial. SETTING A Swedish University
Hospital from January 2009 to March 2013. PATIENTS A total of 31 patients
(chemotherapy 17, chemoradiotherapy 14) included in a multi-centre trial
randomising chemotherapy vs. chemoradiotherapy and operated at Karolinska
University Hospital, Huddinge. INTERVENTIONS Cisplatin and 5-fluorouracil,
either with or without concurrent radiotherapy (40Gy), were given prior to
surgery. Cardiac function was assessed with LiDCOplus (LiDCO Ltd, London,
United Kingdom), echocardiography, troponin T and N-terminal pro-B-type
natriuretic peptide, before, during and after surgery. MAIN OUTCOME
MEASURES The primary outcome was the interaction effect of the neoadjuvant
treatment on stroke volume index during the perioperative period.
Secondary outcomes were the interaction effects of oxygen delivery index,
cardiac index, echocardiography and biochemical markers. RESULTS The
groups were matched regarding comorbidities, but patients in the
chemoradiotherapy group were older (66 vs. 60 years P=0.03). Haemodynamic
values changed in a similar way in both groups during the study period.
The chemoradiotherapy group had a lower cardiac index before surgery (2.9
vs. 3.4lmin<sup>-1</sup> m<sup>-2</sup>, P=0.03). On the third
postoperative day, both groups displayed a hyperdynamic state compared
with baseline, with no increase in troponin T, and a similar increase in
N-terminal pro-B-type natriuretic peptide. CONCLUSION Neoadjuvant
chemoradiotherapy for oesophageal or gastrooesophageal junction cancer
seems to induce only a marginal negative effect on cardiac function
compared with neoadjuvant chemotherapy. This difference did not remain
when patients' haemodynamics were challenged by surgery.
<17>
Accession Number
20160581930
Author
Eberl S.; Preckel B.; Bergman J.J.; Van Dieren S.; Hollmann M.W.
Institution
(Eberl, Preckel, Hollmann) Department of Anaesthesiology, Academic Medical
Centre, University of Amsterdam, Meibergdreef 9, Amsterdam 1100 DD,
Netherlands
(Bergman) Department of Gastroenterology and Hepatology, Academic Medical
Centre, University of Amsterdam, Amsterdam, Netherlands
(Van Dieren) Clinical Research Unit, Academic Medical Centre, University
of Amsterdam, Amsterdam, Netherlands
Title
Satisfaction and safety using dexmedetomidine or propofol sedation during
endoscopic oesophageal procedures.
Source
European Journal of Anaesthesiology. 33 (9) (pp 631-637), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND Dexmedetomidine possesses anxiolytic and hypnotic properties
without respiratory side-effects, making it theoretically an ideal
sedative agent for endoscopic procedures. OBJECTIVE We aimed to compare
satisfaction and safety among outpatients receiving sedation with
dexmedetomidine or propofol for endoscopic oesophageal procedures. DESIGN
A randomised controlled study. SETTING Endoscopic intervention suite at
the Academic Medical Centre in Amsterdam, Netherlands. PARTICIPANTS
Patients aged at least 18 years, and American Society of
Anesthesiologists' physical status 1 to 3. INTERVENTION Total 63 patients
were randomised to receive either dexmedetomidine (D) or propofol (P).
Pain was treated with alfentanil in both groups. MAIN OUTCOME MEASURES The
primary outcomes were patients' and endoscopists' satisfaction levels
measured by validated questionnaires (1=very dissatisfied; 7=highly
satisfied). A secondary outcome was safety, determined by blood pressure,
heart rate and oxygen saturation during and after the procedure, and
respiratory rate and noninvasive cardiac output during the procedure.
RESULTS Satisfaction of patients [median (IQR); group D, 5.0 (3.75 to
5.75) vs. group P, 6.25 (5.3 to 6.5)] and satisfaction of
gastroenterologists [group D, 5.0 (4.4 to 5.8) vs. group P, 6.0 (5.4 to
6.0)] were lower in group D (both P<0.001). More patients in group D would
not recommend this form of sedation to one of their friends (group D, 15
of 32 vs. group P, 1 of 31; P<0.001). Total 30min after the procedure,
heart rate [group D, 60bpm (52 to 69) vs. group P, 70bpm (60 to 81),
P=0.031] and SBP group D, 112mmHg (92 to 132) vs. group P, 120mmHg (108 to
132); P=0.013] were significantly lower after dexmedetomidine sedation.
There were no other differences in safety between groups. CONCLUSION
Compared with propofol, sedation with dexmedetomidine resulted in less
satisfaction, and caused prolonged haemodynamic depression after
endoscopic oesophageal procedures.
<18>
Accession Number
20160580707
Author
Paredes S.; Cortinez L.; Contreras V.; Silbert B.
Institution
(Paredes, Cortinez, Contreras) Anesthesiology Division, Pontificia
Universidad Catolica de Chile, Santiago, Chile
(Silbert) Centre for Anaesthesia and Cognitive Function, Department of
Anaesthesia, St Vincent's Hospital, Melbourne, Fitzroy, Vic., Australia
(Silbert) Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne
Medical School, University of Melbourne, Melbourne, Vic., Australia
Title
Post-operative cognitive dysfunction at 3 months in adults after
non-cardiac surgery: a qualitative systematic review.
Source
Acta Anaesthesiologica Scandinavica. 60 (8) (pp 1043-1058), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Blackwell Munksgaard
Abstract
Background: Post-operative cognitive dysfunction is defined as a decline
in cognitive functions that occurs after surgery, but different diagnostic
criteria and incidences have been reported in medical literature. Our aim
was to determine incidence of post-operative cognitive dysfunction 3
months after non-cardiac surgery in adults. Methods: A systematic review
of available evidence was performed by PRISMA guidelines. A search was
done in May-July 2015 on PubMed, EMBASE, CINAHL, LILACS, Scielo, Clinical
Trials, and Grey Literature Reports. Inclusion criteria were prospective
design studies with patients over 18 years old, surgery under general or
regional anesthesia, follow-up for 3 months, and use of a neurocognitive
battery for diagnosis. We excluded studies made on cardiac or brain
surgery patients. Risk of bias was assessed using tools from National
Heart Lung and Blood Institute. Results: We selected 24 studies. Average
age was 68 years. Only five studies reported incidence of cognitive
decline for a non-surgical control group. Median number of tests used was
5 (range 3-13). Pooled incidence of post-operative cognitive dysfunction
at 3 months was 11.7% [95% CI 10.9-12.5] but with several methodological
differences between studies. Increasing age was the most consistent risk
factor identified (seven studies). Conclusions: Post-operative cognitive
dysfunction in patients is frequent, especially in patients over 60 years
old. Limitations include methodological differences in studies. Efforts
must be made to reach a consensus in definition and diagnosis for future
research.
<19>
[Use Link to view the full text]
Accession Number
20160521212
Author
McGuinness S.P.; Parke R.L.; Drummond K.; Willcox T.; Bailey M.
Institution
(McGuinness, Parke) CVICU Research, Auckland City Hospital, Grafton, PO
Box 110147, Auckland 1148, New Zealand
(McGuinness, Parke) Medical Research Institute of New Zealand, Wellington,
New Zealand
(McGuinness, Parke, Bailey) ANZIC-Research Centre, Department of
Epidemiology and Preventive Medicine, Monash University, Melbourne,
Australia
(Drummond) Royal Adelaide Hospital, Adelaide, SA, Australia
(Willcox) Clinical Perfusion, Green Lane Cardiothoracic Surgical Unit,
Auckland City Hospital, Auckland, New Zealand
(Willcox) Department of Anaesthesiology, University of Auckland, Auckland,
New Zealand
Title
A multicenter, randomized, controlled Phase IIb trial of avoidance of
hyperoxemia during cardiopulmonary bypass.
Source
Anesthesiology. 125 (3) (pp 465-473), 2016. Date of Publication: 01 Sep
2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Cardiac surgery utilizing cardiopulmonary bypass (CPB) is one
of the most common forms of major surgery. Cardiac surgery-associated
multiorgan dysfunction (CSA-MOD) is well recognized and includes acute
kidney injury (AKI), hepatic impairment, myocardial damage, and
postoperative neurologic deficit. Pathophysiology of CSA-MOD involves
numerous injurious pathways linked to the use of CPB including oxidative
stress and formation of reactive iron species. During cardiac surgery with
CPB, arterial return blood is oxygenated to supranormal levels. This study
aimed to determine whether the avoidance of arterial hyperoxemia decreased
oxidative stress and reduced the severity of the multiorgan dysfunction in
patients undergoing cardiac surgery utilizing CPB. Methods: The study was
a multicenter, open-label, parallel-group, randomized controlled study of
the avoidance of arterial hyperoxemia versus usual care in patients
undergoing cardiac surgery involving CPB. Primary outcome was the
incidence and severity of AKI. Secondary outcomes included serum
biomarkers for CSA-MOD, duration of mechanical ventilation, and length of
intensive care and hospital stay. Results: A total of 298 patients were
randomized and analyzed at two hospitals in New Zealand and Australia.
Mean Pao 2 was significantly different between groups during CPB. There
was no difference in the development of AKI (intervention arm 72.0% vs.
usual care 66.2%; difference, -5.8% [95% CI, -16.1 to 4.7%]; P = 0.28),
other markers of organ damage, or intensive care unit and hospital length
of stay. Conclusions: Avoiding modest hyperoxemia during CPB failed to
demonstrate any difference in AKI, markers of organ damage, or length of
stay.
<20>
Accession Number
20160137792
Author
Yamamoto S.; Yamaga T.; Sakai Y.; Ishida T.; Nakasone S.; Ohira M.; Ota
E.; Mori R.
Institution
(Yamamoto, Yamaga, Sakai, Ishida, Nakasone) Shinshu University Hospital,
Department of Rehabilitation, 3-1-1 Asahi, Matsumoto-shi, Nagano 390-8621,
Japan
(Yamamoto, Ota, Mori) National Center for Child Health and Development,
Department of Health Policy, Tokyo, Japan
(Ohira) Shinshu University, Department of Physical Therapy, School of
Health Sciences, Nagano, Japan
Title
Association between physical performance and cardiovascular events in
patients with coronary artery disease: Protocol for a meta-analysis.
Source
Systematic Reviews. 5 (1) (no pagination), 2016. Article Number: 32. Date
of Publication: 18 Feb 2016.
Publisher
BioMed Central Ltd.
Abstract
Background: Physical performance such as muscle strength or walking speed
of patients with coronary artery disease (CAD) is lower than that of
people who do not have CAD and is related to mortality and re-admission
rates. Recent studies have shown that skeletal muscle strength, such as
grip strength, was closely associated with cardiac events. Physical
performance testing is quick, safe, and inexpensive and provides a
reliable assessment tool for routine clinical practice. The aim of this
meta-analysis is to clarify the association between physical performance
testing and the risk of cardiovascular events and mortality.
Methods/design: This meta-analysis will include male and female
participants of any age in community settings who have a history of the
following conditions or procedures: myocardial infarction, or coronary
revascularization (coronary artery bypass grafting, percutaneous
transluminal coronary angioplasty, or coronary artery stent), angina
pectoris, heart failure, heart transplant, or coronary artery disease
defined by angiography. We will search EMBASE and MEDLINE, PubMed, and the
Cochrane Library with no limitations on date, language, document type, or
publication status. Identified studies will be prospective and
retrospective cohort studies. Physical performance will be defined as
upper extremity strength, lower extremity strength, walking speed, or
other performance scale. Six review authors will independently extract
study characteristics from included studies. Participants will be divided
into subgroups according to age (middle-aged <65 years and elderly >65
years), diagnosis (coronary artery disease and heart failure) and
follow-up time (up to 12 months and over 12 months). We will pool hazard
ratios of Cox proportional hazard models after logarithmic transformation
and perform the meta-analysis by using inverse-variance method.
Discussion: To our knowledge, this meta-analysis will be the first report
to assess the association between physical performance and cardiovascular
events in CAD patients. We hope that these findings may help to estimate
the prognosis for CAD patients in clinical practice. Systematic review
registration: PROSPERO CRD42015020886.
<21>
Accession Number
611808442
Author
Shirai T.
Institution
(Shirai) University of California San Diego, San Diego, CA, United States
Title
Lifestyle and healthy behavior in exercise activities among people with
cardiovascular disease-a crossnational study of cardiac rehabilitation
participants in the United States and Japan.
Source
Journal of Alternative and Complementary Medicine. Conference:
International Congress on Integrative Medicine and Health, ICIMH 2016
United States. Conference Start: 20160517 Conference End: 20160520. 22 (6)
(pp A115), 2016. Date of Publication: 2016.
Publisher
Mary Ann Liebert Inc.
Abstract
Purpose: This study's purpose was to investigate the perspectives of
patients in the United States (US) and Japan (JPN) healthy behavior
through exercise performed to reverse the progression of cardiovascular
disease (CVD). It also examined how patients' beliefs that their CVD was
influenced by genetic factors. Research provides strong evidence that
exercise is beneficial in preventing CVD. However, little is known about
patients' perspectives on what constitutes healthy behavior in exercise
especially in the context of cross-cultural lifestyle differences between
JPN and US. Methods: A cross-sectional study with a self-reported
questionnaire was administered in a CR in Osaka, JPN and a CR in San
Diego, US. People with myocardial infarction or coronary artery bypass
surgery (CABG), and who participated more than four times in a phase II CR
program were recruited to participate in the study by mail or online. A
total of 176 people (JPN: 120; US: 56) participated in this study from
April 2015 to September 2015. Participants in JPN were 100% Asian, aged
71.0 (SD 9.32), and 75% of participants in US were Caucasian, aged 66.5
(SD 12.04). Results: Most participants failed to reach their stated
exercise goal in the recent 4 weeks (JPN: Ideal exercise goal - 3.70 days
and 5.38 hours/week vs. actual 3.08 days and 4.35 hours/week; US: Ideal -
4.47 days and 7.92 hours/week vs. actual 3.54 days and 6.51 hours/ week).
However, US participants had higher confidence in their ability to achieve
their exercise goals. People with CABG in particular had lower confidence.
Higher mean of belief in genetic predisposition of their condition was
seen in US participants (48.41%). A large percentage (41.7%) of JPN
participants admit insufficient knowledge about exercise. Conclusion: This
study suggests that to promote healthy behavior in exercise, CRs in Japan
should emphasize education and CRs in US should emphasize weight
management.
<22>
Accession Number
611808092
Author
Seely D.; Chamberland P.; Herrington C.; Spooner C.; Threader J.; Ennis
J.; Fazekas A.; Zhao L.; Seely A.
Institution
(Seely, Herrington, Zhao) Ottawa Integrative Cancer Centre, Ottawa, ON,
Canada
(Chamberland) Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Spooner) Paradigm Naturopathic Medicine, Vernon, BC, Canada
(Threader) Royal Melbourne Hospital, Melbourne, Australia
(Fazekas, Seely) Ottawa Hospital, Ottawa, ON, Canada
Title
Integrative intervention palette development for the thoracic
perioperative integrative surgical care evaluation (POISE) trial.
Source
Journal of Alternative and Complementary Medicine. Conference:
International Congress on Integrative Medicine and Health, ICIMH 2016
United States. Conference Start: 20160517 Conference End: 20160520. 22 (6)
(pp A135-A136), 2016. Date of Publication: 2016.
Publisher
Mary Ann Liebert Inc.
Abstract
Purpose: The Thoracic POISE Trial is the first randomized pragmatic trial
to explore the impact of an integrative program of care for patients with
thoracic cancer on surgical adverse events, survival, recurrence and
quality of life. The first stage of this three-stage trial will involve
the development and refinement of an integrative intervention palette that
will be applied peri-operatively for people with lung or gastro-esophageal
cancer. The palette of therapies is driven by both practice and evidence
and requires a truly collaborative multidisciplinary group to agree on and
implement a whole-person program of care. Methods: The intervention
development process is guided by three main principles: 1) evidence of
benefit and safety from scientific investigation; 2) holism across pre-
and post-operative treatment goals and therapeutic approaches; and 3)
consensus among doctors of naturopathic and conventional medicine. To
assess for utilization and rationale of use, all members of the Oncology
Association of Naturopathic Physicians were surveyed for their
recommendations. All recommendations made by more than 40% of respondents
went through systematic review to collect relevant literature related to
the intervention in question, thoracic cancer, and/or surgery. Additional
therapies brought forward outside the survey were considered based on
evidence for efficacy, safety and feasibility. Results: A total of 14
pre-operative treatment recommendations were considered and reviewed
across four domains including: 1) natural health products, 2) physical
therapies, 3) mental-emotional treatments, and 4) nutritional approaches.
For post-operative care, 21 recommendations were reviewed across the same
domains. Of the recommendations a handful of core therapies will be
selected for application in the clinical trial. Conclusion: The
intervention development process using welldefined and transparent
principles has fostered an effective collaboration of naturopathic
doctors, thoracic surgeons, oncologists, pharmacists, and epidemiologists.
This collaboration and consensus for treatment in a large multicentre and
multidisciplinary randomized trial is essential to its success and
conduct.
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Accession Number
611755152
Author
Koller M.
Institution
(Koller) Center for Clinical Studies, University Hospital Regensburg,
Regensburg, Germany
Title
Update of the EORTC questionnaire for assessing quality of life in
patients with lung cancer: Introducing the new EORTC QLQ-LC29.
Source
Journal of Clinical Oncology. Conference: 2016 Annual Meeting of the
American Society of Clinical Oncology, ASCO 2016 United States. Conference
Start: 20160603 Conference End: 20160607. 34 (no pagination), 2016. Date
of Publication: May 2016.
Publisher
American Society of Clinical Oncology
Abstract
Background: The EORTC QLQ-LC13 was the first module developed to be used
in conjunction with the core questionnaire C30. Since the publication of
the LC13 in 1994, major advances have been made in the treatment of lung
cancer as well as in assessing quality of life. Therefore, the EORTC
decided to support a project to update the LC13. Methods: The study design
followed the Phase I to III approach described in the EORTC Module
Development Manual. Phase I generates relevant quality of life issues
using a mix of sources, including patient involvement. Phase II transforms
issues into questionnaire items. An international multi-center study
investigated the feasibility of the provisional module (Phase III).
Patients had to fill in the EORTC QLQ-C30 and a 78-item provisional lung
cancer module generated in Phases I and II. Patients rated each of the
items regarding perceived importance, comprehensibility, and acceptance.
The 78 items were assessed against a set of pre-specified statistical
criteria comprised of distribution properties of the items and patient
ratings. Biometrical methods primarily included descriptive statistics and
basic psychometric analyses (Cronbach's alpha). Results: A total of 12
centers from Cyprus, Germany, Italy, Israel, Spain, Norway, Poland,
Taiwan, and UK participated in the Phase III study. 200 patients with
histologically confirmed lung cancer were enrolled. Mean age was 64 years
(range 39-91). 59% of the patients were male, 82% had NSCLC, and 56% were
treated with a palliative approach. 29 out of the 78 items met the
pre-specified statistical. Initial psychometric analyses suggested a five
multi-item scale structure (coughing, shortness of breath, side effects,
tumor progression related to existential issues, surgery-related symptoms;
all Cronbach's alphas > .70). Conclusions: The updated module retained 12
of the 13 original LC13 items and contains new items that assess therapy
side effects of targeted therapy, radio-chemotherapy, and thoracic
surgery. A large-scale international multi-center Phase IV study will be
conducted to fully assess the psychometric properties of the updated lung
cancer module.
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