PubMed Health⌕ Search

Biomedical subjects

L G Futterman

Publications and source records attributed to L G Futterman.

At least 19 recordsLinked to original sources
PubMed1995

Presumed consent: the solution to the critical organ donor shortage?

Extraordinary advances in science and medicine such as transplantation of human tissues not only bring about previously unimaginable societal benefits but also create profound implications that involve autonomy and belonging, opposing moral considerations, and legal concerns. Today, technology is changing faster than our values. The issue of salvaging organs from the dead to meet the escalating need for human organs for lifesaving organ transplantation has evolved into an intricate web of interdisciplinary concerns and value conflicts; right and wrong are opinions and consensus does not seem to exist. This organ supply-demand mismatch, as well as suggestions for its resolution, has become a major challenge to the transplant community and to those in political and bioethical arenas. A methodical transition to presumed consent, or opting-out legislation, which removes the burden of decision from the family and the burden of request from the healthcare professional, may be the only solution to correct the imbalance between human organ need and availability.

Ethics, Medical↗
PubMed1995

Sudden death in athletes.

HCM, as well as coronary and myocardial structural abnormalities, is the most common pathology leading to SCD in young athletes. Furthermore, SCD from fatal arrhythmia seems to be the most common mechanism of death. In this population, however, data are insufficient to support either invasive or noninvasive approaches to clarify risk stratification for SCD. Because of the large population, variants of normal found within the athletic population, and the rarity of the disease, screening for individuals at risk is neither practical nor cost-effective. Not all athletes with HCM are at the same risk for SCD; a thorough history and physical examination should alert the health professional to potential risk factors. Efforts are under way to stratify athletes at risk for SCD to determine who can participate in competitive sports and who should not. However, until research can accurately define variables of hemodynamic and electrical instability that permit reliable identification of athletes with HCM who are at risk for SCD, the recommendation is to disqualify athletes with confirmed HCM from moderate- to high-intensity competitive sports. This recommendation includes athletes with or without symptoms or left ventricular outflow obstruction. Due to the decreased risk of SCD in older athletes, individual judgment of eligibility may be used. Athletes thought to have had myocarditis should be withdrawn from all competitive sports for a convalescent period of approximately 6 months, with thorough cardiac assessment and testing performed before returning to training. Athletes with atrial or ventricular tachyarrhythmia must be screened for structural abnormality, heart response during exercise, and the frequency and duration of the arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Heart rate variability: prognostic implications.

HRV offers information about sympathetic and parasympathetic autonomic function and thus can serve as a measure of risk stratification for serious cardiac arrhythmias and sudden cardiac death. HRV appears to be altered in patients with acute myocardial infarction or diabetic neuropathy and is affected by other physiologic and pathophysiologic processes. Use of HRV measurements requires continued investigation to determine optimal methods and tools by which HRV indices and its variables are analyzed. Long-term studies are required to help correct for differences in values pertaining to age and disease process. Also, studies are needed to determine how patient management strategies will be affected by knowledge gained through HRV analysis and to determine which patient populations should be monitored for HRV analysis and to identify those at risk for sudden cardiac death.

Age Factors↗
PubMed1994

Unexplained syncope: diagnostic value of tilt-table testing.

Vasovagal syncope is a common syncope in patients who have no structural heart disease and occurs more often in young adults. It typically occurs in the erect posture, either standing or sitting. Upon recognition of the prodrome associated with NCS, subjects may avert syncope by lying down or putting the head between the knees. Use of head-up tilting is a recognized diagnostic tool and widely used for the evaluation of vasovagal syncope. However, cardiac diagnostic tests are not 100% accurate. This fact was recently underscored by what occurred in the recent tragic loss, due to ventricular fibrillation, of basketball star Reggie Lewis of the Boston Celtics. It is alleged that the tilt-table test was positive but that he also had structural heart disease. The most important diagnostic tool is the physician's clinical judgment.

Adult↗
PubMed1994

Radiofrequency catheter ablation for supraventricular tachycardias: Part II.

Use of percutaneous catheter ablation with radiofrequency current for cardiac arrhythmias is expanding rapidly. Technical ease, high success and low complication rates have allowed RFCA to become standard treatment for accessory AV connections and is the therapeutic procedure of choice for patients with atrioventricular node reentry tachycardias. Techniques still being investigated and evaluated for the treatment of supraventricular tachycardias include laser catheter ablation, cryocatheter ablation and microwave catheter ablation. With further clinical experience, the efficacy and safety of these and other procedures can be determined.

Adolescent↗
PubMed1993

Syndrome X: fact or fancy?

Syndrome X continues to be a puzzle to the profession. A consensus as to the definition, etiology, pathology, prognosis and treatment has still to be developed.

Behavior Therapy↗
PubMed1993

Radiofrequency catheter ablation for supraventricular tachycardias: Part I.

Ablative therapy in the treatment of arrhythmias is an exciting development of the last decade. Although direct-current, high-energy shock can be effective treatment for many supraventricular tachycardias, clinicians are concerned about potential problems associated with its use. Drug therapy for arrhythmias has been inadequate, ineffective, poorly tolerated and fraught with toxic or proarrhythmic reactions. Because of its relative technical ease, high success rate and low complication rate, RFCA remains the therapeutic procedure of choice for patients with atrioventricular nodal reentrant supraventricular tachycardia. Other catheter ablation techniques such as laser, cryocatheter and microwave catheter are still being tested.

Adult↗
PubMed1988

Cardiac transplantation: a comprehensive nursing perspective. Part 1.

Orthotopic cardiac transplantation has become the treatment of choice for selected patients with end-stage heart disease. Proliferation of cardiac transplantation centers and relaxed selection criteria have resulted in increasing populations of transplant candidates and recipients. As these numbers continue to grow, so too do the numbers of nursing personnel who must respond to the intricacies and demands of cardiac transplantation. Nursing care begins with physiologic and psychologic support of a patient with terminal cardiac disease and continues throughout the transplantation evaluation, waiting, surgical, postoperative, and outpatient periods. In addition to routine postsurgical care, the nurse involved in cardiac transplantation needs to be familiar with the function of a denervated heart, as well as with the effects of unbalanced immunosuppression and immunocompetence. The surge of organ transplantation in the last several years has brought about administrative concerns regarding the financial impact of increasing numbers of transplantations, as well as an inadequate supply of necessary donor organs. This critical shortage of suitable donors demands that nurses and other health care professionals become active in enlarging the donor organ pool by identifying potential organ donors, maintaining optimal hemodynamics and oxygenation so as to ensure organ viability, and providing emotional support of the grieving family.

Heart Failure↗
PubMed1988

Cardiac transplantation: a comprehensive nursing perspective. Part 2.

Many of the postoperative concerns of the cardiac transplant recipient are similar to those of any patient after cardiac surgery. Immunosuppression and immunocompetence, however, pose additional considerations for this patient population. Current immunosuppressive protocols include agents such as azathioprine, prednisone, cyclosporine, T cell antibodies, and monoclonal antibodies, most of which blunt the body's response to foreign antigens. Follow-up and long-term care of the cardiac transplant recipient must address potential problems associated with long-term immunosuppression, such as infection, malignant processes, accelerated graft atherosclerosis, and overall quality of life.

Heart Transplantation↗