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PubMed2004

[Prion diseases].

Explore the source record for details and available documents.

Clinical Trials as Topic↗
PubMedDate not supplied

The pediatric cardiology pharmacopoeia: 2004 update.

Seven years ago, Pediatric Cardiology published the first version of a review article outlining the various medications used in the field of heart diseases in children. This article is an update and expansion to what we have previously presented. Therapeutic intervention, both surgical and through cardiac catheterization, has enabled cure and palliation of an increasingly expanding spectrum of diseases at earlier ages and with more complex lesions. Refinement of these procedures includes more advanced tools as well as the support of an expanding armament of pharmacopoeia used to stabilize and support patients before, during, and after such procedures. In addition to updating previously published data regarding inotropes, antiarrhythmics, vasodilators, diuretics, sedatives, and analgesics as well as a variety of miscellaneous medications, this article describes the use of pulmonary medications frequently needed in patients with congestive heart failure, pulmonary edema, and chronic lung disease. We also describe the difficult management of withdrawal as a result of use of sedatives and analgesics. The most recent recommendation for subacute bacterial endocarditis prophylactic antibiotic regimens is also described.

Cardiology↗
PubMed2005

Role of systematic reviews and meta-analysis in evidence-based medicine.

The overwhelming increase in the quantity of clinical evidence has led to detachment of the evidence and practice because new evidence can be integrated into clinical practice only after it has been critically appraised and synthesized on the basis of the existing evidence. Because many clinicians lack the skills and the time for such information processing, systematic reviews and meta-analyses, their quantitative counterparts, play an important role in health care. Well performed systematic reviews provide clinically relevant information for surgeons, abrogating the need to identify, read, and evaluate many individual studies. This article reviews the basic principles of meta-analysis, discusses its potential weaknesses such as heterogeneity and publication bias, and highlights special situations when dealing with surgical trials.

Evidence-Based Medicine↗
PubMed2000

Intravascular ultrasound for assessment of coronary allograft vasculopathy.

Coronary allograft vasculopathy (CAV) is the major factor limiting the long-term survival after cardiac transplantation. Intravascular ultrasound (IVUS) markedly improved our knowledge about in vivo morphology of CAV by precise determination of vessel morphology. In vivo studies with IVUS demonstrated that transplant vasculopathy may present with a very heterogeneous morphology suggesting a dual etiology of transplant coronary artery disease. The high incidence of donor-transmitted atherosclerosis and its role in further progression of CAV could be demonstrated by the use of IVUS. Beside intimal hyperplasia, adaptive remodeling processes of vessel and lumen geometry may have physiologic and prognostic importance. IVUS is so far the only method that allows the evaluation of compensatory enlargement and shrinkage of coronary vessels in CAV. IVUS investigations allow the assessment of CAV progression in early angiographically not visible stages. The influence of different medical treatment regimens on CAV progression can be quantified. Further studies showed that IVUS parameters may have prognostic impact on subsequent clinical events and angiographic progression of CAV. However, besides all the diagnostic information provided by IVUS, the main application of this method is currently in the field of clinical research.

Clinical Trials as Topic↗
PubMed2005

[Cardiac resynchronization therapy and arrhythmias].

Cardiac resynchronization therapy (CRT) is now considered an established therapy for patients with chronic heart failure in the presence of a wide QRS complex. Though proarrhythmic effects have been described in a few cases, CRT did not increase the frequency of ventricular tachyarrhythmias in prospective studies. In patients on CRT therapy, persistent atrial fibrillation sometimes converts back to sinus rhythm, possibly dependent on the duration of atrial fibrillation.

Arrhythmias, Cardiac↗
PubMed2005

[Tumor lysis syndrome: risk factors and treatment].

Tumor lysis syndrome is a typical oncological complication, characterized by hyperuricemia, hyperkalemia, hyperphosphatemia with secondary hypocalcemia, acidosis and acute renal failure. it occurs particularly in patients with lymphoproliferative diseases during therapy with potent myelosuppressive substances. patients with solid tumors rarely develop a tumor lysis syndrome during anti-neoplastic therapy (chemo-, hormonal-, steroid therapy, radiotherapy). host-related (e.g. pre-existing volume depletion, hyperuricemia, acidic urine) and tumor-related (e.g. large tumor burden, tumor sensitivity to therapy, advanced stage) risk factors contribute markedly to the development of tumor lysis syndrome. prophylaxis and treatment of tumor lysis syndrome consist of adequate hydration of the patients (3 l fluid/m2/day) in order to maintain urine production of > or =100 ml/h, controlled alkalinisation (urine pH 7.0-7.5) and, if necessary, extracorporeal therapy (intermittent or continuous hemodialysis or hemodiafiltration). recombinant urate oxidase (rasburicase) reduces uric acid values by far more effectively than allopurinol. treatment with rasburicase (01.-0.2 mg/kg for 1-7 days) does not only markedly reduce the incidence of tumor lysis syndrome in patients with malignancy but also morbidity and mortality. hyperphosphate-induced acute renal failure due to intrarenal calcium phosphate precipitation may, however, occur even during rasburicase therapy

Clinical Trials as Topic↗
PubMed1993

Issues in contemporary cardiac rehabilitation: a historical perspective.

Cardiac rehabilitation consists of exercise, psychosocial support and education and is prescribed most often for patients with coronary heart disease. Its purpose is to facilitate readaptation to normal life through the achievement of maximal functional capability and to reduce heart disease risk factors. It began historically with progressive ambulation after myocardial infarction and by 1980 became a standardized inpatient therapy performed according to a stepped procedure. Predischarge exercise testing was added and has become a meaningful contribution to the concept of risk stratification after an acute coronary event. Rehabilitation has subsequently become part of the outpatient environment and is delivered by multiple models. Meta-analyses have shown that rehabilitation reduces overall and cardiovascular deaths by about 20% and sudden death by about 37% during the year after an acute myocardial infarction. The significance of this, however, must now be modulated by the dynamic role of aggressive coronary intervention. Selection for such intervention has become an important adjunctive aspect of rehabilitation. Newer findings suggest that those stratified at low risk will benefit most by the modification of coronary risk factors, and that patients previously thought to be poor candidates for rehabilitation (such as those with significant left ventricular dysfunction and low work capacity) may experience substantial relative functional benefit. Beyond risk stratification, important contemporary issues include surveillance of patients after angioplasty, the effectiveness of rehabilitation in the attenuation or reversal of both native and vein graft atherosclerosis and consideration of such currently emphasized end points as quality of life and economic evaluation.

Bed Rest↗
PubMed1994

The provision of patient and family education.

Health-care professionals no longer have the option on whether or not to include patient health education into patient care. The U.S. Joint Commission on Accreditation of Health Care Organizations (JCAHO) requires that patient and family education is provided in specifically identified areas. In order for health providing institutions to be approved, these standards must be met. Health-care providers, however, should realize that patient health education (PHE) can be delivered in a variety of ways and JCAHO does not set conditions as to which methods of delivery are applied. Several modes of PHE approaches are cited in this article, along with an example as to how to put them into practice.

Delivery of Health Care↗
PubMed2004

Clinical trial of an educational intervention to achieve recommended cholesterol levels in patients with coronary artery disease.

BACKGROUND: Despite national efforts to improve cholesterol management for patients with coronary artery disease, many patients are not reaching recommended cholesterol target levels. We sought to determine whether a nurse-based educational intervention, designed to educate patients with confirmed coronary artery disease about personal low-density lipoprotein (LDL) cholesterol target levels and encourage partnership with physicians, could increase adherence with National Cholesterol Education Program target levels (LDL cholesterol level < or =100 mg/dL). METHODS: Patients hospitalized with confirmed coronary artery disease were randomized to undergo a nurse-based educational intervention (375 patients) or usual care (381 patients) for a 12-month period after hospitalization. The primary outcome was the proportion of patients at the LDL cholesterol target level 1 year after hospitalization. The secondary outcome was the proportion of patients with accurate knowledge of LDL cholesterol target levels. RESULTS: The groups were similar at baseline in demographic and clinical characteristics, percent at LDL cholesterol target level (43.9% and 41.1%, respectively), and percent with knowledge of LDL cholesterol target levels (both 5%). The proportion of patients at LDL cholesterol target levels at 1 year did not differ between the intervention (70.2%) and usual care group (67.4%, P =.46). At the conclusion of the trial, patient knowledge about LDL cholesterol target level was higher for the intervention group than the usual care group (19.6% and 6.7%, respectively, P =.001), but this was not associated with improved cholesterol management. CONCLUSIONS: Our nurse-based educational intervention did not result in a significant increase in the proportion of patients who reached target LDL cholesterol levels 1 year after hospitalization. Although the intervention improved patient knowledge of LDL cholesterol target levels, overall rates of LDL cholesterol knowledge remained low, and it was not associated with improved cholesterol management.

Aged↗
PubMed2004

The association between quality improvement activities performed by managed care organizations and quality of care.

PURPOSE: Little data are available to assess the efforts of managed care organizations to improve quality of care. This analysis assessed differences in performance rates between organizations with and without quality improvement activities. METHODS: We reviewed 399 self-reported quality improvement activities submitted by organizations seeking accreditation by the National Committee for Quality Assurance. Processes or outcomes assessed in quality improvement activities were linked to corresponding measures in the effectiveness-of-care database of the Health Plan Employer Data and Information Set (HEDIS). Performance rates for managed care organizations with and without quality improvement activities were then compared. RESULTS: The cross-sectional analysis included 79 quality improvement activities from 50 organizations, covering 12 effectiveness-of-care categories. Each activity had a matching performance score in the database. Financial incentives for providers were associated with substantially higher performance rates in organizations employing this type of intervention. Eight effectiveness-of-care categories had at least four organizations reporting specific quality improvement activities for the care category of interest; statistically significant improvements were observed for follow-up visits for patients after hospitalization for mental illness, checkups after delivery, and screening for cervical cancer. CONCLUSION: Based on objective and audited information, the estimated effects of self-reported quality improvement activities were often small and inconsistent. In some instances, the observed effect was contrary to the expected direction. Limitations of the available dataset and the caveats of a cross-sectional study design precluded a number of analytical options. Longer-term, prospective studies are needed to explore further the relation between quality improvement activities and objective measures of clinical performance.

Accreditation↗