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Out-of-hospital cardiac arrests in children  

Directory of Open Access Journals (Sweden)

Full Text Available Prehospital pediatric cardiac arrest is a rare event compared with adult cardiac arrest. Despite the recent advancements in postresuscitation care improving the outcome of adult patients, similar evidence is lacking in pediatric victims of cardiac arrest. In this brief article, the current data on pediatric cardiac arrest occurring in the prehospital setting are reviewed. The annual incidence of pediatric out-of-hospital cardiac arrest is approximately 8-10 cases per 100,000 persons. The outcome is generally poor, as only 2-9.6% of patients survive to hospital discharge. The neurologic outcome of survivors is good in 24-31% of patients. Current evidence is insufficient to strongly support or refute the use of mild therapeutic hypothermia during the postresuscitation phase in pediatric patients. The application of a goal-directed treatment protocol for pediatric cardiac arrest and postresuscitation syndrome needs to be evaluated.

Kamarainen Antti

2010-01-01

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Out-of-hospital therapeutic hypothermia in cardiac arrest victims  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Despite many years of research, outcome after cardiac arrest is dismal. Since 2005, the European Resuscitation Council recommends in its guidelines the use of mild therapeutic hypothermia (32-34° for 12 to 24 hours in patients successfully resuscitated from cardiac arrest. The benefit of resuscitative mild hypothermia (induced after resuscitation is well established, while the benefit of preservative mild to moderate hypothermia (induced during cardiac arrest needs further investigation before recommending it for clinical routine. Animal data and limited human data suggest that early and fast cooling might be essential for the beneficial effect of resuscitative mild hypothermia. Out-of-hospital cooling has been shown to be feasible and safe by means of intravenous infusion with cold fluids or non-invasively with cooling pads. A combination of these cooling methods might further improve cooling efficacy. If out-of-hospital cooling will further improve functional outcome as compared with in-hospital cooling needs to be determined in a prospective, randomised, sufficiently powered clinical trial.

Holzer Michael

2009-10-01

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Electronic registration of out-of-hospital cardiac arrests  

DEFF Research Database (Denmark)

Introduction: The reported incidences of out-of-hospital cardiac arrests (OHCA) in western countries vary considerably. According to the latest report from Danish Cardiac Arrest Database (DCAD) the incidence rate in Denmark in 2004 was 51/100,000/year. The report states however that this number is uncertain. As the first region in the country, North Denmark Region has introduced a prehospital electronic healthcare record (designated amPHI™) in all of its 50 emergency ambulances. We used data from amPHI™ to examine the incidence of OHCA in the region.   Methods: We extracted patient data from the amPHI™ database from 1st May to 31st December 2006. We then identified the patients who met the criteria for OHCA set by the DCAD: “Situations to which an ambulance is called, and where either the ambulance-staff or others have performed chest compressions or given electrical defibrillation”. We stratified those patients according to whether they received first aid, the identity of the first aid provider and the initial cardiac rhythm as diagnosed by the patient monitor.   Results: 18,666 patients where in contact with an emergency ambulance in the study period. Of those 296 (89/100,000/year) met the definition of cardiac arrest. 83 of those (28 %) received first aid. The first aid was provided by layman (68 %), physicians (11 %), nurses (11 %) and first-aiders (4 %). In 6 % the identity of the first aid provider was unknown. The majority of the patients (n = 177 (58 %)) had asystole upon ambulance arrival. 37 (12 %) had ventricular fibrillation, 32 (10 %) had other arrhythmias, 21 (7 %) had sinus rhythm and a single patient (0.3 %) had ventricular tachycardia.   Conclusions: We have shown amPHI™ to be a valuable tool for accessing information about OHCA. By a stringent electronic registration we found a considerably higher incidence rate for OHCA, than documented by the analogue nationwide registry. Further we discovered a high rate of first aid to OHCA-patients. Finally our data showed a high occurence of asystolia in patients who met the official criteria for OHCA.

Nielsen, Niels Dalsgaard; Dahl, Michael

2007-01-01

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Hospital admissions and pharmacotherapy before out-of-hospital cardiac arrest according to age  

DEFF Research Database (Denmark)

BACKGROUND: The underlying etiology of sudden cardiac death varies with age and is likely to be reflected in type and number of healthcare contacts. We aimed to determine the specific type of healthcare contact shortly before out-of-hospital cardiac arrest (OHCA) across ages. METHODS: OHCA patients were identified in the nationwide Danish Cardiac Arrest Register and Copenhagen Medical Emergency Care Unit (2001-2006). We matched every OHCA patients with 10 controls on sex and age. Healthcare contacts were evaluated 30 days before event by individual-level-linkage of nationwide registers. RESULTS: We identified 16,924 OHCA patients, median age 70.0 years (Q1-Q3: 59-80). OHCA patients had a higher number of hospitalizations and received more pharmacotherapy compared to the control population across all ages (p for difference 89) were

Weeke, Peter; Folke, Fredrik

2012-01-01

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Out-of-hospital therapeutic hypothermia in cardiac arrest victims  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Despite many years of research, outcome after cardiac arrest is dismal. Since 2005, the European Resuscitation Council recommends in its guidelines the use of mild therapeutic hypothermia (32-34°) for 12 to 24 hours in patients successfully resuscitated from cardiac arrest. The benefit of resuscitative mild hypothermia (induced after resuscitation) is well established, while the benefit of preservative mild to moderate hypothermia (induced during cardiac arrest) needs furt...

Holzer Michael; Arrich Jasmin; Behringer Wilhelm; Sterz Fritz

2009-01-01

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Post-hypothermia fever is associated with increased mortality after out-of-hospital cardiac arrest  

DEFF Research Database (Denmark)

Post-cardiac arrest fever has been associated with adverse outcome before implementation of therapeutic hypothermia (TH), however the prognostic implications of post-hypothermia fever (PHF) in the era of modern post-resuscitation care including TH has not been thoroughly investigated. The aim of the study was to assess the prognostic implication of PHF in a large consecutive cohort of comatose survivors after out-of-hospital cardiac arrest (OHCA) treated with TH.

Bro-Jeppesen, John; Hassager, Christian

2013-01-01

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Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest - implementation and clinical management  

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Background: With the publication of two randomized controlled trials (RCTs) in 2002, therapeutic hypothermia (TH) was re-introduced in postresuscitation care of comatose out-of-hospital cardiac arrest (OHCA) patients. Many issues, however, were unresolved, including implementation protocol, cooling technique, clinical management, implications of TH treatment on prognostic accuracy and therapeutic benefit in subgroups of OHCA excluded from the initial RCTs. Objectives: We ...

Busch, Michael

2012-01-01

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Assessing the impact of prehospital intubation on survival in out-of-hospital cardiac arrest.  

LENUS (Irish Health Repository)

There is a developing body of literature documenting adverse survival outcome of out-of-hospital endotracheal intubation for critical multiple trauma and head injury patients. OBJECTIVE: To compare the rates of survival to hospital admission and discharge of nontraumatic out-of-hospital cardiac arrest (OHCA) patients who received successful out-of-hospital endotracheal intubation and those who were not intubated. METHODS: We conducted a retrospective analysis from an ongoing database of OHCA patients brought to a large suburban tertiary care emergency department by paramedic services between 1995 and 2006. We dichotomized patients by whether they were successfully endotracheally intubated or not prior to hospital arrival. Utstein style cardiac arrest variables were abstracted for all cases. All survivors to hospital admission were reviewed to exclude those patients in whom intubation was not attempted or unnecessary, such as those who had successful first-shock recovery of spontaneous circulation. We used chi square and logistic regression techniques for analysis, using survival to discharge as the primary outcome and survival to admission as a secondary outcome. RESULTS: There were 1,515 total cases with 33 early survivors excluded. Overall, 1,220 (86.2%) were intubated; of those intubated, 270 (20.2%) survived to admission and 93 (7.0%) survived to discharge. Upon univariate analysis, there was no difference in survival between intubated and non intubated groups (6.5% vs 10.0%, OR = 0.63, 95% CI 0.37,1.08). For patients initially in ventricular fibrillation\\/ventricular tachycardia (VT\\/VF), in a multivariate Logit model, intubation significantly decreased survival to discharge, adjusted odds ratio (OR) = 0.52 (95% confidence interval 0.27, 0.998). Intubated non-VF patients were more likely to survive to admission, adjusted OR 2.96 (1.04, 8.43), but not to discharge (1.8% vs. 1.0%, p = 1.0). CONCLUSION: This observational study in an unselected population shows that patients in VF\\/VT arrest who underwent out-of-hospital intubation were less likely to survive to discharge than those not intubated. Out-of-hospital intubation of patients with non-VF arrest was associated with an increased rate of survival to admission, but not survival to discharge. Future prospective studies are needed to define the role of out-of-hospital endotracheal intubation in cardiac arrest patients.

Egly, Joshua

2012-02-01

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Out-of-hospital cardiac arrest (OHCA) survival in rural Northwest Ireland: 17 years' experience.  

LENUS (Irish Health Repository)

SAVES, the name used to describe a register of survivors of out-of-hospital cardiac arrest (OHCA), was established in rural Northwest Ireland in 1992. From 1992 to 2008, 80 survivors were identified (population 239,000 (2006)). Most incidents were witnessed (69\\/70) and all were in shockable rhythm at the time of first rhythm analysis (66\\/66). Of 66 patients who could be traced, 46 were alive in December 2008. Average survival rates appeared to increase over the lifetime of the database. SAVES has also contributed to the development of a national OHCA register.

Masterson, Siobhán

2011-05-01

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Antipsychotics and associated risk of out-of-hospital cardiac arrest  

DEFF Research Database (Denmark)

Antipsychotic drugs have been associated with sudden cardiac death, but differences in the risk of out-of-hospital cardiac arrest (OHCA) associated with different antipsychotic drug classes are not clear. We identified all OHCA in Denmark (2001-2010). Risk of OHCA associated with antipsychotic drug use was evaluated by conditional logistic regression analysis in case-time-control models. In total, 2,205 (7.6%) of 28,947 OHCA patients received treatment with an antipsychotic drug at the time of event. Overall treatment with any antipsychotic was associated with OHCA (odds ratio [OR]= 1.53, 95% confidence interval [CI]:1.23-1.89) as was use with typical antipsychotics (OR= 1.66, CI: 1.27-2.17). By contrast, overall atypical antipsychotics drug use was not (OR= 1.29, CI: 0.90-1.85). Two individual typical antipsychotic drugs were associated with OHCA, haloperidol (OR= 2.43, CI: 1.20-4.93) and levomepromazine (OR= 2.05, CI: 1.18-3.56) as was one atypical antipsychotic, quetiapine (OR= 3.64, CI: 1.59-8.30).Clinical Pharmacology & Therapeutics (2014); Accepted article preview online 24 June 2014; doi:10.1038/clpt.2014.139.

Weeke, Peter; Jensen, Aksel

2014-01-01

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Out-of-Hospital Cardiac Arrests and Outdoor Air Pollution Exposure in Copenhagen, Denmark  

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Cardiovascular disease is the number one cause of death globally and air pollution can be a contributing cause. Acute myocardial infarction and cardiac arrest are frequent manifestations of coronary heart disease. The objectives of the study were to investigate the association between 4 657 out-of-hospital cardiac arrests (OHCA) and hourly and daily outdoor levels of PM(10), PM(2.5), coarse fraction of PM (PM(10-2.5)), ultrafine particle proxies, NO(x), NO(2), O(3) and CO in Copenhagen, Denmark, for the period 2000-2010. Susceptible groups by age and sex was also investigated. A case-crossover design was applied. None of the hourly lags of any of the pollutants were significantly associated with OHCA events. The strongest association with OHCA events was observed for the daily lag4 of PM(2.5), lag3 of PM(10), lag3 of PM(10-2.5), lag3 of NO(x) and lag4 of CO. An IQR increase of PM(2.5) and PM(10) was associated with a significant increase of 4% (95% CI: 0%; 9%) and 5% (95% CI: 1%; 9%) in OHCA events with 3 days lag, respectively. None of the other daily lags or other pollutants was significantly associated with OHCA events. Adjustment for O(3) slightly increased the association between OHCA and PM(2.5) and PM(10). No susceptible groups were identified.

Wichmann, Janine; Folke, Fredrik

2013-01-01

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Antipsychotics and Associated Risk of Out-of-Hospital Cardiac Arrest.  

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Antipsychotic drugs have been associated with sudden cardiac death, but differences in the risk of out-of-hospital cardiac arrest (OHCA) associated with different antipsychotic drug classes are not clear. We identified all OHCAs in Denmark (2001-2010). The risk of OHCA associated with antipsychotic drug use was evaluated by conditional logistic regression analysis in case-time-control models. In total, 2,205 (7.6%) of 28,947 OHCA patients received treatment with an antipsychotic drug at the time of the event. Overall, treatment with any antipsychotic drug was associated with OHCA (odds ratio (OR) = 1.53, 95% confidence interval (CI): 1.23-1.89), as was use with typical antipsychotics (OR = 1.66, CI: 1.27-2.17). By contrast, overall, atypical antipsychotic drug use was not (OR = 1.29, CI: 0.90-1.85). Two individual typical antipsychotic drugs, haloperidol (OR = 2.43, CI: 1.20-4.93) and levomepromazine (OR = 2.05, CI: 1.18-3.56), were associated with OHCA, as was one atypical antipsychotic drug, quetiapine (OR = 3.64, CI: 1.59-8.30). PMID:24960522

Weeke, P; Jensen, A; Folke, F; Gislason, G H; Olesen, J B; Fosbøl, E L; Wissenberg, M; Lippert, F K; Christensen, E F; Nielsen, S L; Holm, E; Kanters, J K; Poulsen, H E; Køber, L; Torp-Pedersen, C

2014-10-01

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Surviving out-of-hospital cardiac arrest: just a matter of defibrillators?  

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Out-of-hospital sudden cardiac arrest (OHCA) is a leading cause of death all over the world. Although the outcome of OHCA resulting from 'nonshockable' rhythms (asystole and pulseless electrical activity) is poor regardless of resuscitation efforts, 'shockable' rhythms such as ventricular tachycardia or fibrillation may carry a good prognosis if early defibrillation is performed. At present, simplified cardiopulmonary resuscitation techniques (hands-only cardiopulmonary resuscitation) and automated external defibrillators (AEDs) offer lay people the possibility to provide lifesaving treatment to OHCA victims in the critical minutes before the arrival of the emergency medical system. Programs aimed at increasing provision of cardiopulmonary resuscitation and use of AEDs by lay people have been set up in different countries, including Italy, and have contributed to improve survival rates. However, success of these programs critically depends on appropriate planning and design, and on cultural predisposition of witnesses to undertake immediate measures of resuscitation in the case of OHCA. Placement of a large number of AEDs may carry high costs and little benefits if it is uncoordinated and not preceded by educational campaigns to spread widely the 'culture of resuscitation' in the population. PMID:24950347

Zorzi, Alessandro; Gasparetto, Nicola; Stella, Federica; Bortoluzzi, Andrea; Cacciavillani, Luisa; Basso, Cristina

2014-08-01

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Differences between out-of-hospital cardiac arrest in residential and public locations and implications for public-access defibrillation  

DEFF Research Database (Denmark)

The majority of out-of-hospital cardiac arrests (OHCAs) occur in residential locations, but knowledge about strategic placement of automated external defibrillators in residential areas is lacking. We examined whether residential OHCA areas suitable for placement of automated external defibrillators could be identified on the basis of demographic characteristics and characterized individuals with OHCA in residential locations.

Folke, Fredrik; Gislason, Gunnar H

2010-01-01

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Safety of therapeutic hypothermia combined with primary percutaneous coronary intervention after out-of-hospital cardiac arrest  

DEFF Research Database (Denmark)

BACKGROUND: The safety of therapeutic hypothermia combined with percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest has been challenged after reports of high risk of stent thrombosis. METHODS: We searched the Western Denmark Heart Registry to identify patients with an acute coronary angiography due to out-of-hospital cardiac arrest performed at our institution between September 2010 and September 2013. We identified 68 unconscious patients, who were resuscitated after out-of-hospital cardiac arrest and underwent acute PCI with stent implantation and immediate therapeutic hypothermia, and followed these for 30 days. Target temperature of 32-34°C was achieved by either an invasive or a non-invasive cooling system. RESULTS: All patients had elevated myocardial biomarkers and 37 patients had ST-segment elevation myocardial infarction. Bare metal stents were implanted in 14 and drug-eluting stents in 54 patients. All patients received antithrombotic treatment with a standard loading dose of 300 mg acetylsalicylic acid and 10,000 units heparin intravenously prior PCI. Clopidogrel or ticagrelor was administered orally through a gastric tube immediately after PCI. During the procedure abciximab or bivalirudin was administered in 44 patients. Electrocardiographic and clinical signs of stent thrombosis were found in one patient. CONCLUSIONS: We observed one stent thrombosis in this cohort of 68 consecutive patients with out-of-hospital cardiac arrest who were treated with PCI and therapeutic hypothermia. This suggests that PCI with stent implantation can be performed with acceptable safety in these patients.

Chisholm, Gro E; Grejs, Anders

2014-01-01

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The Cardiocerebral Resuscitation protocol for treatment of out-of-hospital primary cardiac arrest  

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Full Text Available Abstract Out-of-hospital cardiac arrest (OHCA is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF. But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol.

Ewy Gordon A

2012-09-01

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Prehospital intranasal evaporative cooling for out-of-hospital cardiac arrest: a pilot, feasibility study.  

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Intranasal evaporative cooling presents a novel means of initiating therapeutic hypothermia after an out-of-hospital cardiac arrest (OHCA). Few studies have evaluated the use of intranasal therapeutic hypothermia using the Rhinochill device in the prehospital setting. We sought to evaluate the use of Rhinochill in the Physician Response Unit of London's Air Ambulance, aiming to describe the feasibility of employing it during prehospital resuscitation for OHCA. We prospectively evaluated the Rhinochill device over a 7-month period. Inclusion criteria for deployment included: age above 18 years, Physician Response Unit on-scene within maximum of 10 min after return-of-spontaneous circulation (ROSC), witnessed OHCA or unwitnessed downtime of less than 10 min, pregnancy not suspected, normal nasal anatomy, and likely ICU candidate if ROSC were to be achieved. Thirteen patients were included in the evaluation. The average time from the 999 call to initiation of cooling was 39.5 min (range 22-61 min). The average prehospital temperature change in patients who achieved ROSC was -1.9°C. Patients were cooled for an average of 38 min prehospital. In all cases, the doctor and paramedic involved with the resuscitation reported that the Rhinochill was easy to set up and use during resuscitation and that it did not interfere with standard resuscitation practice. Intranasal evaporative cooling using the Rhinochill system is feasible in an urban, prehospital, doctor/paramedic response unit. Cooling with Rhinochill was not found to interfere with prehospital resuscitation and resulted in significant core body temperature reduction. Further research on the potential benefit of intra-arrest and early initiation of intranasal evaporative cooling is warranted. PMID:24300245

Lyon, Richard M; Van Antwerp, Jerry; Henderson, Charles; Weaver, Anne; Davies, Gareth; Lockey, David

2014-10-01

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Comparison of role of early (less than six hours) to later (more than six hours) or no cardiac catheterization after resuscitation from out-of-hospital cardiac arrest.  

Science.gov (United States)

Despite reports of patients with resuscitated sudden cardiac arrest (rSCA) receiving acute cardiac catheterization, the efficacy of this strategy is largely unknown. We hypothesized that acute cardiac catheterization of patients with rSCA would improve survival to hospital discharge. A retrospective cohort of 240 patients with out-of-hospital rSCA caused by ventricular tachycardia or fibrillation was identified from 11 institutions in Seattle, Washington from 1999 through 2002. Patients were grouped into those receiving acute catheterization within 6 hours (?6-hour group, n = 61) and those with deferred catheterization at >6 hours or no catheterization during the index hospitalization (>6-hour group, n = 179). Attention was directed to survival to hospital discharge, neurologic status, extent of coronary artery disease, presenting electrocardiographic findings, and symptoms before arrest. Propensity-score methods were used to adjust for the likelihood of receiving acute catheterization. Survival was greater in patients who underwent acute catheterization (72% in the ?6-hour group vs 49% in the >6-hour group, p = 0.001). Percutaneous coronary intervention was performed in 38 of 61 patients (62%) in the ?6-hour group and 13 of 170 patients (7%) in the >6-hour group (p bystander cardiopulmonary resuscitation, daytime presentation, history of percutaneous coronary intervention or stroke, and acute ST-segment elevation were positively associated with receiving cardiac catheterization. In conclusion, in this series of patients who sustained out-of-hospital cardiac arrest, acute catheterization (<6 hours of presentation) was associated with improved survival. PMID:22100026

Strote, Justin A; Maynard, Charles; Olsufka, Michele; Nichol, Graham; Copass, Michael K; Cobb, Leonard A; Kim, Francis

2012-02-15

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Out-of-hospital cardiac arrest from air embolism during sexual intercourse: case report and review of the literature.  

Science.gov (United States)

We report the successful resuscitation of a 38-year-old woman in cardiac arrest following heterosexual intercourse 7 days after spontaneous abortion and an instrumental uterine evacuation. The collapse was thought to be due to venous air embolism (VAE). Her survival neurologically intact was attributed to appropriate first aid, pre-hospital and subsequent hospital intensive care. Neither a case of an out-of-hospital air embolism where the patient made a good recovery, nor a case of miscarriage followed by collapse from air embolism has been reported in the literature. Air embolism is a very infrequent cause of out-of-hospital cardiac arrest with a high mortality rate. Predominant causal reasons are severe penetrating neck or thoracic injuries and sexual activities in pregnancy, when air can pass into the damaged veins in the wall of the uterus and lead to total obstruction in the heart. Diagnostics and management techniques for venous air embolism are discussed. Air embolism should be included in the differential diagnosis for all young women in cardiac arrest, particularly when occurring during sexual activity. Instructions in risks of sexual intercourse during pregnancy and the puerperium should become part of pregnant women's education. PMID:17291667

Truhlar, Anatolij; Cerny, Vladimir; Dostal, Pavel; Solar, Miroslav; Parizkova, Renata; Hruba, Iva; Zabka, Ladislav

2007-06-01

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Early Outcomes of Out-of-Hospital Cardiac Arrest after Early Defibrillation: a 24 Months Retrospective Analysis  

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Full Text Available Introduction: Cardiovascular disease remains the most common cause of death in the United States and most other Western nations. Among these deaths, sudden, out-of-hospital cardiac arrest claims approximately 1000 lives each day in the United States alone. Most of these cardiac arrests are due to ventricular fibrillation. Though highly reversible with the rapid application of a defibrillator, ventricular fibrillation is otherwise fatal within minutes, even when cardiopulmonary resuscitation is provided immediately. The overall survival rate in the United States is estimated to be less than 5 percent. Recent developments in automated-external-defibrillator technology have provided a means of increasing the rate of prompt defibrillation after out-of-hospital cardiac arrest. After minimal training, nonmedical personnel (e.g., flight attendants and casino workers are also able to use defibrillators in the workplace, with lifesaving effects. Nonetheless, such programs have involved designated personnel whose job description includes assisting persons who have had sudden cardiac arrest. Data are still lacking on the success of programs in which automated external defibrillators have been installed in public places to be used by persons who have no specific training or duty to act. Materials and Methods: All patients who had an out-of-hospital cardiac arrest between January 2003 and December 2004 and who received early defibrillation for ventricular fibrillation were included. We conducted a 24 months retrospective population-based analysis of the outcome in our population. Results: Over a 24 month period, 446 people had non–traumatic cardiac arrest, and in all of them it was observed to be ventricular fibrillation. In a very few cases, the defibrillator operators were good Samaritans, acting voluntarily. Eighty-nine patients (about 19% with ventricular fibrillation were successfully resuscitated, including eighteen who regained consciousness before hospital admission. Conclusion: Automated external defibrillators deployed in readily accessible, well-marked areas, are really very effective in assisting patients with cardiac arrest. However, it's quite true that, in the cases of survivors, most of our users had good prior training in the use of these devices.

Paolo Terranova

2006-10-01

 
 
 
 
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Chest compressions before defibrillation for out-of-hospital cardiac arrest: A meta-analysis of randomized controlled clinical trials  

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Full Text Available Abstract Background Current 2005 guidelines for advanced cardiac life support strongly recommend immediate defibrillation for out-of-hospital cardiac arrest. However, findings from experimental and clinical studies have indicated a potential advantage of pretreatment with chest compression-only cardiopulmonary resuscitation (CPR prior to defibrillation in improving outcomes. The aim of this meta-analysis is to evaluate the beneficial effect of chest compression-first versus defibrillation-first on survival in patients with out-of-hospital cardiac arrest. Methods Main outcome measures were survival to hospital discharge (primary endpoint, return of spontaneous circulation (ROSC, neurologic outcome and long-term survival. Randomized, controlled clinical trials that were published between January 1, 1950, and June 19, 2010, were identified by a computerized search using SCOPUS, MEDLINE, BIOS, EMBASE, the Cochrane Central Register of Controlled Trials, International Pharmaceutical Abstracts database, and Web of Science and supplemented by conference proceedings. Random effects models were used to calculate pooled odds ratios (ORs. A subgroup analysis was conducted to explore the effects of response interval greater than 5 min on outcomes. Results A total of four trials enrolling 1503 subjects were integrated into this analysis. No difference was found between chest compression-first versus defibrillation-first in the rate of return of spontaneous circulation (OR 1.01 [0.82-1.26]; P = 0.979, survival to hospital discharge (OR 1.10 [0.70-1.70]; P = 0.686 or favorable neurologic outcomes (OR 1.02 [0.31-3.38]; P = 0.979. For 1-year survival, however, the OR point estimates favored chest compression first (OR 1.38 [0.95-2.02]; P = 0.092 but the 95% CI crossed 1.0, suggesting insufficient estimate precision. Similarly, for cases with prolonged response times (> 5 min point estimates pointed toward superiority of chest compression first (OR 1.45 [0.66-3.20]; P = 0.353, but the 95% CI again crossed 1.0. Conclusions Current evidence does not support the notion that chest compression first prior to defibrillation improves the outcome of patients in out-of-hospital cardiac arrest. It appears that both treatments are equivalent. However, subgroup analyses indicate that chest compression first may be beneficial for cardiac arrests with a prolonged response time.

Meier Pascal

2010-09-01

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Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions--a nationwide prospective feasibility study  

DEFF Research Database (Denmark)

Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases.

Krarup, Niels Henrik; Terkelsen, Christian Juhl

2011-01-01

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Antidepressant Use and Risk of Out-of-Hospital Cardiac Arrest : A Nationwide Case-Time-Control Study  

DEFF Research Database (Denmark)

Treatment with some types of antidepressants has been associated with sudden cardiac death. It is unknown whether the increased risk is due to a class effect or related to specific antidepressants within drug classes. All patients in Denmark with an out-of-hospital cardiac arrest (OHCA) were identified (2001-2007). Association between treatment with specific antidepressants and OHCA was examined by conditional logistic regression in case-time-control models. We identified 19,110 patients with an OHCA; 2,913 (15.2%) were receiving antidepressant treatment at the time of OHCA, with citalopram being the most frequently used type of antidepressant (50.8%). Tricyclic antidepressants (TCAs; odds ratio (OR) = 1.69, confidence interval (CI): 1.14-2.50) and selective serotonin reuptake inhibitors (SSRIs; OR = 1.21, CI: 1.00-1.47) were both associated with comparable increases in risk of OHCA, whereas no association was found for serotonin-norepinephrine reuptake inhibitors/noradrenergic and specific serotonergic antidepressants (SNRIs/NaSSAs; OR = 1.06, CI: 0.81-1.39). The increased risks were primarily driven by: citalopram (OR = 1.29, CI: 1.02-1.63) and nortriptyline (OR = 5.14, CI: 2.17-12.2). An association between cardiac arrest and antidepressant use could be documented in both the SSRI and TCA classes of drugs.

Weeke, P; Jensen, Aksel Karl Georg

2012-01-01

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Out-of hospital cardiac arrest in Okayama city (Japan: outcome report according to the "Utsutein Style".  

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Full Text Available

The purpose of this study was to evaluate the outcomes for out-of-hospital cardiac arrest (OHCA and cardiopulmonary resuscitation (CPR in the city of Okayama, Japan, during a 1-year period after the reorganization of defibrillation by Emergency Life-Saving Technicians (ELSTs with standing orders of CPR. The data were collected prospectively according to an Utstein style between June 1, 2003 and May 31, 2004; OHCA was confirmed in 363 patients. Cardiac arrest of presumed cardiac etiology (179 was witnessed by a bystander in 62 (34.6% cases. Of this group, ventricular fibrillation (VF was documented in 20 cases (32.3%, and 1 patient (5% was discharged alive without severe neurological disability. This outcome is average in Japan, but it is quite low level compared with Western countries because there is less VF in Japan. The Utstein style revealed that we must try to detect VF before the rhythm changes and to provide defibrillation as soon as possible in order to improve outcomes. Further research will be required to accurately evaluate OHCA in Okayama city.

Hayashi,Hoei

2005-04-01

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Out of hospital cardiac arrest outside home in Sweden, change in characteristics, outcome and availability for public access defibrillation  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background A large proportion of patients who suffer from out of hospital cardiac arrest (OHCA outside home are theoretically candidates for public access defibrillation (PAD. We describe the change in characteristics and outcome among these candidates in a 14 years perspective in Sweden. Methods All patients who suffered an OHCA in whom cardiopulmonary resuscitation (CPR was attempted between 1992 and 2005 and who were included in the Swedish Cardiac Arrest Register (SCAR. We included patients in the survey if OHCA took place outside home excluding crew witnessed cases and those taken place in a nursing home. Results 26% of all OHCAs (10133 patients out of 38710 patients fulfilled the inclusion criteria. Within this group, the number of patients each year varied between 530 and 896 and the median age decreased from 68 years in 1992 to 64 years in 2005 (p for trend = 0.003. The proportion of patients who received bystander CPR increased from 47% in 1992 to 58% in 2005 (p for trend The median time from cardiac arrest to defibrillation among witnessed cases was 12 min in 1992 and 10 min in 2005 (p for trend = 0.029. Survival to one month among all patients increased from 8.1% to 14.0% (p for trend = 0.01. Among patients found in a shockable rhythm survival increased from 15.3% in 1992 to 27.0% in 2005 (p for trend Conclusion In Sweden, there was a change in characteristics and outcome among patients who suffer OHCA outside home. Among these patients, bystander CPR increased, but the occurrence of VF decreased. One-month survival increased moderately overall and highly significantly among patients found in VF, even though the time to defibrillation changed only moderately.

Rosenqvist Mårten

2009-04-01

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[How I treat ... out-of-hospital cardiac arrest. The role of the emergency medical dispatcher].  

Science.gov (United States)

Sudden cardiac arrest is an event associated with a very low survival rate. The latter is inversely proportional to the duration of the cardiovascular arrest. The chain of survival concept is a sequence of 4 events to be carried out as fast as possible with a view to ensure the patient's survival. This sequence consists of early access to and activation of the emergency medical system, early initiation of basic cardiopulmonary resuscitation, early defibrillation and early specialized care. The number of potential witnesses trained in Basic Life Support (BLS) does not guarantee an adequate basic resuscitation before the arrival of medical aid. In order to optimize the management of victims and callers, the concept of dispatching-assisted cardiopulmonary resuscitation based on a structured protocol has been implemented. The implementation of this plan to improve the quality of call handling required training and assessment of impacts on beneficiaries. The research datashow a reduction of the duration of cardiac arrest, an increase in resuscitation initiated by a witness, an improved survival rate, and a decreased stress and unanimous approval of dispatchers. Currently, the process is being improved and sustained. PMID:24830210

Stipulante, S; Zandona, R; El Fassi, M; Collas, D; Tubes, R; Delfosse, A S; Etienne, A M; D'Orio, V; Ghuysen, A

2014-03-01

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Predictors of Neurologic Outcome in Patients Resuscitated from Out-of-Hospital Cardiac Arrest Using Classification and Regression Tree Analysis.  

Science.gov (United States)

The estimated survival rate of 8% to 10% after out-of-hospital cardiac arrest (OHCA) remains dismal. Few studies have addressed predictors of functional neurologic outcome after successful resuscitation. The objective of the study was to identify variables associated with favorable neurologic outcomes, defined by a Glasgow Coma Scale of 14 or 15, after OHCA. We used a propensity analysis and classification and regression tree model of 184 OHCA patients surviving to hospital admission at a cardiac arrest receiving center in Los Angeles County from 2008 to 2013. Forty-three patients (23%) had a favorable outcome, median age was 65 years (interquartile range [IQR] 54 to 76), and 98 (53%) were men. Sixty-six patients (36%) presented with a shockable rhythm. The majority were witnessed, either by a civilian (n = 115, 63%) or a paramedic (n = 25, 14%). Bystander cardiopulmonary resuscitation was performed on 84 patients (46%); median dose of epinephrine was 2 mg (IQR 1 to 3). Median time to return of spontaneous circulation was 21 minutes (IQR 16 to 29); the median lactate level was 5.2 mmol/L (IQR 2.8 to 9.2). Lower epinephrine doses (value of 34.5% (95% CI 31.6% to 46.1%), a negative predictive value of 94.4% (95% CI 85.5% to 98.2%), and an area under the curve of 0.89. The propensity score-adjusted logistic regression model demonstrated that receiving surviving to hospital admission, a good neurologic outcome was associated with having received <1.5 mg of epinephrine and a lactate level <5 mmol/L. PMID:25118118

Kaji, Amy H; Hanif, Arslan M; Bosson, Nichole; Ostermayer, Daniel; Niemann, James T

2014-10-01

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Cerebral oximetry and cerebral blood flow monitoring in 2 pediatric survivors with out-of-hospital cardiac arrest.  

Science.gov (United States)

In pediatric out-of-hospital cardiac arrest (POHCA), cardiovascular monitoring tools have improved resuscitative endeavors and cardiovascular outcomes but with still poor neurologic outcomes. Regarding cardiac arrest in patients with congenital heart disease during surgery, the application of cerebral oximetry with blood volume index (BVI) during the resuscitation has shown significant results and prognostic significance. We present 2 POHCA patients who had cerebral oximetry with BVI monitoring during their arrest and postarrest phase in the emergency department and its potential prognostic aspect.Basic procedures include left and right cerebral oximetry with BVI monitoring at every 5-second interval during cardiac arrest, resuscitation, and postarrest in 2 POHCA patients in the pediatric emergency department.Regional cerebral tissue oxygen saturation (rSo2) with BVI readings in these 2 POHCA survivors demonstrated interesting cerebral physiology, blood flow, and potential prognostic outcome. In 1 patient, the reference range of cerebral rSo2 with positive blood flow during arrest and postarrest phases consistently occurred. This neurologic monitoring had its significance when the resuscitation effectiveness was used and end-tidal CO2 changes were lost. The other patient's cerebral rSo2 with simultaneous BVI readings and trending showed the effectiveness of the emergency medical services (EMS) resuscitation.Cerebral oximetry with cerebral blood flow index monitoring in these POHCA survivors demonstrates compelling periarrest and postarrest cerebral physiology information and prognostication. Cerebral oximetry with cerebral BVI monitoring during these arrest phases has potential as a neurologic monitor for the resuscitative intervention's effectiveness and its possible neurologic prognostic application in the pediatric OCHA patients. PMID:24275043

Abramo, Thomas; Aggarwal, Nitin; Kane, Ian; Crossman, Kristen; Meredith, Mark

2014-04-01

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Survival after out-of-hospital cardiac arrest in relation to sex : A nationwide registry-based study  

DEFF Research Database (Denmark)

AIM: Crude survival has increased following an out-of-hospital cardiac arrest (OHCA). We aimed to study sex-related differences in patient characteristics and survival during a 10-year study period. METHODS: Patients ?12 years old with OHCA of a presumed cardiac cause, and in whom resuscitation was attempted, were identified through the Danish Cardiac Arrest Registry 2001-2010. A total of 19.372 patients were included. RESULTS: One-third were female, with a median age of 75 years (IQR 65-83). Compared to females, males were five years younger; and less likely to have severe comorbidities, e.g., chronic obstructive pulmonary disease (12.8% vs. 16.5%); but more likely to have arrest outside of the home (29.4% vs. 18.7%), receive bystander CPR (32.9% vs. 25.9%), and have a shockable rhythm (32.6% vs. 17.2%), all p<0.001. Thirty-day crude survival increased in males (3.0% in 2001 to 12.9% in 2010); and in females (4.8% in 2001 to 6.7% in 2010), p<0.001. Multivariable logistic regression analyses adjusted for patient characteristics including comorbidities, showed no survival difference between sexes in patients with a non-shockable rhythm (OR 1.00; CI 0.72-1.40), while female sex was positively associated with survival in patients with a shockable rhythm (OR 1.31; CI 1.07-1.59). Analyses were rhythm-stratified due to interaction between sex and heart rhythm. There was no interaction between sex and calendar-year. CONCLUSIONS: Temporal increase in crude survival was more marked in males due to poorer prognostic characteristics in females with a lower proportion of shockable rhythm. In an adjusted model, female sex was positively associated with survival in patients with a shockable rhythm.

Wissenberg, Mads; Hansen, Carolina Malta

2014-01-01

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Out-of-hospital cardiac arrest and placement of automated external defibrillators in the community.  

DEFF Research Database (Denmark)

INDLEDNING Chancen for at overleve et hjertestop udenfor hospital er i de første minutter efter kollaps afhængig af hjælpen fra nærmeste tilstedeværende. Dette har faciliteret strategier for placering af automatiske eksterne defibrillatorer (AED) i det offentlige rum og muliggjort hurtig defibrillering før ambulance ankomst. Sådanne strategier betegnes ’defibrillering med offentlig adgang’ (public access defibrillation (PAD)). Megen forskning har fokuseret på placering af og overlevelse med brug af AED i udvalgte områder, hvorimod der er meget begrænset viden om hvor udbredt AED’er bør være i det offentlige rum. Tilsvarende er der begrænset viden om hvor AED’er strategisk bør opsættes uden for hospital, når forekomst af hjertestop i området er ukendt. I denne afhandling fokuseres på analyser af hjertestop i boligområder og offentligt rum og har følgende formål: 1) At undersøge hvordan forskellige AED placeringsstrategier påvirker PAD i boligområder og det offentligt rum; 2) at estimere risikoen for hjertestop afhængig af et områdes geografiske- og demografiske karakteristika, hvilket kan tjene som rettesnor for hvor AED bør placeres strategisk udenfor hospital; 3) at undersøge om der er forskelle i patientkarakteristika afhængigt af hvor hjertestoppet forekommer (boligområde versus offentligt rum); 4) at estimere omkostnings-effektiviteten for PAD programmer i boligområder og det offentligt rum afhængigt af valgte AED placeringsstrategi. METODE OG RESULTATER I perioden 1994-2005 blev alle personer med hjertestop udenfor hospital registreret af Akutlægebilen i København. Det Europæiske Kvadratnet, et defineret og harmoniseret kvadratnet for hele Europa med standardiseret størrelse og lokalisering af alle kvadratnetceller, blev benyttet til optælling af hjertestop forekommet i hver enkelt 100x100-meter celle i København. Antallet af hjertestop i hver enkelt celle blev analyseret i forhold til cellens underliggende geografiske og demografiske karakteristika. I alt blev 4828 hjertestop inkluderet i studieperioden; 3554 (74%) forekom i boligområder og 1274 (26%) i offentligt rum. Hvis anbefalingerne for AED placering fra det Europæiske Råd for Genoplivning fulgtes (1 hjertestop hvert 2. år), ville dette kræve AED opsætning svarende til 1% af det samlede areal for København og medføre dækning af 20% af alle hjertestop i offentligt rum. En større dækningsgrad kunne opnås ved at følge anbefalingerne fra den Amerikanske Hjerteforening (1 hjertestop hvert 5. år). Dette ville kræve AED opsætning svarende til 10% af Københavns areal og medføre dækning af næsten 70% af samtlige hjertestop i offentligt rum. Endvidere påvistes en paradoksal AED placering i offentligt rum, hvor hovedparten af opsatte AED’er skete i områder med lav hjertestop forekomst. Baseret på simple, demografiske karakteristika for beboede områder (befolkningstæthed, gennemsnitsalder, gennemsnitlig indkomst og andelen med kort uddannelse) var det muligt at identificere områder med høj forekomst af hjertestop. Disse områder udgjorde mindre end 3% af alle boligområder men inkluderede op mod 9% af alle hjertestop i boligområder. Personer med hjertestop i boligområder havde imidlertid øget forekomst af karakteristika forbundet med dårlig prognose, herunder højere alder, mandligt køn, oftere hjertestop om natten, længere responstid for ambulance og mindre sandsynlighed for at have stødbar hjerterytme sammenlignet med hjertestop i offentligt rum. KONKLUSION Denne afhandling viser, at en stor andel af hjertestop i offentligt rum kan dækkes ved strategisk opsætning af AED’er indenfor et begrænset geografisk område. Såfremt AED opsætning styres af tilfældige lokale eller politiske initiativer, fandtes en stor risiko for paradoksal AED placering, hvor opsætning primært forekom i områder med lav hjertestop forekomst. Ved at benytte simple, demografiske karakteristika for beboede områder i København, var det muligt at identificere boligområder med høj forekomst af hjertestop. Hj

Folke, Fredrik

2010-01-01

31

Serum Potassium Changes During Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest-Should It Be Treated?  

DEFF Research Database (Denmark)

Background: Therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) is associated with adverse events, for example hypokalemia and arrhythmias. In the present study, we report the impact of serum potassium changes related to the rate of cardiac arrhythmias, and the advantages and disadvantages of potassium supplementation are discussed. Methods: Fifty-four consecutive patients suffering from OHCA and treated with TH (32-34°C) for 24 hours at one University Hospital were included and followed for 48 hours. Results: Serum potassium levels decreased during cooling from a median admission value of 4.0?mmol/L (quartiles 3.6-4.5?mmol/L) to a nadir of 3.6?mmol/L (3.5-3.9?mmol/L) 6 hours after target temperature (p=0.005), and 76% reached values of 5.5?mmol/L. Potassium supplementation was initiated at 3.5?mmol/L (quartiles 3.2-3.6?mmol/L) and stopped at 4.5?mmol/L (4.1-4.8?mmol/L). A total of 11% of patients experienced ventricular fibrillation (VF) or ventricular tachycardia (VT). Potassium levels in patients experiencing VF or VT were lower, though not significantly (p=0.119) compared to the rest of the patients. Conclusion: Serum potassium decreases significantly during the induction of TH (p=0.005). Potassium levels were not found to be different in patients with and without VF/VT in this study, perhaps due to the low number of patients, as a difference has been seen in other studies. It is recommended that an infusion of supplementary potassium be initiated during the early cooling phase in order to avoid severe hypokalemia (serum potassium 5.5?mmol/L), as serum potassium increases during rewarming.

Kirkegaard, Hans

2012-01-01

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Targeting out-of-hospital cardiac arrest: the effect of heparin administered during cardiopulmonary resuscitation (T-ARREST  

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Full Text Available Introduction. Heparin administration during cardiopulmonary resuscitation (CPR may prevent activation of coagulation after successful resuscitation for out-of-hospital cardiac arrest (OHCA. We hypothesize that such an approach is not associated with an increased rate of bleeding, but it has not been evaluated. We performed a pilot randomized clinical study assessing the safety of intra-arrest heparin administration in OHCA patients with suspected acute myocardial infarction (AMI and its impact on their prognosis. Materials and Methods. OHCA patients were randomized during CPR to 10 000 units of intra-arrest intravenous heparin (Group H or to treatment without heparin (Group C. The occurrence of major bleeding and the presence of a favourable neurological result 3 months after OHCA, were analyzed. Results. Out of 88 randomized patients, AMI was subsequently confirmed in 63 of them (71.6 %. There were 30 patients in group H and 33 in group C. No major bleeding event was observed in either group. Return of spontaneous circulation (ROSC, Group H: 40.0%, Group C: 45.4%, p=0.662 and a good neurological result 3 months after OHCA (Group H: 6.7 %, Group C: 9.1 %, p=0.921 did not differ between groups. Conclusions. Intravenous administration of 10 000 units of heparin during CPR for OHCA in patients with supposed AMI was safe. We did not find any improvement in prognosis for our sample of limited size. Though the procedure proved safe, we recommend postponing the administration of heparin until ROSC, assessment of clinical state and recording of a twelve-lead ECG.

JIRÍ KNOR

2011-10-01

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Acute coronary angiography in patients resuscitated from out-of-hospital cardiac arrest-A systematic review and meta-analysis  

DEFF Research Database (Denmark)

INTRODUCTION: Out-of-hospital cardiac arrest has a poor prognosis. The main aetiology is ischaemic heart disease. AIM: To make a systematic review addressing the question: "In patients with return of spontaneous circulation following out-of-hospital cardiac arrest, does acute coronary angiography with coronary intervention improve survival compared to conventional treatment?" METHODS: Peer reviewed articles written in English with relevant prognostic data were included. Comparison studies on patients with and without acute coronary angiography were pooled in a meta-analysis. RESULTS: Thirty-two non-randomised studies were included of which 22 were case-series without patients with conservative treatment. Seven studies with specific efforts to control confounding had statistical evidence to support the use of acute coronary angiography following resuscitation from out-of-hospital cardiac arrest. The remaining 25 studies were considered neutral. Following acute coronary angiography, the survival to hospital discharge, 30 days or six months ranged from 23% to 86%. In patients without an obvious non-cardiac aetiology, the prevalence of significant coronary artery disease ranged from 59% to 71%. Electrocardiographic findings were unreliable for identifying angiographic findings of acute coronary syndrome. Ten comparison studies demonstrated a pooled unadjusted odds ratio for survival of 2.78 (1.89; 4.10) favouring acute coronary angiography. CONCLUSION: No randomised studies exist on acute coronary angiography following out-of-hospital cardiac arrest. An increasing number of observational studies support feasibility and a possible survival benefit of an early invasive approach. In patients without an obvious non-cardiac aetiology, acute coronary angiography should be strongly considered irrespective of electrocardiographic findings due to a high prevalence of coronary artery disease.

Moesgaard, Jacob; Ravkilde, Jan

2012-01-01

34

Successful use of therapeutic hypothermia in an opiate induced out-of-hospital cardiac arrest complicated by severe hypoglycaemia and amphetamine intoxication: a case report  

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Full Text Available Abstract The survival to discharge rate after unwitnessed, non-cardiac out-of-hospital cardiac arrest (OHCA is dismal. We report the successful use of therapeutic hypothermia in a 26-year old woman with OHCA due to intentional poisoning with heroin, amphetamine and insulin. The cardiac arrest was not witnessed, no bystander CPR was initiated, the time interval from the call to ambulance arrival was 9 minutes and the initial cardiac rhythm was asystole. Eight minutes of advanced cardiac life support resulted in ROSC. Upon hospital admission, the patient's pupils were dilated. Her arterial lactate was 17 mmol/l, base excess -20, pH 6.9 and serum glucose 0.2 mmol/l. During the first 24 hours in the ICU, the patient developed maximally dilated pupils not reacting to light and became increasingly haemodynamically unstable, requiring both inotropic support and massive fluid resuscitation. After 1 week in the ICU, however, she made an uneventful recovery with a Cerebral Performance Category of 1 at hospital discharge and at a follow up examination at 6 months. Conclusion According to most prognostic factors, the patient had a statistical chance for survival of less than 1%, not taking into account her severe state of hypoglyaemia. We suggest that this case exemplifies the need for more studies on the use of TH in non-coronary causes of OHCA.

Søreide Eldar

2010-01-01

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Risk factors among people surviving out-of-hospital cardiac arrest and their thoughts about what lifestyle means to them : a mixed methods study  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background: The known risk factors for coronary heart disease among people prior suffering an out-of-hospital cardiac arrest with validated myocardial infarction aetiology and their thoughts about what lifestyle means to them after surviving have rarely been described. Therefore the aim of the study was to describe risk factors and lifestyle among survivors. Methods: An explanatory mixed methods design was used. All people registered in the Northern Sweden MONICA myocardial registry between t...

Forslund, Ann-sofie; Lundblad, Dan; Jansson, Jan-ha?kan; Zingmark, Karin; So?derberg, Siv

2013-01-01

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Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest is hampered by interruptions in chest compressions-A nationwide prospective feasibility study  

DEFF Research Database (Denmark)

AIM OF THE STUDY: Quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome following out-of-hospital cardiac arrest. The aim of our study was to evaluate the quality of CPR provided by emergency medical service providers (Basic Life Support (BLS) capability) and emergency medical service providers assisted by paramedics, nurse anesthetists or physician-manned ambulances (Advanced Life Support (ALS) capability) in a nationwide, unselected cohort of out-of-hospital cardiac arrest cases. METHODS: We conducted a prospective, observational study of out-of-hospital cardiac arrest with non-traumatic etiology (>18 years of age) occurring from the 1st to the 31st of January 2009 and treated by the primary Danish emergency medical service operator, covering approximately 85% of the population. One hundred and ninety-one cases were eligible for analysis. Follow-up was up to one year or death. Quality of CPR was evaluated using measurements of transthoracic impedance. RESULTS: The majority of patients were treated by ambulances with ALS capability (54%). Interruptions in CPR related to loading of the patient into the emergency medical service vehicle were substantial, but independent of whether patients were managed by ALS or BLS capable units (222s versus 224s, P=0.76) as were duration of interruptions during rhythm analysis alone (20s versus 22s, P=0.33) and defibrillation (24s versus 26s, P=0.07). CONCLUSIONS: Nationwide, routine monitoring of transthoracic impedance is feasible. CPR is hampered by extended interruptions, particularly during loading of the patient into the emergency medical service vehicle, rhythm analysis and defibrillation.

Krarup, Niels Henrik; Terkelsen, Christian Juhl

2010-01-01

37

No fate but what we make: a case of full recovery after out-of-hospital cardiac arrest  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract An 80 years old man suffered a cardiac arrest shortly after arrival to his local health department. Basic Life Support was started promptly and nine minutes later, on evaluation by an Advanced Life Support team, the victim was defibrillated with a 200J shock. When orotracheal intubation was attempted, masseter muscle contraction was noticed: on revaluation, the victim had pulse and spontaneous breathing. Thirty minutes later, the patient had been transferred to an emergency department. As he complained of chest pain, the ECG showed a ST segment depression in leads V4 to V6 and laboratorial tests showed cardiac troponine I slightly elevated. A coronary angiography was performed urgently: significant left main plus three vessel coronary artery disease was disclosed. Eighteen hours after the cardiac arrest, a quadruple coronary artery bypass grafting operation was undertaken. During surgery, a fresh thrombus was removed from the middle left anterior descendent artery. Post-operative course was uneventful and the patient was discharged seven days after the procedure. Twenty four months later, he remains asymptomatic. In this case, the immediate call for the Advanced Life Support team, prompt basic life support and the successful defibrillation, altogether, contributed for the full recovery. Furthermore, the swiftness in the detection and treatment of the acute reversible cause (myocardial ischemia in this case was crucial for long-term prognosis.

Andrade Maria J

2009-12-01

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Treatment of out-of-hospital cardiac arrest with a low-energy impedance-compensating biphasic waveform automatic external defibrillator. The LIFE Investigators.  

Science.gov (United States)

Few victims of sudden cardiac arrest survive. A new generation of automatic external defibrillators (AEDs), smaller, lighter, easier to use, and less costly, makes the goal of widespread AED deployment and early defibrillation feasible. A low-energy impedance-compensating biphasic waveform allows AED device characteristics more suitable to the goal of early defibrillation than high-energy waveforms. This study observed the performance of such a biphasic waveform in the out-of-hospital setting on 100 consecutive victims of sudden cardiac arrest treated by a wide range of first-responders. AEDs incorporating 150-J impedance-compensating biphasic waveforms were placed into service of 34 EMS systems. Data were obtained from the AED PC data card-recording system. The first endpoint was to determine the effectiveness of this waveform in terminating ventricular fibrillation (VF). The second endpoint was to determine whether or not the use of such an AED culminated in an organized rhythm at the time of patient transfer to an advanced life support (ALS) team or emergency department (ED). The third endpoint was to assess the efficiency of the human-factors design of the AED by measuring user time intervals. The 34 sites provided data from 286 consecutive AED uses, 100 from SCA victims with VF as their initial rhythm upon attachment of the AED. All 286 patients were correctly identified by the AED as requiring a shock (100% sensitivity for the 100 VF patients) or not (100% specificity to the 186 patients not presenting in VF). Times from emergency call to first shock delivery averaged 9.1 +/- 7.3 minutes. A single 150-J biphasic shock defibrillated the initial VF episode in 86% of patients. For all 450 episodes of VF in these 100 patients, an average of 86% +/- 24% of VF episodes were terminated with a single biphasic shock. Of the 449 VF episodes that received up to three shocks, 97% +/- 11% were terminated with three shocks or fewer. The average number of shocks per VF episode was 1.3 +/- 0.7. The average time from AED power-on and pads attached to first defibrillation was 25 +/- 23 sec. At the time of patient transfer, an organized rhythm was present in 65% of the VF patients; asystole was the result in 25%, and VF was in progress in 10%. It is concluded that low-energy impedance-compensating biphasic waveforms terminate long-duration VF at high rates in out-of-hospital cardiac arrest and provide defibrillation rates exceeding those previously achieved with high-energy shocks. Use of this waveform allows AED device characteristics consistent with widespread AED deployment and early defibrillation. PMID:9883348

Gliner, B E; Jorgenson, D B; Poole, J E; White, R D; Kanz, K G; Lyster, T D; Leyde, K W; Powers, D J; Morgan, C B; Kronmal, R A; Bardy, G H

1998-01-01

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A pilot study of angiotensin converting enzyme (ACE) genotype and return of spontaneous circulation following out-of-hospital cardiac arrest  

Science.gov (United States)

Objective In the last few years the genetic influence on health and disease outcome has become more apparent. The ACE genotype appears to play a significant role in the pathophysiology of several disease processes. This pilot study aims at showing the feasibility to examine the genetic influence of the ACE genotype on return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA). Methods We performed a prospective observational study of all OHCAs of presumed cardiac origin in a well-defined population. We collected prehospital blood samples for the determination of ACE genotype and used this information together with Utstein template parameters in a multivariable analysis to examine the relationship between ROSC and ACE genotype. Results We collect blood samples in 156 of 361 patients with OHCA of presumed cardiac origin, 127 samples were analysed (mean age 67?years, 86% male, 79% witnessed OHCA, 80% bystander CPR, 62% had a shockable rhythm, ROSC 77%). Distribution of the ACE gene polymorphisms: insertion polymorphism (II) n=22, 17%, insertion/deletion polymorphism (ID) n=66, 52% and deletion polymorphism (DD) n=39, 31%. We found no significant association between ACE II vs ACE DD/DI and ROSC (OR 1.72; CI 0.52 to 5.73; p=0.38). Other ACE genotype groupings (II/ID vs DD or II vs DD) did not change the overall finding of lack of impact of ACE genotype on ROSC. Conclusions This pilot study did not indicate a significant association between ACE gene polymorphism and ROSC. However, it has demonstrated that prehospital genetic studies including blood sampling are feasible and ethically acceptable.

Lindner, Thomas W; Deakin, Charles D; Aarset?y, Hildegunn; Rubertsson, Sten; Heltne, Jon-Kenneth; S?reide, Eldar

2014-01-01

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Genetic, clinical and pharmacological determinants of out-of-hospital cardiac arrest: rationale and outline of the AmsteRdam Resuscitation Studies (ARREST) registry  

Science.gov (United States)

Introduction Out-of-hospital cardiac arrest (OHCA) is a major public health problem. Recognising the complexity of the underlying causes of OHCA in the community, we aimed to establish the clinical, pharmacological, environmental and genetic factors and their interactions that may cause OHCA. Methods and analysis We set up a large-scale prospective community-based registry (AmsteRdam Resuscitation Studies, ARREST) in which we prospectively include all resuscitation attempts from OHCA in a large study region in the Netherlands in collaboration with Emergency Medical Services. Of all OHCA victims since June 2005, we prospectively collect medical history (through hospital and general practitioner), and current and previous medication use (through community pharmacy). In addition, we include DNA samples from OHCA victims with documented ventricular tachycardia/fibrillation during the resuscitation attempt since July 2007. Various study designs are employed to analyse the data of the ARREST registry, including case–control, cohort, case only and case-cross over designs. Ethics and dissemination We describe the rationale, outline and potential results of the ARREST registry. The design allows for a stable and reliable collection of multiple determinants of OHCA, while assuring that the patient, lay-caregiver or medical professional is not hindered in any way. Such comprehensive data collection is required to unravel the complex basis of OHCA. Results will be published in peer-reviewed journals and presented at relevant scientific symposia.

Blom, M T; van Hoeijen, D A; Bardai, A; Berdowski, J; Souverein, P C; De Bruin, M L; Koster, R W; de Boer, A; Tan, H L

2014-01-01

 
 
 
 
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Treatment and outcomes of ST segment elevation myocardial infarction and out-of-hospital cardiac arrest in a regionalized system of care based on presence or absence of initial shockable cardiac arrest rhythm.  

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The aim of this study was to evaluate the treatment and outcomes of patients with ST-segment elevation myocardial infarctions complicated by out-of-hospital cardiac arrest in a regional system of care. In this retrospective study, the effect of the absence of an initial shockable arrest rhythm was analyzed. The primary end point of survival with good neurologic outcome in patients with and without an initial shockable arrest rhythm was adjusted for age, witnessed arrest, bystander cardiopulmonary resuscitation, and treatment with therapeutic hypothermia and percutaneous coronary intervention. One-hundred sixty-eight of 348 patients (49%) survived to hospital discharge. Patients with a shockable initial rhythm were more likely to receive therapeutic hypothermia (48% vs 37%, risk ratio 1.2, 95% confidence interval [CI] 1.0 to 1.5) and to be treated in the cardiac catheterization laboratory (80% vs 43%, risk ratio 2.8, 95% CI 2.0 to 3.8). The likelihood of survival with good neurologic outcome in patients with a shockable initial rhythm compared with those presenting without a shockable rhythm was 4.8 (95% CI 2.7 to 8.7). In patients who underwent percutaneous coronary intervention, the likelihood of survival with good neurologic outcome was higher (risk ratio 2.7, 95% CI 1.1 to 6.8) in those with a shockable rhythm. In conclusion, the absence of an initial shockable rhythm in patients with ST-segment elevation myocardial infarctions plus out-of-hospital cardiac arrest is associated with significantly worse survival and neurologic outcome. These differences persist despite application of therapies including therapeutic hypothermia and percutaneous coronary intervention within a regionalized system of care. PMID:25118120

Thomas, Joseph L; Bosson, Nichole; Kaji, Amy H; Ji, Yong; Sung, Gene; Shavelle, David M; French, William J; Koenig, William; Niemann, James T

2014-10-01

42

Combination of veno-arterial extracorporeal membrane oxygenation and hypothermia for out-of-hospital cardiac arrest due to Taxus intoxication.  

Science.gov (United States)

ABSTRACTA young woman presented with cardiac arrest following ingestion of yew tree leaves of the Taxus baccata species. The toxin in yew tree leaves has negative inotropic and dromotropic effects. The patient had a cardiac rhythm that alternated between pulseless electrical activity with a prolonged QRS interval and ventricular fibrillation. When standard resuscitation therapy including digoxin immune Fab was ineffective, a combination of extracorporeal membrane oxygenation (ECMO) and hypothermia was initiated. The total duration of low flow/no flow was 82 minutes prior to the initiation of ECMO. After 36 hours of ECMO (including 12 hours of electrical asystole), the patient's electrocardiogram had normalized and the left ventricular ejection fraction was 50%. At this time, dobutamine and the ECMO were stopped. The patient had a full neurologic recovery and was discharged from the intensive care unit after 5 days and from the hospital 1 week later. PMID:25358285

Thooft, Aurélie; Goubella, Ahmed; Fagnoul, David; Taccone, Fabio S; Brimioulle, Serge; Vincent, Jean-Louis; De Backer, Daniel

2014-11-01

43

Nurses’ attitude in out-of-hospital cardiopulmonary resuscitation  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Sudden cardiac arrest is one of the leading causes of death in Europe. Bystanders’ early Cardio-Pulmonary Resuscitation (CPR) may double or triple survival rates of out-of-hospital cardiac arrest victims.Aim: To investigate nurses’ attitude, in starting or not CPR and also the most frequent reasons that deter them from engaging in.Materials and Methods: The study had a sample of 177 nurses and assistant nurses that were working in nine hospitals of Athens. Nurses filled out the same, pred...

Maria Meidani; Maria Polikandrioti; Virginia Karamali; Theodore Kapadohos

2008-01-01

44

The Study Protocol for the LINC (LUCAS in Cardiac Arrest Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The LUCAS™ device delivers mechanical chest compressions that have been shown in experimental studies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end tidal CO2, compared with results from standard manual cardiopulmonary resuscitation (CPR. Two randomised pilot studies in out-of-hospital cardiac arrest patients have not shown improved outcome when compared with manual CPR. There remains evidence from small case series that the device can be potentially beneficial compared with manual chest compressions in specific situations. This multicentre study is designed to evaluate the efficacy and safety of mechanical chest compressions with the LUCAS™ device whilst allowing defibrillation during on-going CPR, and comparing the results with those of conventional resuscitation. Methods/design This article describes the design and protocol of the LINC-study which is a randomised controlled multicentre study of 2500 out-of-hospital cardiac arrest patients. The study has been registered at ClinicalTrials.gov (http://clinicaltrials.gov/ct2/show/NCT00609778?term=LINC&rank=1. Results Primary endpoint is four-hour survival after successful restoration of spontaneous circulation. The safety aspect is being evaluated by post mortem examinations in 300 patients that may reflect injuries from CPR. Conclusion This large multicentre study will contribute to the evaluation of mechanical chest compression in CPR and specifically to the efficacy and safety of the LUCAS™ device when used in association with defibrillation during on-going CPR.

Rubertsson Sten

2013-01-01

45

Reporting of data from out-of-hospital cardiac arrest has to involve emergency medical dispatching--taking the recommendations on reporting OHCA the Utstein style a step further  

DEFF Research Database (Denmark)

OBJECTIVES: As a part of the chain of survival, the emergency medical communication centre (EMCC) and the emergency medical dispatcher (EMD) has an important role in early identification of out-of-hospital cardiac arrests (OHCA). The EMD may provide instructions to the caller and thereby initiate cardiopulmonary resuscitation in a substantial number of subjects and thus contribute to increased survival. The EMCC provides a response with first responders, ambulances, physician manned units and potentially other health care providers. EMCC in many cases initiates the communication with experts in the referral hospital and provide added value to the post resuscitation care by providing advanced transport, logistics and follow up. In research there is a growing focus on the EMCC/EMDs impact on survival in OHCA. The lack of standards in reporting results from medical dispatching is an obstacle for thorough evaluation of results in this area and comparison of data. The objective for this paper is to introduce a framework for uniform reporting of the dispatching process for quality improvement, collecting and reporting data and exchanging information regarding OHCA.

Castrén, M; Bohm, K

2011-01-01

46

Invasive coronary treatment strategies for out-of-hospital cardiac arrest: a consensus statement from the European Association for Percutaneous Cardiovascular Interventions (EAPCI)/Stent for Life (SFL) groups.  

Science.gov (United States)

Due to significant improvement in the pre-hospital treatment of patients with out-of-hospital cardiac arrest (OHCA), an increasing number of initially resuscitated patients are being admitted to hospitals. Because of the limited data available and lack of clear guideline recommendations, experts from the EAPCI and "Stent for Life" (SFL) groups reviewed existing literature and provided practical guidelines on selection of patients for immediate coronary angiography (CAG), PCI strategy, concomitant antiplatelet/anticoagulation treatment, haemodynamic support and use of therapeutic hypothermia. Conscious survivors of OHCA with suspected acute coronary syndrome (ACS) should be treated according to recommendations for ST-segment elevation myocardial infarction (STEMI) and high-risk non-ST-segment elevation -ACS (NSTE-ACS) without OHCA and should undergo immediate (if STEMI) or rapid (less than two hours if NSTE-ACS) coronary invasive strategy. Comatose survivors of OHCA with ECG criteria for STEMI on the post-resuscitation ECG should be admitted directly to the catheterisation laboratory. For patients without STEMI ECG criteria, a short "emergency department or intensive care unit stop" is advised to exclude non-coronary causes. In the absence of an obvious non-coronary cause, CAG should be performed as soon as possible (less than two hours), in particular in haemodynamically unstable patients. Immediate PCI should be mainly directed towards the culprit lesion if identified. Interventional cardiologists should become an essential part of the "survival chain" for patients with OHCA. There is a need to centralise the care of patients with OHCA to experienced centres. PMID:24832635

Noc, Marko; Fajadet, Jean; Lassen, Jens F; Kala, Petr; MacCarthy, Philip; Olivecrona, Goran K; Windecker, Stephan; Spaulding, Christian

2014-05-01

47

Invasive coronary treatment strategies for out-of-hospital cardiac arrest : a consensus statement from the European Association for Percutaneous Cardiovascular Interventions (EAPCI)/Stent for Life (SFL) groups  

DEFF Research Database (Denmark)

Due to significant improvement in the pre-hospital treatment of patients with out-of-hospital cardiac arrest (OHCA), an increasing number of initially resuscitated patients are being admitted to hospitals. Because of the limited data available and lack of clear guideline recommendations, experts from the EAPCI and "Stent for Life" (SFL) groups reviewed existing literature and provided practical guidelines on selection of patients for immediate coronary angiography (CAG), PCI strategy, concomitant antiplatelet/anticoagulation treatment, haemodynamic support and use of therapeutic hypothermia. Conscious survivors of OHCA with suspected acute coronary syndrome (ACS) should be treated according to recommendations for ST-segment elevation myocardial infarction (STEMI) and high-risk non-ST-segment elevation -ACS (NSTE-ACS) without OHCA and should undergo immediate (if STEMI) or rapid (less than two hours if NSTE-ACS) coronary invasive strategy. Comatose survivors of OHCA with ECG criteria for STEMI on the post-resuscitation ECG should be admitted directly to the catheterisation laboratory. For patients without STEMI ECG criteria, a short "emergency department or intensive care unit stop" is advised to exclude non-coronary causes. In the absence of an obvious non-coronary cause, CAG should be performed as soon as possible (less than two hours), in particular in haemodynamically unstable patients. Immediate PCI should be mainly directed towards the culprit lesion if identified. Interventional cardiologists should become an essential part of the "survival chain" for patients with OHCA. There is a need to centralise the care of patients with OHCA to experienced centres.

Noc, Marko; Fajadet, Jean

2014-01-01

48

Ins and outs of cardiac voltage-gated potassium channels.  

Science.gov (United States)

Voltage-gated potassium (Kv) channels play an important role in regulating cardiac muscle excitability by controlling action potential duration and frequency. Essential for this activity is proper localization and organization of the cardiac Kv channels in specific microdomains of the plasma membrane. The underlying processes involve tight control of anterograde and retrograde Kv channel trafficking into and out of the plasma membrane. Thus, cardiac Kv channel density at the cell surface is regulated by a dynamic interplay of endocytotic and recycling pathways, the mechanisms of which are mostly unknown. Recent studies have indicated that the lipid composition in the Kv channel surround profoundly influences these processes. Local differences in lipid composition altering the mechanic state of the lipid bilayer or a specific interaction with an important domain of the Kv channel markedly affect voltage-sensitive gating, clustering, and mobility of cardiac Kv channels and, thereby, the excitability in the healthy and diseased heart muscles. PMID:19394895

Pongs, Olaf

2009-06-01

49

Payment of hospital cardiac services.  

Science.gov (United States)

This report describes how acute-care community hospitals in the United States get paid for services when their patients either are entitled to Medicare or Medicaid benefits or subscribe to a Blue Cross or Blue Shield plan, a commercial insurance plan, a health maintenance organization, a preferred provider organization, or some other third-party payment mechanism. The focus of this report is on cardiac services, which are the most common type of inpatient services provided by acute-care community hospitals. Over the past three decades, extraordinary advances in medical and surgical technologies as well as healthier life-styles have cut the annual death rate for coronary heart disease in half. Despite this progress, cardiovascular disease remains the number one cause of hospitalization. On average nationwide, diseases and disorders of the circulatory system are the primary reason for 17 percent of all patient admissions, and among the nation's 35 million Medicare beneficiaries they are the primary reason for 25 percent of all admissions. In the United States heart disease is the leading cause of death and a major cause of morbidity. Its diagnosis and treatment are often complex and costly, often requiring multiple hospitalizations and years of medical management. To focus management attention and resources on the immense cardiology marketplace, many hospitals have hired individuals with strong clinical backgrounds to manage their cardiology programs. These "front-line" managers play a key role in coordinating a hospital's services for patients with cardiovascular disease. Increasingly, these managers are being asked to become active participants in the reimbursement process. This report was designed to meet their needs. Because this report describes common reimbursement principles and practices applicable to all areas of hospital management and because it provides a "tool kit" of analytical, planning, and forecasting techniques, it could also be useful to hospital marketing, planning, finance, and accounting personnel. In addition, the rich reservoir of data contained in the appendixes to this report may be of interest to hospital chief executive officers, cardiologists, and cardiovascular surgeons. In addition to the introduction and summary sections, this report contains five main sections. Sequentially, these deal with: the ways hospitals get paid for what they do; ICD-9 coding DRGs, PPS, and Medicare claims administration; ways to analyze how well your hospital is doing; planning and forecasting; the new Resource-Based Relative Value Scale.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:10115896

Unger, W J

1991-01-01

50

Nurses’ attitude in out-of-hospital cardiopulmonary resuscitation  

Directory of Open Access Journals (Sweden)

Full Text Available Sudden cardiac arrest is one of the leading causes of death in Europe. Bystanders’ early Cardio-Pulmonary Resuscitation (CPR may double or triple survival rates of out-of-hospital cardiac arrest victims.Aim: To investigate nurses’ attitude, in starting or not CPR and also the most frequent reasons that deter them from engaging in.Materials and Methods: The study had a sample of 177 nurses and assistant nurses that were working in nine hospitals of Athens. Nurses filled out the same, predetermined questionnaire, voluntarily and anonymously. The collected answers were analyzed with the help of the statistical program SPSS v.16, using x2 and Kendall’s Tau-B methods.Results: From 177 participants, 78% (137 were women and 22% (40 men with mean age 31 years (±7. According to their education, 16% (28 were Assistant Nurses, 79% (140 Registered Nurses (ATEI, AEI and 5% (9 Nurses had an MSc diploma. Nurses that had been recently trained in certified BLS courses felt more confident and were more willing to start CPR in a known victim (p=0.004 and in an unknown victim (p=0.02 comparing to nurses that had been trained a long time ago or never. Most frequent reasons nurses reported that deter them from starting CPR are the fear of a possible lawsuit (43%, the fear of harming instead of helping (30% and the fear of infectious transmission from victim to rescuer (15%. The fear of harming correlates considerably with lower ages (the younger the nurse the more is afraid, p=0.04 and also correlates substantially with the training in a certified CPR course (the more a nurse is trained, the less is afraid, p<0.001. Accordingly, the fear of infection diminishes as long as the CPR training is repeated (p=0.03.Conclusions: According to the results, there is a necessity of continuous education and re-education of nurses, in certified Basic Life Support programs. With frequent and specialized training, nurses will show more willingness to engage in an out-of-hospital arrest situation, in a familiar or unknown victim and, moreover, fears that deter them from starting CPR are remarkably reduced.

Maria Meidani

2008-10-01

51

Análisis de la inclusión de la policía en la respuesta de emergencias al paro cardiorrespiratorio extrahospitalario Analysis of the inclussion of police personnel on the out of hospital cardiac arrest emergency response  

Directory of Open Access Journals (Sweden)

Full Text Available OBJETIVO: El presente estudio busca analizar una alternativa al pronóstico de paro cardiorrespiratorio extrahospitalario (PCE como problema de salud pública al involucrar a los cuerpos policiacos en la respuesta de emergencias. MATERIAL Y MÉTODOS: Se analizó retrospectivamente un registro de PCE iniciado en junio de 2009. Se contrastó un modelo basado en un número limitado de ambulancias con primera respuesta por la policía. RESULTADOS: La mortalidad fue de 100%, tiempos de respuesta elevados y 10.8% recibió reanimación cardiopulmonar (RCP por testigos presenciales. En 63.7% de los eventos la policía llegaba antes que la ambulancia y en 1.5% el policía dio RCP. El costo por vida salvada fue 5.8-60 millones de pesos en un modelo sólo con ambulancias vs. 0.5-5.5 millones de pesos en un modelo con primera respuesta policiaca. CONCLUSIONES: La intervención de la policía en la ciudad de Querétaro facilitaría la disminución de la mortalidad por PCE a un menor costo.OBJETIVE: Out-of-hospital cardiac arrest (OCHA is a public health problem in which survival depends on community initial response among others. This study tries to analyze what's the proportional cost of enhancing such response by involving the police corps in it. MATERIALS AND METHODS: We analyzed retrospectively an OCHA registry started on June 2009. We contrasted a model with limited number of ambulances and police based first response. RESULTS: Mortality was 100%, response times high and 10.8% of the victims were receiving cardiopulmonary resuscitation (CPR by bystanders. In 63.7% of the events the police arrived before the ambulance, in 1.5% of these cases the police provided CPR. The cost for each saved life was of 5.8-60 million Mexican pesos per life with only ambulance model vs 0.5-5.5 million Mexican pesos on a police first response model with 12 ambulances. CONCLUSIONS: In Queretaro interventions can be performed taking advantage of the response capacity of the existing police focused on diminishing mortality from OCHA at a lesser cost than delegating this function only to ambulances.

Andrea Aguilera-Campos

2012-02-01

52

Análisis de la inclusión de la policía en la respuesta de emergencias al paro cardiorrespiratorio extrahospitalario / Analysis of the inclussion of police personnel on the out of hospital cardiac arrest emergency response  

Scientific Electronic Library Online (English)

Full Text Available SciELO Mexico | Language: Spanish Abstract in spanish OBJETIVO: El presente estudio busca analizar una alternativa al pronóstico de paro cardiorrespiratorio extrahospitalario (PCE) como problema de salud pública al involucrar a los cuerpos policiacos en la respuesta de emergencias. MATERIAL Y MÉTODOS: Se analizó retrospectivamente un registro de PCE in [...] iciado en junio de 2009. Se contrastó un modelo basado en un número limitado de ambulancias con primera respuesta por la policía. RESULTADOS: La mortalidad fue de 100%, tiempos de respuesta elevados y 10.8% recibió reanimación cardiopulmonar (RCP) por testigos presenciales. En 63.7% de los eventos la policía llegaba antes que la ambulancia y en 1.5% el policía dio RCP. El costo por vida salvada fue 5.8-60 millones de pesos en un modelo sólo con ambulancias vs. 0.5-5.5 millones de pesos en un modelo con primera respuesta policiaca. CONCLUSIONES: La intervención de la policía en la ciudad de Querétaro facilitaría la disminución de la mortalidad por PCE a un menor costo. Abstract in english OBJETIVE: Out-of-hospital cardiac arrest (OCHA) is a public health problem in which survival depends on community initial response among others. This study tries to analyze what's the proportional cost of enhancing such response by involving the police corps in it. MATERIALS AND METHODS: We analyzed [...] retrospectively an OCHA registry started on June 2009. We contrasted a model with limited number of ambulances and police based first response. RESULTS: Mortality was 100%, response times high and 10.8% of the victims were receiving cardiopulmonary resuscitation (CPR) by bystanders. In 63.7% of the events the police arrived before the ambulance, in 1.5% of these cases the police provided CPR. The cost for each saved life was of 5.8-60 million Mexican pesos per life with only ambulance model vs 0.5-5.5 million Mexican pesos on a police first response model with 12 ambulances. CONCLUSIONS: In Queretaro interventions can be performed taking advantage of the response capacity of the existing police focused on diminishing mortality from OCHA at a lesser cost than delegating this function only to ambulances.

Andrea, Aguilera-Campos; Enrique, Asensio-Lafuente; Juan Manuel, Fraga-Sastrías.

53

Análisis de la inclusión de la policía en la respuesta de emergencias al paro cardiorrespiratorio extrahospitalario / Analysis of the inclussion of police personnel on the out of hospital cardiac arrest emergency response  

Scientific Electronic Library Online (English)

Full Text Available SciELO Public Health | Language: Spanish Abstract in spanish OBJETIVO: El presente estudio busca analizar una alternativa al pronóstico de paro cardiorrespiratorio extrahospitalario (PCE) como problema de salud pública al involucrar a los cuerpos policiacos en la respuesta de emergencias. MATERIAL Y MÉTODOS: Se analizó retrospectivamente un registro de PCE in [...] iciado en junio de 2009. Se contrastó un modelo basado en un número limitado de ambulancias con primera respuesta por la policía. RESULTADOS: La mortalidad fue de 100%, tiempos de respuesta elevados y 10.8% recibió reanimación cardiopulmonar (RCP) por testigos presenciales. En 63.7% de los eventos la policía llegaba antes que la ambulancia y en 1.5% el policía dio RCP. El costo por vida salvada fue 5.8-60 millones de pesos en un modelo sólo con ambulancias vs. 0.5-5.5 millones de pesos en un modelo con primera respuesta policiaca. CONCLUSIONES: La intervención de la policía en la ciudad de Querétaro facilitaría la disminución de la mortalidad por PCE a un menor costo. Abstract in english OBJETIVE: Out-of-hospital cardiac arrest (OCHA) is a public health problem in which survival depends on community initial response among others. This study tries to analyze what's the proportional cost of enhancing such response by involving the police corps in it. MATERIALS AND METHODS: We analyzed [...] retrospectively an OCHA registry started on June 2009. We contrasted a model with limited number of ambulances and police based first response. RESULTS: Mortality was 100%, response times high and 10.8% of the victims were receiving cardiopulmonary resuscitation (CPR) by bystanders. In 63.7% of the events the police arrived before the ambulance, in 1.5% of these cases the police provided CPR. The cost for each saved life was of 5.8-60 million Mexican pesos per life with only ambulance model vs 0.5-5.5 million Mexican pesos on a police first response model with 12 ambulances. CONCLUSIONS: In Queretaro interventions can be performed taking advantage of the response capacity of the existing police focused on diminishing mortality from OCHA at a lesser cost than delegating this function only to ambulances.

Andrea, Aguilera-Campos; Enrique, Asensio-Lafuente; Juan Manuel, Fraga-Sastrías.

54

Análisis de la inclusión de la policía en la respuesta de emergencias al paro cardiorrespiratorio extrahospitalario / Analysis of the inclussion of police personnel on the out of hospital cardiac arrest emergency response  

Scientific Electronic Library Online (English)

Full Text Available SciELO Mexico | Language: Spanish Abstract in spanish OBJETIVO: El presente estudio busca analizar una alternativa al pronóstico de paro cardiorrespiratorio extrahospitalario (PCE) como problema de salud pública al involucrar a los cuerpos policiacos en la respuesta de emergencias. MATERIAL Y MÉTODOS: Se analizó retrospectivamente un registro de PCE in [...] iciado en junio de 2009. Se contrastó un modelo basado en un número limitado de ambulancias con primera respuesta por la policía. RESULTADOS: La mortalidad fue de 100%, tiempos de respuesta elevados y 10.8% recibió reanimación cardiopulmonar (RCP) por testigos presenciales. En 63.7% de los eventos la policía llegaba antes que la ambulancia y en 1.5% el policía dio RCP. El costo por vida salvada fue 5.8-60 millones de pesos en un modelo sólo con ambulancias vs. 0.5-5.5 millones de pesos en un modelo con primera respuesta policiaca. CONCLUSIONES: La intervención de la policía en la ciudad de Querétaro facilitaría la disminución de la mortalidad por PCE a un menor costo. Abstract in english OBJETIVE: Out-of-hospital cardiac arrest (OCHA) is a public health problem in which survival depends on community initial response among others. This study tries to analyze what's the proportional cost of enhancing such response by involving the police corps in it. MATERIALS AND METHODS: We analyzed [...] retrospectively an OCHA registry started on June 2009. We contrasted a model with limited number of ambulances and police based first response. RESULTS: Mortality was 100%, response times high and 10.8% of the victims were receiving cardiopulmonary resuscitation (CPR) by bystanders. In 63.7% of the events the police arrived before the ambulance, in 1.5% of these cases the police provided CPR. The cost for each saved life was of 5.8-60 million Mexican pesos per life with only ambulance model vs 0.5-5.5 million Mexican pesos on a police first response model with 12 ambulances. CONCLUSIONS: In Queretaro interventions can be performed taking advantage of the response capacity of the existing police focused on diminishing mortality from OCHA at a lesser cost than delegating this function only to ambulances.

Andrea, Aguilera-Campos; Enrique, Asensio-Lafuente; Juan Manuel, Fraga-Sastrías.

2012-02-01

55

Análisis de la inclusión de la policía en la respuesta de emergencias al paro cardiorrespiratorio extrahospitalario / Analysis of the inclussion of police personnel on the out of hospital cardiac arrest emergency response  

Scientific Electronic Library Online (English)

Full Text Available SciELO Public Health | Language: Spanish Abstract in spanish OBJETIVO: El presente estudio busca analizar una alternativa al pronóstico de paro cardiorrespiratorio extrahospitalario (PCE) como problema de salud pública al involucrar a los cuerpos policiacos en la respuesta de emergencias. MATERIAL Y MÉTODOS: Se analizó retrospectivamente un registro de PCE in [...] iciado en junio de 2009. Se contrastó un modelo basado en un número limitado de ambulancias con primera respuesta por la policía. RESULTADOS: La mortalidad fue de 100%, tiempos de respuesta elevados y 10.8% recibió reanimación cardiopulmonar (RCP) por testigos presenciales. En 63.7% de los eventos la policía llegaba antes que la ambulancia y en 1.5% el policía dio RCP. El costo por vida salvada fue 5.8-60 millones de pesos en un modelo sólo con ambulancias vs. 0.5-5.5 millones de pesos en un modelo con primera respuesta policiaca. CONCLUSIONES: La intervención de la policía en la ciudad de Querétaro facilitaría la disminución de la mortalidad por PCE a un menor costo. Abstract in english OBJETIVE: Out-of-hospital cardiac arrest (OCHA) is a public health problem in which survival depends on community initial response among others. This study tries to analyze what's the proportional cost of enhancing such response by involving the police corps in it. MATERIALS AND METHODS: We analyzed [...] retrospectively an OCHA registry started on June 2009. We contrasted a model with limited number of ambulances and police based first response. RESULTS: Mortality was 100%, response times high and 10.8% of the victims were receiving cardiopulmonary resuscitation (CPR) by bystanders. In 63.7% of the events the police arrived before the ambulance, in 1.5% of these cases the police provided CPR. The cost for each saved life was of 5.8-60 million Mexican pesos per life with only ambulance model vs 0.5-5.5 million Mexican pesos on a police first response model with 12 ambulances. CONCLUSIONS: In Queretaro interventions can be performed taking advantage of the response capacity of the existing police focused on diminishing mortality from OCHA at a lesser cost than delegating this function only to ambulances.

Andrea, Aguilera-Campos; Enrique, Asensio-Lafuente; Juan Manuel, Fraga-Sastrías.

2012-02-01

56

[Aortic valve-sparing operation for chronic dissecting aneurysm of the sinus of valsalva associated with redissection in a young woman who experienced out-of-hospital cardiac arrest].  

Science.gov (United States)

A 38-year-old woman was admitted to our hospital because she experienced cardiopulmonary arrest at her wedding;her cardiac beats were resumed 20 min after cardiopulmonary resuscitation performed by her relatives and hotel staffs. Enhanced computed tomography revealed acute aortic redissection in chronic dissecting aneurysm in the right sinus of Valsalva, which was believed to have occurred in the 4th month of pregnancy 2 years before. Echocardiography showed moderate aortic regurgitation. We performed aortic valve-sparing operation and ascending aortic replacement with partial remodeling of the right sinus of Valsalva. She returned to work 2 months later without high-order dysfunction. PMID:23917231

Matsumoto, Mitsuaki; Kubo, Yoji; Kemmochi, Reiko; Yamasawa, Takahiko; Oka, Takefumi; Iwasaki, Jun; Morimoto, Naoki; Hagioka, Shingo; Sugiyama, Junichi; Hagiya, Hideharu

2013-08-01

57

Out-of-hospital treatment in case of drowning  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction. Drowning is a leading preventable cause of unintentional morbidity and mortality. The dominant pathophysiological mechanism of drowning includes the development of acute hypoxia. First aid. The rescue procedure of a drowning person includes careful pulling the victim out of the water, examination, maintenance of the airways passable and urgent transfer to hospital. Basic life support. The first and most important treatment option of a drowning victim is the provision of ventilation which increases the chances of survival. As soon as the unresponsive victim is removed from the water, the lay rescuer should immediately begin chest compressions and provide cycles of ventilations and compressions. Some recent investigations have revealed that exterior compression of the chest is a necessary measure even in a situation when by­standers cannot provide airway. It is recommended to train by­standers to provide basic life support and apply automated external defibrillator in a drowning person whenever indicated and as early as possible. Advanced life support. In drowning, the victim with cardiac arrest requires advanced life support, including an early intubation. Extended medical measures, which are primarily provided by medical professionals, include cervical spine immobilization in case a spinal injury is suspected, or, establishment of the ventilation with oxygen, emergency transport, application of reanimation and advanced vital support measures.

Popovi? Vladan

2011-01-01

58

Cardiac myofibroblasts: cells out of balance. A new thematic series  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract We are pleased to introduce a new thematic series dealing with cardiac fibrosis and its association with cardiovascular diseases. A wide variety of cardiovascular diseases are associated with cardiac fibrosis, which is now widely recognized to be not a secondary, but rather a primary contributor to cardiac dysfunction. The purpose of the current series of papers and reviews is to provide the reader with an up-to-date synopsis of the very latest research results and hypotheses that impact on cardiac fibrosis and disease.

Dixon Ian M C

2012-09-01

59

Out-of-hospital treatment in case of drowning  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Introduction. Drowning is a leading preventable cause of unintentional morbidity and mortality. The dominant pathophysiological mechanism of drowning includes the development of acute hypoxia. First aid. The rescue procedure of a drowning person includes careful pulling the victim out of the water, examination, maintenance of the airways passable and urgent transfer to hospital. Basic life support. The first and most important treatment option of a drowning victim is the provision of ve...

Popovi? Vladan; Gvozdenovi? Ljiljana; Ivanov Igor; Mili? Saša

2011-01-01

60

Out-of-hospital noninvasive ventilation: epidemiology, technology and equipment  

Directory of Open Access Journals (Sweden)

Full Text Available Noninvasive ventilation has been utilized successfully in the pre- and out-of-hospital settings for a variety of disorders, including respiratory distress syndrome in neonates, neurologic and pulmonary diseases in infants and children, and heart failure as well as chronic obstructive pulmonary disease in adults. A variety of interfaces as well as mechanical positive pressure devices have been used: simple continuous positive airway pressure devices are available which do not require sophisticated equipment, while a broad spectrum of ventilators have been used to provide bilevel positive airway pressure. Extensive training of transport teams may be important, particularly when utilizing bilevel positive airway pressure in infants and children.

Thyyar M. Ravindranath

2012-04-01

 
 
 
 
61

Epidemiology of cardiac arrest outside and inside hospital - Experiences from registries in Sweden  

Directory of Open Access Journals (Sweden)

Full Text Available Cardiac arrest is a dramatic condition leading to sudden death if someone cannot perform two interventions, basic life support and early defibrillation, that have been proved to improve long-term survival. The ‘Utstein style', recently introduced, represents a standard of practice both inside and outside hospital with recommended guidelines for the uniform reporting of clinical data from the patient suffering cardiac arrest. In Sweden the vast majority of patients suffering from cardiac arrest regardless whether inside or outside hospital are included in webbased national registers (one for out-of-hospital cardiac arrest (OHCA and one for in-hospital-cardiac arrest (IHCA. In this article we will present our experiences from OHCA and IHCA separately.

JOHAN HERLITZ

2010-09-01

62

Therapeutic hypothermia after in-hospital cardiac arrest: a critique.  

Science.gov (United States)

More than 210,000 in-hospital cardiac arrests occur annually in the United States. Use of moderate therapeutic hypothermia (TH) in comatose survivors after return of spontaneous circulation following out-of-hospital cardiac arrest (OOH-CA) caused by ventricular fibrillation or pulseless ventricular tachycardia is recommended strongly by many professional organizations and societies. The use of TH after cardiac arrest associated with nonshockable rhythms and after in-hospital cardiac arrest (IH-CA) is recommended to be considered by these same organizations and is being applied widely. The use in these latter circumstances is based on an extrapolation of the data supporting its use after out-of-hospital cardiac arrest associated with shockable rhythms. The purpose of this article is to review the limitations of existing data supporting these extended application of TH after cardiac arrest and to suggest approaches to this dilemma. The data supporting its use for OOH-CA appear to this author, and to some others, to be rather weak, and the data supporting the use of TH for IH-CA appear to be even weaker and to include no randomized controlled trials (RCTs) or supportive observational studies. The many reasons why TH might be expected to be less effective following IH-CA are reviewed. The degree of neurologic injury may be more severe in many of these cases and, thus, may not be responsive to TH as currently practiced following OOH-CA. The potential adverse consequences of the routine use of TH for IH-CA are listed and include complications associated with TH, interference with diagnostic and interventional therapy, and use of scarce personnel and financial resources. Most importantly, it inhibits the ability of researchers to conduct needed RCTs. The author believes that the proper method of providing TH in these cases needs to be better defined. Based on this analysis the author concludes that TH should not be used indiscriminantly following most cases of IH-CA, and instead clinicians should concentrate their efforts in conducting high-quality large RCTs or large-scale, well-designed prospective observation studies to determine its benefits and identify appropriate candidates. PMID:24751488

Hessel, Eugene A

2014-06-01

63

Characteristiscs of fatal patient cases out of Riga hospitals  

Directory of Open Access Journals (Sweden)

Full Text Available Health care system becomes less accessible to the people in Latvia. Health insurance is practically destroyed from April, 2010. The aim of our study is to analyze reasons of death of persons who died out of hospital in Riga. We have investigated 130 post mortem examination protocols from Pathology centre of Riga Eastern Clinical university hospital. We have evaluated the information from family doctor and ambulance care medical staff. In our analyzed group 58% of persons were found dead at home without any medical aid but 25% – died in the ambulance car after call to public institutions. Alarming is fact that 43,8% of patients died at 4–5th decade of age. There was also such vulnerably group as homeless people. The most common reasons of death were acute and chronic variations of cardio-vascular and lung curable pathologies. In Latvia there is urgent necessity of costless medical offices for poor and defenceless persons. Patient’s delay in seeking medical help is the decisive phase for late diagnosis of diseases and mortality. It is necessary to renew health insurance system in Latvia. All levels of medical staff and students of medical universities must be involved in providing information on early disease symptoms, diagnosis and treatment options in different media.

Smits A.

2012-10-01

64

Characteristics of in-hospital cardiac arrest and cardiopulmonary resuscitation  

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Full Text Available Aim We have studied epidemiology of in-hospital cardiac arrest, characteristics of organizing a reanimationand its,procedures as well as its documenting.Methods We analyzed all resuscitation procedure data where anesthesiology reanimation teams (RT providedcardiopulmonary resuscitation (CPR during one-year period. We included resuscitation attemptsthat were initiated outside the Department of Anesthesiology, excluding incidents in operation rooms andIntensive Care Unit (ICU. Data on every cardiac arrest and CPR were entered in a special form.Results During one-year period 87 CPR were performed. Victims of cardiac arrest were principallyelderly patients (age 60 – 80, mostly male (60%. Most frequent victims were neurological patients(42%, surgical patients (21% and neurosurgical patients (10%. The leading cause of cardiac arrestwas primary heart disease, following neurological diseases and respiration disorders of severe etiology.In over 90% cases CPR was initiated by medical personnel in their respective departments, RT arrivedwithin 5 minutes in 73,56% cases. Initially survival was 32%, but full recovery was accomplished in 4patients out of 87 (4,6%.Conclusion Victims of cardiac arrest are patients whose primary disease contributes to occurrence ofcardiorespiratory complications. High mortality and low percentage of full recovery can be explainedby characteristics of patients (old age, nature and seriousness of primary disease which significantly affectthe outcome of CPR. In some cases a question is raised whether to initiate the CPR at all. We wouldlike to point out that continous monitoring of potentially critical patients may prevent cardiorespiratoryincidents whereas the quality and success of CPR may be improved by training of staff and better technicalequipment on the relevant locations in the in the hospital where such incidents usually occur.

Josip Ivi?

2009-02-01

65

Out-of-hospital cardiopulmonary resuscitation in four Serbian university cities: outcome follow-up according to the «Utstein style»  

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Full Text Available Aims. To investigate the return of spontaneous circulation (ROSC, survival to discharge, six-month and one-year survival of patients with out-of-hospital cardiac arrest in four university cities in Serbia.Methods. A prospective, two-year, multicentre study was designed. Using the Utstein template, we recorded out-of-hospital cardiopulmonary (CPR and its outcomes, and analyzed the immediate survival (ROSC>20 min., short-term survival (to discharge, long-term survival (one year after discharge, or death following out-of-hospital CPR.Results. During the study period, 591 patients met the inclusion criteria for enrollment and out-of-hospital CPR. The etiology of arrest was cardiac in 33.8% of patients. Cardiac arrest was witnessed by the advanced life support (ALS team in 15.6% of cases. Asystole was the most frequent initial rhythm at time of arrest (46.4%. The highest survival rate (P<0,001 was observed in cases with initial VF and pulseless VT, while patients with asystole and pulseless electrical activity (PEA had the least chance of survival. Within the whole group of patients, ROSC was detected with a frequency of 69.7%. The frequency of patients who died in the field or during admission to hospital was 58.9%, while 28.6% of admitted patients died before discharge. Thirteen percent of patients survived until discharge, and the overall six-month and one-year survival rates were 11.3% and 10%, respectively. No statistical difference in survival rates among the cities was found.Conclusion. The Utstein template should be implemented in the form of an official protocol for out-of-hospital CPR follow-up in all emergency medical services in Serbia.

SLADJANA ANDJELIC

2010-04-01

66

Paediatric out-of-hospital resuscitation in an area with scattered population (Galicia-Spain  

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Full Text Available Abstract Background Cardiorespiratory arrest (CRA is a rare event in childhood. Our objective was to determine the characteristics of paediatric CRA and the immediate results of cardiopulmonary resuscitation (CPR in Galicia, a community with a very scattered population. Methods All children (aged from newborn to 16 years old who suffered an out-of-hospital CRA in Galicia and were assisted by the Public Foundation Medical Emergencies of Galicia-061 staff, from June 2002 to February 2005, were included in the study. Data were prospectively recorded following the Utstein's style guidelines. Results Thirty-one cases were analyzed (3.4 CRA annual cases per 100.000 paediatric population. The arrest was respiratory in 16.1% and cardiac in 83.9% of cases. CRA occurred at home in 58.1% of instances. Time CRA to initiation of CPR was shorter than 10 minutes in 32.2% and longer than 20 minutes in 29.0% of cases. 22.6% of children received bystander CPR. The first recorded rhythm was asystole in 67.7% of cases. Bag-mask ventilation was used in 67.7% and in 83.8% oro-tracheal intubation was done. A peripheral venous access was achieved in 67.7% and intraosseous access was used in 16.1% of patients. 93.5% of children were treated with adrenaline. After initial CPR, sustained restoration of spontaneous circulation was achieved in 38.7% of cases. Six children (19.4% survived until hospital discharge. Four of 5 children with respiratory arrest survived, whereas only 2 of 26 children with cardiac arrest survived until hospital discharge. Conclusion Despite the handicap of a highly disseminated population, paediatric CRA characteristics and CPR results in Galicia are comparable to references from other communities. Programs to increase bystander CPR, equip laypeople with basic CPR skills and to update life support knowledge of health staff are needed to improve outcomes.

Cegarra-García María

2007-05-01

67

Diagnostic cardiac catheterisation in a hospital without on-site cardiac surgery  

Digital Repository Infrastructure Vision for European Research (DRIVER)

OBJECTIVE—To assess the feasibility, safety, and clinical impact of diagnostic cardiac catheterisation in a multipurpose laboratory in a district general hospital without cardiac surgery.?METHODS—A prospective audit of the first 2000 consecutive cases between September 1992 and March 1997. Unstable patients were referred to a surgical centre for investigation, in line with subsequently published British Cardiac Society (BCS) guidelines, but all other patients requiring cardiac cathet...

Papaconstantinou, H.; Marshall, A.; Burrell, C.

1999-01-01

68

Cardiac changes in hospitalized patients of trauma.  

Science.gov (United States)

Modern clinical management of the patients sustaining traumatic injuries and thermal burns has resulted in their longer survival, but the clinical and pathological effects of these traumatic injuries over the myocardium have been largely neglected. It is speculated that certain factors such as the inflammatory and degenerative lesions of the heart, prolonged clinical course, and the subsequent stress and strain may play role in hastening the death. In the present study, 125 hospitalized cases of traumatic injuries and thermal burns brought for medicolegal autopsy were examined, with the purpose to find out the incidence, its significance, and the extent of the myocardial lesions due to stress and strain following trauma. About 20% patients had myocardial lesions recognized at gross and histological examination at autopsy. A myocardial lesion does develop in the cases of traumatic injuries and thermal burns. No significant sex difference is seen in the cases showing positive myocardial lesions. However, a relationship exists between these myocardial lesions and the after-effects developing in the cases of trauma. These myocardial lesions seen in the cases of traumatic injuries can be termed as early ischemic or anoxic lesions in the absence of any specific coronary pathology. The intensity of myocardial lesions increases with increase in the survival period of the patient. The findings in the study support the concept of human stress cardiomyopathy and demonstrate the potential significance of stress in precipitating death. PMID:24827391

Gawande, Ninad B; Tumram, Nilesh Keshav; Dongre, Anand Paikuji

2014-09-01

69

Microbial Contamination of Staff’s Hand while Going out of Hospital  

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Full Text Available Background and Objective: Cross-transmission of microorganisms by the hands of health care workers is considered as a main transmission route of nosocomial infections. The aim of this study was to investigate the microbial contamination of health-care worker’s hands while going out of hospital. Material and Methods: Wearing the sterile glove with liquid culture, we obtained 100 Samples from the staff’s hands of three departments (clerical department, emergency ward and central laboratory of Emam Reza hospital. After that, the samples were cultured. Results: Of all personnel, 40% have the habit of washing their hands. Of these, 95 percent wash their hands with water and soap, and 5 percent with alcohol rubs. Of 100 cultured samples, 90 have microorganisms including non-pathogen gram-positive bacillus (29%, coagulase-positive staphylococcus (39%, coagulase-negative staphylococcus (47%, Enterococci (3%, micrococcus (25% and candida (3%. Contamination in those who had not washed their hands is 62.6% and in those who washed is 37.7% (P=0.04. Conclusion: Hands of health-care workers become progressively contaminated by the potential pathogens during daily activities. To reduce the rate of contamination, it is helpful if we ask staff to wash their hands while going out of hospital. Keywords: Microbial Flora; Hospital’s Staff; Hand Washing

Naderinasab, M. (PhD

2013-01-01

70

Implementation of a titrated oxygen protocol in the out-of-hospital setting.  

Science.gov (United States)

Oxygen is one of the most frequently-used therapeutic agents in medicine and the most commonly administered drug by prehospital personnel. There is increasing evidence of harm with too much supplemental oxygen in certain conditions, including stroke, chronic obstructive pulmonary disease (COPD), neonatal resuscitations, and in postresuscitation care. Recent guidelines published by the British Thoracic Society (BTS) advocate titrated oxygen therapy, but these guidelines have not been widely adapted in the out-of-hospital setting where high-flow oxygen is the standard. This report is a description of the implementation of a titrated oxygen protocol in a large urban-suburban Emergency Medical Services (EMS) system and a discussion of the practical application of this out-of-hospital protocol. PMID:24983332

Bosson, Nichole; Gausche-Hill, Marianne; Koenig, William

2014-08-01

71

Moving out of the Laboratory: Deploying Pervasive Technologies in a Hospital  

DEFF Research Database (Denmark)

The authors deployed a distributed system containing a location-tracking system, a context-awareness system, wall-sized displays, and mobile phones in a Danish hospital's operating ward. This article presents the lessons they learned from deploying these pervasive computing technologies and a checklist of questions for researchers to consider relating to hardware, software, and organizational issues when moving pervasive systems out of the laboratory. This article is part of a special issue on Real-World Deployments.

Hansen, Thomas Riisgaard; Bardram, Jakob

2006-01-01

72

Out of hospital difficult intubation resolved with nasotracheal use of a gum elastic bougie  

Digital Repository Infrastructure Vision for European Research (DRIVER)

We report the case of a 30?year old man managed in an out of hospital setting for a cardiorespiratory arrest. The patient was impossible to intubate under direct laryngoscopy because of a severe mouth opening limitation associated with a buffalo neck. After failure of direct laryngoscopy and intubating laryngeal mask airway, an Eschmann tracheal tube introducer (gum elastic bougie) was introduced through a nostril. The bougie could be blindly inserted into the trachea, and the patient was i...

Combes, X.; Soupizet, F.; Jabre, P.; Margenet, A.; Marty, J.

2006-01-01

73

Symptoms of anxiety and cardiac hospitalizations at 12 months in patients with heart failure  

DEFF Research Database (Denmark)

Heart failure (HF) is a leading cause of hospitalization. Clinical and socio-demographic factors have been associated with cardiac admissions, but little is known about the role of anxiety. We examined whether symptoms of anxiety were associated with cardiac hospitalizations at 12 months in HF patients.

Damen, Nikki L; Pelle, Aline J

2012-01-01

74

Audit of cardiac catheterisation in a district general hospital: implications for training  

Digital Repository Infrastructure Vision for European Research (DRIVER)

OBJECTIVE—To assess complications of diagnostic cardiac catheterisation in a non-surgical centre by review of the first three years' experience and audit of 2804 diagnostic left heart procedures.?DESIGN—Analysis of a prospective database of cardiac catheter procedures.?SETTING—District general hospital without available on site cardiac surgery.?RESULTS—The rate of major complications of cardiac catheterisation was 0.07%. Mortality was 0.07%, and the rate of arterial complicatio...

Smith, L.; Spyer, G.; Dean, J.

1999-01-01

75

Nutritional Status of the Cardiac Patients Hospitalized in Cardiology Ward of Alzahra Hospital and its Comparison with Healthy Eating Index  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Cardiovascular diseases are getting epidemic due to social reconstruction, technology advancement and over population in urban areas, inappropriate food habits and immobility. This study has tried to define the indexes of healthy nutrition in cardiac patients hospitalized in cardiac ward of Alzahra hospital and to compare it with Healthy Eating Index (HEI). Healthy Eating Index has been also designed to evaluate diet quality in different societies. This is a descriptive analytical study...

Bahreini, N.; Entezari, M.; Hassansadeh, A.; Ganjalideshti, M.; Jalali, M.

2007-01-01

76

End-of-life hospital referrals by out-of-hours general practitioners: a retrospective chart study  

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Full Text Available Abstract Background Many patients are transferred from home to hospital during the final phase of life and the majority die in hospital. The aim of the study is to explore hospital referrals of palliative care patients for whom an out-of-hours general practitioner was called. Methods A retrospective descriptive chart study was conducted covering a one-year period (1/Nov/2005 to 1/Nov/2006 in all eight out-of-hours GP co-operatives in the Amsterdam region (Netherlands. All symptoms, sociodemographic and medical characteristics were recorded in 529 charts for palliative care patients. Multivariate logistic regression analysis was performed to identify the variables associated with hospital referrals at the end of life. Results In all, 13% of all palliative care patients for whom an out-of-hours general practitioner was called were referred to hospital. Palliative care patients with cancer (OR 5,1, cardiovascular problems (OR 8,3, digestive problems (OR 2,5 and endocrine, metabolic and nutritional (EMN problems (OR 2,5 had a significantly higher chance of being referred. Patients receiving professional nursing care (OR 0,2 and patients for whom their own general practitioner had transferred information to the out-of-hours cooperative (OR 0,4 had a significantly lower chance of hospital referral. The most frequent reasons for hospital referral, as noted by the out-of-hours general practitioner, were digestive (30%, EMN (19% and respiratory (17% problems. Conclusion Whilst acknowledging that an out-of-hours hospital referral can be the most desirable option in some situations, this study provides suggestions for avoiding undesirable hospital referrals by out-of-hours general practitioners at the end of life. These include anticipating digestive, EMN, respiratory and cardiovascular symptoms in palliative care patients.

De Korte-Verhoef Maria C

2012-08-01

77

REGISTRO DE PARO CARDÍACO EN EL ADULTO Registries of outer hospital cardiac arrest in Bogotta-Colombia  

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Full Text Available En nuestro país no hay un registro estandarizado de los eventos cardíacos que requieren reanimación cerebro-cardio-pulmonar (RCCP siguiendo los lineamientos "Utstein". El propósito de este estudio fue determinar la calidad de los registros extrahospitalarios de paro cardíaco en el adulto, en Bogotá-Colombia. Entre enero y marzo de 2005 se realizó un análisis retrospectivo de los casos que correspondieron a paro cardíaco en el adulto atendidos por el "Centro Regulador de Urgencias del Distrito (CRU". El estudio reveló un registro deficiente de los eventos que requirieron RCCP realizados a nivel prehospitalario, e identificó al trauma como causa de paro cardíaco en 22% de los casos, una cifra particularmente elevada si se compara con los reportes mundiales, que oscilan entre 5% y 8%. Recomienda la estandarización del registro de paro cardíaco en el adulto, para lo cual se sugiere utilizar el formato de registro que sigue los lineamientos "Utstein".There is not a standardized registry form of cardiac events requiring cardiopulmonary resuscitation (CPR in our country such as the Utstein style. The purpose of this study was to determine the quality of the registries of out-ofhospital cardiac arrests in Bogotá-Colombia. A retrospective survey of registries of cardiac events assisted by a regulatory center "Centro Regulador de Urgencias del Distrito (CRU" was conducted, between January and March, 2005. The study reveals a poor registry of outof-hospital cardiac arrest in Bogotá-Colombia, and identifies trauma as the cause of cardiac arrest in 22% of cases, a particularly high figure compared with 5-8% registered worldwide. Recommend the standardization of the registry form of out-of-hospital cardiac arrest and suggest to use the "uniform reporting of data following cardiac arrest - the Utstein style". The registry forms are shown in appendix 1-2. Suggestions are welcome.

Ricardo Navarro Vargas

2005-07-01

78

A Computerized Evaluation Methodology for Pre-Hospital EMS Cardiac Care  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The computerized application of cardiac care protocols for pre-hospital EMS care is presented. The program logic is reviewed and an example of its application is provided. Uses of the results of the program in EMS management are suggested.

Nagurney, Frank K.

1980-01-01

79

Neuropsychological, Academic, and Adaptive Functioning in Children Who Survive In-Hospital Cardiac Arrest and Resuscitation.  

Science.gov (United States)

This study of 25 children, ages 2-15, who survived a cardiac arrest while hospitalized, found that a majority of subjects exhibited low-average to deficient levels of performance on neuropsychologic, achievement, and adaptive behavior measures. Duration of cardiac arrest and a medical risk score were significantly correlated with decreased…

Morris, Robin D.; And Others

1993-01-01

80

Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation / Parada cardíaca extrahospitalaria: factores determinantes de la sobrevida inmediata después de maniobras de resucitación cardiopulmonar / Parada cardíaca extra-hospitalar: fatores determinantes da sobrevida imediata após manobras de ressuscitação cardiopulmonar  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: analisar fatores determinantes da sobrevida imediata de pessoas que receberam manobras de ressuscitação cardiopulmonar pelas equipes de suporte avançado do Serviço de Atendimento Móvel de Urgência, de Belo Horizonte. MÉTODO: trata-se de estudo epidemiológico, retrospectivo, no qual f [...] oram analisadas 1.165 fichas de atendimento, do período de 2008 a 2010. Os dados coletados seguiram o estilo Utstein, sendo submetidos à estatística descritiva e analítica com testes de nível de significância de 5%. RESULTADOS: a maioria era do sexo masculino, a mediana da idade foi de 64 anos e a do tempo de deslocamento, nove minutos. A sobrevida imediata foi observada em 239 pessoas. Verificou-se associação desse desfecho com a "parada cardiorrespiratória presenciada por pessoas treinadas em suporte básico de vida" (OR=3,49; p Abstract in spanish OBJETIVO: analizar factores determinantes de la sobrevida inmediata de personas que recibieron maniobras de resucitación cardiopulmonar por los equipos de soporte avanzado del Servicio de Atención Móvil de Urgencia de Belo Horizonte. MÉTODO: se trata de estudio epidemiológico, retrospectivo en [...] el cual fueron analizadas 1.165 fichas de atención, en el período de 2008 a 2010. Los datos recolectados siguieron el estilo Utstein, siendo sometidos a la estadística descriptiva y analítica con pruebas de nivel de significancia de 5%. RESULTADOS: la mayoría era del sexo masculino, la mediana de la edad fue de 64 años y el de tiempo de traslado, nueve minutos. La sobrevida inmediata fue observada en 239 personas. Se verificó asociación de ese resultado con la "parada cardiorrespiratoria presenciada por personas entrenadas en soporte básico de vida" (OR=3,49; p Abstract in english OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU) of Belo Horizonte. METHOD: this is a retrospective, epidemiological study which analyzed 1,1 [...] 65 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%. RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p

Daniela Aparecida, Morais; Daclé Vilma, Carvalho; Allana dos Reis, Correa.

2014-07-01

 
 
 
 
81

Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation / Parada cardíaca extrahospitalaria: factores determinantes de la sobrevida inmediata después de maniobras de resucitación cardiopulmonar / Parada cardíaca extra-hospitalar: fatores determinantes da sobrevida imediata após manobras de ressuscitação cardiopulmonar  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: analisar fatores determinantes da sobrevida imediata de pessoas que receberam manobras de ressuscitação cardiopulmonar pelas equipes de suporte avançado do Serviço de Atendimento Móvel de Urgência, de Belo Horizonte. MÉTODO: trata-se de estudo epidemiológico, retrospectivo, no qual f [...] oram analisadas 1.165 fichas de atendimento, do período de 2008 a 2010. Os dados coletados seguiram o estilo Utstein, sendo submetidos à estatística descritiva e analítica com testes de nível de significância de 5%. RESULTADOS: a maioria era do sexo masculino, a mediana da idade foi de 64 anos e a do tempo de deslocamento, nove minutos. A sobrevida imediata foi observada em 239 pessoas. Verificou-se associação desse desfecho com a "parada cardiorrespiratória presenciada por pessoas treinadas em suporte básico de vida" (OR=3,49; p Abstract in spanish OBJETIVO: analizar factores determinantes de la sobrevida inmediata de personas que recibieron maniobras de resucitación cardiopulmonar por los equipos de soporte avanzado del Servicio de Atención Móvil de Urgencia de Belo Horizonte. MÉTODO: se trata de estudio epidemiológico, retrospectivo en [...] el cual fueron analizadas 1.165 fichas de atención, en el período de 2008 a 2010. Los datos recolectados siguieron el estilo Utstein, siendo sometidos a la estadística descriptiva y analítica con pruebas de nivel de significancia de 5%. RESULTADOS: la mayoría era del sexo masculino, la mediana de la edad fue de 64 años y el de tiempo de traslado, nueve minutos. La sobrevida inmediata fue observada en 239 personas. Se verificó asociación de ese resultado con la "parada cardiorrespiratoria presenciada por personas entrenadas en soporte básico de vida" (OR=3,49; p Abstract in english OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU) of Belo Horizonte. METHOD: this is a retrospective, epidemiological study which analyzed 1,1 [...] 65 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%. RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p

Daniela Aparecida, Morais; Daclé Vilma, Carvalho; Allana dos Reis, Correa.

82

Implementing a working together model for Aboriginal patients with acute coronary syndrome: an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse working together to improve hospital care.  

Science.gov (United States)

Acute coronary syndrome (ACS) contributes to the disparity in life expectancy between Aboriginal and non-Aboriginal Australians. Improving hospital care for Aboriginal patients has been identified as a means of addressing this disparity. This project developed and implemented a working together model of care, comprising an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse, providing care coordination specifically directed at improving attendance at cardiac rehabilitation services for Aboriginal Australians in a large metropolitan hospital in Melbourne. A quality improvement framework using a retrospective case notes audit evaluated Aboriginal patients' admissions to hospital and identified low attendance rates at cardiac rehabilitation services. A working together model of care coordination by an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse was implemented to improve cardiac rehabilitation attendance in Aboriginal patients admitted with ACS to the cardiac wards of the hospital. A retrospective medical records audit showed that there were 68 Aboriginal patients admitted to the cardiac wards with ACS from 1 July 2008 to 30 June 2011. A referral to cardiac rehabilitation was recorded for 42% of these. During the implementation of the model of care, 13 of 15 patients (86%) received a referral to cardiac rehabilitation and eight of the 13 (62%) attended. Implementation of the working together model demonstrated improved referral to and attendance at cardiac rehabilitation services, thereby, has potential to prevent complications and mortality. PMID:25200319

Daws, Karen; Punch, Amanda; Winters, Michelle; Posenelli, Sonia; Willis, John; MacIsaac, Andrew; Rahman, Muhammad Aziz; Worrall-Carter, Linda

2014-11-01

83

A Controlled Trial of Hospital versus Home-Based Exercise in Cardiac Patients.  

Science.gov (United States)

Examined the effect of 6-month hospital-based exercise training versus 6-month monitored home-based training in cardiac rehabilitation patients following surgery, investigating which conferred the greatest physical, quality of life, and social support benefits. Home-based training resulted in improvements in exercise performance as great as those…

Arthur, Heather M.; Smith, Kelly M.; Kodis, Jennifer; McKelvie, Robert

2002-01-01

84

Cardiac risk factors, medicine usage, and hospital course in immigrants from the former Soviet Union.  

Science.gov (United States)

Immigrants from the former Soviet Union have a higher prevalence of cardiac risk factors and more problems obtaining health care in the United States than American-born Caucasians. This study compared differences between patients of these two populations admitted for diagnosis of chest pain or shortness of breath. Immigrants from the former Soviet Union (who had been in the U.S. for an average of 20 years) had more cardiac risk factors than American-born Caucasians including more hypertension (81% vs. 50%, p=.002), positive family history (53% vs. 30%, p=.030), more previous heart attacks (45% vs. 20%, p=.012), more prior cardiac catheterizations (51% vs. 18%, pimmigrant patients used foreign medications. Thus, there are major differences between immigrants from the former Soviet Union who are admitted to the cardiac units of an urban New York hospital and American-born Caucasians. Knowledge of these differences is important for caregivers. PMID:16702716

Fridman, Vladimir; Vandalovsky, Ella; Bergmann, Steven R

2006-05-01

85

Cardiocerebral resuscitation: advances in cardiac arrest resuscitation  

Directory of Open Access Journals (Sweden)

Full Text Available Cardiac arrest remains a leading cause of death in the world. Although advances in emergency cardiac care has been achieved, the survival rate of those non hospitalized hospital cardiac arrest remains low. Update in guidelines for CPR and emergency cardiovascular, their approach to out of hospital cardiac arrest is far from optimal. This provides an opportunity to advocate cardiocerebral resuscitation as an alternative to  traditional cardiopulmonary resuscitation for non hospitalized cardiac arrest. Because cardiocerebral resuscitation results in improved survival and cerebral function in patients with witnessed cardiac arrest and a shockable rhythm whom have greatest chance of survival, it should replace CPR especially for non hospitalized cardiac arrest.(Med J Indones 2011; 20:306-9Keywords: cardiocerebral resuscitation, cardiac arrest,  cardiopulmonary resuscitation

Erwin Mulia

2011-11-01

86

Emergencias extrahospitalarias: el paciente suicida / Out-of-hospital emergencies: the suicidal patient  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Introducción: La conducta suicida ha existido desde que la humanidad existe, sin embargo, la concepción positiva o negativa del mismo ha cambiado a través de las diferentes culturas. En la actualidad, supone un grave problema de salud pública, y se estudia desde diferentes perspectivas y áreas de co [...] nocimiento, tratando de dar una visión global para poder entender este fenómeno tan interesante, apasionante y, en ciertos momentos desconcertante. Objetivo: Por tanto, el objetivo del presente estudio es analizar el perfil de las personas que cometen un acto suicida en la ciudad de Madrid y que son atendidos en el área de la emergencia extrahospitalaria. Método: Estudio observacional, descriptivo y retrospectivo, encuadrado en SAMUR-Protección Civil durante el año 2008, analizando todos los casos atendidos de ideación, tentativa y suicidio consumado donde han intervenido un Soporte Vital Avanzado y la Unidad de Asistencia Psicológica. Se ha analizado una muestra de 96 pacientes suicidas, donde el 48,4% fueron tentativas de suicidio, seguidos de un 44,2% de suicidios consumados y un 7,4% de ideación autolítica, atendidos principalmente en los meses de marzo y mayo, turno de mañana - tarde, y en el distrito de Puente de Vallecas, intervenciones demandadas desde Madrid 112 en su mayor porcentaje. Resultados: Se establece un perfil de paciente suicida como varón, de 25-35 años, español, soltero, con patología psiquiátrica en tratamiento, sin tentativas previas, que había verbalizado sus intenciones autolíticas, teniendo como factor desencadenante la propia enfermedad física o psíquica, que elige como método autolítico la defenestración sin presencia de otras personas, al cuál se le traslada al Hospital y presenta como diagnóstico principal TCE, trauma o politraumatismo. Conclusiones: El conocimientog del perfil del paciente suicida atendidos en diversas áreas permite conocer en mayor medida, los factores de riesgo de la conducta suicida, así como puede favorecer actuaciones preventivas futuras. Abstract in english Background: Suicidal behavior has existed since mankind exists, however, positive or negative view of it has changed through different cultures. At present, poses a significant public health problem, and studied from different perspectives and areas of expertise, trying to give an overview to unders [...] tand this phenomenon so interesting, exciting and at times bewildering. Therefore, the objective of this study is to analyze the profile of people who commit a suicide in the city of Madrid and are treated in the outpatient emergency area. Methods: Observational, descriptive and retrospective study, framed in SAMUR-Civil Protection in 2008, analyzing all cases seen ideation, suicide attempt, which have involved an Advanced Life Support and Counselling Unit. We analyzed a sample of 96 suicidal patients, where 48.4% were attempted suicide, followed by 44.2% of suicides and suicidal ideation 7.4%, seen mainly in the months of March and May, morning session-afternoon, and in the district of Puente de Vallecas, intervention from Madrid 112 defendants in the highest percentage. Results: Establishing a patient profile suicide as male, 25-35 years, Spanish, single, with psychiatric disorders in treatment, but previous attempts, he had verbalized his intentions autolytic, taking as a trigger for the physical or mental illness itself, which chooses defenestration as autolytic method without the presence of others, to which he was transferred to the Hospital and has a diagnosis of TBI, trauma or polytrauma. Conclusions: Knowledge of the profile of the suicidal patient treated in different areas allows better known, the risk factors of suicidal behavior and may facilitate future preventive actions.

T., Pacheco Tabuenca; J.I., Robles Sánchez.

87

Emergencias extrahospitalarias: el paciente suicida / Out-of-hospital emergencies: the suicidal patient  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Introducción: La conducta suicida ha existido desde que la humanidad existe, sin embargo, la concepción positiva o negativa del mismo ha cambiado a través de las diferentes culturas. En la actualidad, supone un grave problema de salud pública, y se estudia desde diferentes perspectivas y áreas de co [...] nocimiento, tratando de dar una visión global para poder entender este fenómeno tan interesante, apasionante y, en ciertos momentos desconcertante. Objetivo: Por tanto, el objetivo del presente estudio es analizar el perfil de las personas que cometen un acto suicida en la ciudad de Madrid y que son atendidos en el área de la emergencia extrahospitalaria. Método: Estudio observacional, descriptivo y retrospectivo, encuadrado en SAMUR-Protección Civil durante el año 2008, analizando todos los casos atendidos de ideación, tentativa y suicidio consumado donde han intervenido un Soporte Vital Avanzado y la Unidad de Asistencia Psicológica. Se ha analizado una muestra de 96 pacientes suicidas, donde el 48,4% fueron tentativas de suicidio, seguidos de un 44,2% de suicidios consumados y un 7,4% de ideación autolítica, atendidos principalmente en los meses de marzo y mayo, turno de mañana - tarde, y en el distrito de Puente de Vallecas, intervenciones demandadas desde Madrid 112 en su mayor porcentaje. Resultados: Se establece un perfil de paciente suicida como varón, de 25-35 años, español, soltero, con patología psiquiátrica en tratamiento, sin tentativas previas, que había verbalizado sus intenciones autolíticas, teniendo como factor desencadenante la propia enfermedad física o psíquica, que elige como método autolítico la defenestración sin presencia de otras personas, al cuál se le traslada al Hospital y presenta como diagnóstico principal TCE, trauma o politraumatismo. Conclusiones: El conocimientog del perfil del paciente suicida atendidos en diversas áreas permite conocer en mayor medida, los factores de riesgo de la conducta suicida, así como puede favorecer actuaciones preventivas futuras. Abstract in english Background: Suicidal behavior has existed since mankind exists, however, positive or negative view of it has changed through different cultures. At present, poses a significant public health problem, and studied from different perspectives and areas of expertise, trying to give an overview to unders [...] tand this phenomenon so interesting, exciting and at times bewildering. Therefore, the objective of this study is to analyze the profile of people who commit a suicide in the city of Madrid and are treated in the outpatient emergency area. Methods: Observational, descriptive and retrospective study, framed in SAMUR-Civil Protection in 2008, analyzing all cases seen ideation, suicide attempt, which have involved an Advanced Life Support and Counselling Unit. We analyzed a sample of 96 suicidal patients, where 48.4% were attempted suicide, followed by 44.2% of suicides and suicidal ideation 7.4%, seen mainly in the months of March and May, morning session-afternoon, and in the district of Puente de Vallecas, intervention from Madrid 112 defendants in the highest percentage. Results: Establishing a patient profile suicide as male, 25-35 years, Spanish, single, with psychiatric disorders in treatment, but previous attempts, he had verbalized his intentions autolytic, taking as a trigger for the physical or mental illness itself, which chooses defenestration as autolytic method without the presence of others, to which he was transferred to the Hospital and has a diagnosis of TBI, trauma or polytrauma. Conclusions: Knowledge of the profile of the suicidal patient treated in different areas allows better known, the risk factors of suicidal behavior and may facilitate future preventive actions.

T., Pacheco Tabuenca; J.I., Robles Sánchez.

2011-12-01

88

Quality of out-of-hospital palliative emergency care depends on the expertise of the emergency medical team—a prospective multi-centre analysis  

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The number of palliative care patients who live at home and have non-curable life-threatening diseases is increasing. This is largely a result of modern palliative care techniques (e.g. specialised out-of-hospital palliative medical care services), changes in healthcare policy and the availability of home care services. Accordingly, pre-hospital emergency physicians today are more likely to be involved in out-of-hospital emergency treatment of palliative care patients with advanced disease.In...

Wiese, Christoph H. R.; Bartels, Utz; Marczynska, Karolina; Ruppert, David; Graf, Bernhard M.; Hanekop, Gerd G.

2009-01-01

89

Estimating cost savings from regionalizing cardiac procedures using hospital discharge data  

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Full Text Available Abstract Background We examined whether higher procedure volumes for coronary artery bypass graft (CABG surgery or percutaneous coronary interventions (PCI were associated with lower costs per patient, and if so, estimated the financial savings from regionalizing cardiac procedures. Methods Cost regressions with hospital-specific dummy variables measured within-hospital cost reductions associated with increasing hospital volume. We used the regression estimates to predict the change in total costs that would result from moving patients in low-volume hospitals to higher volume facilities. Results A 10% increase in PCI procedure volume lowered costs per patient by 0.7%. For the average hospital performing CABG in 2000, a 10% increase in volume was associated with a 2.8% reduction in average costs. Despite these lower costs, the predicted savings from regionalizing all PCI procedures in the sample from lower to high-volume hospitals amounted to only 1.1% of the entire costs of performing PCI procedures for the sample in 2000. Similarly, the cost savings for CABG were estimated to be only 3.5%. Conclusion Higher volumes were associated with lower costs per procedure. However, the total potential savings from regionalizing cardiac procedures is relatively minor, and may not justify the risks of reducing access to needed services.

Petersen Laura A

2007-06-01

90

Nursing assistance at the hospital discharge after cardiac surgery: integrative review.  

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The study aimed to analyze the available evidence in the literature on nursing care in the hospital post-cardiac surgery. Data were collected from electronic databases LILACS, SciELO, MEDLINE, via DeCS thoracic surgery, hospital, nursing care, in the period 2001 to 2011. Ten articles were selected that showed the need to develop a plan of nursing discharge focusing on prevention of complications and coping with physical limitations resulting from heart surgery. Thus, the discharge should be considered from the time of admission, with carefully planned actions involving patient and family. PMID:24598961

Jesus, Daniela Fraga de; Marques, Patrícia Figueiredo

2013-01-01

91

Cardiac disease in pregnancy: A 4-year audit at Pretoria Academic Hospital  

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Full Text Available SciELO South Africa | Language: English Abstract in english BACKGROUND: Pre-existing medical disease constitutes one of the five major causes of maternal death in South Africa. Increasing numbers of women with heart disease reach adulthood as a result of advances in diagnoses and treatment of heart disease in childhood. OBJECTIVE: To assess the profile of ca [...] rdiac disease and the maternal and fetal outcome of pregnant patients at Pretoria Academic Hospital (PAH). METHODS: A retrospective analysis was carried out on 189 pregnant cardiac patients who delivered at PAH between January 2002 and December 2005. RESULTS: Nearly 1% of all mothers who delivered at PAH had underlying cardiac disease. Most cardiac lesions were valvular disease secondary to childhood rheumatic heart disease. Pulmonary oedema was associated with the greatest morbidity and mortality. The severe morbidity rate was 11.6% and the case fatality rate 3.3%. The mean gestational age at delivery was 35 weeks; 18 (9.7%) babies were born before 34 weeks. CONCLUSION: Cardiac disease in pregnancy is associated with high morbidity and mortality rates for mothers and their babies. Multidisciplinary evaluation with discussion of risk factors, appropriate family planning and optimising of the cardiac state before conception is advised.

P, Soma-Pillay; A P, Macdonald; T M, Mathivha; J L, Bakker; M O, Mackintosh.

92

Nutritional Status of the Cardiac Patients Hospitalized in Cardiology Ward of Alzahra Hospital and its Comparison with Healthy Eating Index  

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Full Text Available Cardiovascular diseases are getting epidemic due to social reconstruction, technology advancement and over population in urban areas, inappropriate food habits and immobility. This study has tried to define the indexes of healthy nutrition in cardiac patients hospitalized in cardiac ward of Alzahra hospital and to compare it with Healthy Eating Index (HEI. Healthy Eating Index has been also designed to evaluate diet quality in different societies. This is a descriptive analytical study conducted cross-sectionally in cardiac patients hospitalized in cardiac ward of Alzahra hospital in Isfahan, Iran. Nutritional status was investigated by completing the last three days dietary Recalls. Nutritional index was calculated based on food pyramid guidelines, fat calorie percentage from total calorie, intake of saturated fats percentage and cholesterol, calcium, Iron and food variation. The range of this index was from 0-10 so the total score was 100. Calculation of this index was made with respect to the data of nutrition intakes compared to healthy food index. The score of food variation was defined by routine food intake in the society. The score of nutrition index was categorized into three groups of lower than 50 (weak, 51-80 (needs a change and improvement and over 81 (good. Mean comparison test was used to compare healthy food index with nutrients intake and the number of servings of food pyramid guidelines. Mean age of cardiac patients was 65.5±7.9 and the nutrition index score were 36.3 in males and 35.7 in females. The intake servings from food pyramid in patients with good index score was significantly higher compared to other groups (p<0.001. Bread and cereal intake were as 8.6±1.8 serving, Vegetables 5±1.8, fruits 1.9±1 diary and milk product 1.4±0.5 and meat 1.6±1.1. There was an association between lipid intake and saturated fat percentage (p<0.001. Mean intake of fruit, milk and meat was less than HEI and for cholesterol, vegetables and salt, it was higher than HEI (p<0.5. Mean intake of cereal and saturated fats, were similar to HEI (p>0.5. Pearson correlation test showed that there was no significant association between age and nutrition variation, calcium, vegetables and bread (p>0.5. Level of education had a significant direct association with food variation, Iron, meat and fruit intake (p<0.5 but not with other items (p<0.5. 73.2% of diet should be changed and improved while in 3.3% it was good. 23.5% followed weak food pattern. Healthy food index is an appropriate tool to evaluate nutrition quality of cardiac patients. The diet in most of the cardiac patients needs improvement and changes in appropriate food education is essential.

N. Bahreini

2007-01-01

93

Cardiac arrest teams and time of day: effects on surviving in-hospital resuscitation  

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Full Text Available Martin Christ, Wolfgang Dierschke, Katharina Isabel von Auenmueller, Marc van Bracht, Martin Grett, Hans-Joachim Trappe Department of Cardiology and Angiology, Marienhospital Herne, Ruhr – University Bochum, Herne, Germany Objectives: Little is known about the factors that influence survival following in-hospital resuscitation, but previous investigations have suggested that in-hospital resuscitations outside of regular working hours are associated with worse survival rates. Material and methods: In-hospital cardiac arrest teams at our hospital were instructed to complete a questionnaire following every emergency call between July 2011 and June 2013. Data on all resuscitation attempts were collected and analyzed. Results: A total of 65 in-hospital resuscitations were recorded in 42 males (64.6% and 23 females (35.4% (mean age 72.0±14.3 years. A total of 54 (83.1% cardiac arrests were witnessed; seven (10.8% showed a shockable rhythm at the time of the first ECG. Resuscitation attempts lasted 29.3±41.3 minutes, and 4.1±3.1 mg epinephrine was given. Return of spontaneous circulation could be achieved in 38 patients (58.5%; 29 (44.6% survived the first day, 23 (35.4% the seventh day, and 15 patients (23.1% were discharged alive. Significantly more in-hospital resuscitations were obtained for those performed during non-regular working hours (P<0.001, with higher neuron-specific enolase levels at 72 hours after resuscitation during nonregular working hours (P=0.04. Patients who were discharged alive were significantly younger (P=0.01, presented more often with an initial shockable rhythm (P=0.04, and had a shorter duration of resuscitation (P<0.001 with the need of a lower dose of epinephrine (P<0.001. Discussion: Survival rates following in-hospital resuscitation were poor at any time, but appear to depend less on time-dependent effects of the quality of resuscitation and more on time-dependent effects of recognition of cardiac arrests. Keywords: sudden cardiac death, emergency medicine, time of day

Christ M

2014-06-01

94

Hospital ownership and performance: evidence from stroke and cardiac treatment in Taiwan.  

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This paper compares program expenditure and treatment quality of stroke and cardiac patients between 1997 and 2000 across hospitals of various ownership types in Taiwan. Because Taiwan implemented national health insurance in 1995, the analysis is immune from problems arising from the complex setting of the U.S. health care market, such as segmentation of insurance status or multiple payers. Because patients may select admitted hospitals based on their observed and unobserved characteristics, we employ instrument variable (IV) estimation to account for the endogeneity of ownership status. Results of IV estimation find that patients admitted to non-profit hospitals receive better quality care, either measured by 1- or 12-month mortality rates. In terms of treatment expenditure, our results indicate no difference between non-profits and for-profits index admission expenditures, and at most 10% higher long-term expenditure for patients admitted to non-profits than to for-profits. PMID:18486978

Lien, Hsien-Ming; Chou, Shin-Yi; Liu, Jin-Tan

2008-09-01

95

Use of the out-of-hours emergency dental service at two south-east London hospitals  

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Full Text Available Abstract Background Prior to the introduction of the 2006 NHS dental contract in England and Wales, general dental practitioners (GDPs were responsible for the provision of out-of-hours (OOH emergency dental services (EDS; however there was great national variation in service provision. Under the contractual arrangements introduced 1st April 2006, local commissioning agencies became formally responsible for the provision of out-of-hours emergency dental services. This study aimed to examine patients' use of an out-of-hours emergency dental service and to determine whether the introduction of the 2006 national NHS dental contract had resulted in a change in service use, with a view to informing future planning and commissioning of care. Methods A questionnaire was administered to people attending the out-of-hours emergency dental service at two inner city London hospitals over two time periods; four weeks before and six months after the introduction of the dental contract in April 2006. The questionnaire explored: reasons for attending; dental registration status and attendance; method of access; knowledge and use of NHS Direct; satisfaction with the service; future preferences for access and use of out-of-hours dental services. Data were compared to determine any impact of the new contract on how and why people accessed the emergency dental service. Results The response rate was 73% of attendees with 981 respondents for the first time period and 546 for the second. There were no significant differences between the two time periods in the gender, age, ethnic distribution or main language of service users accessing the service. Overall, the main dental problem was toothache (72% and the main reason for choosing this service was due to the inability to access another emergency dental service (42%. Significantly fewer service users attended the out-of-hours emergency dental service during the second period because they could not get an appointment with their own dentist (p = 0.002 from 28% to 20% and significantly more service users in the second period felt the emergency dental service was easier to get to than their own dentist (P = 0.003 from 8% to 14%. Service users found out about the service from multiple sources, of which family and friends were the most common source (30%. In the second period fewer service users were obtaining information about the service from dental receptionists (P = 0.002 from 14% to 9% and increased use of NHS Direct for a dental problem was reported (P = 0.002 from 16% to 22% along with more service users being referred to the service by NHS Direct (P = 0.02 from 19% to 24%. The most common preference for future emergency dental care was face-to-face with a dentist (79%. Conclusion This study has provided an insight into how and why people use an out-of-hours emergency dental service and has helped to guide future commissioning of these services. Overall, the service was being used in much the same way both before and after the 2006 dental contract. Significantly more use was being made of NHS Direct after April 2006; however, informal information networks such as friends and family remain an important source of information about accessing emergency dental services.

Wright Desmond

2009-07-01

96

Hospital variation in transfusion and infection after cardiac surgery: a cohort study  

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Full Text Available Abstract Background Transfusion practices in hospitalised patients are being re-evaluated, in part due to studies indicating adverse effects in patients receiving large quantities of stored blood. Concomitant with this re-examination have been reports showing variability in the use of specific blood components. This investigation was designed to assess hospital variation in blood use and outcomes in cardiac surgery patients. Methods We evaluated outcomes in 24,789 Medicare beneficiaries in the state of Michigan, USA who received coronary artery bypass graft surgery from 2003 to 2006. Using a cohort design, patients were followed from hospital admission to assess transfusions, in-hospital infection and mortality, as well as hospital readmission and mortality 30 days after discharge. Multilevel mixed-effects logistic regression was used to calculate the intrahospital correlation coefficient (for 40 hospitals and compare outcomes by transfusion status. Results Overall, 30% (95 CI, 20% to 42% of the variance in transfusion practices was attributable to hospital site. Allogeneic blood use by hospital ranged from 72.5% to 100% in women and 49.7% to 100% in men. Allogeneic, but not autologous, blood transfusion increased the odds of in-hospital infection 2.0-fold (95% CI 1.6 to 2.5, in-hospital mortality 4.7-fold (95% CI 2.4 to 9.2, 30-day readmission 1.4-fold (95% CI 1.2 to 1.6, and 30-day mortality 2.9-fold (95% CI 1.4 to 6.0 in elective surgeries. Allogeneic transfusion was associated with infections of the genitourinary system, respiratory tract, bloodstream, digestive tract and skin, as well as infection with Clostridium difficile. For each 1% increase in hospital transfusion rates, there was a 0.13% increase in predicted infection rates. Conclusion Allogeneic blood transfusion was associated with an increased risk of infection at multiple sites, suggesting a system-wide immune response. Hospital variation in transfusion practices after coronary artery bypass grafting was considerable, indicating that quality efforts may be able to influence practice and improve outcomes.

Saint Sanjay

2009-07-01

97

A process model to support automated measurement and detection of out-of-bounds events in a hospital laboratory process  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: English Abstract in english Business Activity Monitoring (BAM) allows organizations to capture enterprise events from their source systems and utilize these to detect non-compliant business situations. Similar concepts may be leveraged in the healthcare domain to improve the quality of patient care and the efficiency of clinic [...] al processes. This paper introduces a generic set of constructs for formally specifying threshold values relevant for cycle time and utilization calculations. It also describes a mechanism to capture information, including thresholds, about important business parameters for Six Sigma measurement. This full set of constructs are the basis for automated measurement and monitoring and are incorporated into the process model during the definition or capture phase thereby linking the definition and monitoring phases through a common underlying process model. Bespoke software is also described which uses the constructs contributed by this research to manage and monitor process models and enterprise events. A process performance module provides automated measurement and monitoring capabilities. At an aggregate level, this is achieved through the provision of process cycle time data for selected time periods on demand and the examination of business processes at frequent intervals with alerts generated for exceptional scenarios. At a more granular level, this solution uses a rules-based approach to evaluate individual events and generate alerts for out-of-bounds business parameters. This paper demonstrates the benefits of these capabilities for health informatics through application to a Laboratory Testing process observed at a local hospital. The paper also suggests recommendations for the extension of current modelling languages with respect to the constructs detailed herein.

Claire, Costello; Owen, Molloy.

2009-08-01

98

The ecology of medical care in Norway: wide use of general practitioners may not necessarily keep patients out of hospitals  

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Full Text Available Background. Our aim was to investigate the pattern of self reported symptoms and utilisation of health care services in Norway. Design and methods. With data from the cross-sectional Tromsø Study (2007-8, we estimated population proportions reporting symptoms and use of seven different health services. By logistic regression we estimated differences according to age and gender. Results. 12,982 persons aged 30-87 years participated, 65.7% of those invited. More than 900/1000 reported symptoms or health problems in a year as well as in a month, and 214/1000 and 816/1000 visited a general practitioner once or more in a month and a year, respectively. The corresponding figures were 91/1000 and 421/1000 for specialist outpatient visits, and 14/1000 and 116/1000 for hospitalisations. Physiotherapists were visited by 210/1000, chiropractors by 76/1000, complementary and alternative medical providers by 127/1000, and dentists by 692/1000 in a year. Women used most health care services more than men, but genders used hospitalisations and chiropractors equally. Utilisation of all services increased with age, except chiropractors, dentists and complementary and alternative medical providers. Conclusions. Almost the entire population reported health related problems during the previous year, and most residents visited a general practitioner. Yet there were high rates of inpatient and outpatient specialist utilisation. We suggest that wide use of general practitioners may not necessarily keep patients out of specialist care and hospitals.

Olav Helge Førde

2012-06-01

99

Efficacy of the EZ-IO® needle driver for out-of-hospital intraosseous access - a preliminary, observational, multicenter study  

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Full Text Available Abstract Background Intraosseous (IO access represents a reliable alternative to intravenous vascular access and is explicitly recommended in the current guidelines of the European Resuscitation Council when intravenous access is difficult or impossible. We therefore aimed to study the efficacy of the intraosseous needle driver EZ-IO® in the prehospital setting. Methods During a 24-month period, all cases of prehospital IO access using the EZ-IO® needle driver within three operational areas of emergency medical services were prospectively recorded by a standardized questionnaire that needed to be filled out by the rescuer immediately after the mission and sent to the primary investigator. We determined the rate of successful insertion of the IO needle, the time required, immediate procedure-related complications, the level of previous experience with IO access, and operator's subjective satisfaction with the device. Results 77 IO needle insertions were performed in 69 adults and five infants and children by emergency physicians (n = 72 applications and paramedics (n = 5 applications. Needle placement was successful at the first attempt in all but 2 adults (one patient with unrecognized total knee arthroplasty, one case of needle obstruction after placement. The majority of users (92% were relative novices with less than five previous IO needle placements. Of 22 responsive patients, 18 reported pain upon fluid administration via the needle. The rescuers' subjective rating regarding handling of the device and ease of needle insertion, as described by means of an analogue scale (0 = entirely unsatisfied, 10 = most satisfied, provided a median score of 10 (range 1-10. Conclusions The EZ-IO® needle driver was an efficient alternative to establish immediate out-of-hospital vascular access. However, significant pain upon intramedullary infusion was observed in the majority of responsive patients.

Latasch Leo

2011-10-01

100

A process model to support automated measurement and detection of out-of-bounds events in a hospital laboratory process  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: English Abstract in english Business Activity Monitoring (BAM) allows organizations to capture enterprise events from their source systems and utilize these to detect non-compliant business situations. Similar concepts may be leveraged in the healthcare domain to improve the quality of patient care and the efficiency of clinic [...] al processes. This paper introduces a generic set of constructs for formally specifying threshold values relevant for cycle time and utilization calculations. It also describes a mechanism to capture information, including thresholds, about important business parameters for Six Sigma measurement. This full set of constructs are the basis for automated measurement and monitoring and are incorporated into the process model during the definition or capture phase thereby linking the definition and monitoring phases through a common underlying process model. Bespoke software is also described which uses the constructs contributed by this research to manage and monitor process models and enterprise events. A process performance module provides automated measurement and monitoring capabilities. At an aggregate level, this is achieved through the provision of process cycle time data for selected time periods on demand and the examination of business processes at frequent intervals with alerts generated for exceptional scenarios. At a more granular level, this solution uses a rules-based approach to evaluate individual events and generate alerts for out-of-bounds business parameters. This paper demonstrates the benefits of these capabilities for health informatics through application to a Laboratory Testing process observed at a local hospital. The paper also suggests recommendations for the extension of current modelling languages with respect to the constructs detailed herein.

Claire, Costello; Owen, Molloy.

 
 
 
 
101

Desmosomal Molecules In and Out of Adhering Junctions: Normal and Diseased States of Epidermal, Cardiac and Mesenchymally Derived Cells  

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Full Text Available Current cell biology textbooks mention only two kinds of cell-to-cell adhering junctions coated with the cytoplasmic plaques: the desmosomes (maculae adhaerentes, anchoring intermediate-sized filaments (IFs, and the actin microfilament-anchoring adherens junctions (AJs, including both punctate (puncta adhaerentia and elongate (fasciae adhaerentes structures. In addition, however, a series of other junction types has been identified and characterized which contain desmosomal molecules but do not fit the definition of desmosomes. Of these special cell-cell junctions containing desmosomal glycoproteins or proteins we review the composite junctions (areae compositae connecting the cardiomyocytes of mature mammalian hearts and their importance in relation to human arrhythmogenic cardiomyopathies. We also emphasize the various plakophilin-2-positive plaques in AJs (coniunctiones adhaerentes connecting proliferatively active mesenchymally-derived cells, including interstitial cells of the heart and several soft tissue tumor cell types. Moreover, desmoplakin has also been recognized as a constituent of the plaques of the complexus adhaerentes connecting certain lymphatic endothelial cells. Finally, we emphasize the occurrence of the desmosomal transmembrane glycoprotein, desmoglein Dsg2, out of the context of any junction as dispersed cell surface molecules in certain types of melanoma cells and melanocytes. This broadening of our knowledge on the diversity of AJ structures indicates that it may still be too premature to close the textbook chapters on cell-cell junctions.

Sebastian Pieperhoff

2010-01-01

102

Hospital variation in the use of noninvasive cardiac imaging and its association with downstream testing, interventions, and outcomes.  

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IMPORTANCE Current guidelines allow substantial discretion in use of noninvasive cardiac imaging for patients without acute myocardial infarction (AMI) who are being evaluated for ischemia. Imaging use may affect downstream testing and outcomes. OBJECTIVE To characterize hospital variation in use of noninvasive cardiac imaging and the association of imaging use with downstream testing, interventions, and outcomes. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of hospitals using 2010 administrative data from Premier, Inc, including patients with suspected ischemia on initial evaluation who were seen in the emergency department, observation unit, or inpatient ward; received at least 1 cardiac biomarker test on day 0 or 1; and had a principal discharge diagnosis for a common cause of chest discomfort, a sign or symptom of cardiac ischemia, and/or a comorbidity associated with coronary disease. We excluded patients with AMI. MAIN OUTCOMES AND MEASURES At each hospital, the proportion of patients who received noninvasive imaging to identify cardiac ischemia and the subsequent rates of admission, coronary angiography, and revascularization procedures. RESULTS We identified 549,078 patients at 224 hospitals. The median (interquartile range) hospital noninvasive imaging rate was 19.8% (10.9%-27.7%); range, 0.2% to 55.7%. Median hospital imaging rates by quartile were Q1, 6.0%; Q2, 15.9%; Q3, 23.5%; Q4, 34.8%. Compared with Q1, Q4 hospitals had higher rates of admission (Q1, 32.1% vs Q4, 40.0%), downstream coronary angiogram (Q1, 1.2% vs Q4, 4.9%), and revascularization procedures (Q1, 0.5% vs Q4, 1.9%). Hospitals in Q4 had a lower yield of revascularization for noninvasive imaging (Q1, 7.6% vs Q4, 5.4%) and for angiograms (Q1, 41.2% vs Q4, 38.8%). P <.001 for all comparisons. Readmission rates to the same hospital for AMI within 2 months were not different by quartiles (P?=?.51). Approximately 23% of variation in imaging use was attributable to the behavior of individual hospitals. CONCLUSIONS AND RELEVANCE Hospitals vary in their use of noninvasive cardiac imaging in patients with suspected ischemia who do not have AMI. Hospitals with higher imaging rates did not have substantially different rates of therapeutic interventions or lower readmission rates for AMI but were more likely to admit patients and perform angiography. PMID:24515551

Safavi, Kyan C; Li, Shu-Xia; Dharmarajan, Kumar; Venkatesh, Arjun K; Strait, Kelly M; Lin, Haiqun; Lowe, Timothy J; Fazel, Reza; Nallamothu, Brahmajee K; Krumholz, Harlan M

2014-04-01

103

Postoperative cardiac arrest due to cardiac surgery complications  

International Nuclear Information System (INIS)

To examine the role of anesthetists in the management of cardiac arrest occurring in association with cardiac anesthesia. In this retrospective study we studied the potential performances for each of the relevant incidents among 712 patients undergoing cardiac operations at Golestan and Naft Hospitals Ahwaz between November 2006 and July 2008. Out of total 712 patients undergoing cardiac surgery, cardiac arrest occurred in 28 cases (3.9%) due to different postoperative complications. This included massive bleeding (50% of cardiac arrest cases, 1.9% of patients); pulseless supra ventricular tachycardia (28.5% of cardiac arrest cases, 1.1% of patients); Heart Failure (7% of cardiac arrest cases, 0.2% of patients); Aorta Arc Rapture (3.5% of cardiac arrest cases, 0.1% of patients); Tamponade due to pericardial effusion (3.5% of cardiac arrest cases, 0.1% of total patients); Right Atrium Rupture (3.5% of cardiac arrest cases, 0.1% of patients) were detected after cardiac surgery. Out of 28 cases 7 deaths occurred (25% of cardiac arrest cases, 0.1% of patients). The most prevalent reason for cardiac arrest during post operative phase was massive bleeding (50%) followed by pulseless supra ventricular tachycardia (28.5%). Six patients had some morbidity and the remaining 15 patients recovered. There are often multiple contributing factors to a cardiac arrest under cardiac anesthesia, as much a complete systematic assessment of the patient, equipment, and drugs should be completed. We also found that the diagnosis and management of cardiac arrest in association with cardiac anesthesia differs considerably from that encountered elsewhere. (author)

104

Relationship between quantitative cardiac neuronal imaging with 123I-meta-iodobenzylguanidine and hospitalization in patients with heart failure  

International Nuclear Information System (INIS)

Hospitalization in patients with systolic heart failure is associated with morbidity, mortality, and cost. Myocardial sympathetic innervation, imaged by 123I-meta-iodobenzylguanidine (123I-mIBG), has been associated with cardiac events in a recent multicenter study. The present analysis explored the relationship between 123I-mIBG imaging findings and hospitalization. Source documents from the ADMIRE-HF trial were reviewed to identify hospitalization events in patients with systolic heart failure following cardiac neuronal imaging using 123I-mIBG. Time to hospitalization was analyzed with the Kaplan-Meier method and compared to the mIBG heart-to-mediastinum (H/M) ratio using multiple-failure Cox regression. During 1.4 years of median follow-up, 362 end-point hospitalizations occurred in 207 of 961 subjects, 79 % of whom had H/M ratio <1.6. Among subjects hospitalized for any cause, 88 % had H/M ratio <1.6 and subjects with H/M ratio <1.6 experienced hospitalization earlier than subjects with higher H/M ratios (log-rank p = 0.003). After adjusting for elevated brain natriuretic peptide (BNP) and time since heart failure diagnosis, a low mIBG H/M ratio was associated with cardiac-related hospitalization (HR 1.48, 95 % CI 1.05 - 2.0; p = 0.02). The mIBG H/M ratio may risk-stratify patients with heart failure for cardiac-related hospitalization, especially when used in conjunction with BNP. Further studies are warranted to examine these relationships. (orig.)

105

Relationship between quantitative cardiac neuronal imaging with {sup 123}I-meta-iodobenzylguanidine and hospitalization in patients with heart failure  

Energy Technology Data Exchange (ETDEWEB)

Hospitalization in patients with systolic heart failure is associated with morbidity, mortality, and cost. Myocardial sympathetic innervation, imaged by {sup 123}I-meta-iodobenzylguanidine ({sup 123}I-mIBG), has been associated with cardiac events in a recent multicenter study. The present analysis explored the relationship between {sup 123}I-mIBG imaging findings and hospitalization. Source documents from the ADMIRE-HF trial were reviewed to identify hospitalization events in patients with systolic heart failure following cardiac neuronal imaging using {sup 123}I-mIBG. Time to hospitalization was analyzed with the Kaplan-Meier method and compared to the mIBG heart-to-mediastinum (H/M) ratio using multiple-failure Cox regression. During 1.4 years of median follow-up, 362 end-point hospitalizations occurred in 207 of 961 subjects, 79 % of whom had H/M ratio <1.6. Among subjects hospitalized for any cause, 88 % had H/M ratio <1.6 and subjects with H/M ratio <1.6 experienced hospitalization earlier than subjects with higher H/M ratios (log-rank p = 0.003). After adjusting for elevated brain natriuretic peptide (BNP) and time since heart failure diagnosis, a low mIBG H/M ratio was associated with cardiac-related hospitalization (HR 1.48, 95 % CI 1.05 - 2.0; p = 0.02). The mIBG H/M ratio may risk-stratify patients with heart failure for cardiac-related hospitalization, especially when used in conjunction with BNP. Further studies are warranted to examine these relationships. (orig.)

Parker, Matthew W.; Sood, Nitesh [University of Connecticut, School of Medicine Department of Medicine, Farmington, CT (United States); Hartford Hospital, Division of Cardiology, Hartford, CT (United States); Ahlberg, Alan W. [Hartford Hospital, Division of Cardiology, Hartford, CT (United States); Jacobson, Arnold F. [GE Healthcare, Princeton, NJ (United States); Heller, Gary V. [The Intersocietal Accreditation Commission, Ellicott City, MD (United States); Lundbye, Justin B. [University of Connecticut, School of Medicine Department of Medicine, Farmington, CT (United States); The Hospital of Central Connecticut, Division of Cardiology, New Britain, CT (United States)

2014-09-15

106

Pleuropulmonary and cardiac changes after cardiac surgery in plain-film radiography and their influence on the length of hospital treatment  

International Nuclear Information System (INIS)

Of the parameters investigated, the increase in size of the cardiac shadow was the only one to have an effect on the length of the patients' stay in the hospital. In patients with increased heart size after surgery, pleural effusions on the right side were rather more frequent than in the control group. Intrapulmonary or pleural changes were frequent. The length of stationary treatment was not affected by the incidence or localisation of these. (orig.)

107

Dimensionality of the Hospital Anxiety and Depression Scale (HADS) in Cardiac Patients: Comparison of Mokken Scale Analysis and Factor Analysis  

Science.gov (United States)

The Hospital Anxiety and Depression Scale (HADS) measures anxiety and depressive symptoms and is widely used in clinical and nonclinical populations. However, there is some debate about the number of dimensions represented by the HADS. In a sample of 534 Dutch cardiac patients, this study examined (a) the dimensionality of the HADS using Mokken…

Emons, Wilco H. M.; Sijtsma, Klaas; Pedersen, Susanne S.

2012-01-01

108

Women of Child-Bearing Age Have Better In-Hospital Cardiac Arrest Survival Outcomes than Equal Aged Men  

Science.gov (United States)

Objectives Estrogen and progesterone improve neurologic outcomes in experimental models of cardiac arrest and stroke. Our objective was to determine whether women of child-bearing age are more likely than men to survive to hospital discharge following in-hospital cardiac arrest. Design Prospective, observational study Setting 519 hospitals in the National Registry of CPR database Patients 95,852 men and women 15-44 years and ?56 years with pulseless cardiac arrests from 01/01/00 through 07/31/08 Measurements and Main Results Patients were stratified a priori by sex and age groups (15-44 years and ?56 years). Fixed effects regression conditioning on hospital was used to examine the relationship between age, sex and survival outcomes. The unadjusted survival to discharge rate for younger women of child bearing age (15-44 years of age) was 19% (940/4887) versus 17% (1203/7025) for younger men (p=.013). The adjusted hospital discharge difference between these younger women and men was 2.8% (95% CI, 1.0%-4.6%; p=.002) and these younger women also had a 2.6% (95% CI, 0.9% - 4.3%; p=.002) absolute increase in favorable neurologic outcome. For older women compared with men (?56 years), there were no demonstrable differences in discharge rates (18% versus 18%, adjusted difference -0.1%; 95% CI, -0.9% - +0.6%; p=.68) or favorable neurologic outcome (14% versus 14%, adjusted difference -0.1%; 95% CI, -0.7% - +0.5%; p=.74). Conclusions Women of child-bearing age were more likely than comparably aged men to survive to hospital discharge following in-hospital cardiac arrest, even after controlling for etiology of arrest and other important variables. PMID:20228684

Topjian, Alexis A.; Localio, A. Russell; Berg, Robert A.; Alessandrini, Evaline A.; Meaney, Peter A.; Pepe, Paul E.; Larkin, G. Luke; Peberdy, Mary Ann; Becker, Lance B; Nadkarni, Vinay M.

2014-01-01

109

A cellular transtelephonic defibrillator for management of cardiac arrest outside the hospital.  

Science.gov (United States)

A cellular transtelephonic defibrillator facilitates early defibrillation in remote areas and involves electrocardiographic diagnosis and defibrillation control by a physician remote from but in voice contact with the patient-unit operator. The patient unit contains a microprocessor, microphone, defibrillator, electrocardiogram/defibrillator electrode pads and cellular telephone. Activation of the patient-unit initiates automatic dialing and contact with the remotely sited base station within 35 to 50 seconds. The physician at the base station identifies the rhythm and controls defibrillator charging and discharge. The minimal interaction required between the system and the local operator makes it suitable for use by minimally trained first responders. The cellular transtelephonic defibrillator has been tested in 211 calls responded to by a physician-manned mobile coronary care unit over distances up to 15 miles in an urban area. Satisfactory electrocardiographic transmission and voice communication were established in 172 of 211 calls (81.5%). In 39 (18.5%), connection with the base station either could not be established or maintained mainly because of geographic location or battery failure. One hundred direct current shocks of 50 to 360 J were effectively administered to 22 patients with 48 episodes of ventricular fibrillation or ventricular tachycardia with successful correction of 46 of 48 episodes using 1 to 4 shocks per episode. Widespread distribution of such devices could improve survival in patients with cardiac arrest outside the hospital. PMID:1927950

Dalzell, G W; McKeown, P P; Roberts, M J; Adgey, A A

1991-10-01

110

Positive predictive value and impact of misdiagnosis of a heart failure diagnosis in administrative registers among patients admitted to a University Hospital cardiac care unit  

DEFF Research Database (Denmark)

To evaluate the positive predictive value (PPV) of a diagnosis of heart failure (HF) in the Danish National Registry of Patients (NRP) among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF.

Mard, Shan; Nielsen, Finn Erland

2010-01-01

111

Fighting cardiac arrest: Automated external defibrillator  

Directory of Open Access Journals (Sweden)

Full Text Available Ventricular tachyarrhythmias - Ventricular fibrillation (VF and Ventricular tachycardia (VT account for most of out-of-hospital sudden cardiac arrests. Defibrillation is the specific therapy for VF/pulseless VT. Time to defibrillation is the most important determinant of survival from these cardiac arrests. Automated external defibrillator (AED has largely replaced the conventional defibrillator in Basic life support (BLS programmes for out-of-hospital cardiac arrests. AED use by trained laypersons in the community as part of Public Access Defibrillation (PAD programmes has significantly reduced time to defibrillation and increased survival. AED is now being stipulated for home use in people at high risk of sudden cardiac death. AED placement is also recommended in all areas of hospital. Physicians and Intesivists should strive to familiarize the medical fraternity in our country with AED use so that PAD programmes can be launched in the near future.

Kumar V

2003-01-01

112

Cardiac arrest in children  

Directory of Open Access Journals (Sweden)

Full Text Available Major advances in the field of pediatric cardiac arrest (CA were made during the last decade, starting with the publication of pediatric Utstein guidelines, the 2005 recommendations by the International Liaison Committee on Resuscitation, and culminating in multicenter collaborations. The epidemiology and pathophysiology of in-hospital and out-of-hospital CA are now well described. Four phases of CA are described and the term "post-cardiac arrest syndrome" has been proposed, along with treatment goals for each of its four phases: immediate post-arrest, early post-arrest, intermediate and recovery phase. Hypothermia is recommended to be considered as a therapy for post-CA syndrome in comatose patients after CA, and large multicenter prospective studies are underway. We reviewed landmark articles related to pediatric CA published during the last decade. We present the current knowledge of epidemiology, pathophysiology and treatment of CA relevant to pre-hospital and acute care health practitioners.

Tress Erika

2010-01-01

113

Antimicrobial Susceptibility Pattern of Clinical Isolates of Pseudomonas aeruginosa in an Indian Cardiac Hospital.  

Directory of Open Access Journals (Sweden)

Full Text Available Out of the 5933 samples collected a total of 51 isolates of pseudomonas aeruginosa were collected consecutively between 26-December-2010 to 28-February-2011 from different patients. The total of 51 positive isolates consists both of pediatric as well as adult patients. The study was therefore carried out using bothmanual (Kirby-Bauer method as well as automated (Vitek2 system method to determine the Antimicrobial susceptibility pattern of pseudomonas aeruginosa isolates from in-patients and out-patients attending the microbiology section of the hospitals. The isolation rate of Pseudomonas aeruginosa was found to be 8.5% out of the total positive samples which were analyzed. In my study, notable sensitivity (100% to P.aeruginosa was observed against Aztreonam while it was found to be different in case of a study carried out in India earlier which observed Carbepenems with 19.40% resistance. In the study colistin showed the highest (100% sensitivity followed by Amikacin against P. aeruginosa , which is in corroboration with an earlier report published from India. Amikacin seems to be a promising therapy for Pseudomonal infection. Hence, its use should be restricted to severe nosocomial infections, in order to avoid rapid emergence of resistant strains. The sensitivity of Pseudomonas aeruginosa towards Imipenem is found to be 35.294% and towards Meropenem is 41.176%, which is different in case of the earlier study from India. An effective national and state level antibiotic policy and draft guidelines should be introduced to preserve the effectiveness of antibiotics and for better patient management.

S.Meenakumari

2011-09-01

114

Hypothermia and pediatric cardiac arrest  

Directory of Open Access Journals (Sweden)

Full Text Available The survival outcome following pediatric cardiac arrest still remains poor. Survival to hospital discharge ranges anywhere from 0 to 38% when considering both out-of-hospital and in-hospital arrests, with up to 50% of the survivors having neurologic injury. The use of mild induced hypothermia has not been definitively proven to improve outcomes following pediatric cardiac arrest. This may be due to the lack of consensus regarding target temperature, best method of cooling, optimal duration of cooling and identifying the patient population who will receive the greatest benefit. We review the current applications of induced hypothermia in pediatric patients following cardiac arrest after searching the current literature through Pubmed and Ovid journal databases. We put forth compiled recommendations/guidelines for initiating hypothermia therapy, its maintenance, associated monitoring and suggested adjunctive therapies to produce favorable neurologic and survival outcomes.

Schlunt Michelle

2010-01-01

115

Comparison of radiation doses in permanent cardiac pacemaker implantation in three Greek hospitals  

International Nuclear Information System (INIS)

n in any of the hospitals and, therefore, DAP and T were calculated in terms of median values. According to our results, median values of DAP and T were: 6.7 Gycm2 and 2.6 min (Hospital A), 9.0 Gycm2 and 3.0 min (Hospital B), 7.7 Gycm2 and 6.5 min (Hospital C). It appears that Hospital A gave the lowest dose to the patient with the lowest fluoroscopy time. However, at comparable fluoroscopy time with Hospital A and even less than half the fluoroscopy time of Hospital C, Hospital B presented the highest DAP. The results show that probably its X ray equipment is calibrated in higher dose rate than the other two hospitals. The correlation between every patient clinical and technical factor collected (W, H, BMI, kVp and T) and DAP were investigated separately. No correlation was found between DAP and patient weight, height or BMI. No correlation was also found between DAP and kilovoltage. Finally, significant correlation was found in all three hospitals between DAP and T (r=0.72 Hospital A, r=0.87 Hospital B, r=0.87 Hospital C). Comparison of results with recent literature such as those reported by the National Radiation Protection Board (NRPB) (27 Gycm2 and 10.7 min) showed that radiation doses are lower for all three Greek hospitals. The results of the study showed that comparable radiation doses are given in the three hospitals participating in the study. These doses are lower than internationally established reference levels. It was found that patient dimensions do not affect patient radiation dose. The limitation of the study was that the X ray equipment dose rate was not investigated in detail to explain small differences between hospitals and this should be done in the near future. (author)

116

Myocardial Redox State Predicts In-Hospital Clinical Outcome After Cardiac Surgery Effects of Short-Term Pre-Operative Statin Treatment  

Digital Repository Infrastructure Vision for European Research (DRIVER)

OBJECTIVES: The purpose of this study was to evaluate the role of the myocardial redox state in the development of in-hospital complications after cardiac surgery and the effect of statins on the myocardial redox state. BACKGROUND: Statins improve clinical outcome after cardiac surgery, but it is unclear whether they exert their effects by modifying the myocardial redox state. METHODS: We quantified myocardial superoxide anion (O(2)(-)) and peroxynitrite (ONOO(-)) and their enzymatic sources ...

Antoniades, C.; Demosthenous, M.; Reilly, S.; Margaritis, M.; Zhang, Mh; Antonopoulos, A.; Marinou, K.; Nahar, K.; Jayaram, R.; Tousoulis, D.; Bakogiannis, C.; Sayeed, R.; Triantafyllou, C.; Koumallos, N.; Psarros, C.

2012-01-01

117

Hospital-based versus community-based shared care cardiac rehabilitation after acute coronary syndrome : protocol for a randomized clinical trial  

DEFF Research Database (Denmark)

Participation in cardiac rehabilitation (CR) is poor although CR reduces morbidity and mortality. One way in which attendance may potentially be improved is by involving municipal health-care centres (MHCC) and the patient's general practitioner (GP) to a larger degree in a model of shared care cardiac rehabilitation (SC-CR). Our study tests the feasibility of SC-CR and compares the attendance and effects of SC-CR with the individually tailored hospital-based CR (H-CR) programme.

Bertelsen, Jannik Buus; Refsgaard, Jens

2013-01-01

118

Transfer of residents to hospital prior to cardiac death: the influence of nursing home quality and ownership type  

Science.gov (United States)

Objectives We hypothesised that among nursing home decedents, nursing home for-profit status and poor quality-of-care ratings, as well as patient characteristics, would lower the likelihood of transfer to hospital prior to heart disease death. Methods Using death certificates from a large metropolitan area (Tampa Florida Metropolitan Statistical Area) for 1998–2002, we geocoded residential street addresses of heart disease decedents to identify 2172 persons who resided in nursing homes (n=131) at the time of death. We analysed decedent place of death as an indicator of transfer prior to death. Multilevel logistic regression modelling was used for analysis. Cause of death and decedent characteristics were obtained from death certificates. Nursing home characteristics, including state inspector ratings for multiple time points, were obtained from Florida's Agency for Healthcare Administration. Results Nursing home for-profit status, level of nursing care and quality-of-care ratings were not associated with the likelihood of transfer to hospital prior to heart disease death. Nursing homes >5 miles from a hospital were more likely to transfer decedents, compared with facilities located close to a hospital. Significant predictors of no transfer for nursing home residents were being white, female, older, less educated and widowed/unmarried. Conclusions In this study population, contrary to our hypotheses, sociodemographic characteristics of nursing home decedents were more important predictors of no transfer prior to cardiac death than quality rankings or for-profit status of nursing homes. PMID:25332794

Anic, Gabriella M; Pathak, Elizabeth Barnett; Tanner, Jean Paul; Casper, Michele L; Branch, Laurence G

2014-01-01

119

Frequency of cardiac defects among children at echocardiography centre in a teaching hospital  

International Nuclear Information System (INIS)

ory of Rheumatic fever among 45 (30%) children. There were 106 (70.6%) children from lower socio-economic class and 79 (52.6%) parents had history of cousin marriages. Conclusion: Frequency of cardiac defects was more in children of male sex, lower socio-economic group, from birth to three years age and children from primipara mothers in our specified locality. Rheumatic fever, cousin's marriage, and prescribed drugs intake during pregnancy (for metabolic and hormonal disorders) were other contributors to cardiac defects. (author)

120

Avaliação da aderência ao programa de reabilitação cardíaca em um hospital particular geral / Evaluating compliance to a cardiac rehabilitation program in a private general hospital  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Identificar os principais fatores que influenciaram o participante do nosso programa de reabilitação cardiovascular a faltar em suas terapias e correlacioná-los a idade, risco cardiovascular e motivação de nossa população. MÉTODOS: Realizou-se um estudo retrospectivo transversal com 42 pac [...] ientes (69,15±13,93 anos) participantes do programa de reabilitação cardíaca de um hospital geral particular de São Paulo, por meio da análise de duas escalas: a Escala de Barreiras para Reabilitação Cardíaca e a Escala de Disposição. Utilizou-se a correlação de Spearman para relacioná-las com absenteísmo, risco cardiovascular, idade e tempo de reabilitação cardíaca. RESULTADOS: A pontuação total da escala de barreiras foi 31±6 e o escore médio foi de 1,47±0,31. As principais barreiras foram relacionadas às subescalas "viagem/conflito de trabalho" e "problemas pessoais/familiares". A porcentagem de absenteísmo foi 8,4% do número de sessões possíveis de serem realizadas no mês. As faltas e os cancelamentos apresentaram correlação positiva com o risco cardiovascular (p=0,01; r=0,4) e correlações negativas com Escala de Disposição inicial (p=0,03; r=-0,35) e idade (p=0,02; r=-0,35). CONCLUSÃO: "Viagem/conflito de trabalho", "problemas pessoais/familiares" e baixa disposição inicial foram os principais fatores de absenteísmo em um programa de reabilitação cardíaca de um hospital geral particular de São Paulo. Abstract in english OBJECTIVE: Identify the primary factors that influenced the participant in our cardiovascular rehabilitation program towards missing their therapy sessions, and to correlate those factors with age, cardiovascular risk, and motivation of our population. METHODS: We conducted a retrospective study wit [...] h 42 patients (69.15±13.93 years) participating in the cardiac rehabilitation program at a general hospital in São Paulo, through the analysis of two scales applied during the initial evaluation: Cardiac Rehabilitation Barriers Scale and scale of the original provision. We used Spearman correlation to relate them to absenteeism, cardiovascular risk age and duration of cardiac rehabilitation. RESULTS: The total score of barriers was 31±6 and the mean score of 1.47±0.31. The main barriers subscales were related to "travel/labor dispute" and "personal problems/family." The percentage of absenteeism was 8.4% in the number of sessions that could be made in the month. The faults and cancellations were positively correlated with cardiovascular risk (p=0.01; r=0.4) and negatively with scale provision of baseline (p=0.03; r=-0.35) and age (p=0.02; r=-0.35). CONCLUSION: "Travel/labor dispute", "personal/ family problems", and low initial provision are the main factors absenteism in a cardiac rehabilitation program in a general hospital in São Paulo.

Vanessa, Mair; Ana Paula, Breda; Marcos Eduardo Boquembuzo, Nunes; Luciana Diniz Nagem Janot de, Matos.

 
 
 
 
121

Recognizing the Deteriorating Patient Prior to Cardiac Arrest: Predictive Criteria and Risk Factors  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Cardiac arrest is a common end point of various pathophysiological pathways. Out-of-hospital and in-hospital cardiac arrests have a similarly poor survival, although differences exist in terms of pathogenetic mechanisms and prognostic factors. There is time to recognize the deteriorating patient, especially in hospital. Early warning scores and systems that rely on physiological parameters present a window of opportunity for recognizing the deteriorating patient for early intervention. In ord...

Mine Durusu Tanr?över

2011-01-01

122

Major depression and first-time hospitalization with ischemic heart disease, cardiac procedures and mortality in the general population : A retrospective Danish population-based cohort study  

DEFF Research Database (Denmark)

Objective: We investigated the association between unipolar depression and incident hospital admissions due to ischemic heart disease, invasive cardiac procedures and mortality independent of other medical illnesses.Methods: A population-based cohort of 4.6 million persons aged 15 years or older and born in Denmark was followed up from 1995-2009. Incidence rate ratio (IRR) and mortality rate ratio (MRR) were estimated by survival analysis, stratified by or adjusted for gender, age, severe chronic somatic comorbidity and calendar time.Results: Adjusted risks of cardiac hospital admissions and death were significantly increased by up to 15% and 68%, respectively, in persons with hospital admissions due to depression, and were most increased in 15-59 year old women (IRR: 1.64; MRR: 2.57) and men with depression (IRR: 1.39; MRR: 2.21), and during the first 180 days after being diagnosed with depression (women: IRR: 1.38; MRR: 2.35; men: IRR: 1.42; MRR: 2.67). One-year mortality after new ischemic heart disease was elevated by 34% in women and men. By contrast, overall rates of invasive cardiac procedures following cardiac hospitalizations were significantly decreased by 34% in persons with depression but were twofold increased in men recently diagnosed with depression.Conclusion: Clinical depression leading to hospitalization was a risk factor for new cardiac complications independent of somatic comorbidity in the magnitude of other cardiac risk factors, particularly in individuals between 15-59 years of age and during the first weeks following psychiatric admission. Our findings support recent cardiovascular disease prevention guidelines on assessing depression among other psychosocial factors in patients at increased cardiovascular disease (CVD) risk.

Gasse, Christiane; Laursen, Thomas M

2014-01-01

123

The impact of cardiac and noncardiac comorbidities on the short-term outcomes of patients hospitalized with acute myocardial infarction: a population-based perspective  

Directory of Open Access Journals (Sweden)

Full Text Available Han-Yang Chen,1 Jane S Saczynski,1–3 David D McManus,1,4 Darleen Lessard,1 Jorge Yarzebski,1 Kate L Lapane,1 Joel M Gore,4 Robert J Goldberg1,3 1Department of Quantitative Health Sciences, 2Department of Medicine, 3Meyers Primary Care Institute, 4Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA Objectives: The objectives of our large observational study were to describe the prevalence of cardiac and noncardiac comorbidities in a community-based population of patients hospitalized with acute myocardial infarction (AMI at all medical centers in central Massachusetts, and to examine whether multiple comorbidities were associated with in-hospital death rates and hospital length of stay. Methods: The study sample consisted of 2,972 patients hospitalized with AMI at all eleven greater Worcester medical centers in central Massachusetts during the three study years of 2003, 2005, and 2007. Results: The average age of this hospitalized population was 71 years, 55% were men, 93% were Caucasian, and approximately one third had developed an ST segment elevation AMI during the years under study. Hypertension (75% was the most common cardiac condition identified in patients hospitalized with AMI whereas renal disease (22% was the most common noncardiac comorbidity diagnosed in this study population. Approximately one in every four hospitalized patients had any four or more of the seven cardiac conditions examined, while one in 13 had any three or more of the five noncardiac conditions studied. Patients with four or more cardiac comorbidities were more than twice as likely to have died during hospitalization and have a prolonged hospital length of stay, compared to those without any cardiac comorbidities. Patients with three or more noncardiac comorbidities had markedly increased odds of dying during hospitalization and having a prolonged hospital stay compared to those with no noncardiac comorbidities previously diagnosed. Conclusion: Our findings highlight the need for additional contemporary data to improve the short-term outcomes of patients hospitalized with AMI and multiple concurrent medical illnesses. Keywords: population-based study, chronic conditions, acute coronary syndrome

Chen HY

2013-11-01

124

Seroprevalence study of Helicobacter pylori infection among visitors of cardiac patients in Razi hospital in Ahvaz, Iran  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction and objective: Seroepidemiological studies have shown a significant difference in seroprevalence of Helicobacter pylori (HP and its outcome. The aim of this study was to assess the prevalence of HP infection in a normal population (patient's visitors and to determine frequency of some risk factors of this infectious agent. Materials and methods: Cardiac visitors in Razi hospital in Ahvaz were tested for the presence of anti HP-IgG by ELISA assay. Frequency of risk factors for HP acquisition in HP seropositive individuals was studied. Results: The studied subjects included 96 persons with mean age of 58.03 ±11.53 years in whom 52% were females. Fifty five (61.1% persons presented a positive result for anti HP-IgG test Conclusion: HP Seropositivity was not affected by age, sex and residential area. Crowding was the most important risk factors for HP acquisition.

Seyed Mohammad Alavi

2010-01-01

125

Therapeutic hypothermia after cardiac arrest.  

Science.gov (United States)

Prognosis following out-of-hospital cardiac arrest is generally poor, which is mostly due to the severity of neuronal damage. Recently, the use of therapeutic hypothermia has gradually occupied an important role in managing neuronal injuries in some cases of cardiac arrests. Some of the clinical trials conducted in comatose post-resuscitation cardiac arrest patients within the last decade have shown induced hypothermia to be effective in facilitating neuronal function recovery. This method has since been adopted in a number of guidelines and protocols as the standard method of treatment in carefully selected patient groups. Patient inclusion criteria ensure that hypothermia-associated complications are kept to a minimum while at the same time maximizing the treatment benefits. In the present work, we have examined different aspects in the use of therapeutic hypothermia as a means of managing comatose patients following cardiac arrest. PMID:25281626

Alshimemeri, Abdullah

2014-01-01

126

Do we need cardiac arrest centres in Australia?  

Science.gov (United States)

The mortality rate post admission to hospital after successful resuscitation from out-of-hospital cardiac arrest is high, with significant variation between regions and individual institutions. While prehospital factors such as age, bystander cardiopulmonary resuscitation and total cardiac arrest time are known to influence outcome, several aspects of post-resuscitative care including therapeutic hypothermia, coronary intervention and goal-directed therapy may also influence patient survival. Regional systems of care have improved provider experience and patient outcomes for those with ST elevation myocardial infarction and life-threatening traumatic injury. In particular, hospital factors such as hospital size and interventional cardiac care capabilities have been found to influence patient mortality. This paper reviews the evidence supporting the possible development and implementation of Australian cardiac arrest centres. PMID:22757740

Stub, D; Bernard, S; Smith, K; Bray, J E; Cameron, P; Duffy, S J; Kaye, D M

2012-11-01

127

Repair of a Complex Congenital Cardiac Defect  

Medline Plus

Full Text Available ... OF A COMPLEX CONGENITAL CARDIAC DEFECT CHILDREN'S HOSPITAL BOSTON BOSTON, MASSACHUSETTS October 5, 2007 00:00:14 ANNOUNCER: Over the next hour, live from Children's Hospital Boston's cardiac OR, see cardiac surgeons repair a complex ...

128

Repair of a Complex Congenital Cardiac Defect  

Medline Plus

Full Text Available REPAIR OF A COMPLEX CONGENITAL CARDIAC DEFECT CHILDREN'S HOSPITAL BOSTON BOSTON, MASSACHUSETTS October 5, 2007 00:00: ... ANNOUNCER: Over the next hour, live from Children's Hospital Boston's cardiac OR, see cardiac surgeons repair a ...

129

Koronarangiografi bør overvejes efter hjertestop uden for hospital  

DEFF Research Database (Denmark)

Cardiac arrest has a poor prognosis. Ischaemic heart disease is the main cause of out-of-hospital cardiac arrest. This paper is a review of the essential studies on acute coronary angiography and angioplasty in post resuscitation care. No randomised studies were found. Observational studies support the use of acute angiography in ST-segment elevation myocardial infarction. The negative predictive value of ST-segment elevation can be low after out-of-hospital cardiac arrest, and acute angiography should be considered regardless of electrocardiographic findings.

Moesgaard, Jacob; LØfgren, Bo

2011-01-01

130

The cardiac catheterization laboratory personnel TLD dosimetry in Dr. Faghihi Hospital in Shiraz  

International Nuclear Information System (INIS)

In this study all of the personnel of Angiography of Dr.Faghihi hospital used TLD service During 2002-2003. This service was given by center for Radiation Protection and Application of the Shiraz University. These staff were divided in two group, one groups was technicians and the other group was the nurses. The result of this research shows that the maximum dose received to Technicians and nurses were 0.4mSv and 0.55mSV respectively. The average annual dose to technicians and nurses were 0.02 mSv and 0.19 mSv. This result shows that the nurses of this hospital receive more dose than the techniques

131

Recognizing the Deteriorating Patient Prior to Cardiac Arrest: Predictive Criteria and Risk Factors  

Directory of Open Access Journals (Sweden)

Full Text Available Cardiac arrest is a common end point of various pathophysiological pathways. Out-of-hospital and in-hospital cardiac arrests have a similarly poor survival, although differences exist in terms of pathogenetic mechanisms and prognostic factors. There is time to recognize the deteriorating patient, especially in hospital. Early warning scores and systems that rely on physiological parameters present a window of opportunity for recognizing the deteriorating patient for early intervention. In order to prevent cardiac arrests and improve the subsequent survival, it is necessary to implement a rapid and effective chain of survival and to move from a reactive approach to a proactive one.

Mine Durusu Tanr?över

2011-04-01

132

Frequency and echocardiographic study of dilated cardiomyopathy in children presenting with cardiac failure  

International Nuclear Information System (INIS)

Objective: To evaluate the role of echocardiography in diagnosis of dilated cardiomyopathy as a cause of cardiac failure in children. Design: This was descriptive study. Children presenting with cardiac failure from indoor patients were selected and echocardiography along with chest X- ray, ECG, cardiac enzymes and ASO titre was performed in all patients. Subject: Fifty hospitalized patients with congestive heart failure were selected consecutively from hospitalized patients. Main Outcome: Role of echocardiography in the diagnosis of dilated cardiomyopathy in children presenting with cardiac failure. Results: Out of fifty patients admitted with cardiac failure 27 (54%) cases were found to be dilated cardiomyopathy while congenital heart disease, myocarditis and rheumatic heart disease were found in 12 (24%), 8 (16%) and 3 (6%) cases respectively. Conclusion: Dilated cardiomyopathy is an important cause of cardiac failure in children and echocardiography is an important tool to diagnose and differentiate dilated cardiomyopathy from other causes of cardiac failure. (author)

133

The early minutes of in-hospital cardiac arrest: Shock or CPR? A population based prospective study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Objectives In the early minutes of cardiac arrest, timing of defibrillation and cardiopulmonary resuscitation during the basic life support phase (BLS CPR is debated. Aims of this study were to provide in-hospital incidence and outcome data, and to investigate the relation between outcome and time from collapse to defibrillation, time to BLS CPR, and CPR quality. Methods Resuscitation attempts during a 3-year period at St. Olav's University Hospital (960 beds were prospectively registered. The times between collapse and initiation of BLS CPR, and defibrillation were determined. CPR quality was assessed by the resuscitation team. The relation between these variables and outcome (short term survival and discharge was explored using non-parametric correlation and logistic regression. Results CPR was started in a total of 223 arrests, an incidence of 77 episodes per 1000 beds per year. Return of spontaneous circulation occurred in 40%, and 29 patients (13% survived to discharge. Median time from collapse to BLS CPR was 1 minute; CPR was judged to be of good quality in half of the episodes. CPR during the first 3 minutes in ventricular fibrillation (VF/VT was negatively associated with survival, but later proved beneficial. For patients with non-shockable rhythms, we found no association between outcome and time to BLS or CPR quality. Conclusion Our findings indicate that defibrillation should have priority during the first 3 minutes of VF/VT. Later, patients benefit from CPR in conjunction with defibrillation. Patients presenting with non-shockable rhythms have a grave prognosis, and the outcome was not associated with time to BLS or CPR quality.

Skogvoll Eirik

2008-09-01

134

Cardiac ablation procedures  

Science.gov (United States)

Catheter ablation; Radiofrequency catheter ablation ... Cardiac ablation procedures are done in a hospital laboratory by specially trained staff. This includes cardiologists (heart doctors) trained ...

135

Grupo educativo de cirurgia cardíaca em um hospital universitário: impacto psicológico / Cardiac surgery educational group in a university hospital: psychological impact  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Este estudo avaliou o impacto psicológico de um grupo educativo de cirurgia cardíaca em pacientes de um hospital universitário. Participaram 73 sujeitos, dos quais 62% eram homens. A média de idade foi 52 anos, desvio-padrão foi 16. Os pacientes foram submetidos a uma sessão multidisciplinar com exp [...] osição dialogada sobre cardiopatias, procedimento cirúrgico e sintomas psicológicos. Os resultados mostraram que, para poucos pacientes (36%), o grupo ajudou a esclarecer dúvidas sobre o tratamento, demonstrando a necessidade de ajustes nas estratégias didáticas para melhor compreensão dos conteúdos. A análise das emoções percebidas após participação no programa revelou que 70% responderam estar esperançosos. A contraposição entre "esperança" e "tranquilidade" foi uma resposta emocional esperada frente à vivência da cirurgia, avaliada como uma condição de ameaça ambiental. Conclui-se que o grupo educativo foi benéfico para o ajustamento psicossocial do paciente à cirurgia. Entretanto, maior eficácia será alcançada mediante aperfeiçoamento do método de atuação e inclusão de um programa interdisciplinar estruturado para controle do stress. Abstract in english This study assessed the psychological impact of an educational group for cardiac surgery patients in a university hospital. Seventy-three subjects took part in the study - 62% were men with an average age of 52 (standard deviation = 16), subjected to a multidisciplinary session including discussion [...] about heart disease, surgical procedures and psychological symptoms. The results showed that for a few patients (36%), the group helped to clarify questions about the treatment, demonstrating the need for adjustments in teaching strategies for a better understanding of the content. The analysis of emotions perceived after participation in the program showed that 70% were said to be hopeful. The contrast between "hope" and "tranquility" was an expected emotional response given the experience of surgery, evaluated as an environmental threat condition. It was concluded that the educational group was beneficial to the patients' psychosocial adjustment to surgery. However, greater effectiveness will be achieved by improving the performance method and the inclusion of an interdisciplinary program designed to control stress.

Jeanny Joana Rodrigues Alves de, Santana; Luan Flávia Barufi, Fernandes; Carla Rodrigues, Zanin; Christiane Maia, Waeteman; Marcelo, Soares.

136

A CASE-CROSSOVER ANALYSIS OF PARTICULATE MATTER AIR POLLUTION AND OUT-OF-HOSPITAL PRIMARY CARDIAC ARREST. (R827355C001)  

Science.gov (United States)

The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

137

Análise das complicações hospitalares relacionadas ao cateterismo cardíaco / Analysis of in-hospital complications related to cardiac catheterization  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese INTRODUÇÃO: As complicações relacionadas ao cateterismo cardíaco são os principais limitantes desta técnica, e podem variar desde eventos adversos leves e transitórios até eventos graves, como infarto do miocárdio ou morte. OBJETIVO: Avaliar a incidência de complicações imediatas do cateterismo card [...] íaco diagnóstico em adultos, conforme um modelo de categorização das complicações em tipo e gravidade. MÉTODO: Estudo de coorte prospectivo em um centro de referência. As características dos pacientes foram registradas, e estes foram acompanhados até a alta hospitalar. As complicações foram categorizadas em nove modalidades: alérgica, isquêmica, vascular, arrítmica, vaso-vagal, pirogênica, neurológica, embólica e congestivas, e estratificadas em leves (intercorrências), moderadas (resolvidas em até 24 horas) ou graves (necessitou internação ou intervenção). Os fatores preditivos de complicações foram identificados por análise multivariada. RESULTADOS: Foram incluídos 1916 indivíduos, sendo 59,4% do sexo masculino e com média de idade de 58,3±11,1 anos. Complicações ocorreram em 175 pacientes (190 eventos), sendo que 62,5% foram intercorrências leves, 24% moderadas e 13,5% graves. Foi registrado apenas um óbito (0,05% dos indivíduos). As complicações vasculares foram as mais incidentes (35,6%), seguidas das vagais (18,3%), isquêmicas (15,4%) e alérgicas (14,4%). Os fatores de risco para complicações pela análise multivariada foram uso de anticoagulante (3,59; 1,67-7,74; p=0,006) e duração prolongada do exame (1,03; 1,02-1,04; p Abstract in english BACKGROUND: The major limitations of cardiac catheterization are the occurrence of complications related to its invasive nature. Complications can vary from mild and transitory reactions to severe adverse events like myocardial infarction or death. OBJECTIVE: To assess the incidence, type and severi [...] ty of complications related to cardiac catheterization in adults using a comprehensive system previously described. METHODS: We conducted a prospective cohort study in a tertiary reference center, and patient characteristics and in-hospital outcomes were registered in a dedicated database. Complications were categorized in nine types: allergic, ischemic, vascular, arrythmic, vagal, pyrogenic, neurological, embolic and congestive, and stratified in mild, moderate (resolved in 24 hours) or severe (needed hospitalization or another intervention). The predictive factors of complications were assessed by multivariate analysis. RESULTS: We included 1916 individuals, 59% male and with a mean age of 58±11 years. Complications occurred in 175 patients (190 events), and 63% were mild, 24% moderate e 13% severe. There was one (0.05%) death in the entire cohort. Vascular complications were the most common type (36%), followed by vagal (18%), ischemic (15%) and allergic (14%). Risk factors for complications by multivariate analysis were anticoagulant use (OR=3.59; CI=1.67-7.74; p=0.006) and prolonged examination time (OR=1.03; CI=1.02-1.04; p

Géderson, Rossato; Alexandre Schaan de, Quadros; Rogério, Sarmento-Leite; Carlos Antonio M., Gottschall.

2007-03-01

138

Response interval is important for survival until admission after prehospital cardiac arrest  

DEFF Research Database (Denmark)

An increasing distance to the nearest hospital must be expected as a result of centralization of acute care at a small number of hospitals. This may have important consequences in emergency situations, such as prehospital or out-of-hospital cardiac arrest (OHCA) where the aim is to obtain return of spontaneous circulation (ROSC), i.e. successful resuscitation. The aim of this study was to describe the impact of response interval on sustained ROSC, i.e. ROSC at hospital admission, after OHCA with presumed cardiac aetiology.

Do, Hien Quoc; Nielsen, SØren Loumann

2010-01-01

139

Trauma penetrante cardíaco en la unidad de emergencia del Hospital Carlos Van Buren Penetrating cardiac trauma. Review of 36 operated patients  

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Full Text Available El trauma penetrante cardíaco representa una de las mayores causas de muerte por motivo de violencia urbana y se clasifica en penetrante o contuso. La causa más común de trauma cardíaco penetrante es la herida por arma blanca o de fuego. La principal causa de trauma penetrante cardíaco en nuestra serie fue la lesión por arma blanca, siendo el ventrículo derecho la principal cámara cardíaca afectada. Los resultados quirúrgicos son comparables con otras series, con una mortalidad del 16,6% y una morbilidad de 22%. La mortalidad quirúrgica está relacionada con el retraso de la cirugía, o la lesión por arma de fuego, o la presencia de lesiones complejas. Aún sigue siendo fundamental el diagnóstico clínico y el manejo precoz.Background: The most common cause of cardiac penetrating trauma is wounds caused by knives or firearms. Aim: To review the operated cases of penetrating cardiac trauma in a public hospital emergency room. Material and Methods: Review of medical records of patients operated for penetrating cardiac trauma between 1986 and 2009. Results: We retrieved the records of 36 patients (33 males with a median age of 30 years. Ninety four percent of lesions were cause by knife wounds. In 24 patients, the right ventncle was injured. Immediate surgical mortality was 17% and 22% of patients had complications. Conclusions: Surgical mortality in penetrating cardiac trauma is related to the delay of surgical correction, injury by firearms or the presence of complex lesions.

GONZALO GÓMEZ C

2009-10-01

140

Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM: a randomised controlled trial [ISRCTN72884263  

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Full Text Available Abstract Background Cardiac rehabilitation following myocardial infarction reduces subsequent mortality, but uptake and adherence to rehabilitation programmes remains poor, particularly among women, the elderly and ethnic minority groups. Evidence of the effectiveness of home-based cardiac rehabilitation remains limited. This trial evaluates the effectiveness and cost-effectiveness of home-based compared to hospital-based cardiac rehabilitation. Methods/design A pragmatic randomised controlled trial of home-based compared with hospital-based cardiac rehabilitation in four hospitals serving a multi-ethnic inner city population in the United Kingdom was designed. The home programme is nurse-facilitated, manual-based using the Heart Manual. The hospital programmes offer comprehensive cardiac rehabilitation in an out-patient setting. Patients We will randomise 650 adult, English or Punjabi-speaking patients of low-medium risk following myocardial infarction, coronary angioplasty or coronary artery bypass graft who have been referred for cardiac rehabilitation. Main outcome measures Serum cholesterol, smoking cessation, blood pressure, Hospital Anxiety and Depression Score, distance walked on Shuttle walk-test measured at 6, 12 and 24 months. Adherence to the programmes will be estimated using patient self-reports of activity. In-depth interviews with non-attendees and non-adherers will ascertain patient views and the acceptability of the programmes and provide insights about non-attendance and aims to generate a theory of attendance at cardiac rehabilitation. The economic analysis will measure National Health Service costs using resource inputs. Patient costs will be established from the qualitative research, in particular how they affect adherence. Discussion More data are needed on the role of home-based versus hospital-based cardiac rehabilitation for patients following myocardial infarction and revascularisation, which would be provided by the Birmingham Rehabilitation Uptake Maximisation Study (BRUM study and has implications for the clinical management of these patients. A novel feature of this study is the inclusion of non-English Punjabi speakers.

Lane Deirdre

2003-09-01

 
 
 
 
141

Repair of a Complex Congenital Cardiac Defect  

Medline Plus

Full Text Available ... 00:00:14 ANNOUNCER: Over the next hour, live from Children's Hospital Boston's cardiac OR, see cardiac ... cardiac case and answer your email questions. OR-Live makes it easy for you to learn more. ...

142

Abasto, surtimiento y gasto de bolsillo en medicamentos en hospitales públicos de México en 2009 / Supply prescription filling and out-of-pocket expenditures on medicines in public hospitals in Mexico in 2009  

Scientific Electronic Library Online (English)

Full Text Available SciELO Public Health | Language: Spanish Abstract in spanish OBJETIVO. Analizar la disponibilidad de medicamentos en las farmacias hospitalarias, el surtimiento de prescripciones a pacientes egresados y el gasto de bolsillo en medicamentos de pacientes hospitalizados. MATERIAL Y MÉTODOS. Análisis descriptivo de la Encuesta Nacional de Satisfacción y Trato Ade [...] cuado (ENSATA) de 2009 con una muestra representativa de hospitales públicos sobre disponibilidad de una lista de 83 medicamentos en el momento de la visita a la farmacia, la proporción del surtimiento de recetas a pacientes en el momento de su alta y su gasto de bolsillo durante su estancia hospitalaria. RESULTADOS. En total se entrevistó a 26 271 pacientes egresados de los 160 hospitales públicos visitados. La disponibilidad de medicamentos en el ámbito nacional fue de 82%. Los hospitales de los Servicios Estatales de Salud (SESA) mostraron una disponibilidad de 77% (variación de 30 a 96%). El surtimiento completo de recetas fue de 97% en las instituciones de seguridad social, cifra que contrasta con 56.2% de los hospitales de los SESA, que además presentaron una gran varianza entre estados (13 a 94%) La mediana del gasto de pacientes hospitalizados fue de 150 pesos moneda nacional (1% gastó más de 10 000 pesos. CONCLUSIONES. La falta de los medicamentos en los hospitales tiene un impacto económico en el gasto de los hogares, particularmente en aquellos que cuentan con pocos recursos, y puede aumentar la morbilidad o mortalidad de los pacientes hospitalizados en las instituciones públicas. Abstract in english OBJECTIVE. To analyze the availability of drugs in public hospitals, the prescription-filling patterns for in-patients when they are discharged and their out-of-pocket expenditure during their hospitalization. MATERIAL AND METHODS. Using the National Satisfaction and Responsiveness Survey (ENSATA) 2 [...] 009, which includes a representative sample of public hospitals in Mexico in 2009, the availability of 83 essential medicines in the hospital pharmacies at the day of visit, the proportion of prescriptions completely filled for patients when they are discharged and their out-of-pocket expenditure during their hospitalization were analyzed. RESULTS. A total of 26 271 patients in 160 public hospitals were interviewed. The mean availability of drugs was 82% for all hospitals, with the lowest availability for the Ministry of Health (SESA) hospitals (77%, with a range of 30 to 96%). Patients discharged at social security hospitals received in 97% of cases a complete prescription filling, while in SESA hospitals the average was only 56.2%, with a large variance among states (13 to 94%). The median inpatient spending was 150 pesos in national currency (1% spent over 10 000 pesos). CONCLUSIONS. The lack of medicines in public hospitals may increase in-patient morbidity and mortality and has an economic impact on household spending, particularly in those with scarce resources.

Sergio, Sesma-Vázquez; Octavio, Gómez-Dantés; Veronika J, Wirtz; Manuel, Castro-Tinoco.

143

Abasto, surtimiento y gasto de bolsillo en medicamentos en hospitales públicos de México en 2009 / Supply prescription filling and out-of-pocket expenditures on medicines in public hospitals in Mexico in 2009  

Scientific Electronic Library Online (English)

Full Text Available SciELO Mexico | Language: Spanish Abstract in spanish OBJETIVO. Analizar la disponibilidad de medicamentos en las farmacias hospitalarias, el surtimiento de prescripciones a pacientes egresados y el gasto de bolsillo en medicamentos de pacientes hospitalizados. MATERIAL Y MÉTODOS. Análisis descriptivo de la Encuesta Nacional de Satisfacción y Trato Ade [...] cuado (ENSATA) de 2009 con una muestra representativa de hospitales públicos sobre disponibilidad de una lista de 83 medicamentos en el momento de la visita a la farmacia, la proporción del surtimiento de recetas a pacientes en el momento de su alta y su gasto de bolsillo durante su estancia hospitalaria. RESULTADOS. En total se entrevistó a 26 271 pacientes egresados de los 160 hospitales públicos visitados. La disponibilidad de medicamentos en el ámbito nacional fue de 82%. Los hospitales de los Servicios Estatales de Salud (SESA) mostraron una disponibilidad de 77% (variación de 30 a 96%). El surtimiento completo de recetas fue de 97% en las instituciones de seguridad social, cifra que contrasta con 56.2% de los hospitales de los SESA, que además presentaron una gran varianza entre estados (13 a 94%) La mediana del gasto de pacientes hospitalizados fue de 150 pesos moneda nacional (1% gastó más de 10 000 pesos. CONCLUSIONES. La falta de los medicamentos en los hospitales tiene un impacto económico en el gasto de los hogares, particularmente en aquellos que cuentan con pocos recursos, y puede aumentar la morbilidad o mortalidad de los pacientes hospitalizados en las instituciones públicas. Abstract in english OBJECTIVE. To analyze the availability of drugs in public hospitals, the prescription-filling patterns for in-patients when they are discharged and their out-of-pocket expenditure during their hospitalization. MATERIAL AND METHODS. Using the National Satisfaction and Responsiveness Survey (ENSATA) 2 [...] 009, which includes a representative sample of public hospitals in Mexico in 2009, the availability of 83 essential medicines in the hospital pharmacies at the day of visit, the proportion of prescriptions completely filled for patients when they are discharged and their out-of-pocket expenditure during their hospitalization were analyzed. RESULTS. A total of 26 271 patients in 160 public hospitals were interviewed. The mean availability of drugs was 82% for all hospitals, with the lowest availability for the Ministry of Health (SESA) hospitals (77%, with a range of 30 to 96%). Patients discharged at social security hospitals received in 97% of cases a complete prescription filling, while in SESA hospitals the average was only 56.2%, with a large variance among states (13 to 94%). The median inpatient spending was 150 pesos in national currency (1% spent over 10 000 pesos). CONCLUSIONS. The lack of medicines in public hospitals may increase in-patient morbidity and mortality and has an economic impact on household spending, particularly in those with scarce resources.

Sergio, Sesma-Vázquez; Octavio, Gómez-Dantés; Veronika J, Wirtz; Manuel, Castro-Tinoco.

144

Trauma penetrante cardíaco en la unidad de emergencia del Hospital Carlos Van Buren / Penetrating cardiac trauma. Review of 36 operated patients  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish El trauma penetrante cardíaco representa una de las mayores causas de muerte por motivo de violencia urbana y se clasifica en penetrante o contuso. La causa más común de trauma cardíaco penetrante es la herida por arma blanca o de fuego. La principal causa de trauma penetrante cardíaco en nuestra se [...] rie fue la lesión por arma blanca, siendo el ventrículo derecho la principal cámara cardíaca afectada. Los resultados quirúrgicos son comparables con otras series, con una mortalidad del 16,6% y una morbilidad de 22%. La mortalidad quirúrgica está relacionada con el retraso de la cirugía, o la lesión por arma de fuego, o la presencia de lesiones complejas. Aún sigue siendo fundamental el diagnóstico clínico y el manejo precoz. Abstract in english Background: The most common cause of cardiac penetrating trauma is wounds caused by knives or firearms. Aim: To review the operated cases of penetrating cardiac trauma in a public hospital emergency room. Material and Methods: Review of medical records of patients operated for penetrating cardiac tr [...] auma between 1986 and 2009. Results: We retrieved the records of 36 patients (33 males) with a median age of 30 years. Ninety four percent of lesions were cause by knife wounds. In 24 patients, the right ventncle was injured. Immediate surgical mortality was 17% and 22% of patients had complications. Conclusions: Surgical mortality in penetrating cardiac trauma is related to the delay of surgical correction, injury by firearms or the presence of complex lesions.

GONZALO, GÓMEZ C; JOSÉ, HOLA B.

145

Incidence of Subclinical Hypothyroidism in Cardiac Surgery Patients. Comparison of Presentation Characteristics, Hospital and Medium-Term Outcomes with Euthyroid Patients  

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Full Text Available Subclinical hypothyroidism (SCHT is common, with an occurrence of up to 10% of the adult population and defined biochemically only by elevated TSH and normal T4. SCHT affects negatively on lipid and carbohydrate metabolism increasing the risk of ischemic heart disease, affects negatively on cardiac performance and have a close correlation with renal function. The aim of this study is to compare presentation characteristics and outcomes between euthyroid pts and pts with SCHT who underwent cardiac surgery. Methods: 474 pts from June 2003 through September 2004 had TSH and T4 measured. 365 pts were euthyroid (Group 1, 41 pts had SCHT (Group 2. Groups were compared by demographics and EuroSCORE (ES risk profiles. Operative and hospital outcomes were compared as was follow-up mortality up to 96 months. Results: There were more females in Group 2, p = 0.04, more pts with CHF and number of NYHA III-IV pts (p < 0.05. More pts in Group 2 had elevated s-crea (p < 0.0001 and atrial fibrillation (p = 0.007. Comparing the Groups by EuroSCORE (ES showed higher risk scores in Group 2 pts (Additive ES 6.8 vs 8.5 and Logistic ES 12.3% vs 18.1%, p = 0.01 and 0.03. Hospital mortality was higher in Group 2 (12.2% vs 4.1%, p = 0.04 and the number of pts needing extended care was higher in Group 2 (p = 0.01. Follow up mortality was doubled in Group 2 pts up to 96 months compared to Group 1 (p < 0.0001. Conclusions: Presentation characteristics and risk scores are different and worse in SCHT pts compared with euthyroid pts. Hospital and follow-up mortality are increased in SCHT pts.

Aarne Jyrala

2012-09-01

146

[Clinical cardiac rehabilitation].  

Science.gov (United States)

Outpatient cardiac rehabilitation (CR) is offered in at least 100 hospitals in the Netherlands. The majority of cardiac patients are well-served with physical training and education. Some patients with complex cardiac pathology and other problems, including health problems, may however benefit from multidisciplinary in-hospital CR. We present three cardiac patients. The first patient, a 58-year-old man, had coronary and pulmonary disease, suboptimally treated diabetes and psychological problems. He participated in in-hospital CR for 7 weeks, which led to an improved physical and emotional condition. The second patient was 80 years old and did not recover properly following an aortic valve replacement. With in-hospital CR she acquired new skills for mastering the activities of daily life. The third patient we described, a 57-year-old man, suffered from ischaemic heart failure and had had recurrent implantable cardiac defibrillator (ICD) shocks. He was referred for cardiac transplantation but 7 weeks of in-hospital CR resulted in an improved exercise tolerance, significant weight loss and an adequate level of coping with his disease. In-hospital CR is a niche service, but may provide relief for some cardiac patients. PMID:20356430

Brügemann, Johan; Edel, Jan Pieter; Zijlstra, Felix

2010-01-01

147

Comparison of effective doses between computed tomography cardiac angiography and conventional angiography at Pantai Hospital, Kuala Lumpur  

Science.gov (United States)

This research studies two types of cardiac angiography procedures, namely Computed Tomography Cardiac Angiography (CTCA) and Conventional Angiography (CA). The following research was executed to estimate the difference of mean effective doses that the patients received through both procedures. The mean dose-length-product (DLP) from CTCA and mean dose-area-product (DAP) from CA were utilized in calculating the effective doses. The result shows that the mean effective dose for CTCA and CA are 1.71±0.59 mSv and 53.25±14.22 mSv respectively. This proves that the mean effective dose received by patients undergoing CA is higher than patients undergoing CTCA. According to t-test, both procedures differ significantly, with a difference amounting to p<0.0001. The increases of the effective dose that the patients received through CA procedure were influenced by exposure time, the coronary anatomical condition, the operator's experience, and the operation methods.

Mohamed, Faizal; Moin, F. H. A.

2013-05-01

148

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... appreciate the volume of cardiac disease compared to other diseases. If you look at the top bar, ... the hospital for cardiovascular disease compared to many other causes of illness. And if you look at ...

149

Psychiatric Co-Morbidity and Its Associated Factors in Patients with Non Cardiac Chest Pain: A Study from a Tertiary Care Hospital, Kolkata  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Chest pain is a common symptom for patients to attend hospital outdoor all over the world. Majority of the chest pain is due to non-cardiac causes. Both organic and psychiatric causes contribute to the causes of non-cardiac chest pain. Objectives: To find out the socio-demographic profile of the study population, types of psychiatric disorders present in the study population and to find out the association between the presence of psychiatric disorder in the study population with the relevant socio-demographic variables. Material and Method : This is a hospital based descriptive cross sectional study done on 88 diagnosed patients of noncardiac chest pain in the Department Of Psychiatry ,Calcutta National Medical College in the time period of January to July 2011 .Data were collected with the help of predesigned pretested proforma and analysed by SPSS 16.0 . Results: The study revealed that the mean age of the study population was 35.91 years .Most (37.5% of the study population were having middle school education. Regarding psychiatric co morbidities present 58( 65.9%of the study population had psychiatric disorder in some form . Of these 58 (65.9% patients majority (44.9% were having panic disorders followed by depressive disorders (36.2%. Presence of psychiatric disorder was significantly more in married people (p= 0.011, nuclear family (p =0.002, people from rural areas (p=0.001, lower socioeconomic status (p=0.014. Conclusion: No significant association of presence of psychiatric disorder with religion, sex, educational status or occupation was found. [Natl J of Med Res 2013; 3(1.000: 9-12

Abhik Sinha

2013-02-01

150

Nursing assistance at the hospital discharge after cardiac surgery: integrative review / Assistência de enfermagem na alta hospitalar em pós-operatório de cirurgia cardíaca: revisão integrativa  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese O estudo objetivou analisar evidências disponíveis na literatura sobre a assistência de enfermagem na alta hospitalar em pós-operatório de cirurgia cardíaca. Os dados foram coletados das bases eletrônicas LILACS, SciELO, MEDLINE, através dos DeCS cirurgia torácica, alta hospitalar, cuidados de enfer [...] magem, no período de 2001 a 2011. Foram selecionados dez artigos que revelaram a necessidade de desenvolver um plano de alta de enfermagem com foco na prevenção das complicações e no enfrentamento das limitações físicas decorrentes da cirurgia cardíaca. Destarte, a alta hospitalar deve ser pensada desde o momento da admissão, com ações de cuidado planejadas envolvendo paciente e familiar. Abstract in english The study aimed to analyze the available evidence in the literature on nursing care in the hospital post-cardiac surgery. Data were collected from electronic databases LILACS, SciELO, MEDLINE, via DeCS thoracic surgery, hospital, nursing care, in the period 2001 to 2011. Ten articles were selected t [...] hat showed the need to develop a plan of nursing discharge focusing on prevention of complications and coping with physical limitations resulting from heart surgery. Thus, the discharge should be considered from the time of admission, with carefully planned actions involving patient and family.

Daniela Fraga de, Jesus; Patrícia Figueiredo, Marques.

2013-12-01

151

Positive predictive value and impact of misdiagnosis of a heart failure diagnosis in administrative registers among patients admitted to a University Hospital cardiac care unit  

Directory of Open Access Journals (Sweden)

Full Text Available Shan Mard, Finn Erland NielsenDepartment of Cardiology, Herlev University Hospital, DenmarkObjective: To evaluate the positive predictive value (PPV of a diagnosis of heart failure (HF in the Danish National Registry of Patients (NRP among patients admitted to a University Hospital cardiac care unit, and to evaluate the impact of misdiagnosing HF.Design: The NRP was used to identify patients with heart failure from July 1, 2005 to June 30, 2007. Heart failure was defined in accordance with European Society of Cardiology (ESC guidelines. The recorded diagnoses from the NRP were compared with clinical data from the medical records.Results: We identified 758 patients with a diagnosis of heart failure in the NRP. The PPV of a heart failure discharge diagnosis was 84.0% (95% confidence interval: 81.2–86.6. Patients with a discharge diagnosis of HF in the NRP without fulfilling the ESC criteria for HF had a better survival rate, a lower rate of rehospitalization, none were followed in the outpatient clinic, and they had a lower consumption of anticongestive medicine after discharge.Conclusion: We found a relatively high PPV of the HF diagnosis in the NRP, and the NRP can therefore be a valuable tool for identification of patients with HF. However, using the NRP alone will not give a true picture of the cost and total burden of the disease.Keywords: heart failure, diagnosis, positive predictive value, National Registry of Patients

Shan Mard

2010-10-01

152

[Defibrillators--end of sudden cardiac death?].  

Science.gov (United States)

The ventricular fibrillation is still the main cause of a sudden cardiac death, even though it was described 155 years ago in experiment (M. Hoffa 1849) and its therapy--defibrillation--has been known since 1947 (C. Beck). In Europe 2500 inhabitants suffer from cardiac arrest daily and 90% is caused by ventricular fibrillation. A key interval for an effective defibrillation seems to be 3-8 minutes from the begining of a cardiac arrest. Automated (automatized) external defibrillators (AED) have been used for last 15 years, especially in USA. However it is still unclear how many devices will be needed and where to place them. We don't know if they improve the prognosis of patients with out of hospital cardiac arrest during ventricular fibrillation. The individualisation of the risk of a sudden cardiac death has brought a new method to the clinical practise--implantation of cardioverter-defibrillator (ICD). Their efficacy in reduction of total mortality was verified first in the field of secondary prevention--in patients after cardiac arrest (AVID study) and than in the field of primary prevention--in patients with risk markers (left ventricle dysfunction, non sustained ventricular tachycardias) but without sustained malignant arrhythmia in anamnesis (MUSTT, CIDS, MADIT I, MADIT II). Defibrillators (external, automated, implantable) obviously don't mean the end of the sudden cardiac death. The incidence of sudden cardiac death can be reduced significantly with prevention (nutrition, prevention of CAD) and one attention should be drawn to the fact even in the future. PMID:15651143

Kozák, M

2004-10-01

153

Impacto de la rehabilitación cardiaca intrahospitalaria en pacientes con I.M.A Impact of cardiac intra-hospital rehabilitation in patients with Acute Myocardial Infarction  

Directory of Open Access Journals (Sweden)

Full Text Available Se realizó un estudio retrospectivo longitudinal y descriptivo sobre las ventajas de la aplicación de la fase 1 de la RC en el 100% de los pacientes con IMA de bajo riesgo atendidos en el periodo 2003-2004 en el Hospital General Docente ""Comandante Pinares"" en la provincia Pinar del Río. La investigación se basó en la toma de datos obtenidos en los expedientes clínicos de estos pacientes, que están archivados; donde las variables que se exploraron en las encuestas aplicadas incluyen anamnesis, examen físico, electrocardiograma, telecardiografía, aparición de complicaciones mayores y finalmente la clasificación funcional dada al alta hospitalaria. Todos los resultados demostraron las ventajas de la rehabilitación como parte esencial de la atención y terapéutica a la que deben tener acceso los pacientes con afecciones cardíacas de cualquier edad, para mejorar su calidad de vida.A retrospective, longitudinal and descriptive study was done on the advantages of applying the stage I of the RC in 100% of low-risk AMI patients assisted at Comandante Pinares General Teaching Hospital (HGCP during 2003-2004 in Pinar del Río province. The research was based on data collected from the clinical records of these patients, which are filed. The variables explored during the surveys include: anamnesis, physical examination, electrocardiogram, telecardiography, ocurrence of major complications and finally the functional classification done at hospital discharge. All results showed the rehabilitation advantages as essential part of the assistance and therapy which patients of any age and with cardiac disorders should have access to in order to improve their quality of life.

Liván Cruz Benítez

2006-12-01

154

Predictores de mortalidad intrahospitalaria y hospitalización prolongada en la insuficiencia cardíaca: resultados preliminares del registro nacional de insuficiencia cardíaca. Grupo ICARO Predictors of hospital death and prolonged hospitalization in patients with cardiac failure in Chilean hospitals  

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Background: Heart failure (HF) is one of the most common causes for hospital admission. Aim: To evaluate clinical predictors of mortality and prolonged hospital stay among patients admitted for HF in Chilean hospitals. Patients and Methods: Prospective registry of 14 centers. Patients admitted for HF in functional class III and IV were included. Epidemiological, clinical data, functional class, decompensation cause, electrocardiogram, echocardiogram, treatment and evo...

Pablo Castro G; Hugo Verdejo P.; José Luis Vukasovic R; Eduardo Garcés; Ilse González

2006-01-01

155

Improved cardiac arrest outcomes: as time goes by?  

Science.gov (United States)

In a recent issue of Critical Care, Mally and colleagues reported outcomes from an observational study of out-of-hospital cardiac arrests in Slovenia. Multivariable analysis identified independent predictors for hospital discharge, including higher end-tidal carbon dioxide (ETCO2) levels, higher mean arterial pressure (MAP) and the recency (years) of the arrest. ETCO2 has been previously demonstrated to correlate with cardiac index, and predict successful resuscitation. Initial ETCO2 reflects the initial adequacy of resuscitation, and the ETCO2 on admission to hospital reflects a number of factors, including the adequacy of ventilation. During resuscitation, coronary perfusion pressure appears important for survival, but there are limited human data to guide hemodynamic management after cardiac arrest. A higher blood pressure could represent more vasoconstriction, less vasodilation, avoidance of hyperventilation, or a better cardiac output. Improved hospital discharge was also observed during the later years of the study. During this period a number of factors could have contributed to the improved outcome. These include new guidelines, the awareness of the importance of good CPR (including avoidance of hyperventilation), and better post-resuscitation care (including therapeutic hypothermia). It is hard to unravel the actual contribution of these factors to the final outcome, but the authors should be commended for their excellent overall results, and their thought provoking manuscript. PMID:17498319

Morley, Peter T

2007-01-01

156

Características cardíacas e metabólicas de corredores de longa distância do ambulatório de cardiologia do esporte e exercício, de um hospital terciário / Cardiac and metabolic characteristics in long distance runners of sport and exercise cardiology outpatient facility of a tertiary hospital  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Caracterizar parâmetros cardíacos, eletrocardiográficos e funcionais, e respostas cardiopulmonares ao exercício em corredores de longa distância brasileiros, acompanhados no Ambulatório de Cardiologia do Esporte e Exercício de um hospital terciário. MÉTODOS: De uma população inicial de 443 [...] atletas, de ambos os sexos, de diferentes modalidades esportivas, foram avaliados 162 (37%) corredores de longa distância, do sexo masculino, com idade variando entre quatorze e 67 anos. Registros eletrocardiográficos (doze derivações) e ecocardiográficos (modos mono e bidimensional) foram realizados em repouso. Respostas cardiopulmonares foram avaliadas durante teste em esteira rolante, com protocolo em rampa. RESULTADOS: Alterações metabólicas e doenças cardiovasculares foram diagnosticadas em 17% e 9% dos corredores, respectivamente. Bradicardia sinusal e hipertrofia ventricular esquerda foram verificadas em 62% e 33% dos corredores, respectivamente. Alterações estruturais, como cavidade ventricular > 55mm, espessura relativa de parede > 0,44 e índice de massa ventricular > 134g/m2 foram encontradas em 15%, 11% e 7% dos corredores, respectivamente. Fração de ejeção Abstract in english OBJECTIVE: To characterize electrocardiographic and functional cardiac parameters and cardiopulmonary responses to exercise in long-distance Brazilian runners monitored at the Sport and Exercise Cardiology Outpatient Facility of a tertiary care hospital. METHODS: Of an initial population of 443 male [...] and female athletes of different sport modalities, we assessed 162 (37%) long-distance male runners, aged from 14 to 67. Electrocardiographic (12 leads) and echocardiographic (M-mode and two-dimensional) parameters were recorded at rest. Cardiopulmonary responses were evaluated on a treadmill with a ramp protocol. RESULTS: Metabolic alterations and cardiovascular diseases were diagnosed in 17% and 9% of the runners, respectively. Sinus bradycardia and left ventricular hypertrophy were observed in 62% and 33% of the runners, respectively. Structural alterations such as ventricular cavity > 55mm, relative wall thickness > 0.44, and ventricular mass index > 134g/m2 were found in 15%, 11% and 7% of the runners, respectively. Ejection fraction

Luciene Ferreira, Azevedo; Patrícia Chakur, Brum; Dudley, Rosemblatt; Patrícia de Sá, Perlingeiro; Antônio Carlos Pereira, Barretto; Carlos Eduardo, Negrão; Luciana Diniz Nagem Janot de, Matos.

2007-01-01

157

Resultados de la revascularización coronaria en el cardiocentro del Hospital «Hermanos Ameijeiras», en un período de 20 años / Results of coronary revascularization in the Cardiac Center of the "Hermanos Ameijeiras" Clinical Surgical Hospital over 20 years  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish INTRODUCCIÓN. En el cardiocentro del Hospital «Hermanos Ameijeiras», la cirugía cardiovascular se practica hace más de 20 años, a lo largo de los cuales se fueron introduciendo y desarrollando diversas técnicas de revascularización miocárdica. El objetivo de esta investigación fue describir los resu [...] ltados de la cirugía de revascularización coronaria en ese período. MÉTODOS. Se realizó una investigación descriptiva, longitudinal, retrospectiva, con cortes transversales quinquenales, comparando cada quinquenio con el siguiente. Del total de 763 pacientes sometidos a revascularización coronaria en el período comprendido entre enero de 1985 y diciembre del 2004, se excluyeron 17 por presentar historias clínicas extraviadas o con datos incompletos y 15 pacientes operados sin circulación extracorpórea, por lo que el universo de estudio quedó conformado por 731 pacientes, operados todos con circulación extracorpórea. RESULTADOS. Predominaron los pacientes con edades entre 51 y 60 años de edad y del sexo masculino; con el tabaquismo y la hipertensión arterial como factores de riesgo más frecuentes. Los estados clínicos predominantes fueron la angina estable crónica y la angina inestable. Predominó la revascularización con tres puentes con tendencia al ascenso, así como el uso de la vena safena, pero con una evolución ascendente en el empleo de la arteria mamaria interna y disminución en la implantación de la vena safena como único conducto. El tiempo de circulación extracorpórea y de paro anóxico mostró una tendencia a la disminución. Las complicaciones más frecuentes fueron las sepsis urinaria y respiratoria. Disminuyeron las muertes por causas cardíacas, entre las cuales el fallo multiorgánico y el bajo gasto cardíaco fueron las principales. Disminuyó el bajo gasto transoperatorio pero hubo tendencia al aumento en el posoperatorio y del fallo multiorgánico. CONCLUSIONES. El uso de revascularización coronaria tuvo una tendencia ascendente en estos 20 años, sobre todo en pacientes de la tercera edad y del sexo masculino, en los que el tabaquismo y la hipertensión arterial fueron los factores de riesgo mayormente asociados. Predominó la revascularización con tres puentes y el uso de la safena, pero con tendencia al uso ascendente de la arteria mamaria interna. La mortalidad tuvo un comportamiento decreciente. Abstract in english INTRODUCTION. In Cardiac Center of the "Hermanos Ameijeiras" Clinical Surgical Hospital cardiovascular surgery is done from more twenty years ago introducing and developing different techniques of myocardial revascularization. The objective of present research was to describe the results of coronary [...] revascularization over that period. METHODS. A retrospective, longitudinal and descriptive research with five-year cross-sectional cuts was conducted comparing each five-year period with the following one. From the total of 763 patients underwent coronary revascularization from January,1985 to December, 2004, 17 patients were excluded due to missing medical records or with incomplete data and 15 patients operated on without extracorporeal circulation, thus, the universe included 731 patients operated on with this technique. RESULTS. There was predominance the patients aged between 51 and 60years and male sex where smoking and high blood pressure were the more frequent risk factors. The predominant clinical stages were the chronic stable angina and the unstable angina as well as revascularization with three bridges and a trend to rise, as well as the saphenous vein use but with an ascending evolution as the only duct. The time of extracorporeal circulation and anoxic arrest showed a trend to decrease. The more frequent complications were the urinary and respiratory sepsis. There was a decrease of deaths from cardiac causes among which the multiorgan failure and the low cardiac output were the major ones. The low transoperative output decreased but there was a trend to increase

Manuel, Nafeh Abi-Rezk; Raiza, Hernández Núñez; Natanael, Carballo Hidalgo; Alejandro, Villar Inclan; Luis, Guevara González; Nicolás, Chaos González; Rigoberto, Chil Díaz; Katina, Rodríguez Rey.

2011-03-01

158

Resultados de la revascularización coronaria en el cardiocentro del Hospital «Hermanos Ameijeiras», en un período de 20 años / Results of coronary revascularization in the Cardiac Center of the "Hermanos Ameijeiras" Clinical Surgical Hospital over 20 years  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish INTRODUCCIÓN. En el cardiocentro del Hospital «Hermanos Ameijeiras», la cirugía cardiovascular se practica hace más de 20 años, a lo largo de los cuales se fueron introduciendo y desarrollando diversas técnicas de revascularización miocárdica. El objetivo de esta investigación fue describir los resu [...] ltados de la cirugía de revascularización coronaria en ese período. MÉTODOS. Se realizó una investigación descriptiva, longitudinal, retrospectiva, con cortes transversales quinquenales, comparando cada quinquenio con el siguiente. Del total de 763 pacientes sometidos a revascularización coronaria en el período comprendido entre enero de 1985 y diciembre del 2004, se excluyeron 17 por presentar historias clínicas extraviadas o con datos incompletos y 15 pacientes operados sin circulación extracorpórea, por lo que el universo de estudio quedó conformado por 731 pacientes, operados todos con circulación extracorpórea. RESULTADOS. Predominaron los pacientes con edades entre 51 y 60 años de edad y del sexo masculino; con el tabaquismo y la hipertensión arterial como factores de riesgo más frecuentes. Los estados clínicos predominantes fueron la angina estable crónica y la angina inestable. Predominó la revascularización con tres puentes con tendencia al ascenso, así como el uso de la vena safena, pero con una evolución ascendente en el empleo de la arteria mamaria interna y disminución en la implantación de la vena safena como único conducto. El tiempo de circulación extracorpórea y de paro anóxico mostró una tendencia a la disminución. Las complicaciones más frecuentes fueron las sepsis urinaria y respiratoria. Disminuyeron las muertes por causas cardíacas, entre las cuales el fallo multiorgánico y el bajo gasto cardíaco fueron las principales. Disminuyó el bajo gasto transoperatorio pero hubo tendencia al aumento en el posoperatorio y del fallo multiorgánico. CONCLUSIONES. El uso de revascularización coronaria tuvo una tendencia ascendente en estos 20 años, sobre todo en pacientes de la tercera edad y del sexo masculino, en los que el tabaquismo y la hipertensión arterial fueron los factores de riesgo mayormente asociados. Predominó la revascularización con tres puentes y el uso de la safena, pero con tendencia al uso ascendente de la arteria mamaria interna. La mortalidad tuvo un comportamiento decreciente. Abstract in english INTRODUCTION. In Cardiac Center of the "Hermanos Ameijeiras" Clinical Surgical Hospital cardiovascular surgery is done from more twenty years ago introducing and developing different techniques of myocardial revascularization. The objective of present research was to describe the results of coronary [...] revascularization over that period. METHODS. A retrospective, longitudinal and descriptive research with five-year cross-sectional cuts was conducted comparing each five-year period with the following one. From the total of 763 patients underwent coronary revascularization from January,1985 to December, 2004, 17 patients were excluded due to missing medical records or with incomplete data and 15 patients operated on without extracorporeal circulation, thus, the universe included 731 patients operated on with this technique. RESULTS. There was predominance the patients aged between 51 and 60years and male sex where smoking and high blood pressure were the more frequent risk factors. The predominant clinical stages were the chronic stable angina and the unstable angina as well as revascularization with three bridges and a trend to rise, as well as the saphenous vein use but with an ascending evolution as the only duct. The time of extracorporeal circulation and anoxic arrest showed a trend to decrease. The more frequent complications were the urinary and respiratory sepsis. There was a decrease of deaths from cardiac causes among which the multiorgan failure and the low cardiac output were the major ones. The low transoperative output decreased but there was a trend to increase

Manuel, Nafeh Abi-Rezk; Raiza, Hernández Núñez; Natanael, Carballo Hidalgo; Alejandro, Villar Inclan; Luis, Guevara González; Nicolás, Chaos González; Rigoberto, Chil Díaz; Katina, Rodríguez Rey.

159

Ritmo circadiano y variaciones temporales en el paro cardiaco súbito extrahospitalario / Circadian rhythm and time variations in out-hospital sudden cardiac arrest  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Objetivos: Analizar las características cronobiológicas y las variaciones temporales del paro cardiaco extrahospitalario (PCEH). Diseño: Estudio descriptivo retrospectivo. Pacientes: Todos los casos de PCEH de origen cardíaco registrados en la base de datos del servicio de emergencias médicas (SEM) [...] de la Comunidad Autónoma de Castilla y León (España) durante 18 meses. Variables de interés principales: Edad, sexo, recuperación de la circulación espontánea, primer ritmo monitorizado (desfibrilable /no desfibrilable), lugar de alerta [(hogar, lugar público, centro atención primaria (AP)], testigo (familiar, transeúnte, fuerzas de seguridad, personal AP), hora de alerta (0-8; 8-16; 16-24), hora de activación del equipo de emergencias, hora de atención y día de la semana. Análisis univariante mediante Chi², varianza y tests no paramétricos. Análisis cronobiológico mediante transformada rápida de Fourier y test Cosinor. Resultados: Se estudiaron 1.286 casos registrados entre enero 2007 y junio 2008. Se observaron diferencias estadísticas significativas en menor edad (p Abstract in english Objectives: To analyze the chronobiological and time variations of out- hospital cardiac arrest (OHCA). Design: A retrospective descriptive study was made. Patients: All cases of OHCA of cardiac origin registered over 18 months in the database of the emergency medical service (EMS) of the Autonomous [...] Community of Castilla y León (Spain) were evaluated. Variables analyzed: Age, sex, recovery of spontaneous circulation (ROSC), first monitored rhythm (amenable / not amenable to defibrillation), alert site [(home, public place, primary care (PC) center], alerting person (family, witness, law enforcement member, PC center staff), alert time (0-8; 8-16; 16-24), emergency team activation time, care time and day of the week. Univariate analysis (chi-squared), variance, and nonparametric tests comparing the variables in three periods of 8hours. Chronobiological analysis by fast Fourier transform and Cosinor testing. Results: We studied 1286 cases reported between January 2007 and June 2008. Statistically significant differences were observed in terms of younger age, higher incidence in the victim's home, and greater frequency of family-cohabiting persons as witnesses in the period between 0 and 8hours. Chronobiological analysis found daily rhythm (circadian) with acrophase at 11.16h (p

J.B., López-Messa; J.I., Alonso-Fernández; J.M., Andrés-de Llano; J.R., Garmendia-Leiza; J., Ardura-Fernández; F. de, Castro-Rodríguez; J.M., Gil-González.

160

Ritmo circadiano y variaciones temporales en el paro cardiaco súbito extrahospitalario / Circadian rhythm and time variations in out-hospital sudden cardiac arrest  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Objetivos: Analizar las características cronobiológicas y las variaciones temporales del paro cardiaco extrahospitalario (PCEH). Diseño: Estudio descriptivo retrospectivo. Pacientes: Todos los casos de PCEH de origen cardíaco registrados en la base de datos del servicio de emergencias médicas (SEM) [...] de la Comunidad Autónoma de Castilla y León (España) durante 18 meses. Variables de interés principales: Edad, sexo, recuperación de la circulación espontánea, primer ritmo monitorizado (desfibrilable /no desfibrilable), lugar de alerta [(hogar, lugar público, centro atención primaria (AP)], testigo (familiar, transeúnte, fuerzas de seguridad, personal AP), hora de alerta (0-8; 8-16; 16-24), hora de activación del equipo de emergencias, hora de atención y día de la semana. Análisis univariante mediante Chi², varianza y tests no paramétricos. Análisis cronobiológico mediante transformada rápida de Fourier y test Cosinor. Resultados: Se estudiaron 1.286 casos registrados entre enero 2007 y junio 2008. Se observaron diferencias estadísticas significativas en menor edad (p Abstract in english Objectives: To analyze the chronobiological and time variations of out- hospital cardiac arrest (OHCA). Design: A retrospective descriptive study was made. Patients: All cases of OHCA of cardiac origin registered over 18 months in the database of the emergency medical service (EMS) of the Autonomous [...] Community of Castilla y León (Spain) were evaluated. Variables analyzed: Age, sex, recovery of spontaneous circulation (ROSC), first monitored rhythm (amenable / not amenable to defibrillation), alert site [(home, public place, primary care (PC) center], alerting person (family, witness, law enforcement member, PC center staff), alert time (0-8; 8-16; 16-24), emergency team activation time, care time and day of the week. Univariate analysis (chi-squared), variance, and nonparametric tests comparing the variables in three periods of 8hours. Chronobiological analysis by fast Fourier transform and Cosinor testing. Results: We studied 1286 cases reported between January 2007 and June 2008. Statistically significant differences were observed in terms of younger age, higher incidence in the victim's home, and greater frequency of family-cohabiting persons as witnesses in the period between 0 and 8hours. Chronobiological analysis found daily rhythm (circadian) with acrophase at 11.16h (p

J.B., López-Messa; J.I., Alonso-Fernández; J.M., Andrés-de Llano; J.R., Garmendia-Leiza; J., Ardura-Fernández; F. de, Castro-Rodríguez; J.M., Gil-González.

2012-09-01

 
 
 
 
161

Ways out of danger  

International Nuclear Information System (INIS)

The volume divides into five sections: ways out of danger; pressure leading into danger; what might save us, and will it grow to become effective; tedious paths out of danger; companions out of danger. The author puts the question whether the true art of politics will be restored. He shows that by reducing politics to mere crisis management we shall not be enabled to overcome the serious problems of the eighties. He points out future possibilities by making clear the chances and misdevelopments of energy policy, of foreign, development and defence policy. The political experience of recent years, the new approach showing different needs and ways of life should be taken seriously as hopeful signs and ought to be reflected in politics again. (HSCH)

162

Repair of a Complex Congenital Cardiac Defect  

Medline Plus

Full Text Available REPAIR OF A COMPLEX CONGENITAL CARDIAC DEFECT CHILDREN'S HOSPITAL BOSTON BOSTON, MASSACHUSETTS October 5, 2007 00:00:14 ANNOUNCER: Over the next hour, live from Children's Hospital ...

163

Out of the Picture.  

Science.gov (United States)

About 500,000 youngsters drop out of school each year. Reasons children drop out involve a combination of school and personal problems. Dropouts typically believe they have little control over their lives. Sidebars discuss ways of counting dropouts, suggest what schools should do, and provide selected references. (MLF)

Black, Susan

1998-01-01

164

Prehospital randomised assessment of a mechanical compression device in cardiac arrest (PaRAMeDIC trial protocol  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Survival after out-of-hospital cardiac arrest is closely linked to the quality of CPR, but in real life, resuscitation during prehospital care and ambulance transport is often suboptimal. Mechanical chest compression devices deliver consistent chest compressions, are not prone to fatigue and could potentially overcome some of the limitations of manual chest compression. However, there is no high-quality evidence that they improve clinical outcomes, or that they are cost effective. The Prehospital Randomised Assessment of a Mechanical Compression Device In Cardiac Arrest (PARAMEDIC trial is a pragmatic cluster randomised study of the LUCAS-2 device in adult patients with non-traumatic out-of-hospital cardiac arrest. Methods/design The primary objective of this trial is to evaluate the effect of chest compression using LUCAS-2 on mortality at 30 days post out-of-hospital cardiac arrest, compared with manual chest compression. Secondary objectives of the study are to evaluate the effects of LUCAS-2 on survival to 12 months, cognitive and quality of life outcomes and cost-effectiveness. Methods: Ambulance service vehicles will be randomised to either manual compression (control or LUCAS arms. Adult patients in out-of-hospital cardiac arrest, attended by a trial vehicle will be eligible for inclusion. Patients with traumatic cardiac arrest or who are pregnant will be excluded. The trial will recruit approximately 4000 patients from England, Wales and Scotland. A waiver of initial consent has been approved by the Research Ethics Committees. Consent will be sought from survivors for participation in the follow-up phase. Conclusion The trial will assess the clinical and cost effectiveness of the LUCAS-2 mechanical chest compression device. Trial Registration: The trial is registered on the International Standard Randomised Controlled Trial Number Registry (ISRCTN08233942.

McCabe Chris

2010-11-01

165

Learning Out of Leaders  

Digital Repository Infrastructure Vision for European Research (DRIVER)

This paper investigates the estimation problem in a regression-type model. To be able to deal with potential high dimensions, we provide a procedure called LOL, for Learning Out of Leaders with no optimization step. LOL is an auto-driven algorithm with two thresholding steps. A first adaptive thresholding helps to select leaders among the initial regressors in order to obtain a first reduction of dimensionality. Then a second thresholding is performed on the linear regressio...

Kerkyacharian, Gerard; Mougeot, Mathilde; Picard, Dominique; Tribouley, Karine

2010-01-01

166

Evaluation of clinical and demographic characteristics and their association with length of hospital stay in patients admitted to cardiac intensive care unit with the diagnosis of acute heart failure  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: Despite increasing incidence, data regarding clinical and demographic characteristics of patients with acute heart failure (AHF admitted to cardiac intensive care unit (ICU are inconclusive. The aim of this study was to assess the presentation characteristics and factors determining the length of hospital stay in this particular patient population.Methods: We conducted a single-center, prospective study involving 150 patients hospitalized to cardiac ICU with the primary diagnosis of AHF. Chi-square and Student t tests were used for the analysis of categorical and continuous variables, respectively. Linear regression analysis (LRA was used to determine the factors affecting the length of hospital stay. Results: Forty-nine percent of the patients had new-onset AHF and 25% had preserved left ventricular ejection fraction (LVEF. In 25.3% of all patients and 46.6% of the patients with new-onset HF the precipitating factor was acute coronary syndrome. Atrial fibrillation and valvular heart disease as precipitating factors were more common in patients with preserved EF, when compared to low EF group. LRA showed that presence of anemia [?=1.62; 95% CI 0.08-3.15; p=0.039] and severe mitral regurgitation (?=2.55; 95% CI 0.06-5.05; p=0.045 and systolic blood pressure (?=-0.03; 95% CI -0.06 - -0.002; p=0.039 and blood urea nitrogen (?=0.034; 95% CI 0.006 - 0.06; p=0.016 were the independent predictors of length of stay. Conclusion: Underlying cardiovascular risk factors, comorbidities and precipitating pathologies were diverse and highlighted the inhomogeneous characteristics of AHF syndromes. However, in-hospital mortality was high and initial clinical presentation characteristics were significantly associated with in-hospital outcome.

Sami ?ahin

2012-02-01

167

Cardiac lipofibromatosis.  

Science.gov (United States)

We present a case of cardiac lipofibromatosis associated with atrial fibrillation and complete heart block requiring permanent pacemaker implantation. Multimodality cardiac imaging including transthoracic echocardiography and cardiac magnetic resonance were useful for tissue characterization of this rare cardiac diagnosis. PMID:23146562

Shen, Seeger; Rizkallah, Jacques; Kirkpatrick, Iain D C; Khadem, Ali; Jassal, Davinder S

2013-04-01

168

Intraoperative and Anesthesia-Related Cardiac Arrest and Its Mortality in Older Patients: A 15-Year Survey in a Tertiary Teaching Hospital  

Science.gov (United States)

Background Little information is known about factors that influence perioperative and anesthesia-related cardiac arrest (CA) in older patients. This study evaluated the incidence, causes and outcome of intraoperative and anesthesia-related CA in older patients in a Brazilian teaching hospital between 1996 and 2010. Methods During the study, older patients received 18,367 anesthetics. Data collected included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status, anesthesia type, medical specialty team and outcome. All CAs were categorized by cause into one of four groups: patient's disease/condition-related, surgery-related, totally anesthesia-related or partially anesthesia-related. Results All intraoperative CAs and deaths rates are shown per 10,000 anesthetics. There were 100 CAs (54.44; 95% confidence intervals [CI]: 44.68–64.20) and 68 deaths (37.02; 95% CI: 27.56–46.48). The majority of CAs were patient's disease-/condition-related (43.5; 95% CI: 13.44–73.68). There were six anesthesia-related CAs (3.26; 95% CI: 0.65–5.87) - 1 totally and 5 partially anesthesia-related, and three deaths, all partially anesthesia-related (1.63; 95% CI: 0.0–3.47). ASA I-II physical status patients presented no anesthesia-related CA. Anesthesia-related CA, absent in the last five years of the study, was due to medication-/airway-related causes. ASA physical status was the most important predictor of CA (odds ratio: 14.52; 95% CI: 4.48–47.08; P<0.001) followed by emergency surgery (odds ratio: 8.07; 95% CI: 5.14–12.68; P<0.001). Conclusions The study identified high incidence of intraoperative CAs with high mortality in older patients. The large majority of CAs were caused by factors not anesthesia-related. Anesthesia-related CA and mortality rates were 3.26 and 1.63 per 10,000 anesthetics, with no anesthesia-related CA in the last five years of the study. Major predictors of intraoperative CAs were poorer ASA physical status and emergency surgery. All anesthesia-related CAs were medication-related or airway-related, which is important for prevention strategies. PMID:25117481

Nunes, Juscimar C.; Braz, Jose R. C.; Oliveira, Thais S.; de Carvalho, Lidia R.; Castiglia, Yara M. M.; Braz, Leandro G.

2014-01-01

169

Insuficiencia cardíaca en hospitales chilenos: resultados del Registro Nacional de Insuficiencia Cardíaca, Grupo ICARO Cardiac failure in Chilean hospitals: results of the National Registry of Heart Failure, ICARO  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background: Heart failure (HF) is a major public health problem. In Chile hospitalized patients due to HF have not been characterized. Aim: To evaluate clinical profile and outcome of patients hospitalized for heart failure in Chilean hospitals. Patients and Methods: Prospective registry of 14 centers. Patients hospitalized for HF in functional class III and IV were included. Epidemiological and clinical data, functional class, type of presentation, decompensation cau...

Pablo Castro G; José Luis Vukasovic R; Eduardo Garcés S; Luis Sepúlveda M; Marcela Ferrada K; Sergio Alvarado O

2004-01-01

170

Learning Out of Leaders  

CERN Document Server

This paper investigates the problem of selection and estimation in a high dimensional regression-type model. We propose a procedure with no optimization called LOL, for Learning Out of Leaders. LOL is an auto-driven algorithm with two thresholding steps. A first adaptive thresholding helps to select leaders among the initial regressors in such a way to reduce the dimensionality. Then a second thresholding follows the estimations and predictions performed by linear regression on the leaders. Theoretical results are proved. As an estimation procedure, LOL is optimal since the upper exponential bounds are achieved. Rates of convergence are provided and show that LOL is also consistent as a selection procedure. An extensive computational experiment is conducted to emphasize the practical good performances of LOL.

Kerkyacharian, Gerard; Picard, Dominique; Tribouley, Karine

2010-01-01

171

Trombosis venosa mayor asociada a catéter de hipotermia terapéutica en un paciente con paro cardiorrespiratorio recuperado: comunicación de un caso y revisión de la literatura Venous thrombosis secondary to catheter insertion for hypothermia after cardiac arrest: Report of one case  

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To improve survival and reduce neurological injury, the use of mild hypothermia following cardiac arrest has been recommended. We report a 65 years old woman who presented an out-of-hospital ventricular fibrillation and cardiac arrest. The patient was comatose following initial resuscitation and was admitted into the ICU, where cooling was initiated using an intravascular catheter. After 48 hours, rewarming was initiated. Although no neurological impairment was observ...

Jaime Retamal; Jean Bachler; Ricardo Mejía; Orlando Concha; Max Andresen

2011-01-01

172

Influence of mild therapeutic hypothermia on the inflammatory response after successful resuscitation from cardiac arrest  

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BACKGROUND: Patients after successful cardiopulmonary resuscitation (CPR) from out-of-hospital cardiac arrest (OHCA) exhibit a systemic inflammatory response. Although animal studies document conflicting data on the influence of hypothermia on cytokine release in various settings, no data exist if hypothermia affects the inflammatory response after successful cardiopulmonary resuscitation. MATERIALS AND METHODS: Arrest- and treatment-related variables of 71 patients were documented and se...

Stoppe, Christian

2009-01-01

173

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... sudden death. Sudden death, even you survive to go to the hospital but survive out of those ... 35 percent going to have it, 65 percent go to die -- to survive may be under 65. ...

174

Toleration out of respect?  

DEFF Research Database (Denmark)

Under conditions of pluralism different cultures, interests or values can come into conflict, which raises the problem of how to secure peaceful co-existence. The idea of toleration historically emerged as an answer to this problem. Recently Rainer Forst has argued that toleration should not just be based on a modus vivendi designed to secure peaceful co-existence, but should be based on moral reasons. Forst therefore advances what he calls the ‘respect conception’ of toleration as an in itself morally desirable type of relationship, which is furthermore the only conception of toleration that avoids various so-called ‘paradoxes of toleration’. The paper first examines whether Forst’s respect conception can be applied descriptively to distinguish between actual patterns of behaviour and classify different acts of toleration. Then the focus is shifted to toleration out of respect as a normative prescription, which Forst presents as a requirement of justice. At both levels, it is argued that Forst’s respect conception is problematic since it presupposes that answers to very substantial normative questions, which are precisely what people tend to disagree on under conditions of pluralism, are already at hand. The respect conception therefore seems to be at best a theoretical idea belonging in ideal-theory, not a useful practical solution to actual conflicts under conditions of pluralism.

Lægaard, Sune

2014-01-01

175

Sudden cardiac death: Role of therapeutic hypothermia  

Directory of Open Access Journals (Sweden)

Full Text Available Permanent neurocognitive deficits due to cerebral sequelae account for the majority of long-term morbidity and mortality in survivors of cardiac arrest today. Albeit therapeutic hypothermia had been used as effective measure to ameliorate cerebral ischemia-reperfusion injury during surgery for decades, it was not yet introduced into regular post-arrest care until 2003 due to significant side effects of profound hypothermia. These include shivering, higher infection rates, coagulopathy or cardiac arrhythmias, but are less frequently observed with mild therapeutic hypothermia. When body temperature is kept around 33°C, the beneficial effects of hypothermia clearly outweigh its adverse effects. Therefore, treatment of comatose survivors of out-of-hospital cardiac arrest using mild therapeutic hypothermia has now been widely adopted around the globe. Although it still remains controversial who, how, when, and for how long to cool, with only six patients requiring treatment to save one additional life, it is clear that therapeutic hypothermia is the single most effective intervention in brain resuscitation available today.

Matthias Derwall

2012-05-01

176

A collaborative chain out of phase  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: The aim of this study is to explore the obstacles to collaborations between nurses in hospital and municipal care in the discharge of hospital patients who need continuing care.Methods: First, we conducted in-depth interviews of nurses in hospitals and nurses in municipal care. Second, we developed questionnaires and distributed them to a representative sample of Norwegian municipalities to study the representativeness of the most important findings from the interviews.Results: Municipal care nurses reported that the information they receive from hospital departments usually is insufficient for a complete understanding of a patient's needs. Formal discharge reports from hospital serve as a post factum formalization and authorization of information collected by municipal nurses in an ad hoc fashion and via oral communication.  Typically, formal information routines are out of phase with the information needed by municipal care professionals.Conclusions: Hospital information provided at discharge is neither sufficient nor timely with respect to the information needs of nurses in municipal care. Organizational efforts and the use of information technology might ease some obstacles, but several problems will remain because of differences in professional orientation and the contexts of care delivery.

Bård Paulsen

2013-03-01

177

Incidence of Subclinical Hypothyroidism in Cardiac Surgery Patients. Comparison of Presentation Characteristics, Hospital and Medium-Term Outcomes with Euthyroid Patients  

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Subclinical hypothyroidism (SCHT) is common, with an occurrence of up to 10% of the adult population and defined biochemically only by elevated TSH and normal T4. SCHT affects negatively on lipid and carbohydrate metabolism increasing the risk of ischemic heart disease, affects negatively on cardiac performance and have a close correlation with renal function. The aim of this study is to compare presentation characteristics and outcomes between euthyroid pts and pts with SCHT who underwent ca...

Aarne Jyrala; Gatto, Nicole M.; Kay, Gregory L.

2012-01-01

178

Causes and indications for reoperation in valve replacement and coronary artery bypass graft (CABG in 915 patients in cardiac surgery department in Imam Khomeini Hospital, 1374-77  

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Full Text Available Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female. The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A Valvular complications (female/male=3/1, B Non valvular complications (female/male=1/3. The most common nonvalvular complication was bleeding (66.6 percent. The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915 the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.

Radmehr H

2001-08-01

179

The Effects of Cardiac Rehabilitation on Changes in the Lipid Profile of Iranian Male and Female with Coronary Artery Disease Refered to Emam Khomeini Hospital Complex  

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Full Text Available Background and aim: One of the most important part of management and modification of CAD risk factor is to control the level of plasma lipid profile. Application of comprehensive cardiac rehabilitation in patient with CAD could decrease the level of CHL, TG, LDL and increasing of HDL .There are a lot of studies that discuss the effect of rehabilitation on different people with different races and life style . Material and Methods: Thirty six patients with the age (40-75 who were referred by cardiologist participated in this study. Fast walking on treadmill, biking on stationary bicycle and cycling with upper body ergometer were chosen as aerobic exercises. For assessing the short term and long term effects of this protocol, blood sampling were taken at three stages; before exercise initiation, after 12 and 24 sessions of exercise. Results: Following the cardiac rehabilitation protocol, the level of CHL, LDL and the ratio of LDL/HDL and CHL/HDL decreased significantly. Conclusion: Cardiac rehabilitation could be used as means to improve lipid profile level in blood serum, prevention of cardiovascular disease and reducing mortality and morbidity rates.

Shohreh Jalaei

2010-12-01

180

Trastuzumab-associated cardiac dysfunction  

International Nuclear Information System (INIS)

We analyzed 127 consecutive patients who received trastuzumab-based chemotherapy from December, 2003 to February, 2009 in our hospital. Of 127 patients, cardiac dysfunction appeared in 6 patients (4.7%). Cardiac dysfunction was defined as a decline in left ventricular (LV) ejection fraction (EF) ?55% with absolute reduction of at least 10% from baseline. Among the 6 patients with cardiac dysfunction, one patient suffered symptomatic heart failure. Other patients were asymptomatic. The 4 patients of the 5 patients recovered their cardiac dysfunction after withdrawal of trastuzumab. Patients with trastuzumab-associated cardiac dysfunction had a history of administration of epirubicin or taxane, lower registration LVEF, and larger LV end-diastolic dimension (?49 mm). We recommend that LV function be assessed by echocardiography or multigated radionuclide angiography scans prior to instituting trastuzumab therapy and at three-month intervals during therapy. Trastuzumab should be discontinued in patients who develop a decrease in LVEF below 45% or congestive heart failure. (author)

 
 
 
 
181

Cardiac cephalgia  

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The purpose of this review was to provide a critical evaluation of medical literature on so-called “cardiac cephalgia” or “cardiac cephalalgia”. The 2004 International Classification of Headache Disorders codes cardiac cephalgia to 10.6 in the group of secondary headaches attributed to disorder of homoeostasis. This headache is hardly recognizable and is associated to an ischaemic cardiovascular event, of which it may be the only manifestation in 27% of cases. It usually occurs after ...

Bini, Annamaria; Evangelista, Andrea; Castellini, Paola; Lambru, Giorgio; Ferrante, Tullia; Manzoni, Gian Camillo; Torelli, Paola

2009-01-01

182

Cardiac perioperative complications in noncardiac surgery  

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Full Text Available Anesthesiologists are confronted with an increasing population of patients undergoing noncardiac surgery who are at risk for cardiac complications in the perioperative period. Perioperative cardiac complications are responsible for significant mortality and morbidity. The aim of the present study was to determine the incidence of perioperative (operative and postoperative cardiac complications and correlations between the incidence of perioperative cardiac complications and type of surgical procedure, age, presence of concurrent diseases. A total of 100 patients with cardiac diseases undergoing noncardiac surgery were included in the prospective study (Group A 50 patients undergoing intraperitoneal surgery and Group B 50 patients undergoing breast and thyroid surgery. The patients were followed up during the perioperative period and after surgery until leaving hospital to assess the occurrence of cardiac events. Cardiac complications (systemic arterial hypertension, systemic arterial hypotension, abnormalities of cardiac conduction and cardiac rhythm, perioperative myocardial ischemia and acute myocardial infarction occurred in 64% of the patients. One of the 100 patients (1% had postoperative myocardial infarction which was fatal. Systemic arterial hypertension occurred in 57% of patients intraoperatively and 33% postoperatively, abnormalities of cardiac rhythm in 31% of patients intraoperatively and 17% postoperatively, perioperative myocardial ischemia in 23% of patients intraoperatively and 11% of postoperatively. The most often cardiac complications were systemic arterial hypertension, abnormalities of cardiac rhythm and perioperative myocardial ischemia. Factors independently associated with the incidence of cardiac complications included the type of surgical procedure, advanced age, duration of anaesthesia and surgery, abnormal preoperative electrocardiogram, abnormal preoperative chest radiography and diabetes.

Radovanovi? Dragana

2008-01-01

183

Perfil de recém-nascidos submetidos à cirurgia cardíaca em hospital privado do Município de São Paulo / Profile of newborns who underwent cardiac surgery in a private hospital in the city of São Paulo / Perfil de los recién nacidos sometidos a cirugía cardiaca en un Hospital privado del municipio de Sao Paulo  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Estudo transversal cujo objetivo foi descrever o perfil dos recém-nascidos submetidos à cirurgia cardíaca em um hospital privado, referência em cirurgia cardíaca neonatal, no município de São Paulo. Foram analisados prontuários de 30 pacientes internados entre julho de 2001 a dezembro de 2005. Foram [...] incluídos neonatos com idade > 35 semanas, com anomalias cardíacas. Excluíram-se os neonatos com óbito no 1. pós-operatório (OP) e com outras malformações sistêmicas. A maioria dos RNs nasceu a termo, com peso > a 2.500g e submetidos à cirurgia na primeira semana de vida. Foram identificados 24 diferentes diagnósticos de cardiopatias e 14 diferentes intervenções cirúrgicas. No 1. PO, todos os neonatos estavam com dispositivos para monitorar os parâmetros vitais ou como via de acesso para tratamento e suporte de vida, mostrando não só a complexidade do tratamento, como a necessidade de planejamento e organização do serviço na implementação da assistência a estes pacientes. Abstract in spanish El objetivo en este estudio transversal fue caracterizar a los recién nacidos sometidos a cirugía cardiaca en un hospital privado del municipio de Sao Paulo. Los dados fueron obtenidos de las historias clínicas de los recién nacidos sometidos a cirugía entre julio de 2001 y diciembre del 2005. Los r [...] ecién nacidos con 35 semanas o más de gestación fueron incluidos y excluidos los recién nacidos con óbito en el 1er dia de post-operatorio (PO) y con otras malformaciones sistémicas. La mayoría de los RNs nació a término, con peso a 2.500g e sometidos a la cirugía en la primera semana de vida. Fueron identificados 24 diferentes diagnósticos de cardiopatías y 14 diferentes intervenciones quirúrgicas. En el 1er dia de PO, todos los neonatos estaban con dispositivos para monitorear los parámetros vitales o como vía de acceso para el tratamiento y soporte de vida, mostrando no sólo la complejidad del tratamiento, sino también la necesidad de planificación y organización del servicio en la implementación de la asistencia a estos pacientes. Abstract in english The aim of this cross-sectional study was to characterize newborns that underwent cardiac surgery in a private hospital, a reference center in neonatal cardiac surgery, in the city of São Paulo. Data were collected from medical reports from July, 2001 to December, 2005. Newborns with gestational age [...] of more than 35 weeks were included in the study. Newborns that died on the first 48 postoperative hours and with other malformations were excluded. Most of the neonates were term, weighted 2,500 grams or more, and underwent surgery in the first week of life. There were 24 different diagnoses identified and 14 different types of surgery performed. In the first post-operative day, all newborns had invasive devices for vital signs monitoring or for treatment and life support, which shows not only the complexity of the treatment but the need for planning and organizing health services in order to provide adequate care for these patients.

Mariana, Bueno; Amélia Fumiko, Kimura.

2008-03-01

184

Perfil de recém-nascidos submetidos à cirurgia cardíaca em hospital privado do Município de São Paulo / Profile of newborns who underwent cardiac surgery in a private hospital in the city of São Paulo / Perfil de los recién nacidos sometidos a cirugía cardiaca en un Hospital privado del municipio de Sao Paulo  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Estudo transversal cujo objetivo foi descrever o perfil dos recém-nascidos submetidos à cirurgia cardíaca em um hospital privado, referência em cirurgia cardíaca neonatal, no município de São Paulo. Foram analisados prontuários de 30 pacientes internados entre julho de 2001 a dezembro de 2005. Foram [...] incluídos neonatos com idade > 35 semanas, com anomalias cardíacas. Excluíram-se os neonatos com óbito no 1. pós-operatório (OP) e com outras malformações sistêmicas. A maioria dos RNs nasceu a termo, com peso > a 2.500g e submetidos à cirurgia na primeira semana de vida. Foram identificados 24 diferentes diagnósticos de cardiopatias e 14 diferentes intervenções cirúrgicas. No 1. PO, todos os neonatos estavam com dispositivos para monitorar os parâmetros vitais ou como via de acesso para tratamento e suporte de vida, mostrando não só a complexidade do tratamento, como a necessidade de planejamento e organização do serviço na implementação da assistência a estes pacientes. Abstract in spanish El objetivo en este estudio transversal fue caracterizar a los recién nacidos sometidos a cirugía cardiaca en un hospital privado del municipio de Sao Paulo. Los dados fueron obtenidos de las historias clínicas de los recién nacidos sometidos a cirugía entre julio de 2001 y diciembre del 2005. Los r [...] ecién nacidos con 35 semanas o más de gestación fueron incluidos y excluidos los recién nacidos con óbito en el 1er dia de post-operatorio (PO) y con otras malformaciones sistémicas. La mayoría de los RNs nació a término, con peso a 2.500g e sometidos a la cirugía en la primera semana de vida. Fueron identificados 24 diferentes diagnósticos de cardiopatías y 14 diferentes intervenciones quirúrgicas. En el 1er dia de PO, todos los neonatos estaban con dispositivos para monitorear los parámetros vitales o como vía de acceso para el tratamiento y soporte de vida, mostrando no sólo la complejidad del tratamiento, sino también la necesidad de planificación y organización del servicio en la implementación de la asistencia a estos pacientes. Abstract in english The aim of this cross-sectional study was to characterize newborns that underwent cardiac surgery in a private hospital, a reference center in neonatal cardiac surgery, in the city of São Paulo. Data were collected from medical reports from July, 2001 to December, 2005. Newborns with gestational age [...] of more than 35 weeks were included in the study. Newborns that died on the first 48 postoperative hours and with other malformations were excluded. Most of the neonates were term, weighted 2,500 grams or more, and underwent surgery in the first week of life. There were 24 different diagnoses identified and 14 different types of surgery performed. In the first post-operative day, all newborns had invasive devices for vital signs monitoring or for treatment and life support, which shows not only the complexity of the treatment but the need for planning and organizing health services in order to provide adequate care for these patients.

Mariana, Bueno; Amélia Fumiko, Kimura.

185

Crisis management during anaesthesia: cardiac arrest  

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Background: Cardiac arrest attributable to anaesthesia occurs at the rate of between 0.5 and 1 case per 10 000 cases, tends to have a different profile to that of cardiac arrest occurring elsewhere, and has an in-hospital mortality of 20%. However, as individual practitioners encounter cardiac arrest rarely, the rapidity with which the diagnosis is made and the consistency of appropriate management varies considerably.

Runciman, W.; Morris, R.; Watterson, L.; Williamson, J.; Paix, A.

2005-01-01

186

Repair of a Complex Congenital Cardiac Defect  

Medline Plus

Full Text Available ... CARDIAC DEFECT CHILDREN'S HOSPITAL BOSTON BOSTON, MASSACHUSETTS October 5, 2007 00:00:14 ANNOUNCER: Over the next ... on the camera it looks like it's a big blob of tissue where you really can't ...

187

Repair of a Complex Congenital Cardiac Defect  

Medline Plus

Full Text Available ... live webcast. My name is Emile Bacha. I'm one of the cardiac surgeons at Children's Hospital ... the heart is immobile and has stopped. I'm not quite certain whether he's going to want ...

188

Repair of a Complex Congenital Cardiac Defect  

Medline Plus

Full Text Available ... CARDIAC DEFECT CHILDREN'S HOSPITAL BOSTON BOSTON, MASSACHUSETTS October 5, 2007 00:00:14 ANNOUNCER: Over the next ... in no significant distress. His weight is 6.5 kg, but he's not growing well. The echo -- ...

189

Cardiac asthma.  

Science.gov (United States)

Cardiac dyspnea, especially if present only with exercise, is often confused with asthma and exercise-induced bronchospasm. Cardiac dyspnea or asthma is the consequence of pulmonary edema due to pulmonary venous hypertension and not due to asthmatic bronchoconstriction. In overt, acute congestive heart failure, the diagnosis may be readily made by history and physical examination and pertinent laboratory and imaging data. PMID:23337063

Buckner, Kern

2013-02-01

190

Cardiac rhabdomyosarcoma  

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Full Text Available Background. Primary malignant cardiac tumors are rare entities and rhabdomyosarcoma accounts 20% of these lesions. Case report. We presented a female patient with loss of appetite and loss of weight. She also had symptoms of heart failure and bilateral pleural effusions. A mobile tumor in the left heart with the entrance from the left atrium to left ventricle during diastole was seen by transthoracic echocardiography. The tumor was extirpated in total, histologic diagnosis was rhabdomyosarcoma, and the patient died after 6 months. Conclusion. Primary malignant cardiac tumors can simulate heart failure or systemic disorders. Cardiac rhabdomyosarcomas have a poor prognosis with the average survival of 6 months after the occurrence of symptoms and making a diagnosis. In cardiac insufficiency, differential diagnostics should be used to consider cardiac tumors that could be with certainty confirmed or excluded by echocardiography.

Damjanovi? Miodrag R.

2007-01-01

191

Insuficiencia cardíaca en hospitales chilenos: resultados del Registro Nacional de Insuficiencia Cardíaca, Grupo ICARO / Cardiac failure in Chilean hospitals: results of the National Registry of Heart Failure, ICARO  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english Background: Heart failure (HF) is a major public health problem. In Chile hospitalized patients due to HF have not been characterized. Aim: To evaluate clinical profile and outcome of patients hospitalized for heart failure in Chilean hospitals. Patients and Methods: Prospective registry of 14 cente [...] rs. Patients hospitalized for HF in functional class III and IV were included. Epidemiological and clinical data, functional class, type of presentation, decompensation cause, electrocardiogram, echocardiogram, treatment and evolution were registered. Results: Three hundred seventy two patients aged 69±13 years old, 59% men, were assessed. The main etiologies of HF were ischemic in 31.6%, hypertensive in 35.2%, valvular in 14.9% and idiopathic in 7.4%. There was a history of hypertension 69%, diabetes in 35%, myocardial infarction in 22%, atrial fibrillation (AF) in 28%. The presentation form of HF was chronic decompensated in 86%, acute in 12%, refractory in 2%. The causes of decompensation were non compliance with diet or medical prescriptions in 28%, infections in 22% and AF 17%. ECG showed AF in 36% and left bundle branch block in 16%. Echocardiography was performed in 52% of the patients, 69% had left ventricular ejection fraction

Pablo, Castro G; José Luis, Vukasovic R; Eduardo, Garcés S; Luis, Sepúlveda M; Marcela, Ferrada K; Sergio, Alvarado O.

2004-06-01

192

Rationale, Development and Implementation of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest  

Science.gov (United States)

Objective To describe the development, design and consequent scientific implications of the Resuscitation Outcomes Consortium (ROC) population-based registry; ROC Epistry–Cardiac Arrest. Methods The ROC Epistry–Cardiac Arrest is designed as a prospective population-based registry of all Emergency Medical Services (EMS)-attended 9-1-1 calls for patients with out-of-hospital cardiac arrest occurring in the geographical area described by the eight US and three Canadian regions. The data set was derived by an North American interdisciplinary steering committee. Enrolled cases include individuals of all ages who experience cardiac arrest outside the hospital, with evaluation by organized EMS personnel and: a) attempts at external defibrillation (by lay responders or emergency personnel), or chest compressions by organized EMS personnel; OR b) were pulseless but did not receive attempts to defibrillate or CPR by EMS personnel. Selected data items are categorized as mandatory or optional and undergo revisions approximately every 12 months. Where possible all definitions are referenced to existing literature. Where a common definition did not exist one was developed. Optional items include standardized CPR process data elements. It is anticipated the ROC Epistry–Cardiac Arrest will enroll between approximately 9000 and 13,500 treated all rhythm arrests and 4000 and 5000 ventricular fibrillation arrests annually and approximately 8000 EMS-attended but untreated arrests. Conclusion We describe the rationale, development, design and future implications of the ROC Epistry– Cardiac Arrest. This paper will serve as the reference for subsequent ROC manuscripts and for the common data elements captured in both ROC Epistry–Cardiac Arrest and the ROC trials. PMID:18479802

Morrison, Laurie J.; Nichol, Graham; Rea, Thomas D.; Christenson, Jim; Callaway, Clifton W.; Stephens, Shannon; Pirrallo, Ronald G.; Atkins, Dianne L.; Davis, Daniel P.; Idris, Ahamed H.; Newgard, Craig

2014-01-01

193

Out of shadow / Peeter Linnap  

Index Scriptorium Estoniae

"Out of shadow" oli näitus Baltimaade 1990. aastate kunstist Ameerika publikule - sõnumiks iseseisvumisjärgsete aastate materiaalse, sotsiaalse ning vaimuelu peegeldused/tõlgendused visuaalses kunstis

Linnap, Peeter, 1960-

2007-01-01

194

Pre-hospital treatment of STEMI patients. A scientific statement of the Working Group Acute Cardiac Care of the European Society of Cardiology  

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In ST-elevation myocardial infarction (STEMI) the pre-hospital phase is the most critical, as the administration of the most appropriate treatment in a timely manner is instrumental for mortality reduction. STEMI systems of care based on networks of medical institutions connected by an efficient emergency medical service are pivotal. The first steps are devoted to minimize the patient's delay in seeking care, rapidly dispatch a properly staffed and equipped ambulance to make the diagnosis on ...

Tubaro, M.; Danchin, N.; Goldstein, P.; Filippatos, G.; Hasin, Y.; Heras, M.; Jansky, P.; Norekval, Tm; Swahn, E.; Thygesen, K.; Vrints, C.; Zahger, D.; Arntz, Hr; Bellou, A.; La Coussaye, Je

2011-01-01

195

Cardiac Rehabilitation  

Science.gov (United States)

Cardiac rehabilitation (rehab) is a medically supervised program to help people who have A heart attack Angioplasty or coronary artery bypass grafting for coronary heart disease A heart valve repair or replacement A ...

196

Gasometria arterial em dois diferentes métodos de transporte intra-hospitalar no pós-operatório imediato de cirurgia cardíaca Arterial blood gas analysis in two different intra-hospital transport methods for postoperative cardiac surgery patients  

Directory of Open Access Journals (Sweden)

Full Text Available OBJETIVO: Avaliar as repercussões gasométricas de dois métodos de ventilação (ventilador de transporte e ressuscitador manual autoinflável durante o transporte intra-hospitalar de pacientes submetidos à cirurgia cardíaca. MÉTODOS: Estudo observacional, longitudinal, prospectivo e randomizado. Foram coletadas gasometrias arteriais ao final da cirurgia e ao final do transporte do paciente. RESULTADOS: Foram incluídos 23 pacientes: 13 no Grupo ventilador de transporte e 10 no ressuscitador manual autoinflável. As características dos pacientes entre os grupos foram semelhantes, exceto pela maior gravidade no Grupo ventilador de transporte. Observaram-se diferenças significativas nas comparações das variações percentuais dos dados gasométricos: pH (VT: + 4% vs RMA: - 5%, p=0,007, PaCO2 (VT: - 8% vs RMA: + 13%, p=0,006, PaO2 (VT: + 47% vs RMA: - 34%, p=0,01 e SatO2 (VT: + 0,6% vs RMA: - 1,7%, p=0,001. CONCLUSÃO: O uso de ventilador mecânico causa menor repercussão nos gases sanguíneos no transporte intra-hospitalar de pacientes após de cirurgia cardíaca.OBJECTIVE: To evaluate the effects on blood gases by two methods of ventilation (with transport ventilation or self-inflating manual resuscitator during intra-hospital transport of patients after cardiac surgery. METHODS: Observational, longitudinal, prospective, randomized study. Two samples of arterial blood were collected at the end of the surgery and another at the end of patient transport. RESULTS: We included 23 patients: 13 in the Group with transport ventilation and 10 in the Group with self-inflating manual resuscitator. Baseline characteristics were similar between both groups, except for higher acute severity of illness in the Group with transport ventilation. We observed significant differences in comparisons of percentage variations of gasometric data: pH (transport ventilation + 4% x MR -5%, p=0.007, PaCO2 (-8% x +13%, p=0.006, PaO2 (+47% x -34%, p=0.01 and SatO2 (+0.6% x -1.7%, p=0.001. CONCLUSION: The use of mechanical ventilation results in fewer repercussions for blood gas analysis in the intra-hospital transport of cardiac surgery patients.

Newton Almeida Lima Junior

2012-06-01

197

Gasometria arterial em dois diferentes métodos de transporte intra-hospitalar no pós-operatório imediato de cirurgia cardíaca / Arterial blood gas analysis in two different intra-hospital transport methods for postoperative cardiac surgery patients  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Avaliar as repercussões gasométricas de dois métodos de ventilação (ventilador de transporte e ressuscitador manual autoinflável) durante o transporte intra-hospitalar de pacientes submetidos à cirurgia cardíaca. MÉTODOS: Estudo observacional, longitudinal, prospectivo e randomizado. Foram [...] coletadas gasometrias arteriais ao final da cirurgia e ao final do transporte do paciente. RESULTADOS: Foram incluídos 23 pacientes: 13 no Grupo ventilador de transporte e 10 no ressuscitador manual autoinflável. As características dos pacientes entre os grupos foram semelhantes, exceto pela maior gravidade no Grupo ventilador de transporte. Observaram-se diferenças significativas nas comparações das variações percentuais dos dados gasométricos: pH (VT: + 4% vs RMA: - 5%, p=0,007), PaCO2 (VT: - 8% vs RMA: + 13%, p=0,006), PaO2 (VT: + 47% vs RMA: - 34%, p=0,01) e SatO2 (VT: + 0,6% vs RMA: - 1,7%, p=0,001). CONCLUSÃO: O uso de ventilador mecânico causa menor repercussão nos gases sanguíneos no transporte intra-hospitalar de pacientes após de cirurgia cardíaca. Abstract in english OBJECTIVE: To evaluate the effects on blood gases by two methods of ventilation (with transport ventilation or self-inflating manual resuscitator) during intra-hospital transport of patients after cardiac surgery. METHODS: Observational, longitudinal, prospective, randomized study. Two samples of ar [...] terial blood were collected at the end of the surgery and another at the end of patient transport. RESULTS: We included 23 patients: 13 in the Group with transport ventilation and 10 in the Group with self-inflating manual resuscitator. Baseline characteristics were similar between both groups, except for higher acute severity of illness in the Group with transport ventilation. We observed significant differences in comparisons of percentage variations of gasometric data: pH (transport ventilation + 4% x MR -5%, p=0.007), PaCO2 (-8% x +13%, p=0.006), PaO2 (+47% x -34%, p=0.01) and SatO2 (+0.6% x -1.7%, p=0.001). CONCLUSION: The use of mechanical ventilation results in fewer repercussions for blood gas analysis in the intra-hospital transport of cardiac surgery patients.

Newton Almeida, Lima Junior; Silvia Correa, Bacelar; André Miguel, Japiassú; Samária Ali, Cader; Rosane Coelho Fernandes, Lima; Estélio Henrique Martin, Dantas; Alexandre Gomes, Sancho; Jefferson Braga, Caldeira.

2012-06-01

198

Gasometria arterial em dois diferentes métodos de transporte intra-hospitalar no pós-operatório imediato de cirurgia cardíaca / Arterial blood gas analysis in two different intra-hospital transport methods for postoperative cardiac surgery patients  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Avaliar as repercussões gasométricas de dois métodos de ventilação (ventilador de transporte e ressuscitador manual autoinflável) durante o transporte intra-hospitalar de pacientes submetidos à cirurgia cardíaca. MÉTODOS: Estudo observacional, longitudinal, prospectivo e randomizado. Foram [...] coletadas gasometrias arteriais ao final da cirurgia e ao final do transporte do paciente. RESULTADOS: Foram incluídos 23 pacientes: 13 no Grupo ventilador de transporte e 10 no ressuscitador manual autoinflável. As características dos pacientes entre os grupos foram semelhantes, exceto pela maior gravidade no Grupo ventilador de transporte. Observaram-se diferenças significativas nas comparações das variações percentuais dos dados gasométricos: pH (VT: + 4% vs RMA: - 5%, p=0,007), PaCO2 (VT: - 8% vs RMA: + 13%, p=0,006), PaO2 (VT: + 47% vs RMA: - 34%, p=0,01) e SatO2 (VT: + 0,6% vs RMA: - 1,7%, p=0,001). CONCLUSÃO: O uso de ventilador mecânico causa menor repercussão nos gases sanguíneos no transporte intra-hospitalar de pacientes após de cirurgia cardíaca. Abstract in english OBJECTIVE: To evaluate the effects on blood gases by two methods of ventilation (with transport ventilation or self-inflating manual resuscitator) during intra-hospital transport of patients after cardiac surgery. METHODS: Observational, longitudinal, prospective, randomized study. Two samples of ar [...] terial blood were collected at the end of the surgery and another at the end of patient transport. RESULTS: We included 23 patients: 13 in the Group with transport ventilation and 10 in the Group with self-inflating manual resuscitator. Baseline characteristics were similar between both groups, except for higher acute severity of illness in the Group with transport ventilation. We observed significant differences in comparisons of percentage variations of gasometric data: pH (transport ventilation + 4% x MR -5%, p=0.007), PaCO2 (-8% x +13%, p=0.006), PaO2 (+47% x -34%, p=0.01) and SatO2 (+0.6% x -1.7%, p=0.001). CONCLUSION: The use of mechanical ventilation results in fewer repercussions for blood gas analysis in the intra-hospital transport of cardiac surgery patients.

Newton Almeida, Lima Junior; Silvia Correa, Bacelar; André Miguel, Japiassú; Samária Ali, Cader; Rosane Coelho Fernandes, Lima; Estélio Henrique Martin, Dantas; Alexandre Gomes, Sancho; Jefferson Braga, Caldeira.

199

Characterization of Out of Lesson and Out Of School Physical  

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Full Text Available Principal purpose of the study is characteristics of out of lesson and out of school physical activities of children in selectedprimary schools in the Podkarpackie province. Inspiration for undertakings originate research was the opportunity to familiarizeoneself with the types of physical activity of students in their free time and the influence of formal and legal factors on theorganizational level of additional physical activities. The research was conducted in 60 primary schools in the Podkarpackieprovince. The basic condition in selecting the schools for the research owned a proper sport facility by the school. Research wasconducted in April and May, 2005. Empirical material was gathered by means of a diagnostic survey. Questionnaire of thesurvey included a set of closed questions. Students of physical education and headmasters of the schools were the respondents.The research indicates low level of physical activity of people of various ages. It should be assumed that this state of affairscorresponds to the state of physical education at schools. Therefore, in the search for optimal solutions, out of lesson and outof school activities should be included in the process of preparation of the young generation to physical activity in their adultlives. In conclusion, additional physical activity of children relies, to a large extent, on community service performed byteachers. Most of the times, out of lesson and out of school activities are occasional and incidental in nature and rarelyconstitute a part of an organized sequence of systematic events scheduled for specified points in time.

Krzysztof WARCHO?

200

Validation of a computer case definition for sudden cardiac death in opioid users  

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Full Text Available Abstract Background To facilitate the use of automated databases for studies of sudden cardiac death, we previously developed a computerized case definition that had a positive predictive value between 86% and 88%. However, the definition has not been specifically validated for prescription opioid users, for whom out-of-hospital overdose deaths may be difficult to distinguish from sudden cardiac death. Findings We assembled a cohort of persons 30-74 years of age prescribed propoxyphene or hydrocodone who had no life-threatening non-cardiovascular illness, diagnosed drug abuse, residence in a nursing home in the past year, or hospital stay within the past 30 days. Medical records were sought for a sample of 140 cohort deaths within 30 days of a prescription fill meeting the computer case definition. Of the 140 sampled deaths, 81 were adjudicated; 73 (90% were sudden cardiac deaths. Two deaths had possible opioid overdose; after removing these two the positive predictive value was 88%. Conclusions These findings are consistent with our previous validation studies and suggest the computer case definition of sudden cardiac death is a useful tool for pharmacoepidemiologic studies of opioid analgesics.

Kawai Vivian K

2012-08-01

 
 
 
 
201

Automated external defibrillators inaccessible to more than half of nearby cardiac arrests in public locations during evening, nighttime, and weekends : Circulation  

DEFF Research Database (Denmark)

BACKGROUND: Despite wide dissemination, use of automated external defibrillators (AEDs) in community settings is limited. We assessed how AED accessibility affected coverage of cardiac arrests in public locations. METHODS AND RESULTS: We identified cardiac arrests in public locations (1994-2011) in terms of location and time and viewed them in relation to the location and accessibility of all AEDs linked to the emergency dispatch center as of December 31, 2011, in Copenhagen, Denmark. AED coverage of cardiac arrests was defined as cardiac arrests within 100 m (109.4 yd) of an AED and further categorized according to AED accessibility at the time of cardiac arrest. Daytime, evening, and nighttime were defined as 8 am to 3:59 pm, 4 to 11:59 pm, and midnight to 7:59 am, respectively. Of 1864 cardiac arrests in public locations, 61.8% (n=1152) occurred during the evening, nighttime, or weekends. Of 552 registered AEDs, 9.1% (n=50) were accessible at all hours, and 96.4% (n=532) were accessible during the daytime on all weekdays. Regardless of AED accessibility, 28.8% (537 of 1864) of all cardiac arrests were covered by an AED. Limited AED accessibility decreased coverage of cardiac arrests by 4.1% (9 of 217) during the daytime on weekdays and by 53.4% (171 of 320) during the evening, nighttime, and weekends. CONCLUSIONS: Limited AED accessibility at the time of cardiac arrest decreased AED coverage by 53.4% during the evening, nighttime, and weekends, which is when 61.8% of all cardiac arrests in public locations occurred. Thus, not only strategic placement but also uninterrupted AED accessibility warrant attention if public-access defibrillation is to improve survival after out-of-hospital cardiac arrest.

Gislason, G. H.

2013-01-01

202

Incidence, predisposing factors, management and survival following cardiac arrest due to subarachnoid haemorrhage: a review of the literature  

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Full Text Available Abstract Introduction The prevalence of cardiac arrest among patients with subarachnoid haemorrhage [SAH], and the prevalence of SAH as the cause following out-of-hospital cardiac arrest [OHCA] or in-hospital cardiac arrest [IHCA] is unknown. In addition it is unclear whether cardiopulmonary resuscitation [CPR] and post-resuscitation care management differs, and to what extent this will lead to meaningful survival following cardiac arrest [CA] due to SAH. Aim We reviewed the literature in order to describe; 1.The prevalence and predisposing factors of CA among patients with SAH 2.The prevalence of SAH as the cause of OHCA or IHCA and factors characterising CPR 3.The survival and management of SAH patients with CA. Material and methods The following sources, PubMed, CinAHL and The Cochrane DataBase were searched using the following Medical Subheadings [MeSH]; 1. OHCA, IHCA, heart arrest and 2. subarachnoid haemorrhage. Articles containing relevant data based on the abstract were reviewed in order to find results relevant to the proposed research questions. Manuscripts in other languages than English, animal studies, reviews and case reports were excluded. Results A total of 119 publications were screened for relevance and 13 papers were included. The prevalence of cardiac or respiratory arrest among all patients with SAH is between 3-11%, these patients commonly have a severe SAH with coma, large bleeds and evidence of raised intracerebral pressure on computed tomography scans compared to those who did not experience a CA. The prevalence of patients with SAH as the cause of the arrest among OHCA cases vary between 4 to 8% among those who die before hospital admission, and between 4 to 18% among those who are admitted. The prevalence of SAH as the cause following IHCA is low, around 0.5% according to one recent study. In patients with OHCA survival to hospital discharge is poor with 0 to 2% surviving. The initial rhythm is commonly asystole or pulseless electrical tachycardia. In IHCA the survival rate is variable with 0-27% surviving. All survivors experience brief cardiac arrests with short latencies to ROSC. Conclusion Cardiac arrest is a fairly common complication following severe SAH and these patients are encountered both in the pre-hospital and in-hospital setting. Survival is possible if the arrest occurs in the hospital and the latency to ROSC is short. In OHCA the outcome seems to be uniformly poor despite initially successful resuscitation.

Skrifvars Markus B

2012-11-01

203

About Cardiac Arrest  

Science.gov (United States)

... High Blood Pressure Tools & Resources Stroke More About Cardiac Arrest Updated:Sep 10,2014 What is cardiac arrest? ... to heart disease and stroke. Start exploring today ! Cardiac Arrest • Home • About Cardiac Arrest • Understand Your Risk for ...

204

Out-of-ecliptic dust  

International Nuclear Information System (INIS)

Predictions of the number density of interplanetary dust particles out of the ecliptic plane are derived from model computations by adjusting the parameters to the run of brightness of the zodiacal light in the ecliptic plane and at right angles to the Sun from the ecliptic plane to the ecliptic pole. Within the limits of the simple models, surfaces of equal number density are presented. The number density of zodiacal dust particles is not expected to fall below 20% within 0.5 AU above the earth's orbit. The use of space probes in and out of the ecliptic is discussed, and the possibility of discriminating between different dust distribution functions by means of out-of-ecliptic probes is demonstrated for a space probe in an orbit of 1 AU radius and 30 deg inclination with respect to the ecliptic plane

205

Fast tracking in adult cardiac surgery at Pakistan Institute of Medical Sciences  

International Nuclear Information System (INIS)

Background: Early extubation after cardiac operation is an important aspect of fast-track cardiac anaesthesia. The length of stay in ICU limits utilisation of operation theatre in cardiac surgery. Increasing cost, limited resources, and newer surgical strategies have stimulated effectiveness of all routines in cardiac surgery, anaesthesia, and intensive care. Aim of this study was to determine the feasibility of fast-tracking in adult cardiac surgery and its effects on post operative recovery in our setup. Methods: This descriptive study was conducted over 14 months between Jul 16, 2007 to Sep 16, 2008. All the open heart cases were included unless absolute contraindications were there. We applied the rapid recovery protocol adopted from Oslo Hospital Norway in an attempt to achieve fast-tracking in our setup. Results: Two-hundred-seventy-four consecutive cases out of 400 operated cases were included in this study. Mean age was 47.69 +- 15.11 years, 27.7% were females, 5.8% were emergency cases, 5.1% were COPD, 11.1% were atrial fibrillation, and 6.9% were NYHA class-III cases. CABG was done in 66.1% cases and mean CPB-time was 75.92 +- 16.20 min. Mean Ventilation-time was 4.47+-4.48 hrs., 86% patients were fast-tracked to be extubated within 6 hours, and 85.4% patients remained free of post-op complications. Six (2.2%) re-intubatIions, 2.6% arrhythmias, 6.6% pleural effusions and 2.2% consolidation were observed post-operatively. Mean ICU stay was 2.49 +- 0.95 days and in-hospital mortality was 2.2%. Conclusion: Fast-tracking with extubation within 6 hours is feasible approach which minimises the post-operative complications significantly in adult cardiac surgical patients. (author)

206

Clinically Significant Contrast Induced Acute Kidney Injury after Non-Emergent Cardiac Catheterization - Risk Factors and Impact on Length of Hospital Stay  

International Nuclear Information System (INIS)

Objective: To evaluate the frequency and risk factors associated with clinically significant contrast-induced nephropathy (CIN) in patients undergoing non-emergent coronary angiography. Study Design: Descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2005 to December 2007. Methodology: Case records of patients who underwent coronary angiography with a serum creatinine of >= 1.5 mg/dl at the time of procedure were evaluated. Clinically significant contrast induced nephropathy (CSCIN) was defined as either doubling of serum creatinine from baseline value within a week following the procedure or need for emergency hemodialysis after the procedure. Results: One hundred and sixteen patients met the inclusion criteria. Mean age was 64.0 +- 11.5 years, 72% were males. Overall prevalence of CIN was 17% (rise of serum creatinine by A= 0.5 mg/dl) while that of clinically significant CIN (CSCIN) was 9.5% (11 patients). Patients with CSCIN had significantly lower left ventricular ejection fraction (p = 0.03, OR: 0.24; 95% CI = 0.06 A= 0.91) and higher prevalence of cerebrovascular disease (p < 0.001, OR: 14.66; 95% CI = 3.30 - 65.08). Mean baseline serum creatinine was significantly higher, 3.0 +- 1.5 vs. 2.0 +- 1.1 mg/dl (p = 0.03, OR: 1.47; 95% CI = 1.03 - 2.11) whereas mean GFR estimated by Cockcroft-Gault formula was significantly lower at 25 +- 7.4 vs. 41.0 +- 14.6 ml/minute (p = 0.001, OR = 0.89, 95% CI = 0.84 A= 0.95) at the time of procedure in patients with CSCIN. Mean length of hospital stay was significantly higher in this group compared to those without CIN, 9.0 +- 5.1 vs. 3.0 +- 3.2 days (p = 0.001, OR = 1.31, 95% CI = 1.12 - 1.54). Multivariate analysis revealed low GFR (p = 0.001, OR = 0.88; 95% CI = 0.82 - 0.95) and low ejection fraction (p = 0.03, OR = 0.20; 95% CI = 0.04 - 0.91) to be independent factors associated with CSCIN. No significant differences were noted between the two groups in patients with hypertension, diabetes and heart failure. Conclusion: CSCIN is a significant concern in high risk groups despite prophylaxis. Patients with lower EF, cerebrovascular disease and low GFR at the time of procedure are more likely to have CIN. (author)

207

[Surgical treatment of prosthetic endocarditic of cardiac valves].  

Science.gov (United States)

Results of surgical treatment of patients with cardiac valves prosthetic endocarditis are discussed. General hospital lethality was 15.4%. Immediate results of operations using different type of prosthetic cardiac valves were analyzed. Biological grafts permits to decrease the rate of prosthetic endocarditic recurrence on hospital stage. Urgency of repeated surgery and also radical resection of infected focus with possible reconstruction of fibrous ring integrity influence hospital lethality. PMID:17047587

Skonin, I I; Mironenko, V A; Aliev, Sh M; Popov, D A; Beridze, I Z

2006-01-01

208

Perinatal Outcomes of Pregnant Women with Cardiac Disease at the “Ramón Gonzalez Coro” Gynecologic & Obstetric Teaching Hospital. Resultados perinatales en las gestantes cardiópatas del Hospital Docente Ginecobstétrico “Ramón González Coro”.  

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Full Text Available Introduction: pregnancy in women with heart disease is commonly associated with increased perinatal morbidity. Objective: to describe perinatal outcomes in pregnant women with heart disease who were treated according to a new working protocol. Method: a descriptive study with some analytic aspects was conducted in the Heart Disease and Pregnancy service of the “Ramón Gonzalez Coro’’ Gynecologic and Obstetric Teaching Hospital from 2000-2009. The universe consisted on the 472 pregnant women with heart disease that received follow up during that period. They were treated according to the protocol applied since 2000. Data were obtained through a questionnaire and were processed using the SPSS 11,5 system for Windows, through determination of absolute and relative frequencies. They included: obstetric complications, mode of delivery, cesarean indication, gestational age at delivery and neonatal complications. Results: 51 (10, 8 % patients presented obstetric complications. Vaginal delivery was the most common mode of pregnancy termination. It took place in 242 (51, 3 % patients. Cesarean sections were performed in 146 (30, 9 % of cases, being previous cesarean sections the first cause, 42 (28, 8 %. 17 (3, 6 % patients presented neonatal complications. Conclusion: the new protocol applied to pregnant women with heart disease at ‘’Ramón Gonzalez Coro’’ Gynecologic and Obstetric Teaching Hospital, contributed to improve perinatal outcomes.Introducción: el embarazo en las mujeres cardiópatas se asocia con un incremento de la morbilidad perinatal. Objetivo: describir los resultados perinatales en gestantes cardiópatas atendidas con un nuevo protocolo de trabajo. Método: estudio observacional, descriptivo y retrospectivo con algunos elementos analíticos, realizado en el Servicio de Cardiopatía y Embarazo del Hospital “González Coro”, del 2000-2009. El universo se constituyó por las 472 gestantes cardiópatas atendidas durante ese período y a las cuales se aplicó el protocolo diseñado desde el año 2000. Los datos analizados fueron: complicaciones obstétricas, tipo de terminación del embarazo, indicación de la cesárea, edad gestacional al parto y complicaciones neonatales, se obtuvieron a través de encuestas y se procesaron mediante el sistema estadístico SPSS- 11,5, utilizando frecuencias absolutas y relativas. Resultados: de 472 casos, 51 (10,8 % presentaron complicaciones obstétricas. La forma de terminación del embarazo más frecuente fue el parto eutocico en 242 (51,3 % pacientes, 146 (30,9 % gestantes terminaron su gestación mediante cesárea siendo la causa más frecuente: la cesárea anterior con 42 casos para un 28,8 %. En 17 pacientes para el 3,6 % se presentaron complicaciones neonatales. Conclusión: el nuevo protocolo de trabajo aplicado a la gestante cardiópata en el Servicio de Cardiopatía y Embarazo del Hospital “González Coro” contribuyó a mejorar los resultados perinatales.

Yanara Gutiérrez Aliaga

2011-11-01

209

Cardiac tumours  

International Nuclear Information System (INIS)

Primary cardiac neoplasms are rare and they are not covered comprehensively in the literature, including textbooks. A Medline search from January 2007 to July 2008 was performed to update the existing literature. Cardiac tumour manifestation may mimic other conditions. It may lead to fatal complications like sudden death, and because the tumour can act as a nidus for the formation of fibrin-platelet aggregates, embolic events occur. Its rarity means that an average physician would have minimal experience with its management. This review will serve as a useful reference. (authors)

210

Relação do teste de caminhada pós-operatório e função pulmonar com o tempo de internação da cirurgia cardíaca Relationship on walk test and pulmonary function tests with the length of hospitalization in cardiac surgery patients  

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Full Text Available OBJETIVO: A função pulmonar é apontada como preditora do tempo de hospitalização na cirurgia cardíaca. E o teste de caminhada de seis minutos (TC6' tem sido utilizado para caracterizar a capacidade funcional em pacientes cardiopatas, porém há poucos estudos que o correlacione com tempo de internação hospitalar. O objetivo desta pesquisa foi verificar se há correlação da função pulmonar pré e pós-operatória e da capacidade da deambulação pósoperatória com tempo de internação pós-operatória. MÉTODOS: Foi realizada uma coorte prospectiva com 18 pacientes, sendo 8 do gênero masculino e 10 do gênero feminino, com idade acima de 40 anos (média 64,89 ± 6,95 anos, internados para a submissão de cirurgias de revascularização do miocárdio e/ou troca valvar. Para caracterizar a função pulmonar, os pacientes foram submetidos a uma espirometria no pré-operatório e ao 5º dia pós-operatório. Neste último período também foi realizado um teste de caminhada de 6 minutos (TC6' para caracterizar a capacidade de deambulação. RESULTADO: Não houve correlação significativa da função pulmonar pré e pós-operatória com o tempo de internação pós-operatória. Somente a distância percorrida no TC6' apresentou correlação negativa significativa (rho=-0,62 com o tempo de internação pós-operatória. A distância no TC6' obteve correlação positiva significativa com a capacidade vital forçada (r=0,59 e volume expiratório forçado no 1º segundo (r=0,52. CONCLUSÃO: Esses resultados sugerem que os pacientes com maior capacidade de deambulação no pós-operatório apresentam menor tempo de internação e sugere-se também que a distância no TC6' pode representar melhor a capacidade funcional desses pacientes do que a função pulmonar isoladamente.OBJECTIVE: The lung function is identified as a predictor of time of hospitalization in heart surgery. Meanwhile sixminute walk test has been used to establish functional capacity of cardiac patients, however there are few studies that correlate it with the length of hospital stay. The aim of this research was to determine whether there is correlation of preoperative and postoperative lung function and the ability of walking during the hospital stay. METHODS: A prospective cohort with 18 patients was performed, being 8 males and 10 females, with age above 40 years (medium 64.89 ± 6.95 years. Patients where admitted for coronary artery bypass graft surgery and/or exchange valve. To characterize the pulmonary function, patients were submitted to spirometry in preoperative and the 5th postoperative day. In the latter period was also a test for 6 minutes walk (6MWT to characterize the ability to walk. RESULTS: There was not significant correlation of preoperative and postoperative pulmonary function with length of hospital stay. Only the distance covered in 6MWT showed a significant negative correlation (rho= 0.62 with length of stay. The distance in 6MWT obtained a significant positive correlation with forced vital capacity (r=0.59 and first second of a maximal forced expiratory manoeuvre (r=0.52. CONCLUSION: These results suggest that patients with increased postoperative capacity to walk have a shorter time of hospitalization and it also suggest that the distance in the 6MWT can better represent the functional capacity of these patients than pulmonary function alone.

Elayne Kelen de Oliveira

2009-12-01

211

Relação do teste de caminhada pós-operatório e função pulmonar com o tempo de internação da cirurgia cardíaca / Relationship on walk test and pulmonary function tests with the length of hospitalization in cardiac surgery patients  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: A função pulmonar é apontada como preditora do tempo de hospitalização na cirurgia cardíaca. E o teste de caminhada de seis minutos (TC6') tem sido utilizado para caracterizar a capacidade funcional em pacientes cardiopatas, porém há poucos estudos que o correlacione com tempo de internaçã [...] o hospitalar. O objetivo desta pesquisa foi verificar se há correlação da função pulmonar pré e pós-operatória e da capacidade da deambulação pósoperatória com tempo de internação pós-operatória. MÉTODOS: Foi realizada uma coorte prospectiva com 18 pacientes, sendo 8 do gênero masculino e 10 do gênero feminino, com idade acima de 40 anos (média 64,89 ± 6,95 anos), internados para a submissão de cirurgias de revascularização do miocárdio e/ou troca valvar. Para caracterizar a função pulmonar, os pacientes foram submetidos a uma espirometria no pré-operatório e ao 5º dia pós-operatório. Neste último período também foi realizado um teste de caminhada de 6 minutos (TC6') para caracterizar a capacidade de deambulação. RESULTADO: Não houve correlação significativa da função pulmonar pré e pós-operatória com o tempo de internação pós-operatória. Somente a distância percorrida no TC6' apresentou correlação negativa significativa (rho=-0,62) com o tempo de internação pós-operatória. A distância no TC6' obteve correlação positiva significativa com a capacidade vital forçada (r=0,59) e volume expiratório forçado no 1º segundo (r=0,52). CONCLUSÃO: Esses resultados sugerem que os pacientes com maior capacidade de deambulação no pós-operatório apresentam menor tempo de internação e sugere-se também que a distância no TC6' pode representar melhor a capacidade funcional desses pacientes do que a função pulmonar isoladamente. Abstract in english OBJECTIVE: The lung function is identified as a predictor of time of hospitalization in heart surgery. Meanwhile sixminute walk test has been used to establish functional capacity of cardiac patients, however there are few studies that correlate it with the length of hospital stay. The aim of this r [...] esearch was to determine whether there is correlation of preoperative and postoperative lung function and the ability of walking during the hospital stay. METHODS: A prospective cohort with 18 patients was performed, being 8 males and 10 females, with age above 40 years (medium 64.89 ± 6.95 years). Patients where admitted for coronary artery bypass graft surgery and/or exchange valve. To characterize the pulmonary function, patients were submitted to spirometry in preoperative and the 5th postoperative day. In the latter period was also a test for 6 minutes walk (6MWT) to characterize the ability to walk. RESULTS: There was not significant correlation of preoperative and postoperative pulmonary function with length of hospital stay. Only the distance covered in 6MWT showed a significant negative correlation (rho= 0.62) with length of stay. The distance in 6MWT obtained a significant positive correlation with forced vital capacity (r=0.59) and first second of a maximal forced expiratory manoeuvre (r=0.52). CONCLUSION: These results suggest that patients with increased postoperative capacity to walk have a shorter time of hospitalization and it also suggest that the distance in the 6MWT can better represent the functional capacity of these patients than pulmonary function alone.

Elayne Kelen de, Oliveira; Vinicius Zacarias Maldaner da, Silva; Aída Luiza Ribeiro, Turquetto.

212

Halogenated anaesthetics and cardiac protection in cardiac and non-cardiac anaesthesia  

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Full Text Available Volatile anaesthetic agents have direct protective properties against ischemic myocardial damage. The implementation of these properties during clinical anaesthesia can provide an additional tool in the treatment or prevention, or both, of ischemic cardiac dysfunction in the perioperative period. A recent meta-analysis showed that desflurane and sevoflurane reduce postoperative mortality and incidence of myocardial infarction following cardiac surgery, with significant advantages in terms of postoperative cardiac troponin release, need for inotrope support, time on mechanical ventilation, intensive care unit and overall hospital stay. Multicentre, randomised clinical trials had previously demonstrated that the use of desflurane can reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalisation following coronary artery bypass graft surgery either with and without cardiopulmonary bypass. The American College of Cardiology/American Heart Association Guidelines recommend volatile anaesthetic agents during non-cardiac surgery for the maintenance of general anaesthesia in patients at risk for myocardial infarction. Nonetheless, e vidence in non-coronary surgical settings is contradictory and will be reviewed in this paper together with the mechanisms of cardiac protection by volatile agents.

Landoni Giovanni

2009-01-01

213

Cardiac Pacemakers  

International Nuclear Information System (INIS)

A complete survey of physiological biophysical,clinical and engineering aspects of cardiac facing,including the history and an assessment of possible future developments.Among the topics studied are: pacemakers, energy search, heart stimulating with pacemakers ,mathematical aspects of the electric cardio stimulation chronic, pacemaker implants,proceeding,treatment and control

214

Cardiac CT  

Science.gov (United States)

... calcium in the coronary arteries. Another type of CT scanner, called electron-beam computed tomography (EBCT), also is used to detect calcium in the coronary arteries. Outlook Because an x-ray machine is used, cardiac CT involves radiation. The ...

215

Radiation exposure during cardiac catheterization procedures  

International Nuclear Information System (INIS)

For some time there has been an increased interest in more information about radiation exposure during cardiac catheterization because of: relatively high doses to workers and patient; rapid increase of numbers of examinations; introduction of new procedure-types (e.g. Percutaneous Transluminal Coronary Angiography, PTCA) and introduction of new techniques (e.g. Digital Subtraction Angiography, DSA). This paper reports about a study on the exposure to medical personnel and patient in two major hospitals in the Netherlands. The Total number of cardiac catheterization procedures in both hospitals amounts to circa 3000 per year (approximately 10% of all cardiac procedures c.q. 20% of all PTCA procedures in the Netherlands). This study is related to 1300 cardiac examinations

216

Introduction: Staying Out of Court  

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The ways court procedures can be avoided is a classical theme in socio-legal studies and criminology. The preface to a book published on that theme by the Erasmus School of Law in 1988, on the occasion of its 25th anniversary, covers the then dominant view very well: ‘They [people who advocate out of court settlements, RvS] consider the judge as an ultimum remedium. And that is how it often should be’. Topics covered in that jubilee volume ranged from arbitration and administrative re...

Swaaningen, R.

2008-01-01

217

Cardiac catheterisation in nonagenarians: Single center experience  

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Objective To explore the treatment, procedure related risks, and outcomes of patients older than 90 years of age undergoing cardiac catheterization. Methods We retrospectively studied 32 patients ? 90 years (93.0 ± 1.2 years) who underwent cardiac catheterisation in a tertiary specialist hospital (0.2% of 14,892 procedures during three years). The results were compared to a patient cohort younger than 90 years of age. Results Baseline characteristics revealed a higher prevalence of diab...

Marc-Alexander Ohlow; Aly Hassan

2012-01-01

218

Reoperation for bleeding in cardiac surgery  

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At Odense University Hospital (OUH), 5–9% of all unselected cardiac surgical patients undergo reoperation due to excessive bleeding. The reoperated patients have an approximately three times greater mortality than non-reoperated. To reduce the rate of reoperations and mortality due to postoperative bleeding, we aim to identify risk factors that predict reoperation. A total of 1452 consecutive patients undergoing cardiac surgery using extracorporeal circulation (ECC) between November 2005 an...

Kristensen, Katrine Lawaetz; Rauer, Line Juul; Mortensen, Poul Erik; Kjeldsen, Bo Juel

2012-01-01

219

Dental treatment before cardiac valve replacement  

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The aim of the dissertation is to develop recommendations for dental treatment before cardiac valve replacement. Therefore clinical follow up examinations were performed on patients who received mechanical or biological cardiac valve replacement therapy between 1995 – 2001 at the German Heart Centre Munich. Prior to heart surgery the patients underwent comprehensive dental procedures at the Department of Craniofacial Surgery at the Rechts der Isar Hospital, Technical University of Munich. B...

Auer-bahrs, Julia Katharina

2005-01-01

220

Cardiac sarcoidosis.  

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The prognosis of sarcoidosis often considered as "benign" is significantly changed in the presence of a cardiac localization. An in-depth interview, a clinical examination together with ECG are often for most of sarcoidosis. Certain conditions (severe multisystemic sarcoidosis, rares localizations in particular neurological, renal, gastric) lead to necessary investigations: Holter ECG, echocardiography, thallium scintigraphy with dipyridamole test, PET scanner and MRI in order to identify infraclinical presentations. Diagnosis relies on guidelines of Japansese criteria, but can benefit from MRI and PET scanner even though their place is not yet clearly defined in clinical pratice. Diagnosing cardiac sarcoidosis means deciding an immunosuppressive treatment. It is highly important to gather all criteria to validate a consistent diagnosis or at least a high probability. In order to best adapt therapy, a coordinated patient care involving the cardiologist and the sarcoidosis specialist is necessary. PMID:22608949

Chapelon-Abric, Catherine

2012-06-01

 
 
 
 
221

Cardiac Calcification  

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Full Text Available There is a spectrum of different types of cardiac"ncalcifications with the importance and significance"nof each type of cardiac calcification, especially"ncoronary artery calcification. Radiologic detection of"ncalcifications within the heart is quite common. The"namount of coronary artery calcification correlates"nwith the severity of coronary artery disease (CAD."nCalcification of the aortic or mitral valve may indicate"nhemodynamically significant valvular stenosis."nMyocardial calcification is a sign of prior infarction,"nwhile pericardial calcification is strongly associated"nwith constrictive pericarditis. A spectrum of different"ntypes of cardiac calcifications (linear, annular,"ncurvilinear,... could be seen in chest radiography and"nother imaging modalities. So a carful inspection for"ndetection and reorganization of these calcifications"nshould be necessary. Numerous modalities exist for"nidentifying coronary calcification, including plain"nradiography, fluoroscopy, intravascular ultrasound,"nMRI, echocardiography, and conventional, helical and"nelectron-beam CT (EBCT. Coronary calcifications"ndetected on EBCT or helical CT can be quantifie,"nand a total calcification score (Cardiac Calcification"nScoring may be calculated. In an asymptomatic"npopulation and/or patients with concomitant risk"nfactors like diabetes mellitus, determination of the"npresence of coronary calcifications identifies the"npatients at risk for future myocardial infarction and"ncoronary artery disease. In patients without coronary"ncalcifications, future cardiovascular events could"nbe excluded. Therefore, detecting and recognizing"ncalcification related to the heart on chest radiography"nand other imaging modalities such as fluoroscopy, CT"nand echocardiography may have important clinical"nimplications.

Morteza Joorabian

2011-05-01

222

Robotic cardiac surgery: an anaesthetic challenge.  

Science.gov (United States)

Robotic cardiac surgery with the da Vinci robotic surgical system offers the benefits of a minimally invasive procedure, including a smaller incision and scar, reduced risk of infection, less pain and trauma, less bleeding and blood transfusion requirements, shorter hospital stay and decreased recovery time. Robotic cardiac surgery includes extracardiac and intracardiac procedures. Extracardiac procedures are often performed on a beating heart. Intracardiac procedures require the aid of peripheral cardiopulmonary bypass via a minithoracotomy. Robotic cardiac surgery, however, poses challenges to the anaesthetist, as the obligatory one-lung ventilation (OLV) and CO2 insufflation may reduce cardiac output and increase pulmonary vascular resistance, potentially resulting in hypoxaemia and haemodynamic compromise. In addition, surgery requires appropriate positioning of specialised cannulae such as an endopulmonary vent, endocoronary sinus catheter, and endoaortic clamp catheter under the guidance of transoesophageal echocardiography. Therefore, cardiac anaesthetists should have a working knowledge of these systems, OLV and haemodynamic support. PMID:24958894

Wang, Gang; Gao, Changqing

2014-08-01

223

Acute kidney injury and critical cardiac disease.  

Science.gov (United States)

The field of cardiac intensive care continues to advance in tandem with congenital heart surgery. The survival of patients with critical congenital heart disease is seldom in question. Consequently, the focus has now shifted to that of morbidity reduction and eventual elimination. Acute kidney injury (AKI) after cardiac surgery is associated with adverse outcomes, including prolonged intensive care and hospital stays, diminished quality of life, and increased long-term mortality. Acute kidney injury occurs frequently, complicating 30% to 40% of adult and pediatric cardiac surgeries. Patients who require dialysis are at high risk of mortality, but even minor degrees of postoperative AKI portend a significant increase in mortality and morbidity. PMID:23803993

Cooper, David S; Charpie, John R; Flores, Francisco X; William Gaynor, J; Salvin, Joshua W; Devarajan, Prasad; Krawczeski, Catherine D

2011-07-01

224

Sudden Cardiac Arrest  

Science.gov (United States)

... Arrest (SCA) Back to Heart Diseases & Disorders Sudden Cardiac Arrest (SCA) Sudden Cardiac Arrest ( SCA ) occurs when the heart stops beating, abruptly ... to saving someone who is having a sudden cardiac arrest , it is important to understand the difference. The ...

225

Cardiac conduction system  

Science.gov (United States)

The cardiac conduction system is a group of specialized cardiac muscle cells in the walls of the heart that send signals ... to contract. The main components of the cardiac conduction system are the SA node, AV node, bundle ...

226

Continued breathing followed by gasping or apnea in a swine model of ventricular fibrillation cardiac arrest  

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Full Text Available Abstract Background Continued breathing following ventricular fibrillation has here-to-fore not been described. Methods We analyzed the spontaneous ventilatory activity during the first several minutes of ventricular fibrillation (VF in our isoflurane anesthesized swine model of out-of-hospital cardiac arrest. The frequency and type of ventilatory activity was monitored by pneumotachometer and main stream infrared capnometer and analyzed in 61 swine during the first 3 to 6 minutes of untreated VF. Results During the first minute of VF, the air flow pattern in all 61 swine was similar to those recorded during regular spontaneous breathing during anesthesia and was clearly different from the patterns of gasping. The average rate of continued breathing during the first minute of untreated VF was 10 breaths per minute. During the second minute of untreated VF, spontaneous breathing activity either stopped or became typical of gasping. During minutes 2 to 5 of untreated VF, most animals exhibited very slow spontaneous ventilatory activity with a pattern typical of gasping; and the pattern of gasping was crescendo-decrescendo, as has been previously reported. In the absence of therapy, all ventilatory activity stopped 6 minutes after VF cardiac arrest. Conclusion In our swine model of VF cardiac arrest, we documented that normal breathing continued for the first minute following cardiac arrest.

Zuercher Mathias

2010-08-01

227

Frequency of causative factors for pleural effusions: a hospital based study  

International Nuclear Information System (INIS)

To determine the frequency of various causative factors of pleural effusion in adults. Combined Military Hospital, Attock and PAF hospital Faisal Karachi. One hundred and fifty patients of clinical signs of pleural effusion, were selected and then, further classified in to transudative and exudative variety by carrying out pleural fluid routine testing and using Light's criteria . Later the final etiological diagnosis was made with the help of appropriate laboratory tests. Out of total 150 patients who were studied, 123 patients were found to have exudative effusions whereas 27 cases had transudative effusion. A total of five 5 patients (3.33%) were lost to follow up. Three patients were out of exudative variety and 02 were from transudative variety. Out of 120 patient of exudative pleural effusion, 70(58.2%) had tuberculosis, 28(23.2%) had malignancy, 12(10%) had pneumonia, 5(6%) were uraemic, 2(1.6%) had pulmonary embolism, and rheumatoid arthritis, Systemic lupus erythematosis and liver abscess were causative factors in 1(0.8%) each patient. Out of transudative effusions, 14(56%) had congestive cardiac failure, 5(20%) had cirrhosis liver, 4(16%) had nephrotic syndrome and 1(4%) each had cardiac tamponade and myxoedema. The most common cause of pleural effusion remains tuberculosis. (author)

228

Measurement of cardiac volume by computed tomography  

International Nuclear Information System (INIS)

and shunt lesion and LV volume in aortic valvular disease and mitral regurgitation. Between the left ventricular lumen volume by CT and its end-diastolic volume by ventriculography (area-length method), there was a good relationship (r = 0.81) in 17 cases without cardiac aneurysms out of 22 ischemic cardiac patients examined by ventriculography (RAO and LAO views). (J.P.N.)

229

La formación en urgencias extrahospitalarias y su adecuación al nuevo programa de la especialidad de Medicina Familiar y Comunitaria: ¿hemos avanzado? / Training in out-of-hospital emergency services and its adaptation to the new Family and Community Medicine speciality programme.: have we gone forward?  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Objetivo: Conocer la rotación en urgencias extrahospitalarias de los residentes de Medicina Familiar y Comunitaria (MFyC) y comparar su evolución durante el periodo 2005-2010. Diseño del estudio: Estudio observacional descriptivo longitudinal. Emplazamiento: Unidades Docentes (UU.DD.) de MFyC. Parti [...] cipantes: Responsables de UU.DD. de MFyC. Respondieron el 61,1% en 2005 y el 60,0% en 2010. Mediciones principales: Mediante cuestionario autoadministrado, comparando su evolución entre 2005 y 2010, se midió la proporción de residentes que realizan guardias en atención primaria, rotación por servicios de emergencias, grado de supervisión de éstas y evaluación de las mismas. Se describen las variables de estudio mediante cálculo de proporciones y medias e intervalos de confianza al 95%. Resultados: En el año 2010 la proporción de UU.DD. en las que los residentes de MFyC realizaron guardias en atención primaria fue del 87,7% (IC95% 78,3-97,1) y en 2005 del 74,5% (IC95% 62,1-87,0), supervisadas por tutores de medicina de familia en el 61,5% de los casos en 2010 (53,7% en 2005). La rotación por los servicios de emergencias se incrementó del 87,3% al 91,1%. En los SUAP/servicios de emergencias la tutorización de los residentes fue ejercida por tutores acreditados en el 53,1% en 2005 y en el 51,0% en 2010. Conclusiones: La rotación en urgencias extrahospitalarias ha mejorado al aplicarse el nuevo programa de la especialidad. Se ha de mejorar la tutorización y evaluación de esta rotación. Abstract in english Objective: To establish family and community medicine (FCM) resident rotation in out-of-hospital emergencies and compare its progress during the period 2005-2010. Design: Observational, descriptive and longitudinal study. Location: FCM teaching units. Participants: Those in charge of FCM teaching un [...] its. 61,1% responded in 2005 and 60,0% en 2010. Main Surveyed Data: By way of self-administrated questionnaire, comparing its progress between 2005 and 2010, the proportion of residents who carry out primary care duties, emergency services rotation, degree of their supervision and their assessment. Study variables are described by way of calculation of proportions and averages and 95% confidence intervals. Results: In the year 2010, the proportion of teaching units in which FCM residents carried out primary care duties was 87,7% (IC95% 78,3-97,1), and in 2005, 74,5% (IC95% 62,1-87,0), supervised by family medicine tutors in 61,5% of cases in 2010 (53,7% en 2005). Emergency service rotation was increased by 87,3% to 91,1%. In the SUAP/emergency services, the tutoring of residents was performed by authorized tutors in 53,1% in 2005 and in 51,0% in 2010. Conclusions: Rotation in out-of-hospital emergencies has improved by applying the new speciality programme. The tutoring and assessment of this rotation are in need of improvement.

Magdalena, Canals Aracil; Alba, Riesgo García.

230

Risk factors for surgical-site infection after cardiac surgery  

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Objective: Surgical site infection is a serious complication inpatients undergoing heart surgery because in addition to highmorbitity rates, length of hospital stay and hospital costs areincreased. This study aims to identify pre-, peri- and postoperativerisk factors related to surgical-site infection after cardiac surgery.Methods: The study comprised 1053 patients undergoing cardiacsurgery, with sternotomy, performed consecutively, between June1 and October 31, 1999, by three cardiac surgery...

Fermina Mendonça Borges; Renato Satovschi Grinbaum; Jacyr Pasternak; Eduardo Alexandrino Servolo de Medeiros

2005-01-01

231

Trasplante cardiaco / Cardiac transplant  

Scientific Electronic Library Online (English)

Full Text Available SciELO Costa Rica | Language: Spanish Abstract in spanish La insuficiencia cardiaca es un cuadro clínico frecuente y de apreciable mortalidad. A menudo de nuestra área de atracción emergen cardiópatas con diferentes grados de discapacidad, dependientes de familiares para su atención y que requieren re-hospitalizaciones y tratamientos costosos y a pesar de [...] ello con mal pronóstico. Las autoridades sanitarias y particularmente el estado invierten anualmente mucho dinero en el tratamiento de los enfermos que la padecen y también en la cobertura de incapacidades para estos individuos. El trasplante cardiaco se ha implementado en el mundo como una excelente opción de tratamiento de los pacientes con insuficiencia cardiaca, capaz de brindar al menos 10 años de vida a pesar de lo riguroso del seguimiento, tanto para el paciente y su familia, como para el personal medico. El Hospital R. A. Calderón Guardia inició hace un año un Programa de Trasplante Cardiaco, presentamos aquí los 2 primeros pacientes y su seguimiento. Abstract in english Heart failure is a common clinical problem that implies pretty high mortality. From the Calderon Guardia Hospital drawing area emerge individuals with different degrees of disability, depending upon their families for their needs, requiring frequent hospitalizations and expensive treatments and stil [...] l with bad prognosis. The government dedicates large amounts of money to the treatment of these patients and also to cover for their disability. Cardiac transplantation has been implemented worldwide as a viable solution for persons with heart failure, able to expand their life for at least 10 extra years, in spite of the rigorous follow up protocols for the patients and health personnel as well. One year ago the R. A. Calderon Guardia Hospital started a heart transplant program, we herein present the first 2 patients and their follow up.

Donato, Salas-Segura; Mario, Sánchez Suen; Carlos, Salazar-Vargas.

232

Trasplante cardiaco Cardiac transplant  

Directory of Open Access Journals (Sweden)

Full Text Available La insuficiencia cardiaca es un cuadro clínico frecuente y de apreciable mortalidad. A menudo de nuestra área de atracción emergen cardiópatas con diferentes grados de discapacidad, dependientes de familiares para su atención y que requieren re-hospitalizaciones y tratamientos costosos y a pesar de ello con mal pronóstico. Las autoridades sanitarias y particularmente el estado invierten anualmente mucho dinero en el tratamiento de los enfermos que la padecen y también en la cobertura de incapacidades para estos individuos. El trasplante cardiaco se ha implementado en el mundo como una excelente opción de tratamiento de los pacientes con insuficiencia cardiaca, capaz de brindar al menos 10 años de vida a pesar de lo riguroso del seguimiento, tanto para el paciente y su familia, como para el personal medico. El Hospital R. A. Calderón Guardia inició hace un año un Programa de Trasplante Cardiaco, presentamos aquí los 2 primeros pacientes y su seguimiento.Heart failure is a common clinical problem that implies pretty high mortality. From the Calderon Guardia Hospital drawing area emerge individuals with different degrees of disability, depending upon their families for their needs, requiring frequent hospitalizations and expensive treatments and still with bad prognosis. The government dedicates large amounts of money to the treatment of these patients and also to cover for their disability. Cardiac transplantation has been implemented worldwide as a viable solution for persons with heart failure, able to expand their life for at least 10 extra years, in spite of the rigorous follow up protocols for the patients and health personnel as well. One year ago the R. A. Calderon Guardia Hospital started a heart transplant program, we herein present the first 2 patients and their follow up.

Donato Salas-Segura

2008-12-01

233

Impact of hospital infections on patients outcomes undergoing cardiac surgery at Santa Casa de Misericórdia de Marília / Impacto das infecções hospitalares na evolução de pacientes submetidos à cirurgia cardíaca na Santa Casa de Misericórdia de Marília  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese Objetivo: O objetivo deste estudo foi determinar as taxas das infecções hospitalares, os fatores de risco associados e o impacto destas infecções na mortalidade dos pacientes submetidos à cirurgia cardíaca. Métodos: coorte retrospectivo que incluiu 2060 pacientes consecutivos, no período de 20 [...] 06 a 2012 na Santa Casa de Misericórdia de Marília. Resultados: Foram diagnosticadas 351 infecções hospitalares (17%), sendo 227 infecções não cirúrgicas e 124 infecções cirúrgicas. As principais infecções foram: mediastinite (2,0%), infecção urinária (2,8%), pneumonia (2,3%), infecção da corrente sanguínea (1,7%). A mortalidade global intra-hospitalar foi de 6,4%. As variáveis independentes associadas às infecções não cirúrgicas foram: idade > 60 anos (OR 1,59; IC95%1,09-2,31), internação em UTI > 2 dias (OR5,49; IC95% 2,98-10,09), ventilação mecânica > 2 dias (OR11,93; IC95% 6,1 - 23,08), uso de sonda vesical >3 dias (OR 4,85 IC95% 2,95 -7,99). Infecções hospitalares não cirúrgicas foram mais frequentes em pacientes com infecção cirúrgica (32,3% versus 7,2%; OR 6,1; IC95% 4,03- 9,24). As variáveis independentes associadas a mortalidade foram: idade >60 anos (OR= 2,0 ; IC 95% 1,4-3,0), uso de droga vasopressora (OR 3,4; IC95% 1,9-6,0), uso de insulina (OR=1,8; IC 95% 1,2-2,8), reintervenção cirúrgica (OR=4,4 IC95% 2,1-9,0) pneumonia (OR=4,3 IC95% 2,1-8,9) e infecção da corrente sanguíneas (OR=4,7; IC95% 2,0-11,2). Conclusão: infecções hospitalares não cirúrgicas são frequentes pós cirurgia cardíaca, e aumentam a chance de infecção cirúrgica e a mortalidade. Abstract in english Objective: this study aimed to determine the incidence of nosocomial infections, the risk factors and the impact of these infections on mortality among patients undergoing to cardiac surgery. Methods: Retrospective cohort study of 2060 consecutive patients from 2006 to 2012 at the Santa Casa d [...] e Misericórdia de Marília. Results: 351 nosocomial infections were diagnosed (17%), 227 non-surgical infections and 124 surgical wound infections. Major infections were mediastinitis (2.0%), urinary tract infection (2.8%), pneumonia (2.3%), and bloodstream infection (1.7%). The in-hospital mortality was 6.4%. Independent variables associated with non-surgical infections were age > 60 years (OR 1.59, 95% CI 1.09 to 2.31), ICU stay > 2 days (OR 5, 49, 95% CI 2.98 to 10, 09), mechanical ventilation > 2 days (OR11, 93, 95% CI 6.1 to 23.08), use of urinary catheter > 3 days (OR 4.85 95% CI 2.95 -7.99). Non-surgical nosocomial infections were more frequent in patients with surgical wound infection (32.3% versus 7.2%, OR 6.1, 95% CI 4.03 to 9.24). Independent variables associated with mortality were age greater than 60 years (OR 2.0; 95% CI 1.4 to3.0), use of vasoactive drugs (OR 3.4, 95% CI 1.9 to 6, 0), insulin use (OR 1.8; 95% CI 1.2 to 2.8), surgical reintervention (OR 4.4; 95% CI 2.1 to 9.0) pneumonia (OR 4.3; 95% CI 2.1 to 8.9) and bloodstream infection (OR = 4.7, 95% CI 2.0 to 11.2). Conclusion: Non-surgical hospital infections are common in patients undergoing cardiac surgery; they increase the chance of surgical wound infection and mortality.

Lucieni Oliveira, Conterno; Silvana Martins Dias, Toni; Rubiana Gonçalves, Konkiewitz; Elaine Salla, Guedes; Rubens Tofano de, Barros; Marcos Gradim, Tiveron.

2014-04-01

234

Patients’ anxiety before cardiac catheterization  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: To identify researches related to anxiety and strategies to reduce it in patients who are in the pre-cardiac catheterization period. Methods: A bibliographic research was carried out in the on line databases of PubMed, MedLine, CINAHL, LILACS and SciELO, from 1997 to 2009 in MedLine and from 1999 to 2009 in the others databases. The boolean expressions “and” and “or” has been used with the descriptors in Portuguese and in English. The inclusion of discerning was related about the presence, level and workable of the anxiety from the period of pre-cardiac catheterization. Results: Coping most of 17 researches selected were in American scientific publications, with experimental-descriptive studies. The possibilities of intercurrence and/or complications during and post-procedure, diagnostic, possibility of bad prognostic, being alone during the waiting, the first time submission the procedure, lost information and/or orientation and long time waiting could cause anxiety in pre-cardiac catheterization. Maintenance of escort and family alongside the patient, information adapted to the patient understanding level, overcoming traumas and difficulties with a multiprofessional approach, pharmacologic and non pharmacologic therapies were strategies to reduce the anxiety. Conclusions: The nurses are responsible to provide a humanized assistance to offer a fast recuperation, minimize traumas of the hospitalization and the procedure. The knowledge of the causes and the strategies are fundamental to reduce the level of anxiety in pre-catheterization cardiac.

Leandro Loureiro Buzatto

2010-12-01

235

Prevención primaria y secundaria de muerte súbita en un hospital de la Seguridad Social de Costa Rica: reporte del registro de pacientes con desfibrilador automático implantable, 2007-2011 / Primary and secondary prevention of sudden cardiac death in a hospital of the social security system in Costa Rica: report from the registry of patients with implantable cardioverter-defibrillators, 2007-2011  

Scientific Electronic Library Online (English)

Full Text Available SciELO Costa Rica | Language: Spanish Abstract in spanish Justificación y objetivo: diversos estudios han demostrado la eficacia de los desfibriladores automáticos implantables en la prevención de la muerte súbita cardiaca. La aplicación de dicha evidencia debe ser evaluada mediante registros. El objetivo de este estudio fue describir las principales carac [...] terísticas epidemiológicas y clínicas y las complicaciones de los pacientes a quienes se les implanta un desfibrilador automático implantable en un hospital de tercer nivel en Costa Rica. Métodos: estudio observacional de cohorte, retrospectivo, que incluyó la totalidad de pacientes a quienes se les implantó un desfibrilador automático implantable en el hospital “Dr. Rafael Ángel Calderón Guardia” entre 2007 y 2011. Resultados: se incluyó 23 pacientes. La edad media fue de 55 ± 18 años. La cardiopatía isquémica fue la etiología más frecuente (10 pacientes). Veinte pacientes estaban en clase funcional I o II; la fracción de eyección media fue 0,38 ± 0,17. En los 18 pacientes el desfibrilador automático se implantó por prevención secundaria. Cinco pacientes presentaron una complicación temprana, todos ellos con dispositivos bicamerales: 2 hematomas menores, una disección del seno coronario, un desplazamiento del electrodo atrial derecho y un ictus cardioembólico. Hubo un total de 101 terapias (en 8 pacientes), de las cuales 94 fueron apropiadas (en 5 pacientes) y 7 inapropiadas (en 3 pacientes); dos de estos últimos habían tenido episodios previos de fibrilación atrial. Conclusión: este registro muestra que la mayoría de los implantes de desfibriladores automáticos se realizan por prevención secundaria, con una alta tasa de terapias adecuadas y una baja tasa de terapias inadecuadas y de complicaciones; además, permite evaluar las indicaciones y las complicaciones asociadas con esta terapia. Abstract in english Aim: Several studies have demonstrated the efficacy of implantable cardioverter-defibrillators in the prevention of sudden cardiac death. The validation of this evidence has to be assessed through various registries. The objective of this study was to describe the main epidemiological and clinical c [...] haracteristics of patients who were referred to a tertiary hospital in Costa Rica to be treated with a cardioverter-defibrillators implantable; as well as the associated problems and complications. Methods: A retrospective observational cohort study, which included all patients who were treated with a cardioverter-defibrillator implantable in the “Dr. Rafael A. Calderón Guardia” hospital between 2007 and 2011. Results: Twenty three patients were included. The mean age was 55 ± 18 years. Ischemic heart disease was the most frequent etiology (10 patients). Twenty patients had functional class I or II and the mean ejection fraction was 0.38 ± 0.17. In 18 patients, the cardioverter-defibrillator was implanted for secondary prevention. Five patients had an early complication; all of them had dual-chamber devices: 2 minor hematomas, 1 coronary sinus dissection, 1 right atrial lead displacement, and 1 cardio embolic stroke. From a total of 101 therapies (in 8 patients), 94 were appropriate (in 5 patients) and 7 were inappropriate (in 3 patients); 2 of the latter 3 patients had a history of atrial fibrillation episodes. Conclusion: This registry shows that the majority of implantable cardioverter-defibrillators implantations are performed as a secondary prevention, with a high rate of adequate therapies and a low rate of inadequate ones. The registry allowed an assessment of the indications and complications of this device therapy.

Hugo, Arguedas-Jiménez; Oswaldo, Gutiérrez-Sotelo.

236

Prevención primaria y secundaria de muerte súbita en un hospital de la Seguridad Social de Costa Rica: reporte del registro de pacientes con desfibrilador automático implantable, 2007-2011 / Primary and secondary prevention of sudden cardiac death in a hospital of the social security system in Costa Rica: report from the registry of patients with implantable cardioverter-defibrillators, 2007-2011  

Scientific Electronic Library Online (English)

Full Text Available SciELO Costa Rica | Language: Spanish Abstract in spanish Justificación y objetivo: diversos estudios han demostrado la eficacia de los desfibriladores automáticos implantables en la prevención de la muerte súbita cardiaca. La aplicación de dicha evidencia debe ser evaluada mediante registros. El objetivo de este estudio fue describir las principales carac [...] terísticas epidemiológicas y clínicas y las complicaciones de los pacientes a quienes se les implanta un desfibrilador automático implantable en un hospital de tercer nivel en Costa Rica. Métodos: estudio observacional de cohorte, retrospectivo, que incluyó la totalidad de pacientes a quienes se les implantó un desfibrilador automático implantable en el hospital “Dr. Rafael Ángel Calderón Guardia” entre 2007 y 2011. Resultados: se incluyó 23 pacientes. La edad media fue de 55 ± 18 años. La cardiopatía isquémica fue la etiología más frecuente (10 pacientes). Veinte pacientes estaban en clase funcional I o II; la fracción de eyección media fue 0,38 ± 0,17. En los 18 pacientes el desfibrilador automático se implantó por prevención secundaria. Cinco pacientes presentaron una complicación temprana, todos ellos con dispositivos bicamerales: 2 hematomas menores, una disección del seno coronario, un desplazamiento del electrodo atrial derecho y un ictus cardioembólico. Hubo un total de 101 terapias (en 8 pacientes), de las cuales 94 fueron apropiadas (en 5 pacientes) y 7 inapropiadas (en 3 pacientes); dos de estos últimos habían tenido episodios previos de fibrilación atrial. Conclusión: este registro muestra que la mayoría de los implantes de desfibriladores automáticos se realizan por prevención secundaria, con una alta tasa de terapias adecuadas y una baja tasa de terapias inadecuadas y de complicaciones; además, permite evaluar las indicaciones y las complicaciones asociadas con esta terapia. Abstract in english Aim: Several studies have demonstrated the efficacy of implantable cardioverter-defibrillators in the prevention of sudden cardiac death. The validation of this evidence has to be assessed through various registries. The objective of this study was to describe the main epidemiological and clinical c [...] haracteristics of patients who were referred to a tertiary hospital in Costa Rica to be treated with a cardioverter-defibrillators implantable; as well as the associated problems and complications. Methods: A retrospective observational cohort study, which included all patients who were treated with a cardioverter-defibrillator implantable in the “Dr. Rafael A. Calderón Guardia” hospital between 2007 and 2011. Results: Twenty three patients were included. The mean age was 55 ± 18 years. Ischemic heart disease was the most frequent etiology (10 patients). Twenty patients had functional class I or II and the mean ejection fraction was 0.38 ± 0.17. In 18 patients, the cardioverter-defibrillator was implanted for secondary prevention. Five patients had an early complication; all of them had dual-chamber devices: 2 minor hematomas, 1 coronary sinus dissection, 1 right atrial lead displacement, and 1 cardio embolic stroke. From a total of 101 therapies (in 8 patients), 94 were appropriate (in 5 patients) and 7 were inappropriate (in 3 patients); 2 of the latter 3 patients had a history of atrial fibrillation episodes. Conclusion: This registry shows that the majority of implantable cardioverter-defibrillators implantations are performed as a secondary prevention, with a high rate of adequate therapies and a low rate of inadequate ones. The registry allowed an assessment of the indications and complications of this device therapy.

Hugo, Arguedas-Jiménez; Oswaldo, Gutiérrez-Sotelo.

2013-03-01

237

Hemodilution, kidney dysfunction and cardiac surgery  

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Full Text Available Hemodilution has been used in cardiac surgery to reduce blood viscosity and peripheral vascular resistance, decrease the need for blood transfusions, attenuate the risk of transfusions and diminish systemic inflammatory response syndrome and hospital costs. The lowest hematocrit level during cardiopulmonary bypass has been stated as 20%. However, severe hemodilution in cardiopulmonary bypass for patients undergoing cardiac surgery has been recognized as a risk factor for hospital deaths and reduced long-term survival. The introduction of normothermia restarted the debate about the lowest acceptable hematocrit during cardiopulmonary bypass. The objective of this review is to evaluate hemodilution during cardiac surgery as a risk factor for the development of post-operative acute renal failure.

Fabio Papa Taniguchi

2009-03-01

238

Critical appraisal of cardiac implantable electronic devices: complications and management  

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Full Text Available Luigi Padeletti1, Giosuè Mascioli2, Alessandro Paoletti Perini1, Gino Grifoni1, Laura Perrotta1, Procolo Marchese3, Luca Bontempi3, Antonio Curnis31Istituto di Clinica Medica e Cardiologia, Università degli Studi di Firenze, Italia; 2Elettrofisiologia, Istituto Humanitas Gavazzeni, Bergamo, Italia; 3Elettrofisiologia, Spedali Civili, Brescia, ItaliaAbstract: Population aging and broader indications for the implant of cardiac implantable electronic devices (CIEDs are the main reasons for the continuous increase in the use of pacemakers (PMs, implantable cardioverter-defibrillators (ICDs and devices for cardiac resynchronization therapy (CRT-P, CRT-D. The growing burden of comorbidities in CIED patients, the greater complexity of the devices, and the increased duration of procedures have led to an augmented risk of infections, which is out of proportion to the increase in implantation rate. CIED infections are an ominous condition, which often implies the necessity of hospitalization and carries an augmented risk of in-hospital death. Their clinical presentation may be either at pocket or at endocardial level, but they can also manifest themselves with lone bacteremia. The management of these infections requires the complete removal of the device and subsequent, specific, antibiotic therapy. CIED failures are monitored by competent public authorities, that require physicians to alert them to any failures, and that suggest the opportune strategies for their management. Although the replacement of all potentially affected devices is often suggested, common practice indicates the replacement of only a minority of devices, as close follow-up of the patients involved may be a safer strategy. Implantation of a PM or an ICD may cause problems in the patients' psychosocial adaptation and quality of life, and may contribute to the development of affective disorders. Clinicians are usually unaware of the psychosocial impact of implanted PMs and ICDs. The main difference between PM and ICD patients is the latter's dramatic experience of receiving a shock. Technological improvements and new clinical evidences may help reduce the total burden of shocks. A specific supporting team, providing psychosocial help, may contribute to improving patient quality of life.Keywords: pacemaker, cardiac cardioverter-defibrillator, cardiac implantable electronic devices, infection, recall, quality of life 

Padeletti L

2011-09-01

239

Cardiac PACS: strategies for planning, integration & vendor selection.  

Science.gov (United States)

Cardiologists are clamoring for better imaging techniques, the ability to view images from their office or home, and for the resulting improvement in efficiency which translates into increased profitability. The future is here; are you ready? Cardiac systems have developed into full-blown information management and digital imaging systems. Hospitals are moving aggressively to update their cardiac information systems and identifying the significant role the CIS (cardiac information system) plays in the selection process. It is important to plan the infrastructure of your cardiac PACS (picture archival communication system) and determine how it will integrate with the radiology PACS. Equally important is the integration potential with other hospital information systems such as the laboratory, pharmacy and billing, etc. Answers to these decision factors are provided in addition to information pertaining to the overall cardiac PACS planning process and vendor offerings. PMID:14567270

Bruski, Georgann B; Cutler, Sara

2003-01-01

240

Prospective assessment of different indices of cardiac risk for patients undergoing noncardiac surgeries  

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OBJECTIVE: To compare the accuracy of 4 different indices of cardiac risk currently used for predicting perioperative cardiac complications. METHODS: We studied 119 patients at a university-affiliated hospital whose cardiac assessment had been required for noncardiac surgery. Predictive factors of high risk for perioperative cardiac complications were assessed through clinical history and physical examination, and the patients were followed up after surgery until the 4th postoperative day to ...

Heinisch Roberto Henrique; Barbieri Caroline Ferrari; Nunes Filho João Rogério; Oliveira Glauce Lippi de; Heinisch Liana Miriam Miranda

2002-01-01

 
 
 
 
241

Myocardial stunning after resuscitation from cardiac arrest following spinal anaesthesia.  

Science.gov (United States)

Cardiac arrest associated with spinal anaesthesia has been well researched. Myocardial stunning after successful resuscitation from cardiac arrest is seen in up to 2/3(rd) of in-hospital cardiac arrests. Myocardial stunning after resuscitation from cardiac arrest associated with spinal anaesthesia has probably not been reported earlier. Our case, an ASA physical status I lady, posted for tubal reanastomosis surgery developed bradycardia followed by asystole, approximately 5 minutes after giving subarachnoid block. Return of spontaneous circulation (ROSC) was achieved within 2 minutes with cardiopulmonary resuscitation (CPR) and defibrillation for pulseless ventricular tachycardia. Patient developed delayed pulmonary oedema, which was probably due to myocardial stunning. In the present case, inadequate preloading could have precipitated bradycardia progressing to cardiac arrest which, after resuscitation led to reversible myocardial dysfunction. We conclude that early vasopressor infusion, titrated fluids and echocardiography should be considered in immediate post cardiac arrest phase following spinal anaesthesia. PMID:24963188

Kurhekar, Pranjali Madhav; Yachendra, Vsg; Babu, Simi P; Govindasamy, Raghavelu

2014-03-01

242

Critical appraisal of cardiac implantable electronic devices: complications and management  

Science.gov (United States)

Population aging and broader indications for the implant of cardiac implantable electronic devices (CIEDs) are the main reasons for the continuous increase in the use of pacemakers (PMs), implantable cardioverter-defibrillators (ICDs) and devices for cardiac resynchronization therapy (CRT-P, CRT-D). The growing burden of comorbidities in CIED patients, the greater complexity of the devices, and the increased duration of procedures have led to an augmented risk of infections, which is out of proportion to the increase in implantation rate. CIED infections are an ominous condition, which often implies the necessity of hospitalization and carries an augmented risk of in-hospital death. Their clinical presentation may be either at pocket or at endocardial level, but they can also manifest themselves with lone bacteremia. The management of these infections requires the complete removal of the device and subsequent, specific, antibiotic therapy. CIED failures are monitored by competent public authorities, that require physicians to alert them to any failures, and that suggest the opportune strategies for their management. Although the replacement of all potentially affected devices is often suggested, common practice indicates the replacement of only a minority of devices, as close follow-up of the patients involved may be a safer strategy. Implantation of a PM or an ICD may cause problems in the patients’ psychosocial adaptation and quality of life, and may contribute to the development of affective disorders. Clinicians are usually unaware of the psychosocial impact of implanted PMs and ICDs. The main difference between PM and ICD patients is the latter’s dramatic experience of receiving a shock. Technological improvements and new clinical evidences may help reduce the total burden of shocks. A specific supporting team, providing psychosocial help, may contribute to improving patient quality of life. PMID:22915942

Padeletti, Luigi; Mascioli, Giosue; Perini, Alessandro Paoletti; Grifoni, Gino; Perrotta, Laura; Marchese, Procolo; Bontempi, Luca; Curnis, Antonio

2011-01-01

243

Cardiac surgery in a fixed-reimbursement environment.  

Science.gov (United States)

Hospital and physician services in Canada are funded by public (government) sources. This article will describe the practice of cardiac surgery in this setting. Federal legislation has prescribed the principles of accessibility, universality, comprehensiveness, portability, and public administration for essential healthcare services in Canada. Provincial and territorial governments are responsible for the provision of services, receiving federal tax and cash transfers that supplement provincial/territorial funds for hospital, physician, and community health services. Hospitals negotiate annually for global budgets. Physicians work as independent contractors in hospitals (and communities) and are usually paid as specified by fee-for-service contracts negotiated at intervals with governments. Cardiac surgical services have been planned conjointly with government. Forty-two centers in Canada serve a population of 28 million. All but three of these centers are located in tertiary teaching hospitals; all but one do more than 200 pumps annually. The rate of cardiac operations is 80 per 100,000 population. In Ontario, the Provincial Adult Cardiac Care Network makes recommendations to governments about the distribution of the 7,600 pumps annually (population, 11 million), rationalizing waiting lists based on an urgency rating scale. Patients requiring emergent/urgent operations are well served. The average waiting time for an elective cardiac operation is 10.5 weeks. The waiting list mortality is less than 0.5%. The Provincial Adult Cardiac Care Network also determines the placement of new programs and participates in creating hospital funding formulas developed from a combination of resource and acuity intensity weighting. Most surgeons hold full-time academic appointments but are funded largely by practice income. Surgical fees average $2,000 (Canada) per case. Overhead, including malpractice insurance, is approximately 45%. All Canadian patients enjoy reasonably timely access to good cardiac surgical care. Further constraints on physician compensation and (academic) hospital funding will compromise this balance. PMID:8572826

Scully, H E

1996-02-01

244

Feasibility of correlating the pulse check with focused point-of-care echocardiography during pediatric cardiac arrest: a case series.  

Science.gov (United States)

Rapidly determining whether an unresponsive child is in cardiac arrest or in shock, and requiring cardiopulmonary resuscitation can be problematic. The pulse check in children has been shown to be unreliable, not only for laypersons, but also for healthcare providers. The recommendation for checking the pulse in unresponsive children has been eliminated for laypersons in the latest edition of the Emergency Cardiovascular Care guidelines. Thus the decision to initiate cardiopulmonary resuscitation in children, with the goal of delivering effective chest compressions, can be fraught with uncertainty. Despite the use of pediatric advanced life support guidelines developed by the American Heart Association and the American Academy of Pediatrics, management and decision making during resuscitation of children in cardiac arrest can be challenging. Outcomes for out-of-hospital pediatric cardiac arrest remain poor. The decision to end resuscitation in children, often an emotionally charged situation, can also be particularly difficult for physicians. Information from focused point-of-care echocardiography that allows for correlation with the presence or absence of a pulse and real time assessment of resuscitation may help direct and optimize the delivery of resuscitative interventions. We report our preliminary clinical observations of using focused point-of-care echocardiography to correlate with the pulse check during resuscitation in a series of pediatric cardiac arrests. PMID:18280628

Tsung, James W; Blaivas, Michael

2008-05-01

245

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... the use of a cardiac defibrillator in open heart surgery and what is the risk to the phrenic ... You don't use cardiac defibrillator in open heart surgery at the moment of the point of that ...

246

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... implantation of an automated implantable cardiac defibrillator. The surgery will be performed by Dr. Hanscy Seide and ... use of a cardiac defibrillator in open heart surgery and what is the risk to the phrenic ...

247

Optimizing neurologic prognosis after cardiac arrest  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Neurologic disability is a feared outcome of resuscitation from cardiac arrest. The study by Rech and colleagues in the previous issue of Critical Care describes the use of neuron-specific enolase to inform an early prognosis in patients who survived in-hospital cardiac arrest. In their study 'none of the patients had a DNR order and there was no limitation of life support.' As a result, 10% of patients remained in a vegetative state at 6 months, a higher percentage than in other recent studi...

Tirschwell, David

2006-01-01

248

Data Resource Profile: adult cardiac surgery database of the Netherlands Association for Cardio-Thoracic Surgery.  

Science.gov (United States)

In 2007 The Netherlands Association for Cardio-Thoracic Surgery (Nederlandse Vereniging voor Thoraxchirurgie, NVT) instituted the Adult Cardiac Surgery Database. The dataset comprises demographic factors, type of intervention, in-hospital mortality and 18 risk factors for mortality after cardiac surgery, according to the European System for Cardiac Operative Risk Evaluation definitions. Currently, this procedural database contains over 60 000 interventions. Completeness of data is excellent and national coverage of all 16 Dutch cardio-thoracic surgery centres has been achieved since the start. The primary goal of the database is to control and maintain the quality of care by evaluation of outcomes. This is accomplished by regular feedback and comparison of outcomes. For a subset of the database (procedures from 10 out of 16 centres) longer-term follow-up has been established by means of data linkage to two national registries. This provides information on survival status, causes of death and readmissions. The database has recently been used for research, resulting in methodological papers aimed at optimizing comparison of outcomes. In future, clinical issues will also be addressed, for example survival after coronary artery bypass grafting and valve surgery. PMID:23396848

Siregar, Sabrina; Groenwold, Rolf H H; Versteegh, Michel I M; Takkenberg, Johanna J M; Bots, Michiel L; van der Graaf, Yolanda; van Herwerden, Lex A

2013-02-01

249

Pulmonary embolism as a cause of cardiac arrest: Hypothermia in post-resuscitation period (cooling therapy  

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Full Text Available Introduction. Pulmonary embolism as a possible cause of acute heart failure is a potentially fatal condition that can cause death in all age groups. Patients successfully resuscitated after cardiac arrest have a high risk of increased mortality and their poor long­term outcome is often associated with severe neurological complications. Case Outline. This is a case report of a 67­year­old man after a successful cardiopulmonary resuscitation (CPR which was followed by therapeutic hypothermia (TH. The patient visited the dermatological outpatients’ department with clinical presentation of pain and swelling of the right leg, shortness of breath and chest pain. During examination the patient lost consciousness, stopped breathing and had cardiac arrest. ECG was done which registered asystole. We began CPR. After 59 minutes of resuscitation return of heartbeat was achieved. The patient was transported to the Emergency Department. On admission, after computerized tomography (CT of the chest confirmed massive pulmonary embolism (PE, the patient was administered thrombolytic therapy with Metalyse (tenecteplase and anti­coagulation therapy (heparin. After stabilization, therapeutic hypothermia was applied. Combination of EMCOOLSpad on the chest and abdomen and cold Ringer lactate 500 ml at 4°C was flushed. Temperature was decreased to 33°C and kept stabile for 24 hours. After eight days the patient was conscious with a minimal neurological deficit. Conclusion. As shown in this case report, and according to the rich experience elsewhere, cooling therapy after out­of­hospital cardiac arrest and successful CRP may be useful in preventing neurological complications.

Nikovi? Vuk

2013-01-01

250

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... dying. And the third way of dying is sudden cardiac death. This is the proverbial person that was stepping ... might feel if they're at risk for sudden cardiac death? Sudden cardiac death, sometime if give you notice, ...

251

Diffuse infiltrative cardiac tuberculosis  

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Full Text Available We present the cardiac magnetic resonance images of an unusual form of cardiac tuberculosis. Nodular masses in a sheet-like distribution were seen to infiltrate the outer myocardium and pericardium along most of the cardiac chambers. The lesions showed significant resolution on antitubercular therapy.

Gulati Gurpreet

2011-01-01

252

Atrial fibrillation following cardiac surgery.  

Science.gov (United States)

Atrial tachyarrhythmias, usually atrial fibrillation or atrial flutter, are the most common complications of cardiac surgery. Atrial tachyarrhythmias are associated with patient discomfort/anxiety, hemodynamic deterioration, cognitive impairment, thromboembolic events (including stroke), exposure to the risks of antiarrhythmic treatments, longer hospital stays and increased costs. Many approaches to the prevention of postoperative atrial tachyarrhythmias have been studied. Of these, studies using perioperative beta-blocking agents or amiodarone provide level A evidence of efficacy and, in properly selected patients, have shown a high degree of safety. Less convincing, level B evidence exists for the use of postoperative temporary atrial pacing and for perioperative intravenous magnesium treatment. The treatment of postoperative atrial tachyarrhythmias is similar to those occurring in other settings and includes excluding other potential causes of atrial tachyarrhythmias, antithrombotic or anticoagulation therapy, control of the ventricular response rate and consideration of restoring/maintaining sinus rhythm. The selection of therapies to achieve these goals should consider the sympathetic nervous system discharge state of the postoperative environment and the natural history of postoperative atrial fibrillation, which includes spontaneous resolution of the arrhythmogenic tendency after approximately six weeks. The Canadian Cardiovascular Society Consensus Conference recommendations for the prevention of atrial tachyarrhythmias after cardiac surgery and for the treatment of atrial tachyarrhythmias that occur after cardiac surgery are presented along with evidence that supports these recommendations. PMID:16239988

Mitchell, L Brent; Crystal, Eugene; Heilbron, Brett; Pagé, Pierre

2005-09-01

253

Methemoglobinaemia in Cardiac Patients on Nitrate Therapy  

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Full Text Available Background: Methaemoglobinaemia refers to the oxidation of ferrous iron to ferric iron within the haemoglobin molecule, which occurs following oxidative stresses. The subsequent impairment in oxygen transport may lead to progressive hypoxia that is highly dangerous condition especially in borderline patients like the cardiac patient.Objectives: In the present work, authors explore the extent of methaemoglobinaemia in cardiac patients receiving nitrate therapy.Methodology: The study included 970 cardiac patients presented in cardiology department, Mansoura Specialised Medical Hospital, Egypt, in the period from February to July 2009. Patients were taking oral, sublingual, dermal preparation or a combination of two preparations.Results: cases of the study had methemoglobin level 1.1782 ± 0.3476 g/dL with insignificant difference between males and females. Methemoglobin showed positive correlation with carboxyhemogloin and negative correlation with O2 content and O2 saturation. It was significantly higher in cardiac patient with chest infection, anaemia and diabetic patients but didn't differ in hepatic or non hepatic cardiac patients. 3.2% of cardiac patients who receive more than one nitrate preparation (either oral and dermal or oral and sublingual therapy have methemoglobin level significantly higher than those who receive single preparation. There is significant difference in methemoglobin level in cardiac patients complaining of myocardial infarction “MI”, unstable Angina, atrial fibrillation “AF” and hypertensive heart disease “HTN”.Conclusions: It is concluded that commonly used dosages of nitrates are capable of causing elevations of methemoglobin ranged from 0.9 – 5.3 g/dl. Although the elevation in methaemoglobin (MetHb levels was not of routine clinical significance, there was statistically significant increase in MetHb levels in cardiac patients with another pathologic condition as anaemia, diabetes mellitus or chest infections. Also, it was significantly higher in patients receiving more than one nitrate therapy in combination.

Abdel Aziz A. Ghanem

2010-06-01

254

Cardiac gated ventilation  

International Nuclear Information System (INIS)

There are several theoretic advantages to synchronizing positive pressure breaths with the cardiac cycle, including the potential for improving distribution of pulmonary and myocardial blood flow and enhancing cardiac output. The authors evaluated the effects of synchronizing respiration to the cardiac cycle using a programmable ventilator and electron beam CT (EBCT) scanning. The hearts of anesthetized dogs were imaged during cardiac gated respiration with a 50 msec scan aperture. Multi slice, short axis, dynamic image data sets spanning the apex to base of the left ventricle were evaluated to determine the volume of the left ventricular chamber at end-diastole and end-systole during apnea, systolic and diastolic cardiac gating. The authors observed an increase in cardiac output of up to 30% with inspiration gated to the systolic phase of the cardiac cycle in a non-failing model of the heart

255

Controlled Cardiac Computed Tomography  

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Full Text Available Cardiac computed tomography (CT has been a hot topic for years because of the clinical importance of cardiac diseases and the rapid evolution of CT systems. In this paper, we propose a novel strategy for controlled cardiac CT that may effectively reduce image artifacts due to cardiac and respiratory motions. Our approach is radically different from existing ones and is based on controlling the X-ray source rotation velocity and powering status in reference to the cardiac motion. We theoretically show that by such a control-based intervention the data acquisition process can be optimized for cardiac CT in the cases of periodic and quasiperiodic cardiac motions. Specifically, we formulate the corresponding coordination/control schemes for either exact or approximate matches between the ideal and actual source positions, and report representative simulation results that support our analytic findings.

Ge Wang

2006-04-01

256

Controlled Cardiac Computed Tomography  

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Full Text Available Cardiac computed tomography (CT has been a hot topic for years because of the clinical importance of cardiac diseases and the rapid evolution of CT systems. In this paper, we propose a novel strategy for controlled cardiac CT that may effectively reduce image artifacts due to cardiac and respiratory motions. Our approach is radically different from existing ones and is based on controlling the X-ray source rotation velocity and powering status in reference to the cardiac motion. We theoretically show that by such a control-based intervention the data acquisition process can be optimized for cardiac CT in the cases of periodic and quasiperiodic cardiac motions. Specifically, we formulate the corresponding coordination/control schemes for either exact or approximate matches between the ideal and actual source positions, and report representative simulation results that support our analytic findings.

2006-01-01

257

Cardiac tumours in children  

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Full Text Available Abstract Cardiac tumours are benign or malignant neoplasms arising primarily in the inner lining, muscle layer, or the surrounding pericardium of the heart. They can be primary or metastatic. Primary cardiac tumours are rare in paediatric practice with a prevalence of 0.0017 to 0.28 in autopsy series. In contrast, the incidence of cardiac tumours during foetal life has been reported to be approximately 0.14%. The vast majority of primary cardiac tumours in children are benign, whilst approximately 10% are malignant. Secondary malignant tumours are 10–20 times more prevalent than primary malignant tumours. Rhabdomyoma is the most common cardiac tumour during foetal life and childhood. It accounts for more than 60% of all primary cardiac tumours. The frequency and type of cardiac tumours in adults differ from those in children with 75% being benign and 25% being malignant. Myxomas are the most common primary tumours in adults constituting 40% of benign tumours. Sarcomas make up 75% of malignant cardiac masses. Echocardiography, Computing Tomography (CT and Magnetic Resonance Imaging (MRI of the heart are the main non-invasive diagnostic tools. Cardiac catheterisation is seldom necessary. Tumour biopsy with histological assessment remains the gold standard for confirmation of the diagnosis. Surgical resection of primary cardiac tumours should be considered to relieve symptoms and mechanical obstruction to blood flow. The outcome of surgical resection in symptomatic, non-myxomatous benign cardiac tumours is favourable. Patients with primary cardiac malignancies may benefit from palliative surgery but this approach should not be recommended for patients with metastatic cardiac tumours. Surgery, chemotherapy and radiotherapy may prolong survival. The prognosis for malignant primary cardiac tumours is generally extremely poor.

Parsons Jonathan M

2007-03-01

258

Provision of out-of-hours interventional radiology services in the London Strategic Health Authority  

Energy Technology Data Exchange (ETDEWEB)

Aim: To review the provision of out-of-hours interventional radiology (IR) services in the London Strategic Health Authority (SHA). Materials and methods: All 29 acute hospitals in the London SHA were contacted between November 2008 and January 2009. A questionnaire based on the Royal College of Radiologists (RCR) guidelines assessed the provision of out-of-hours IR services. An 'ad-hoc' service was defined as on-call provision where not all the radiologists could perform intervention: If IR was required out of hours, an interventionalist came in when off-duty or the patient was transferred. Results: Seventeen out of the 29 (59%) hospitals provided ad-hoc out-of-hours services, eight (28%) provided a 24-hour rota, and four (14%) provide no out-of-hours cover. No ad-hoc service had formal transfer arrangements to a centre providing a 24 h service. Only two hospitals providing a 24 h service had six radiologists on the rota. Conclusion: Strategic planning for out-of-hours IR across London is recommended. This is likely to be welcomed by the hospitals involved, allowing informal arrangements to be formalized, and collaboration to provide comprehensive regional networks, provided appropriate funding is made available. A national audit is recommended; it is unlikely these findings are unique to London.

Illing, R.O., E-mail: rowland@doctors.org.u [University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU (United Kingdom); Ingham Clark, C.L.; Allum, C. [Whittington Hospital NHS Trust, London (United Kingdom)

2010-04-15

259

Provision of out-of-hours interventional radiology services in the London Strategic Health Authority  

International Nuclear Information System (INIS)

Aim: To review the provision of out-of-hours interventional radiology (IR) services in the London Strategic Health Authority (SHA). Materials and methods: All 29 acute hospitals in the London SHA were contacted between November 2008 and January 2009. A questionnaire based on the Royal College of Radiologists (RCR) guidelines assessed the provision of out-of-hours IR services. An 'ad-hoc' service was defined as on-call provision where not all the radiologists could perform intervention: If IR was required out of hours, an interventionalist came in when off-duty or the patient was transferred. Results: Seventeen out of the 29 (59%) hospitals provided ad-hoc out-of-hours services, eight (28%) provided a 24-hour rota, and four (14%) provide no out-of-hours cover. No ad-hoc service had formal transfer arrangements to a centre providing a 24 h service. Only two hospitals providing a 24 h service had six radiologists on the rota. Conclusion: Strategic planning for out-of-hours IR across London is recommended. This is likely to be welcomed by the hospitals involved, allowing informal arrangements to be formalized, and collaboration to provide comprehensive regional networks, provided appropriate funding is made available. A national audit is recommended; it is unlikely these findings are unique to London.

260

Primary cardiac osteosarcoma in a 42-year-old woman  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract We describe here a 42-year-old woman who was admitted to hospital with a pedunculated mass in her left atrium. She was diagnosed with a primary cardiac osteosarcoma with special immunohistochemical characteristics. Echocardiography and computed tomography can be used to differentiate cardiac osteosarcomas from routine intracardiac tumors. The patient was treated by surgical removal of the mass. Two years later, she has shown no evidence of disease recurrence. We discuss pri...

Zou Jianyong; Su Chunhua

2010-01-01

 
 
 
 
261

Contracting out of clinical services in Zimbabwe.  

Science.gov (United States)

Contracting is increasingly recommended to developing countries as a way of improving the efficiency of the health sector. However, empirical evidence regarding its effectiveness in this respect is almost completely absent. In Zimbabwe, a long standing contract exists between the Ministry of Health and Wankie Colliery to provide clinical services in the Colliery's 400 bed hospital. This paper details a study of the Zimbabweans' experience with the contract. Its success is assessed using comparisons with a neighbouring government hospital of the price of services (vs the cost in the government hospital); the situation of hospital workers; and the quality of services delivered. The Colliery has established a monopoly position for hospital services in the district. However, it appears to offer services of at least as good quality at prices which are lower than the unit costs of the government hospital when capital costs are included. Nevertheless, the contract cannot be considered a success due to the failure to contain its total cost. Approximately 70% of provincial non-salary recurrent expenditure is consumed by the contract while only a minority of the province's population have access to the Colliery hospital. Screening patients, both with respect to their ability to pay and to their need for secondary level services does not take place with the result that utilization levels are not controlled. The study highlights a number of important issues affecting contracting in developing country setting: First, contracted institutions attain powerful bargaining positions if there are no viable competitors and the government does not itself retain capacity to offer an alternative service. Second, specific skills are needed for the management of contracts at all levels. If the process of contract development responds to a crisis driven agenda resulting from civil service retrenchment and public expenditure cuts, it is unlikely that adequate consideration will be given to the development of such skills and the retention of key personnel. If such details are neglected, otherwise feasible efficiency gains will prove elusive. PMID:7667666

McPake, B; Hongoro, C

1995-07-01

262

Magnetocardiography and cardiac risk.  

Science.gov (United States)

Risk evaluation is a challenging problem in clinical cardiology. Recently, the development of new therapeutic strategies for malignant cardiac arrhythmias and ischemia has urged the need for more accurate screening methods of risk patients The purpose of this review is to summarize the current scientific evidence on the applicability of a new method, high-resolution magnetocardiography (HR-MCG), in identification of cardiac patients at risk of malignant ventricular arrhythmias and ischemic episodes. In recent years different methods for recognizing the electromagnetic abnormalities indicating the increased risk have been used with promising results. At present, the following conclusions can be made: 1) MCG can reliably identify patients prone to malignant ventricular arrhythmias after myocardial infarction as well as in cardiomyopathy, in long QT syndrome, and in operated congenital heart disease. 2) Several analysis methods seem to work: high-pass filtering, relative smoothness score and magnetic field map trajectory plots. 3) Detection and localization of acute and chronic ischemia seems technically feasible and may be one of the most important new clinical applications of the method. 4) Larger clinical series are needed to optimize these techniques and to evaluate their feasibility in the clinics. 5) Prognostic studies should also be started as soon as possible. There are already many multichannel MCG measurement systems available in hospitals to enable clinical studies.ZUSAMMENFASSUNG: Die Risikoabschätzung stellt in der klinischen Kardiologie ein schwieriges Problem dar. Kürzlich hat die Entwicklung neuer Strategien bei malignen kardialen Arrhythmien und der Ischämie die, Notwendigkeit an exakteren Untersuchungsmethoden bei Risikopatienten unterstrichen. Diese Ubersicht soll dem Zweck dienen, die derzeitige wissenschaftliche Anwendbarkeit einer neuen Methode, der hochauflösenden Magnetokardiographie (HR-MCG) bei Herzpatienten nachzuweisen, bei denen ein Risiko des Auftretens maligner Kammerarrhythmien und ischämischen Episoden beseht. Im Verlauf der letzten Jahre sind mit vielversprechenden Resultaten verschiedene Methoden zum Nachweis elektromagnetischer Störungen entwickelt worden, die auf ein erhöhtes Risiko hinweisen. Momentan können daraus die folgenden Schlussfolgerungen gezogen werden: 1) Die MCG kann das erhöhte Risiko bei den Patienten zuverlässig aufzeigen, die einen Herzinfarkt durchgemacht haben oder an einer Kardiomyopathie, einem langen QT-Syndrom oder einer operierten, kongenitalen Herzerkrankung leiden. 2) Es scheinen verschiedene Auswertungsmethoden zu funktionieren: Hochpassfiltrierung, Relative Smoothness Score und Magnetkarten-Trajektaufzeichnungen. 3) Nachweis und Lokalisation der akuten und chronischen Ischämie erscheinen technisch möglich zu sein und können eine der wichtigsten neuen klinischen Untersuchungsmethoden darstellen. 4) Umfangreichere klinische Studien sind erforderlich, um die Optimierung dieser Methoden zu erreichen und ihre Eignung unter klinischen Bedingungen aufzuzeigen. 5) So bald als möglich sollten ausserdem prognostische Studien eingeleitet werden. Es existieren in Krankenhäusern bereits einige Multikanal-MCG-Messgeräte, die sich zur Durchführung klinischer Studien eignen. PMID:19484514

Mäkijärvi, M

1997-09-01

263

A case of thyroid storm with cardiac arrest  

Directory of Open Access Journals (Sweden)

Full Text Available Yutaka Nakashima,1 Tsuneaki Kenzaka,2 Masanobu Okayama,3 Eiji Kajii31Department for Support of Rural Medicine, Yamaguchi Grand Medical Center, 2Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan; 3Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, JapanAbstract: A 23-year-old man became unconscious while jogging. He immediately received basic life support from a bystander and was transported to our hospital. On arrival, his spontaneous circulation had returned from a state of ventricular fibrillation and pulseless electrical activity. Following admission, hyperthyroidism led to a suspicion of thyroid storm, which was then diagnosed as a possible cause of the cardiac arrest. Although hyperthyroidism-induced cardiac arrest including ventricular fibrillation is rare, it should be considered when diagnosing the cause of treatable cardiac arrest.Keywords: hyperthyroidism, ventricular fibrillation, treatable cardiac arrest, cardiac arrest, cardiopulmonary arrest

Nakashima Y

2014-05-01

264

Redução do período de internação e de despesas no atendimento de portadores de cardiopatias congênitas submetidos à intervenção cirúrgica cardíaca no protocolo da via rápida / The reduction in hospital stay and costs in the care of patients with congenital heart diseases undergoing fast-track cardiac surgery  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Avaliar o atendimento de cardiopatas congênitos e cardiopatas isquêmicos submetidos à cirurgia cardíaca no protocolo de atendimento na via rápida (fast-track recovery) em relação ao convencional. MÉTODOS: Avaliada a movimentação de 175 pacientes, 107 (61%) homens e 68 (39%) mulheres, idade [...] s entre 0,3-81 anos nas diferentes unidades hospitalares. RESULTADOS: A taxa de alta das diferentes unidades hospitalares por unidade de tempo, dos cardiopatas congênitos atendidos no protocolo da via rápida em relação ao convencional foi: a) 11,3 vezes a taxa de alta quando assistidos no protocolo da via convencional, quanto ao tempo de permanência no centro cirúrgico; b) 6,3 vezes quanto à duração da intervenção cirúrgica; c) 6,8 vezes quanto à duração da anestesia; d) 1,5 vezes quanto à duração da perfusão; e) 2,8 vezes quanto à permanência na unidade de recuperação pós-operatória I; f) 6,7 vezes quanto à permanência no hospital (período de tempo entre a data da internação e a data da alta); g) 2,8 vezes quanto à permanência na unidade de internação pré-operatória; h) 2,1 vezes quanto à permanência na unidade de internação após a alta da recuperação pós-operatória; i) associada com redução de despesas pré e pós-operatórias. A diferença não foi significativa nos portadores de cardiopatia isquêmica. CONCLUSÃO: Verificou-se redução do período de internação e de despesas no atendimento dos pacientes submetidos à intervenção cirúrgica cardíaca no protocolo da via rápida. Abstract in english OBJECTIVE: To assess the care provided to patients with congenital heart diseases and ischemic heart diseases undergoing cardiac surgery according to the fast-track recovery protocol compared with those undergoing the conventional procedure. METHODS: The transfer of patients from one hospital unit t [...] o another was assessed for 175 patients, 107 (61%) men and 68 (39%) women, with ages ranging from 0.3 to 81 years. RESULTS: The discharge rate from the different hospital units per unit of time of the patients with congenital heart diseases treated according to the fast-track recovery protocol compared with that of patients conventionally treated was as follows: a) 11.3 times faster than the discharge rate of patients treated according to the conventional protocol, in regard to the time spent in the operating room; b) 6.3 times faster in regard to the duration of the surgical intervention; c) 6.8 times faster in regard to the duration of anesthesia; d) 1.5 times faster in regard to the duration of perfusion; e) 2.8 times faster in regard to the stay in the postoperative recovery I unit; f) 6.7 times faster in regard to hospital stay (time period between hospital admission and hospital discharge); g) 2.8 times faster in regard to the stay in the preoperative unit; h) 2.1 times faster in regard to the stay in the admission unit after discharge from postoperative recovery; i) associated with reduced costs. The difference was not significant for patients with ischemic heart disease. CONCLUSION: A reduction in the length of hospital stay and costs for the care of patients undergoing cardiac surgery according to the fast-track protocol was observed.

Alfredo Manoel da Silva, Fernandes; Alfredo José, Mansur; Luis Fernando, Canêo; Domingos Dias, Lourenço; Marilde Albuquerque, Piccioni; Sonia Mieken, Franchi; Cristina Machado C., Afiune; Jorge Wiliam, Gadioli; Sérgio de Almeida, Oliveira; José Antonio Franchini, Ramires.

265

Redução do período de internação e de despesas no atendimento de portadores de cardiopatias congênitas submetidos à intervenção cirúrgica cardíaca no protocolo da via rápida The reduction in hospital stay and costs in the care of patients with congenital heart diseases undergoing fast-track cardiac surgery  

Directory of Open Access Journals (Sweden)

Full Text Available OBJETIVO: Avaliar o atendimento de cardiopatas congênitos e cardiopatas isquêmicos submetidos à cirurgia cardíaca no protocolo de atendimento na via rápida (fast-track recovery em relação ao convencional. MÉTODOS: Avaliada a movimentação de 175 pacientes, 107 (61% homens e 68 (39% mulheres, idades entre 0,3-81 anos nas diferentes unidades hospitalares. RESULTADOS: A taxa de alta das diferentes unidades hospitalares por unidade de tempo, dos cardiopatas congênitos atendidos no protocolo da via rápida em relação ao convencional foi: a 11,3 vezes a taxa de alta quando assistidos no protocolo da via convencional, quanto ao tempo de permanência no centro cirúrgico; b 6,3 vezes quanto à duração da intervenção cirúrgica; c 6,8 vezes quanto à duração da anestesia; d 1,5 vezes quanto à duração da perfusão; e 2,8 vezes quanto à permanência na unidade de recuperação pós-operatória I; f 6,7 vezes quanto à permanência no hospital (período de tempo entre a data da internação e a data da alta; g 2,8 vezes quanto à permanência na unidade de internação pré-operatória; h 2,1 vezes quanto à permanência na unidade de internação após a alta da recuperação pós-operatória; i associada com redução de despesas pré e pós-operatórias. A diferença não foi significativa nos portadores de cardiopatia isquêmica. CONCLUSÃO: Verificou-se redução do período de internação e de despesas no atendimento dos pacientes submetidos à intervenção cirúrgica cardíaca no protocolo da via rápida.OBJECTIVE: To assess the care provided to patients with congenital heart diseases and ischemic heart diseases undergoing cardiac surgery according to the fast-track recovery protocol compared with those undergoing the conventional procedure. METHODS: The transfer of patients from one hospital unit to another was assessed for 175 patients, 107 (61% men and 68 (39% women, with ages ranging from 0.3 to 81 years. RESULTS: The discharge rate from the different hospital units per unit of time of the patients with congenital heart diseases treated according to the fast-track recovery protocol compared with that of patients conventionally treated was as follows: a 11.3 times faster than the discharge rate of patients treated according to the conventional protocol, in regard to the time spent in the operating room; b 6.3 times faster in regard to the duration of the surgical intervention; c 6.8 times faster in regard to the duration of anesthesia; d 1.5 times faster in regard to the duration of perfusion; e 2.8 times faster in regard to the stay in the postoperative recovery I unit; f 6.7 times faster in regard to hospital stay (time period between hospital admission and hospital discharge; g 2.8 times faster in regard to the stay in the preoperative unit; h 2.1 times faster in regard to the stay in the admission unit after discharge from postoperative recovery; i associated with reduced costs. The difference was not significant for patients with ischemic heart disease. CONCLUSION: A reduction in the length of hospital stay and costs for the care of patients undergoing cardiac surgery according to the fast-track protocol was observed.

Alfredo Manoel da Silva Fernandes

2004-07-01

266

Cardiac Complications in Acute Ischemic Stroke  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Introduction: To characterize cardiac complications in acute ischemic stroke (AIS) patients admitted from an urban emergency department (ED). Methods: Retrospective cross-sectional study evaluating AIS patients admitted from the ED within 24 hours of symptom onset who also had an echocardiogram performed within 72 hours of admission. Results: Two hundred AIS patients were identified with an overall in-hospital mortality rate of 8% (n¼ 16). In our cohort, 57 (28.5%) of 200 ...

Christopher Lewandowski; Robert Sherwin; Gayathri Iyer; Brian Silver; Cynthia Martinez-Capolino; Emanuel Rivers; Wira, Charles R.

2011-01-01

267

Autologous Transfusion in Cardiac Surgery  

Directory of Open Access Journals (Sweden)

Full Text Available Preoperative autologous blood donation is commonly used to reduce exposure to homologous blood transfusions among patients undergoing elective cardiac surgery. The aim of this study was to evaluate the effect of autologous transfusion on patients' hematocryte value, intra and postoperative blood loss, hospitalization time, the development of infective complications and other factors. Materials and Methods: Between June 2001 to April 2002, 208 patients were underwent cardiac surgery in cardiac surgery ward in Imam Khomeini Medical Center. One or more blood units donate from 104 Patients before cardiopulmonary bypass and heparin injection, and transfused to them after CPB and Protamin injection (autologous Group, group 1. 104 patients underwent cardiac surgery routinely (control group, group 2."nResults: Mean of age was 55.9±8.6 in group 1 and 56.6±9.3 in group 2 (P=NS. 73 male and 31 females were in group 1 and 79 males and 25 females were in group 2 (P=NS. Smoking, familial history, hyperlipidemia, diabetes mellitus, renal failure, hypertension, stroke, and history of myocardial infarction was similar in two groups."nSeverity of angina, urgency operation, number vessels disease, duration of cardiopulmonary bypass, duration of aortic cross clamp time, use of internal thoracic artery graft, and number of grafts was similar in both groups. Mean of bleeding post operation was 548 cc in group 1 and 803 cc in-group 2 (P=0.003. Bleeding that need to operation was 1.8% in group 1 and 8.6% in group 2 (P=0.002. Wound infection, mediastinitis, renal failure, ventilatory prolonged, stroke, need to Intra-aortic Balloon Pump (IABP, intraoperative bleeding, and hospital stay was similar in both groups. Mean of extubationt time was 10.2 hours in group 1 and 14.8 hours in group 2 (P=0.001."nConclusion: Preoperative and intra-operative donations are safe and continue to contribute uniquely to blood conservation, providing important options in comprehensive blood conservation programs in current pediatric open-heart surgery."n"n"n"n"n"n"n 

Radmehr H

2003-11-01

268

Digital cardiac imaging  

International Nuclear Information System (INIS)

This handbook provides a scientific framework for understanding digital cardiac imaging and reviews the present status and recent advances of several cardiac imaging modalities, including digital radiography, nuclear cardiology, digital two-demensional echocardiography, Doppler echocardiography, computed tomography, positron emission tomography, and magnetic resonance imaging. The contributors represent an interdisciplinary team of investigators interested in the use of digital cardiac imaging in the understanding of cardiac disease. The book attempts to provide the reader with an introduction to basic principles in digital computing, image acquisition, and image processing. (orig.)

269

Incidência de parada cardíaca durante anestesia, em hospital universitário de atendimento terciário: estudo prospectivo entre 1996 e 2002 / Cardiac arrest during anesthesia at a tertiary teaching hospital: prospective survey from 1996 to 2002 / Incidencia de parada cardíaca durante anestesia, en hospital universitario de servicio terciario: estudio prospectivo entre 1996 y 2002  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: A incidência e causas de parada cardíaca (PC) durante a anestesia variam e são difíceis de comparar diante dos diversos métodos usados nos estudos. A pesquisa teve como objetivo estudar todas as PC ocorridas no intra e pós-operatório, durante um período de sete anos, de 19 [...] 96 a 2002, em hospital de ensino de atendimento terciário para determinar incidência e causas da PC. MÉTODO: A incidência prospectiva de PC ocorrida durante a anestesia em 40.941 pacientes consecutivos foi identificada, utilizando-se um Banco de Dados. Todos os casos de PC e óbito foram revisados por uma Comissão, para determinar o fator desencadeante da PC ou óbito. A incidência de PC foi calculada em relação à idade, sexo, estado físico, segundo a classificação da ASA, tipo de atendimento, fatores desencadeantes, como alteração do estado físico do paciente e complicações cirúrgicas e anestésicas, tipo de anestesia e evolução para óbito. RESULTADOS: Ocorreram 138 PC (33,7:10.000), sendo a maioria em recém-nascidos, crianças até um ano e idosos, no sexo masculino (65,2%), em pacientes com estado físico ASA III ou superior, em atendimento de emergência e durante anestesia geral. Alterações do estado físico foram o principal fator de PC (23,9:10.000), seguidas de complicações cirúrgicas isoladamente (4,64:10.000) ou associadas a alterações do estado físico (2,44:10.000) e da anestesia isoladamente (1,71:10.000) ou associadas a alterações do estado físico (0,98:10.000). O risco de óbito relacionado à anestesia como fator principal ou contributivo foi igual para ambos (0,49:10.000). As principais causas da mortalidade associada à anestesia foram os problemas ventilatórios (45,4%), eventos relacionados à medicação empregada (27,3%), aspiração pulmonar (18,2%) e hidratação excessiva (9,1%). CONCLUSÕES: A incidência de PC durante a anestesia ainda continua elevada. A maioria das PC e óbitos associados à anestesia foi relacionada ao manuseio das vias aéreas e à administração de medicamentos e anestésicos. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: La incidencia y causas de parada cardíaca (PC) durante la anestesia varían y son difíciles de comparar delante de los diversos métodos usados en los estudios. El objetivo de la pesquisa fue de como estudiar todas las PC ocurridas en el intra y pos-operatorio, durante un pe [...] ríodo de siete años, de 1996 a 2002, en un hospital de enseñanza de servicio terciario para determinar incidencia y causas de la PC. MÉTODO: La incidencia prospectiva de PC ocurrida durante la anestesia en 40.941 pacientes consecutivos fue identificada, utilizándose un Banco de datos. Todos los casos de PC y fallecimiento fueron revisados por una Comisión, para determinar el factor desencadenante de la PC o fallecimiento. La incidencia de la PC fue calculada con relación a la edad, sexo, estado físico, según la clasificación de la ASA, tipo de servicio, factores desencadenantes, como alteración del estado físico del paciente y complicaciones quirúrgicas y anestésicas, tipo de anestesia y evolución para fallecimiento. RESULTADOS: Ocurrieron 138 PC (33,7:10.000), siendo la mayoría en recién nacidos, niños hasta un año de edad y ancianos, en el sexo masculino (65,2%), en pacientes con estado físico ASA III o superior, en servicio de emergencia y durante anestesia general. Alteraciones del estado físico fueron el principal factor de PC (23,9:10.000), seguidas de complicaciones quirúrgicas aisladamente (4,64:10.000) o asociadas a alteraciones del estado físico (2,44:10.000) y de la anestesia aisladamente (1,71:10.000) o asociadas a alteraciones del estado físico (0,98:10.000). El riesgo de fallecimiento relacionado a la anestesia como factor principal o contributivo fue igual para ambos (0,49:10.000). Las principales causas de la mortalidad asociada a la anestesia fueron los problemas ventilatorios (45,4%), eventos relacionados a la medi

Leandro Gobbo, Braz; José Reinaldo Cerqueira, Braz; Norma Sueli Pinheiro, Módolo; Paulo do, Nascimento Júnior; Ana Paula, Shuhama; Laís Helena Camacho, Navarro.

2004-12-01

270

Incidência de parada cardíaca durante anestesia, em hospital universitário de atendimento terciário: estudo prospectivo entre 1996 e 2002 / Cardiac arrest during anesthesia at a tertiary teaching hospital: prospective survey from 1996 to 2002 / Incidencia de parada cardíaca durante anestesia, en hospital universitario de servicio terciario: estudio prospectivo entre 1996 y 2002  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: A incidência e causas de parada cardíaca (PC) durante a anestesia variam e são difíceis de comparar diante dos diversos métodos usados nos estudos. A pesquisa teve como objetivo estudar todas as PC ocorridas no intra e pós-operatório, durante um período de sete anos, de 19 [...] 96 a 2002, em hospital de ensino de atendimento terciário para determinar incidência e causas da PC. MÉTODO: A incidência prospectiva de PC ocorrida durante a anestesia em 40.941 pacientes consecutivos foi identificada, utilizando-se um Banco de Dados. Todos os casos de PC e óbito foram revisados por uma Comissão, para determinar o fator desencadeante da PC ou óbito. A incidência de PC foi calculada em relação à idade, sexo, estado físico, segundo a classificação da ASA, tipo de atendimento, fatores desencadeantes, como alteração do estado físico do paciente e complicações cirúrgicas e anestésicas, tipo de anestesia e evolução para óbito. RESULTADOS: Ocorreram 138 PC (33,7:10.000), sendo a maioria em recém-nascidos, crianças até um ano e idosos, no sexo masculino (65,2%), em pacientes com estado físico ASA III ou superior, em atendimento de emergência e durante anestesia geral. Alterações do estado físico foram o principal fator de PC (23,9:10.000), seguidas de complicações cirúrgicas isoladamente (4,64:10.000) ou associadas a alterações do estado físico (2,44:10.000) e da anestesia isoladamente (1,71:10.000) ou associadas a alterações do estado físico (0,98:10.000). O risco de óbito relacionado à anestesia como fator principal ou contributivo foi igual para ambos (0,49:10.000). As principais causas da mortalidade associada à anestesia foram os problemas ventilatórios (45,4%), eventos relacionados à medicação empregada (27,3%), aspiração pulmonar (18,2%) e hidratação excessiva (9,1%). CONCLUSÕES: A incidência de PC durante a anestesia ainda continua elevada. A maioria das PC e óbitos associados à anestesia foi relacionada ao manuseio das vias aéreas e à administração de medicamentos e anestésicos. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: La incidencia y causas de parada cardíaca (PC) durante la anestesia varían y son difíciles de comparar delante de los diversos métodos usados en los estudios. El objetivo de la pesquisa fue de como estudiar todas las PC ocurridas en el intra y pos-operatorio, durante un pe [...] ríodo de siete años, de 1996 a 2002, en un hospital de enseñanza de servicio terciario para determinar incidencia y causas de la PC. MÉTODO: La incidencia prospectiva de PC ocurrida durante la anestesia en 40.941 pacientes consecutivos fue identificada, utilizándose un Banco de datos. Todos los casos de PC y fallecimiento fueron revisados por una Comisión, para determinar el factor desencadenante de la PC o fallecimiento. La incidencia de la PC fue calculada con relación a la edad, sexo, estado físico, según la clasificación de la ASA, tipo de servicio, factores desencadenantes, como alteración del estado físico del paciente y complicaciones quirúrgicas y anestésicas, tipo de anestesia y evolución para fallecimiento. RESULTADOS: Ocurrieron 138 PC (33,7:10.000), siendo la mayoría en recién nacidos, niños hasta un año de edad y ancianos, en el sexo masculino (65,2%), en pacientes con estado físico ASA III o superior, en servicio de emergencia y durante anestesia general. Alteraciones del estado físico fueron el principal factor de PC (23,9:10.000), seguidas de complicaciones quirúrgicas aisladamente (4,64:10.000) o asociadas a alteraciones del estado físico (2,44:10.000) y de la anestesia aisladamente (1,71:10.000) o asociadas a alteraciones del estado físico (0,98:10.000). El riesgo de fallecimiento relacionado a la anestesia como factor principal o contributivo fue igual para ambos (0,49:10.000). Las principales causas de la mortalidad asociada a la anestesia fueron los problemas ventilatorios (45,4%), eventos relacionados a la medi

Leandro Gobbo, Braz; José Reinaldo Cerqueira, Braz; Norma Sueli Pinheiro, Módolo; Paulo do, Nascimento Júnior; Ana Paula, Shuhama; Laís Helena Camacho, Navarro.

271

Device-related atypical pressure ulcer after cardiac surgery.  

Science.gov (United States)

Medical devices must be closely monitored to prevent harm to patients. Pressure ulcers secondary to medical devices present a significant health burden in terms of length of stay in hospital and cost. Intensivists, anaesthetists and other professionals involved in managing critically ill patients following cardiac surgery need to be aware that pressure ulcers may develop in atypical sites and present at a later stage of the hospital stay. This case report highlights the important issue of device-related pressure ulcers in the cardiac surgical intensive care setting, particularly when the clinical status of the patient may preclude routine assessment and prophylaxis. An algorithm for preventing such pressure ulcers is suggested. PMID:25139595

Glasgow, D; Millen, I S; Nzewi, O C; Varadarajaran, B

2014-08-01

272

Vigilância de infecção de sítio cirúrgico no pós-alta hospitalar de cirurgia cardíaca reconstrutora / Surgical site infection surveillance in post-hospital discharge after cardiac reconstructive surgery / Vigilancia de la infección de sitio quirúrgico después del alta hospitalaria de cirugía cardíaca reconstructiva  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese A incidência de doenças cardiovasculares vem aumentando a cada ano e, na maioria das vezes, a cirurgia de revascularização do miocárdio se faz necessária, sendo a infecção de sítio cirúrgico, uma das principais complicações. Este estudo teve por objetivo identificar sinais e sintomas de infecção de [...] sítio cirúrgico no pós-alta hospitalar de cirurgia cardíaca reconstrutora. Trata-se de um estudo quantitativo descritivo de caráter prospectivo. A coleta de dados foi realizada na residência de 20 pacientes maiores de 18 anos, submetidos à cirurgia cardíaca reconstrutora, em um hospital filantrópico de nível quaternário, situado em São José do Rio Preto-SP, Brasil. Quatro pacientes apresentavam exsudato seroso ou purulento e hiperemia na incisão cirúrgica. Evidenciou-se uma taxa de 20% de infecção de sítio cirúrgico no pós-alta hospitalar. Ressalta-se a necessidade de implementar um método de vigilância no período cirúrgico focalizado no pós-alta hospitalar que possibilite uma real notificação das infecções de sítio cirúrgico, já que estas podem ser subnotificadas ocasionando uma alta taxa de morbi-mortalidade. Abstract in spanish Cada año la incidencia de las enfermedades cardiovasculares ha ido en aumento, y en la mayoría de los casos, la cirugía de revascularización miocárdica se hace necesaria, siendo la infección de sitio quirúrgico una de las principales complicaciones. Este estudio tuvo como objetivo identificar señale [...] s y síntomas de infección de sitio quirúrgico después del alta hospitalaria de cirugía cardíaca reconstructiva. Este es un estudio cuantitativo descriptivo de carácter prospectivo. La recolección de datos se realizó en la residencia de 20 pacientes mayores de 18 años, sometidos a cirugía cardíaca reconstructiva en un hospital filantrópico cuaternario, de São José de Rio Preto-SP, Brazil. Cuatro pacientes presentaban exudado seroso o purulento e hiperemia en la incisión quirúrgica. Se encontró una tasa de 20% de infección de sitio quirúrgico después del alta hospitalaria. Destacamos la necesidad de aplicar un método de vigilancia en el período posterior al alta hospitalaria para permitir una información real de las infecciones del sitio quirúrgico, ya que estas pueden no ser reportadas, causando una alta tasa de morbilidad y mortalidad. Abstract in english The incidence of cardiovascular disease has been increasing annually in recent years, and in the majority of cases Myocardial Revascularization surgery becomes necessary. One of the principle complications of this procedure is post-surgical infection of the surgical site. This study aimed to identif [...] y signs and symptoms of infection of surgical site in the post-hospital discharge following cardiac reconstructive surgery. This is a descriptive quantitative study of a prospective character. Data was collected in the respective houses of 20 patients older than 18 years old who were submitted to cardiac reconstructive surgery in a quaternary philanthropic hospital located in São José do Rio Preto, SP, Brazil. Four patients presented serous exudate or festering and hyperemia in the surgical incision. An infection rate of the surgical site of 20% was found in post-hospital discharges studied. We highlight the need to implement a surveillance method in the period following post-hospital discharge to enable a real notification of surgical site infections, as these may be underreported and cause a high mortality rate.

Vanessa Damiana Menis, Sasaki; Adilson Edson, Romanzini; Ana Paula Marcielo de, Jesus; Edevã de, Carvalho; João Junior, Gomes; Valquiria Barco, Damiano.

2011-06-01

273

Emergency coronary artery surgery after refractory cardiac arrest: a single centre experience.  

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OBJECTIVE--To determine the incidence and outcome of refractory cardiac arrest necessitating emergency coronary artery bypass grafting. DESIGN--Retrospective survey of cardiac catheterisation and surgical records. SETTING--The London Chest Hospital. PATIENTS--All patients requiring emergency coronary artery bypass grafting after cardiovascular collapse in the catheterisation suite between January 1984 and December 1989. MAIN OUTCOME MEASURES--Incidence of refractory cardiac arrest in the stud...

Powney, J. G.; Bonser, R. S.; Lentini, S.

1992-01-01

274

Perceptions of cardiac rehabilitation patients, specialists and rehabilitation programs regarding cardiac rehabilitation wait times  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background In 2006, the Canadian Cardiovascular Society (CCS Access to Care Working Group recommended a 30-day wait time benchmark for cardiac rehabilitation (CR. The objectives of the current study were to: (1 describe cardiac patient perceptions of actual and ideal CR wait times, (2 describe and compare cardiac specialist and CR program perceptions of wait times, as well as whether the recommendations are appropriate and feasible, and (3 investigate actual wait times and factors that CR programs perceive to affect these wait times. Methods Postal and online surveys to assess perceptions of CR wait times were administered to CR enrollees at intake into 1 of 8 programs, all CCS member cardiac specialists treating patients indicated for CR, and all CR programs listed in Canadian directories. Actual wait times were ascertained from the Canadian Cardiac Rehabilitation Registry. The design was cross-sectional. Responses were described and compared. Results Responses were received from 163 CR enrollees, 71 cardiac specialists (9.3% response rate, and 92 CR programs (61.7% response rate. Patients reported that their wait time from hospital discharge to CR initiation was 65.6?±?88.4?days (median, 42?days, while their ideal median wait time was 28?days. Most patients (91.5% considered their wait to be acceptable, but ideal wait times varied significantly by the type of cardiac indication for CR. There were significant differences between specialist and program perceptions of the appropriate number of days to wait by most indications, with CR programs perceiving shorter waits as appropriate (p? Conclusions Wait times following access to cardiac rehabilitation are prolonged compared with consensus recommendations, and yet are generally acceptable to most patients. Wait times following percutaneous coronary intervention in particular may need to be shortened. Future research is required to provide an evidence base for wait time benchmarks.

Grace Sherry L

2012-08-01

275

Desigualdades entre pacientes hospitalizados por doenças cardíacas e vasculares-cerebrais em localidade do Estado de São Paulo (Brasil), 1986 / Inequalities among patients hospitalized for cardiac and cerebral-vascular diseases in the City of the State of S. Paulo, Brazil, 1986  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Valendo-se de um sistema de informações sobre hospitalizações no Município de Ribeirão Preto, SP (Brasil) foram estudadas as características clínico-epidemiológicas referidas dos pacientes internados, em 1986, por doenças cardíacas e vasculares-cerebrais (DCVC). De 43.499 hospitalizações ocorridas n [...] aquele ano, 4.673 foram ocasionadas por doenças cardíacas e vasculares-cerebrais. Utilizando a fonte de financiamento da internação como indicador do estrato social ao qual pertence o paciente, foram compostos 4 grupos de estudo: particulares, "outros", previdenciários e "não pagantes"; estes grupos apresentaram diferenças significativas quanto a coeficiente de internações por DCVC, média e mediana de idade na hospitalização, perfil ocupacional, duração da internação, freqüência dos sub-grupos diagnósticos, coeficientes de mortalidade e a idade média e mediana nos casos de óbitos. Estas diferenças foram atribuídas às disparidades sociais no nível de vida e condições de trabalho dos grupos estudados o que determina diferenças no adoecer, ser assistido e no morrer. Abstract in english The clinical and epidemiological characteristics of hospitalizations due to cardiac and cerebral-vascular diseases (CCVD - ICD 390 - 438), which occurred in 1986, were studied on the basis of data from an information system relating to medical care in the City of Ribeirão Preto, State of S. Paulo, B [...] razil. These causes accounted for 4,673 of the annual total of 43,449 hospital admissions. Using the sources of payment of the hospitalization as an indicator of the patients' social strata, the following four study groups were defined: private, social insurance, non-paying and "others". These groups showed significant differences in relation to the following variables: hospitalization rates due to CCVD, mean and median age at admission and time of death, occupation, average length of stay in the hospital, mortality rates and relative frequencies of specific sub-group diagnosis. These differences are attributed to inequalities in the standard of living and in the working conditions of the groups, which determine diverse patterns of disease, medical care and mortality.

Juan Stuardo, Yazlle Rocha; Alzira de Oliveira, Jorge; Breno José G., Simões; Fábio Leite, Vichi.

276

Taking the GMO risk out of Europe'  

...Taking the GMO risk out of Europe's food production | EurActiv specialreport-risk-hazard-policymaking,cap,Common Agicultural Policy,GMOs,organic food,Risk assessment EU news ... hazard in policymaking › Opinion Taking the GMO risk out of Europe's food production [fr] -A + A Published 07 June ...updated 10 June 2013 2 comments Tags Common Agicultural Policy GMOs organic food Risk assessment The EUrsquo;s post-2013 Common Agricultural Policy and EU other legislation must ...farmers and food producers are no longer threatened by the risk of GMO contamination, argues Antje Kölling. Antje Kölling is the policy ...

277

INCIDENCE OF SUDDEN CARDIAC DEATH IN ZIVINICE MUNICIPALITY, BOSNIA AND HERZEGOVINA, DURING THE YEAR 2007  

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Full Text Available

Introduction: sudden cardiac death (SCD is an unexpected natural death due to cardiac causes in a short time period in a person with or without preexisting heart disease. Incidence of SCD in general population is 1/1000 inhabitants.

Aims: to determine the incidence of SCD at a territory of Zivinice municipality.

Patients and methods: this study is a prospective examination of SCD by using the data from death certificates, data received from interviews with competent physicians, witnesses and family members. Definition and criteria of SCD by European Society of Cardiologist and American Heart Association from 2001 and use of International Classification of Diseases, version 10, were applied to determine the number of SCD.

Results: sudden cardiac death is the single most frequent cause of death in inhabitants of the Živinice municipality. The incidence of SCD at the municipal Živinice was 1 .4 cases per 1000 inhabitants per year. Mean age was 66.3 (±12,6 years; in average, men were 7.2 years younger than women. The risk for SCD was 1.24-fold higher in men than in women. Correlation between the age and numbers of SCD was high (r=0.89; p<0.005. The most frequent risk factors were age, family history of SCD and/or cardiovascular disease and inadequate physical activity; leading conventional risk factor was hypertension. Witnesses of sudden cardiac death were present in 58.0% cases. None of the persons with out-of-hospital SCD received adequate first aid from bystanders.

Conclusion: Sudden cardiac death is the single most frequent cause of death among inhabitants of Zivinice municipality; proportion of SCD within all other causes of death was 22.3%. Incidence of SCD however, is not significantly higher when compared to industrialized countries. A risk for sudden cardiac death is significantly higher and directly depends on the presence and number of risk factors.

Mirsad Bijelic

2009-11-01

278

Abordagem do paciente reanimado, pós-parada cardiorrespiratória / Care of patient resuscitated from cardiac arrest  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: A parada cardiorrespiratória (PCR) ocorrida em ambulatório tem elevada mortalidade, sendo a sobrevida entre 5% e 35%. Dos pacientes que são reanimados uma percentagem elevada permanece com déficits neurológicos, resultantes das lesões ocorridas, tanto no período de ausênci [...] a de circulação ou durante a reperfusão. No entanto a compreensão dos mecanismos da lesão cerebral não tem traduzido na melhoria do prognóstico. A hipotermia terapêutica após a reanimação parece ser uma opção válida associada à diminuição destas seqüelas neurológicas. O objetivo deste estudo foi rever a evidência científica relativa à abordagem do paciente reanimado após PCR. CONTEÚDO: Descrição e abordagem dos principais fatores de risco associados à lesão neurológica após PCR, bem como dos seus critérios de prognóstico.Feita pesquisa não sistemática na base de dados PubMed dos artigos referentes à abordagem terapêutica dos pacientes reanimados de parada cardíaca. As referências bibliográficas dos artigos de revisão foram igualmente analisadas. Elaboradas normas práticas para essa abordagem. CONCLUSÕES: Os pacientes que sobrevivem à PCR têm elevado risco de permanecer com lesões neurológicas graves. A hipotermia terapêutica e o controle das variáveis fisiológicas, com otimização da perfusão cerebral, podem melhorar o seu prognóstico. Abstract in english BACKGROUND AND OBJECTIVES: Out-of-hospital cardiac arrest is a major cause of death with survival rates as low as 5% to 35%. A large number of patients who survive resuscitation will face significant neurological damage, as a result of the ischemia that occurs both during cardiac arrest and reperfus [...] ion. However understanding of the mechanisms responsible for brain damage has not resulted in prognostic improvement. Therapeutic hypothermia after resuscitation may be a valid option associated to reduction of neurological damage. The purpose of this study was to review scientific evidence related to a therapy for patients resuscitated from cardiac arrest. CONTENTS: Description and analysis of the main risk factors associated with neurological damage after resuscitation from cardiac arrest as well as prognostic criteria was carried out. A non-systematic search was conducted in the PubMed data base for papers on a therapeutic approach for patients resuscitated from cardiac arrest. Bibliographic references of reviewed papers were also analyzed. Practical rules were drafted for such an approach. CONCLUSIONS: Patients resuscitated from cardiac arrest face a high level of risk of neurological damage. Therapeutic hypothermia and control of physiological parameters to optimise brain perfusion, may improve prognosis.

João Carlos Ramos Gonçalves, Pereira.

2008-06-01

279

Cardiac gallium citrate concentration  

International Nuclear Information System (INIS)

Cardiac accumulation of 67Ga was noted in a 45 year-old black female with a history of fever and shortness of breath. Cardiac 67Ga uptake has been uncommonly cited and we report such a finding in a case of Cox sackie B viral pericarditis. (orig.)

280

Garfinkel Cardiac Data  

Science.gov (United States)

Cardiac data on multiple variables for a selected population of 220 men and 338 women participating in a drug treatment study of dobutamine for heart attack prevention. Garfinkel, Alan, et. al. "Prognostic Value of Dobutamine Stress Echocardiography in Predicting Cardiac Events in Patients With Known or Suspected Coronary Artery Disease." Journal of the American College of Cardiology 33.3 (1999) 708-16.

Alan Garfinkel (University of California Los Angeles;Physiological Sci/Med-Cardio)

2009-01-10

 
 
 
 
281

Preoperative cardiac risk management  

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Full Text Available Approximately 100 million people undergo noncardiac surgery annually worldwide. It is estimated that around 3% of patients undergoing noncardiac surgery experience a major adverse cardiac event. Although cardiac events, like myocardial infarction, are major cause of perioperative morbidity or mortality, its true incidence is difficult to assess. The risk of perioperative cardiac complications depends mainly on two conditions: 1 identified risk factors, and 2 the type of the surgical procedure. On that basis, different scoring systems have been developed in order to accurately assess the perioperative cardiac risk and to improve the patient management. Importantly, patients with estimated high risk should be tested preoperatively by non-invasive cardiac imaging modalities. According to test results, they can proceed directly to planed surgery with the use of cardioprotective drugs (ß-blockers, statins, aspirin, or to myocardial revascularization prior to non-cardiac surgery. In this review, we discuss the role of clinical cardiac risk factors, laboratory measurements, additional non-invasive cardiac testing, and consequent strategies in perioperative management of patients undergoing noncardiac surgery.

Vidakovi? Radosav

2011-01-01

282

Diagnosis of traumatic cardiac contusion  

International Nuclear Information System (INIS)

Cardiac contusion following blunt chest trauma remains a diagnostic problem because of a lack of sensitive diagnostic tests. This study evaluated thallous chloride Tl 201 single-photon-emission computed tomography in a series of 48 patients following blunt chest trauma. Of the 48 patients, 23 had normal scans. None of these patients proved to have serious arrhythmias during three days of continuous monitoring. Of 25 patients with abnormal or ambiguous studies, five (20%) developed serious arrhythmias requiring therapy. Single-photon-emission computed tomography scanning thus was sensitive in indicating that group of patients at risk of serious arrhythmias, and may therefore prove to be a useful screening test to determine the need for hospitalization and arrhythmia monitoring following blunt chest trauma

283

Mathematical cardiac electrophysiology  

CERN Document Server

This book covers the main mathematical and numerical models in computational electrocardiology, ranging from microscopic membrane models of cardiac ionic channels to macroscopic bidomain, monodomain, eikonal models and cardiac source representations. These advanced multiscale and nonlinear models describe the cardiac bioelectrical activity from the cell level to the body surface and are employed in both the direct and inverse problems of electrocardiology. The book also covers advanced numerical techniques needed to efficiently carry out large-scale cardiac simulations, including time and space discretizations, decoupling and operator splitting techniques, parallel finite element solvers. These techniques are employed in 3D cardiac simulations illustrating the excitation mechanisms, the anisotropic effects on excitation and repolarization wavefronts, the morphology of electrograms in normal and pathological tissue and some reentry phenomena. The overall aim of the book is to present rigorously the mathematica...

Colli Franzone, Piero; Scacchi, Simone

2014-01-01

284

Biomaterials for cardiac regeneration  

CERN Document Server

This book offers readers a comprehensive biomaterials-based approach to achieving clinically successful, functionally integrated vasculogenesis and myogenesis in the heart. Coverage is multidisciplinary, including the role of extracellular matrices in cardiac development, whole-heart tissue engineering, imaging the mechanisms and effects of biomaterial-based cardiac regeneration, and autologous bioengineered heart valves. Bringing current knowledge together into a single volume, this book provides a compendium to students and new researchers in the field and constitutes a platform to allow for future developments and collaborative approaches in biomaterials-based regenerative medicine, even beyond cardiac applications. This book also: Provides a valuable overview of the engineering of biomaterials for cardiac regeneration, including coverage of combined biomaterials and stem cells, as well as extracellular matrices Presents readers with multidisciplinary coverage of biomaterials for cardiac repair, including ...

Ruel, Marc

2015-01-01

285

High Thoracic Epidural Analgesia in Cardiac Surgery : Part 1-High Thoracic Epidural Analgesia Improves Cardiac Performance in Cardiac Surgery Patients  

DEFF Research Database (Denmark)

OBJECTIVE: The purpose of this study was to evaluate the perioperative cardioprotective effect of high thoracic epidural analgesia (HTEA), primarily expressed as an effect on cardiac performance and hemodynamics in patients undergoing cardiac surgery. DESIGN: A randomized, prospective study. PARTICIPANTS: Sixty low-to-moderate risk patients between the ages of 65 and 80 years scheduled for elective coronary artery bypass graft surgery with or without aortic valve replacement. SETTING: A university hospital. INTERVENTION: Patients randomized to receive HTEA as a supplement to general anesthesia. MEASUREMENTS AND MAIN RESULTS: Perioperative hemodynamic measurements, perioperative fluid balance, and postoperative release of cardiac enzymes were collected. The end-diastolic volume index (EDVI), the stroke volume index (overall 38 v 32 mL), the cardiac index (overall 2.35 v. 2.18 L/minute/m(2)), the central venous pressure, and central venous oxygenation were higher in the HTEA group. The mean arterial blood pressure was marginally lower in the HTEA group, whereas no difference was noted in the heart rate or peripheral saturation between the groups. No differences were found in the postoperative levels of troponin T and CK-MB between groups. NT-proBNP changed over time (p <0.001) and was lower in the HTEA group (p = 0.013), with maximal values of 291 ± 265 versus 326 ± 274. CONCLUSIONS: The findings of a higher stroke volume index and central venous oxygenation without an increase in heart rate or mean arterial pressure suggest that HTEA improves cardiac performance in elderly cardiac surgery patients.

Jakobsen, Carl-Johan; Bhavsar, Rajesh

2012-01-01

286

Comparison of Plasma Cardiac Troponin I and Cardiac Enzymes in Haemodialysis Patients of Gorgan (South East of Iran  

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Full Text Available The objectives of this study were to evaluate the effect of haemodialysis on plasma Cardiac Troponin I and cardiac enzymes before and after the dialysis process. Twenty two patients with Chronic Renal Failure (CRF disease who were haemodialyzed at 5th Azar hospital of Gorgan Dialysis Center were recruited for this study (2005. The patients do not have coronary heart disease. Plasma cardiac enzymes showed no significant difference in the post dialysis group when compared with predialysis. Plasma levels of Cardiac Troponin I in 12 haemodialyzed patients were significantly increased in the postdialysis group when compared with predialysis, whereas plasma level of Cardiac Troponin I in 10 haemodialyzed patients were undetectable ( less than 0.1 ?g L-1. The observation of meaningful increasing level of plasma Cardiac Troponin I in the haemodialyzed patients after the process of dialysis shows that Cardiac Troponin I is highly specific marker for Acute Myocardial Infarction (AMI when compared with other cardiac enzymes and is particularly useful for detecting AMI in chronic renal failure and haemodialysis patients which can prevent sudden cardiovascular abnormality and sudden silent myocardial infarction in these patients.

Abdoljalal Marjani

2007-01-01

287

Entrepreneurs out of necessity': A snapshot  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Entrepreneurs out of necessity identified by the Global Entrepreneurship Monitor survey are a sizeable group across countries. They tend to have low education, run smaller firms, expect their firms to grow less, but are likely to stay in the market. This evidence is a challenge for existing theories of heterogeneous firms.

Poschke, Markus

2010-01-01

288

France, Germany drop out of ITER race  

International Nuclear Information System (INIS)

The list of countries willing to host a multi-billion dollar fusion facility got much shorter when France and Germany effectively took themselves out of the competition, making Japan the odd-on favorite as the site for the International Thermonuclear Experimental Reactor (ITER) if it is built. This article describes the history and the possible future for the ITER

289

UK pulls out of plans for ILC  

CERN Multimedia

"A funding crisis at one of the UK's leading research councils has forced the country to pull out of plans for the International Linear Collider (ILC). The science and Technology Facilities Council (STFC) says in a report published today that it does not see "a practicable path towards the realization of this facility as currently conceived on a reasonable timescale". (1 page)

Durrani, Matin

2007-01-01

290

Out-of-plane emission of  

International Nuclear Information System (INIS)

We present experimental results concerning azimuthal distributions of mid-rapidity light particles and intermediate mass fragments for heavy ion collisions between 150 - 800 AMeV measured with the FOPI detector. The magnitude of the out-of-plane emission signal is investigated as a function of the collision centrality, incident energy, fragment charge, mass and transverse momentum. (authors)

291

Characterization of people in cardiac surgeries: a descriptive study  

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Objective: To characterize patients undergoing cardiac surgery at a referral hospital in northern of Ceara. Method: This is a quantitative and descriptive study using documentary analysis carried out by 176 medical records in accordance with the ethical aspects of Resolution 196/96. Results: We identified predominantly men, married, living in distant cities of the health service and a greater tendency for people over 40 years old. The hospital stay was low, contributing to reduc...

Ponte, Keila Maria Azevedo; Silva, Lucia Fatima Da; Borges, Maria Cristina Leite Arau?jo; Araga?o, Antonia Eliana Araujo; Arruda, Lidyane Parente; Galiza, Francisca Tereza

2013-01-01

292

The cardiac patient during Ramadan and Hajj  

Science.gov (United States)

The holy month of Ramadan is one of the five pillars of Islam. During this month, fasting Muslims refrain from eating, drinking, smoking, and sex from dawn until sunset. Although the Quran exempts sick people from the duty of fasting, it is not uncommon for many heart disease patients to fast during Ramadan. Despite the fact that more than a billion Muslims worldwide fast during Ramadan, there is no clear consensus on its effects on cardiac disease. Some studies have shown that the effects of fasting on stable patients with cardiac disease are minimal and the majority of patients with stable cardiac illness can endure Ramadan fasting with no clinical deterioration. Fasting during Ramadan does not seem to increase hospitalizations for congestive heart failure. However, patients with decompensated heart failure or those requiring large doses of diuretics are strongly advised not to fast, particularly when Ramadan falls in summer. Patients with controlled hypertension can safely fast. However, patients with resistant hypertension should be advised not to fast until their blood pressure is reasonably controlled. Patients with recent myocardial infarction, unstable angina, recent cardiac intervention or cardiac surgery should avoid fasting. Physician advice should be individualized and patients are encouraged to seek medical advice before fasting in order to adjust their medications, if required. The performance of the Hajj pilgrimage is another pillar of Islam and is obligatory once in the lifetime for all adult Muslims who are in good health and can afford to undertake the journey. Hajj is a physically, mentally, emotionally, and spiritually demanding experience. Medical checkups one or two months before leaving for Hajj is warranted, especially for those with chronic illnesses such as cardiovascular disease. Patients with heart failure, uncontrolled hypertension, serious arrhythmias, unstable angina, recent myocardial infarction, or cardiac surgery should be considered unfit for undertaking the Hajj pilgrimage. PMID:25278723

Chamsi-Pasha, Hassan; Ahmed, Waqar H.; Al-Shaibi, Khaled F.

2014-01-01

293

The Chinese version of the cardiac depression scale: Mokken scaling  

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Full Text Available Abstract Background Myocardial infarction is a major cause of death and morbidity in many countries, including China. The aim of this study was to analyse a Mandarin Chinese translation of the Cardiac Depression Scale for a hierarchy of items according to the criteria of Mokken scaling. Findings Data from 438 Chinese participants who completed the Chinese translation of the Cardiac Depression Scale were analysed using the Mokken scaling procedure and the 'R' statistical programme using the diagnostics available in these programmes. Correlations between Mandarin Chinese items and Chinese translations of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory were also analysed. Fifteen items from the Mandarin Chinese Cardiac Depression Scale were retained in a weak but reliable Mokken scale; invariant item ordering was evident but of low accuracy and the Mokken scaled items of the Chinese Cardiac Depression Scale correlated with the Hospital Anxiety and Depression Scale and the Beck Depression Inventory. Conclusions Items from the Mandarin Chinese Cardiac Depression Scale form a Mokken scale and this offers further insight into how the items of the Cardiac Depression Scale relate to the measurement of depression in people with a myocardial infarction.

Watson Roger

2012-03-01

294

Modeling inherited cardiac disorders.  

Science.gov (United States)

Advances in the understanding and treatment of cardiac disorders have been thwarted by the inability to study beating human cardiac cells in vitro. Induced pluripotent stem cells (iPSCs) bypass this hurdle by enabling the creation of patient-specific iPSC-derived cardiomyocytes (iPSC-CMs). These cells provide a unique platform to study cardiac diseases in vitro, especially hereditary cardiac conditions. To date, iPSC-CMs have been used to successfully model arrhythmic disorders, showing excellent recapitulation of cardiac channel function and electrophysiologic features of long QT syndrome types 1, 2, 3, and 8, and catecholaminergic polymorphic ventricular tachycardia (CPVT). Similarly, iPSC-CM models of dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM) have shown robust correlation of predicted morphologic, contractile, and electrical phenotypes. In addition, iPSC-CMs have shown some features of the respective phenotypes for arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), LEOPARD syndrome, Pompe's disease, and Friedriech's ataxia. In this review, we examine the progress of utilizing iPSC-CMs as a model for cardiac conditions and analyze the potential for the platform in furthering the biology and treatment of cardiac disorders.?? PMID:24632794

Sallam, Karim; Kodo, Kazuki; Wu, Joseph C

2014-01-01

295

Out of equilibrium statistical ensemble inequivalence  

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We consider a paradigmatic model describing the one-dimensional motion of $N$ rotators coupled through a mean-field interaction, and subject to the perturbation of an external magnetic field. The latter is shown to significantly alter the system behaviour, driving the emergence of ensemble inequivalence in the out-of-equilibrium phase, as signalled by a negative (microcanonical) magnetic susceptibility. The thermodynamic of the system is analytically discussed, building on a...

Ninno, Giovanni; Fanelli, Duccio

2010-01-01

296

Fungi causing dying out of heather seedlings  

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Full Text Available The aim of the study was to determine the fungi causing dying out of one-yearold heather seedlings. Observations were carried out on: 'Amethyst', 'Annemarie', 'Colette', 'Perestroika' and 'Reini'. The shoots revealing necrotic symptoms were plated on PDA medium. 25 species of fungi were isolated. Among them Pestalotia sydowiana, Alternaria alternata, Cylindrocarpon destructans, Leptosphaeria coniothyrium and Epicoccum purpurascens were dominant, while Mammaria echinobotryoides, Phoma leveillei, Kaissleriella subalpina, Botrytis cinerea and Phytophthora cinnamomi occurred less frequently.

Maria Kowalik

2005-12-01

297

Patient dose in cardiac multislice computed tomography  

International Nuclear Information System (INIS)

Cardiac Multislice Computed Tomography (MSCT) is mainly used for the quantification of coronary artery calcification and for minimally invasive coronary angiography. Many physicians are not aware of the radiation doses delivered to the patient in these exams. The aim of this study is to evaluate and compare the radiation doses that are delivered to the patient during specific cardiac MSCT examinations in two different hospitals in Madrid. The volume computed tomographic dose index (CTDI vol), the dose length product (DLP), and the effective dose (E) are the most useful parameters to describe and compare radiation doses received from cardiac MSCT examinations. To calculate effective doses the spreadsheet developed by ImPACT was used. Computed tomography dose index (CTDIn) in air was measured with an ionization chamber model 20x5-2CT and dose-length product (DLP) values were obtained from the scanner consol for each examination. Results and conclusions: Effective dose values of 18,2 mSv and 24 mSv for coronary angiography were found in the two hospitals. The difference in dose is mainly due to the different mode of acquisition in the applied protocols rather than to the type of scanner used. (Author)

298

Pre-hospital treatment of STEMI patients. A scientific statement of the working group acute cardiac care of the European society of cardiology | Tratamiento prehospitalario de los pacientes con IAMCEST. Una declaración científica del Working Group Acute Cardiac Care de la European Society of Cardiology  

Digital Repository Infrastructure Vision for European Research (DRIVER)

In ST-elevation myocardial infarction (STEMI) the pre-hospital phase is the most critical, as the administration of the most appropriate treatment in a timely manner is instrumental for mortality reduction. STEMI systems of care based on networks of medical institutions connected by an efficient emergency medical service are pivotal. The first steps are devoted to minimize the patient's delay in seeking care, rapidly dispatch a properly staffed and equipped ambulance to make the diagnosis on ...

Tubaro, M.; Danchin, N.; Goldstein, P.; Filippatos, G.; Hasin, Y.; Heras, M.; Jansky, P.; Norekval, Tm; Swahn, E.; Thygesen, K.; Vrints, C.; Zahger, D.; Arntz, Hr; Bellou, A.; La Coussaye, Je

2012-01-01

299

Economic and biological costs of cardiac imaging  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Medical imaging market consists of several billion tests per year worldwide. Out of these, at least one third are cardiovascular procedures. Keeping in mind that each test represents a cost, often a risk, and a diagnostic hypothesis, we can agree that every unnecessary and unjustifiable test is one test too many. Small individual costs, risks, and wastes multiplied by billions of examinations per year represent an important population, society and environmental burden. Unfortunately, the appropriateness of cardiac imaging is extra-ordinarily low and there is little awareness in patients and physicians of differential costs, radiological doses, and long term risks of different imaging modalities. For a resting cardiac imaging test, being the average cost (not charges of an echocardiogram equal to 1 (as a cost comparator, the cost of a CT is 3.1x, of a SPECT 3.27x, of a Cardiovascular Magnetic Resonance imaging 5.51x, of a PET 14.03x, and of a right and left heart catheterization 19.96x. For stress cardiac imaging, compared with the treadmill exercise test equal to 1 (as a cost comparator, the cost of stress echocardiography is 2.1x and of a stress SPECT scintigraphy is 5.7x. Biohazards and downstream long-term costs linked to radiation-induced oncogenesis should also be considered. The radiation exposure is absent in echo and magnetic resonance, and corresponds to 500 chest x rays for a sestamibi cardiac stress scan and to 1150 chest x rays for a thallium scan. The corresponding extra-risk in a lifetime of fatal cancer is 1 in 2000 exposed patients for a sestamibi stress and 1 in 1000 for a thallium scan. Increased awareness of economic, biologic, and environmental costs of cardiac imaging will hopefully lead to greater appropriateness, wisdom and prudence from both the prescriber and the practitioner. In this way, the sustainability of cardiac imaging will eventually improve.

Picano Eugenio

2005-05-01

300

Neurologic complications of cardiac tumors.  

Science.gov (United States)

Cardiac tumors are an uncommon cause for neurologic disease, but if undiagnosed can be associated with devastating neurologic consequences. Primary cardiac tumors, both benign and neoplastic, and metastatic tumors occur. Primary cardiac tumors are more likely to be associated with neurologic embolic complications. Metastatic cardiac tumors are more likely to be associated with valvular distraction, arrhythmia, diminished cardiac output and indirect neurological dysfunction. Primary and metastatic cardiac tumors may result in cerebral metastatic disease. Atrial myxoma, a benign primary cardiac tumor, is the most common cardiac tumor associated with neurologic disease, and most commonly causes cerebral embolization and stroke. The use of thrombolytic therapy for these strokes is controversial. Additionally, delayed manifestations, including aneurysm formation and intracranial hemorrhage, are possible. Aneurysm formation has been described as occurring after removal of the primary tumor. The availability of noninvasive cardiac imaging has significantly helped decrease the neurologic morbidity of cardiac tumors and has led to frequent successful intervention. PMID:24365298

Roeltgen, David; Kidwell, Chelsea S

2014-01-01

 
 
 
 
301

Molecular Basis of Cardiac Myxomas  

Directory of Open Access Journals (Sweden)

Full Text Available Cardiac tumors are rare, and of these, primary cardiac tumors are even rarer. Metastatic cardiac tumors are about 100 times more common than the primary tumors. About 90% of primary cardiac tumors are benign, and of these the most common are cardiac myxomas. Approximately 12% of primary cardiac tumors are completely asymptomatic while others present with one or more signs and symptoms of the classical triad of hemodynamic changes due to intracardiac obstruction, embolism and nonspecific constitutional symptoms. Echocardiography is highly sensitive and specific in detecting cardiac tumors. Other helpful investigations are chest X-rays, magnetic resonance imaging and computerized tomography scan. Surgical excision is the treatment of choice for primary cardiac tumors and is usually associated with a good prognosis. This review article will focus on the general features of benign cardiac tumors with an emphasis on cardiac myxomas and their molecular basis.

Pooja Singhal

2014-01-01

302

Hospital diversification.  

Science.gov (United States)

Hospital diversification and its impact on the operating ratio are studied for 168 hospitals during the period from 1999 to 2004. Diversification and the operating ratio are modeled in a two-stage least squares (TSLS) framework as being jointly dependent. Institutional diversification is found to yield a better financial position, and the better operating ratio allows the institution the wherewithal to diversify. The impact of external government planning and hospital competition are also measured. An institution lifecycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification and divestiture, occasionally leading to closure or merger. Management's attitude concerning risk and reward is considered. PMID:18972998

Eastaugh, Steven R

2005-01-01

303

Nationwide study of sudden cardiac death in persons aged 1-35 years  

DEFF Research Database (Denmark)

Aims The aim of this investigation was to study the incidence of sudden cardiac death (SCD) in persons aged 1-35 years in a nationwide setting (5.38 million people) by systematic evaluation of all deaths. Methods and results All deaths in persons aged 1-35 years in Denmark in 2000-06 were included. Death certificates were read independently by two physicians. The National Patient Registry was used to retrieve information on prior medical history. All autopsy reports were read and the cause of death was revised based on autopsy findings. We identified 625 cases of sudden unexpected death (10% of all deaths), of which 156 (25%) were not autopsied. Of the 469 autopsied cases, 314 (67%) were SCD. The most common cardiac cause of death was ischaemic heart disease (13%); 29% of autopsied sudden unexpected death cases were unexplained. In 45% of SCD cases, the death was witnessed; 34% died during sleep; 89% were out-of-hospital deaths. Highest possible incidence rate of SCD in the young was 2.8 per 100 000 person-years including non-autopsied cases of sudden unexpected death. Excluding those, the incidence rate declined to 1.9 per 100 000 person-years. Conclusions A total of 7% of all deaths in the young can be attributed to SCD, when including non-autopsied cases (autopsy ratio 75%). The incidence rate of SCD in the young of 2.8 per 100 000 person-years is higher than previously reported.

Winkel, Bo Gregers; Holst, Anders Gaarsdal

2011-01-01

304

Feasibility of a laryngeal tube for airway management during cardiac arrest by first responders.  

Science.gov (United States)

Airway management is of major importance in prehospital emergency care. Bag-valve mask (BVM) ventilation and endotracheal intubation (ETI) have been shown to be difficult, especially when caregivers are inexperienced. Alternative methods have been studied, and supraglottic devices have been shown to provide reasonable ease of placement and effective ventilation in manikin studies and anaesthetised patients. First responders (FR) are employed by many emergency medical services (EMS) to shorten initiation of emergency care, and they are trained to provide basic CPR including BVM and use of automated external defibrillators (AED) in case of out-of-hospital cardiac arrest (OCHA). The aim of this research was to study the feasibility of manikin-trained FRs using a laryngeal tube (LT) as a primary airway method during cardiac arrest. We trained 300 FRs to use a LT during OHCA. The FRs used a LT in 64 OHCA cases. The LT was correctly placed on the first attempt in 46/64 cases (71.9%) and on the second attempt in 13/64 cases (20.3%). Insertion was reported as being easy in 55/64 cases (85.9%). Median insertion time was 23.1s, with a range of 3-240s. We found that after manikin training, the FRs inserted the LT and performed adequate ventilation with a reasonable success rate and insertion time. PMID:22940595

Länkimäki, S; Alahuhta, S; Kurola, J

2013-04-01

305

Predictors of low cardiac output in decompensated severe heart failure  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english OBJECTIVE: To identify predictors of low cardiac output and mortality in decompensated heart failure. INTRODUCTION: Introduction: Patients with decompensated heart failure have a high mortality rate, especially those patients with low cardiac output. However, this clinical presentation is uncommon, [...] and its management is controversial. METHODS: We studied a cohort of 452 patients hospitalized with decompensated heart failure with an ejection fraction of 60 years, and 64.6% were men. Low cardiac output was present in 281 (63%) patients on admission. Chagas disease was the cause of heart failure in 92 (20.4%) patients who had higher B type natriuretic peptide levels (1,978.38 vs. 1,697.64 pg/mL; P = 0.015). Predictors of low cardiac output were Chagas disease (RR: 3.655, P

Marcelo Eidi, Ochiai; Juliano Novaes, Cardoso; Kelly Regina Novaes, Vieira; Marcelo Villaça, Lima; Euler Cristovan Ochiai, Brancalhao; Antonio Carlos Pereira, Barretto.

306

A Case of Recurrent Cardiac Arrest and Light Chain Cardiac Amyloidosis  

Science.gov (United States)

Introduction: Light chain amyloidosis is a clonal plasma cell disorder characterized by monoclonal light chain deposition in body organs. The diagnostic challenge belies the variable, often elusive nature of amyloid disease presentation. Cardiac involvement in particular may be seen in up to 50% of cases, and is associated with poor prognosis. We present a case of light chain cardiac amyloidosis, with multi-system derangements, leading to recurrent cardiac arrest despite resuscitative efforts. Case Report: A 59-year-old man with a history of end-stage renal disease presented with the complaint of sudden onset of shortness of breath. Atrial fibrillation with rapid ventricular response was noted. While undergoing treatment, complications arose on 3 separate occasions at which time the patient experienced a precipitous fall in heart rate, cardiac arrest, and successful resuscitation. An echocardiogram was performed which revealed a 25% reduction in ejection fraction and new left ventricular septal thickening in comparison to an evaluation 3 months prior. Cardiac catheterization was unremarkable for coronary artery disease. Over the course of hospitalization, there was progressive muscle weakness. Nerve conduction studies were performed, revealing diffuse axonal sensorimotor neuropathy. The link between diffuse polyneuropathy, autonomic instability, persistent hypotension requiring intravenous vasoactive support, and recurrent asystole remained unclear. Amyloidosis workup with immunofixation electrophoresis revealed free kappa light chain excess. Before further workup, the patient went into asystole, unresponsive to resuscitative efforts. Post-mortem findings suggest cardiac arrest due to amyloidosis of the heart secondary to multiple myeloma. Of note, amyloid deposits were found focally in blood vessels of the kidney and peripheral nerves. Discussion: Early detection of cardiac involvement is crucial as illustrated above. Advanced echocardiographic techniques including speckle tracking plus strain imaging, may lead to earlier, amyloid-specific identification. Gadolinium-enhanced cardiac MRI has also been employed, with futility reserved for infiltrative cardiac disease states without renal insufficiency. Potentially, utilizing the above imaging studies, in association with cardiac biomarkers such as NT-pro BNP, may lead to the development of prognostication tools to identify patient's at high risk for death. Goal for early detection and institution of prognosis models are aimed at early implementation of treatment strategies including heart transplantation, high-dose chemotherapy, and autologous stem cell support. For patients with a myriad of symptoms and suspicion of amyloidosis, we encourage early lab and imaging studies, because any delay in diagnosis and initiation of treatment is inevitably too late.

Azuma, Steven

2014-01-01

307

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... Implantable Cardiac Defibrillator February 19, 2009 Halifax Health Medical Center, Daytona Beach, FL Welcome to Halifax Health ... Webcast screen, and open the door to informed medical care. Welcome and thank you for joining us ...

308

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... the next slide we'll also appreciate the volume of cardiac disease compared to other diseases. If ... And then, depending on the recommendations for that specific device, eventually that goes over a couple of ...

309

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... the slides that we have here, you'll notice that deaths from cardiovascular disease have been declining ... death? Sudden cardiac death, sometime if give you notice, but 99 percent of the time you don' ...

310

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... They go to the Internet, they do their research, they call their peers and figure out where ... use of a cardiac defibrillator in open heart surgery and what is the risk to the phrenic ...

311

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... Dr. Stoner about the current state of cardiac disease here in the United States. So where are we right now, Dr. Stoner, with heart disease? Well, Matt, we're going to see tonight ...

312

Sudden cardiac death  

Directory of Open Access Journals (Sweden)

Full Text Available Sudden cardiac death in an athlete is rare and tragic event. An athlete's death draws high public attention given that athletes are considered the healthiest category of society. The vast majority of sudden cardiac death in young athletes is due to congenital cardiac malformations such as hypertrophie cardiomyopathy and various coronary artery anomalies. In athletes over age 35, the usual cause of sudden cardiac death is coronary artery disease. With each tragic death of a young athlete, there is a question why this tragedy has not been prevented. The American College of Sports Medicine and the American Heart Association recommend that a pre-participation exam should include a complete cardiovascular history and physical examination.

Aran?elovi? Aleksandra ?.

2004-01-01

313

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available Automatic Implantable Cardiac Defibrillator February 19, 2009 Halifax Health Medical Center, Daytona Beach, FL Welcome to Halifax Health Daytona Beach, Florida. Over the next hour you'll ...

314

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available Automatic Implantable Cardiac Defibrillator February 19, 2009 Halifax Health Medical Center, Daytona Beach, FL Welcome to Halifax ... it and cause it to contract and have control over it. No way, man. I don't ...

315

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... Disney, or in Vegas in one of the casino, everybody has a defibrillator and they will shock ... use of a cardiac defibrillator in open heart surgery and what is the risk to the phrenic ...

316

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available Automatic Implantable Cardiac Defibrillator February 19, 2009 Halifax Health Medical Center, Daytona Beach, FL Welcome to Halifax Health Daytona Beach, Florida. Over the next hour you' ...

317

Perioperative Cardiac Arrests  

Directory of Open Access Journals (Sweden)

Full Text Available Perioperative cardiac arrests represent the most serious complication of anesthesia and surgery. It is believed that the incidence and mortality of cardiac arrest has declined, however, a more recent review questioned whether these rates have changed over the last 5 decades. It is difficult to compare the reports from different epochs, because medical practice has advanced, surgical acuity increased, and patients in extremes of age undergo surgery today. In the present article we review the information regarding the incidence of perioperative cardiac arrests and predictors of survival covering the period since the first comprehensive report by Beecher and Todd in 1954. We focus on our publications that report perioperative cardiac arrest at Mayo Clinic for adult noncardiac surgery, during regional anesthesia, and arrests in our pediatric surgical practice.

JURAJ SPRUNG

2008-10-01

318

Cardiac muscle cells  

Science.gov (United States)

Cardiac muscles are found only in the heart. They work together to bring deoxygenated blood in and push oxygenated blood out into the body. Essentially, they keep your heart pumping and your body alive.

Nathanael Reveal (None;)

2007-07-02

319

Trombosis venosa mayor asociada a catéter de hipotermia terapéutica en un paciente con paro cardiorrespiratorio recuperado: comunicación de un caso y revisión de la literatura / Venous thrombosis secondary to catheter insertion for hypothermia after cardiac arrest: Report of one case  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english To improve survival and reduce neurological injury, the use of mild hypothermia following cardiac arrest has been recommended. We report a 65 years old woman who presented an out-of-hospital ventricular fibrillation and cardiac arrest. The patient was comatose following initial resuscitation and was [...] admitted into the ICU, where cooling was initiated using an intravascular catheter. After 48 hours, rewarming was initiated. Although no neurological impairment was observed, physical examination of the right inguinal area and echo-Doppler examination revealed an extensive catheter-related thrombophlebitis with right ileocaval vein occlusion., with high risk of masive and life threatening pulmonary embolism. We report a clinical case and review the literature to point out the need for a high index of diagnostic suspicion of deep venous thrombosis in these specific setting.

Jaime, Retamal; Jean, Bachler; Ricardo, Mejía; Orlando, Concha; Max, Andresen.

1201-12-01

320

Trombosis venosa mayor asociada a catéter de hipotermia terapéutica en un paciente con paro cardiorrespiratorio recuperado: comunicación de un caso y revisión de la literatura / Venous thrombosis secondary to catheter insertion for hypothermia after cardiac arrest: Report of one case  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english To improve survival and reduce neurological injury, the use of mild hypothermia following cardiac arrest has been recommended. We report a 65 years old woman who presented an out-of-hospital ventricular fibrillation and cardiac arrest. The patient was comatose following initial resuscitation and was [...] admitted into the ICU, where cooling was initiated using an intravascular catheter. After 48 hours, rewarming was initiated. Although no neurological impairment was observed, physical examination of the right inguinal area and echo-Doppler examination revealed an extensive catheter-related thrombophlebitis with right ileocaval vein occlusion., with high risk of masive and life threatening pulmonary embolism. We report a clinical case and review the literature to point out the need for a high index of diagnostic suspicion of deep venous thrombosis in these specific setting.

Jaime, Retamal; Jean, Bachler; Ricardo, Mejía; Orlando, Concha; Max, Andresen.

 
 
 
 
321

Analysis of Prognostic Factors of Esophageal and Gastric Cardiac Carcinoma Patients after Radical Surgery Using Cox Proportional Hazard Model-A Random Sampling Study from the Fourth Hospital of Hebei Medical University during the Period of 1996-2004  

Directory of Open Access Journals (Sweden)

Full Text Available OBJECTIVE To retrospectively analyze clinical data of patients from our hospital who underwent radical surgery for esophageal carcinoma and for adenocarcinoma of the gastric cardia, as well as to investigate prognostic factors affecting the long-term survival of the patients. METHODS Data from the patients eligible for our study, admitted to the 4th Hospital of Hebei Medical University from January 1996 to December 2004, were randomized, and 12 distinctive clinicopathologic factors influencing the survival rate of those who underwent radical surgery for esophageal carcinoma or carcinoma of the gastric cardia were collected. Univariate and multivariate analysis of these individual variables were performed using the Cox proportional hazard model. RESULTS It was shown by univariate analysis that age, tumor size, pathologic type, lymph node status, TNM staging, depth of infi ltration and encroachment into local organs, etc., were the factors that markedly influenced the prognosis of patients ( P < 0.01. Multivariate analysis showed that pathologic type, number of the lymph node metastases, involvement of local organs, and TNM staging were independent prognostic factors ( P < 0.05. CONCLUSION The independent factors influencing the prognosis of patients with esophageal cancer and carcinoma of the gastric cardia include pathologic type, number of lymph node metastases, involvement of local organs and TNM staging. The main prognostic factors aff ecting the patient’s survival are patient age, tumor size and depth of in fi ltration. In addition, patients with involvement of the local organs have a worse prognosis, and they should be closely followed up.

Wei LIU

2009-08-01

322

Out-of-Plane Cmos Compatible Magnetometers  

CERN Document Server

Three-dimensional MEMS magnetometers with use of residual stresses in thin multilayers cantilevers are presented. Half-loop cantilevers based on Lorentz-force deflection convert magnetic flux in changes, thanks to piezoresistive transducers mounted in Wheatstone bridge. Magnetic field in the order of 10 Gauss was measured with a sensitivity of 0.015 mV/Gauss. A Finite Element Model of the device has been developed with Ansys for static and dynamic simulations. Novel out-of-plane ferromagnetic nickel plate magnetometer is also presented.

Ghorba, M El; Sobieski, S; Raskin, J -P

2008-01-01

323

Ways out of the environmental crisis  

International Nuclear Information System (INIS)

The book documents the interdisciplinary papers held at a meeting on 'Ways out of the environmental crisis' in November 1985. Guided by the principle of concrete responsibilities emphasis was on the following subjects: Time presses - definition and consequences of the awareness of an imminent environmental catastrophe; air pollution and water pollution recapitulated; economic strategies for the benefit of pollution abatement; ethical and theological aspects; acceptable environmental policies - prospects and perspectives. The papers reflect the relation between the environment, the present generation, posterity, gross national producns and energy consumption, and present a number of scientifically founded alternative strategies. (HSCH) With 16 figs., 1 tab

324

Conceptual lay-out of small launcher  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The objective of this diploma thesis is to perform a conceptual lay-out of a small launcher. Re- quirements have been defined in order to realize this first preliminary study and design of a small launcher. In that frame, a MATLAB code has been written in order to simulate the rocket tra- jectories. An optimization program on launcher staging has been written as well. To validate this code, the VEGA and Ariane 5 launchers have been used. Then from studies on existing launchers, simulations ha...

Ballard, Claire

2012-01-01

325

[Cardiac CT: New applications].  

Science.gov (United States)

Since the introduction of the 64-generation scanners, the accuracy and robustness of the diagnosis of coronary artery disease has progressed. The main advantage of cardiac CT is the exclusion of coronary artery disease by its excellent negative predictive value. Currently, cardiac CT applications extend thanks to innovations both in terms of technological development systems scanner or stents implanted, that the evolution of surgical procedures such as TAVI. PMID:25261169

Pesenti-Rossi, D; Baron, N; Allouch, P; Convers, R; Gibault-Genty, G; Aubert, S

2014-11-01

326

Cardiac imaging in adults  

Energy Technology Data Exchange (ETDEWEB)

This book approaches adult cardiac disease from the correlative imaging perspective. It includes chest X-rays and angiographs, 2-dimensional echocardiograms with explanatory diagrams for clarity, plus details on digital radiology, nuclear medicine techniques, CT and MRI. It also covers the normal heart, valvular heart disease, myocardial disease, pericardial disease, bacterial endocarditis, aortic aneurysm, cardiac tumors, and congenital heart disease of the adult. It points out those aspects where one imaging technique has significant superiority.

Jaffe, C.C.

1987-01-01

327

Cardiac imaging in adults  

International Nuclear Information System (INIS)

This book approaches adult cardiac disease from the correlative imaging perspective. It includes chest X-rays and angiographs, 2-dimensional echocardiograms with explanatory diagrams for clarity, plus details on digital radiology, nuclear medicine techniques, CT and MRI. It also covers the normal heart, valvular heart disease, myocardial disease, pericardial disease, bacterial endocarditis, aortic aneurysm, cardiac tumors, and congenital heart disease of the adult. It points out those aspects where one imaging technique has significant superiority

328

Awareness in cardiac anesthesia.  

LENUS (Irish Health Repository)

Cardiac surgery represents a sub-group of patients at significantly increased risk of intraoperative awareness. Relatively few recent publications have targeted the topic of awareness in this group. The aim of this review is to identify areas of awareness research that may equally be extrapolated to cardiac anesthesia in the attempt to increase understanding of the nature and significance of this scenario and how to reduce it.

Serfontein, Leon

2010-02-01

329

Cardiac output measurement instruments controlled by microprocessors  

International Nuclear Information System (INIS)

The nuclear medicine and biophysics laboratory of the Necker-Enfants malades University Hospital Centre has built a microprocessor controlled Cardiac flowmetre. The principle of the cardiac output measurement from a radiocardiogram is well established. After injection of a radioactive indicator upstream from the heart cavities the dilution curve is obtained by the use of a gamma-ray precordial detector. This curve normally displays two peaks due to passage of the indicator into the right and left sides of the heart respectively. The output is then obtained from the stewart Hamilton principle once recirculation is eliminated. The graphic method used for the calculation however is long and tedious. The decreasing fraction of the dilution curve is projected in logarithmic space in order to eliminate recirculation by determining the mean straight line from which the decreasing exponential is obtained. The principle of the use of microprocessors is explained (electronics, logics)

330

Cardiac Image Registration  

Directory of Open Access Journals (Sweden)

Full Text Available Long procedure time and somewhat suboptimal results hinder the widespread use of catheter ablation of complex arrhythmias such as atrial fibrillation (AF. Due to lack of contrast differentiation between the area of interest and surrounding structures in a moving organ like heart, there is a lack of proper intraprocedural guidance using current imaging techniques for ablation. Cardiac image registration is currently under investigation and is in clinical use for AF ablation. Cardiac image registration, which involves integration of two images in the context of left atrium (LA, is intermodal, with the acquired image and the real-time reference image residing in different image spaces, and involves optimization, where one image space is transformed into the other. Unlike rigid body registration, cardiac image registration is unique and challenging due to cardiac motion during the cardiac cycle and due to respiration. This review addresses the basic principles of the emerging technique of registration and the inherent limitations as they relate to cardiac imaging and registration.

2008-09-01

331

Out-of-equilibrium electromagnetic radiation  

International Nuclear Information System (INIS)

We derive general formulae for photon and dilepton production rates from an arbitrary non-equilibrated medium from first principles in quantum field theory. At lowest order in the electromagnetic coupling constant, these relate the rates to the unequal-time in-medium photon polarization tensor and generalize the corresponding expressions for a system in thermodynamic equilibrium. We formulate the question of electromagnetic radiation in real time as an initial value problem and consistently describe the virtual electromagnetic dressing of the initial state. As an simple application, we consider an out-of-equilibrium system of non-interacting massless quarks and find, in particular, that the photon production rate vanishes for rather general initial conditions. We discuss recent findings concerning finite lifetime effects in the literature in the light of this result. Next, we consider the case of slowly evolving systems and work out the first corrections to the known static expressions for the emission rates in a systematic gradient expansion. These involve energy-nonconserving (off-shell) elementary processes, as a direct consequence of the explicit breaking of time-translation invariance. Finally, we propose a method for the calculation of the relevant unequal-time current-current correlator in the general case, based on the introduction of a S-shape contour in real time. This might be combined with recent developments in nonequilibrium quantum field theory to study electromagnetic radiation in out-of-equilibrium situations. (author)

332

A managed protocol for treatment of deceased potential donors reduces the incidence of cardiac arrest before organ explant  

Science.gov (United States)

Objective To assess the effect of the application of a managed protocol for the maintenance care of deceased potential multiple organ donors at two hospitals. Methods A before (Phase 1)/after (Phase 2) study conducted at two general hospitals, which included consecutively potential donors admitted to two intensive care units. In Phase 1 (16 months), the data were collected retrospectively, and the maintenance care measures of the potential donors were instituted by the intensivists. In Phase 2 (12 months), the data collection was prospective, and a managed protocol was used for maintenance care. The two phases were compared in terms of their demographic variables, physiological variables at diagnosis of brain death and the end of the process, time to performance of brain death confirmatory test and end of the process, adherence to bundles of maintenance care essential measures, losses due to cardiac arrest, family refusal, contraindications, and the conversion rate of potential into actual donors. Student's t- and chi-square tests were used, and p-value < 0.05 was considered to be significant. Results A total of 42 potential donors were identified (18 in Phase 1 and 24 in Phase 2). The time interval between the first clinical assessment and the recovery decreased in Phase 2 (Phase 1: 35.0±15.5 hours versus Phase 2: 24.6±6.2 hours; p = 0.023). Adherence increased to 10 out of the 19 essential items of maintenance care, and losses due to cardiac arrest also decreased in Phase 2 (Phase 1: 27.8 versus 0% in Phase 2; p = 0.006), while the convertion rate increased (Phase 1: 44.4 versus 75% in Phase 2; p = 0.044). The losses due to family refusal and medical contraindication did not vary. Conclusion The adoption of a managed protocol focused on the application of essential measures for the care of potential deceased donors might reduce the loss of potential donors due to cardiac arrest. PMID:23917929

Westphal, Glauco Adrieno; Zaclikevis, Viviane Renata; Vieira, Kalinca Daberkow; Cordeiro, Rodrigo de Brito; Horner, Marina Borges W.; de Oliveira, Thamy Pellizzaro; Duarte, Robson; Sperotto, Geonice; da Silveira, Georgiana; Caldeira, Milton; Coll, Elisabeth; Yus-Teruel, Santiago

2012-01-01

333

Increasing cardiac interventions among the aged.  

LENUS (Irish Health Repository)

Ireland\\'s over 65 year population is growing. As incidence of coronary events rises with age, there is a growing population of elderly patients with cardiac disease. The changing age profile of patients treated by a tertiary hospital\\'s Cardiology service was quantified using Hospital Inpatient Enquiry data. 53% of CCU admissions were aged > or = 65 years, with admissions aged > or = 85 years in 2008 four times greater than in 2002. Percentages of patients undergoing diagnostic coronary angiography and percutaneous coronary interventions in 1997 aged > or = 70 years were 19% and 18% respectively. By 2007, these percentages had risen to 31% and 34% respectively--greatest increases were in the very elderly age categories. The proportion of ICD recipients aged > 70 years increased from 8% in 2003 to 25% by 2008. The proportion of elderly patients receiving advanced cardiac care is increasing. This trend will continue and has clear resource implications. Outcomes of interventions in the very old need further investigation, since the \\'old old\\' are under-represented in clinical trials.

Groarke, J D

2010-11-01

334

Cardiac catheterisation in nonagenarians: Single center experience  

Directory of Open Access Journals (Sweden)

Full Text Available Objective To explore the treatment, procedure related risks, and outcomes of patients older than 90 years of age undergoing cardiac catheterization. Methods We retrospectively studied 32 patients ? 90 years (93.0 ± 1.2 years who underwent cardiac catheterisation in a tertiary specialist hospital (0.2% of 14,892 procedures during three years. The results were compared to a patient cohort younger than 90 years of age. Results Baseline characteristics revealed a higher prevalence of diabetes (P < 0.001, chronic obstructive pulmonary disease (P < 0.04, previous myocardial infarction (P < 0.02, and complex coronary anatomy (SYNTAX score 33 vs. 19 in nonagenarians. Patients < 90 years of age showed more hyperlipidemia (P < 0.01 and previous percutaneous coronary interventions (P < 0.015. Nonagenarians underwent coronary angiography more often for acute coronary syndrome (ACS (P < 0.003, were presented more often in cardiogenic shock (P < 0.003, and were transferred faster to coronary angiography in cases of ACS (P < 0.0001. The observed in-hospital mortality rate (13% study group vs. 1% control group; P < 0.003 in nonagenarians was lower than the calculated rate of thrombolysis in myocardial infarction (TIMI and global registry of acute cardiac events (GRACE mortality and strongly influenced by the severity of clinical presentation and the presence of co-morbidities. Conclusion Despite the common scepticism that cardiac catheterisation exposes patients ? 90 years to an unwarranted risk, our data demonstrate an acceptable incidence of complications and mortality in this group of patients.

Marc-Alexander Ohlow

2012-06-01

335

Genoplivning med automatisk ekstern defibrillator på hospital  

DEFF Research Database (Denmark)

Early defibrillation is a determinant of survival in cardiac arrest. We report a Danish case of successful in-hospital resuscitation using an automated external defibrillator (AED). This case illustrates important aspects of implementation of in-hospital use of an AED, i.e. location of the AED, education of the staff, systematic registration and data collection and technical aspects of AED use. If in-hospital AED implementation is carefully executed, its use may provide a safe and effective way of obtaining early defibrillation. Udgivelsesdato: 2009-Jan-26

LØfgren, Bo; Wahlgreen, Claus

2009-01-01

336

Automatic Implantable Cardiac Defibrillator  

Medline Plus

Full Text Available ... slide, you're looking at discharges from the hospital for cardiovascular disease, you'll see that although ... at the top bar, represents admissions to the hospital for cardiovascular disease compared to many other causes ...

337

A morte no contexto hospitalar: as equipes de reanimação cardíaca La muerte en el contexto hospitalario: los equipos de reanimación cardiaca Death in the hospital context: the teams of cardiac reviving  

Directory of Open Access Journals (Sweden)

Full Text Available A autora investigou o significado do trabalho cotidiano com a morte sob a perspectiva dos profissionais que integram uma equipe de reanimação cárdio-pulmonar de um Hospital Universitário. Pertencer a esta equipe implica em uma forma de lidar com a morte com a intenção explícita de revertê-la. A literatura vem evidenciando a preocupação de diferentes autores com o cotidiano profissional dessa natureza, dada sua tendência ao desgaste das pessoas. O estudo foi conduzido segundo a metodologia de investigação fenomenológica; foram realizadas entrevistas com todos os integrantes da referida equipe, utilizando a gravação. Os dados analisados evidenciam que os profissionais percebem o trabalho sob uma perspectiva funcionalista, onde o tempo se revela como fator determinante na luta contra a morte; é um trabalho permeado pelo sucesso/insucesso e por dificuldades; gera uma postura de onipotência/impotência e requer um enfrentamento. Evidenciam também desgaste, sentimentos de impotência e fracasso quando a reanimação não é possível. Referendam ainda o alerta mundial de se atentar para cotidianos de trabalho desgastantes e de que as escolas e instituições de saúde implementem canais para elaboração dessa forma de desgaste e para o redimensionamento do papel do profissional de saúde.La autora investigó el significado del trabajo cotidiano con la muerte sobre la perspectiva de los profesionales que integran un equipo de reanimación cardiopulmonar de un hospital universitario. Pertenecer a este equipo implica de alguna manera, convivir con la muerte con una intensión explícita de revertirla. La literatura viene evidenciando la preocupación de diferentes autores con el cotidiano profesional de esta naturaleza, dada su tendencia al desgaste de las personas. El estudio fue conducido según la metodología de investigación fenomenológica y fueron realizadas entrevistas con todos los integrantes del equipo referido, utilizando la grabación. Los datos analizados permiten evidenciar que los profesionales perciben el trabajo sobre una perspectiva funcionalista, donde el tiempo se revela como factor determinante en la lucha contra la muerte; es un trabajo permeado por el éxito/fracaso y por dificultades; genera una postura de omnipotencia/impotencia y requiere un enfrentamiento. Evidencian también desgaste, sentimientos de impotencia y de fracaso cuando la reanimación no es posible. Refuerzan aún la alerta mundial en relación con trabajos cotidianos desgastantes y el hecho de que las escuelas e instituciones de salud desarrollen canales para la valoración de esa forma de desgaste y para la redimensión del papel del profesional de salud.The author investigated the meaning of the daily work with the death on the perspective of the professionals that integrate a team of heart and lung revival from a university hospital. To belong to this team implies somehow, to live together with the death with an explicit objective of reverting it. The literature evidences the concern of several authors with these professionals, considering their tendency of wearines. The study was developed according to the methodology of phenomenological investigation and was carried out through recorded interviews with all members of the referred team. The analyzed data allowed authors to evidence that the professionals perceive the work on a functionalist perspective, where the time is revealed as a decisive factor against death; it is a work permeated by the success/failure and difficulties; it generates a posture of omnipotence/ impotence and requires a confrontation. They also evidenced waste, feelings of impotence and of failure when the reanimation is not possible. They still reinforce the concern about daily exhausting work and the advise for schools and institutions of health to develop channels for the evaluation of weariness and for the new valuation of the health professionals role.

Nájela Hassan Saloum

1999-12-01

338

A morte no contexto hospitalar: as equipes de reanimação cardíaca / Death in the hospital context: the teams of cardiac reviving / La muerte en el contexto hospitalario: los equipos de reanimación cardiaca  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese A autora investigou o significado do trabalho cotidiano com a morte sob a perspectiva dos profissionais que integram uma equipe de reanimação cárdio-pulmonar de um Hospital Universitário. Pertencer a esta equipe implica em uma forma de lidar com a morte com a intenção explícita de revertê-la. A lite [...] ratura vem evidenciando a preocupação de diferentes autores com o cotidiano profissional dessa natureza, dada sua tendência ao desgaste das pessoas. O estudo foi conduzido segundo a metodologia de investigação fenomenológica; foram realizadas entrevistas com todos os integrantes da referida equipe, utilizando a gravação. Os dados analisados evidenciam que os profissionais percebem o trabalho sob uma perspectiva funcionalista, onde o tempo se revela como fator determinante na luta contra a morte; é um trabalho permeado pelo sucesso/insucesso e por dificuldades; gera uma postura de onipotência/impotência e requer um enfrentamento. Evidenciam também desgaste, sentimentos de impotência e fracasso quando a reanimação não é possível. Referendam ainda o alerta mundial de se atentar para cotidianos de trabalho desgastantes e de que as escolas e instituições de saúde implementem canais para elaboração dessa forma de desgaste e para o redimensionamento do papel do profissional de saúde. Abstract in spanish La autora investigó el significado del trabajo cotidiano con la muerte sobre la perspectiva de los profesionales que integran un equipo de reanimación cardiopulmonar de un hospital universitario. Pertenecer a este equipo implica de alguna manera, convivir con la muerte con una intensión explícita de [...] revertirla. La literatura viene evidenciando la preocupación de diferentes autores con el cotidiano profesional de esta naturaleza, dada su tendencia al desgaste de las personas. El estudio fue conducido según la metodología de investigación fenomenológica y fueron realizadas entrevistas con todos los integrantes del equipo referido, utilizando la grabación. Los datos analizados permiten evidenciar que los profesionales perciben el trabajo sobre una perspectiva funcionalista, donde el tiempo se revela como factor determinante en la lucha contra la muerte; es un trabajo permeado por el éxito/fracaso y por dificultades; genera una postura de omnipotencia/impotencia y requiere un enfrentamiento. Evidencian también desgaste, sentimientos de impotencia y de fracaso cuando la reanimación no es posible. Refuerzan aún la alerta mundial en relación con trabajos cotidianos desgastantes y el hecho de que las escuelas e instituciones de salud desarrollen canales para la valoración de esa forma de desgaste y para la redimensión del papel del profesional de salud. Abstract in english The author investigated the meaning of the daily work with the death on the perspective of the professionals that integrate a team of heart and lung revival from a university hospital. To belong to this team implies somehow, to live together with the death with an explicit objective of reverting it. [...] The literature evidences the concern of several authors with these professionals, considering their tendency of wearines. The study was developed according to the methodology of phenomenological investigation and was carried out through recorded interviews with all members of the referred team. The analyzed data allowed authors to evidence that the professionals perceive the work on a functionalist perspective, where the time is revealed as a decisive factor against death; it is a work permeated by the success/failure and difficulties; it generates a posture of omnipotence/ impotence and requires a confrontation. They also evidenced waste, feelings of impotence and of failure when the reanimation is not possible. They still reinforce the concern about daily exhausting work and the advise for schools and institutions of health to develop channels for the evaluation of weariness and for the new valuation of the health professionals rol

Nájela Hassan, Saloum; Magali Roseira, Boemer.

1999-12-01

339

Out of Context: Thinking Cultural Studies Diasporically  

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Full Text Available This essay on cultural studies and the African Diaspora argues for a rethinking of cultural studies in two critical ways: firstly, that cultural studies, from its founding institutional and conceptual moment, cannot but be thought diasporically; and, secondly, that cultural studies be thought ‘out of’, or, against, context—that is, cultural studies is most revealing in its political and literary articulation when it is not read, as many of its advocates claim, contextually. This essay offers a broad critique of cultural studies and the (African diaspora but derives its most cogent and creative argument from its ability to read together the work of two diasporic authors, deracinated South African and Australian writers, J. M. Coetzee and David Malouf.

Grant Farred

2011-04-01

340

Politics out of the History of Politics  

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Full Text Available Wendy Brown’s approach in Politics out of History is characterized by an attempt to analyze the presence of the past which can be read not only under the light of Nietzsche’s legacy, but also through a comparison with Hannah Arendt’s conception of the gap between the past and the future. Like Arendt, Brown aims to look at the present as the site of politics and freedom, even though the former conceives the break with tradition as the unavoidable starting point, while the latter assumes that that break is not fully accomplished because it was not recognized. Rather, it produces Wounded Attachments whose effect is that of limiting the possibility of left criticism. Moving from this parallel, Brown’s analysis is compared to the Italian philosophy of sexual difference, stressing their common interest in thinking freedom beyond a female identity built on a presumed common oppression.

Diana Sartori

2012-11-01

 
 
 
 
341

Hospital fundamentals.  

Science.gov (United States)

Under the current system, orthopaedic trauma surgeons must work in some form of hospital setting as our primary service involves treatment of the trauma patient. We must not forget that just as a trauma center cannot exist without our services, we cannot function without their support. As a result, a clear understanding of the balance between physicians and hospitals is paramount. Historical perspective enables physicians and hospital personnel alike to understand the evolution of hospital-physician relationship. This process should be understood upon completion of this chapter. The relationship between physicians and hospitals is becoming increasingly complex and multiple forms of integration exist such as joint ventures, gain sharing, and co-management agreements. For the surgeon to negotiate well, an understanding of hospital governance and the role of the orthopaedic traumatologist is vital to success. An understanding of the value provided by the traumatologist includes all aspects of care including efficiency, availability, cost effectiveness, and research activities. To create effective and sustainable healthcare institutions, physicians and hospitals must be aligned over a sustained period of time. Unfortunately, external forces have eroded the historical basis for the working relationship between physicians and hospitals. Increased competition and reimbursement cuts, coupled with the increasing demands for quality, efficiency, and coordination and the payment changes outlined in healthcare reform, have left many organizations wondering how to best rebuild the relationship. The principal goal for the physician when partnering with a hospital or healthcare entity is to establish a sustainable model of service line management that protects or advances the physician's ability to make impactful improvements in quality of patient care, decreases in healthcare costs, and improvements in process efficiency through evidence-based practices and protocols. PMID:24918827

Althausen, Peter L; Hill, Austin D; Mead, Lisa

2014-07-01

342

Emergency Open Cardiac Massage via Subxyphoid Approach in Ruptured Type A Aortic Dissection  

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Full Text Available Patient sustained cardiac tamponade caused by rupture of type A aortic dissection may result in sudden death. Pericardiocentesis is a lifesaving procedure; nevertheless, blood may occlude the catheter and fail to relieve the pressure. However, open-chest cardiac massage in resuscitation has been studied in animal models by some medical centers and laboratories with inspiring results. We report a 58-year-old woman who was transferred from a local hospital with the diagnosis of cardiac tamponade caused by ruptured type A aortic dissection. Pulseless electrical activity followed by cardiac arrest occurred thereafter. Successful resuscitation in the emergency department was achieved using open cardiac massage through the sub-xyphoid region by opening a pericardial window. Therefore, in unstable patients with cardiac tamponade due to aortic dissection, this resuscitative procedure is feasible, safe and efficient.

Hsing-Lin Lin

2010-10-01

343

Cardiac involvement in hemochromatosis.  

Science.gov (United States)

Cardiac hemochromatosis or primary iron-overload cardiomyopathy is an important and potentially preventable cause of heart failure. This is initially characterized by diastolic dysfunction and arrhythmias and in later stages by dilated cardiomyopathy. Diagnosis of iron overload is established by elevated transferrin saturation (>55%) and elevated serum ferritin (>300 ng/mL). Genetic testing for mutations in the HFE (high iron) gene and other proteins, such as hemojuvelin, transferrin receptor, and ferroportin, should be performed if secondary causes of iron overload are ruled out. Patients should undergo comprehensive 2D and Doppler echocardiography to evaluate their systolic and diastolic function. Newer modalities like strain imaging and speckle-tracking echocardiography hold promise for earlier detection of cardiac involvement. Cardiac magnetic resonance imaging with measurement of T2* relaxation times can help quantify myocardial iron overload. In addition to its value in diagnosis of cardiac iron overload, response to iron reduction therapy can be assessed by serial imaging. Therapeutic phlebotomy and iron chelation are the cornerstones of therapy. The average survival is less than a year in untreated patients with severe cardiac impairment. However, if treated early and aggressively, the survival rate approaches that of the regular heart failure population. PMID:24503941

Gulati, Vinay; Harikrishnan, Prakash; Palaniswamy, Chandrasekar; Aronow, Wilbert S; Jain, Diwakar; Frishman, William H

2014-01-01

344

Cardiac radiology: centenary review.  

Science.gov (United States)

During the past century, cardiac imaging technologies have revolutionized the diagnosis and treatment of acquired and congenital heart disease. Many important contributions to the field of cardiac imaging were initially reported in Radiology. The field developed from the early stages of cardiac imaging, including the use of coronary x-ray angiography and roentgen kymography, to nowadays the widely used echocardiographic, nuclear medicine, cardiac computed tomographic (CT), and magnetic resonance (MR) applications. It is surprising how many of these techniques were not recognized for their potential during their early inception. Some techniques were described in the literature but required many years to enter the clinical arena and presently continue to expand in terms of clinical application. The application of various CT and MR contrast agents for the diagnosis of myocardial ischemia is a case in point, as the utility of contrast agents continues to expand the noninvasive characterization of myocardium. The history of cardiac imaging has included a continuous process of advances in our understanding of the anatomy and physiology of the cardiovascular system, along with advances in imaging technology that continue to the present day. © RSNA, 2014 Listen to a discussion of the history of radiology. PMID:25340434

de Roos, Albert; Higgins, Charles B

2014-11-01

345

The Homeless Mentally Ill: No Longer Out of Sight and Out of Mind. Human Resources Series.  

Science.gov (United States)

The increasing presence of the mentally ill among the nation's homeless is the topic of this report. The problems presented by deinstitutionalization are discussed, including: (1) the homeless mentally ill as a disruptive element of society; (2) mentally ill persons who shuttle between the hospital and the community; (3) young chronic patients who…

Paterson, Andrea; Craig, Rebecca T.

1985-01-01

346

General practitioners' satisfaction with and attitudes to out-of-hours services  

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Full Text Available Abstract Background In recent years, Dutch general practitioner (GP out-of-hours service has been reorganised into large-scale GP cooperatives. Until now little is known about GPs' experiences with working at these cooperatives for out-of-hours care. The purpose of this study is to gain insight into GPs' satisfaction with working at GP cooperatives for out-of-hours care in separated and integrated cooperatives. Methods A GP cooperative separate from the hospital Accident and Emergency (A&E department, and a GP cooperative integrated within the A&E department of another hospital. Both cooperatives are situated in adjacent geographic regions in the South of the Netherlands. One hundred GPs were interviewed by telephone; fifty GPs working at the separated GP cooperative and fifty GPs from the integrated GP cooperative. Opinions on different aspects of GP cooperatives for out-of-hours care were measured, and regression analysis was performed to investigate if these could be related to GP satisfaction with out-of-hours care organisation. Results GPs from the separated model were more satisfied with the organisation of out-of-hours care than GPs from the integrated model (70 vs. 60 on a scale score from 0 to 100; P = 0.020. Satisfaction about out-of-hours care organisation was related to opinions on workload, guarantee of gatekeeper function, and attitude towards out-of-hours care as being an essential part of general practice. Cooperation with medical specialists was much more appreciated at the integrated model (77 vs. 48; P Conclusion GPs in this study appear to be generally satisfied with the organisation of GP cooperatives for out-of-hours care. Furthermore, GPs working at the separated cooperative seem to be more satisfied compared to GPs working at the integrated cooperative.

Wesseling Geertjan

2005-03-01

347

Plasma cardiac natriuretic peptide determination as a screening test for the detection of patients with mild left ventricular impairment.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

OBJECTIVE: To determine the usefulness of measuring the cardiac natriuretic peptides, atrial natriuretic factor, N-terminal pro-atrial natriuretic factor, and brain natriuretic peptide, as screening tests for identifying patients with mild left ventricular impairment. DESIGN: Cross-sectional evaluation of the diagnostic accuracy of the cardiac natriuretic peptides. SETTING: Cardiac catheterisation unit, Norwegian central hospital. PATIENTS: A consecutive series of 254 patients undergoing diag...

Omland, T.; Aakvaag, A.; Vik-mo, H.

1996-01-01

348

Pseudoaneurysm of the femoral artery after cardiac catheterisation: diagnosis and treatment by manual compression guided by Doppler colour flow imaging.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

OBJECTIVE--To assess the value of Doppler colour flow imaging for diagnosing and guiding non-surgical treatment of pseudoaneurysm of the femoral artery complicating cardiac catheterisation. DESIGN--A prospective study. SETTING--Cardiac department in a teaching hospital. PATIENTS--9 patients (8 female, 1 male) who presented with pseudoaneurysm 1-15 days after cardiac catheterisation. INTERVENTIONS--The femoral arterial communication to the false aneurysm was localised by Doppler colour flow im...

Currie, P.; Turnbull, C. M.; Shaw, T. R.

1994-01-01

349

Hospital philanthropy.  

Science.gov (United States)

It remains an open question whether hospital spending on fundraising efforts to garner philanthropy is a good use of funds. Research and industry reports provide conflicting results. We describe the accounting and data challenges in analysis of hospital philanthropy, which include measurement of donations, measurement of fundraising expenses, and finding the relationships among organizations where these cash flows occur. With these challenges, finding conflicting results is not a surprise. PMID:23614267

Smith, Dean G; Clement, Jan P

2013-01-01