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Sample records for at-risk cardiovascular patients

  1. Identifying primary care patients at risk for future diabetes and cardiovascular disease using electronic health records

    Directory of Open Access Journals (Sweden)

    Shrader Peter

    2009-09-01

    Full Text Available Abstract Background Prevention of diabetes and coronary heart disease (CHD is possible but identification of at-risk patients for targeting interventions is a challenge in primary care. Methods We analyzed electronic health record (EHR data for 122,715 patients from 12 primary care practices. We defined patients with risk factor clustering using metabolic syndrome (MetS characteristics defined by NCEP-ATPIII criteria; if missing, we used surrogate characteristics, and validated this approach by directly measuring risk factors in a subset of 154 patients. For subjects with at least 3 of 5 MetS criteria measured at baseline (2003-2004, we defined 3 categories: No MetS (0 criteria; At-risk-for MetS (1-2 criteria; and MetS (≥ 3 criteria. We examined new diabetes and CHD incidence, and resource utilization over the subsequent 3-year period (2005-2007 using age-sex-adjusted regression models to compare outcomes by MetS category. Results After excluding patients with diabetes/CHD at baseline, 78,293 patients were eligible for analysis. EHR-defined MetS had 73% sensitivity and 91% specificity for directly measured MetS. Diabetes incidence was 1.4% in No MetS; 4.0% in At-risk-for MetS; and 11.0% in MetS (p MetS vs No MetS = 6.86 [6.06-7.76]; CHD incidence was 3.2%, 5.3%, and 6.4% respectively (p Conclusion Risk factor clustering in EHR data identifies primary care patients at increased risk for new diabetes, CHD and higher resource utilization.

  2. Aspirin and omeprazole for secondary prevention of cardiovascular disease in patients at risk for aspirin-associated gastric ulcers.

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    García-Rayado, Guillermo; Sostres, Carlos; Lanas, Angel

    2017-08-01

    Cardiovascular disease is the most important cause of morbidity and mortality in the world and low-dose aspirin is considered the cornerstone of the cardiovascular disease prevention. However, low-dose aspirin use is associated with gastrointestinal adverse effects in the whole gastrointestinal tract. In this setting, co-therapy with a proton pump inhibitor is the most accepted strategy to reduce aspirin related upper gastrointestinal damage. In addition, some adverse effects have been described with proton pump inhibitors long term use. Areas covered: Low-dose aspirin related beneficial and adverse effects in cardiovascular system and gastrointestinal tract are reviewed. In addition, this manuscript summarizes current data on upper gastrointestinal damage prevention and adverse events with proton pump inhibition. Finally, we discuss the benefit/risk ratio of proton pump inhibitor use in patients at risk of gastrointestinal damage taking low-dose aspirin. Expert commentary: Nowadays, with the current available evidence, the combination of low-dose aspirin with proton pump inhibitor is the most effective therapy for cardiovascular prevention in patients at high gastrointestinal risk. However, further studies are needed to discover new effective strategies with less related adverse events.

  3. Association between Cardiorespiratory Fitness and Health-Related Quality of Life among Patients at Risk for Cardiovascular Disease in Uruguay

    Science.gov (United States)

    Payne, Jonathan P. W.; Rienzi, Edgardo G.; Lavie, Carl J.; Blair, Steven N.; Pate, Russell R.

    2015-01-01

    To date, few studies have examined the relationship between cardiorespiratory fitness (CRF) and health-related quality of life (HRQoL) in populations at high risk for developing cardiovascular disease (CVD). Purpose To examine the association between objectively measured CRF and physical and mental components of HRQoL in a Uruguayan cohort at risk for developing CVD. Methods Patient data records from 2002–2012 at the Calidad de Vida Center were examined. To assess CRF, participants performed a submaximal exercise test. During the evaluation, participants also completed the SF-36, a HRQoL measure comprised of eight dimensions that are summarized by physical and mental component scores (PCS and MCS, respectively). ANCOVA was used to examine the relationship between HRQoL dimensions and CRF. Logistic regression was then used to compare the odds of having a HRQoL component score above the norm across CRF. All analyses were performed separately for males and females with additional stratified analyses across age and BMI conducted among significant trends. Results A total of 2,302 subjects were included in the analysis. Among females, a significant relationship was observed between CRF and vitality, physical functioning, physical role, bodily pain, and general health dimensions. However, for males the only dimension found to be significantly associated with CRF was physical health. After adjusting for potential confounders, a significant linear trend (p<0.001) for PCS scores above the norm across CRF levels was observed for females only. Conclusion Among females with one or more risk factors for developing CVD, higher levels of CRF were positively associated with the vitality and physical dimensions of HRQoL, as well as the overall PCS. However, among males the only dimension associated with CRF was physical functioning. Future studies should examine this relationship among populations at risk for developing CVD in more detail and over time. PMID:25901358

  4. Knowledge and attitudes of primary care physicians in the management of patients at risk for cardiovascular events

    Directory of Open Access Journals (Sweden)

    Turakhia Mintu P

    2008-07-01

    Full Text Available Abstract Background Adherence to clinical practice guidelines for management of cardiovascular disease (CVD is suboptimal. The purposes of this study were to identify practice patterns and barriers among U.S. general internists and family physicians in regard to cardiovascular risk management, and examine the association between physician characteristics and cardiovascular risk management. Methods A case vignette survey focused on cardiovascular disease risk management was distributed to a random sample of 12,000 U.S. family physicians and general internists between November and December 2006. Results Responses from a total of 888 practicing primary care physicians who see 60 patients per week were used for analysis. In an asymptomatic patient at low risk for cardiovascular event, 28% of family physicians and 37% of general internists made guideline-based preventive choices for no antiplatelet therapy (p Conclusion Despite the benefits demonstrated for managing cardiovascular risks, gaps remain in primary care practitioners' management of risks according to guideline recommendations. Innovative educational approaches that address barriers may facilitate the implementation of guideline-based recommendations in CVD risk management.

  5. Carotid and femoral artery wall thickness and stiffness in patients at risk for cardiovascular disease, with special emphasis on hyperhomocysteinemia.

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    Smilde, T J; van den Berkmortel, F W; Boers, G H; Wollersheim, H; de Boo, T; van Langen, H; Stalenhoef, A F

    1998-12-01

    Recent developments in ultrasound technology enable the noninvasive measurement of structural and functional vessel wall changes. Until now, the effect of homocysteine on the arterial wall has remained unclear: reports on intima-media thickness (IMT) yield conflicting results, whereas data on vessel wall stiffness are lacking. Because several cardiovascular risk factors result in an increased IMT or stiffness, different groups at risk for atherosclerotic disease, with special emphasis on hyperhomocysteinemia, were studied. Nineteen patients homozygous and 14 subjects heterozygous for cystathionine beta-synthase (CBS) deficiency, 21 patients with familial hypercholesterolemia (FH), 15 patients with essential hypertension, 20 smokers, and 28 control subjects were studied. The IMT values (both right and left) of the common carotid artery (CCA), bulb (BUL), internal carotid artery (ICA), and common femoral artery (CFA) were measured in millimeters by high-resolution ultrasound (Biosound). The distensibility (DC, in 10(-3). kPa-1) and compliance (CC in mm2. kPa-1) coefficients of the CCA (right and left) and CFA (right) were determined by a wall track system (Pie Medical). The mean IMT of the posterior wall in the CCA was 0.70+/-0.09 mm in healthy controls. For patients with vascular disease, FH, and hypertension and in smokers, the mean CCA IMT was larger, whereas no major differences in IMT were observed in patients either homozygous or heterozygous for CBS deficiency. The DC and CC in the right CCA were 23.5+/-6.9 (10(-3). kPa-1) and 0.9+/-0.3 (mm2. kPa-1) in healthy subjects, slightly lower in patients homozygous for CBS deficiency, and clearly lower in patients with vascular disease, FH, and hypertension. No positive correlation was found between plasma homocysteine level and either IMT, CC, or DC. Because smoking was a confounder in each risk group, a stepwise regression analysis was carried out to assess the contribution of each risk factor on IMT and arterial

  6. Preeclampsia : At risk for remote cardiovascular disease

    NARCIS (Netherlands)

    Harskamp, Ralf E.; Zeeman, Gerda G.

    2007-01-01

    Epidemiological data indicate that women with preeclampsia are more likely to develop cardiovascular disease (CVD) later in life. Population-based studies relate preeclampsia to an increased risk of later chronic hypertension (RR, 2.00 to 8.00) and cardiovascular morbidity/mortality (RR, 1.3 to

  7. Percentile categorization of QT interval as an approach for identifying adult patients at risk for cardiovascular death.

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    Mohebi, Reza; Jehan, Ayesha; Grober, Aaron; Froelicher, Victor

    2017-08-01

    The results from studies of the association of QT prolongation with cardiovascular death (CVD) have been inconsistent. The purpose of this study was to compare the major correction formulas to percentile values of QT for heart rate ranges as to their ability to remove the relationship of QT to heart rate and to predict CVD. Participants were 16,531 veterans who had an initial ECG at the Veterans Affairs Medical Center, Palo Alto, between March 31, 1987, and December 20, 1999, and were followed for CVD. The 4 major correction formulas (Bazett, Fridericia, Framingham, and Hodges) were used to correct QT interval. In addition, the percentiles for heart rate ranges as proposed by Schwartz were calculated. During median follow-up of 17.8 years, 455 CVD events occurred. When compared to the other equations, QTc Bazett had the greatest dependence on heart rate (R2 = 0.18). The hazard ratio (95% confidence interval) for CVD was 2.08 (1.28-3.9) for the 98th percentile of QT interval by heart rate ranges, 2.05 (1.27-3.33) for QTc Bazett, 1.39 (0.44-4.34) for QTc Fridericia, 1.05 (0.26-4.24) for QTc Hodges, and 1.12 (0.28-4.52) for QTc Framingham. The hazard ratio of QTc Bazett was significantly higher than the other formulas except for the 98th percentile method. The Framingham, Hodges, and Fridericia equations remove the effect of heart rate on QT interval significantly better than the Bazett equation. Using QT-interval percentiles based on heart rate provides a consistent approach both for identifying those whose QT intervals prolong due to drugs or other stressors and for assessing CVD risk. Published by Elsevier Inc.

  8. Therapy of patients at risk.

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    Skidmore, F D

    1990-01-01

    This is an informal discussion of how the author manages fibrocystic breast disease. Cystic disease of the breast is common in premenopausal women, peaking at age 48. It usually follows a cyclic pattern, increasing premenstrually, and often developing during missed periods before menopause. Sometimes iatrogenic causes, such as premenopausal estrogen replacement or cimetidine, are responsible. 6% of women with cystic disease will progress to breast cancer by the age of 52. Patients are treated with excisional biopsy, and are followed up every 6 months. Disease can manifest on the range from benign fibroadenoma, to epitheliosis, to carcinoma in situ. It is advisable to discontinue birth control pills immediately in women with cyst disease. Estrogen replacement is especially contraindicated for these women because it will cause fibroadenosis in the upper outer quadrant, retard the process of fatty degeneration of breast tissue, and increase the woman's chances of more cysts, more biopsies, and more anxiety as future mammograms become increasingly difficult to interpret.

  9. Cardiovascular risk in relation to body mass index and use of evidence-based preventive medications in patients with or at risk of atherothrombosis.

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    Hansel, Boris; Roussel, Ronan; Elbez, Yedid; Marre, Michel; Krempf, Michel; Ikeda, Yasuo; Eagle, Kim A; Elisaf, Moses; Bhatt, Deepak L; Steg, Ph Gabriel

    2015-10-21

    Explore the relation between body mass index (BMI) and cardiovascular disease, and the influence of optimal medical therapy (OMT) on this relationship. Patients from the REACH cohort, an international, prospective cohort of patients with or at high risk of atherosclerosis with documentation of potential confounders, including treatments and risk factors, were followed up to 4 years (n = 54 285). Patients were categorized according to baseline BMI (ranging from underweight to Grade III obesity). Optimal medical therapy was defined as the use of the four cardioprotective medication classes (statins, ACE inhibitors/angiotensin II receptor blockers, β-blockers, and antiplatelet agents). The main outcomes were all-cause mortality, cardiovascular (CV) mortality, and CV events. In primary and secondary prevention, a reverse J-shaped curve best described the relationship between BMI categories and the incidence of the various outcomes. In secondary prevention, the highest adjusted risks were observed for underweight patients (1.97, P obese patients (0.73, P obesity persisted in patients receiving OMT. An obesity paradox was observed in both primary and secondary CV prevention patients. The intensity of use of evidence-based preventive medications does not account for the paradoxical CV protection associated with obesity. At extremes of BMI, further interventions beyond OMT may be needed to reduce CV risk. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  10. Combined measurement of copeptin, high-sensitivity troponin T, and N-terminal proBNP improves the identification of patients at risk of cardiovascular death

    DEFF Research Database (Denmark)

    Alehagen, Urban; Dahlström, Ulf; Carstensen, John

    2012-01-01

    Objectives: A multimarker strategy for the handling of patients with heart failure has been suggested in the literature. Therefore, the potential prognostic relevance of combined copeptin, high-sensitivity troponin T (HS-TnT), and N-terminal proBNP (NT-proBNP) measurement in plasma from elderly...... and all mortality was registered. Cardiovascular mortality was evaluated using Kaplan–Meier plots and multivariate Cox proportional hazard regression analyses. Results: Copeptin, HS-TnT, and NT-proBNP measurements provided independent prognostic information in a multivariate setting over 5 years (hazard......). In the 13-year follow-up, combined copeptin and HS-TnT measurement did not provide independent prognostic information. Conclusion: Combined copeptin, HS-TnT, and NT-proBNP plasma measurements provide prognostic information on cardiovascular mortality that is superior to single biomarker use....

  11. Unravelling effectiveness of a nurse-led behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: study protocol for a cluster randomised controlled trial.

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    Westland, Heleen; Bos-Touwen, Irene D; Trappenburg, Jaap C A; Schröder, Carin D; de Wit, Niek J; Schuurmans, Marieke J

    2017-02-22

    Self-management interventions are considered effective in patients with chronic disease, but trials have shown inconsistent results, and it is unknown which patients benefit most. Adequate self-management requires behaviour change in both patients and health care providers. Therefore, the Activate intervention was developed with a focus on behaviour change in both patients and nurses. The intervention aims for change in a single self-management behaviour, namely physical activity, in primary care patients at risk for cardiovascular disease. The aim of this study is to evaluate the effectiveness of the Activate intervention. A two-arm cluster randomised controlled trial will be conducted to compare the Activate intervention with care as usual at 31 general practices in the Netherlands. Approximately 279 patients at risk for cardiovascular disease will participate. The Activate intervention is developed using the Behaviour Change Wheel and consists of 4 nurse-led consultations in a 3-month period, integrating 17 behaviour change techniques. The Behaviour Change Wheel was also applied to analyse what behaviour change is needed in nurses to deliver the intervention adequately. This resulted in 1-day training and coaching sessions (including 21 behaviour change techniques). The primary outcome is physical activity, measured as the number of minutes of moderate to vigorous physical activity using an accelerometer. Potential effect modifiers are age, body mass index, level of education, social support, depression, patient-provider relationship and baseline number of minutes of physical activity. Data will be collected at baseline and at 3 months and 6 months of follow-up. A process evaluation will be conducted to evaluate the training of nurses, treatment fidelity, and to identify barriers to and facilitators of implementation as well as to assess participants' satisfaction. To increase physical activity in patients and to support nurses in delivering the intervention

  12. Providing food to treat adolescents at risk for cardiovascular disease.

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    de Ferranti, Sarah D; Milliren, Carly E; Denhoff, Erica Rose; Quinn, Nicolle; Osganian, Stavroula K; Feldman, Henry A; Ebbeling, Cara B; Ludwig, David S

    2015-10-01

    Diet modification is recommended to treat childhood cardiovascular (CV) risk factors; however, the optimal dietary strategy is unknown. In a randomized trial, the effect of a low-fat (LF) and a low-glycemic-load (LGL) reduced-calorie diet were examined in youth with overweight/obesity with CV risk factors. Using a novel intervention, we delivered LF or LGL meals and nutrition education to the home for 8 weeks (Intensive Phase), followed by 4 months Maintenance without food provision. Between-group differences in the change in insulin area under the curve (InsAUC) by oral glucose tolerance test and other risk factors were analyzed. Overall, participants (n = 27) showed substantial improvement during the Intensive Phase, including InsAUC (-59 ± 18.2 µU/ml × 120 min, P = 0.004), total cholesterol (-9.9 ± 3.6 mg/dl, P = 0.01), weight (-2.7 ± 0.5 kg, P risk factors that diminished without food delivery and did not differ based on dietary intervention. If scalable, food provision may represent an alternative nutrition treatment strategy. © 2015 The Obesity Society.

  13. Identifying admitted patients at risk of dying

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Knudsen, Torben; Hallas, Jesper

    2013-01-01

    Risk assessment is an important part of emergency patient care. Risk assessment tools based on biochemical data have the advantage that calculation can be automated and results can be easily provided. However, to be used clinically, existing tools have to be validated by independent researchers....... This study involved an independent external validation of four risk stratification systems predicting death that rely primarily on biochemical variables....

  14. Screening for at-risk drinking behavior in trauma patients.

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    Plackett, Timothy P; Ton-That, Hieu H; Mueller, Jeanne; Grimley, Karen M; Kovacs, Elizabeth J; Esposito, Thomas J

    2015-06-01

    A blood alcohol level above 0 g/dL is found in up to 50% of patients presenting with traumatic injuries. The presence of alcohol in the blood not only increases the risk of traumatic injury, but it is also associated with worse outcomes and trauma recidivism. In light of these risks, the American College of Surgeons Committee on Trauma advocates screening for at-risk drinking. Although many institutions use blood alcohol levels to determine at-risk drinking in trauma patients, the Alcohol Use Disorders Identification Test (AUDIT) offers a cheap and easy alternative. Few direct comparisons have been made between these 2 tests in trauma patients. To compare the utility of blood alcohol level and AUDIT score as indicators of at-risk drinking in trauma patients. Records for all trauma patients aged 18 years or older who were admitted to a level I trauma center from May 2013 through June 2014 were reviewed in this retrospective cohort study. Inclusion criteria required patients to have undergone both blood alcohol level testing and AUDIT on admission. A blood alcohol level greater than 0 g/dL and an AUDIT score equal to or above 8 were considered positive for at-risk drinking. Performance of both tests was indexed against the National Institute of Alcohol Abuse and Alcoholism (NIAAA) criteria for at-risk drinking. Of 750 patients admitted for trauma, 222 records (30%) contained data on both blood alcohol level and AUDIT score. The patients were predominantly male (178 [80%]) and had a mean (SD) age of 40.1 (16.7) years. Most patients (178 [80%]) had sustained blunt trauma. Ninety-seven patients (44%) had a positive blood alcohol level, 70 (35%) had a positive AUDIT score, and 54 (24%) met NIAAA criteria for at-risk drinking. The sensitivity and specificity of having a positive blood alcohol level identify at-risk drinking were 61% and 62%, respectively. The sensitivity and specificity of having a positive AUDIT score identify at-risk drinking were 83% and 81

  15. [Cardiovascular risk factors in the population at risk of poverty and social exclusión].

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    Álvarez-Fernández, Carlos; Vaquero-Abellán, Manuel; Ruíz-Gandara, África; Romero-Saldaña, Manuel; Álvarez-López, Carlos

    2017-03-01

    Detect if there are differences in prevalence, distribution of cardiovascular risk factors and risk according to REGICOR and SCORE's function; between people belonging to different occupational classes and population at risk of social exclusion. Cross-sectional. SITE: Occupational health unit of the City Hall of Córdoba. Sample availability of 628 people, excluding 59 by age or incomplete data. The group of municipal workers was obtained randomly while all contracted exclusion risk was taken. No preventive, diagnostic or therapeutic actions that modify the course of the previous situation of workers were applied. Smoke, glucose, lipids, blood pressure and BMI as main variables. T-student were used for comparison of means and percentages for Chi 2 . Statistical significance attached to an alpha error <5% and confidence interval with a 95% security. Receiver operator curves (ROC) were employed to find out what explanatory variables predict group membership of workers at risk of exclusion. Smoking (95% CI: -.224;-.443), hypercholesterolemia (95% CI: -.127;-.320), obesity (95% CI: -.005;-0.214), diabetes (95% CI: -.060;-.211) and cardiovascular risk were higher in men at risk of exclusion. In women there were differences in the same variables except smoking (P=.053). The existence of inequalities in prevalence of cardiovascular risk factors is checked. In a context of social crisis, health promotion and primary prevention programs directing to the most vulnerable, they are needed to mit. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  16. Awareness of vitamin D deficiency among at-risk patients

    Directory of Open Access Journals (Sweden)

    Alemu Esubalew

    2012-01-01

    Full Text Available Abstract Background Vitamin D deficiency is a significant problem for a growing proportion of the UK population. Individuals with dark or covered skin are at particularly high risk due to ethno-cultural, environmental and genetic factors. We assessed the level of awareness of vitamin D deficiency among at-risk patients in order to identify groups most in need of education. Findings A cross-sectional survey using a piloted questionnaire was conducted among consecutive at-risk patients without a diagnosis of Vitamin D deficiency arriving at a large inner city general practice in the North West of England over a five day period. The survey was completed by 221 patients. The mean age was 35 years. 28% of them (n = 61 had never heard about vitamin D. Older patients (p = 0.003 were less likely to have heard about vitamin D. 54% of participants were unaware of the commonest symptoms of vitamin D deficiency. 34% did not expose their skin other than their face in the last one year, and 11% did not include vitamin D rich foods in their diet. Conclusion The majority of at-risk patients are aware of vitamin D; nevertheless, there is a significant lack of knowledge among older people, who have higher morbidity. A programme of targeted education of the at-risk population is recommended.

  17. Predicting At-Risk Patient Profiles from Big Prescription Data

    OpenAIRE

    Genevès, Pierre; Calmant, Thomas; Layaïda, Nabil; Lepelley, Marion; Artemova, Svetlana; Bosson, Jean-Luc

    2017-01-01

    We show how the analysis of very large amounts of drug prescription data make it possible to detect, on the day of hospital admission, patients at risk of developing complications during their hospital stay. We explore, for the first time, to which extent volume and variety of big prescription data help in constructing predictive models for the automatic detection of at-risk profiles.Our methodology is designed to validate our claims that: (1) drug prescription data on the day of admission co...

  18. [Nursing diagnoses for patients at risk of developing pressure ulcer].

    Science.gov (United States)

    de Araújo, Thiago Moura; de Araújo, Márcio Flávio Moura; Caetano, Joselany Áfio; Galvão, Marli Teresinha Gimenez; Damasceno, Marta Maria Coelho

    2011-01-01

    This cross-sectional study aimed to identify nursing diagnoses in critical patients at risk of developing pressure ulcer. It was carried out at an Intensive Care Unit in Fortaleza-CE, Brazil, using an intentional sample of thirteen subjects at risk of pressure ulcer, evaluated according to the Waterlow scale. In total, 45 nursing diagnoses were evidenced, seventeen of which were clinically significant for the development of pressure ulcer. The frequency levels for nine of these nursing diagnoses were ≥ 80%, mainly: Impaired skin integrity (100%), Impaired walking (87%), Impaired swallowing (80%), Impaired bed mobility (80%) and Impaired gas exchange (80%). The knowledge of those nursing diagnoses is important in detecting the effects and clinical basis of skin lesions.

  19. Predicting patients at risk for pain associated with electrochemotherapy

    DEFF Research Database (Denmark)

    Quaglino, Pietro; Matthiessen, Louise Wichmann; Curatolo, Pietro

    2015-01-01

    BACKGROUND: Electrochemotherapy describes the use of electric pulses to enhance chemotherapy uptake, and has proven highly efficient in treating cutaneous metastases. Patients referred for electrochemotherapy present with diverse clinical pictures, from multiple small lesions to large, ulcerated...... lesions. Post-electrochemotherapy pain has been observed in some patients. The objectives of this study were to evaluate pain scores before and after electrochemotherapy, and to investigate if patients at risk of post-procedure pain could be identified. METHODS: Seven cancer centres in the International...... patients 39% had metastatic melanoma, 18% squamous cell carcinoma, 16% breast cancer, 13% basal-cell carcinoma, and 14% other malignancies. Median size of the largest nodules was 2.3 cm (range 0.3-40 cm). A majority of patients presented with low pain scores, and this continued through follow-up (74...

  20. Identifying Patients at Risk and Patients in Need

    DEFF Research Database (Denmark)

    Schmidt, Thomas

    2015-01-01

    En væsentlig andel af patienter oplever forværring under indlæggelse på Fælles Akutmodtagelsen (FAM). At identificere disse forværringer før de bliver alvorlige er vanskeligt for klinikere eftersom de behandler meget forskellige patienter under et stort pres for at bevare overblik og årvågenhed...... mellem organisationen og dens teknologi med henblik på at udarbejde et bedre beslutningsunderstøttende system til monitorering af patienter. Baseret på en organisatorisk-, en modellerings- og en prototypebaseret vinkel udledes fem forskningsspørgsmål, som dirigerer arbejdet: 1. Hvilke organisatoriske og...... tekniske faktorer kan besværliggøre opsporing af patienter, i risiko for forværring under indlæggelse på FAM? 2. Hvilke faktorer spiller ind på, i hvor høj grad patienter monitoreres under indlæggelse på et korttidssengeafsnit? 3. Hvordan kan et patientmonitoreringssystem håndtere patienters forskellighed...

  1. Are ACE Inhibitors and Beta-blockers Dangerous in Patients at Risk for Anaphylaxis?

    Science.gov (United States)

    Coop, Christopher A; Schapira, Rebecca S; Freeman, Theodore M

    The objective of this article is to review the available studies regarding angiotensin converting enzyme (ACE) inhibitors and beta-blockers and their effect on patients at risk for anaphylaxis. A literature search was conducted in PUBMED to identify peer-reviewed articles using the following keywords: anaphylaxis, ACE inhibitor, beta-blocker, food allergy, radiocontrast media, venom allergy, skin testing, and immunotherapy. Some studies show an increased risk of anaphylaxis in patients who are taking ACE inhibitors and beta-blockers, whereas others studies do not show an increased risk. For venom immunotherapy, there are more data supporting the concomitant use of beta-blockers and ACE inhibitors in the build-up and maintenance phases. Most of the medical literature is limited to case reports and retrospective data. Prospective controlled trials are needed on this important topic. For those patients at risk of anaphylaxis who lack cardiovascular disease, it is recommended to avoid beta-blockers and possibly ACE inhibitors. However, for those patients with cardiovascular disease, beta-blockers and ACE inhibitors have been shown to increase life expectancy. Consideration should be given for the concomitant use of these medications while patients are receiving venom immunotherapy. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. All rights reserved.

  2. Unravelling effectiveness of a nurse-led behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care : Study protocol for a cluster randomised controlled trial

    NARCIS (Netherlands)

    Westland, Heleen; Bos-Touwen, Irene D.; Trappenburg, Jaap C A; Schröder, Carin D.; de Wit, Niek J.; Schuurmans, Marieke J.

    2017-01-01

    BACKGROUND: Self-management interventions are considered effective in patients with chronic disease, but trials have shown inconsistent results, and it is unknown which patients benefit most. Adequate self-management requires behaviour change in both patients and health care providers. Therefore,

  3. Body mass index and myocardium at risk in patients with acute coronary syndrome.

    Science.gov (United States)

    Arrebola-Moreno, A L; Marfil-Alvarez, R; Catena, A; García-Retamero, R; Arrebola, J P; Melgares-Moreno, R; Ramirez-Hernández, J A; Kaski, J C

    2014-04-01

    Whilst traditional studies have shown that obese individuals are at a higher risk of cardiovascular events compared to lean subjects, recent studies in patients with acute myocardial infarction (AMI) have suggested that obesity may exert protective effects (the "obesity paradox"). We sought to assess the relationship between body mass index (BMI) and the BARI score (BARIsc), a validated tool used to assess myocardium at risk, in patients with acute coronary syndrome. Participants were 116 consecutive patients (mean age, 60.6 years; 97 men) with AMI (68 ST elevated myocardial infarction, STEMI; 48 non-ST elevated myocardial infarction, NSTEMI). Demographics, BMI, risk factors, biochemistry data, left ventricular function, angiographic data and the BARIsc were assessed in every patient. Multiple linear regression analyses showed that BMI significantly correlated with BARIsc; β=.23, p<0.02. This was found only in the overweight/obese patients, β=.27, p<0.01, but not in patients with normal BMIs, β=0.08, p=0.71. An increased body weight is associated with an increased area of myocardium at risk in patients with ACS. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  4. Managing the patient at risk for a second stroke.

    Science.gov (United States)

    Weber, Michael A

    2005-04-01

    Cerebrovascular disease is a major cause of mortality world-wide, and the prevalence is expected to increase as a result of projected demographic trends. Aggressive antihypertensive therapy is one intervention that has proven highly effective in reducing the risk of stroke, with relatively small blood pressure reductions affording measurable benefit even in patients not conventionally considered hypertensive. Comparative clinical trials are revealing evidence of differential impacts of antihypertensive classes on the incidence of cerebrovascular disease that will probably be important for therapeutic choice in patients with risk factors for stroke. In particular, the role of the renin-angiotensin system in cerebrovascular disease has come under scrutiny as a result of evidence that angiotensin II receptor blockers (ARBs), but perhaps not angiotensin converting enzyme inhibitors, can reduce the risk of a first stroke to a greater degree than might be expected from their effects on blood pressure alone. Although preclinical evidence suggests that there are differential effects of the type 1 and type 2 receptor activation, the clinical relevance of this is not yet known. Furthermore, the effect on the incidence of stroke conferred by blood pressure control in the early morning hours - the time when the incidence of strokes peaks--has not been tested. Some evidence for the beneficial effect of an ARB on secondary stroke prevention comes from the MOrbidity and mortality after Stroke --Eprosartan compared with nitrendipine in Secondary prevention study (MOSES), which showed that the ARB protected against cerebro- and cardiovascular events in hypertensive patients with a previous stroke over and above the protection offered by blood pressure control. These hypotheses are among those being examined in two current large-scale trials: the Prevention Regimen For Effectively avoiding Second Strokes (PRoFESS), and The ONgoing Telmisartan Alone and in combination with Ramipril

  5. Cardiovascular Risk in Patients with Psoriatic Arthritis

    Directory of Open Access Journals (Sweden)

    Tracy Y. Zhu

    2012-01-01

    Full Text Available Psoriatic arthritis (PsA is an inflammatory arthritis associated with psoriasis. In addition to skin and joint involvement, there is increasing evidence suggesting that patients with PsA also have an increase in risk of clinical and subclinical cardiovascular diseases, mostly due to accelerating atherosclerosis. Both conventional and nonconventional cardiovascular risk factors contribute to the increased cardiovascular risk in PsA. Chronic inflammation plays a pivotal role in the pathogenesis of atherosclerosis in PsA, acting independently and/or synergistically with the conventional risk factors. In this paper, we discuss the current literature indicating that patients with PsA are at risk of cardiovascular diseases.

  6. Decomposing gender differences in low-density lipoprotein cholesterol among veterans with or at risk for cardiovascular illness.

    Science.gov (United States)

    Sambamoorthi, Usha; Mitra, Sophie; Findley, Patricia A; Pogach, Leonard M

    2012-03-01

    To measure the extent to which gender differences in poor lipid control among individuals at risk for cardiovascular diseases could be explained by patient-level characteristics. Cross-sectional analyses of merged Veteran Health Administration (VHA) and Medicare claims data for the fiscal years (FY) 2002 and 2003 consisting of veterans using VHA facilities and were diagnosed with diabetes or heart disease or hypertension during FY 2002 and had recorded LDL cholesterol values in FY2003 (N = 527,568). There were 10,582 women and 516,986 men veterans. Poor lipid control was defined as LDL cholesterol values ≥130 mg/dL. Multivariate techniques consisted of logistic regressions. Based on the parameter estimates and distribution of individual characteristics, we used a decomposition technique to analyze factors that contributed to the gender difference in poor lipid control. A significantly higher percent of women (27.4%) than men (17.1%) had LDL cholesterol values ≥130 mg/dL. Of the 10.3 percentage point difference in lipid control, 3.4 percentage points were explained by variables included in the model. The gender difference in poor lipid control was mostly explained by age, physical illnesses, use of lipid lowering medications and depression. Only one-third of the gender difference in poor lipid control could be explained by differences in individual characteristics, some of which are modifiable or could be used to identify groups at risk with poor lipid control. Our findings suggest that gender differences in lipid control could be partially reduced by increasing the prescription of lipid lowering drugs and treating depression among women. Interventions that improve lipid control in the non-elderly will also benefit women. However the largest part of the difference in lipid control between women and men remains unexplained and further research is needed to identify additional modifiable and unmodifiable factors. Copyright © 2012 Jacobs Institute of Women

  7. Acute Infarct Extracellular Volume Mapping to Quantify Myocardial Area at Risk and Chronic Infarct Size on Cardiovascular Magnetic Resonance Imaging.

    Science.gov (United States)

    Garg, Pankaj; Broadbent, David A; Swoboda, Peter P; Foley, James R J; Fent, Graham J; Musa, Tarique A; Ripley, David P; Erhayiem, Bara; Dobson, Laura E; McDiarmid, Adam K; Haaf, Philip; Kidambi, Ananth; van der Geest, Rob J; Greenwood, John P; Plein, Sven

    2017-07-01

    Late gadolinium enhancement (LGE) imaging overestimates acute infarct size. The main aim of this study was to investigate whether acute extracellular volume (ECV) maps can reliably quantify myocardial area at risk (AAR) and final infarct size (IS). Fifty patients underwent cardiovascular magnetic resonance imaging acutely (24-72 hours) and at convalescence (3 months). The cardiovascular magnetic resonance protocol included cines, T2-weighted imaging, native T1 maps, 15-minute post-contrast T1 maps, and LGE. Optimal AAR and IS ECV thresholds were derived in a validation group of 10 cases (160 segments). Eight hundred segments (16 per patient) were analyzed to quantify AAR/IS by ECV maps (ECV thresholds for AAR is 33% and IS is 46%), T2-weighted imaging, T1 maps, and acute LGE. Follow-up LGE imaging was used as the reference standard for final IS and viability assessment. The AAR derived from ECV maps (threshold of >33) demonstrated good agreement with T2-weighted imaging-derived AAR (bias, 0.18; 95% confidence interval [CI], -1.6 to 1.3) and AAR derived from native T1 maps (bias=1; 95% CI, -0.37 to 2.4). ECV demonstrated the best linear correlation to final IS at a threshold of >46% (R=0.96; 95% CI, 0.92-0.98; Pmaps demonstrated better agreement with final IS than acute IS on LGE (ECV maps: bias, 1.9; 95% CI, 0.4-3.4 versus LGE imaging: bias, 10; 95% CI, 7.7-12.4). On multiple variable regression analysis, the number of nonviable segments was independently associated with IS by ECV maps (β=0.86; Pmaps can reliably quantify AAR and final IS in reperfused acute myocardial infarction. Acute ECV maps were superior to acute LGE in terms of agreement with final IS. IS quantified by ECV maps are independently associated with viability at follow-up. © 2017 American Heart Association, Inc.

  8. Invasive fungal disease in specific at-risk patients

    Directory of Open Access Journals (Sweden)

    Rosario Urbino

    2013-01-01

    Full Text Available Hematological patients, such as patients with lymphoproliferative syndromes, pediatric patients and patients in ICU, are not conventionally classified as high risk patients for the development of IFI, however invasive fungal infections should not be underestimated. In this subset of patients, particularly patients with lymphoproliferative syndromes are classified at intermediate risk for IFI especially if treated with monoclonal antibodies, purine analogs or steroids. With regard to pediatric patients the incidence of IFD is lower than in adults and is greater in patients with acute myeloid leukemia and in allotransplant patients. Finally, in patients in ICU there is high incidence of mold and Candida. Factors associated with increased mortality is the delay in admission in intensive care units, high-dose corticosteroid therapy, and GvHD.  

  9. Biliopancreatic malignancy: screening the at risk patient with molecular markers.

    Science.gov (United States)

    Caldas, C

    1999-01-01

    Biliopancreatic malignancy is one of the leading causes of cancer death in the Western world. Defining at risk groups has been difficult. Diabetes mellitus and pancreatitis increase the risk of pancreatic carcinoma, and inflammatory bowel disease and associated sclerosing colangitis increase the risk of biliary tract malignancy. Pancreatic carcinoma has also been described in pedigrees with inherited cancer predisposition. Extensive molecular profiling of pancreatic carcinomas has been accomplished over the past few years, but similar knowledge in other biliopancreatic malignancies is lacking. In almost all pancreas cancers at least one alteration will occur out of a combination of K-ras mutations and inactivation of the tumor suppressor genes p16/MTS1/ink4a, p53 and DPC4/Smad4. Mutations of K-ras and p16 have been described in hyperplastic and dysplastic pancreatic ductal lesions believed to be the non-malignant precursors of pancreatic carcinoma. Detection of K-ras mutations in clinical samples (biliopancreatic secretions, stool, duodenal aspirates, and blood) identical to ones present in primary pancreatic cancers and/or their precursor ductal lesions has been reported in pilot studies. Recently detection of 18q deletions (at the DPC4 locus) in pancreatic secretions from early pancreatic cancers was also reported. These advances raise the possibility that within well defined at risk groups it will be possible to use a combined set of molecular markers to screen clinical samples and detect early pancreatic cancer or even pre-malignant lesions. The fulfillment of this promise will depend on proving the role of molecular screening in decreasing morbidity and mortality, which will require well designed clinical studies.

  10. Which health professionals are most at risk for cardiovascular disease? Or do not be a manager

    Directory of Open Access Journals (Sweden)

    Eliska Sovova

    2014-02-01

    Full Text Available Objectives: Health care workers constitute a high-risk occupational category owing to the character of their work that includes high-risk environment, shift work and mental as well as physical stress. In occupational medicine, caring for their health condition should be a priority and include measures aimed at preventing cardiovascular diseases. The study aimed at determining the prevalence of cardiovascular disease (CVD risk factors in employees of a large hospital and assessing their effect on the incidence of cardiovascular events. Materials and Methods: The group comprised 3124 employees with a mean age of 36.1 years (SD = 11.4, out of whom 562 were males (mean age of 37.1 years, range: 18-72; SD = 12.26 and 2562 were females (mean age of 35.9 years, range: 18-68; SD = 11.24. At their initial examination, the employees filled in a questionnaire on basic CVD risk factors (according to valid recommendations. This was supplemented with objective data to determine the risk of CVD using valid charts. From this group, a subset of persons at a high or intermediate risk was selected, comprising 247 individuals with a mean age of 54.1 years (SD = 5.73. After 5-9 years (mean 7.24±1.38 years, they either underwent another examination or their health status was ascertained by phone or in a computer database. The end point was the incidence of cardiovascular events (sudden death, acute myocardial infarction, unstable angina pectoris, percutaneous coronary intervention, cardiac failure, stroke or transient ischemic attack. Results: The end point was noted in a total of 15 males (6.07% and 6 females (2.42%, being statistically significantly present in managers (males p < 0.00007, females p < 0.00001, male physicians/surgeons (p < 0.025, tertiary-educated males (p < 0.0095, female smokers (p < 0.015, male ex-smokers (p < 0.007, overweight or obese males (p < 0.02 and those with the waist-to-hip ratio above 1.0 (p < 0.005. Conclusions: Cardiovascular events

  11. Optimizing the clinical identification and management of patients at risk for anaphylaxis.

    Science.gov (United States)

    Stoloff, Stuart W

    2010-08-01

    Anaphylaxis is a serious, systemic allergic reaction that is rapid in onset and can cause death. Anaphylaxis often occurs in the absence of a health care professional, so it is essential for patients at risk for anaphylaxis to be identified and prepared in the event of an emergency. Identifying at-risk patients goes beyond a history of anaphylaxis; it is important to identify patients who may be at risk for a more severe anaphylactic reaction. Patients at risk for anaphylaxis should be provided an epinephrine auto-injector and appropriately trained in its use in the community setting.

  12. Identification of older hospitalized patients at risk for functional decline

    NARCIS (Netherlands)

    Hoogerduijn, J.G.

    2011-01-01

    Between 30% and 60% of older patients experience functional decline after hospitalization, resulting in a decline in health-related quality of life and autonomy. This is associated with increased risk of readmission, nursing home placement and mortality, increased length of hospital stay and

  13. Women at risk for cardiovascular disease lack knowledge of heart attack symptoms.

    Science.gov (United States)

    Flink, Laura E; Sciacca, Robert R; Bier, Michael L; Rodriguez, Juviza; Giardina, Elsa-Grace V

    2013-03-01

    It is not known whether cardiovascular disease (CVD) risk level is related to knowledge of the leading cause of death of women or heart attack symptoms. Women with higher CVD risk estimated by Framingham Risk Score (FRS) or metabolic syndrome (MS) have lower CVD knowledge. Women visiting primary care clinics completed a standardized behavioral risk questionnaire. Blood pressure, weight, height, waist size, fasting glucose, and lipid profile were assessed. Women were queried regarding CVD knowledge. Participants (N = 823) were Hispanic women (46%), non-Hispanic white (37%), and non-Hispanic black (8%). FRS was determined in 278: low (63%), moderate (29%), and high (8%); 24% had ≥3 components of MS. The leading cause of death was answered correctly by 54%, heart attack symptoms by 67%. Knowledge was lowest among racial/ethnic minorities and those with less education (both Pheart attack symptoms (P = 0.018), but not after multivariable adjustment. Women with higher FRS were less likely to know heart attack symptoms. Efforts to target those at higher CVD risk must persist, or the most vulnerable may suffer disproportionately, not only because of risk factors but also inadequate knowledge. © 2013 Wiley Periodicals, Inc.

  14. Patients at risk for contrast-induced acute kidney injury

    Directory of Open Access Journals (Sweden)

    Michele Meschi

    2013-04-01

    Full Text Available Subjects with hypovolemia and/or dehydration and pre-existing renal failure are considered at highest risk for radiocontrast-medium-induced acute kidney injury (RCI-AKI, and this risk increases in the presence of glomerular filtration rate or creatinine clearance rates lower than 60 mL/min (stage 3-5 chronic kidney disease according to the National Kidney Foundation. The authors critically review the evidence-based literature on RCI-AKI, its diagnosis, epidemiological aspects, predisposing conditions, and markers of risk, including advanced age. Procedures requiring the use of iodinated contrast media are increasingly performed in patients over 70 years of age, and there is no definitive consensus regarding the role of advanced age as a marker of risk for RCI-AKI.

  15. Endothelial function after 10 days of bed rest in individuals at risk for type 2 diabetes and cardiovascular disease

    DEFF Research Database (Denmark)

    Sonne, Mette Paulii; Højbjerre, Lise; Alibegovic, Amra C

    2011-01-01

    Aims: Physical inactivity is considered to be deleterious to vascular health, and in particular first degree relatives to patients with type 2 diabetes (FDR) and persons born with low birth weight (LBW) who may later in life develop cardiovascular disease. A period of imposed physical inactivity ...

  16. Randomized controlled trial of magnesium sulfate in women at risk of preterm delivery-neonatal cardiovascular effects.

    Science.gov (United States)

    Paradisis, M; Osborn, D A; Evans, N; Kluckow, M

    2012-09-01

    Use of antenatal magnesium sulfate (MgSO(4)) may reduce cerebral palsy in infants born very preterm. Low systemic blood flow in the first day in very preterm infants has been associated with cerebral injury and adverse motor outcome. The aim was to determine the effect of MgSO(4) on systemic blood flow in preterm infants. Randomized trial of MgSO(4) versus saline placebo given to mothers at risk of delivery before 30 weeks gestation. Echocardiographic monitoring performed at 3 to 5, 10 to 12 and 24 h. A total of 48 infants were exposed to MgSO(4) and 39 to placebo. Infants exposed to MgSO(4) were significantly more likely to receive volume expansion (42% versus 21%). Inotrope use did not differ significantly (40% versus 26%). There was no significant difference in mean lowest superior vena cava (SVC) flow or right ventricular output (RVO), or incidence of low SVC flow or RVO in the first 24 h. Infants exposed to MgSO(4) had a significantly higher heart rate and were more likely to have low SVC flow at 10 to 12 h but not other times. Antenatal MgSO(4) produced no consistent cardiovascular effects in the infant in the first 24 h. There is no evidence from this study to suggest the mechanism by which antenatal MgSO(4) prevents cerebral palsy is through a cardiovascular effect in the newborn.

  17. Identification of patients at risk for ischaemic cerebral complications after carotid endarterectomy with TCD monitoring

    DEFF Research Database (Denmark)

    Horn, J; Naylor, A R; Laman, D M

    2005-01-01

    Transcranial Doppler (TCD) monitoring for micro embolic signals (MES), directly after carotid endarterectomy (CEA) may identify patients at risk of developing ischaemic complications. In this retrospective multicentre study, this hypothesis was investigated....

  18. Identification of patients at risk for ischaemic cerebral complications after carotid endarterectomy with TCD monitoring

    DEFF Research Database (Denmark)

    Horn, J; Naylor, A R; Laman, D M

    2005-01-01

    Transcranial Doppler (TCD) monitoring for micro embolic signals (MES), directly after carotid endarterectomy (CEA) may identify patients at risk of developing ischaemic complications. In this retrospective multicentre study, this hypothesis was investigated.......Transcranial Doppler (TCD) monitoring for micro embolic signals (MES), directly after carotid endarterectomy (CEA) may identify patients at risk of developing ischaemic complications. In this retrospective multicentre study, this hypothesis was investigated....

  19. n-3 fatty acids and cardiovascular outcomes in patients with dysglycemia

    DEFF Research Database (Denmark)

    Bosch, Jackie; Gerstein, Hertzel C; Dagenais, Gilles R

    2012-01-01

    The use of n-3 fatty acids may prevent cardiovascular events in patients with recent myocardial infarction or heart failure. Their effects in patients with (or at risk for) type 2 diabetes mellitus are unknown.......The use of n-3 fatty acids may prevent cardiovascular events in patients with recent myocardial infarction or heart failure. Their effects in patients with (or at risk for) type 2 diabetes mellitus are unknown....

  20. On the Prediction of At-Risk Patients with Big Data

    OpenAIRE

    Genevès, Pierre; Calmant, Thomas; Layaïda, Nabil; Lepelley, Marion; Artemova, Svetlana; Bosson, Jean-Luc

    2017-01-01

    We propose a system for detecting, on the day of hospital admission, patients at risk of developing complications during their hospital stay. We propose a method borrowing techniques from AI and supervised learning for the automatic detection of at-risk profiles based on a fine-grained analysis of prescription data at the time of admission. Our system relies on a distributed architecture adapted for processing large volumes of medical records and clinical data. We report on practical experime...

  1. Identifying patients at risk for high-grade intra-abdominal hypertension following trauma laparotomy

    NARCIS (Netherlands)

    K.D. Strang; D.L. van Imhoff (Diederik); E.M.M. van Lieshout (Esther); S.K. D'Amours (Scott); O.J.F. van Waes (Oscar)

    2015-01-01

    markdownabstractBackground: Abdominal Compartment Syndrome (ACS) is an uncommon but deleterious complication after trauma laparotomy. Early recognition of patients at risk of developing ACS is crucial for their outcome. The aim of this study was to compare the characteristics of patients who

  2. Disruption of resting functional connectivity in Alzheimer's patients and at-risk subjects.

    Science.gov (United States)

    Krajcovicova, Lenka; Marecek, Radek; Mikl, Michal; Rektorova, Irena

    2014-10-01

    The resting brain exhibits continuous intrinsic activity, which is correlated between groups of regions forming resting state networks. Evaluating resting connectivity is a popular approach for studying brain diseases. Several hundred studies are now available that address integrity of resting connectivity in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI), as well as preclinical at-risk subjects. Most studies focus on the default mode network, a system of specific brain areas showing strong connected resting activity that attenuates during goal-directed behavior. The extent of intrinsic brain activity tends to be strongly correlated with cognitive processes and is specifically disrupted in AD and MCI patients and at-risk subjects, with changes seeming to evolve during the transition between the disease stages. In this study, we review the current findings in default mode network and other resting state network studies in AD and MCI patients and at-risk subjects as assessed by resting state functional magnetic resonance imaging.

  3. Impact of Gender on Satisfaction and Confidence in Cholesterol Control Among Veterans at Risk for Cardiovascular Disease.

    Science.gov (United States)

    Goldstein, Karen M; Stechuchak, Karen M; Zullig, Leah L; Oddone, Eugene Z; Olsen, Maren K; McCant, Felicia A; Bastian, Lori A; Batch, Bryan C; Bosworth, Hayden B

    2017-07-01

    Compared with men, women have poorer lipid control. Although potential causes of this disparity have been explored, it is unknown whether patient-centered factors such as satisfaction and confidence contribute. We evaluated (1) whether satisfaction with lipid control and confidence in ability to improve it vary by gender and (2) whether sociodemographic characteristics modify the association. We evaluated baseline survey responses from the Cardiovascular Intervention Improvement Telemedicine Study, including self-rated satisfaction with cholesterol levels and confidence in controlling cholesterol. Participants had poorly controlled hypertension and/or hypercholesterolemia. A total of 428 veterans (15% women) participated. Compared with men, women had higher low-density lipoprotein values at 141.2 versus 121.7 mg/dL, respectively (p women were less satisfied with their cholesterol levels than men with estimated mean scores of 4.3 versus 5.6 on a 1-10 Likert scale (p confidence by gender. Participants with support for tracking medications reported higher confidence levels than those without, estimated mean 7.8 versus 7.2 (p Women veterans at high risk for cardiovascular disease were less satisfied with their lipid control than men; however, confidence in ability to improve lipid levels was similar. Veterans without someone to help to track medications were less confident, and women were less likely to have this type of social support. Lack of social support for medication tracking may be a factor in lingering gender-based disparities in hyperlipidemia.

  4. Triggers for driving treatment of at-risk patients with invasive fungal disease.

    NARCIS (Netherlands)

    Drgona, L.; Colita, A.; Klimko, N.; Rahav, G.; Ozcan, M.A.; Donnelly, J.P.

    2013-01-01

    Timing of treatment for invasive fungal disease (IFD) is critical for making appropriate clinical decisions. Historically, many centres have treated at-risk patients prior to disease detection to try to prevent fungal colonization or in response to antibiotic-resistant fever. Many studies have

  5. The research on endothelial function in women and men at risk for cardiovascular disease (REWARD study: methodology

    Directory of Open Access Journals (Sweden)

    Lavoie Kim L

    2011-08-01

    Full Text Available Abstract Background Endothelial function has been shown to be a highly sensitive marker for the overall cardiovascular risk of an individual. Furthermore, there is evidence of important sex differences in endothelial function that may underlie the differential presentation of cardiovascular disease (CVD in women relative to men. As such, measuring endothelial function may have sex-specific prognostic value for the prediction of CVD events, thus improving risk stratification for the overall prediction of CVD in both men and women. The primary objective of this study is to assess the clinical utility of the forearm hyperaemic reactivity (FHR test (a proxy measure of endothelial function for the prediction of CVD events in men vs. women using a novel, noninvasive nuclear medicine -based approach. It is hypothesised that: 1 endothelial dysfunction will be a significant predictor of 5-year CVD events independent of baseline stress test results, clinical, demographic, and psychological variables in both men and women; and 2 endothelial dysfunction will be a better predictor of 5-year CVD events in women compared to men. Methods/Design A total of 1972 patients (812 men and 1160 women undergoing a dipyridamole stress testing were recruited. Medical history, CVD risk factors, health behaviours, psychological status, and gender identity were assessed via structured interview or self-report questionnaires at baseline. In addition, FHR was assessed, as well as levels of sex hormones via blood draw. Patients will be followed for 5 years to assess major CVD events (cardiac mortality, non-fatal MI, revascularization procedures, and cerebrovascular events. Discussion This is the first study to determine the extent and nature of any sex differences in the ability of endothelial function to predict CVD events. We believe the results of this study will provide data that will better inform the choice of diagnostic tests in men and women and bring the quality of

  6. Erectile dysfunction in the cardiovascular patient

    National Research Council Canada - National Science Library

    Vlachopoulos, Charalambos; Jackson, Graham; Stefanadis, Christodoulos; Montorsi, Piero

    2013-01-01

    Erectile dysfunction is common in the patient with cardiovascular disease. It is an important component of the quality of life and it also confers an independent risk for future cardiovascular events...

  7. Reduced glomerular filtration rate and its association with clinical outcome in older patients at risk of vascular events: secondary analysis.

    LENUS (Irish Health Repository)

    Ford, Ian

    2009-01-20

    Reduced glomerular filtration rate (GFR) is associated with increased cardiovascular risk in young and middle aged individuals. Associations with cardiovascular disease and mortality in older people are less clearly established. We aimed to determine the predictive value of the GFR for mortality and morbidity using data from the 5,804 participants randomized in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER).

  8. Cardiovascular biomarkers in patients with psoriasis.

    Science.gov (United States)

    Gerdes, Sascha; Osadtschy, Swetlana; Buhles, Norbert; Baurecht, Hansjoerg; Mrowietz, Ulrich

    2014-05-01

    Psoriasis is a systemic inflammatory disease of the skin with associated comorbidity. Severe forms of psoriasis are associated with increased mortality, which might be due to cardiovascular (CV) comorbidity. In this study, we investigated in 79 patients with psoriasis compared to 80 healthy volunteers different biomarkers that play a role in vascular disease and inflammation, such as C-reactive protein (CRP), human soluble CD40 ligand (sCD40L), oxidized low-density lipoprotein (ox-LDL), human matrix Gla protein (MGP) and fetuin-A. Our results showed that CRP (P LDL did not show any significant difference. In multivariate analyses controlling for sex, age and BMI, these findings were confirmed. Thus, CV biomarkers are altered in patients with psoriasis. If the decrease in fetuin-A as well as the increase in sCD40L can be proven in further studies, these biomarkers may help to characterize a subgroup of patients who are at risk to develop CVD and/or monitor the effect of therapeutic antipsoriatic strategies on concomitant diseases. This knowledge may be useful in the management of high-need patients with psoriasis. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Screening Dementia in the Outpatient Department: Patients at Risk for Dementia

    OpenAIRE

    Tai, Shu-Yu; Huang, Shu-Wan; Hsu, Chia-Ling; Yang, Chiu-Hsien; Chou, Mei-Chuan; Yang, Yuan-Han

    2014-01-01

    The targeted screening for individuals at the risks of having dementia would be crucial to the further public health issues for dementia. This study aimed to conduct a screening study in an outpatient department of a regional hospital to screen people who were at risk of developing comorbid dementia. Patients who visited Kaohsiung Municipal Ta-Tung Hospital (KMTTH) clinics during the period from June 1, 2013, to May 31, 2014, were invited to participate in this screening voluntarily. The trai...

  10. Retractions in the medical literature: how many patients are put at risk by flawed research?

    Science.gov (United States)

    Steen, R Grant

    2011-11-01

    Clinical papers so flawed that they are eventually retracted may put patients at risk. Patient risk could arise in a retracted primary study or in any secondary study that draws ideas or inspiration from a primary study. To determine how many patients were put at risk, we evaluated 788 retracted English-language papers published from 2000 to 2010, describing new research with humans or freshly derived human material. These primary papers-together with all secondary studies citing them-were evaluated using ISI Web of Knowledge. Excluded from study were 468 basic science papers not studying fresh human material; 88 reviews presenting older data; 22 case reports; 7 papers retracted for journal error and 23 papers unavailable on Web of Knowledge. Overall, 180 retracted primary papers (22.8%) met the inclusion criteria. Subjects enrolled and patients treated in 180 primary studies and 851 secondary studies were combined. Retracted papers were cited over 5000 times, with 93% of citations being research related, suggesting that ideas promulgated in retracted papers can influence subsequent research. Over 28 000 subjects were enrolled-and 9189 patients were treated-in 180 retracted primary studies. Over 400 000 subjects were enrolled-and 70 501 patients were treated-in 851 secondary studies which cited a retracted paper. Papers retracted for fraud (n=70) treated more patients per study (pclinical studies were tallied.

  11. Are patients at risk for psychological maladjustment during fertility treatment less willing to comply with treatment? Results from the Portuguese validation of the SCREENIVF

    NARCIS (Netherlands)

    Lopes, V.; Canavarro, M.C.; Verhaak, C.M.; Boivin, J.; Gameiro, S.

    2014-01-01

    STUDY QUESTION: Do patients at risk for psychological maladjustment during fertility treatment present lower intentions to comply with recommended treatment than patients not at risk? SUMMARY ANSWER: Patients at risk of psychological maladjustment present similar high intentions to comply with

  12. Health status of cardiac genetic disease patients and their at-risk relatives.

    Science.gov (United States)

    Ingles, Jodie; Yeates, Laura; Hunt, Lauren; McGaughran, Julie; Scuffham, Paul A; Atherton, John; Semsarian, Christopher

    2013-05-25

    Health status is an important outcome measure that incorporates multiple dimensions of health, including symptoms, functional status, and psychosocial factors. While health status has been shown to be a predictor for hospital readmission, morbidity and mortality in the heart failure setting, there are limited data in cardiac genetic disease. We examined health status in a number of cardiac genetic disease groups compared to the general Australian population. A total of 409 individuals were assessed. Individuals with inherited cardiomyopathies [hypertrophic cardiomyopathy (HCM), familial dilated cardiomyopathy (FDC), arrhythmogenic right ventricular cardiomyopathy (ARVC)] and primary arrhythmogenic disorders [long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT)], as well as their first-degree relatives, completed the Medical Outcomes Survey Short Form-36 (SF-36). The physical and mental component scores (PCS and MCS) and SF-6D utility score were assessed. Patients with HCM (p<0.001), FDC (p<0.05), and CPVT (p<0.05) were found to have a significantly lower PCS, while patients with LQTS (p<0.01) had a lower MCS. Individuals at risk of HCM (p<0.0001) and genotype positive-phenotype negative HCM patients (p<0.01) both had a higher PCS and utility scores compared to the clinically affected HCM population. Individuals at risk of LQTS had significantly higher PCS than those with a clinical diagnosis of LQTS (p<0.05) and similarly individuals at risk of FDC had significantly higher PCS than FDC patients (p<0.05). In HCM, female gender (p=0.002), presence of co-morbidities (p<0.0001) and higher NYHA functional class (p<0.0001) were predictors of a lower PCS. Patients with a clinical diagnosis of a genetic heart disease have an impaired health status, related to both physical and mental function. Clinical management strategies in such patient groups need to consider health status as an important outcome measure. Copyright © 2011 Elsevier

  13. How do patients at risk portray candidates for coronary heart disease? A qualitative interview study

    DEFF Research Database (Denmark)

    Frich, J.C.; Malterud, K.; Fugelli, P.

    2007-01-01

    OBJECTIVE: To explore how patients at risk of coronary heart disease (CHD) portray candidates for CHD. DESIGN: Qualitative interview study. SETTING: Norway. SUBJECTS: A total of 20 men and 20 women diagnosed with heterozygous familial hypercholesterolemia (FH) recruited through a lipid clinic. MAIN...... OUTCOME MEASURES: Participants' beliefs concerning persons who are considered candidates for CHD. RESULTS: Some participants believed that CHD could happen to anyone, while the majority conveyed detailed notions of persons they considered to be likely victims of CHD. Participants often portrayed...... the coronary candidate as someone who was different from themselves. Among those who mentioned gender, all presented the candidate as a man. Some women said that they had to reconcile themselves to being at risk of CHD, since they at first had conceived CHD as a man's disease. While some participants...

  14. The stability of myocardial area at risk estimated electrocardiographically in patients with ST elevation myocardial infarction

    DEFF Research Database (Denmark)

    Carlsen, Esben A; Hassell, Mariëlla E C J; van Hellemond, Irene E G

    2014-01-01

    In patients with ST-elevation myocardial infarction (STEMI) the amount of myocardial area at risk (MaR) indicates the maximal potential loss of myocardium if the coronary artery remains occluded. During the time course of infarct evolution ischemic MaR is replaced by necrosis, which results...... and Selvester score, indicating MaR, is stable until myocardial reperfusion therapy. In a retrospective analysis of a study population of 114 patients, 33 patients were included. The combined Aldrich and Selvester score was determined in ECGs recorded in the ambulance (ECG1) and in the hospital before...... (12 patients) of the combined Aldrich and Selvester score. In conclusion, the ECG estimated MaR was stable between the earliest recording time and initiation of reperfusion treatment only in a subgroup of the patients with STEMI. The findings of this study may suggest heterogeneity in regards...

  15. Burden of informal caregiving for stroke patients. Identification of caregivers at risk of adverse health effects.

    Science.gov (United States)

    van Exel, N J A; Koopmanschap, M A; van den Berg, B; Brouwer, W B F; van den Bos, G A M

    2005-01-01

    We assessed the objective and subjective burden of caregiving for stroke patients and investigated which characteristics of the patient, the informal caregiver and the objective burden contribute most to subjective burden and to the condition of feeling substantially burdened. We studied a sample of 151 stroke survivors and their primary informal caregivers. We collected data through patient and caregiver interviews 6 months after stroke. Both the level of subjective burden and the condition of feeling substantially burdened were associated with both caregiver's and patient's health-related quality of life, patient's age, and the number of caregiving tasks performed. These conditions can be used in clinical practice to identify potentially vulnerable caregivers in need of support and at risk of adverse health effects. Monitoring stroke survivors as well as their family caregivers at discharge may help to prevent or alleviate caregiver burden.

  16. Using the Care Dependency Scale for identifying patients at risk for pressure ulcer.

    Science.gov (United States)

    Dijkstra, Ate; Kazimier, Hetty; Halfens, Ruud J G

    2015-11-01

    The aim of this study was to evaluate risk screening for pressure ulcer by using the Care Dependency Scale (CDS) for patients receiving home care or admitted to a residential or nursing home in the Netherlands. Pressure ulcer is a serious and persistent problem for patients throughout the Western world. Pressure ulcer is among the most common adverse events in nursing practice and when a pressure ulcer occurs it has many consequences for patients and healthcare professionals. Cross-sectional design. The convenience sample consisted of 13,633 study participants, of whom 2639 received home care from 15 organisations, 4077 were patients from 67 residential homes and 6917 were admitted in 105 nursing homes. Data were taken from the Dutch National Prevalence Survey of Care Problems that was carried out in April 2012 in Dutch healthcare settings. For the three settings, cut-off points above 80% sensitivity were established, while in the residential home sample an almost 60% combined specificity score was identified. The CDS items 'Body posture' (home care), 'Getting dressed and undressed' (residential homes) and 'Mobility' (nursing homes) were the most significant variables which affect PU. The CDS is able to distinguish between patients at risk for pressure ulcer development and those not at risk in both home care and residential care settings. In nursing homes, the usefulness of the CDS for pressure ulcer detection is limited. © 2015 John Wiley & Sons Ltd.

  17. Identifying patients at risk for high-grade intra-abdominal hypertension following trauma laparotomy.

    Science.gov (United States)

    Strang, Steven G; Van Imhoff, Diederik L; Van Lieshout, Esther M M; D'Amours, Scott K; Van Waes, Oscar J F

    2015-05-01

    Abdominal Compartment Syndrome (ACS) is an uncommon but deleterious complication after trauma laparotomy. Early recognition of patients at risk of developing ACS is crucial for their outcome. The aim of this study was to compare the characteristics of patients who developed high-grade intra-abdominal hypertension (IAH) (i.e., grade III or IV; intra-abdominal pressure, IAP >20 mm Hg) following an injury-related laparotomy versus those who did not (i.e., IAP ≤20 mm Hg). A retrospective analysis of consecutive trauma patients admitted to a level 1 trauma centre in Australia between January 1, 1995 and January 31, 2010 was performed. A comparison was made between characteristics of patients who developed high-grade IAH following trauma laparotomy versus those who did not. A total of 567 patients (median age 31 years) were included in this study. Of these patients 10.2% (58/567) developed high-grade IAH of which 51.7% (30/58) developed ACS. Patients with high-grade IAH were older (pgrade IAH received larger volumes of crystalloids (pgrade IAH suffered higher mortality rates (25.9% (15/58) vs. 12.2% (62/509); p=0.012). Of all patients who underwent a trauma laparotomy, 10.2% developed high-grade IAH, which increases the risk of mortality. Patients with acidosis, coagulopathy, and hypothermia were especially at risk. In these patients, the abdomen should be left open until adequate resuscitation has been achieved, allowing for definitive surgery. This is a level III retrospective study. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Noninvasive hemoglobin monitoring in critically ill pediatric patients at risk of bleeding.

    Science.gov (United States)

    García-Soler, P; Camacho Alonso, J M; González-Gómez, J M; Milano-Manso, G

    2017-05-01

    To determine the accuracy and usefulness of noninvasive continuous hemoglobin (Hb) monitoring in critically ill patients at risk of bleeding. An observational prospective study was made, comparing core laboratory Hb measurement (LabHb) as the gold standard versus transcutaneous hemoglobin monitoring (SpHb). Pediatric Intensive Care Unit of a tertiary University Hospital. Patients weighing >3kg at risk of bleeding. SpHb was measured using the Radical7 pulse co-oximeter (Masimo Corp., Irvine, CA, USA) each time a blood sample was drawn for core laboratory analysis (Siemens ADVIA 2120i). Sociodemographic characteristics, perfusion index (PI), pleth variability index, heart rate, SaO 2 , rectal temperature, low signal quality and other events that can interfere with measurement. A total of 284 measurements were made (80 patients). Mean LabHb was 11.7±2.05g/dl. Mean SpHb was 12.32±2g/dl (Pearson 0.72, R 2 0.52). The intra-class correlation coefficient was 0.69 (95%CI 0.55-0.78)(p<0.001). Bland-Altman analysis showed a mean difference of 0.07 ±1.46g/dl. A lower PI and higher temperature independently increased the risk of low signal quality (OR 0.531 [95%CI 0.32-0.88] and 0.529 [95%CI 0.33-0.85], respectively). SpHb shows a good overall correlation to LabHb, though with wide limits of agreement. Its main advantage is continuous monitoring of patients at risk of bleeding. The reliability of the method is limited in cases with poor peripheral perfusion. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  19. A Path Analysis of a Randomized "Promotora de Salud" Cardiovascular Disease-Prevention Trial among At-Risk Hispanic Adults

    Science.gov (United States)

    de Heer, Hendrik Dirk; Balcazar, Hector G.; Castro, Felipe; Schulz, Leslie

    2012-01-01

    This study assessed effectiveness of an educational community intervention taught by "promotoras de salud" in reducing cardiovascular disease (CVD) risk among Hispanics using a structural equation modeling (SEM) approach. Model development was guided by a social ecological framework proposing CVD risk reduction through improvement of…

  20. Immigrant Asian Indians in the U.S.: A Population at Risk for Diabetes and Cardiovascular Disease

    Science.gov (United States)

    Misra, Ranjita

    2009-01-01

    Asian Indians are the third largest and fastest growing Asian subgroup in the U.S. and considered the model minority due to their high education and income level. Unlike other Asian immigrants, they are a more heterogeneous group with a genetic predisposition for diabetes and cardiovascular disease. Current national surveys are incapable of…

  1. Being at risk for cardiovascular disease: Perceptions and preventive behavior in people with and without a known genetic predisposition

    NARCIS (Netherlands)

    Claassen, E.A.M.; Henneman, L.; van der Weijden, T.; Marteau, T.M.; Timmermans, D.R.M.

    2012-01-01

    This study compares and explains differences in perceptions of cardiovascular disease (CVD) risk and preventive behaviors in people with and without a known genetic predisposition to CVD. A cross-sectional study using two samples was performed. The first sample (genetic predisposition; n=51)

  2. Cardiovascular risk in patients with hemophilia

    NARCIS (Netherlands)

    Kamphuisen, Pieter W.; ten Cate, Hugo

    2014-01-01

    Patients with hemophilia, who have a life-long hypocoagulability, seem to have a lower cardiovascular mortality than the general population. Nevertheless, the prevalence of cardiovascular risk factors in patients with hemophilia is as prevalent as in the general population, and hypertension is even

  3. Can the prehospital National Early Warning Score identify patients most at risk from subsequent deterioration?

    Science.gov (United States)

    Shaw, Joanna; Fothergill, Rachael T; Clark, Sophie; Moore, Fionna

    2017-08-01

    The National Early Warning Score (NEWS) aids the early recognition of those at risk of becoming critically ill. NEWS has been recommended for use by ambulance services, but very little work has been undertaken to date to determine its suitability. This paper examines whether a prehospital NEWS derived from ambulance service clinical observations is associated with the hospital ED disposition. Prehospital NEWS was retrospectively calculated from the ambulance service clinical records of 287 patients who were treated by the ambulance service and transported to hospital. In this cohort study, derived NEWS scores were compared with ED disposition data and patients were categorised into the following groups depending on their outcome: discharged from ED, admitted to a ward, admitted to intensive therapy unit (ITU) or died. Prehospital NEWS-based ambulance service clinical observations were significantly associated with discharge disposition groups (pscores escalating in line with increasing severity of outcome. Patients who died or were admitted to ITU had higher scores than those admitted to a ward or discharged from ED (mean NEWS 7.2 and 7.5 vs 2.6 and 1.7, respectively), and in turn those who were admitted to a ward had higher pre-hospital NEWS than those who were discharged (2.6 vs 1.7). Our findings suggest that the NEWS could successfully be used by ambulance services to identify patients most at risk from subsequent deterioration. The implementation of this early warning system has the potential to support ambulance clinician decision making, providing an additional tool to identify and appropriately escalate care for acutely unwell patients. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. At-Risk Phenotype of Neurofibromatose-1 Patients: A Multicentre Case-Control Study

    Directory of Open Access Journals (Sweden)

    Ferkal Salah

    2011-07-01

    Full Text Available Abstract Objectives To assess associations between subcutaneous neurofibromas (SC-NFs and internal neurofibromas in patients with neurofibromatosis type 1 (NF-1 and to determine whether the association between SC-NFs and peripheral neuropathy was ascribable to internal neurofibromas. Patients and methods Prospective multicentre case-control study. Between 2005 and 2008, 110 NF-1 adults having two or more SC-NFs were individually matched for age, sex and hospital with 110 controls who had no SC-NF. Patients underwent standardized MRI of the spinal cord, nerve roots and sciatic nerves and an electrophysiological study. Analyses used adjusted multinomial logistic regression (ORa to estimate the risk of the presence of internal neurofibromas or peripheral neuropathies associated with patients presented 2 to 9 SC-NFs, at least 10 SC-NFs as compared to patients without any (referential category. Results Cases had a mean age of 41 (± 13 years; 85 (80% had two to nine SC-NFs and 21 (19% at least ten SC-NFs. SC-NFs were more strongly associated with internal neurofibromas in patients with ten or more SC-NFs than in patients with fewer NF-SCs (e.g., sciatic nerve, aOR = 29.1 [8.5 to 100] vs. 4.3 [2.1 to 9.0]. The association with SC-NFs was stronger for diffuse, intradural, and > 3 cm internal neurofibromas than with other internal neurofibromas. Axonal neuropathy with slowed conduction velocities (SCV was more strongly associated with having at least ten SC-NFs (aOR = 29.9, 5.5 to 162.3 than with having fewer SC-NFs (aOR = 4.4, 0.9 to 22.0. Bivariate analyses showed that the association between axonal neuropathy with SCV and sciatic neurofibromas was mediated by the association between SC-NFs and sciatic neurofibromas. Conclusion The at-risk phenotype of NF-1 patients (i.e. NF-1 patients with SC-NFs is ascribable to associations linking SC-NFs to internal neurofibromas at risk for malignant transformation and to axonal neuropathies with slowed

  5. Patients at-risk for cost-related medication nonadherence: a review of the literature.

    Science.gov (United States)

    Briesacher, Becky A; Gurwitz, Jerry H; Soumerai, Stephen B

    2007-06-01

    Up to 32% of older patients take less medication than prescribed to avoid costs, yet a comprehensive assessment of risk factors for cost-related nonadherence (CRN) is not available. This review examined the empirical literature to identify patient-, medication-, and provider-level factors that influence the relationship between medication adherence and medication costs. We conducted searches of four databases (MEDLINE, CINAHL, Sciences Citations Index Expanded, and EconLit) from 2001 to 2006 for English-language original studies. Articles were selected if the study included an explicit measure of CRN and reported results on covarying characteristics. We found 19 studies with empirical support for concluding that certain patients may be susceptible to CRN: research has established consistent links between medication nonadherence due to costs and financial burden, but also to symptoms of depression and heavy disease burden. Only a handful of studies with limited statistical methods provided evidence on whether patients understand the health risks of CRN or to what extent clinicians influence patients to keep taking medications when faced with cost pressures. No relationship emerged between CRN and polypharmacy. Efforts to reduce cost-related medication nonadherence would benefit from greater study of factors besides the presence of prescription drug coverage. Older patients with chronic diseases and mood disorders are at-risk for CRN even if enrolled in Medicare's new drug benefit.

  6. What puts heart failure patients at risk for poor medication adherence?

    Directory of Open Access Journals (Sweden)

    Knafl GJ

    2014-07-01

    Full Text Available George J Knafl,1 Barbara Riegel2,31School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; 3Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USABackground: Medication nonadherence is a major cause of hospitalization in patients with heart failure (HF, which contributes enormously to health care costs. We previously found, using the World Health Organization adherence dimensions, that condition and patient level factors predicted nonadherence in HF. In this study, we assessed a wider variety of condition and patient factors and interactions to improve our ability to identify those at risk for hospitalization. Materials and methods: Medication adherence was measured electronically over the course of 6 months, using the Medication Event Monitoring System (MEMS. A total of 242 HF patients completed the study, and usable MEMS data were available for 218 (90.1%. Participants were primarily white (68.3%, male (64.2%, and retired (44.5%. Education ranged from 8–29 years (mean, 14.0 years; standard deviation, 2.9 years. Ages ranged from 30–89 years (mean, 62.8 years; standard deviation, 11.6 years. Analyses used adaptive methods based on heuristic searches controlled by cross-validation scores. First, individual patient adherence patterns over time were used to categorize patients in poor versus better adherence types. Then, risk factors for poor adherence were identified. Finally, an effective model for predicting poor adherence was identified based on identified risk factors and possible pairwise interactions between them. Results: A total of 63 (28.9% patients had poor adherence. Three interaction risk factors for poor adherence were identified: a higher number of comorbid conditions with a higher total number of daily medicines, older age with poorer global sleep quality, and fewer months since diagnosis of HF with poorer

  7. Ursodeoxycholic acid treatment in patients with cystic fibrosis at risk for liver disease.

    Science.gov (United States)

    Siano, Maria; De Gregorio, Fabiola; Boggia, Bartolo; Sepe, Angela; Ferri, Pasqualina; Buonpensiero, Paolo; Di Pasqua, Antonio; Raia, Valeria

    2010-06-01

    Meconium ileus has been detected as a risk factor for development of liver disease in cystic fibrosis, with influence on morbidity and mortality. To evaluate the effect of early treatment with ursodeoxycholic acid in patients with cystic fibrosis and meconium ileus to prevent chronic hepatic involvement and to explore the potential role of therapy on clinical outcomes. 26 cystic fibrosis patients with meconium ileus (16 M, mean age 8,4 years, range 3,5-9) were assigned to two groups: group 1 (14 patients) treated early with ursodeoxycholic acid (UDCAe); group 2 (12 patients) treated with ursodeoxycholic acid at the onset of cystic fibrosis liver disease (UDCAd). Anthropometric data, pulmonary function tests, pancreatic status, complications such as diabetes, hepatic involvement and Pseudomonas aeruginosa colonisation were compared among groups. A higher prevalence of cystic fibrosis chronic liver disease was observed in the UDCAd group with a statistically significant difference at 9 years of age (p<0.05). Chronic infection by P. aeruginosa was found in 7% of UDCAe and 33% of UDCAd (p<0.05). No differences were observed in nutritional status and other complications. Early treatment with ursodeoxycholic acid may be beneficial in patients at risk of developing cystic fibrosis chronic liver disease such as those with meconium ileus. Multicentre studies should be encouraged to confirm these data. Copyright 2009 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  8. Nursing Intervention Classifications (NIC) validated for patients at risk of pressure ulcers.

    Science.gov (United States)

    Bavaresco, Taline; Lucena, Amália de Fátima

    2012-01-01

    to validate the Nursing Intervention Classifications (NIC) for the diagnosis 'Risk of Impaired Skin Integrity' in patients at risk of pressure ulcers (PU). the sample comprised 16 expert nurses. The data was collected with an instrument about the interventions and their definitions were scored on a Likert scale by the experts. The data was analyzed statistically, using the calculation of weighted averages (WA). The study was approved by the Research Ethics Committee (56/2010). nine interventions were validated as 'priority' (WA ≥0.80), among them Prevention of PU (MP=0.92); 22 as 'suggested' (WA >0.50 and <0.80) and 20 were discarded (WA ≤0.50). the prevention of PU results from the implementation of specific interventions related to the risk factors for development of the lesion, with implications for nursing practice, teaching and research.

  9. Identifying patients at risk of nursing home admission: The Leeds Elderly Assessment Dependency Screening tool (LEADS

    Directory of Open Access Journals (Sweden)

    Fear Jon

    2006-03-01

    Full Text Available Abstract Background Discharge from hospital to a nursing home represents a major event in the life of an older person and should only follow a comprehensive functional and medical assessment. A previous study identified 3 dependency scales able to discriminate across outcomes for older people admitted to an acute setting. We wished to determine if a single dependency scale derived from the 3 scales could be created. In addition could this new scale with other predictors be used as a comprehensive tool to identify patients at risk of nursing home admission. Methods Items from the 3 scales were combined and analysed using Rasch Analysis. Sensitivity and specificity analysis and ROC curves were applied to identify the most appropriate cut score. Binary logistic regression using this cut-off, and other predictive variables, were used to create a predictive algorithm score. Sensitivity, specificity and likelihood ratio scores of the algorithm scores were used to identify the best predictive score for risk of nursing home placement. Results A 17-item (LEADS scale was derived, which together with four other indicators, had a sensitivity of 88% for patients at risk of nursing home placement, and a specificity of 85% for not needing a nursing home placement, within 2 weeks of admission. Conclusion A combined short 17-item scale of dependency plus other predictive variables can assess the risk of nursing home placement for older people in an acute care setting within 2 weeks of admission. This gives an opportunity for either early discharge planning, or therapeutic intervention to offset the risk of placement.

  10. Acute myocardial infarct extension into a previously preserved subendocardial region at risk in dogs and patients.

    Science.gov (United States)

    Forman, R; Cho, S; Factor, S M; Kirk, E S

    1983-01-01

    In this study we quantitated the region of preserved myocardium between a subendocardial myocardial infarct (SEMI) and the endocardium in dogs and determined whether this preserved zone was within the region at risk and whether infarct extension could occur in this region. We also evaluated whether a similar subendocardial region exists in patients with SEMI. A 40-minute temporary occlusion of the left anterior descending coronary artery (LAD) in eight dogs resulted in a 35 +/- 5% transmural infarct with 8 +/- 1% subendocardial preservation as assessed by point-counting of the histologic specimens. In vivo perfusion of coronary vessels with Microfil showed that this preserved subendocardial zone was within the region at risk. The preserved subendocardial zone had significantly fewer cell layers in the dogs ventilated with room air than in dogs ventilated with 100% oxygen (8 +/- 4 vs 19 +/- 4, p less than 0.001), which suggests that diffusion from the ventricular cavity was the mechanism of cell preservation. In contrast, the inspired oxygen concentration did not influence the size of the SEMI. Reocclusion of the LAD for 24 hours in an additional eight dogs, 1 week after a SEMI had been created by a 40-minute temporary occlusion, resulted in both subendocardial and subepicardial extension involving 5 +/- % and 29 +/- 9%, respectively, of the transmural myocardium at the infarct center. Subendocardial infarct extension of a similar dimension to that in dogs ventilated on 100% oxygen was observed in postmortem material from eight patients with infarct extension. The preserved layers of subendocardium presumably receive sufficient nutrients from the ventricular cavity to maintain the viability of this region during temporary, but not permanent, reduction of blood supply from the coronary arteries.

  11. Smoking cessation interventions in cardiovascular patients

    NARCIS (Netherlands)

    Wiggers, L. C. W.; Smets, E. M. A.; de Haes, J. C. J. M.; Peters, R. J. G.; Legemate, D. A.

    2003-01-01

    Objectives. To review current evidence for the effectiveness of smoking cessation interventions in cardiovascular patient populations. Design and materials. Studies were obtained from systematic reviews of the Cochrane Tobacco Addiction Review Group. Twelve Cochrane reviews related to secondary

  12. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review.

    Science.gov (United States)

    van Netten, J J; Price, P E; Lavery, L A; Monteiro-Soares, M; Rasmussen, A; Jubiz, Y; Bus, S A

    2016-01-01

    Prevention of foot ulcers in patients with diabetes is extremely important to help reduce the enormous burden of foot ulceration on both patient and health resources. A comprehensive analysis of reported interventions is not currently available, but is needed to better inform caregivers about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to prevent first and recurrent foot ulcers in persons with diabetes who are at risk for ulceration. The available medical scientific literature in PubMed, EMBASE, CINAHL and the Cochrane database was searched for original research studies on preventative interventions. Both controlled and non-controlled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers. From the identified records, a total of 30 controlled studies (of which 19 RCTs) and another 44 non-controlled studies were assessed and described. Few controlled studies, of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, multiple RCTs with low risk of bias show the benefit for the use of daily foot skin temperature measurements and consequent preventative actions, as well as for therapeutic footwear that demonstrates to relieve plantar pressure and that is worn by the patient. To prevent recurrence, some evidence exists for integrated foot care when it includes a combination of professional foot treatment, therapeutic footwear and patient education; for just a single session of patient education, no evidence exists. Surgical interventions can be effective in selected patients, but the evidence base is small. The evidence base to support the use of specific self-management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong, but is small for the use of other, sometimes widely applied, interventions and is

  13. “More than I Expected”: Perceived Benefits of Yoga Practice among Older Adults at Risk for Cardiovascular Disease

    Science.gov (United States)

    Alexander, Gina K.; Innes, Kim E.; Selfe, Terry K.; Brown, Cynthia J.

    2012-01-01

    Objective This study was conducted with participants from trials examining the effects of an Iyengar yoga program on cardiovascular disease risk. The objective of the current study was to evaluate the perceived benefits of yoga in a population of older, predominantly overweight adults participating in a gentle 8-week yoga program. Design This study used a constructivist-interpretive approach to naturalistic inquiry. Setting A total of 42 participants completed the intervention and met the inclusion criteria for the current qualitative study. Intervention The 8-week Iyengar yoga program included two 90-minute yoga classes and five 30-minute home sessions per week. Participants completed weekly logs and an exit questionnaire at the end of the study. Main Outcome Measures Qualitative data from weekly logs and exit questionnaires were compiled and conventional content analysis performed with the use of ATLAS.ti to facilitate the process. Results Four broad themes emerged from content analysis: Practicing yoga improved overall physical function and capacity (for 83% of participants); practicing yoga reduced stress/anxiety and enhanced calmness (83% of participants); practicing yoga enriched the quality of sleep (21% of participants); and practicing yoga supported efforts toward dietary improvements (14% of participants). Conclusions These results suggest that yoga may have ancillary benefits in terms of improved physical function, enhanced mental/emotional state, enriched sleep quality, and improved lifestyle choices, and may be useful as a health promotion strategy in the prevention and management of chronic disease. PMID:23374201

  14. "More than I expected": perceived benefits of yoga practice among older adults at risk for cardiovascular disease.

    Science.gov (United States)

    Alexander, Gina K; Innes, Kim E; Selfe, Terry K; Brown, Cynthia J

    2013-02-01

    This study was conducted with participants from trials examining the effects of an Iyengar yoga program on cardiovascular disease risk. The objective of the current study was to evaluate the perceived benefits of yoga in a population of older, predominantly overweight adults participating in a gentle 8-week yoga program. This study used a constructivist-interpretive approach to naturalistic inquiry. A total of 42 participants completed the intervention and met the inclusion criteria for the current qualitative study. The 8-week Iyengar yoga program included two 90-min yoga classes and five 30-min home sessions per week. Participants completed weekly logs and an exit questionnaire at the end of the study. Qualitative data from weekly logs and exit questionnaires were compiled and conventional content analysis performed with the use of ATLAS.ti to facilitate the process. Four broad themes emerged from content analysis: practicing yoga improved overall physical function and capacity (for 83% of participants); practicing yoga reduced stress/anxiety and enhanced calmness (83% of participants); practicing yoga enriched the quality of sleep (21% of participants); and practicing yoga supported efforts toward dietary improvements (14% of participants). These results suggest that yoga may have ancillary benefits in terms of improved physical function, enhanced mental/emotional state, enriched sleep quality, and improved lifestyle choices, and may be useful as a health promotion strategy in the prevention and management of chronic disease. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. Variations in the Contouring of Organs at Risk: Test Case From a Patient With Oropharyngeal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nelms, Benjamin E., E-mail: alpha@canislupusllc.com [Canis Lupus LLC, Merrimac, WI (United States); Tome, Wolfgang A. [Department of Human Oncology, University of Wisconsin, Madison, WI (United States); Robinson, Greg [Radiation Oncology Resources, Goshen, IN (United States); Wheeler, James [Department of Radiation Oncology, Goshen Health System Goshen, IN (United States)

    2012-01-01

    Purpose: Anatomy contouring is critical in radiation therapy. Inaccuracy and variation in defining critical volumes will affect everything downstream: treatment planning, dose-volume histogram analysis, and contour-based visual guidance used in image-guided radiation therapy. This study quantified: (1) variation in the contouring of organs at risk (OAR) in a clinical test case and (2) corresponding effects on dosimetric metrics of highly conformal plans. Methods and Materials: A common CT data set with predefined targets from a patient with oropharyngeal cancer was provided to a population of clinics, which were asked to (1) contour OARs and (2) design an intensity-modulated radiation therapy plan. Thirty-two acceptable plans were submitted as DICOM RT data sets, each generated by a different clinical team. Using those data sets, we quantified: (1) the OAR contouring variation and (2) the impact this variation has on dosimetric metrics. New technologies were employed, including a software tool to quantify three-dimensional structure comparisons. Results: There was significant interclinician variation in OAR contouring. The degree of variation is organ-dependent. We found substantial dose differences resulting strictly from contouring variation (differences ranging from -289% to 56% for mean OAR dose; -22% to 35% for maximum dose). However, there appears to be a threshold in the OAR comparison metric beyond which the dose differences stabilize. Conclusions: The effects of interclinician variation in contouring organs-at-risk in the head and neck can be large and are organ-specific. Physicians need to be aware of the effect that variation in OAR contouring can play on the final treatment plan and not restrict their focus only to the target volumes.

  16. 199 Multiple Concussions in Young Athletes: Identifying Patients at Risk for Repeat Injury.

    Science.gov (United States)

    Murphy, Meghan; McCutcheon, Brandon A; Kerezoudis, Panagiotis; Rinaldo, Lorenzo; Shepherd, Daniel Levi; Maloney, Patrick R; Gates, Marcus J; Bydon, Mohamad

    2016-08-01

    Concussion diagnosis and management is a topic of interest for health care, education, and government professionals. Given the evidence concerning the association of long-term effects and cumulative insult of multiple concussions, we sought to identify risk factors in young athletes for repeat injury. This study is a retrospective cohort analysis of our institution's series of pediatric sports related concussions. Patient demographics, characteristics, and clinical features of concussion were analyzed in an unadjusted fashion. Bivariate analysis examined these variables in relation to occurrence of subsequent concussion. Multivariable analysis was then used to evaluate for predictors of repeat injury. One hundred ninety-one patients with a mean age of 13.5 years were included for analysis. Relative to patients whose injury was associated with football, patients playing soccer (odds ratio [OR], 5.36; 95% confidence interval [CI], 1.18-24.5), ice hockey/skating (OR, 6.97; 95% CI, 1.60-30.37), and basketball (OR, 5.99; 95% CI, 1.23-29.07) were associated with a significant increased odds of having a subsequent concussion. History of prior concussion was also significantly associated with an increased odds of repeat injury following the index concussion, defined as the first concussion evaluated at our institution (OR, 12.54; 95% CI, 3.78-41.62). Relative to a concussion resulting from a mechanism involving blunt force to the head, patients with a concussion in the setting of a fall were significantly less likely to experience a subsequent concussion (OR, 0.19; 95% CI, 0.05-0.71). Efforts to protect young athletes are of immeasurable value given the potential life years at risk for productivity and quality of life. With the identification of specific sports, prior injury, and mechanism influencing risk of repeat injury, clinicians are more informed to assess and discuss both risk and potential consequences of concussions with young athletes and their families.

  17. Association between Social Network Characteristics and Lifestyle Behaviours in Adults at Risk of Diabetes and Cardiovascular Disease.

    Science.gov (United States)

    Bot, Sandra D; Mackenbach, Joreintje D; Nijpels, Giel; Lakerveld, Jeroen

    2016-01-01

    In this exploratory study we examined the associations between several social network characteristics and lifestyle behaviours in adults at increased risk of diabetes and cardiovascular diseases. In addition, we explored whether similarities in lifestyle between individuals and their network members, or the level of social support perceived by these individuals, could explain these associations. From the control group of the Hoorn Prevention Study, participants with high and low educational attainment were approached for a structured interview between April and August 2010. Inclusion was stopped when fifty adults agreed to participate. Participants and a selection of their network members (e.g. spouses, best friends, neighbours, colleagues) completed a questionnaire on healthy lifestyle that included questions on fruit and vegetable intake, daily physical activity and leisure-time sedentary behaviour. We first examined associations between network characteristics and lifestyle using regression analyses. Second, we assessed associations between network characteristics and social support, social support and lifestyle, and compared the participants' lifestyles to those of their network members using concordance correlation coefficients. Fifty adults (50/83 x 100 = 62% response) and 170 of their network members (170/192 x 100 = 89% response) participated in the study. Individuals with more close-knit relationships, more friends who live nearby, and a larger and denser network showed higher levels of vegetable consumption and physical activity, and lower levels of sedentary behaviour. Perceived social norms or perceived support for behavioural change were not related to healthy lifestyle. Except for spousal concordance for vegetable intake, the lifestyle of individuals and their network members were not alike. Study results suggest that adults with a larger and denser social network have a healthier lifestyle. Underlying mechanisms for these associations should be

  18. Cardiovascular Dysfunction in Patients with End-stage Liver Disease

    Directory of Open Access Journals (Sweden)

    Merceds Susan Mandell

    2008-07-01

    Full Text Available Most patients with advanced liver disease have a normal or even supernormal ejection fraction judged by echocardiogra-phy. Thus, physicians previously assumed that cardiac function was normal in most patients with liver disease. However, further investigation has uncovered multiple problems in cardiac performance that place patients at risk of heart failure. Patients with liver disease have defects in both systolic and diastolic function that only become obvious with physiologic stress such as liver transplantation. In addition there are additional defects in the electromechanical coupling of the heart that can have significant clinical consequences. These collective pathologic changes are termed “cirrhotic cardiomyopathy” and occur to some degree in all patients with liver disease. This review will explore the pathophysiology of cardiovascular changes in patients with end-stage liver disease.

  19. How to stratify patients at risk for resistant bugs in skin and soft tissue infections?

    Science.gov (United States)

    Guillamet, Cristina Vazquez; Kollef, Marin H

    2016-04-01

    This article describes the strategies for stratifying patients with skin and soft tissue infections (SSTIs) according to their risk for infection with multidrug-resistant (MDR) pathogens. Methicillin-resistant Staphylococcus aureus (MRSA) now represents the main cause in a variety of serious SSTIs. Risk factors for MRSA are constantly evolving and the distinction between community-acquired MRSA and hospital-acquired MRSA is becoming less clear from a therapeutic standpoint because of overlapping susceptibility patterns. Given these observations, physicians should be aware that directed empirical coverage of MRSA for serious SSTIs should be required in communities where this resistant pathogen is recognized to be a prevalent cause of infection. Similarly, other MDR bacteria are demonstrating alarming trends as causative pathogens in SSTIs. Pseudomonas aeruginosa, Acinetobacter species, and vancomycin-resistant Enterococcus can play an important role in polymicrobial long-standing infections such as diabetic foot infection and decubiti, but are also increasingly recognized in monomicrobial SSTIs. SSTIs caused by MDR bacteria, both Gram-positive and Gram-negative bacteria, are on the rise especially in patients with long-standing infections and those with prior antibiotic exposure. Recognition of risk factors for infection with MDR bacteria should assist clinicians in targeting appropriate antibiotic therapy to at-risk individuals.

  20. Genotypes of Mycobacterium tuberculosis in patients at risk of drug resistance in Bolivia.

    Science.gov (United States)

    Monteserin, Johana; Camacho, Mirtha; Barrera, Lucía; Palomino, Juan Carlos; Ritacco, Viviana; Martin, Anandi

    2013-07-01

    Bolivia ranks among the 10 Latin American countries with the highest rates of tuberculosis (TB) and multidrug resistant (MDR) TB. In view of this, and of the lacking information on the population structure of Mycobacterium tuberculosis in the country, we explored genotype associations with drug resistance and clustering by analyzing isolates collected in 2010 from 100 consecutive TB patients at risk of drug resistance in seven of the nine departments in which Bolivia is divided. Fourteen isolates were MDR, 29 had other drug resistance profiles, and 57 were pansusceptible. Spoligotype family distribution was: Haarlem 39.4%, LAM 26.3%, T 22.2%, S 2.0%, X 1.0%, orphan 9.1%, with very low intra-family diversity and absence of Beijing genotypes. We found 66 different MIRU-VNTR patterns; the most frequent corresponded to Multiple Locus Variable Analysis (MLVA) MtbC15 patterns 860, 372 and 873. Twelve clusters, each with identical MIRU-VNTR and spoligotypes, gathered 35 patients. We found no association of genotype with drug resistant or MDR-TB. Clustering associated with SIT 50 and the H3 subfamily to which it belongs (pBolivia. However, results should be taken cautiously because the sample is small and includes a particular subset of M. tuberculosis population. Copyright © 2013 Elsevier B.V. All rights reserved.

  1. Perioperative treatment of hemophilia A patients: blood group O patients are at risk of bleeding complications.

    Science.gov (United States)

    Hazendonk, H C A M; Lock, J; Mathôt, R A A; Meijer, K; Peters, M; Laros-van Gorkom, B A P; van der Meer, F J M; Driessens, M H E; Leebeek, F W G; Fijnvandraat, K; Cnossen, M H

    2016-03-01

    ESSENTIALS: Targeting of factor VIII values is a challenge during perioperative replacement therapy in hemophilia. This study aims to identify the extent and predictors of factor VIII underdosing and overdosing. Blood group O predicts underdosing and is associated with perioperative bleeding. To increase quality of care and cost-effectiveness of treatment, refining of dosing is obligatory. Perioperative administration of factor VIII (FVIII) concentrate in hemophilia A may result in both underdosing and overdosing, leading to respectively a risk of bleeding complications and unnecessary costs. This retrospective observational study aims to identify the extent and predictors of underdosing and overdosing in perioperative hemophilia A patients (FVIII levels < 0.05 IU mL(-1)). One hundred nineteen patients undergoing 198 elective, minor, or major surgical procedures were included (median age 40 years, median body weight 75 kg). Perioperative management was evaluated by quantification of perioperative infusion of FVIII concentrate and achieved FVIII levels. Predictors of underdosing and (excessive) overdosing were analyzed by logistic regression analysis. Excessive overdosing was defined as upper target level plus ≥ 0.20 IU mL(-1). Depending on postoperative day, 7-45% of achieved FVIII levels were under and 33-75% were above predefined target ranges as stated by national guidelines. A potential reduction of FVIII consumption of 44% would have been attained if FVIII levels had been maintained within target ranges. Blood group O and major surgery were predictive of underdosing (odds ratio [OR] 6.3, 95% confidence interval [CI] 2.7-14.9; OR 3.3, 95% CI 1.4-7.9). Blood group O patients had more bleeding complications in comparison to patients with blood group non-O (OR 2.02, 95% CI 1.00-4.09). Patients with blood group non-O were at higher risk of overdosing (OR 1.5, 95% CI 1.1-1.9). Additionally, patients treated with bolus infusions were at higher risk of excessive

  2. CNP signal peptide (CNPsp in patients with cardiovascular disease

    Directory of Open Access Journals (Sweden)

    Jacqui eLee

    2015-06-01

    Full Text Available We have previously reported that signal peptide fragments of C-type natriuretic peptide (CNP are present in the human circulation. Here, we provide the first preliminary assessment of the potential utility of CNP signal peptide (CNPsp measurement in acute cardiovascular disease. Utilising our specific and sensitive immunoassay, we assessed the potential of CNPsp measurement to assist in the identification of acute coronary syndromes in 494 patients presenting consecutively with chest pain. The diagnostic and prognostic potential of CNPsp was assessed in conjunction with a contemporary clinical troponin I assay, an investigational highly sensitive troponin T assay and NT-proBNP measurement. Utility was assessed via receiver operator curve characteristic analysis.CNPsp did not identify patients with myocardial infarction (MI or those with unstable angina, nor did it assist the diagnostic ability of clinical or investigational troponin measurement. CNPsp levels were significantly elevated in patients presenting with atrial fibrillation (P<0.05 and were significantly lower in those with a history of previous MI (P<0.05. CNPsp could identify those at risk of mortality within 1 year (P<0.05 and also could identify those at risk of death or re-infarction within 1 year (P<0.01. This is the first exploratory report describing the potential of CNPsp measurement in acute cardiovascular disease. Whilst CNPsp does not have utility in acute diagnosis, it may have potential in assisting risk prognosis with respect to mortality and re-infarction.

  3. OPTIMIZING LIFESTYLE IMPROVES GLYCEMIC PROFILE IN PATIENTS AT RISK FOR DIABETES MELLITUS

    Directory of Open Access Journals (Sweden)

    Rucsandra Dănciulescu Miulescu

    2009-10-01

    Full Text Available There is a pandemic of type 2 diabetes mellitus due to urban and sedentary lifestyle, ageing and obesity.The most important means to prevent this disease is to optimize the lifestyle.Our study aimed to follow-up the effect of moderate caloric restriction and increase of physical activityon clinical and metabolic parameters in persons at risk to develop type 2 diabetes.Twenty-three overweight or obese patients with either altered fasting glucose or altered glucosetolerance were included in this study. They were followed up for 2 years for clinical progress and metabolicprofile, while on lifestyle counseling.The dietary and physical recommendations to improve lifestyle were followed by a small reduction inthe BMI, total cholesterol, systolic and diastolic blood pressure, together with an increase of HDL at 1 and 2years of dietary counseling. However there was a significant reduction in abdominal circumference, fastingglycemia and glycemia at 2 hours during oral glucose tolerance test.The small reduction in BMI indicates the need of a more intensive lifestyle conseling.

  4. Are referring clinicians aware of patients at risk from intravenous injection of iodinated contrast media?

    Energy Technology Data Exchange (ETDEWEB)

    Konen, Eli; Konen, Osnat; Katz, Miriam; Levy, Yair; Rozenman, Judith; Hertz, Marjorie

    2002-02-01

    AIM: The purpose of our study was to assess the level of awareness of referring clinicians to populations at risk for complications of intravascular administration of iodinated contrast media. SUBJECTS AND METHODS: Two hundred and three physicians from three university hospitals completed an anonymous questionnaire regarding risk factors and contraindications to the intravenous administration of iodinated contrast media. The questionnaire included medical conditions with increased risk for anaphylactoid reaction (asthma, hay fever and food allergy) as well as chemotoxic (ischaemic heart disease, phaeochromocytoma and myasthenia gravis) adverse reactions, some with dependence on renal function (metformin treatment, diabetes mellitus and multiple myeloma). Two additional multiple-choice questions addressed pre-medication protocols and risk of nephrotoxicity in diabetic patients. RESULTS: Asthma, food allergy and hay fever were recognized as risk factors by 81{center_dot}3%, 77{center_dot}8% and 61{center_dot}6% of respondents respectively, while ischaemic heart disease, phaeochromocytoma and myasthenia gravis were defined as such only by 9{center_dot}8%, 30{center_dot}0% and 28{center_dot}6% respectively. Metformin treatment, diabetes mellitus and multiple myeloma, in the presence of normal renal function, were considered as risk factors by 46{center_dot}3%, 38{center_dot}9% and 58{center_dot}1% of respondents respectively. One of the generally accepted pre-medication protocols was selected by 89{center_dot}8%. The risk of nephrotoxicity in a diabetic patient was correctly assessed by 63{center_dot}5% of respondents. CONCLUSION: We found a relatively high awareness among referring clinicians of a potential anaphylactoid reaction and nephrotoxicity due to iodinated contrast media. However, additional chemotoxic adverse reactions are less well known. Future efforts to improve communication between clinicians and radiologists should be focused in this direction. Konen

  5. Clinical and Economic Impact of a Digital, Remotely-Delivered Intensive Behavioral Counseling Program on Medicare Beneficiaries at Risk for Diabetes and Cardiovascular Disease.

    Directory of Open Access Journals (Sweden)

    Fang Chen

    Full Text Available Type 2 diabetes and cardiovascular disease impose substantial clinical and economic burdens for seniors (age 65 and above and the Medicare program. Intensive Behavioral Counseling (IBC interventions like the National Diabetes Prevention Program (NDPP, have demonstrated effectiveness in reducing excess body weight and lowering or delaying morbidity onset. This paper estimated the potential health implications and medical savings of a digital version of IBC modeled after the NDPP.Participants in this digital IBC intervention, the Omada program, include 1,121 overweight or obese seniors with additional risk factors for diabetes or heart disease. Weight changes were objectively measured via participant use of a networked weight scale. Participants averaged 6.8% reduction in body weight within 26 weeks, and 89% of participants completed 9 or more of the 16 core phase lessons. We used a Markov-based microsimulation model to simulate the impact of weight loss on future health states and medical expenditures over 10 years. Cumulative per capita medical expenditure savings over 3, 5 and 10 years ranged from $1,720 to 1,770 (3 years, $3,840 to $4,240 (5 years and $11,550 to $14,200 (10 years. The range reflects assumptions of weight re-gain similar to that seen in the DPP clinical trial (lower bound or minimal weight re-gain aligned with age-adjusted national averages (upper bound. The estimated net economic benefit after IBC costs is $10,250 to $12,840 cumulative over 10 years. Simulation outcomes suggest reduced incidence of diabetes by 27-41% for participants with prediabetes, and stroke by approximately 15% over 5 years.A digital, remotely-delivered IBC program can help seniors at risk for diabetes and cardiovascular disease achieve significant weight loss, reduces risk for diabetes and cardiovascular disease, and achieve meaningful medical cost savings. These findings affirm recommendations for IBC coverage by the U.S. Preventive Services Task Force.

  6. 'Work it out': evaluation of a chronic condition self-management program for urban Aboriginal and Torres Strait Islander people, with or at risk of cardiovascular disease.

    Science.gov (United States)

    Mills, Kyly; Gatton, Michelle L; Mahoney, Ray; Nelson, Alison

    2017-09-26

    Chronic diseases disproportionately burden Aboriginal and Torres Strait Islander people in Australia, with cardiovascular (CV) diseases being the greatest contributor. To improve quality of life and life expectancy for people living with CV disease, secondary prevention strategies such as rehabilitation and self-management programs are critical. However, there is no published evidence examining the effect of chronic condition self-management (CCSM) group programs for Aboriginal and Torres Strait Islander people who have, or are at risk of, CV disease specifically. This study evaluates the Work It Out program for its effect on clinical outcome measures in urban Aboriginal and Torres Strait Islander participants with or at risk of CV disease. This study was underpinned by a conceptual framework based on Aboriginal and Torres Strait Islander community control. Participants had at least one diagnosed CV disease, or at least one CV disease risk factor. Short-term changes in clinical outcome measures over (approximately) 12 weeks were evaluated with a quasi-experimental, pre-post test design, using paired t-tests. Factors contributing to positive changes were tested using general linear models. The outcome measures included blood pressure (mmHg), weight (kg), body mass index (kg/m 2 ), waist and hip circumference (cm), waist to hip ratio (waist cm/hip cm) and six minute walk test (6MWT). Changes in several clinical outcome measures were detected, either within the entire group (n = 85) or within specific participant sub-groups. Participant's 6MWT distance improved by an average 0.053 km (95% CI: 0.01-0.07 km). The change in distance travelled was influenced by number of social and emotional wellbeing conditions participants presented with. The weight of participants classified with extreme obesity decreased on average by 1.6 kg (95% CI: 0.1-3.0 kg). Participants with high baseline systolic blood pressure demonstrated a mean decrease of 11 mmHg (95% CI: 3.2-18.8

  7. Cardiovascular risk prediction in chronic kidney disease patients

    Directory of Open Access Journals (Sweden)

    Santiago Cedeño Mora

    2017-05-01

    Conclusion: The cardiovascular risk scores (FRS-CVD and ASCVD [AHA/ACC 2013] can estimate the probability of atherosclerotic cardiovascular events in patients with CKD regardless of renal function, albuminuria and previous cardiovascular events.

  8. LOCAL ANESTHETICS IN PATIENTS WITH CARDIOVASCULAR DISEASES.

    Directory of Open Access Journals (Sweden)

    risto Daskalov

    2015-03-01

    Full Text Available A significant problem in the dental medicine is pain alleviation. Many studies in the dental anesthesiology result in the production of new agents for locoregional anesthesia. Objective: This article aim to present the results of the last studies on the effect of the local anesthetics used in the oral surgery on patients with cardiovascular diseases. Material: A general review of the existing literature on the effect of the adrenaline, included as vasoconstrictor in the local anesthetics, used in patients with cardiovascular diseases is made. The benefits of vasoconstrictors for the quality of the anesthetic effect are proven. Conclusion: A small amount of adrenaline in the anesthetic solution does not result in complications development in patients with controlled cardiovascular diseases. Articaine is recommended agent of first choice for local anesthesia in the oral surgery.

  9. Interactive contour delineation of organs at risk in radiotherapy: Clinical evaluation on NSCLC patients.

    Science.gov (United States)

    Dolz, J; Kirişli, H A; Fechter, T; Karnitzki, S; Oehlke, O; Nestle, U; Vermandel, M; Massoptier, L

    2016-05-01

    Accurate delineation of organs at risk (OARs) on computed tomography (CT) image is required for radiation treatment planning (RTP). Manual delineation of OARs being time consuming and prone to high interobserver variability, many (semi-) automatic methods have been proposed. However, most of them are specific to a particular OAR. Here, an interactive computer-assisted system able to segment various OARs required for thoracic radiation therapy is introduced. Segmentation information (foreground and background seeds) is interactively added by the user in any of the three main orthogonal views of the CT volume and is subsequently propagated within the whole volume. The proposed method is based on the combination of watershed transformation and graph-cuts algorithm, which is used as a powerful optimization technique to minimize the energy function. The OARs considered for thoracic radiation therapy are the lungs, spinal cord, trachea, proximal bronchus tree, heart, and esophagus. The method was evaluated on multivendor CT datasets of 30 patients. Two radiation oncologists participated in the study and manual delineations from the original RTP were used as ground truth for evaluation. Delineation of the OARs obtained with the minimally interactive approach was approved to be usable for RTP in nearly 90% of the cases, excluding the esophagus, which segmentation was mostly rejected, thus leading to a gain of time ranging from 50% to 80% in RTP. Considering exclusively accepted cases, overall OARs, a Dice similarity coefficient higher than 0.7 and a Hausdorff distance below 10 mm with respect to the ground truth were achieved. In addition, the interobserver analysis did not highlight any statistically significant difference, at the exception of the segmentation of the heart, in terms of Hausdorff distance and volume difference. An interactive, accurate, fast, and easy-to-use computer-assisted system able to segment various OARs required for thoracic radiation therapy has

  10. Can we identify patients at risk of life-threatening allergic reactions to food?

    Science.gov (United States)

    Turner, P J; Baumert, J L; Beyer, K; Boyle, R J; Chan, C-H; Clark, A T; Crevel, R W R; DunnGalvin, A; Fernández-Rivas, M; Gowland, M H; Grabenhenrich, L; Hardy, S; Houben, G F; O'B Hourihane, J; Muraro, A; Poulsen, L K; Pyrz, K; Remington, B C; Schnadt, S; van Ree, R; Venter, C; Worm, M; Mills, E N C; Roberts, G; Ballmer-Weber, B K

    2016-09-01

    Anaphylaxis has been defined as a 'severe, life-threatening generalized or systemic hypersensitivity reaction'. However, data indicate that the vast majority of food-triggered anaphylactic reactions are not life-threatening. Nonetheless, severe life-threatening reactions do occur and are unpredictable. We discuss the concepts surrounding perceptions of severe, life-threatening allergic reactions to food by different stakeholders, with particular reference to the inclusion of clinical severity as a factor in allergy and allergen risk management. We review the evidence regarding factors that might be used to identify those at most risk of severe allergic reactions to food, and the consequences of misinformation in this regard. For example, a significant proportion of food-allergic children also have asthma, yet almost none will experience a fatal food-allergic reaction; asthma is not, in itself, a strong predictor for fatal anaphylaxis. The relationship between dose of allergen exposure and symptom severity is unclear. While dose appears to be a risk factor in at least a subgroup of patients, studies report that individuals with prior anaphylaxis do not have a lower eliciting dose than those reporting previous mild reactions. It is therefore important to consider severity and sensitivity as separate factors, as a highly sensitive individual will not necessarily experience severe symptoms during an allergic reaction. We identify the knowledge gaps that need to be addressed to improve our ability to better identify those most at risk of severe food-induced allergic reactions. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Nursing care missed in patients at risk of or having pressure ulcers.

    Science.gov (United States)

    Valles, Jonathan Hermayn Hernández; Monsiváis, María Guadalupe Moreno; Guzmán, Ma Guadalupe Interial; Arreola, Leticia Vázquez

    2016-11-21

    to determine the nursing care missed as perceived by the nursing staff and its relation with the nursing care missed identified in the assessment of patients at risk of or having pressur ulcers. descriptive correlation study. The participants were 161 nurses and 483 patients from a public hospital. The MISSCARE survey was used in combination with a Nursing Care Assessment Form for Patients at Risk of or having pressure ulcers. For the analysis, descriptive and inferential statistics were used. the nursing staff indicated greater omission in skin care (38.5%), position change (31.1%) and the registration of risk factors for the development of pressure ulcers (33.5%). The nursing care missed identified in the assessment related to the use of pressure relief on bony prominences and drainage tubes interfering in the patient's movements (both with 58.6%) and the use of pneumatic mattresses (57.6%). a high percentage of nursing care missed was found according to the staff's perception. Nevertheless, the assessment of the nursing care missed was much higher. No significant relation was found between both. Therefore, it is a priority to reflect on the importance of objective patient assessments. determinar o cuidado de enfermagem omitido percebido pela equipe de enfermagem e sua relação com o cuidado omitido identificado na avaliação de pacientes com risco ou com de úlceras por pressão. estudo descritivo correlacional. Participaram 161 enfermeiras e 483 pacientes de um hospital público. Foram utilizados o levantamento MISSCARE e um Formulário de Avaliação de Cuidados de Enfermagem em Pacientes com Risco ou com úlceras por pressão. Para a análise foi utilizada estatística descritiva e inferencial. a equipe de enfermagem assinalou que há maior omissão no cuidado da pele (38,5%), reposicionamento (31,1%) e no registro de fatores de risco para o aparecimento de úlceras por pressão (33,5%). Os cuidados de enfermagem omitidos identificados na avaliação foram

  12. Cardiovascular risk assessment in hypertensive patients

    Directory of Open Access Journals (Sweden)

    Elaine Amaral de Paula

    2013-06-01

    Full Text Available OBJECTIVE: to assess cardiovascular risk by means of the traditional Framingham score and the version modified through the incorporation of emerging risk factors, such as family history of acute myocardial infarction, metabolic syndrome and chronic kidney disease. METHOD: participants were 50 hypertensive patients under outpatient treatment. The clinical data were collected through a semi-structured interview and the laboratory data from patients' histories. RESULTS: it was verified that the traditional Framingham score was predominantly low (74%, with 14% showing medium risk and 12% high risk. After the inclusion of emerging risk factors, the chance of a coronary event was low in 22% of the cases, medium in 56% and high in 22%. CONCLUSIONS: the comparison between the traditional Framingham risk score and the modified version demonstrated a significant difference in the cardiovascular risk classification, whose correlation shows discreet agreement between the two scales. Lifestyle elements seem to play a determinant role in the increase in cardiovascular risk levels.

  13. Cardiovascular risk assessment in hypertensive patients

    Directory of Open Access Journals (Sweden)

    Elaine Amaral de Paula

    Full Text Available OBJECTIVE: to assess cardiovascular risk by means of the traditional Framingham score and the version modified through the incorporation of emerging risk factors, such as family history of acute myocardial infarction, metabolic syndrome and chronic kidney disease. METHOD: participants were 50 hypertensive patients under outpatient treatment. The clinical data were collected through a semi-structured interview and the laboratory data from patients' histories. RESULTS: it was verified that the traditional Framingham score was predominantly low (74%, with 14% showing medium risk and 12% high risk. After the inclusion of emerging risk factors, the chance of a coronary event was low in 22% of the cases, medium in 56% and high in 22%. CONCLUSIONS: the comparison between the traditional Framingham risk score and the modified version demonstrated a significant difference in the cardiovascular risk classification, whose correlation shows discreet agreement between the two scales. Lifestyle elements seem to play a determinant role in the increase in cardiovascular risk levels.

  14. IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes

    NARCIS (Netherlands)

    Bus, S. A.; van Netten, J. J.; Lavery, L. A.; Monteiro-Soares, M.; Rasmussen, A.; Jubiz, Y.; Price, P. E.

    2016-01-01

    Recommendations To identify a person with diabetes at risk for foot ulceration, examine the feet annually to seek evidence for signs or symptoms of peripheral neuropathy and peripheral artery disease. (GRADE strength of recommendation: strong; Quality of evidence: low) In a person with diabetes who

  15. Interactive contour delineation of organs at risk in radiotherapy: Clinical evaluation on NSCLC patients

    Energy Technology Data Exchange (ETDEWEB)

    Dolz, J., E-mail: jose.dolz.upv@gmail.com [AQUILAB, Loos-les-Lille 59120, France and University Lille, Inserm, CHU Lille, U1189–ONCO-THAI–Image Assisted Laser Therapy for Oncology, Lille F-59000 (France); Kirişli, H. A.; Massoptier, L. [AQUILAB, Loos-les-Lille 59120 (France); Fechter, T.; Karnitzki, S.; Oehlke, O.; Nestle, U. [Department of Radiation Oncology, University Medical Center, Freiburg 79106 (Germany); Vermandel, M. [Inserm Onco Thai U1189, Université Lille 2, CHRU Lille, Lille 59037 (France)

    2016-05-15

    Purpose: Accurate delineation of organs at risk (OARs) on computed tomography (CT) image is required for radiation treatment planning (RTP). Manual delineation of OARs being time consuming and prone to high interobserver variability, many (semi-) automatic methods have been proposed. However, most of them are specific to a particular OAR. Here, an interactive computer-assisted system able to segment various OARs required for thoracic radiation therapy is introduced. Methods: Segmentation information (foreground and background seeds) is interactively added by the user in any of the three main orthogonal views of the CT volume and is subsequently propagated within the whole volume. The proposed method is based on the combination of watershed transformation and graph-cuts algorithm, which is used as a powerful optimization technique to minimize the energy function. The OARs considered for thoracic radiation therapy are the lungs, spinal cord, trachea, proximal bronchus tree, heart, and esophagus. The method was evaluated on multivendor CT datasets of 30 patients. Two radiation oncologists participated in the study and manual delineations from the original RTP were used as ground truth for evaluation. Results: Delineation of the OARs obtained with the minimally interactive approach was approved to be usable for RTP in nearly 90% of the cases, excluding the esophagus, which segmentation was mostly rejected, thus leading to a gain of time ranging from 50% to 80% in RTP. Considering exclusively accepted cases, overall OARs, a Dice similarity coefficient higher than 0.7 and a Hausdorff distance below 10 mm with respect to the ground truth were achieved. In addition, the interobserver analysis did not highlight any statistically significant difference, at the exception of the segmentation of the heart, in terms of Hausdorff distance and volume difference. Conclusions: An interactive, accurate, fast, and easy-to-use computer-assisted system able to segment various OARs

  16. Identifying patients at risk for severe exacerbations of asthma: development and external validation of a multivariable prediction model

    NARCIS (Netherlands)

    Loymans, Rik J. B.; Honkoop, Persijn J.; Termeer, Evelien H.; Snoeck-Stroband, Jiska B.; Assendelft, Willem J. J.; Schermer, Tjard R. J.; Chung, Kian Fan; Sousa, Ana R.; Sterk, Peter J.; Reddel, Helen K.; Sont, Jacob K.; ter Riet, Gerben

    2016-01-01

    Preventing exacerbations of asthma is a major goal in current guidelines. We aimed to develop a prediction model enabling practitioners to identify patients at risk of severe exacerbations who could potentially benefit from a change in management. We used data from a 12-month primary care pragmatic

  17. Identifying patients at risk for severe exacerbations of asthma: development and external validation of a multivariable prediction model

    NARCIS (Netherlands)

    Loymans, R.J.; Honkoop, P.J.; Termeer, E.H.; Snoeck-Stroband, J.B.; Assendelft, W.J.J.; Schermer, T.R.J.; Chung, K.F.; Sousa, A.R.; Sterk, P.J.; Reddel, H.K.; Sont, J.K.; Riet, G. Ter

    2016-01-01

    BACKGROUND: Preventing exacerbations of asthma is a major goal in current guidelines. We aimed to develop a prediction model enabling practitioners to identify patients at risk of severe exacerbations who could potentially benefit from a change in management. METHODS: We used data from a 12-month

  18. Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: A randomized placebo-controlled study

    NARCIS (Netherlands)

    Kalisvaart, Kees J.; de Jonghe, Jos F. M.; Bogaards, Marja J.; Vreeswijk, Ralph; Egberts, Toine C. G.; Burger, Bart J.; Eikelenboom, Piet; van Gool, Willem A.

    2005-01-01

    OBJECTIVES: To study the effectiveness of haloperidol prophylaxis on incidence, severity, and duration of postoperative delirium in elderly hip-surgery patients at risk for delirium. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Large medical school-affiliated general hospital

  19. Interactive contour delineation of organs at risk in radiotherapy: Clinical evaluation on NSCLC patients

    OpenAIRE

    Dolz, Jose; Kirisli, H.A.; Fechter, T; Karnitzki, S.; Oehlke, O.; NESTLE, U; Vermandel, Maximilien; Massoptier, L.

    2016-01-01

    International audience; AbstractPURPOSE: Accurate delineation of organs at risk (OARs) on computed tomography (CT) image is required for radiation treatment planning (RTP). Manual delineation of OARs being time consuming and prone to high interobserver variability, many (semi-) automatic methods have been proposed. However, most of them are specific to a particular OAR. Here, an interactive computer-assisted system able to segment various OARs required for thoracic radiation therapy is introd...

  20. Identification of older hospitalised patients at risk for functional decline, a study to compare the predictive values of three screening instruments.

    NARCIS (Netherlands)

    Hoogerduijn, J.G.; Schuurmans, M.J.; Korevaar, J.C.; Buurman, B.M.; Rooij, S.E. de

    2010-01-01

    Aims and objectives: To establish a screening instrument for identifying older hospitalised patients at risk for functional decline by comparing the predictive values of three screening instruments: identification of seniors at risk, care complexity prediction instrument and hospital admission risk

  1. Identification of older hospitalised patients at risk for functional decline, a study to compare the predictive values of three screening instruments

    NARCIS (Netherlands)

    Hoogerduijn, Jita G.; Schuurmans, Marieke J.; Korevaar, Johanna C.; Buurman, Bianca M.; de Rooij, Sophia E.

    2010-01-01

    Aims and objectives. To establish a screening instrument for identifying older hospitalised patients at risk for functional decline by comparing the predictive values of three screening instruments: identification of seniors at risk, care complexity prediction instrument and hospital admission risk

  2. Individualised dietary counselling for nutritionally at-risk older patients following discharge from acute hospital to home

    DEFF Research Database (Denmark)

    Munk, T; Tolstrup, U; Beck, A M

    2016-01-01

    Background: Many older patients are undernourished after hospitalisation. Undernutrition impacts negatively on physical function and the ability of older patients to perform activities of daily living at home after discharge from acute hospital. The present study aimed to evaluate the evidence...... for an effect of individualised dietary counselling following discharge from acute hospital to home on physical function, and, second, on readmissions, mortality, nutritional status, nutritional intake and quality of life (QoL), in nutritionally at-risk older patients. Methods: A systematic review of randomised......L and readmissions as a result of a lack of data. Conclusions: Individualised dietary counselling by dietitians following discharge from acute hospital to home improved BW, as well as energy and protein intake, in older nutritionally at-risk patients, although without clearly improving physical function. The effect...

  3. What is the best time point to identify patients at risk of developing persistent low back pain?

    Science.gov (United States)

    Melloh, Markus; Elfering, Achim; Käser, Anja; Rolli Salathé, Cornelia; Crawford, Rebecca J; Barz, Thomas; Zweig, Thomas; Aghayev, Emin; Röder, Christoph; Theis, Jean-Claude

    2015-01-01

    Early identification of patients at risk of developing persistent low back pain (LBP) is crucial. Aim of this study was to identify in patients with a new episode of LBP the time point at which those at risk of developing persistent LBP can be best identified. Prospective cohort study of 315 patients presenting to a health practitioner with a first episode of acute LBP. Primary outcome measure was functional limitation. Patients were assessed at baseline, three, six, twelve weeks and six months looking at factors of maladaptive cognition as potential predictors. Multivariate logistic regression analysis was performed for all time points. The best time point to predict the development of persistent LBP at six months was the twelve-week follow-up (sensitivity 78%; overall predictive value 90%). Cognitions assessed at first visit to a health practitioner were not predictive. Maladaptive cognitions at twelve weeks appear to be suitable predictors for a transition from acute to persistent LBP. Already three weeks after patients present to a health practitioner with acute LBP cognitions might influence the development of persistent LBP. Therefore, cognitive-behavioral interventions should be considered as early adjuvant LBP treatment in patients at risk of developing persistent LBP.

  4. Effect of amlodipine on cardiovascular events in hypertensive haemodialysis patients

    DEFF Research Database (Denmark)

    Tepel, Martin; Hopfenmueller, Werner; Scholze, Alexandra

    2008-01-01

    Hypertensive haemodialysis patients may be at a high risk for cardiovascular events. This study was undertaken to ascertain whether the calcium channel blocker amlodipine reduces mortality and cardiovascular events in these high-risk patients.......Hypertensive haemodialysis patients may be at a high risk for cardiovascular events. This study was undertaken to ascertain whether the calcium channel blocker amlodipine reduces mortality and cardiovascular events in these high-risk patients....

  5. Nutrition care-related practices and factors affecting nutritional intakes in hospital patients at risk of pressure ulcers.

    Science.gov (United States)

    Roberts, S; Chaboyer, W; Desbrow, B

    2015-08-01

    Malnutrition is common in hospitals and is a risk factor for pressure ulcers. Nutrition care practices relating to the identification and treatment of malnutrition have not been assessed in patients at risk of pressure ulcers. The present study describes nutrition care practices and factors affecting nutritional intakes in this patient group. The study was conducted in four wards at two hospitals in Queensland, Australia. Adult patients at risk of pressure ulcers as a result of restricted mobility were observed for 24 h to determine their daily oral intake and practices such as nutrition screening, documentation and intervention. Independent samples t-tests and chi-squared tests were used to analyse dietary intake and nutrition care-related data. Predictors of receiving a dietitian referral were identified using logistic regression analyses. Two hundred and forty-one patients participated in the present study. The observed nutritional screening rate was 59% (142 patients). Weight and height were documented in 71% and 34% of cases. Sixty-nine patients (29%) received a dietitian referral. Predictors of receiving a dietitian referral included lower body mass index and longer length of stay. On average, patients consumed 73% and 72% of the energy and protein provided, respectively. Between 22% and 38% of patients consumed Nutrition care practices including malnutrition risk screening and documentation of nutritional parameters appear to be inadequate in patients at risk of pressure ulcers. A significant proportion of these patients eat inadequately at main meals, further increasing their risk of malnutrition and pressure ulcers. © 2014 The British Dietetic Association Ltd.

  6. Predictors of Comfort and Confidence Among Medical Students in Providing Care to Patients at Risk of Suicide.

    Science.gov (United States)

    Patel, Sunaina; Batterham, Philip J; Calear, Alison L; Cryer, Rachel

    2016-12-01

    The aim of this study was to identify factors associated with comfort and confidence in providing care to patients at risk of suicide, in a sample of Australian medical students. An online cross-sectional survey was completed by 116 current medical students (42 % male) aged between 20 and 41 years (M = 25, SD = 3.8). Greater personal experience of suicide and previous contact with patients with psychiatric problems were significantly associated with both increased perceived comfort and increased confidence in providing care for individuals with suicidal thoughts or behaviors, based on self-report. However, these effects may not reflect objective measures of competency and additional research is needed to assess generalizability of the findings due to the sampling method. Increasing medical student contact with patients at risk of suicide through the implementation of psychiatry placements, gateway programs, and early year exposure to patients with psychiatric problems may increase perceived confidence and comfort in providing care to individuals at risk of suicide. Further research should evaluate the impact of such programs on behavioral indices of clinical competency.

  7. Cardiovascular and non-cardiovascular mortality in dialysis patients : where is the link?

    NARCIS (Netherlands)

    Jager, Kitty J.; Lindholm, Bengt; Goldsmith, David; Fliser, Danilo; Wiecek, Andrzej; Suleymanlar, Gultekin; Ortiz, Alberto; Massy, Ziad; Martinez-Castelao, Alberto; Agarwal, Rajiv; Blankestijn, Peter J.; Covic, Adrian; London, Gerard; Zoccali, Carmine; Dekker, Friedo W.

    Over the past decade, the research agenda in dialysis has been dominated by studies on risk factors associated with cardiovascular mortality. It has now become increasingly clear that in dialysis patients, non-cardiovascular causes of death are increased to the same extent as cardiovascular

  8. Event-related potentials in patients with Huntington's disease and relatives at risk in relation to detailed psychometry.

    Science.gov (United States)

    Hömberg, V; Hefter, H; Granseyer, G; Strauss, W; Lange, H; Hennerici, M

    1986-06-01

    Event-related potentials (ERPs) were studied in patients with Huntington's disease (HD) and their offspring at risk in a simple auditory oddball paradigm requiring the counting of the rarer of two stimulus categories. Group statistical analysis revealed prolongation of latencies of components P2, N2 and especially P3 in HD patients and to a lesser extent in at-risks. In a large population of normals the age-latency relationship for component P3 showed a non-linear shape with increasing slope and scatter in the older age groups. A bipartate linear regression analysis splitting the normal population at age 50 was used for detection of abnormalities of P3 latency in individual cases. Abnormal P3 latencies were present in the majority of HD patients and also in 25% of clinically normal at-risks. Correlation analysis of ERP components with detailed psychometry revealed a particularly high association of P3 latencies with measurements requiring speeded information processing in non-verbal tasks. P3 amplitude did not covary with performance scores but unlike P3 latency showed association with depression and psychosis scores. From the results it appears that analysis of ERPs is a useful electrophysiological tool for an objective assessment of cognition both in clinically definite and subclinical stages.

  9. Antidepressant or Antipsychotic Overdose in the Intensive Care Unit - Identification of Patients at Risk

    DEFF Research Database (Denmark)

    Borg, Linda; Julkunen, Anna; Madsen, Kristian Rørbaek

    2016-01-01

    It is often advised that patients who have ingested an overdose of antidepressants (AD) or antipsychotics (AP) are monitored with continuous ECG for minimum of 12-24 hr. These patients are often observed in an ICU. Our aim was to identify the number of patients with AD and/or AP overdose without...

  10. Adult tonsillectomy – are long waiting lists putting patients at risk?

    African Journals Online (AJOL)

    patients had been booked for surgery between January 2000 and December 2003. Only those patients who had been waiting for at least 1½ years were included in the study. Patients were questioned on the following: (i) the number of episodes of tonsillitis per year at time of booking; (ii) number of episodes of tonsillitis per ...

  11. Cardiovascular disease in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Naranjo, Antonio; Sokka, Tuulikki; Descalzo, Miguel

    2008-01-01

    ABSTRACT: INTRODUCTION: We analyzed the prevalence of cardiovascular (CV) disease in patients with rheumatoid arthritis (RA) and its association with traditional CV risk factors, clinical features of RA, and the use of disease-modifying antirheumatic drugs (DMARDs) in a multinational cross......-sectional cohort of nonselected consecutive outpatients with RA (The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis Program, or QUEST-RA) who were receiving regular clinical care. METHODS: The study involved a clinical assessment by a rheumatologist and a self-report questionnaire...

  12. Early identification of 'at-risk' students by the parents of paediatric patients.

    Science.gov (United States)

    O'Keefe, Maree; Whitham, Justine

    2005-09-01

    Assessment of medical student clinical skills is best carried out using multiple assessment methods. A programme was developed to obtain parent evaluations of medical student paediatric interview skills for feedback and to identify students at risk of poor performance in summative assessments. A total of 130 parent evaluations were obtained for 67 students (parent participation 72%, student participation 58%). Parents completed a 13-item questionnaire [Interpersonal Skills Rating Scale (IPS) maximum score 91, higher scores = higher student skill level]. Students received their individual parent scores and de-identified class mean scores as feedback, and participants were surveyed regarding the programme. Parent evaluation scores were compared with student performance in formative and summative faculty assessments of clinical interview skills. Parents supported the programme and participating students valued parent feedback. Students with a parent score that was less than 1 standard deviation (SD) below the class mean (low IPS score students) obtained lower faculty summative assessment scores than did other students (mean +/- SD, 59% +/- 5 versus 64% +/- 7; P class mean (sensitivity 0.38, specificity 0.88). Parent evaluations combined with faculty formative assessments identified 50% of students who subsequently performed below the class mean in summative assessments. Parent evaluations provided useful feedback to students and identified 1 group of students at increased risk of weaker performance in summative assessments. They could be combined with other methods of formative assessment to enhance screening procedures for clinically weak students.

  13. Effect of Allopurinol on Cardiovascular Outcomes in Hyperuricemic Patients

    DEFF Research Database (Denmark)

    Larsen, Kasper Søltoft; Pottegård, Anton; Lindegaard, Hanne M

    2015-01-01

    BACKGROUND: Hyperuricemia and gout have been associated with increased cardiovascular risk. Allopurinol is an effective urate-lowering drug. Whether lowering of urate by allopurinol improves the cardiovascular risk in hyperuricemic patients remains to be established. OBJECTIVE: Our objective...

  14. Prevalence of 'being at risk of malnutrition' and associated factors in adult patients receiving nursing care at home in Belgium.

    Science.gov (United States)

    Geurden, Bart; Franck MPsych, Erik; Lopez Hartmann, Maja; Weyler, Joost; Ysebaert, Dirk

    2015-10-01

    Malnutrition is a known problem in hospitals and nursing homes. This study aims to evaluate the prevalence of being at risk of malnutrition in community living adults receiving homecare nursing and to determine factors independently associated with this risk of malnutrition. Furthermore, it also aimed to describe aspects of current nutritional nursing care. Patients (n = 100) are screened with the Malnutrition Universal Screening Tool to evaluate their risk of malnutrition. A patient survey was used to analyse associated factors. In this population, 29% are at risk for malnutrition. Following a multivariate logistic regression analysis, 'loss of appetite' proved the most important factor. A survey for nurses (n = 61) revealed low awareness, poor knowledge, poor communication between stakeholders and a moderate approach of malnutrition. These findings should encourage homecare nurses to use a recommended screening tool for malnutrition and to actively observe and report loss of appetite to initiate the prescription of individual tailored interventions. Belgian homecare nurses' management does not yet fully comply with international recommendations. Additional training in nutritional nursing care and screening methods for malnutrition is needed. Systematic screening should be further developed and evaluated in this at-risk population. © 2014 Wiley Publishing Asia Pty Ltd.

  15. Burden of informal caregiving for stroke patients: Identification of caregivers at risk of adverse health effects

    NARCIS (Netherlands)

    Exel, N.J.A. van; Koopmanschap, M.A.; Berg, B. van den; Brouwer, W.B.F.; Bos, G.A.M. van den

    2005-01-01

    Background: We assessed the objective and subjective burden of caregiving for stroke patients and investigated which characteristics of the patient, the informal caregiver and the objective burden contribute most to subjective burden and to the condition of feeling substantially burdened. Methods:

  16. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review

    NARCIS (Netherlands)

    van Netten, J. J.; Price, P. E.; Lavery, L. A.; Monteiro-Soares, M.; Rasmussen, A.; Jubiz, Y.; Bus, S. A.

    2016-01-01

    Prevention of foot ulcers in patients with diabetes is extremely important to help reduce the enormous burden of foot ulceration on both patient and health resources. A comprehensive analysis of reported interventions is not currently available, but is needed to better inform caregivers about

  17. Lugol chromoendoscopy combined with brush cytology in patients at risk for esophageal squamous cell carcinoma.

    Science.gov (United States)

    Boller, D; Spieler, P; Schoenegg, R; Neuweiler, J; Kradolfer, D; Studer, R; Grossenbacher, R; Zuercher, U; Meyenberger, C; Borovicka, J

    2009-12-01

    Patients with achalasia or malignancies of the head and neck are at increased risk for esophageal squamous cell carcinoma. The discussion of a screening and surveillance program is controversial. The aim of the present study was to determine the diagnostic potential of Lugol chromoendoscopy combined with brush cytology to diagnose esophageal squamous cell carcinoma and high-grade dysplasia. Secondly, the benefit of additional biomarkers was investigated. A total of 61 patients (21 patients with achalasia and 40 patients with malignancies of the head and neck) were included. Chromoendoscopy with 1.2% Lugol iodine solution with targeted biopsies and brush cytology processed by digital image cytometry (DICM) and fluorescence in situ hybridization (FISH) from unstained lesions (USLs) and stained mucosa were performed. Six of the 61 patients had USLs ≥2 cm. Four patients had high-grade dysplasia (HGD) or carcinoma in situ (CIS). One patient with HGD and one patient with CIS were detected only after Lugol chromoendoscopy. The sensitivity and specificity for detected HGD or CIS in USLs ≥2 cm were 100% and 96.5%. No dysplasia was found in USLs Lugol chromoendoscopy enhances the detection rate of high-risk lesions with dysplasia or carcinoma in situ in large unstained lesions. Biomarkers such as aneuploidy and p53 LOH from brush cytology were not of additional benefit in this setting.

  18. Allergic reactions to iodinated contrast media: premedication considerations for patients at risk.

    Science.gov (United States)

    Schopp, Jennifer G; Iyer, Ramesh S; Wang, Carolyn L; Petscavage, Jonelle M; Paladin, Angelisa M; Bush, William H; Dighe, Manjiri K

    2013-08-01

    The objectives of this article are to review allergy-type reactions to iodinated contrast media and the protocols utilized to prevent or reduce the occurrence of these adverse reactions in high-risk patients. We will begin by discussing the types or classifications of the adverse reactions to iodinated contrast media. We will then discuss reaction mechanisms, identify the patients at highest risk for adverse reactions, and clarify common misperceptions about the risk. Finally, we will discuss the actions of the medications used to help reduce or prevent allergy-type reactions to iodinated contrast media, the protocols used to help reduce or prevent contrast reactions in high-risk patients, and the potential side effects of these medications. We will also discuss the high-risk patient who has received premedication due to a prior index reaction and discuss the risk of having a subsequent reaction, termed "breakthrough reaction." Identifying patient at high risk for an "allergy-type" reaction to contrast media is an essential task of the radiologist. Prevention of or reduction of the risk of an adverse reaction is critical to patient safety. If an examination can be performed without contrast in a patient at high risk for an allergy-type reaction, it may be appropriate to avoid contrast. However, there are situations where contrast media is necessary, and the radiologist plays a vital role in preventing or mitigating an allergy-type reaction.

  19. Primary prevention of cardiovascular diseases in general practice: mismatch between cardiovascular risk and patients' risk perceptions.

    NARCIS (Netherlands)

    Weijden, T. van der; Steenkiste, B.C. van; Stoffers, H.E.; Timmermans, D.R.; Grol, R.P.T.M.

    2007-01-01

    OBJECTIVE: Guidelines on primary prevention of cardiovascular disease (CVD) emphasize identifying high-risk patients for more intensive management, but patients' misconceptions of risk hamper implementation. Insight is needed into the type of patients that general practitioners (GPs) encounter in

  20. Occupations at risk of developing contact allergy to isothiazolinones in Danish contact dermatitis patients

    DEFF Research Database (Denmark)

    Schwensen, Jakob F; Menné, Torkil; Andersen, Klaus E

    2014-01-01

    : painting, welding (blacksmiths), machine operating, and cosmetology. The occupational group of painting was frequent in the group of patients with BIT contact allergy. CONCLUSION: Several high-risk occupations for sensitization to isothiazolinones exist. Regulation on the allowed concentration...

  1. Clinical Presentation of Pediatric Patients at Risk for Sudden Cardiac Arrest.

    Science.gov (United States)

    Dalal, Aarti; Czosek, Richard J; Kovach, Joshua; von Alvensleben, Johannes C; Valdes, Santiago; Etheridge, Susan P; Ackerman, Michael J; Auld, Debbie; Huckaby, Jeryl; McCracken, Courtney; Campbell, Robert

    2016-10-01

    To identify the clinical presentation of children and adolescents affected by 1 of 4 cardiac conditions predisposing to sudden cardiac arrest: hypertrophic cardiomyopathy, long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and anomalous origin of the left coronary artery from the right sinus of Valsalva (ALCA-R). This was a retrospective review of newly diagnosed pediatric patients with hypertrophic cardiomyopathy, LQTS, CPVT, and ALCA-R referred for cardiac evaluation at 6 US centers from 2008 to 2014. A total of 450 patients (257 male/193 female; median age 10.1 years [3.6-13.8 years, 25th-75th percentiles]) were enrolled. Patient age was ≤13 years for 70.4% of the cohort (n = 317). Sudden cardiac arrest was the initial presentation in 7%; others were referred on the basis of abnormal or suspicious family history, personal symptoms, or physical findings. Patients with LQTS and hypertrophic cardiomyopathy were referred most commonly because of family history concerns. ALCA-R was most likely to have abnormal signs or symptoms (eg, exercise chest pain, syncope, or sudden cardiac arrest). Patients with CPVT had a high incidence of syncope and the greatest incidence of sudden cardiac arrest (45%); 77% exhibited exercise syncope or sudden cardiac arrest. This study demonstrated that suspicious or known family history plays a role in identification of many patients ultimately affected by 1 of the 3 genetic disorders (hypertrophic cardiomyopathy, LQTS, CPVT). Important patient and family history and physical examination findings may allow medical providers to identify many pediatric patients affected by 4 cardiac disorders predisposing to sudden cardiac arrest. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. [Achievement of cardiovascular goals in patients diagnosed with type 2 diabetes with and without cardiovascular disease].

    Science.gov (United States)

    Garzón, Gerardo; Gil, Ángel; Herrero, Ana María; Jiménez, Fernando; Cerezo, María José; Domínguez, Cristina

    2015-01-01

    To determine the proportion of patients with type 2 diabetes with and without cardiovascular disease achieving the main cardiovascular goals. Cross-sectional study. A regional health district in a European country, Spain. Year: 2013. Adult patients diagnosed with type 2 diabetes with and without cardiovascular disease. Study using secondary data obtained from electronic records of clinical history. Haemoglobin A1c, blood pressure, LDL cholesterol, smoking and medication were covered. n=49,658 RESULTS: The proportion of patients with diabetes achieving cardiovascular goals (among those with recent measurement) was: haemoglobin A1c 68.8% (CI95%:68.2%-69.4%), blood pressure 74.3% (CI95%:73.9%-74.7%), LDL cholesterol 59.8% (CI95%:59.0%-60.6%), tobacco 80.2% (CI95%:79.6%-80.8%). Only 40%-67% of patients has recent measurement. Only 48.0% (CI95%: 46.6%-49.4%) of patients who needed statins were receiving them. Higher proportion of patients with cardiovascular disease were achiving goals. Differences were small but significant. Cardiovascular goals were measured in around half of patients with diabetes. Proportion of patients achiving cardiovascular goals were similar to published and best in patients with cardiovascular disease but it could improve. This points to prioritising interventions in this group of patients at very high risk, improving the implementation of guidelines and patient adherence. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

  3. [Hyperhomocysteinemia in patients with cardiovascular disease].

    Science.gov (United States)

    Baszczuk, Aleksandra; Kopczyński, Zygmunt

    2014-01-02

    Homocysteine (Hcy) is an endogenous, non-structural protein, a sulfur-containing amino acid emerging on the pathway of methionine and cysteine, actively involved in numerous biochemical reactions. Total concentration of homocysteine in plasma of healthy humans is low and its level is between 5.0 and 15.0 mmol/l, assessed with the use of HPLC, or 5.0-12.0 mmol/l, using immunoassay methods. Higher concentration of this amino acid in blood is called hyperhomocysteinemia. Hyperhomocysteinemia is significantly correlated with cardiovascular disease and its complications: heart attacks and strokes. It is believed that hyperhomocysteinemia damages endothelial cells, reduces the flexibility of vessels, and adversely affects the process of hemostasis. In addition, hyperhomocysteinemia enhances the adverse effects of risk factors such as hypertension, smoking, and impaired glucose, lipid and lipoprotein metabolism, as well as promoting the development of inflammation. The concentration of homocysteine can be effectively lowered by supplementation with folic acid and vitamins B12 and B6. However, intervention studies conducted in the past decade did not confirm the clinical benefit of vitamin therapy lowering the level of homocysteine in blood of patients with cardiovascular disease. Moreover, there is not clear evidence from genetic studies that the presence of the gene for MTFHR polymorphism 677C>T, which is one of the most common causes of hyperhomocysteinemia, is also associated with the development of cardiovascular disease. These results led the researchers to discuss the role of homocysteine in the development and treatment of cardiovascular disease as well as the need for further research on this issue.

  4. Hyperhomocysteinemia in patients with cardiovascular disease

    Directory of Open Access Journals (Sweden)

    Aleksandra Baszczuk

    2014-01-01

    Full Text Available Homocysteine (Hcy is an endogenous, non-structural protein, a sulfur-containing amino acid emerging on the pathway of methionine and cysteine, actively involved in numerous biochemical reactions. Total concentration of homocysteine in plasma of healthy humans is low and its level is between 5.0 and 15.0 mmol/l, assessed with the use of HPLC, or 5.0–12.0 mmol/l, using immunoassay methods. Higher concentration of this amino acid in blood is called hyperhomocysteinemia. Hyperhomocysteinemia is significantly correlated with cardiovascular disease and its complications: heart attacks and strokes. It is believed that hyperhomocysteinemia damages endothelial cells, reduces the flexibility of vessels, and adversely affects the process of hemostasis. In addition, hyperhomocysteinemia enhances the adverse effects of risk factors such as hypertension, smoking, and impaired glucose, lipid and lipoprotein metabolism, as well as promoting the development of inflammation. The concentration of homocysteine can be effectively lowered by supplementation with folic acid and vitamins B12 and B6. However, intervention studies conducted in the past decade did not confirm the clinical benefit of vitamin therapy lowering the level of homocysteine in blood of patients with cardiovascular disease. Moreover, there is not clear evidence from genetic studies that the presence of the gene for MTFHR polymorphism 677C>T, which is one of the most common causes of hyperhomocysteinemia, is also associated with the development of cardiovascular disease. These results led the researchers to discuss the role of homocysteine in the development and treatment of cardiovascular disease as well as the need for further research on this issue.

  5. Pharmacist elicited medication histories in the Emergency Department: Identifying patient groups at risk of medication misadventure

    Directory of Open Access Journals (Sweden)

    Ajdukovic M

    2007-12-01

    Full Text Available The Australian Pharmaceutical Advisory Committee guidelines call for a detailed medication history to be taken at the first point of admission to an Emergency Department (ED. The elderly, in particular those residing in Residential Aged Care Facilities and those with a non-English speaking background, have been identified as patient groups vulnerable to medication misadventure. Objective: to analyse the incidence of discrepancies in medication histories in these demographic groups when pharmacist elicited medication histories were compared with those taken by ED physicians. It also aimed to investigate the incidence of medication related ED presentations. Methods: The study was conducted over a six week period and included 100 patients over the age of 70, who take five or more regular medications, have three or more clinical co-morbidities and/or have been discharged from hospital in three months prior to the study. Results: Twenty four participants were classified as ‘language barrier’; 12 participants were from residential aged care facilities, and 64 participants were classified as ‘general’. The number of correctly recorded medications was lowest in the ‘language barrier’ group (13.8% compared with 18% and 19.6% of medications for ‘general’ patients and patients from residential aged care facilities respectively. Seven of the patients (29.2% with ‘language barrier’; 1 from a residential aged care facility (8.3% and 13 of the (20.3% patients from the ‘general’ category were suspected as having a medication related ED presentation. Conclusion: This study further highlights the positive contribution an ED pharmacist can make to enhancing medication management along the continuum of care. This study also confirms the vulnerability of patients with language barrier to medication misadventure and their need for interpreter services at all stages of their hospitalisation, in particular at the point of ED presentation.

  6. DM1 Patients with Small CTG Expansions are also at Risk of Severe Conduction Abnormalities.

    Science.gov (United States)

    Denicourt, Maxime; Pham, Minh Trang; Mathieu, Jean; Breton, Robert

    2015-01-01

    A high risk of cardiac arrhythmias was reported in myotonic dystrophy type 1 (DM1). The purpose of the study was to evaluate the risk of severe electrocardiographic abnormalities in DM1 patients with small CTG expansions. We assessed the ECG done at DM1 diagnosis for 127 patients with ≤200 CTG repeats and for 82 of them who had ≥1 ECG over a period of follow-up of 11.7 ± 7.6 years (mean ± SD). Criteria of severe ECG abnormality are at least one of the following features: PR interval ≥240 msec, QRS duration ≥120 msec, second-degree or third-degree atrioventricular block, atrial fibrillation or flutter, insertion of a pacemaker or cardioverter-defibrillator. At baseline, ECG was normal for 109 patients out of 127 (85.8%) and only 4 patients (3.1%) presented severe ECG abnormalities. At follow-up, 46 patients out of 82 (56.1%) had a normal ECG and 25 (30.5%) developed severe ECG abnormalities (p < 0.0001) including 6 of them who needed permanent pacemaker insertion. There were also 3 sudden deaths during the follow-up period. Using multivariate Cox regression analysis, age at entry (relative risk RR, 1.05; (95% CI 1.01-1.08; p = 0.012) and muscular weakness (MIRS) at the entry (RR, 2.03; 95% CI 1.28-3.22; p = 0.003) were significant risk factors for the development of severe ECG abnormality. An increased risk of severe ECG abnormalitiesy and cardiac events is observed even in DM1 patients with small CTG expansions and warrants close cardiac follow-up similar to DM1 patients with larger CTG expansions.

  7. Radiogenomics: using genetics to identify cancer patients at risk for development of adverse effects following radiotherapy.

    Science.gov (United States)

    Kerns, Sarah L; Ostrer, Harry; Rosenstein, Barry S

    2014-02-01

    Normal-tissue adverse effects following radiotherapy are common and significantly affect quality of life. These effects cannot be accounted for by dosimetric, treatment, or demographic factors alone, and evidence suggests that common genetic variants are associated with radiotherapy adverse effects. The field of radiogenomics has evolved to identify such genetic risk factors. Radiogenomics has two goals: (i) to develop an assay to predict which patients with cancer are most likely to develop radiation injuries resulting from radiotherapy, and (ii) to obtain information about the molecular pathways responsible for radiation-induced normal-tissue toxicities. This review summarizes the history of the field and current research. A single-nucleotide polymorphism–based predictive assay could be used, along with clinical and treatment factors, to estimate the risk that a patient with cancer will develop adverse effects from radiotherapy. Such an assay could be used to personalize therapy and improve quality of life for patients with cancer. 2014 AACR

  8. Urinary tract symptoms and erectile function in patients at risk of prostate cancer.

    Science.gov (United States)

    Ramírez-Backhaus, M; González-Tampán, J; Ortiz-Rodríguez, I M; Gómez-Ferrer, Á; Rubio-Briones, J; Collado-Serra, A; Calatrava, A; Rodríguez-Torreblanca, C; Solsona-Narbón, E

    2015-01-01

    We estimate that more tan 63000 prostate biopsies are performed in our country each year. There are no functional status data of those patients and if there is a relationship between biopsy result and functional status. In order to solve that question we have performed this study. 1,128 prostate biopsies were included. Patients fill in the IPSS, IIEF-5 and ICIQ-SF questionnaires before the prostate biopsy was performed. A prospective data collection of clinical, pathological and questionnaires results was done. A descriptive analysis was carried out. IPSS and IIEF-5 results were categorized. Results were compared depending on the biopsy result. In the subgroup of patients with prostate cancer, questionnaires results were stratify according to the clinical risk group. The mean age of the sample was 65. Prostate cancer detection rate was 32,71%, 52,2% of the sample had mild lower urinary tract symptoms (LUTS) and 13,4% had severe LUTS at the time of the biopsy. Regarding the impact of LUTS on quality of life (QOL), only 12,6% showed a perfect QOL. More than 50 percent of patients suffered from some degree of erectile dysfunction at the time of the biopsy. According to ICIQ-SF, 24% of the sample experienced some kind of urinary incontinence, although it is true that most of them classified it as small amount. Patients with a positive biopsy had a lower IPSS and IIEF-5 average score. There were no differences in the prostate cancer detection rate stratified by the severity of LUTS. Patients undergoing prostate biopsy have, with a high probability, LUTS. Approximately 50% suffer from some degree of erectile dysfunction and 24% had some kind of urinary leakage. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Identification of primary care patients at risk of nonadherence to antidepressant treatment

    Directory of Open Access Journals (Sweden)

    Ann-Charlotte Åkerblad

    2009-01-01

    Full Text Available Ann-Charlotte Åkerblad1, Finn Bengtsson2, Margareta Holgersson3, Lars von Knorring1, Lisa Ekselius11Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala University, Uppsala, Sweden; 2Division of Clinical Pharmacology, Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden; 3Quintiles AB, Uppsala, SwedenIntroduction: Poor adherence to antidepressant treatment is common, and results in increased disability and costs. Several factors are thought to influence patients’ ability and willingness to adhere. So far, however, consensus is lacking regarding patient characteristics that predict nonadherence. The purpose of this study was to identify predictors of nonadherence to antidepressant treatment that can be ascertained at treatment start.Method: The present study used data from a randomized controlled trial with the main objective of studying the effect of two different compliance-enhancing programs on treatment adherence and treatment response in 1031 primary care patients with major depression. In this study, logistic regression analyses were performed to examine patient- and illness-related characteristics potentially associated with nonadherence.Results: Nonadherence to antidepressant treatment was predicted by age under 35 or over 64 years, presence of personality disorder, sensation-seeking personality traits, substance abuse, and absence of concomitant medications.Conclusion: Certain patient- and illness-related characteristics may imply an increased risk of nonadherence to antidepressant treatment. Giving special attention to subjects with such characteristics may improve adherence.Keywords: unipolar depression, antidepressant, adherence, compliance, SSRI, predictors

  10. Patients With Transmandibular Implants Are at Risk for Severe Complications When Becoming Frail

    NARCIS (Netherlands)

    Hoeksema, Arie R.; Raghoebar, Gerry M.; Vissink, Arjan; Visser, Anita

    Early in the implant era, transmandibular implant systems were used for retention of implant-retained mandibular overdentures in the severely resorbed mandible. These transmandibular systems require very thorough aftercare, especially when patients become frail and dependent on care. As a result,

  11. [Effect of early nutritional intervention in the a outcome of patients at risk clinical nutrition].

    Science.gov (United States)

    Montoya Montoya, Susana; Múnera García, Nora Elena

    2014-02-01

    Hospital malnutrition is a multi-causal process and high prevalence. Nutritional intervention at an early stage improves prognosis of affected patients. To compare the effect of early nutritional intervention with a routine care on clinical outcome in patients with detected nutritional risk screening tool NRS Nutritional Risk Screening 2002, entering an institution of complex health. A quasi-experimental study. Was assessed in the first 48 hours of admission to 891 patients, of whom 247 were at nutritional risk, 116 were the routine care group and 54 the intervention group. We evaluated complications, hospital stay, weight loss, change in body mass index and protein-calorie adequacy. Patients undergoing caloric intake had higher (1617 ± 444.5 vs 1366 ± 467.1 kcal, p = 0.002) and protein (1.2 ± 0.2 vs 0.9 ± 0.3 g, p = 0.000), average weight gain of 0.7% vs a loss of 2.3% (p = 0.000), a proportion of moderate complications 8.2% vs 25.2% (p = 0.012) and decreased time hospital stay of 2.2 days (p = 0.138) compared with routine care group. Early nutritional intervention in patients at nutritional risk decreased the proportion of moderate complications, improved the adequacy of energy, protein and nutritional evolution in terms of weight gain and change in BMI. The length of stay did not differ significantly. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  12. Listeria monocytogenes--which of your patients is not at risk?

    Science.gov (United States)

    Harris, Joanna

    2008-07-01

    Listeria monocytogenes is an environmental bacterium that is capable of causing infection (known as listeriosis) in vulnerable people who generally acquire the organism following the ingestion of contaminated foods. Pregnant women are a particular risk group, as listeriosis in pregnancy is associated with an increased risk of spontaneous abortion, stillbirth, neonatal septicaemia and meningitis. The immunocompromised, and people over the age of 65 to 70 are also at increased risk of listeriosis. Listeriosis can present in a number of ways and may lead to significant morbidity. The mortality rate is between 11% and 60% depending on the age of the patient and the clinical presentation of the infection. There has been wide coverage in both medical and public media of the risk of listeriosis in pregnancy, but little has been published in general nursing journals. The objective of this article is to raise nurses' awareness of listeriosis enabling them to offer optimum advice to vulnerable patients.

  13. How to identify patients with cancer at risk of falling: a review of the evidence.

    LENUS (Irish Health Repository)

    Stone, Carol A

    2011-02-01

    Clinical experience and a limited number of studies suggest that a cancer diagnosis confers a high risk of accidental falls. The negative sequelae of falls in older persons are well documented; risk factors for falls in this population have been extensively investigated and evidence for the efficacy of interventions to reduce falls is steadily emerging. It is not known whether the risk factors for falls and effective interventions for falls risk reduction in patients with cancer are different from those in older persons.

  14. A generative model for segmentation of tumor and organs-at-risk for radiation therapy planning of glioblastoma patients

    Science.gov (United States)

    Agn, Mikael; Law, Ian; Munck af Rosenschöld, Per; Van Leemput, Koen

    2016-03-01

    We present a fully automated generative method for simultaneous brain tumor and organs-at-risk segmentation in multi-modal magnetic resonance images. The method combines an existing whole-brain segmentation technique with a spatial tumor prior, which uses convolutional restricted Boltzmann machines to model tumor shape. The method is not tuned to any specific imaging protocol and can simultaneously segment the gross tumor volume, peritumoral edema and healthy tissue structures relevant for radiotherapy planning. We validate the method on a manually delineated clinical data set of glioblastoma patients by comparing segmentations of gross tumor volume, brainstem and hippocampus. The preliminary results demonstrate the feasibility of the method.

  15. Are Lean and Normal Weight Patients with Polycystic Ovarian Syndrome at Risk of Preeclampsia?

    Directory of Open Access Journals (Sweden)

    Bibi Shahnaz Aali

    2010-01-01

    Full Text Available Background: We examined whether pregnant women with preeclampsia have an increased rateof pre-pregnancy polycystic ovary syndrome (PCOS. This study also evaluated whether theassociation, if any, was a result of preeclampsia and its relationship to PCOS or dependent uponconcurrent obesity.Materials and Methods: In this study, 75 preeclampsia cases and 225 normotensive pregnantcontrols, matched for age and gravidity, were enrolled. A confirmation of pre-pregnancy PCOSwas ascertained by recording medical history, along with a physical examination directed for signsand symptoms of PCOS, an ultrasound report of polycystic ovaries and laboratory tests whichconfirmed hyperandrogenism prior to pregnancy. Body mass index (BMI was calculated for eachpatient. Participants were classified into two categories: lean/normal and obese according to a BMI<25 or greater than 25.1, respectively. Chi-square, Student t test, Fisher-exact and Mann-Whitneytests were used to assess the differences between the groups in addition to the relationship betweenpreeclampsia and PCOS. P values less than 0.05 were considered significant.Results: Age, gravidity and parity were not significantly different between cases and controls.However, a significant difference was found in gestational age and BMI between the groups.Additionally, preeclamptic patients more frequently suffered from pre-pregnancy PCOS thancontrols and a significant relationship was found between preeclampsia and previous PCOS, evenamongst lean/normal weight patients.Conclusion: This study provides convincing evidence that a pre-pregnancy diagnosis of PCOScould predispose the patient to preeclampsia, regardless of a concomitant obesity risk factor.

  16. Development of Arabic version of Berlin questionnaire to identify obstructive sleep apnea at risk patients

    Directory of Open Access Journals (Sweden)

    Abdel Baset M Saleh

    2011-01-01

    Results: The study demonstrated a high degree of internal consistency and stability over time for the developed ABQ. The Cronbach′s alpha coefficient for the 10-item tool was 0.92. Validation of ABQ against AHI at cutoff >5 revealed a sensitivity of 97%, specificity of 90%, positive and negative predictive values of 96% and 93%, respectively. Conclusion: The ABQ is reliable and valid scale in screening patients for the risk of OSA among Arabic-speaking nations, especially in resource-limited settings.

  17. Standardized evaluation of lung congestion during COPD exacerbation better identifies patients at risk of dying

    Directory of Open Access Journals (Sweden)

    Høiseth AD

    2013-12-01

    Full Text Available Arne Didrik Høiseth,1 Torbjørn Omland,1 Bo Daniel Karlsson,2 Pål H Brekke,1 Vidar Søyseth11Cardiothoracic Research Group, Division of Medicine, Akershus University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway; 2Deptartment of Radiology, Akershus University Hospital, Lørenskog, NorwayBackground: Congestive heart failure is underdiagnosed in patients with chronic obstructive pulmonary disease (COPD. Pulmonary congestion on chest radiograph at admission for acute exacerbation of COPD (AECOPD is associated with an increased risk of mortality. A standardized evaluation of chest radiographs may enhance prognostic accuracy.Purpose: We aimed to evaluate whether a standardized, liberal assessment of pulmonary congestion is superior to the routine assessment in identifying patients at increased risk of long-term mortality, and to investigate the association of heart failure with N-terminal prohormone of brain natriuretic peptide (NT-proBNP concentrations.Material and methods: This was a prospective cohort study of 99 patients admitted for AECOPD. Chest radiographs obtained on admission were routinely evaluated and then later evaluated by blinded investigators using a standardized protocol looking for Kerley B lines, enlarged vessels in the lung apex, perihilar cuffing, peribronchial haze, and interstitial or alveolar edema, defining the presence of pulmonary congestion. Adjusted associations with long-term mortality and NT-proBNP concentration were calculated.Results: The standardized assessment was positive for pulmonary congestion in 32 of the 195 radiographs (16% ruled negative in the routine assessment. The standardized assessment was superior in predicting death during a median follow up of 1.9 years (P=0.022, and in multivariable analysis, only the standardized assessment showed a significant association with mortality (hazard ratio 2.4, 95% confidence interval [CI] 1.2–4.7 (P=0.016 and NT-proBNP (relative

  18. Identifying Patients at Risk of Deterioration in the Joint Emergency Department

    DEFF Research Database (Denmark)

    Schmidt, Thomas; Wiil, Uffe Kock

    2015-01-01

    In recent years, Danish hospitals have merged their emergency facilities into Joint Emergency Departments. This poses new collaborative challenges across traditionally separated specialized departments, which now have to collaborate in a shared environment. Despite established protocols and patient...... at the case through the lenses of common information spaces. In particular, we apply Bossen’s seven-parameter framework to discover new dimensions of how Emergency Departments and individual clinicians identify and respond to unforeseen events, and how they handle the associated cognitive challenges. We...

  19. Epileptic patients are at risk of cardiac arrhythmias: A novel approach using QT-nomogram, tachogram, and cardiac restitution plots

    Directory of Open Access Journals (Sweden)

    Marwan S Al-Nimer

    2017-01-01

    Full Text Available Background: Sudden death is reported in patients who had a history of epilepsy and some authors believed that is due to cardiac arrhythmias. Objectives: This study aimed to predict that the epileptic patients are at risk of serious cardiac arrhythmias by QT-nomogram, tachogram (Lorenz, and cardiac restitution plots. Methods: A total number of 71 healthy subjects (Group I and 64 newly diagnosed epileptic patients (Group II were recruited from Al-Yarmouk and Baghdad Teaching hospitals in Baghdad from March 2015 to July 2015 and included in this study. The diagnosis of epilepsy achieved clinically, electroencephalograph record and radio-images including computerized tomography and magnetic image resonance. At the time of entry into the study, an electrocardiography (ECG was done, and the determinants of each ECG record were calculated. The QT-nomogram, tachogram, and cardiac restitution plots were used to identify the patients at risk of cardiac arrhythmias. Results: Significant prolonged corrected QT corrected (QTc and JT corrected intervals were observed in female compared with male at age ≥50 years while the TQ interval was significantly prolonged in males of Group II. Eight patients of Group II had a significant pathological prolonged QTc interval compared with undetectable finding in Group I. QT nomogram did not disclose significant findings while the plots of Lorenz and restitution steepness disclose that the patients of Group II were vulnerable to cardiac arrhythmias. Abnormal ECG findings were observed in the age extremities (≤18 years and ≥50 years in Group II compared with Group I. Conclusion: Utilization of QT-nomogram, restitution steepness, and tachogram plots is useful tools for detection subclinical vulnerable epileptic patient with cardiac arrhythmias.

  20. Epileptic Patients are at Risk of Cardiac Arrhythmias: A Novel Approach using QT-nomogram, Tachogram, and Cardiac Restitution Plots.

    Science.gov (United States)

    Al-Nimer, Marwan S; Al-Mahdawi, Sura A; Abdullah, Namir M; Al-Mahdawi, Akram

    2017-01-01

    Sudden death is reported in patients who had a history of epilepsy and some authors believed that is due to cardiac arrhythmias. This study aimed to predict that the epileptic patients are at risk of serious cardiac arrhythmias by QT-nomogram, tachogram (Lorenz), and cardiac restitution plots. A total number of 71 healthy subjects (Group I) and 64 newly diagnosed epileptic patients (Group II) were recruited from Al-Yarmouk and Baghdad Teaching hospitals in Baghdad from March 2015 to July 2015 and included in this study. The diagnosis of epilepsy achieved clinically, electroencephalograph record and radio-images including computerized tomography and magnetic image resonance. At the time of entry into the study, an electrocardiography (ECG) was done, and the determinants of each ECG record were calculated. The QT-nomogram, tachogram, and cardiac restitution plots were used to identify the patients at risk of cardiac arrhythmias. Significant prolonged corrected QT corrected (QTc) and JT corrected intervals were observed in female compared with male at age ≥50 years while the TQ interval was significantly prolonged in males of Group II. Eight patients of Group II had a significant pathological prolonged QTc interval compared with undetectable finding in Group I. QT nomogram did not disclose significant findings while the plots of Lorenz and restitution steepness disclose that the patients of Group II were vulnerable to cardiac arrhythmias. Abnormal ECG findings were observed in the age extremities (≤18 years and ≥50 years) in Group II compared with Group I. Utilization of QT-nomogram, restitution steepness, and tachogram plots is useful tools for detection subclinical vulnerable epileptic patient with cardiac arrhythmias.

  1. Baseline characteristics and initial treatment decisions for patients with schizophrenia at risk of treatment nonadherence

    Directory of Open Access Journals (Sweden)

    Katarina Kelin

    2010-08-01

    Full Text Available Katarina Kelin1, Alan JM Brnabic2, Richard Newton3, Raúl I Escamilla4, Liang-Jen Chuo5, Malina Simu6, Wenyu Ye2, William Montgomery1, Jamie Karagianis7, Haya Ascher-Svanum81Eli Lilly Australia Pty Ltd, West Ryde, NSW, Australia; 2Intercontinental Information Sciences, Eli Lilly Australia Pty Ltd, Macquarie Park, NSW, Australia; 3Peninsula Health Psychiatric Services, Frankston Hospital, Frankston, VIC, Australia (current affiliation: Department of Psychiatry, Austin Hospital, Heidelberg, VIC, Australia; 4Schizophrenia Clinic, National Institute of Psychiatry, Mexico City, México D.F; 5Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan; 6St Stelian Hospital, Bucharest, Romania; 7Eli Lilly Canada Inc., Toronto, ON, Canada; 8US Outcomes Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USAAbstract: In this year-long, prospective observational study, sociodemographic, clinical, and functional characteristics were assessed in outpatients with schizophrenia from Australia, ­Mexico, Romania, and Taiwan who were switched from their primary oral antipsychotic to another oral or depot antipsychotic at study entry because of physician-perceived ­nonadherence risks. Patients (N = 406 rated their quality of life and functioning level as low. Few patients (10.6%, 43/406 were switched to depot antipsychotics, with country-specific differences (P < 0.001. Although illness severity was similar between subgroups, the depot switch ­subgroup had: a documented history of nonadherence (32.6% versus oral: 4.7%; recent alcohol (48.8% versus 23.2%; P < 0.001 or illicit drug use (16.3% versus 5.0%; P = 0.010; recent depot antipsychotic (20.7% versus 7.5%; P = 0.030 and mood stabilizer use (51.7% versus 26.3%; P = 0.008; poorer attitudes towards medication (P = 0.004; and poorer illness ­awareness (P = 0.041. Findings indicate that even when a risk of nonadherence has been identified, few patients with

  2. A clinical decision model identifies patients at risk for delayed diagnosed injuries after high-energy trauma.

    Science.gov (United States)

    Snoek, Anniek; Dekker, Maaike; Lagrand, Tjerk; Epema, Anniek; van der Ploeg, Tjeerd; van den Brand, J G H

    2013-06-01

    Tertiary trauma survey is widely implemented in trauma care to identify all injuries in trauma patients. However, various studies consistently show that some trauma patients have missed injuries. In this study, we developed a clinical decision model to identify patients who are at risk for delayed diagnosed injuries. During a period of 18 months, we collected the medical records of all the adult patients who presented after a high-energy trauma at the emergency department of a Dutch trauma centre. The type of trauma, patient characteristics, the radiology studies performed, Glasgow Coma Scale, Revised Trauma Score, and Injury Severity Score (ISS) were registered. We thoroughly screened all medical records for delayed diagnosed injuries. Stepwise logistic regression analysis was used to identify the variables associated with the outcome delayed diagnosed injuries and to develop a clinical prediction model. We included 475 patients. Thirteen (2.7%) patients with delayed diagnosed injuries were identified. Stepwise logistic regression analysis revealed several models with the ISS, ICU admittance, and CT-head as predictive variables. The model we proposed with the ISS could identify patients who are at a risk for delayed diagnosed injuries with a sensitivity of 92.3% and a specificity of 86.4%. Our newly developed clinical decision model can identify patients who are at a risk for delayed diagnosed injuries and who should undergo an intensified search for potential unidentified injuries.

  3. Use of Corticosteroids for Urinary Tuberculosis Patients at Risk of Developing Ureteral Obstruction

    Science.gov (United States)

    Matsui, Kosuke; Furumoto, Akitsugu; Ohba, Kojiro; Mochizuki, Kota; Tanaka, Takeshi; Takaki, Masahiro; Morimoto, Konosuke; Ariyoshi, Koya

    2016-01-01

    A 77-year-old man with urinary tuberculosis developed post renal anuria two days after starting an anti-tuberculosis drug regimen. He had bilateral hydronephrosis, and his right kidney was radiologically diagnosed to be non-functioning. A transurethral catheter was placed in the left ureter. No improvement in the ureteral stricture was noted during the initial three weeks of treatment; however, the stricture did thereafter improve after the commencement of oral prednisolone. In cases of urinary tuberculosis, ureteral stricture can deteriorate and result in ureteral obstruction during anti-tuberculosis treatment. Pre-emptive administration of corticosteroids may be beneficial for preventing such stricture in patients with a pre-existing ureteral lesion. PMID:27904125

  4. Metformin revisited: a critical review of the benefit-risk balance in at-risk patients with type 2 diabetes.

    Science.gov (United States)

    Scheen, A J; Paquot, N

    2013-05-01

    Metformin is unanimously considered a first-line glucose-lowering agent. Theoretically, however, it cannot be prescribed in a large proportion of patients with type 2 diabetes because of numerous contraindications that could lead to an increased risk of lactic acidosis. Various observational data from real-life have shown that many diabetic patients considered to be at risk still receive metformin and often without appropriate dose adjustment, yet apparently with no harm done and particularly no increased risk of lactic acidosis. More interestingly, recent data have suggested that type 2 diabetes patients considered at risk because of the presence of traditional contraindications may still derive benefit from metformin therapy with reductions in morbidity and mortality compared with other glucose-lowering agents, especially sulphonylureas. The present review analyzes the benefit-risk balance of metformin therapy in special populations, namely, patients with stable coronary artery disease, acute coronary syndrome or myocardial infarction, congestive heart failure, renal impairment or chronic kidney disease, hepatic dysfunction and chronic respiratory insufficiency, all conditions that could in theory increase the risk of lactic acidosis. Special attention is also paid to elderly patients with type 2 diabetes, a population that is growing rapidly, as older patients can accumulate several comorbidities classically considered contraindications to the use of metformin. A review of the recent scientific literature suggests that reassessment of the contraindications of metformin is now urgently needed to prevent physicians from prescribing the most popular glucose-lowering therapy in everyday clinical practice outside of the official recommendations. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  5. Cardiovascular complications following thoracic radiotherapy in patients with cancer

    DEFF Research Database (Denmark)

    Nielsen, Kirsten Melgaard; Borchsenius, Julie I Helene; Offersen, Birgitte Vrou

    2016-01-01

    Cardiovascular complications following thoracic radiotherapy in patients with cancer are well described. Advancements in surgery, radiotherapy and systemic treatments have led to an increasing number of cancer survivors and thus an increasing number of patients with long-term side effects...... of their cancer treatments. This article describes the short- and long-term cardiovascular morbidity and mortality following thoracic radiotherapy and further, optimal cardiovascular assessments and diagnostic tools in asymptomatic and symptomatic patients....

  6. Cerebral oximetry improves detection of sickle cell patients at risk for nocturnal cerebral hypoxia.

    Science.gov (United States)

    Raj, Ashok B; O'brien, Louise M; Bertolone, Salvatore J; Gozal, David; Edmonds, Harvey L

    2006-11-01

    We previously used cerebral oximetry to identify low cerebral venous oxygen saturation in waking children with sickle cell disease (SCD). Because arterial oxyhemoglobin desaturation is common during sleep in SCD patients, this study compared both waking and sleeping systemic arterial and cerebral venous oxygenation dynamics in children with and without SCD. Seventeen African-American (AA) children with homozygous SCD [8 (4-15) years; 29% male; normal transcranial Doppler velocities] were compared with a control cohort (CON) comprised of six healthy AA children [9 (4-16) years, 33% male]. Standard all-night polysomnographic recordings were performed, including measurement of arterial oxygen saturation by pulse oximetry (SpO(2)). Regional cerebral oxygen saturation (rSO(2)) was measured non-invasively with cerebral oximetry. Intra-cohort comparisons examined the influence of sleep on SpO(2) and rSO(2) in the subjects. Inter-cohort comparisons of SpO(2), rSO(2,) and the rSO(2)/SpO(2) ratio assessed the impact of SCD on systemic and cerebral oxygenation during wakefulness and sleep. Cohort differences in SpO(2) were not statistically significant in either wakefulness or sleep. However, only in the SCD cohort was the magnitude of SpO(2) change statistically significant (P = 0.002). In contrast, both waking and sleep rSO(2) cohort median values did differ significantly [awake: CON 76 (67-86) vs. SCD 62 (58-71), P = 0.01; sleep: CON 65 (60-77) vs. SCD 55 (48-61), P = 0.01)]. The waking rSO(2)/SpO(2) ratio was also significantly lower in the SCD group [CON 0.78 (0.68-0.88) vs. SCD of 0.66 (0.61-0.72); P = 0.015]. During sleep, the ratio was also significantly lower in the SCD group [CON 0.71 (0.66-0.81) vs. SCD 0.59 (0.52-0.65); P = 0.011]. Our findings suggest that SCD patients may be at increased risk of cerebral hypoxia during both wakefulness and sleep.

  7. Quantification of myocardium at risk in ST- elevation myocardial infarction: a comparison of contrast-enhanced steady-state free precession cine cardiovascular magnetic resonance with coronary angiographic jeopardy scores.

    Science.gov (United States)

    De Palma, Rodney; Sörensson, Peder; Verouhis, Dinos; Pernow, John; Saleh, Nawzad

    2017-07-27

    Clinical outcome following acute myocardial infarction is predicted by final infarct size evaluated in relation to left ventricular myocardium at risk (MaR). Contrast-enhanced steady-state free precession (CE-SSFP) cardiovascular magnetic resonance imaging (CMR) is not widely used for assessing MaR. Evidence of its utility compared to traditional assessment methods and as a surrogate for clinical outcome is needed. Retrospective analysis within a study evaluating post-conditioning during ST elevation myocardial infarction (STEMI) treated with coronary intervention (n = 78). CE-SSFP post-infarction was compared with angiographic jeopardy methods. Differences and variability between CMR and angiographic methods using Bland-Altman analyses were evaluated. Clinical outcomes were compared to MaR and extent of infarction. MaR showed correlation between CE-SSFP, and both BARI and APPROACH scores of 0.83 (p myocardial salvage in this patient population. Clinical trial registration information for the parent clinical trial: Karolinska Clinical Trial Registration (2008) Unique identifier: CT20080014. Registered 04th January 2008.

  8. Patient-Reported Barriers to the Prekidney Transplant Evaluation in an At-Risk Population in the United States.

    Science.gov (United States)

    Lockwood, Mark B; Saunders, Milda R; Nass, Rachel; McGivern, Claire L; Cunningham, Patrick N; Chon, W James; Josephson, Michelle A; Becker, Yolanda T; Lee, Christopher S

    2017-06-01

    Despite our knowledge of barriers to the early stages of the transplant process, we have limited insight into patient-reported barriers to the prekidney transplant medical evaluation in populations largely at-risk for evaluation failure. One-hundred consecutive adults were enrolled at an urban, Midwestern transplant center. Demographic, clinical, and quality of life data were collected prior to patients visit with a transplant surgeon/nephrologist (evaluation begins). Patient-reported barriers to evaluation completion were collected using the Subjective Barriers Questionnaire 90-days after the initial medical evaluation appointment (evaluation ends), our center targeted goal for transplant work-up completion. At 90 days, 40% of participants had not completed the transplant evaluation. Five barrier categories were created from the 85 responses to the Subjective Barriers Questionnaire. Patient-reported barriers included poor communication, physical health, socioeconomics, psychosocial influences, and access to care. In addition, determinants for successful evaluation completion included being of white race, higher income, free of dialysis, a lower comorbid burden, and reporting higher scores on the Kidney Disease Quality of Life subscale role-emotional. Poor communication between patients and providers, and among providers, was the most prominent patient-reported barrier identified. Barriers were more prominent in marginalized groups such as ethnic minorities and people with low income. Understanding the prevalence of patient-reported barriers may aid in the development of patient-centered interventions to improve completion rates.

  9. Exercise and sports in cardiac patients and athletes at risk: Balance between benefit and harm.

    Science.gov (United States)

    Maisch, B

    2015-05-01

    Physical training has a well-established role in the primary and secondary prevention of coronary artery disease. Moderate exercise has been shown to be beneficial in chronic stable heart failure. Competitive sports, however, is contraindicated in most forms of hypertrophic cardiomyopathy (HCM), in myocarditis, in pericarditis, and in right ventricular cardiomyopathy/dysplasia. In most European countries, the recommendations of medical societies or public bodies state that these diseases have to be ruled out by prescreening before an individual can take up competitive sports. But the intensity and quality of this health check vary considerably from country to country, from the type of sports activity, and from the individuals who want to participate in sports. Prescreening on an individual basis should also be considered for leisure sports, particularly in people who decide to start training in middle age after years of physical inactivity to regain physical fitness. In leisure sports the initiative for a medical check-up lies primarily in the hands of the "healthy" individual. If she or he plans to participate in extreme forms of endurance sports with excessive training periods such as a marathon or ultramarathon and competitive cycling or rowing, they should be aware that high-intensity endurance sports can lead to structural alterations of the heart muscle even in healthy individuals. Physical exercise in patients with heart disease should be accompanied by regular medical check-ups. Most rehabilitation programs in Europe perform physical activity and training schedules according to current guidelines. Little is known about athletes who are physically handicapped and participate in competitive sports or the Paralympics, and even less is known about individuals with intellectual disabilities (ID) who participate in local, regional, international competitions or the Special Olympics or just in leisure sport activities.

  10. Antiphospholipid syndrome: antibodies to Domain 1 of β2-glycoprotein 1 correctly classify patients at risk.

    Science.gov (United States)

    Pengo, V; Ruffatti, A; Tonello, M; Cuffaro, S; Banzato, A; Bison, E; Denas, G; Padayattil Jose, S

    2015-05-01

    Determination of lupus anticoagulant (LA), anticardiolipin (aCL) and β2-Glycoprotein 1 (aβ2GP1) antibodies is mandatory to classify patients with antiphospholipid syndrome (APS) into risk categories. To measure relevant antibodies, considered to be those of the IgG isotype directed towards β2GP1 and particularly those directed to Domain 1 (Dm1) of the molecule. In this cross-sectional study we measured IgG aβ2GP1-Dm1 by a chemiluminescent immunoassay in a group of individuals initially positive for IgG aβ2GP1 and classified as triple (LAC+, IgG aCL+, IgG aβ2GP1+, n = 32), double (LAC-, IgG aCL+, IgG aβ2GP1+, n = 23) or single positive (LA-, IgG aCL-, IgG aβ2GP1+, n = 10). Geometric mean and standard deviation expressed as chemiluminescent units (CU) in triple, double and single positive groups were 273.0 ± 6.2, 18.2 ± 9.6 and 4.4 ± 2.2, respectively. The geometric mean obtained in 40 healthy subjects was 2.0 ± 2.0. Mean CU values were significantly different among groups and with respect to values found in 40 healthy subjects (P < 0.0001). Positive values of IgG aβ2GP1-Dm1 (above 14.2 CU) were found in 45 individuals while 20 individuals (20/65 = 30.8%) positive for IgG aβ2GP1 were negative for IgG aβ2GPI-Dm1. There was a significant association between positive IgG aβ2GP1-Dm1 and thromboembolic events (P = 0.001). Positive and negative values of IgG aβ2GP1-Dm1 were consistently confirmed after 12 weeks, with only three low positive values being negative after 12 weeks. In conclusion, IgG aβ2GP1-Dm1 seems a robust and reproducible test that in association with the classic tests may be useful in clinical practice in identifying individuals at high risk of developing thromboembolic events. © 2015 International Society on Thrombosis and Haemostasis.

  11. Antioxidants Supplementation in Elderly Cardiovascular Patients

    Directory of Open Access Journals (Sweden)

    Matilde Otero-Losada

    2013-01-01

    Full Text Available Supplementation with antioxidants and its benefit-risk relationship have been largely discussed in the elderly population. We evaluated whether antioxidants supplementation improved the biochemical profile associated with oxidative metabolism in elderly cardiovascular patients. Patients (n=112 received daily supplementation with α-TP 400 mg, beta-carotene 40 mg, and vitamin C 1000 mg for 2 months (treatment. Plasma concentrations of alpha-tocopherol (α-TP, β-carotene (βC, ubiquinol-10 (QH-10, glutathione, and thiobarbituric acid reactive substances (TBARS were determined before and after treatment. Response to treatment was dependent on pretreatment α-TP and βC levels. Increase in α-TP and βC levels was observed only in patients with basal levels <18 μM for α-TP (P<0.01 and <0.30 μM for βC (P<0.02. Ubiquinol-10, glutathione, and TBARS were unaffected by treatment: QH-10 (+57%,  F1,110=3.611, P<0.06, and N.S., glutathione (+21%,  F1,110=2.92, P<0.09, and N.S., and TBARS (−29%,  F1,110=2.26, P<0.14, and N.S.. Treatment reduced oxidative metabolism: 5.3% versus 14.6% basal value (F1,110=9.21, P<0.0003. Basal TBARS/α-TP ratio was higher in smokers compared to nonsmokers: 0.11 ± 0.02 versus 0.06 ± 0.01 (F32,80=1.63, P<0.04. Response to antioxidant supplementation was dependent on basal plasma levels of α-TP and βC. Smoking status was strongly associated with atherosclerotic cardiovascular disease and high TBARS/α-TP ratio (lipid peroxidation.

  12. A lifestyle intervention supported by mobile health technologies to improve the cardiometabolic risk profile of individuals at risk for cardiovascular disease and type 2 diabetes: study rationale and protocol.

    Science.gov (United States)

    Stuckey, Melanie I; Shapiro, Sheree; Gill, Dawn P; Petrella, Robert J

    2013-11-07

    Metabolic syndrome is a cluster of cardiovascular risk factors that greatly increase the risk of developing cardiovascular disease and type 2 diabetes. Regular exercise improves the risk profile, but most people do not successfully change their exercise habits to beneficially reduce risk. Tailored exercise prescribed by a family physician has shown promise as a means to increase fitness and reduce cardiometabolic risk, but optimal implementation practices remain unknown. Mobile health technologies have proved to be a beneficial tool to achieve blood pressure and blood glucose control in patients with diabetes. These technologies may address the limited access to health interventions in rural and remote regions. However, the potential as a tool to support exercise-based prevention activities is not well understood. This study was undertaken to investigate the effects of a tailored exercise prescription alone or supported by mobile health technologies to improve metabolic syndrome and related cardiometabolic risk factors in rural community-dwelling adults at risk for cardiovascular disease and type 2 diabetes. Adults (n = 149) with at least two metabolic syndrome risk factors were recruited from rural communities and randomized to either: 1) an intervention group receiving an exercise prescription and devices for monitoring of risk factors with a smartphone data portal equipped with a mobile health application; or 2) an active control group receiving only an exercise prescription. All participants reported to the research centre at baseline, and at 12-, 24- and 52-week follow-up visits for measurement of anthropometrics and blood pressure and for a blood draw to test blood-borne markers of cardiometabolic health. Vascular and autonomic function were examined. Fitness was assessed and exercise prescribed according to the Step Test and Exercise Prescription protocol. This study tested the effects of a prescriptive exercise intervention alone, versus one supported

  13. [Efficacy and Safety of Rosuvastatin in Patients of Different Risk Groups of Developing Cardiovascular Diseases].

    Science.gov (United States)

    Drapkina, O M; Eliashevich, S O

    2015-01-01

    The purpose of the review - analysis of randomized clinical trials to evaluate the efficacy and safety of rosuvastatin in respect of primary and secondary prevention of cardiovascular events, as well as in patients with acute coronary syndrome. As a primary pathogenetic therapy aimed at reducing the risk of cardiovascular disease and death from cardiovascular disease ischemic nature, used statins, which have both lipid-lowering and pleiotropic other positive properties. When analyzing the results of the comparative evaluation of different statins best performance indicators in primary and secondary prevention of cardiovascular events were at the rosuvastatin. The first drug is bioequivalent to the original rosuvastatin in Russia became mertenil company "Gedeon Richter". The therapeutic equivalence of mertenil is comparable with that of the original drug in patients of different groups at risk of developing cardiovascular complications (from low to very high). Mertenil can be regarded as an effective and safe drug from the group of statins for primary and secondary prevention of cardiovascular complications in patients of all risk groups.

  14. [Efficacy and Safety of Rosuvastatin in Patients of Different Risk Groups of Developing Cardiovascular].

    Science.gov (United States)

    Drapkina, O M; Eliashevich, S O

    2015-02-01

    The purpose of the review - analysis of randomized clinical trials to evaluate the efficacy and safety of rosuvastatin in respect of primary and secondary prevention of cardiovascular events, as well as in patients with acute coronary syndrome. As a primary pathogenetic therapy aimed at reducing the risk of cardiovascular disease and death from cardiovascular disease ischemic nature, used statins, which have both lipid-lowering and pleiotropic other positive properties. When analyzing the results of the comparative evaluation of different statins best performance indicators in primary and secondary prevention of cardiovascular events were at the rosuvastatin. The first drug is bioequivalent to the original rosuvastatin in Russia became mertenil company "Gedeon Richter". The therapeutic equivalence of mertenil is comparable with that of the original drug in patients of different groups at risk of developing cardiovascular complications (from low to very high). Mertenil can be regarded as an effective and safe drug from the group of statins for primary and secondary prevention of cardiovascular complications in patients of all risk groups.

  15. Primary care assessment instruments for patients at risk of, or with, persistent pain: opportunistic findings from a systematic literature review

    Directory of Open Access Journals (Sweden)

    Karen Grimmer-Somers

    2009-06-01

    Full Text Available Karen Grimmer-Somers1, Saravana Kumar1, Nic Vipond2, Gillian Hall21Centre for Allied Health Evidence, University of South Australia, Australia; 2Accident Compensation Corporation, Wellington, New ZealandBackground: Early identification in primary care settings of individuals with, or at-risk of, developing persistent pain, is important to limit development of disability. There is little information to assist primary care providers to choose or deliver relevant, efficient, and soundly constructed assessment instruments for this purpose.Objective: We recently published the findings of a literature review, which produced a compendium of assessment instruments to identify adults with, or at-risk of developing, persistent pain of noncancer origin. This paper reports on instruments opportunistically identified during this review which may be appropriate to primary health care settings for early identification of such patients.Results: One hundred sixteen potentially useful instruments were initially identified in the review, measuring pain severity, psychological distress, functional capacity, quality of life or multidimensional constructs of persistent pain. Following a series of steps, 45 instruments were shortlisted, with sound clinical utility and strong psychometric properties. Of these, 16 instruments were appropriate to primary health care settings because of simple wording, brief items, short administration time, and ease of scoring.Conclusion: No one assessment instrument captured all constructs of persistent pain. The 16 instruments provide a broad choice for primary care clinicians to assist with early identification of adults at risk of, or with persistent pain.Keywords: adults with persistent pain, primary health care assessment, early identification

  16. Cardiovascular risk prediction in chronic kidney disease patients.

    Science.gov (United States)

    Cedeño Mora, Santiago; Goicoechea, Marian; Torres, Esther; Verdalles, Úrsula; Pérez de José, Ana; Verde, Eduardo; García de Vinuesa, Soledad; Luño, José

    Scores underestimate the prediction of cardiovascular risk (CVR) as they are not validated in patients with chronic kidney disease (CKD). Two of the most commonly used scores are the Framingham Risk Score (FRS-CVD) and the ASCVD (AHA/ACC 2013). The aim of this study is to evaluate the predictive ability of experiencing a cardiovascular event (CVE) via these 2scores in the CKD population. Prospective, observational study of 400 prevalent patients with CKD (stages 4 and 5 according the KDOQI; not on dialysis). Cardiovascular risk was calculated according to the 2scores and the predictive capacity of cardiovascular events (atherosclerotic events: myocardial infarction, ischaemic and haemorrhagic stroke, peripheral vascular disease; and non-atherosclerotic events: heart failure) was analysed. Forty-nine atherosclerotic cardiovascular events occurred in 40.3±6.6 months of follow-up. Most of the patients were classified as high CVR by both scores (59% by the FRS-CVD and 75% by the ASCVD). All cardiovascular events occurred in the high CVR patients and both scores (FRS-CVD log-rank 12.2, Prenal function, albuminuria and previous cardiovascular events. The cardiovascular risk scores (FRS-CVD and ASCVD [AHA/ACC 2013]) can estimate the probability of atherosclerotic cardiovascular events in patients with CKD regardless of renal function, albuminuria and previous cardiovascular events. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  17. Cardiovascular magnetic resonance of the myocardium at risk in acute reperfused myocardial infarction: comparison of T2-weighted imaging versus the circumferential endocardial extent of late gadolinium enhancement with transmural projection.

    Science.gov (United States)

    Ubachs, Joey F A; Engblom, Henrik; Erlinge, David; Jovinge, Stefan; Hedström, Erik; Carlsson, Marcus; Arheden, Håkan

    2010-03-29

    In the situation of acute coronary occlusion, the myocardium supplied by the occluded vessel is subject to ischemia and is referred to as the myocardium at risk (MaR). Single photon emission computed tomography has previously been used for quantitative assessment of the MaR. It is, however, associated with considerable logistic challenges for employment in clinical routine. Recently, T2-weighted cardiovascular magnetic resonance (CMR) has been introduced as a new method for assessing MaR several days after the acute event. Furthermore, it has been suggested that the endocardial extent of infarction as assessed by late gadolinium enhanced (LGE) CMR can also be used to quantify the MaR. Hence, we sought to assess the ability of endocardial extent of infarction by LGE CMR to predict MaR as compared to T2-weighted imaging. Thirty-seven patients with early reperfused first-time ST-segment elevation myocardial infarction underwent CMR imaging within the first week after percutaneous coronary intervention. The ability of endocardial extent of infarction by LGE CMR to assess MaR was evaluated using T2-weighted imaging as the reference method. MaR determined with T2-weighted imaging (34 +/- 10%) was significantly higher (p infarction (23 +/- 12%). There was a weak correlation between the two methods (r2 = 0.17, p = 0.002) with a bias of -11 +/- 12%. Myocardial salvage determined with T2-weighted imaging (58 +/- 22%) was significantly higher (p myocardial salvage determined with endocardial extent of infarction (45 +/- 23%). No MaR could be determined by endocardial extent of infarction in two patients with aborted myocardial infarction. This study demonstrated that the endocardial extent of infarction as assessed by LGE CMR underestimates MaR in comparison to T2-weighted imaging, especially in patients with early reperfusion and aborted myocardial infarction.

  18. Can tissue spectrophotometry and laser Doppler flowmetry help to identify patients at risk for wound healing disorders after neck dissection?

    Science.gov (United States)

    Rohleder, Nils H; Flensberg, Sandra; Bauer, Florian; Wagenpfeil, Stefan; Wales, Craig J; Koerdt, Steffen; Wolff, Klaus D; Hölzle, Frank; Steiner, Timm; Kesting, Marco R

    2014-03-01

    Microcirculation and oxygen supply in cervical skin were measured with an optical, noninvasive method in patients with or without radiotherapy before neck dissection. The course of wound healing was monitored after the surgical procedure to identify predictive factors for postoperative wound healing disorders. Tissue spectrophotometry and laser Doppler flowmetry were used to determine capillary oxygen saturation, hemoglobin concentration, blood flow, and blood velocity at 2-mm and 8-mm depths in the cervical skin of 91 patients before neck dissection in a maxillofacial unit of a university hospital in Munich, Germany. Parameters were evaluated for differences between patients with irradiation (24) and without (67) and patients with wound healing disorders (25) and without (66) (univariate or multivariate statistical analyses). Velocity at 2 mm was lower in irradiated skin (P = .016). Flow at 2 mm was higher in patients with wound healing disorders (P = .018). High flow values could help to identify patients at risk for cervical wound healing disorders. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Effect of phenylephrine/ketorolac on iris fixation ring use and surgical times in patients at risk of intraoperative miosis

    Directory of Open Access Journals (Sweden)

    Visco D

    2018-02-01

    Full Text Available Denise Visco Eyes of York Cataract & Laser Center, York, PA, USA Purpose: To evaluate the effect of intracameral phenylephrine/ketorolac (1%/0.3% during cataract surgery on the use of iris fixation ring and surgical time in patients with poor pupil dilation (≤5.0 mm or intraoperative floppy iris syndrome (IFIS. Setting: Private practice outpatient surgical center. Design: This retrospective analysis was conducted from January 1, 2014 to October 7, 2015. Materials and methods: The use of iris fixation rings was evaluated in a retrospective analysis of 46 patients who underwent cataract surgery from January 1, 2014, to October 7, 2015, and who were identified before surgery to be at risk for intraoperative miosis. The qualifying factors were presurgical examination of pupil dilation ≤5.0 mm after being administered topical tropicamide 1% and phenylephrine 2.5% or history of IFIS during surgery in the fellow eye. All patients received a 2-day preoperative course of topical nonsteroidal anti-inflammatory drugs (NSAIDs and day-of-surgery preoperative dilation using topical cyclopentolate 1%, tropicamide 1%, and phenylephrine 10%. Phenylephrine/ketorolac 1%/0.3% (Omidria® or epinephrine 1:1,000 with sulfites was added to the ophthalmic irrigation solution and delivered intracamerally at the start of the procedure and throughout surgery. The use of iris fixation rings and surgical time for each patient were captured for each group. Results: Eighteen (50% of the patients in the epinephrine group and no patients in the phenylephrine/ketorolac group required iris fixation ring insertion to maintain pupil dilation or to control IFIS (p=0.0034. Mean surgical time was significantly shorter in the group of patients who received phenylephrine/ketorolac (p=0.0068. Conclusion: In this retrospective cohort analysis of patients with poorly dilated pupils and/or IFIS, the use of intracameral phenylephrine/ketorolac in patients at risk for intraoperative

  20. Sexual orientation differences in treatment expectation, alliance, and outcome among patients at risk for suicide in a public psychiatric hospital.

    Science.gov (United States)

    Plöderl, Martin; Kunrath, Sabine; Cramer, Robert J; Wang, Jen; Hauer, Larissa; Fartacek, Clemens

    2017-05-15

    Sexual minority (SM) individuals (gay, lesbian, bisexual, or otherwise nonheterosexual) are at increased risk for mental disorders and suicide and adequate mental healthcare may be life-saving. However, SM patients experience barriers in mental healthcare that have been attributed to the lack of SM-specific competencies and heterosexist attitudes and behaviors on the part of mental health professionals. Such barriers could have a negative impact on common treatment factors such as treatment expectancy or therapeutic alliance, culminating in poorer treatment outcomes for SM versus heterosexual patients. Actual empirical data from general psychiatric settings is lacking, however. Thus, comparing the treatment outcome of heterosexual and SM patients at risk for suicide was the primary aim of this study. The secondary aim was to compare treatment expectation and working alliance as two common factors. We report on 633 patients from a suicide prevention inpatient department within a public psychiatric hospital. Most patients were at risk for suicide due to a recent suicide attempt or warning signs for suicide, usually in the context of a severe psychiatric disorder. At least one indicator of SM status was reported by 21% of patients. We assessed the treatment outcome by calculating the quantitative change in suicide ideation, hopelessness, and depression. We also ran related treatment responder analyses. Treatment expectation and working alliance were the assessed common factors. Contrary to the primary hypothesis, SM and heterosexual patients were comparable in their improvement in suicide ideation, hopelessness, or depression, both quantitatively and in treatment responder analysis. Contrary to the secondary hypothesis, there were no significant sexual orientation differences in treatment expectation and working alliance. When adjusting for sociodemographics, diagnosis, and length of stay, some sexual orientation differences became significant, indicating that SM

  1. Nutritional advice in older patients at risk of malnutrition during treatment for chemotherapy: a two-year randomized controlled trial.

    Science.gov (United States)

    Bourdel-Marchasson, Isabelle; Blanc-Bisson, Christelle; Doussau, Adélaïde; Germain, Christine; Blanc, Jean-Frédéric; Dauba, Jérôme; Lahmar, Cyril; Terrebonne, Eric; Lecaille, Cédric; Ceccaldi, Joël; Cany, Laurent; Lavau-Denes, Sandrine; Houede, Nadine; Chomy, François; Durrieu, Jessica; Soubeyran, Pierre; Senesse, Pierre; Chene, Geneviève; Fonck, Mariane

    2014-01-01

    We tested the effect of dietary advice dedicated to increase intake in older patients at risk for malnutrition during chemotherapy, versus usual care, on one-year mortality. We conducted a multicentre, open-label interventional, stratified (centre), parallel randomised controlled trial, with a 1∶1 ratio, with two-year follow-up. Patients were aged 70 years or older treated with chemotherapy for solid tumour and at risk of malnutrition (MNA, Mini Nutritional Assessment 17-23.5). Intervention consisted of diet counselling with the aim of achieving an energy intake of 30 kCal/kg body weight/d and 1.2 g protein/kg/d, by face-to-face discussion targeting the main nutritional symptoms, compared to usual care. Interviews were performed 6 times during the chemotherapy sessions for 3 to 6 months. The primary endpoint was 1-year mortality and secondary endpoints were 2-year mortality, toxicities and chemotherapy outcomes. Between April 2007 and March 2010 we randomised 341 patients and 336 were analysed: mean (standard deviation) age of 78.0 y (4·9), 51.2% male, mean MNA 20.2 (2.1). Distribution of cancer types was similar in the two groups; the most frequent were colon (22.4%), lymphoma (14.9%), lung (10.4%), and pancreas (17.0%). Both groups increased their dietary intake, but to a larger extent with intervention (pnutritional status changes was found. Response to chemotherapy was also similar between the groups. Early dietary counselling was efficient in increasing intake but had no beneficial effect on mortality or secondary outcomes. Cancer cachexia antianabolism may explain this lack of effect. ClinicalTrials.gov NCT00459589.

  2. Evaluation of a Community Pharmacy-Based Screening Questionnaire to Identify Patients at Risk for Drug Therapy Problems.

    Science.gov (United States)

    Pammett, Robert T; Blackburn, David; Taylor, Jeff; Mansell, Kerry; Kwan, Debbie; Papoushek, Christine; Jorgenson, Derek

    2015-09-01

    To determine if a short screening questionnaire can identify patients at risk for drug therapy problems (DTPs) in a community pharmacy setting. Self-administered questionnaire. Three community pharmacies in Saskatoon, Canada. Forty-nine adults who were picking up a refill prescription for a medication that had remained stable over the past 6 months (i.e., no changes to drug, dose, or regimen) during 4 consecutive weeks at each of the three pharmacies between November 2013 and February 2014. All patients completed a self-administered screening questionnaire and underwent a blinded comprehensive medication assessment with a clinical pharmacist. Agreement between the screening questionnaire responses and responses based on information from the medication assessment were assessed with Cohen's κ coefficient. The DTPs identified during the medication assessments were categorized in one of the eight standard DTP categories: unnecessary drug therapy, inappropriate drug, subtherapeutic dose, supratherapeutic dose, drug therapy required, adverse drug reaction, noncompliance, and other or unsure. The DTPs were also assigned a severity-mild, moderate, or severe-using adapted Schneider criteria. The number and severity of DTPs identified were compared among patients categorized as high versus low risk for DTPs as determined by the questionnaire responses. Of the 49 patients who completed the study, 18 (37%) were high risk and 31 (63%) low risk. The agreement between risk categorization based on the screening questionnaire and medication assessment was very good (κ = 0.91, p<0.01). Also, patients identified as high risk on the screening questionnaire had a mean of 3.7 (p<0.01) more DTPs than low-risk patients. Seventeen (94%) of the 18 high-risk patients had at least one moderate or severe DTP compared with 15 (48%) of the 31 low-risk patients. The screening questionnaire was a reliable method for identifying patients in community pharmacies who have a large number of DTPs

  3. Cardiovascular autonomic neuropathy and subclinical cardiovascular disease in normoalbuminuric type 1 diabetic patients

    DEFF Research Database (Denmark)

    Mogensen, Ulrik Madvig; Jensen, Tonny; Køber, Lars

    2012-01-01

    Cardiovascular autonomic neuropathy (CAN) is associated with increased mortality in diabetes. Since CAN often develops in parallel with diabetic nephropathy as a confounder, we aimed to investigate the isolated impact of CAN on cardiovascular disease in normoalbuminuric patients. Fifty......-six normoalbuminuric, type 1 diabetic patients were divided into 26 with (+) and 30 without (-) CAN according to tests of their autonomic nerve function. Coronary artery plaque burden and coronary artery calcium score (CACS) were evaluated using computed tomography. Left ventricular function was evaluated using...... with increased CACS, subclinical left ventricular dysfunction, and increased pulse pressure. In conclusion, CAN in normoalbuminuric type 1 diabetic patients is associated with distinct signs of subclinical cardiovascular disease....

  4. the metabolic syndrome among patients with cardiovascular disease ...

    African Journals Online (AJOL)

    Objectives: To determine the frequency of occurrence of the Metabolic Syndrome among patients presenting with cardiovascular disease at the Korle Bu Teaching Hospital, Ghana. Methods: This was a case-control study of 100 con-secutive cardiovascular disease patients and 100 age- and sex- matched controls who ...

  5. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis

    NARCIS (Netherlands)

    Fellström, Bengt C.; Jardine, Alan G.; Schmieder, Roland E.; Holdaas, Hallvard; Bannister, Kym; Beutler, Jaap; Chae, Dong-Wan; Chevaile, Alejandro; Cobbe, Stuart M.; Grönhagen-Riska, Carola; de Lima, José J.; Lins, Robert; Mayer, Gert; McMahon, Alan W.; Parving, Hans-Henrik; Remuzzi, Giuseppe; Samuelsson, Ola; Sonkodi, Sandor; Sci, D.; Süleymanlar, Gultekin; Tsakiris, Dimitrios; Tesar, Vladimir; Todorov, Vasil; Wiecek, Andrzej; Wüthrich, Rudolf P.; Gottlow, Mattis; Johnsson, Eva; Zannad, Faiez; Fellström, B.; Zannad, F.; Schmieder, R. E.; Holdaas, H.; Jardine, A. G.; Johnsson, E.; Gottlow, M.; Bannister, K.; Beutler, J.; Chae, D.; Cobbe, S. M.; Grönhagen-Riska, C.; de Lima, J.; Lins, R.; McMahon, A.; Mayer, G.; Parving, H.-H.; Chevaile, A.; Remuzzi, G.; Samuelsson, O.; Sonkodi, S.; Süleymanlar, G.; Tsakiris, D.; Tesar, V.; Todorov, V.; Wiecek, A.; Wüthrich, R. P.; Dargie, H.; Ritz, E.; Wedel, H.; Zwinderman, A. H.; Brady, A.; Deighan, C.; Macfarlane, P.; Stott, D.; Gillies, A.; Carney, S.; Faull, R.; Surany, M.; Saltissi, D.; Fraenkel, M.; Mount, P.; Irish, A.; Chan, D.; Dogra, S.; Wei, S.; Roger, S.; Pollock, C.; Cooper, B.; Brown, F.; Healy, H.; Hutchinson, B.; Boudville, N.; Senaratne, S.; Luxton, J.; Disney, A.; Russ, G.; Isbel, N.; Johnson, D.; Wong, J.; Herzig, K.; Walker, R.; Leikis, M.; Masterson, R.; Perkovic, V.; Kramar, R.; Robl, B.; Stummvoll, H.-K.; Holzer, H.; Prager, R.; Graf, H.; Neyer, U.; Kovarik, J.; Balcke, P.; Muyshondt, I.; Claes, K.; Maes, B.; Jadoul, M.; Dupont, P.; Marchal, M.; Pirson, Y.; Cambier, P.; Robin, M.; Warling, X.; Tielemans, C.; van der Niepen, P.; van Vlem, B.; Billiouw, J.-M.; de Meester, J.; Krzesinski, J.-M.; Dubois, B.; Delanaye, P.; Gowdak, L.; Barbosa, A.; Abreu, P.; Balda, C.; Canziani, M. E.; Watanabe, R.; Barata, R.; Lisboa, N.; Vilarinho, R.; Pecoits, R.; Teixeira, P.; Fortes, P.; Kraev, Z.; Koteva, A.; Georgiev, M.; Krivoshiev, S.; Popov, A.; Baldev, T.; Terziiska, G.; Rangelov, R.; Ekova, D.; Vitanova, L.; Mitova, V.; Videnova, N.; Dimitrova, B.; Dosev, D.; Vasileva, V.; Dimitrakov, D.; Blagov, B.; Nikolov, D.; Tilkijan, E.; Kapon, E.; Stavrev, P.; Guncheva, N.; Paunova, P.; Tashkov, B.; Bojadziev, D.; Popova, G.; Delibaltov, I.; Markov, M.; Koleva, N.; Petrova, M.; Berall, M.; Pierratos, A.; Mendelssohn, D.; Hercz, G.; Burgess, E.; Cournoyer, S.; Giroux, C.; Soltys, G.; Savoie, L.; Brunet, S.; Begin, V.; Duncan, J.; Yeung, C.; Cameron, E.; Jastrzebski, J.; Shapiro, J.; Copland, M.; Keown, P.; Singh, R.; Jolly, S.; Mustata, S.; Kates, D.; Jung, B.; Jamal, A.; Levin, A.; Chiu, A.; Chan-Yan, C.; Landsberg, D.; Macrae, J. M.; Gill, J.; de Luca, L.; Kiaii, M.; Taylor, P.; Lambert, F.; Berrard, J.; Youmbissi, J.; Bessette, M.; Turcot, R.; Moreau, V.; Davidman, M.; Bencovitch, D.; Frisch, G.; Lipman, M.; Pannu, N.; Davison, S.; Gourishankar, S.; Rehman, F.; Muirhead, N.; House, A.; Pichette, V.; Leblanc, M.; Prud'Homme, L.; Marcotte, J.; Desjardins, M.-H.; Raymond, M.; Tremblay, R.; Richardson, R.; Chan, C.; Sohi, P.; Pippy, C.; Gogan, N.; Handa, S.; Soroka, S.; Hirsh, D.; Panek, R.; Keough-Ryan, T.; Ting, R.; Fung, J.; Ng, P.; Tam, P.; Chow, S.; Zacharias, J.; Wu, G.; Kim, D.; Wong, G.; Wadgymar, J.; Wong, M.; Schuld, R.; Bitterova, Z.; Hanek, T.; Dvorak, K.; Pavlikova, Z.; Fixa, P.; Zahradnik, J.; Suchanova, J.; Krizova, E.; Zavada, J.; Lachmanova, J.; Mokrejsova, M.; Viklicky, O.; Lyerova, L.; Urbanova, M.; Syrovatka, P.; Kukura, S.; Svara, F.; Sagova, M.; Sulkova, S.; Polakovic, V.; Ryba, M.; Koci, P.; Ladefoged, S.; Jensen, H.; Rasmussen, K.; Nielsen, G.; Østergaard, O.; Nielsen, A.; Lynggaard, F.; Otte, K.; Steffensen, G.; Løkkegaard, N.-J.; Danielsen, H.; Hasling, C.; Hansen, S.; Freese, P.; Hansen, J.; Rasmussen, E.; Nielsen, F.; Egfjord, M.; Szpirt, W.; Mustonen, J.; Saha, H.; Ala-Houhala, I.; Ekstrand, A.; Honkanen, E.; Ylinen, K.; Malmström, R.; Rauta, V.; Tertti, R.; Metsärinne, K.; Heiro, M.; Koivuviita, N.; Kananen, K.; Salmela, A.; Lepistö, P.; Ikäheimo, R.; Pikkujämsä, S.; Karhapää, P.; Lumiaho, A.; Pulkkinen, A.; Helanterä, A.; Wallin, M.; Kolunen, M.; Asola, M.; Huhti, J.; Jääskeläinen, K.; Nuortimo, J.; Stenborg, M.; Erkinheimo, J.; Huuskonen, M.; Paldanius, R.; Helin, K.; Norvio, L.; Haapala, M.; Lindström, C.-J.; Monkam, R.; Bataille, P.; Nour, D.; Bouzerjnidj, M.; Wheatley, P.; Billion, S.; Brignon, P.; Maaz, M.; Charpentier, B.; Durrbach, A.; Djeffal, R.; Snanoudj, R.; El Esper, N.; Choukroun, G.; Dahmane, D.; Fessi, H.; Kessler, M.; Bellou-Zerrouki, M.; Cao-Huu, T.; Lamotte, C.; Lebleu, J.; Luong, C.-N.; Bouali, B.; Reach, I.; Mac-Namara, E.; Bourdon, F.; Majdanali, G.; Bouffandeau, A.; Chaghouri, B.; Hugot, V.; Torres, P. A. U.; Binaut, R.; Fleury, D.; Bacri, J.-L.; Maisonneuve, N.; Vanhille, P.; Lemaitre, V.; Lambrey, G.; Zaoui, P.; Kuentz, F.; Palancin, P.; Milongo, R.; Hachache, T.; Dehais, F.; Dupuy, P.; Wehbe, B.; Benarbia, S.; Yver, L.; Pujo, M.; Fourcade, J.; Philit, J.-B.; Ballé, C.; Bambauer, R.; Bittner, K.; Dragoun, G.-P.; Matzkies, F.; Hartmann, H.; Hoffmann, H.-D.; Kliem, V.; Kraatz, U.; Kraatz, G.; Krämer, H.; Krämer, W.; Krämer-Guth, A.; Kühn, R.; Kulzer, P.; Kurth, C.; Liebl, R.; Merker, L.; Meyer, T.; Mohler, C.; Neumann, K.; Nikolay, J.; Reiter, E.; Schannen, G.; Scherberich, J.; Schmieder, R.; Sperschneider, H.; Wagner, J.; Bast, I.; Anding-Rost, K.; Passauer, J.; Scheuermann, E.; Krause, R.-D.; Pommer, W.; Bhandari, S.; Webb, A.; Lewis, D.; Eadington, D.; Collinson, H.; Sellars, L.; Svreck, P.; Brown, A.; Bow, A.; Ahmed, S.; Severn, A.; Henderson, I.; Jardine, A.; Junor, B.; Nolan, C.; Geddes, C.; McGregor, E.; Mark, P.; Patel, R.; Rodger, S.; Main, J.; Reaich, D.; Paterson, A.; Maxwell, P.; Brown, H.; Finn, M.; O'Donoghue, D.; Wood, G.; Espinosa, O.; Middleton, R.; Woodrow, G.; Wright, M.; Rowe, P.; Cramp, H.; Tse, W.; Fox, J.; Macteir, R.; Isles, C.; Streather, C.; Semple, D.; Banerjee, D.; Mitra, S.; Gokal, R.; Bubtana, A.; Asari, A.; Jeffrey, R.; Mumtaz, R.; El Nahas, M.; Kwan, J.; Kumwenda, M.; Douglas, A.; Harron, C.; Courtney, A.; Sunil, J.; Garrett, P.; Maddekar, N.; Bergin, E.; Harty, J.; Conway, B.; Hollywood, M.; Macgregor, M.; Mackenzie, P.; Papagalanis, N.; Biblaki, D.; Ntatsis, G.; Kaperonis, N.; Siapera, V.; Iatrou, C.; Kontouli, T.; Spanou, E.; Kalocheretis, P.; Zerbala, S.; Sofroniadou, S.; Kelesidis, A.; Xanthopoulou, K.; Tsouchnikas, I.; Papakonstantinou, S.; Sobolos, K.; Bamichas, G.; Siamopoulos, K.; Gouva, C.; Kitsos, A.; Katopodis, K.; Nikolopoulos, P.; Vargemezis, V.; Thodis, E.; Yannatos, E.; Katartzi, K.; Panagoutsos, S.; Kiss, E.; Zsom, M.; Kiss, I.; Lakatos, A.; Fodor, E.; Nádori, E.; Arkossy, O.; Koroknai, L.; Mázik, R.; Vezekényi, Z.; Kovács, A.; Samir, N.; Akócsi, K.; Varga, G.; Ferenczi, S.; Villányi, B.; Schneider, K.; Vinkovits, S.; Czégány, Z.; Onody, Z.; Szegedi, J.; Valikovics, F.; Angyal, S.; Zilahi, Z.; Ladányi, E.; Széll, J.; Berta, K.; Szamosfalvi, B.; Ambrus, C.; Deák, G.; Faludi, M.; Molnár, M.; Zakar, G.; Varga, D.; Kovács, L.; Tüsér, Z.; Bodvarsson, M.; Arnadottir, M.; Redden, D.; Mutwali, A.; Griffin, B.; Lenihan, C.; O'Seaghda, C.; Lappin, D.; Gafney, M.; Akram, M.; Marchesi, D.; Mingardi, G.; Allaria, P.; Giangrande, A.; Lucatello, A.; Caligara, F.; Angelo, L.; Deferrari, G.; Robaudo, C.; Lauria, F.; Imbasciati, E.; Barbisoni, F.; Farina, M.; Maggio, M.; Borlandelli, S.; Badalamenti, S.; Finazzi, S.; Angelini, C.; Bianchi, G.; Spotti, D.; Quartagno, R.; Malberti, F.; La Russa, A.; Pecchini, P.; Ghiringhelli, P.; Zoccali, C.; Delfino, D.; Mallamaci, F.; Marino, F.; Curatola, G.; Caridi, G.; Ciccarelli, M.; Borghi, M.; Tagliaferri, M.; Massazza, M.; Espinoza, B.; Torres, M.; López, E.; Montañez, J. L.; Bochicchio, T.; Cruz, J.; Cordero, L.; Hollander, A.; Hoogeveen, E.; Koolen, M.; Bos, W.; Endeman, H.; Vincent, H.; Geers, T.; Rensma, P.; Apperloo, A.; Haest, R.; van de Ven, P.; Alphen, R.; van Buren, M.; Essen, G.; Woittiez, A.; Ouwehand, A.; Vleming, L.; Krol-van Stratten, M.; Janssen, W.; Kremer Horinga, T.; Kloppenburg, W.; Doorenbos, C.; Sluiter, H.; Smak-Gregoor, P.; van Bommel, E.; Jongh, J.; Verseput, G.; Hagen, E.; Stork, A.; Gaillard, C.; Pondman, M.; Bax, W.; van Geelen, J.; Schrama, Y.; Rietveld, A.; Op de Hoek, C.; Diderich, P.; Kaasjager, H.; Bosch, F.; Reichert, L.; Hemmelder, M.; Halma, C.; Broekroelofs, J.; Haanstra, W.; Vastenburg, G.; de Fijter, C.; Groeneveld, J.; Bergrem, H.; Thorud, L.; Viko, H.; Eggesbø, J.; Halvorsen, C.; Hunderi, O.; Abedini, S.; Broch, L.; Heldal, K.; Lyngdal, P.; Iversen, B.; Øien, C.; Selvig, K.; Witkowicz, J.; Spiechowicz-Zatoń, U.; Marcinkowski, W.; Ksiazek, A.; Baranowicz-Gaszczyk, I.; Jóźwiak, L.; Kuczera, M.; Szweblik, J.; Bieńkowski, J.; Wajda, J.; Bogdanowicz, G.; Jaworska-Wieczorek, J.; Myśliwiec, M.; Barczyk, M.; Kalinowski, M.; Mazerska, M.; Trusewicz, W.; Ostrowski, J.; Błaszczyk, E.; Majczyńska, I.; Kazimierczak, J.; Kacki, J.; Kochman, P.; Rutkowski, B.; Białobrzeska, B.; Jankowska, M.; Chmielewski, M.; Zdrojewski, Z.; Debska-Slizień, A.; Switalski, M.; Kepka, A.; Szewczyk, D.; Fusik, J.; Kuriga, M.; Ostrowski, M.; Myszta, T.; Sułowicz, W.; Radziszewski, A.; Walatek, B.; Kaczmarczyk, I.; Drozdz, M.; Piotrowska, M.; Kraśnicka, M.; Koźmiński, P.; Pawłowska, S.; Zygadło, H.; Zalasińska, I.; Chae, D.-W.; Jin, H.; Kim, S.; Song, Y.; Na, K.-Y.; Oh, J.-E.; Oh, K. H.; Kim, Y.-G.; Kim, B.; Baek, H.-J.; Kim, J.-A.; Lee, Y. J.; Chang, Y.-S.; Park, C. W.; Chung, H.-W.; Han, S.; Kim, Y.-S.; Park, J.-A.; Choi, B.-S.; Yoon, H. E.; Hwang, H.; Yoon, J.-M.; Kim, J.-Y.; Han, S.-W.; Kang, C.-M.; Lee, C.-W.; Kim, G.-H.; Choi, N.-W.; Ihm, C.-G.; Jeong, K.-H.; Kim, M.-J.; Lee, S.-H.; Lee, T.-W.; Wikström, B.; Linde, T.; Nisbeth, U.; Mulec, H.; Kronvall, M.; Frisenette-Fich, C.; Ståhl Nilsson, A.; Mauritz, N.-J.; Schirdewan, S.; Stelin, G.; Ottosson, P.; Stefansson, B.; Ramsauer, B.; Hultström, D.; Hadimeri, H.; Andersson, P.-O.; Al Magdasi, H.; Weiss, L.; Welander, G.; Gröntoft, K. C.; Zezina, L.; Svensson, L.; Fagerström, A.; Lund, U.; Tidman, M.; Lundin, C.; Sjöström, P.; Wessén, P.; Halvarsson, P.; Wrege, U.; Linder, M.; Ekspong, A.; Jensen, G.; Alfredsson, A.; Löfberg, E.; Almroth, G.; Haarhaus, M.; Gisslén, K.; Mathillas, O.; Bock, A.; Burnier, M.; Binet, I.; Tsinalis, D.; Wüthrich, R.; Basci, A.; Turgan, C.; Duranay, M.; Nergizoglu, G.; Gullulu, M.; Turkmen, F.

    2009-01-01

    BACKGROUND: Statins reduce the incidence of cardiovascular events in patients at high cardiovascular risk. However, a benefit of statins in such patients who are undergoing hemodialysis has not been proved. METHODS: We conducted an international, multicenter, randomized, double-blind, prospective

  6. Health status in patients at risk of inherited arrhythmias and sudden unexpected death compared to the general population

    Directory of Open Access Journals (Sweden)

    Nordin Karin

    2010-02-01

    Full Text Available Abstract Background The possibilities in the molecular genetics of long QT syndrome (LQTS and hypertrophic cardiomyopathy (HCM has made family screening, with diagnostic and predictive genetic testing part of the health care offer in genetic counselling of inherited arrhythmias, potentially affecting the subjective health among these individuals. The study compared health status among patients at risk of arrhythmia because of family history or clinical diagnosis of LQTS and HCM with reference health status scores of the general population. Methods In the period 2005-2007, 127 patients (mean age 45 years, 53.5% women, with a family history of arrhythmia (n = 95 or a clinical diagnosis of LQTS (n = 12 or HCM (n = 19 referred for genetic counselling at the medical genetic departments in Norway filled in a questionnaire (Short Form Health Survey SF-36 measuring health status on eight domains. The patient SF-36 scores were compared to expected scores of the general population by t-test, and the relationship between the socio-demographic variables, clinical status, and SF-36 domains were analysed by multiple linear regression. Results The total sample reported significant lower SF-36 score as compared to the general population scores for the domain of general health (mean difference -7.3 ( Conclusions Having a genetic risk of arrhythmia affects general health significantly. In addition, patients with a clinical diagnosis of HCM demonstrate a significantly poorer health in both physical and mental domains.

  7. A healthy diet is associated with less endothelial dysfunction and less low-grade inflammation over a 7-year period in adults at risk of cardiovascular disease

    NARCIS (Netherlands)

    Henry, R.M.A.; Ferreira, I.; Greevenbroek, van M.M.J.; Kallen, van der C.J.H.; Twisk, J.W.R.; Feskens, E.J.M.; Schalkwijk, C.G.; Stehouwer, C.D.A.; Bussel, van B.C.T.

    2015-01-01

    Background: A healthy diet rich in fish, fruit, and vegetables, but moderate in alcohol and low in dairy products and meat, has been associated with a lower rate of incident cardiovascular disease (CVD). The underlying mechanisms, however, remain unclear. Endothelial dysfunction and low-grade

  8. A Healthy Diet Is Associated with Less Endothelial Dysfunction and Less Low-Grade Inflammation over a 7-Year Period in Adults at Risk of Cardiovascular Disease

    NARCIS (Netherlands)

    van Bussel, B.C.T.; Henry, R.M.A.; Ferreira, I.; van Greevenbroek, M.M.J.; van der Kallen, C.J.H.; Twisk, J.W.R.; Feskens, E.J.M.; Schalkwijk, C.G.; Stehouwer, C.D.A.

    2015-01-01

    Background: A healthy diet rich in fish, fruit, and vegetables, but moderate in alcohol and low in dairy products and meat, has been associated with a lower rate of incident cardiovascular disease (CVD). The underlying mechanisms, however, remain unclear. Endothelial dysfunction and low-grade

  9. Exercise training for patients with cardiovascular disease.

    Science.gov (United States)

    Casillas, J M; Gremeaux, V; Damak, S; Feki, A; Pérennou, D

    2007-07-01

    This review surveys effort training, a validated and recommended therapy, in patients with atheromatous cardiovascular disease. This true therapy reduces mortality by 25-35%, reduces clinical manifestations and complications (rhythm problems, thrombosis) and improves physical capacity, reintegration and quality of life. The effects are essentially linked to improved metabolic performance of muscles and reduced endothelial dysfunction, insulin resistance and neurohormonal abnormalities. Training also has an impact on the evolution of major risk factors, especially diabetes and arterial hypertension. The risks are limited as long as the contraindications are respected and the programmes supervised. The indications (stable angina, chronic heart failure, peripheral arterial disease) should be described more precisely by taking into account functional criteria: physical deconditioning, exclusion, compliance, mood swings, and seriousness of risk factors. The training programme should be tailor made and based on evaluation of the patient's adaptation to effort, in terms of frequency, intensity and duration of the exercises. Various types of exercise include overall or segmental physical training; concentric, eccentric, even isokinetic muscle contraction exercises; and proprioceptive rehabilitation. However, knowledge is lacking about the molecular mechanisms of the effects of training, the most effective intensity of effort, and strategies to develop physical activity in this ever-growing population for both primary and secondary prevention.

  10. Cardiovascular risk factors in patients with asymptomatic primary hyperparathyroidism.

    Science.gov (United States)

    García-Martín, Antonia; Reyes-García, Rebeca; García-Castro, José Miguel; Quesada-Charneco, Miguel; Escobar-Jiménez, Fernando; Muñoz-Torres, Manuel

    2014-12-01

    Patients with primary hyperparathyroidism (PHP), even asymptomatic, have an increased cardiovascular risk. However, data on reversibility or improvement of cardiovascular disorders with surgery are controversial. Our aims were to assess the prevalence of classic cardiovascular risk factors in patients with asymptomatic PHP, to explore their relationship with calcium and PTH levels, and analyze the effect of parathyroidectomy on those cardiovascular risk factors. A retrospective, observational study of two groups of patients with asymptomatic PHP: 40 patients on observation and 33 patients who underwent surgery. Clinical and biochemical data related to PHP and various cardiovascular risk factors were collected from all patients at baseline and one year after surgery in the operated patients. A high prevalence of obesity (59.9%), type 2 diabetes mellitus (25%), high blood pressure (47.2%), and dyslipidemia (44.4%) was found in the total sample, with no difference between the study groups. Serum calcium and PTH levels positively correlated with BMI (r=.568, P=.011, and r=.509, P=.026 respectively) in non-operated patients. One year after parathyroidectomy, no improvement occurred in the cardiovascular risk factors considered. Our results confirm the high prevalence of obesity, type 2 diabetes mellitus, high blood pressure, and dyslipidemia in patients with asymptomatic PHP. However, parathyroidectomy did not improve these cardiovascular risk factors. Copyright © 2014 SEEN. Published by Elsevier Espana. All rights reserved.

  11. Short review of dental care for patients with cardiovascular diseases

    Directory of Open Access Journals (Sweden)

    Puškar Slobodan

    2016-01-01

    Full Text Available Introduction: The basic knowledge about cardiovascular diseases (CVD s, the symptoms and complications that can occur during dental interventions in patients suffering from cardiovascular diseases, and how to handle such patients during the dental intervention are essential to every dentist. Dental patients suffering from cardiovascular diseases that are not adequately treated have a significantly higher risk of cardiovascular event during the dental intervention. Results: The most common cardiovascular diseases that need special dental care are: arterial hypertension, coronary heart disease, cerebrovascular disease, heart rhythm disorders and heart failure. Conclusion: Particular attention is needed when patients are treated with anticoagulant and /or antiplatelet therapy or when prevention of bacterial endocarditis is required.

  12. Characteristics of a large cohort of patients with diabetes having at-risk feet and outcomes in patients with foot ulceration referred to a tertiary care diabetes unit.

    Science.gov (United States)

    Riaz, Musarrat; Miyan, Zahid; Zaidi, Syed I; Alvi, Syed Fd; Fawwad, Asher; Ahmadani, Muhammad Y; Zafar, Asim B; Malik, Rayaz A; Basit, Abdul

    2016-10-01

    To identify in a large population cohort the clinical and biochemical characteristics of patients with diabetes at risk of foot ulceration and outcomes in those with foot ulcers. All patients with diabetes attending Baqai Institute of Diabetology and Endocrinology from January 2004 to April 2012 included in the study. Clinical, biochemical and socio-demographic data were collected and patients were categorised into those at no risk of ulceration, at risk of ulceration and those with foot ulcer, according to the University of Texas classification. Patients with foot ulceration followed for their final outcome, that is complete healing, persisted non-healed ulcer, lower extremity amputation, lost to follow-up or death. A total of 18 119 patients with diabetes underwent assessment, 3576 (19·7%) patients defined as at high risk for foot ulceration and 3731 (20·6%) presented with foot ulcer. Age, male gender, hypertension, higher glycated haemoglobin (HbA1c), history of smoking and presence of neuropathy were risk factors (P < 0·000) for foot ulceration. Amputation rate in patients with foot ulceration was significantly related to severity of ulceration at presentation. Preventive foot care practices were followed by 19·02% patients. One thousand eight hundred seventy three (50·2%) patients completely healed, 293 (11%) patients underwent amputation and 397 (10·1%) patients continued to be treated in the foot clinic. All patients with diabetes should be screened for neuropathy to identify those at risk of foot ulceration, as it is the major contributory factor for foot ulceration. The final outcome of foot ulceration was determined by the severity and grade of ulcer at presentation. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  13. Patients with psoriasis have an increased risk of cardiovascular diseases

    DEFF Research Database (Denmark)

    Ahlehoff, Ole; Gislason, Gunnar; Lindhardsen, Jesper

    2012-01-01

    Psoriasis is a chronic immunoinflammatory disease that affects 2-3% of the population and shares pathophysiologic mechanisms and risk factors with cardiovascular diseases. Studies have suggested psoriasis as an independent risk factor for cardiovascular disease and Danish guidelines...... on cardiovascular risk factor modification in patients with psoriasis and psoriatic arthritis have recently been published. We provide a short review of the current evidence and the Danish guidelines....

  14. Use of Exhaled Nitric Oxide Measurement to Identify a Reactive, at-Risk Phenotype among Patients with Asthma

    Science.gov (United States)

    Dweik, Raed A.; Sorkness, Ronald L.; Wenzel, Sally; Hammel, Jeffrey; Curran-Everett, Douglas; Comhair, Suzy A. A.; Bleecker, Eugene; Busse, William; Calhoun, William J.; Castro, Mario; Chung, Kian Fan; Israel, Elliot; Jarjour, Nizar; Moore, Wendy; Peters, Stephen; Teague, Gerald; Gaston, Benjamin; Erzurum, Serpil C.

    2010-01-01

    Rationale: Exhaled nitric oxide (FeNO) is a biomarker of airway inflammation in mild to moderate asthma. However, whether FeNO levels are informative regarding airway inflammation in patients with severe asthma, who are refractory to conventional treatment, is unknown. Here, we hypothesized that classification of severe asthma based on airway inflammation as defined by FeNO levels would identify a more reactive, at-risk asthma phenotype. Methods: FeNO and major features of asthma, including airway inflammation, airflow limitation, hyperinflation, hyperresponsiveness, and atopy, were determined in 446 individuals with various degrees of asthma severity (175 severe, 271 nonsevere) and 49 healthy subjects enrolled in the Severe Asthma Research Program. Measurements and Main Results: FeNO levels were similar among patients with severe and nonsevere asthma. The proportion of individuals with high FeNO levels (>35 ppb) was the same (40%) among groups despite greater corticosteroid therapy in severe asthma. All patients with asthma and high FeNO had more airway reactivity (maximal reversal in response to bronchodilator administration and by methacholine challenge), more evidence of allergic airway inflammation (sputum eosinophils), more evidence of atopy (positive skin tests, higher serum IgE and blood eosinophils), and more hyperinflation, but decreased awareness of their symptoms. High FeNO identified those patients with severe asthma characterized by the greatest airflow obstruction and hyperinflation and most frequent use of emergency care. Conclusions: Grouping of asthma by FeNO provides an independent classification of asthma severity, and among patients with severe asthma identifies the most reactive and worrisome asthma phenotype. PMID:20133930

  15. Smoking cessation and the cardiovascular patient.

    Science.gov (United States)

    Prochaska, Judith J; Benowitz, Neal L

    2015-09-01

    Smoking remains the leading cause of preventable morbidity and mortality. Our review highlights research from 2013 to 2015 on the treatment of cigarette smoking, with a focus on heart patients and cardiovascular outcomes. Seeking to maximize the reach and effectiveness of existing cessation medications, current tobacco control research has demonstrated the safety and efficacy of combination treatment, extended use, reduce-to-quit strategies, and personalized approaches to treatment matching. Further, cytisine has gained interest as a lower-cost strategy for addressing the global tobacco epidemic. On the harm reduction front, snus and electronic nicotine delivery systems are being widely distributed and promoted with major gaps in knowledge of the safety of long-term and dual use. Quitlines, comparable in outcome to in-person treatment, make cessation counseling available on a national scale, though use rates remain relatively low. Employee reward programs are gaining attention given the high costs of tobacco use to employers; sustaining quit rates postpayment, however, has proven challenging. Evidence-based cessation treatments exist. Broader dissemination, adoption, and implementation are key to addressing the tobacco epidemic. The cardiology team has a professional obligation to advance tobacco control efforts and can play an important role in achieving a smoke-free future.

  16. The potential utility of drinking motive questions to screen at-risk drinking in socially anxious patients.

    Science.gov (United States)

    Miller, Peter M; Book, Sarah W; Thomas, Suzanne; Smith, Joshua P; Randall, Patrick K; Randall, Carrie L

    2014-06-01

    Drinking motives are thought to be important mediators of the relationship between social anxiety and alcohol use. This project evaluates whether specific drinking motives accurately reflect alcohol dependence. If so, brief questions about drinking motives could serve as valuable alcohol screening tools with socially anxious patients. This investigation was a secondary analysis of an existing data set of 83 subjects with social anxiety disorder and at-risk alcohol use. The relationship between Drinking Motives Questionnaire (DMQ-R-5) subscales and alcohol dependence was evaluated. Coping-Depression was the only subscale that contributed to the unique prediction of a diagnosis of alcohol dependence. Additionally, two items (i.e. "to cheer up when you're in a bad mood" and "to forget painful memories") predicted a diagnosis of alcohol dependence above and beyond their association with each other. Among patients with social anxiety, two specific questions on the DMQ-R-5 could provide a useful screen for health professionals to predict alcohol dependence. It may be fruitful to specifically target the motives of "to cheer up when you're in a bad mood" and "to forget painful memories" when providing advice during brief interventions.

  17. [Control of cardiovascular risk factors among patients with diabetes with and without cardiovascular disease].

    Science.gov (United States)

    Herrero, A; Garzón, G; Gil, A; García, I; Vargas, E; Torres, N

    2015-10-01

    There is evidence that cardiovascular goals are beneficial in diabetes. To determine the distribution of cardiovascular risk levels in patients with diabetes and the clinical interventions they have received. Descriptive cross-sectional study. SERMAS (Madrid) 2010. All patients with diabetes. (n=41,096). Patients in primary or secondary prevention, metabolic and cardiovascular risk factors control, pharmacological and non-pharmacological interventions. Patient and professional variables. Around one-fifth (21.5%) (95%CI: 21.1% -21.9%) in secondary prevention (very high cardiovascular risk). HbA1c was under control in 31% (95%CI: 30.1%-32%), with 49.9% (95%CI: 48.8%-50.9%) with BP under control, and 39.4% (95% CI: 38.4%-40.4%) with LDL controlled. Only 8.9% (95%CI: 8.3%-9.5%) had a well-controlled HdA1c, BP and LDL, and in 19.8% (95%CI: 19%-20.6%) none of these were under control. Of those with an uncontrolled BP, 23.6% (95% CI: 23.2%-24%) had antihypertensive drugs. There was better control in patients older than 70 years, and those who lived in an urban center, or a lower number of patients per day. In diabetic patients with very high cardiovascular risk (secondary prevention), just half of them had good control of cardiovascular risk factors (BP and LDL). An association was found between better control and older than 70, urban center or lower number of patients per day. This suggests developing strategies to promote a comprehensive control of cardiovascular risk factors in diabetic patients in secondary prevention. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Detection of galactomannan in bronchoalveolar lavage of the intensive care unit patients at risk for invasive aspergillosis

    Directory of Open Access Journals (Sweden)

    Sadegh Khodavaysi

    2015-01-01

    Full Text Available Background and Purpose: Invasive aspergillosis (IA is one of the most common life-threatening fungal infections among the critically ill patients including intensive care unit (ICU patients. Delayed diagnosis and therapy may lead to poor outcomes. Diagnosis may be facilitated by a test for molecular biomarkers, i.e. detection of galactomannan (GM antigen based on enzyme immunoassay, which is of increasing interest in the clinical settings for the diagnosis of IA. In the present study, we assessed GM testing of bronchoalveolar lavage (BAL fluid as a tool for early diagnosis of IA among ICU patients who were at risk for developing IA. Material and Methods: A prospective study was performed in ICU patients with underlying predisposing conditions for IA between August 2010 and September 2011. BAL samples for direct microscopic examination, culture, and GM detection were obtained once or twice weekly. GM in BAL levels was measured using the Platellia Aspergillus EIA test kit. According to modified European Organization for the Research and Treatment of Cancer/ Mycoses Study Group (EORTC/MSG criteria, patients were classified as having probable or possible IA. Results: Out of 43 suspected patients to IA, 13 (30.2% cases showed IA. According to the criteria presented by EORTC/MSG, they were categorized as: 4 cases (30.8% of possible IA and 9 (69.2% of probable IA. Out of 21 BAL samples from patients with IA, 11 (52.4% had at least one positive BAL GM index. Using a cutoff index of 0.5, the sensitivity and specificity, positive and negative predictive values of GM detection in BAL fluid were 100%, 85.7%, 65.7% and 96%, respectively. The sensitivity and specificity was 73% and 92.7% at cutoff ≥1.0, respectively. In 6 of 13 IA cases, BAL culture or direct microscopic examination remained negative, whereas GM in BAL was positive. Conclusion: Our data have revealed that the sensitivity of GM detection in BAL was better than that of conventional tests. It

  19. Risk Factors for Cardiovascular Diseases among Diabetic Patients ...

    African Journals Online (AJOL)

    BACKGROUND: Studies on cardiovascular risk factors among diabetic persons in Ethiopia are lacking. The objective of this study was to determine the prevalence of the cardiovascular risk factors (hypertension, obesity, physical inactivity, dyslipidemia and smoking) among diabetic patients at the diabetic clinic of Jimma ...

  20. Multiple-modality exercise and mind-motor training to improve cardiovascular health and fitness in older adults at risk for cognitive impairment: A randomized controlled trial.

    Science.gov (United States)

    Boa Sorte Silva, Narlon C; Gregory, Michael A; Gill, Dawn P; Petrella, Robert J

    The effects of multiple-modality exercise on arterial stiffening and cardiovascular fitness has not been fully explored. To explore the influence of a 24-week multiple-modality exercise program associated with a mind-motor training in cardiovascular health and fitness in community-dwelling older adults, compared to multiple-modality exercise (M2) alone. Participants (n=127, aged 67.5 [7.3] years, 71% females) were randomized to either M4 or M2 groups. Both groups received multiple-modality exercise intervention (60min/day, 3days/week for 24-weeks); however, the M4 group underwent additional 15min of mind-motor training, whereas the M2 group received 15min of balance training. Participants were assessed at 24-weeks and after a 28-week non-contact follow-up (52-weeks). at 52-weeks, the M4 group demonstrated a greater VO2max (ml/kg/min) compared to the M2 group (mean difference: 2.39, 95% CI: 0. 61 to 4.16, p=0.009). Within-group analysis indicated that the M4 group demonstrated a positive change in VO2max at 24-weeks (mean change: 1.93, 95% CI: 0.82 to 3.05, p=0.001) and 52-weeks (4.02, 95% CI: 2.71 to 5.32, p=0.001). Similarly, the M2 group increased VO2max at 24-weeks (2.28, 95% CI: 1.23 to 3.32, pMind-motor training associated with multiple-modality exercise can positively impact cardiovascular fitness to the same extent as multiple-modality exercise alone. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. [Nursing care in elderly patients with cardiovascular disease].

    Science.gov (United States)

    Enç, Nuray; Öz Alkan, Havva

    2017-09-01

    Aging is a process that has biological, physiological, psychological, sociological and chronological dimensions and can be defined from different directions. The incidence of cardiovascular diseases such as hypertension, coronary heart disease, heart failure, dysrhythmia and heart valve diseases is increasing with age. Cardiovascular diseases are the most common cause of death in people over 65 years of age. It also causes serious health problems and poses a significant burden on the health care system. Nurses have important responsibilities in the care of the elderly patients with cardiovascular system disease. Appropriate nursing care for elderly patient provides positive contributions to patient care outcomes.

  2. Safety of varenicline in patients with cardiovascular disease.

    Science.gov (United States)

    Haber, Stacy L; Boomershine, Virginia; Raney, Erin

    2014-02-01

    Smoking cessation lowers the risk of death substantially in patients with cardiovascular disease. Although varenicline is an effective medication for smoking cessation, its safety in this population has been questioned and evaluated in several studies. In 2 randomized controlled trials of patients with cardiovascular disease, the rates of serious cardiovascular events were up to 2% higher in patients receiving varenicline than placebo, though the differences were not statistically significant. In the first meta-analysis of mostly trials involving patients with a history of cardiovascular disease, varenicline was found to significantly increase the risk of cardiovascular events by 72%; however, a second meta-analysis did not find a significant increased risk. In an observational study, varenicline was not associated with an increased risk of events when compared to bupropion in a subgroup analysis of patients with a history of cardiovascular disease. Because the evidence on the safety of varenicline in this population is limited and conflicting, additional data are needed to formulate stronger conclusions. In the meantime, health care professionals should consider individual smoking patterns, concomitant medical conditions, and cost when recommending smoking cessation pharmacotherapy for patients with cardiovascular disease.

  3. Patients "At Risk'' of Suffering from Persistent Complaints after Mild Traumatic Brain Injury : The Role of Coping, Mood Disorders, and Post-Traumatic Stress

    NARCIS (Netherlands)

    Scheenen, Myrthe E.; Spikman, Jacoba M.; de Koning, Myrthe E.; van der Horn, Harm J.; Roks, Gerwin; Hageman, Gerard; van der Naalt, Joukje

    2017-01-01

    Although most patients recover fully following mild traumatic brain injury (mTBI), a minority (15-25%) of all patients develop persistent post-traumatic complaints (PTC) that interfere with the resumption of previous activities. An early identification of patients who are at risk for PTC is

  4. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis

    DEFF Research Database (Denmark)

    Fellström, Bengt C; Jardine, Alan G; Schmieder, Roland E

    2009-01-01

    BACKGROUND: Statins reduce the incidence of cardiovascular events in patients at high cardiovascular risk. However, a benefit of statins in such patients who are undergoing hemodialysis has not been proved. METHODS: We conducted an international, multicenter, randomized, double-blind, prospective......: In patients undergoing hemodialysis, the initiation of treatment with rosuvastatin lowered the LDL cholesterol level but had no significant effect on the composite primary end point of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. (ClinicalTrials.gov number, NCT00240331.)...... trial involving 2776 patients, 50 to 80 years of age, who were undergoing maintenance hemodialysis. We randomly assigned patients to receive rosuvastatin, 10 mg daily, or placebo. The combined primary end point was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke...

  5. Bone fractures and feeling at risk for osteoporosis among women in Japan: patient characteristics and outcomes in the National Health and Wellness Survey.

    Science.gov (United States)

    Sato, Masayo; Vietri, Jeffrey; Flynn, Jennifer A; Fujiwara, Saeko

    2014-01-01

    Women aged 50 and older in Japan were compared according to perceived risk for osteoporosis and fracture history. Perceived risk was associated with family history of osteoporosis but few other risk factors. Few felt at risk, and perception was only loosely related to epidemiological risks, indicating a need for patient education. Osteoporosis is prevalent but underdiagnosed and undertreated. This study was conducted to explore characteristics associated with history of fractures and feeling at risk for osteoporosis in women aged 50 and older in Japan. Data were provided by a large annual survey representative of Japanese aged 18 and older. Women 50 and older without diagnosed osteoporosis were categorized into four mutually exclusive groups based on fracture history since age 50 and feeling at risk for developing osteoporosis. Sociodemographic and health characteristics were compared across groups using bivariate statistics, and health outcomes were compared using generalized linear models. A total of 16,801 women aged 50 and older were included in the analyses. Most (n = 12,798; 76.2 %) had no fracture since age 50 and did not feel at risk for osteoporosis, 12.9 % (n = 2170) felt at risk but had no fracture, 8.7 % (n = 1455) did not feel at risk despite having a fracture, and 2.2 % (n = 378) had a fracture and felt at risk for osteoporosis. Feeling at risk was slightly more common among those with than without a fracture since age 50 (20.6 vs. 14.5 %, p women in Japan aged 50 and older felt at risk for developing osteoporosis in the future, far fewer than expected by epidemiologists. Risk perception was only loosely related to epidemiological risks for fracture, indicating a need for patient education.

  6. Providing dental treatment for patients with cardiovascular disease.

    Science.gov (United States)

    Waters, B G

    1995-01-01

    The appropriate management of dental patients with cardiovascular disease is contingent on appropriate assessment and evaluation. Baseline vital signs, a good medical history and medical evaluation are all essential for the safe delivery of care. All patients with cardiovascular disease can be managed using the following guidelines: 1. Properly assess the patient. This should include an assessment by the dentist and also a medical consultation if required. 2. Establish what medications the patient is taking along with the dose and timing and note any potential drug interactions and side effects. 3. Use short appointments (less than one hour), preferably in the morning. 4. Premedication should be considered to alleviate anxiety. The intraoperative use of nitrous oxide and oxygen is also a reasonable strategy for patients with cardiovascular disease, particularly those with ischemic heart disease. 5. Effective local anesthesia is important in order to avoid undue stress during the appointment as long as the guidelines for the administration of epinephrine are followed. The use of epinephrine impregnated gingival displacement cord should be strictly avoided in patients with cardiovascular disease. 6. For patients with angina pectoris, a fresh supply of nitroglycerin should be available at the time of the appointment. Prophylactic nitroglycerin has been shown to be effective in the prevention of both hypertension and angina pectoris during dental treatment. The appointment should be terminated early if the patient becomes overly anxious. In the event of cardiovascular symptoms during dental treatment, all work should be stopped. Emergency measures should be instituted if necessary. Preparations for emergencies should be undertaken by all dentists. The treatment of patients with cardiovascular disease is relatively simple if the proper steps are taken. The use of blood pressure measurements on all patients will help to screen for undiagnosed hypertension and all

  7. Cardiovascular disease and cognitive function in maintenance hemodialysis patients

    Science.gov (United States)

    Cardiovascular disease (CVD) and cognitive impairment are common in dialysis patients. Given the proposed role of microvascular disease on cognitive function, particularly cognitive domains that incorporate executive functions, we hypothesized that prevalent systemic CVD would be associated with wor...

  8. Inflammation Markers in Patients with Cardiovascular Disease and Metabolic Syndrome

    National Research Council Canada - National Science Library

    Irena Korita; Anyla Bulo; Michel Langlois; Victor Blaton

    2013-01-01

    The clinical value and the interrelationship of HDL and the metabolic syndrome were studied using plasma levels of TNF-a, IL 6, IL 10, IL 8, IL 1beta, IL 2R in patients with cardiovascular stenosis...

  9. Cardiovascular involvement by osteosarcoma: an analysis of 20 patients

    Energy Technology Data Exchange (ETDEWEB)

    Yedururi, Sireesha; Morani, Ajaykumar C.; Gladish, Gregory W. [The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX (United States); Vallabhaneni, Srilakshmi [Medstar Harbor Hospital, Department of Internal Medicine, Baltimore, MD (United States); Anderson, Peter M. [Levine Children' s Hospital/Levine Cancer Institute, Department of Pediatrics Hematology/Oncology/BMT, Carolinas Healthcare System, Charlotte, NC (United States); Hughes, Dennis; Daw, Najat C. [The University of Texas MD Anderson Cancer Center, Division of Pediatrics, Houston, TX (United States); Wang, Wei-Lien [The University of Texas MD Anderson Cancer Center, Department of Pathology, Houston, TX (United States)

    2016-01-15

    Although hematogenous spread of osteosarcoma is well known, the imaging findings of cardiovascular involvement by osteosarcoma are seldom reported and can be difficult to recognize. The enhanced resolution of modern CT and MRI scanners may lead to better detection of cardiovascular involvement. To describe the key imaging findings and clinical behavior of cardiovascular involvement by osteosarcoma. We retrospectively reviewed the imaging findings and clinical characteristics of 20 patients with cardiovascular involvement by osteosarcoma identified by two pediatric radiologists from a review of imaging studies at our institution from 2007 to 2013. At initial diagnosis, the median age of the patients was 15.1 years (range 4.8-24.6 years), and 7 (35%) patients had detectable metastases. Median time to detection of cardiovascular metastases was 1.8 years (range 0-7.3 years). Sixteen patients died of disease; 4 have survived a median of 7.4 years since initial diagnosis. The sites of cardiovascular involvement were the systemic veins draining the primary and metastatic osteosarcoma, pulmonary arteries, pulmonary veins draining the pulmonary metastases, and heart. A dilated and mineralized terminal pulmonary arteriole is an early sign of metastatic osteosarcoma in the lung. Unfamiliarity with the imaging features resulted in under-recognition and misinterpretation of intravascular tumor thrombus as bland thrombus. Knowledge of imaging findings in the era of modern imaging modalities has enhanced our ability to detect cardiovascular involvement and lung metastases early and avoid misinterpreting tumor thrombus in draining systemic veins or pulmonary arteries as bland thrombus. (orig.)

  10. Osteoprotegerin and mortality in hemodialysis patients with cardiovascular disease

    DEFF Research Database (Denmark)

    Winther, Simon; Christensen, Jeppe Hagstrup; Flyvbjerg, Allan

    2013-01-01

    Abstract BACKGROUND: Patients treated with hemodialysis (HD) have an increased mortality, mainly caused by cardiovascular disease (CVD). Osteoprotegerin (OPG) is a glycoprotein involved in the regulation of the vascular calcification process. Previous studies have demonstrated that OPG is a progn......Abstract BACKGROUND: Patients treated with hemodialysis (HD) have an increased mortality, mainly caused by cardiovascular disease (CVD). Osteoprotegerin (OPG) is a glycoprotein involved in the regulation of the vascular calcification process. Previous studies have demonstrated that OPG...

  11. T1 mapping and T2 mapping at 3T for quantifying the area-at-risk in reperfused STEMI patients.

    Science.gov (United States)

    Bulluck, Heerajnarain; White, Steven K; Rosmini, Stefania; Bhuva, Anish; Treibel, Thomas A; Fontana, Marianna; Abdel-Gadir, Amna; Herrey, Anna; Manisty, Charlotte; Wan, Simon M Y; Groves, Ashley; Menezes, Leon; Moon, James C; Hausenloy, Derek J

    2015-08-12

    Whether T1-mapping cardiovascular magnetic resonance (CMR) can accurately quantify the area-at-risk (AAR) as delineated by T2 mapping and assess myocardial salvage at 3T in reperfused ST-segment elevation myocardial infarction (STEMI) patients is not known and was investigated in this study. 18 STEMI patients underwent CMR at 3T (Siemens Bio-graph mMR) at a median of 5 (4-6) days post primary percutaneous coronary intervention using native T1 (MOLLI) and T2 mapping (WIP #699; Siemens Healthcare, UK). Matching short-axis T1 and T2 maps covering the entire left ventricle (LV) were assessed by two independent observers using manual, Otsu and 2 standard deviation thresholds. Inter- and intra-observer variability, correlation and agreement between the T1 and T2 mapping techniques on a per-slice and per patient basis were assessed. A total of 125 matching T1 and T2 mapping short-axis slices were available for analysis from 18 patients. The acquisition times were identical for the T1 maps and T2 maps. 18 slices were excluded due to suboptimal image quality. Both mapping sequences were equally prone to susceptibility artifacts in the lateral wall and were equally likely to be affected by microvascular obstruction requiring manual correction. The Otsu thresholding technique performed best in terms of inter- and intra-observer variability for both T1 and T2 mapping CMR. The mean myocardial infarct size was 18.8 ± 9.4 % of the LV. There was no difference in either the mean AAR (32.3 ± 11.5 % of the LV versus 31.6 ± 11.2 % of the LV, P = 0.25) or myocardial salvage index (0.40 ± 0.26 versus 0.39 ± 0.27, P = 0.20) between the T1 and T2 mapping techniques. On a per-slice analysis, there was an excellent correlation between T1 mapping and T2 mapping in the quantification of the AAR with an R(2) of 0.95 (P T1 mapping CMR at 3T performed as well as T2 mapping in quantifying the AAR and assessing myocardial salvage in reperfused STEMI patients

  12. Management of cardiovascular diseases in patients with obesity.

    Science.gov (United States)

    Lavie, Carl J; Arena, Ross; Alpert, Martin A; Milani, Richard V; Ventura, Hector O

    2017-07-27

    The management of cardiovascular diseases (CVD) in patients with obesity presents numerous challenges. Obesity has a negative effect on almost all of the major CVD risk factors, and adversely influences cardiovascular structure and function. Patients who are overweight or obese have a higher incidence of almost all CVDs compared with patients who are of normal weight. However, those who are overweight or obese seem to have a better short-term and medium-term prognosis after major CVD events and interventional procedures or cardiac surgeries than leaner patients, a phenomenon termed the 'obesity paradox'. In considering the mechanisms underlying this paradox, we review evidence of the deleterious consequences of obesity in patients with coronary heart disease, and the limited data on the benefits of weight loss in patients with CVD. Additional studies are needed on the efficacy of purposeful weight loss on cardiovascular outcomes to determine the ideal body composition for patients with CVD.

  13. Cost-effectiveness of nutritional counseling for obese patients and patients at risk of ischemic heart disease

    DEFF Research Database (Denmark)

    Olsen, Jens; Willaing, Ingrid; Ladelund, Steen

    2005-01-01

    counseling by a general practitioner (GP) or a dietician. METHODS: A total of 60 GPs, who accepted to participate, were randomized either to give nutritional counseling or to refer patients to a dietician for counseling. The life years gained was estimated using a Cox regression model. Costs were estimated...... on the basis of registered use of time (dieticians) or agreed salaries (GPs). RESULTS: The effect of nutritional counseling comparing GPs and dieticians is greatest when counseling is performed by a GP--0.0919 years versus 0.0274 years. These effects appear to be moderate, but they are significant. It is also...... patient groups and interventions report effects within the same magnitude. The GP group was the most cost-effective, but it must be concluded that both counseling strategies were relatively cost-effective. Even though the cost of gaining an extra life year was estimated to be 59,987 DKK in the dietician...

  14. Cytomegalovirus retinitis after central retinal vein occlusion in a patient on systemic immunosuppression: does venooclusive disease predispose to cytomegalovirus retinitis in patients already at risk?

    Directory of Open Access Journals (Sweden)

    Welling JD

    2012-04-01

    Full Text Available John D Welling, Ahmad B Tarabishy, John ChristoforidisDepartment of Ophthalmology, Havener Eye Institute, Ohio State University, Columbus, OH, USAAbstract: Cytomegalovirus (CMV retinitis remains the most common opportunistic ocular infection in immunocompromised patients. Patients with immunocompromising diseases, such as acquired immunodeficiency syndrome, inherited immunodeficiency states, malignancies, and those on systemic immunosuppressive therapy, are known to be at risk. Recently, it has been suggested that patients undergoing intravitreal injection of immunosuppressive agents may also be predisposed. One previous case report speculated that there may be an additional risk for CMV retinitis in acquired immunodeficiency syndrome patients with venoocclusive disease. This case study presents a case of CMV retinitis following central retinal vein occlusion in a patient on systemic immunosuppressants.Keywords: cytomegalovirus retinitis, central retinal vein occlusion, immunosuppression, solid organ transplant, venous stasis, risk factor

  15. Short and long term effects of a lifestyle intervention for construction workers at risk for cardiovascular disease: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Groeneveld Iris F

    2011-10-01

    Full Text Available Abstract Background The prevalence of overweight and elevated cardiovascular disease (CVD risk among workers in the construction industry is relatively high. Improving lifestyle lowers CVD risk and may have work-related benefits. The purpose of the study was to evaluate the effects on physical activity (PA, diet, and smoking of a lifestyle intervention consisting of individual counseling among male workers in the construction industry with an elevated risk of cardiovascular disease (CVD. Methods In a randomized controlled trial including 816 male blue- and white-collar workers in the construction industry with an elevated risk of CVD, usual care was compared to a 6-month lifestyle intervention. The intervention consisted of individual counseling using motivational interviewing techniques, and was delivered by an occupational physician or occupational nurse. In three face to face and four telephone contacts, the participant's risk profile, personal determinants, and barriers for behavior change were discussed, and personal goals were set. Participants chose to aim at either diet and PA, or smoking. Data were collected at baseline and after six and 12 months, by means of a questionnaire. To analyse the data, linear and logistic regression analyses were performed. Results The intervention had a statistically significant beneficial effect on snack intake (β-1.9, 95%CI -3.7; -0.02 and fruit intake (β 1.7, 95%CI 0.6; 2.9 at 6 months. The effect on snack intake was sustained until 12 months; 6 months after the intervention had ended (β -1.9, 95%CI -3.6; -0.2. The intervention effects on leisure time PA and metabolic equivalent-minutes were not statistically significant. The beneficial effect on smoking was statistically significant at 6 (OR smoking 0.3, 95%CI 0.1;0.7, but not at 12 months (OR 0.8, 95%CI 0.4; 1.6. Conclusions Beneficial effects on smoking, fruit, and snack intake can be achieved by an individual-based lifestyle intervention among

  16. Universal screening for Lynch syndrome among patients with colorectal cancer: patient perspectives on screening and sharing results with at-risk relatives.

    Science.gov (United States)

    Hunter, Jessica Ezzell; Arnold, Kathleen A; Cook, Jennifer E; Zepp, Jamilyn; Gilmore, Marian J; Rope, Alan F; Davis, James V; Bergen, Kellene M; Esterberg, Elizabeth; Muessig, Kristin R; Peterson, Susan K; Syngal, Sapna; Acheson, Louise; Wiesner, Georgia; Reiss, Jacob; Goddard, Katrina A B

    2017-07-01

    Universal screening for Lynch syndrome (LS) among all cases of colorectal cancer (CRC) could increase the diagnosis of LS and reduce morbidity and mortality of LS-associated cancers. Given universal screening includes all patients, irrespective of high risk factors such early age at onset or family history of CRC, it is important to understand perspectives of all patients and not just those at high risk. As part of a study to assess the feasibility and implementation of universal screening, 189 patients newly diagnosed with CRC were surveyed about their interest in screening for LS and communication of results with at-risk family members. Overall, participants responded positively regarding screening for LS, with most wanting to know their genetic risks in general (86%) and risk of hereditary CRC (93%). Prior to receiving screening results, most participants stated they intended to share their screening results with parents (89%), siblings (96%), and children (96%). Of the 28 participants who received a positive LS screening result, 26 (93%) reported sharing their result with at least one first-degree family member. Interest in screening for LS and communication of screening results with family members was not associated with high risk factors. This study indicates that patients are interested in being screened for LS and that sharing information on the risk of LS with at-risk family members is not a significant barrier. These findings provide novel insight into patient perspectives about screening for LS and can guide successful implementation of universal screening programs.

  17. The Finnish Cardiovascular Study (FINCAVAS: characterising patients with high risk of cardiovascular morbidity and mortality

    Directory of Open Access Journals (Sweden)

    Niemi Mari

    2006-03-01

    Full Text Available Abstract Background The purpose of the Finnish Cardiovascular Study (FINCAVAS is to construct a risk profile – using genetic, haemodynamic and electrocardiographic (ECG markers – of individuals at high risk of cardiovascular diseases, events and deaths. Methods and design All patients scheduled for an exercise stress test at Tampere University Hospital and willing to participate have been and will be recruited between October 2001 and December 2007. The final number of participants is estimated to reach 5,000. Technically successful data on exercise tests using a bicycle ergometer have been collected of 2,212 patients (1,400 men and 812 women by the end of 2004. In addition to repeated measurement of heart rate and blood pressure, digital high-resolution ECG at 500 Hz is recorded continuously during the entire exercise test, including the resting and recovery phases. About 20% of the patients are examined with coronary angiography. Genetic variations known or suspected to alter cardiovascular function or pathophysiology are analysed to elucidate the effects and interactions of these candidate genes, exercise and commonly used cardiovascular medications. Discussion FINCAVAS compiles an extensive set of data on patient history, genetic variation, cardiovascular parameters, ECG markers as well as follow-up data on clinical events, hospitalisations and deaths. The data enables the development of new diagnostic and prognostic tools as well as assessments of the importance of existing markers.

  18. Intrapulmonary percussive ventilation superimposed on spontaneous breathing: a physiological study in patients at risk for extubation failure.

    Science.gov (United States)

    Dimassi, Saoussen; Vargas, Frédéric; Lyazidi, Aissam; Roche-Campo, Ferran; Dellamonica, Jean; Brochard, Laurent

    2011-08-01

    Intrapulmonary percussive ventilation (IPV) is a high-frequency ventilation modality that can be superimposed on spontaneous breathing. IPV may diminish respiratory muscle loading and help to mobilize secretions. The aim of this prospective study was to assess the short-term effects of IPV in patients at high risk for extubation failure who were receiving preventive non-invasive ventilation (NIV) after extubation. Respiratory rate, work of breathing, and gas exchange were evaluated in 17 extubated patients during 20 min of IPV and 20 min of NIV delivered via a facial mask, separated by periods of spontaneous breathing. The pressure-support level during NIV was adjusted until tidal volume reached 6-8 ml/kg and positive end-expiratory pressure (PEEP) 4-5 cmH(2)O. For IPV, the pressurisation frequency was set at 250 cycles/min and driving pressure at 1.2 bar. The pressure-time product of the diaphragm (PTPdi/min) was measured using an oesophageal and gastric double-balloon catheter. Transdiaphragmatic pressure and PTPdi/min improved significantly (p < 0.01), from a median [25th-75th percentiles] of 264 [190-300] to 192 [152-221] cmH(2)O s/min with IPV and from 273 [212-397] to 176 [120-216] cmH(2)O s/min with NIV. Respiratory rate decreased significantly from 23 [19-27] to 22 [17-24] breaths/min for IPV and from 25 [19-28] to 20 [18-22] breaths/min for NIV (p < 0.01). Mean PaCO(2) decreased after NIV (from 46 [42-48] to 41 [36-42] mmHg, p < 0.01) but not after IPV. There was no noticeable effect on oxygenation. IPV is an interesting alternative to NIV in patients at risk for post-extubation respiratory failure. Both NIV and IPV diminished the respiratory rate and work of breathing, but IPV was less effective in improving alveolar ventilation.

  19. Factors Predicting Falls and Mobility Outcomes in Patients With Stroke Returning Home After Rehabilitation Who Are at Risk of Falling.

    Science.gov (United States)

    Ng, Mandy Man-Di; Hill, Keith D; Batchelor, Frances; Burton, Elissa

    2017-12-01

    To identify factors predicting falls and limited mobility in people with stroke at 12 months after returning home from rehabilitation. Observational cohort study with 12-month follow-up. Community. People with stroke (N=144) and increased falls risk discharged home from rehabilitation. Not applicable. Falls were measured using monthly calendars completed by participants, and mobility was assessed using gait speed over 5m (high mobility: >0.8m/s vs low mobility: ≤0.8m/s). Both measures were assessed at 12 months postdischarge. Demographics and functional measures, including balance, strength, visual or spatial deficits, disability, physical activity level, executive function, functional independence, and falls risk, were analyzed to determine factors significantly predicting falls and mobility levels after 12 months. Those assessed as being at high falls risk (Falls Risk for Older People in the Community [FROP-Com] score≥19) were 4.5 times more likely to fall by 12 months (odds ratio [OR], 4.506; 95% confidence interval [CI], 1.71-11.86; P=.002). Factors significantly associated with lower usual gait speed (≤0.8m/s) at 12 months in the multivariable analysis were age (OR, 1.07; 95% CI, 1.01-1.14; P=.033), physical activity (OR, 1.09; 95% CI, 1.03-1.17, P=.007), and functional mobility (OR, .83; 95% CI, .75-.93; P=.001). Several factors predicted falls and limited mobility for patients with stroke 12 months after rehabilitation discharge. These results suggest that clinicians should include assessment of falls risk (FROP-Com), physical activity, and dual-task Timed Up and Go test during rehabilitation to identify those most at risk of falling and experiencing limited mobility outcomes at 12 months, and target these areas during inpatient and outpatient rehabilitation to optimize long-term outcomes. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  20. Differences in coping, self-efficacy, and external control beliefs between patients at-risk for psychosis and patients with first-episode psychosis.

    Science.gov (United States)

    Schmidt, Stefanie J; Grunert, Vera-Maria; Schimmelmann, Benno G; Schultze-Lutter, Frauke; Michel, Chantal

    2014-09-30

    Patients with first-episode psychosis (FEP) often show dysfunctional coping patterns, low self-efficacy, and external control beliefs that are considered to be risk factors for the development of psychosis. Therefore, these factors should already be present in patients at-risk for psychosis (AR). We compared frequencies of deficits in coping strategies (Stress-Coping-Questionnaires, SVF-120/SVF-KJ), self-efficacy, and control beliefs (Competence and Control Beliefs Questionnaire, FKK) between AR (n=21) and FEP (n=22) patients using a cross-sectional design. Correlations among coping, self-efficacy, and control beliefs were assessed in both groups. The majority of AR and FEP patients demonstrated deficits in coping skills, self-efficacy, and control beliefs. However, AR patients more frequently reported a lack of positive coping strategies, low self-efficacy, and a fatalistic externalizing bias. In contrast, FEP patients were characterized by being overly self-confident. These findings suggest that dysfunctional coping, self-efficacy, and control beliefs are already evident in AR patients, though different from those in FEP patients. The pattern of deficits in AR patients closely resembles that of depressive patients, which may reflect high levels of depressiveness in AR patients. Apart from being worthwhile treatment targets, these coping and belief patterns are promising candidates for predicting outcome in AR patients, including the conversion to psychosis. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Cost-effectiveness of nutritional counseling for obese patients and patients at risk of ischemic heart disease

    DEFF Research Database (Denmark)

    Olsen, Jens; Willaing, Ingrid; Ladelund, Steen

    2005-01-01

    OBJECTIVES: Obesity and dyslipidemia are risk factors for ischemic heart disease, and prevention and treatment in primary care can reduce these risks. The objective of this cost-effectiveness analysis was to compare the costs and effects (in terms of life years gained) of providing nutritional...... counseling by a general practitioner (GP) or a dietician. METHODS: A total of 60 GPs, who accepted to participate, were randomized either to give nutritional counseling or to refer patients to a dietician for counseling. The life years gained was estimated using a Cox regression model. Costs were estimated...... on the basis of registered use of time (dieticians) or agreed salaries (GPs). RESULTS: The effect of nutritional counseling comparing GPs and dieticians is greatest when counseling is performed by a GP--0.0919 years versus 0.0274 years. These effects appear to be moderate, but they are significant. It is also...

  2. Perceptions of cardiovascular risk among patients with hypertension or diabetes.

    NARCIS (Netherlands)

    Frijling, B.D.; Lobo, C.M.; Keus, I.M.; Jenks, K.M.; Akkermans, R.P.; Hulscher, M.E.J.L.; Prins, A.; Wouden, J.C. van der; Grol, R.P.T.M.

    2004-01-01

    We aimed to examine risk perceptions among patients at moderate to high cardiovascular risk. A questionnaire about perceived absolute risk of myocardial infarction and stroke was sent to 2424 patients with hypertension or diabetes. Response rate was 86.3% and 1557 patients without atherosclerotic

  3. Patient perspective on remote monitoring of cardiovascular implantable electronic devices

    DEFF Research Database (Denmark)

    Versteeg, H; Pedersen, Susanne S.; Mastenbroek, M H

    2014-01-01

    BACKGROUND: Remote patient monitoring is a safe and effective alternative for the in-clinic follow-up of patients with cardiovascular implantable electronic devices (CIEDs). However, evidence on the patient perspective on remote monitoring is scarce and inconsistent. OBJECTIVES: The primary...

  4. Fatalism moderates the relationship between family history of cardiovascular disease and engagement in health-promoting behaviors among at-risk rural Kentuckians.

    Science.gov (United States)

    Mudd-Martin, Gia; Rayens, Mary Kay; Lennie, Terry A; Chung, Misook L; Gokun, Yevgeniya; Wiggins, Amanda T; Biddle, Martha J; Bailey, Alison L; Novak, M J; Casey, Baretta R; Moser, Debra K

    2015-01-01

    In rural communities that experience high rates of cardiovascular disease (CVD) morbidity and mortality, family history education may enhance risk awareness and support engagement in healthy behaviors but could also engender fatalism. This study was conducted to assess if the relationship between family history and adherence to healthy lifestyle behaviors is moderated by fatalism. Baseline data were obtained from 1,027 adult participants in the HeartHealth in Rural Kentucky study. Multiple linear regression was used to determine whether fatalism moderated the relationship between high-risk family history of CVD and adherence to healthy lifestyle behaviors, controlling for sociodemographic variables and CVD risk factors. The relationship between family history and healthy behaviors was assessed for subgroups of participants divided according to the upper and lower quartiles of fatalism score. The relationship between high-risk family history of CVD and adherence to healthy behaviors was moderated by fatalism. Among those with the highest quartile of fatalism scores, high-risk family history predicted greater adherence to healthy behaviors, while among those in the lowest quartile, and among those with the middle 50% of fatalism scores, there was no association between family history and healthy behavior scores. Family history education can provide people at increased risk for CVD important information to guide health practices. This may be particularly relevant for those with a high degree of fatalistic thinking. In rural communities with limited health resources, family history education, combined with assessment of fatalism, may support better targeted interventions to enhance engagement in healthy behaviors. © 2014 National Rural Health Association.

  5. Physical fitness and hypertension in a population at risk for cardiovascular disease: the Henry Ford ExercIse Testing (FIT) Project.

    Science.gov (United States)

    Juraschek, Stephen P; Blaha, Michael J; Whelton, Seamus P; Blumenthal, Roger; Jones, Steven R; Keteyian, Steven J; Schairer, John; Brawner, Clinton A; Al-Mallah, Mouaz H

    2014-12-01

    Increased physical fitness is protective against cardiovascular disease. We hypothesized that increased fitness would be inversely associated with hypertension. We examined the association of fitness with prevalent and incident hypertension in 57 284 participants from The Henry Ford ExercIse Testing (FIT) Project (1991–2009). Fitness was measured during a clinician‐referred treadmill stress test. Incident hypertension was defined as a new diagnosis of hypertension on 3 separate consecutive encounters derived from electronic medical records or administrative claims files. Analyses were performed with logistic regression or Cox proportional hazards models and were adjusted for hypertension risk factors. The mean age overall was 53 years, with 49% women and 29% black. Mean peak metabolic equivalents (METs) achieved was 9.2 (SD, 3.0). Fitness was inversely associated with prevalent hypertension even after adjustment (≥12 METs versus <6 METs; OR: 0.73; 95% CI: 0.67, 0.80). During a median follow‐up period of 4.4 years (interquartile range: 2.2 to 7.7 years), there were 8053 new cases of hypertension (36.4% of 22 109 participants without baseline hypertension). The unadjusted 5‐year cumulative incidences across categories of METs (<6, 6 to 9, 10 to 11, and ≥12) were 49%, 41%, 30%, and 21%. After adjustment, participants achieving ≥12 METs had a 20% lower risk of incident hypertension compared to participants achieving <6 METs (HR: 0.80; 95% CI: 0.72, 0.89). This relationship was preserved across strata of age, sex, race, obesity, resting blood pressure, and diabetes. Higher fitness is associated with a lower probability of prevalent and incident hypertension independent of baseline risk factors.

  6. Design of a RCT evaluating the (cost- effectiveness of a lifestyle intervention for male construction workers at risk for cardiovascular disease: The Health under Construction study

    Directory of Open Access Journals (Sweden)

    van der Beek Allard J

    2008-01-01

    Full Text Available Abstract Background Of all workers in Dutch construction industry, 20% has an elevated risk of cardiovascular disease (CVD. A major risk factor for CVD risk is an unhealthy lifestyle. The aim of our study is to design a lifestyle intervention for construction workers with an elevated CVD risk, and to evaluate its (cost- effectiveness. Methods/Design In a RCT, 692 participants will be randomised to either the control or the intervention group. The control group will receive usual care. For the intervention group, a lifestyle intervention has been designed based on interviews and current literature. The intervention will last 6 months and will comprise 3 face-to-face and 4 telephone contacts, consisting of individual counselling aimed at increasing daily physical activity (PA and improving dietary behaviour, and/or smoking cessation. Counselling will take place at the Occupational Health Service (OHS, and will be done according to motivational interviewing (MI. Additional written information about healthy lifestyle will also be provided to those in the intervention group. At baseline, after 6 and after 12 months, measurements will take place. Primary outcome variables will be the lifestyle behaviours of concern, i.e. daily PA, dietary intake, and smoking status. Secondary outcome variables will be body mass index (BMI, systolic and diastolic blood pressure, total and HDL blood cholesterol, Hba1c and cardio-respiratory fitness (CRF. Sickness absenteeism and cost-effectiveness will be assessed as well. Multilevel analysis will be performed to compare all outcome measures between the intervention group and the control group. Discussion By improving lifestyle, CVD risk may be lowered, yielding benefits for both employee and employer. If proven effective, this lifestyle intervention will be implemented on a larger scale within the Occupational Health Services in construction industry. Trial registration Current Controlled Trials ISRCTN60545588

  7. Comparison of Postoperative Respiratory Monitoring by Acoustic and Transthoracic Impedance Technologies in Pediatric Patients at Risk of Respiratory Depression.

    Science.gov (United States)

    Patino, Mario; Kalin, Megan; Griffin, Allison; Minhajuddin, Abu; Ding, Lili; Williams, Timothy; Ishman, Stacey; Mahmoud, Mohamed; Kurth, C Dean; Szmuk, Peter

    2017-06-01

    .9% specificity (95% CI, 0.90-1.00), 88.9% positive predictive value (95% CI, 0.73-1.00), and 72.1% negative predictive value (95% CI, 0.61-0.84), whereas the TI monitor had 68.5% sensitivity (95% CI, 0.53-0.84), 72.0% specificity (95% CI, 0.60-0.84), 59.0% positive (95% CI, 0.44-0.74), and 79.5% negative predictive value (95% CI, 0.69-0.90). In children at risk of postoperative respiratory depression, RR assessment by RAM was not different to manual counting. RAM was well tolerated, had a lower incidence of false alarms, and had better specificity and positive predictive value than TI. Rigorous evaluation of the negative predictive value is essential to determine the role of postoperative respiratory monitoring with RAM.

  8. Cardiovascular impact in patients undergoing maintenance hemodialysis: Clinical management considerations.

    Science.gov (United States)

    Chirakarnjanakorn, Srisakul; Navaneethan, Sankar D; Francis, Gary S; Tang, W H Wilson

    2017-04-01

    Patients undergoing maintenance hemodialysis develop both structural and functional cardiovascular abnormalities. Despite improvement of dialysis technology, cardiovascular mortality of this population remains high. The pathophysiological mechanisms of these changes are complex and not well understood. It has been postulated that several non-traditional, uremic-related risk factors, especially the long-term uremic state, which may affect the cardiovascular system. There are many cardiovascular changes that occur in chronic kidney disease including left ventricular hypertrophy, myocardial fibrosis, microvascular disease, accelerated atherosclerosis and arteriosclerosis. These structural and functional changes in patients receiving chronic dialysis make them more susceptible to myocardial ischemia. Hemodialysis itself may adversely affect the cardiovascular system due to non-physiologic fluid removal, leading to hemodynamic instability and initiation of systemic inflammation. In the past decade there has been growing awareness that pathophysiological mechanisms cause cardiovascular dysfunction in patients on chronic dialysis, and there are now pharmacological and non-pharmacological therapies that may improve the poor quality of life and high mortality rate that these patients experience. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Therapy of obese patient with Cardiovascular Disease

    OpenAIRE

    Jindal, Ankur; Whaley-Connell, Adam; Brietzke, Stephen; Sowers, James R

    2013-01-01

    Obesity has reached epidemic proportions and is a significant public health concern. Obesity is associated with increased diabetes, cardiovascular and kidney disease, and associated morbidity and mortality. Despite the increasing public health problem of obesity, there is a dearth of effective treatment options. Following the FDA mandated withdrawal of sibutramine, the treatment options for obesity were limited to orlistat as the only pharmacological treatment option for long term management ...

  10. Cardiovascular risk in overweight/obese and lean hypertensive patients.

    Science.gov (United States)

    Neves, Ana Luísa; Couto, Luciana

    2014-04-01

    Obesity and hypertension have been identified as independent risk factors for cardiovascular disease. Nevertheless, the role of obesity in the development and progression of target-organ disease in hypertensive patients is controversial. The objective of this study was to assess the impact of body weight on cardiovascular risk factors, target-organ disease and global cardiovascular risk in hypertensive patients in a primary care setting. A cross-sectional observational study was carried in Vila Nova de Gaia, Portugal (n=150). A detailed medical and personal history was obtained and a physical examination was performed. Venous blood and 24-hour urine samples were collected, and an electrocardiogram was performed. Cardiovascular risk was assessed using the Framingham score. The statistical analysis was performed using SPSS(®). A p-value education on weight reduction and control at primary health care clinics. Copyright © 2011 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  11. Trends in comorbidity in patients hospitalised for cardiovascular disease.

    Science.gov (United States)

    Buddeke, Josefien; Bots, Michiel L; van Dis, Ineke; Liem, Anho; Visseren, Frank L J; Vaartjes, Ilonca

    2017-12-01

    We determined trends over time in cardiovascular and non-cardiovascular comorbidity in patients hospitalised for cardiovascular disease (CVD). The Dutch nationwide hospital register was used to identify patients hospitalised for CVD during 2000-2010. Comorbidity was defined as a previous hospital admission for CVD other than the index CVD, cancer, diabetes, musculoskeletal and connective tissue disorders, respiratory disorders, thyroid gland disorders, kidney disorders and dementia in the five years previous to hospital admittance for the index CVD. Trends were calculated in strata of age and sex and for different types of CVD: coronary heart disease (CHD), cerebrovascular disease (CVA), heart failure (HF) and peripheral arterial disease (PAD). We identified 2,397,773 admissions for CVD between 2000 and 2010. Comorbidity was present in 38%. In HF, PAD, CHD and CVA this was 54%, 46%, 40%, and 32%, respectively. Between 2000 and 2010, the percentage of patients with comorbidity increased (+1.1%), this increase was most pronounced in patients ≥75years (+3.0%). Cardiovascular disease was the most frequent comorbid condition, though became less prevalent over time (men -5%; women: -2%), whereas non-cardiovascular comorbidity increased in men (+4%), and remained similar in women (-1%). Cancer was the most common non-cardiovascular comorbid condition and increased in men and women (men: +5%; women: +4%). Comorbid conditions are highly prevalent in patients hospitalised for CVD, especially HF and PAD patients. In older patients, prevalences increased over time. Cardiovascular diseases were the most common comorbid condition, though the prevalence decreased over the study period whereas the prevalence of cancer increased. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  12. A generative model for segmentation of tumor and organs-at-risk for radiation therapy planning of glioblastoma patients

    DEFF Research Database (Denmark)

    Agn, Mikael; Law, Ian; Munck Af Rosenschöld, Per

    2016-01-01

    We present a fully automated generative method for simultaneous brain tumor and organs-at-risk segmentation in multi-modal magnetic resonance images. The method combines an existing whole-brain segmentation technique with a spatial tumor prior, which uses convolutional restricted Boltzmann machin...

  13. Rosuvastatin: Role in Cardiovascular High-risk Patient

    Directory of Open Access Journals (Sweden)

    John E Feliciano-Alfonso

    2013-01-01

    Full Text Available Statins are the lipid-lowering drug family of first choice in situations of hypercholesterolemia or mixed dyslipidemia with predominant increase in cholesterol. The evidence shows conclusively that each one of the commercially available statins have proven benefits on outcomes of cardiovascular morbidity and mortality. However, rosuvastatin has certain pharmacokinetic efficacy and cost-effectiveness characteristics that make it an attractive molecule to be the statin of choice in patients at high cardiovascular risk.

  14. A healthy diet is associated with less endothelial dysfunction and less low-grade inflammation over a 7-year period in adults at risk of cardiovascular disease.

    Science.gov (United States)

    van Bussel, Bas C T; Henry, Ronald M A; Ferreira, Isabel; van Greevenbroek, Marleen M J; van der Kallen, Carla J H; Twisk, Jos W R; Feskens, Edith J M; Schalkwijk, Casper G; Stehouwer, Coen D A

    2015-03-01

    A healthy diet rich in fish, fruit, and vegetables, but moderate in alcohol and low in dairy products and meat, has been associated with a lower rate of incident cardiovascular disease (CVD). The underlying mechanisms, however, remain unclear. Endothelial dysfunction and low-grade inflammation play important roles in CVD. A healthy diet might modify these phenomena. We investigated the associations between the above food groups and overall biomarker scores of endothelial dysfunction and low-grade inflammation in a 7-y longitudinal study. Using longitudinal data from 557 participants at increased CVD risk from the CODAM (Cohort on Diabetes and Atherosclerosis Maastricht) Study, we assessed diet intake by food-frequency questionnaire and measured plasma biomarkers of endothelial dysfunction [von Willebrand factor, soluble vascular cell adhesion molecule 1, soluble endothelial selectin, soluble thrombomodulin, soluble intercellular adhesion molecule 1 (sICAM-1)] and low-grade inflammation [C-reactive protein, serum amyloid A, interleukin (IL)-6, IL-8, tumor necrosis factor α, and sICAM-1]. At baseline, participants were aged 59.6 ± 6.9 y. Measurements were performed then and after 7 y. Biomarkers were combined into overall scores (sum of z scores; higher scores indicating worse function). Longitudinal data were analyzed with generalized estimating equations and adjusted for sex, age, glucose metabolism, energy intake, body mass index, physical activity, alcohol consumption, and smoking. Higher consumption of fish (per 100 g/wk), but not total consumption of vegetables, fruit, alcohol-containing beverages, dairy products, or meat, was associated with a lower overall endothelial dysfunction score over 7 y (β: -0.027; 95% CI: -0.051, -0.004). No associations were observed with the overall low-grade inflammation score. Further food component analyses indicated that consumption of more lean fish (per 100 g/wk) and raw vegetables (per 100 g/d), and fewer high-fat dairy

  15. Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation

    Directory of Open Access Journals (Sweden)

    Martin Roland

    2012-07-01

    Full Text Available Introduction: In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model.Methods: Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3,646 patients and 17,311 matched controls, and changes in overall secondary care utilisation.Results: Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Case management interventions were associated with a 9% increase in emergency admissions. We found some evidence of imbalance between cases and controls which could have biased this estimate, but simulations of the possible effect of unobserved confounders showed that it was very unlikely that the sites achieved their goal of reducing emergency admissions. However, we found significant reductions of 21% and 22% in elective admissions and outpatient attendance in the six months following an intervention, and overall inpatient and outpatient costs were significantly reduced by 9% during this period. Area level analyses of whole practice populations suggested that overall outpatient attendances were significantly reduced by 5% two years after the start of the case management schemes.Conclusion: Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve

  16. Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation

    Directory of Open Access Journals (Sweden)

    Martin Roland

    2012-07-01

    Full Text Available Introduction: In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model. Methods: Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3,646 patients and 17,311 matched controls, and changes in overall secondary care utilisation. Results: Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Case management interventions were associated with a 9% increase in emergency admissions. We found some evidence of imbalance between cases and controls which could have biased this estimate, but simulations of the possible effect of unobserved confounders showed that it was very unlikely that the sites achieved their goal of reducing emergency admissions. However, we found significant reductions of 21% and 22% in elective admissions and outpatient attendance in the six months following an intervention, and overall inpatient and outpatient costs were significantly reduced by 9% during this period. Area level analyses of whole practice populations suggested that overall outpatient attendances were significantly reduced by 5% two years after the start of the case management schemes. Conclusion: Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve

  17. Primary prevention of cardiovascular diseases in general practice: mismatch between cardiovascular risk and patients' risk perceptions.

    Science.gov (United States)

    van der Weijden, T; van Steenkiste, B; Stoffers, H E J H; Timmermans, D R M; Grol, R

    2007-01-01

    Guidelines on primary prevention of cardiovascular disease (CVD) emphasize identifying high-risk patients for more intensive management, but patients' misconceptions of risk hamper implementation. Insight is needed into the type of patients that general practitioners (GPs) encounter in their cardiovascular prevention activities. How appropriate are the risk perceptions and worries of patients with whom GPs discuss CVD risks? What determines inappropriate risk perception? Cross-sectional study in 34 general practices. The study included patients aged 40 to 70 years with whom CVD risk was discussed during consultation. After the consultation, the GPs completed a registration form, and patients completed a questionnaire. Correlations between patients' actual CVD risk and risk perceptions were analyzed. In total, 490 patients were included. In 17% of the consultations, patients were actually at high risk. Risk was perceived inappropriately by nearly 4 in 5 high-risk patients (incorrect optimism) and by 1 in 5 low-risk patients (incorrect pessimism). Smoking, hypertension, and obesity were determinants of perceiving CVD risk as high, whereas surprisingly, diabetic patients did not report any anxiety about their CVD risk. Men were more likely to perceive their CVD risk inappropriately than women. In communicating CVD risk, GPs must be aware that they mostly encounter low-risk patients and that the perceived risk and worry do not necessarily correspond with the actual risk. Incorrect perceptions of CVD risk among men and patients with diabetes were striking.

  18. Expression of Prostaglandin E2 Enzymes in the Synovium of Arthralgia Patients at Risk of Developing Rheumatoid Arthritis and in Early Arthritis Patients.

    Directory of Open Access Journals (Sweden)

    Maria J H de Hair

    Full Text Available Arthralgia may precede the development of synovial inflammation in autoantibody-positive individuals at risk of developing rheumatoid arthritis (RA. A major pathway involved in pain is the prostaglandin (PG E2 pathway. We investigated this pathway in the synovium of individuals with RA-specific autoantibodies and in early arthritis patients.Nineteen autoantibody-positive individuals (IgM-rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies with arthralgia (n=15 and/or a positive family history of RA (n=8, who had been prospectively followed for at least 2 years, were included. In addition, we included early arthritis patients (disease-modifying antirheumatic drug naïve who after 2 years follow up fulfilled classification criteria for RA (n=63, spondyloarthritis (SpA; n=14, or had unclassified arthritis (UA; n=27. In all subjects we assessed pain and performed synovial biopsy sampling by mini-arthroscopy at baseline. Tissue sections were examined by immunohistochemistry to detect and quantify PGE2 pathway enzymes expression levels (mPGES-1; COX-1 and -2; 15-PGDH.In both study groups synovial expression of PGE2 enzymes was not clearly related to pain sensation. Expression levels at baseline were not associated with the development of arthritis after follow up (6 out of 19 autoantibody-positive individuals. However, in early SpA patients the expression levels of mPGES-1 and COX-1 were significantly increased compared to RA and UA patients.Pain in autoantibody-positive individuals without synovial inflammation who are at risk of developing RA and in early arthritis patients may be regulated by pathways other than the PGE2 pathway or originate at sites other than the synovium. In contrast, in SpA, the PGE2 pathway may be inherently linked to the pathophysiology/etiology of the disease.

  19. Cardiovascular risk factors in patients with type 2 diabetes mellitus ...

    African Journals Online (AJOL)

    Objectives: To determine the proportion of specific cardiovascular risk factors in ambulatory patients with type 2 diabetes and the levels of control achieved in them. Design: Prospective, cross-sectional study over a six month period. Setting: Out-patient diabetic clinic of the Kenyatta National Hospital. Subjects: Two hundred ...

  20. [Relevance of diabetes in high cardiovascular risk hypertensive patients].

    Science.gov (United States)

    Segura, Julián; de la Sierra, Alejandro; Fernández, Sandra; Ruilope, Luis M

    2013-10-05

    The aim of this cross-sectional study was to compare the prevalence of target organ damage (TOD) and established cardiovascular disease (CVD) in a cohort of nondiabetic hypertensive patients with 3 or more cardiovascular risk factors (CVRF) against a group of hypertensives with type 2 diabetes. We included 4,725 hypertensive patients, 62% male, mean age 64 (SD 12) years, with type 2 diabetes mellitus, independently of the number of associated CVRF (N=2,608), or non-diabetics, in which case we required the presence of 3 CVRF (N=2,117). The prevalence of established CVD (clinical interview) and TOD (left ventricular hypertrophy by electrocardiogram, microalbuminuria and estimated glomerular filtration rate) were estimated. Hypertensive patients with type 2 diabetes had an older age and more marked obesity. Furthermore, these patients showed a higher prevalence of micro- and macroalbuminuria, renal failure, left ventricular hypertrophy, atherosclerotic plaques in carotid arteries and CVD compared with nondiabetic hypertensive patients with 3 or more CVRF. Multivariate analysis showed that the risk of TOD or established CVD were associated independently with the presence of diabetes. Hypertensive patients with type 2 diabetes have a higher prevalence of LOD and CVD compared to nondiabetic hypertensive patients with 3 or more CVRF. Although both situations are included in the high cardiovascular risk stratum, it would be expected an increased incidence of cardiovascular complications in hypertensive diabetic patients. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  1. Increased Prevalence of Cardiovascular and Autoimmune Diseases in Periodontitis Patients : A Cross-Sectional Study

    NARCIS (Netherlands)

    Nesse, Willem; Dijkstra, Pieter U.; Abbas, Frank; Spijkervet, Fred K. L.; Stijger, Astrid; Tromp, Jan A. H.; van Dijk, Johan L.; Vissink, Arjan

    2010-01-01

    Background: Associations between periodontitis and cardiovascular and autoimmune diseases are most often assessed in patients with a particular cardiovascular or autoimmune disease. To prevent selection bias, this study assesses the existence of associations between periodontitis and cardiovascular

  2. Risk factors of arterial cardiovascular complications in patients with prior venous thromboembolism

    NARCIS (Netherlands)

    Roshani, S.; Lijfering, W. M.; Coppens, M.; Hamulyák, K.; Prins, M. H.; Büller, H. R.; Middeldorp, S.

    2011-01-01

    Background. The effect of cardiovascular risk factors (CVRs) and thrombophilic defects on the risk of arterial cardiovascular complications in patients with prior venous thromboembolism (VTE) is unclear. Objective. We investigated whether the risk of arterial cardiovascular complications is

  3. Risk factors of arterial cardiovascular complications in patients with prior venous thromboembolism

    NARCIS (Netherlands)

    Roshani, S.; Lijfering, W. M.; Coppens, M.; Hamulyak, K.; Prins, M. H.; Buller, H. R.; Middeldorp, S.

    Background. The effect of cardiovascular risk factors (CVRs) and thrombophilic defects on the risk of arterial cardiovascular complications in patients with prior venous thromboembolism (VTE) is unclear. Objective. We investigated whether the risk of arterial cardiovascular complications is

  4. Increased Prevalence of Cardiovascular and Autoimmune Diseases in Periodontitis Patients: A Cross-Sectional Study

    NARCIS (Netherlands)

    Nesse, Willem; Dijkstra, P.U.; Abbas, Frank; Spijkervet, F.K.L.; Stijger, A.; Tromp, J.A.H.; van Dijk, J.L.; Vissink, A.

    2010-01-01

    Background: Associations between periodontitis and cardiovascular and autoimmune diseases are most often assessed in patients with a particular cardiovascular or autoimmune disease. To prevent selection bias, this study assesses the existence of associations between periodontitis and cardiovascular

  5. CARDIOVASCULAR RISK FACTORS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

    Directory of Open Access Journals (Sweden)

    Ye. D. Bazdyrev

    2014-11-01

    Full Text Available Objective: to detect previously undiagnosed arterial hypertension in patients with chronic obstructive pulmonary disease (COPD as a risk factor for cardiovascular mortality.Materials and methods. 43 patients with stage I–II of COPD and the absence of clinical signs of cardiovascular diseases were examined. Spirometry, body plethysmography and diffusing lung capacity (DLCO were included in the respiratory system assessment. The cardiovascular system was assessed with echocardiography and ambulatory blood pressure monitoring (ABPM.Results. Despite the absence of obvious signs of cardiovascular lesions (an increase of office blood pressure, intracardiac hemodynamic changes, the following cardiovascular risk factors were identified: age (58.2 ± 2.0 years, male gender, smoking, hypercholesterolemia and dyslipidemia (total cholesterol 5.9 ± 0.9 mmol / l, low density lipoproteins 3.8 ± 0.5 mmol / l, triglycerides 1.8 ± 0.2 mmol / l. Correlation analysis has revealed the relation between several respiratory parameters and the severity of dyspnea and quality of life in patients with COPD, as well as its relation with lipid levels.Conclusion. The patients with COPD have a large number of risk factors for CVD. According to ABPM data, arterial hypertension was verified in 18 (41.9 % of 43 patients with COPD at normal level of office blood pressure; moreover, 51.2 % of patients demonstrated low reduction of blood pressure during the night-time that nowadays, is considered to be a predictor of cardiovascular disease and sudden death.

  6. Tai Chi Chuan Exercise for Patients with Cardiovascular Disease

    Science.gov (United States)

    Lan, Ching; Chen, Ssu-Yuan; Wong, May-Kuen; Lai, Jin Shin

    2013-01-01

    Exercise training is the cornerstone of rehabilitation for patients with cardiovascular disease (CVD). Although high-intensity exercise has significant cardiovascular benefits, light-to-moderate intensity aerobic exercise also offers health benefits. With lower-intensity workouts, patients may be able to exercise for longer periods of time and increase the acceptance of exercise, particularly in unfit and elderly patients. Tai Chi Chuan (Tai Chi) is a traditional Chinese mind-body exercise. The exercise intensity of Tai Chi is light to moderate, depending on its training style, posture, and duration. Previous research has shown that Tai Chi enhances aerobic capacity, muscular strength, balance, and psychological well-being. Additionally, Tai Chi training has significant benefits for common cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, poor exercise capacity, endothelial dysfunction, and depression. Tai Chi is safe and effective in patients with acute myocardial infarction (AMI), coronary artery bypass grafting (CABG) surgery, congestive heart failure (HF), and stroke. In conclusion, Tai Chi has significant benefits to patients with cardiovascular disease, and it may be prescribed as an alternative exercise program for selected patients with CVD. PMID:24348732

  7. Tai Chi Chuan Exercise for Patients with Cardiovascular Disease

    Directory of Open Access Journals (Sweden)

    Ching Lan

    2013-01-01

    Full Text Available Exercise training is the cornerstone of rehabilitation for patients with cardiovascular disease (CVD. Although high-intensity exercise has significant cardiovascular benefits, light-to-moderate intensity aerobic exercise also offers health benefits. With lower-intensity workouts, patients may be able to exercise for longer periods of time and increase the acceptance of exercise, particularly in unfit and elderly patients. Tai Chi Chuan (Tai Chi is a traditional Chinese mind-body exercise. The exercise intensity of Tai Chi is light to moderate, depending on its training style, posture, and duration. Previous research has shown that Tai Chi enhances aerobic capacity, muscular strength, balance, and psychological well-being. Additionally, Tai Chi training has significant benefits for common cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, poor exercise capacity, endothelial dysfunction, and depression. Tai Chi is safe and effective in patients with acute myocardial infarction (AMI, coronary artery bypass grafting (CABG surgery, congestive heart failure (HF, and stroke. In conclusion, Tai Chi has significant benefits to patients with cardiovascular disease, and it may be prescribed as an alternative exercise program for selected patients with CVD.

  8. Management of cardiovascular disease in patients with psoriasis

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Skov, Lone

    2016-01-01

    INTRODUCTION: Patients with psoriasis have an increased incidence and prevalence of cardiovascular (CV) risk factors, and CV undertreatment in these patients is a well-established problem. The link between psoriasis and CV disease is present on a pathogenic level, as well as due to modifiable lif......, the importance of screening for CV risk factors and strict adherence to established primary and secondary preventive measures in these patients should be emphasized....

  9. Impact of Acute Hyperglycemia on Myocardial Infarct Size, Area at Risk, and Salvage in Patients With STEMI and the Association With Exenatide Treatment

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Vejlstrup, Niels; Kelbæk, Henning

    2014-01-01

    Hyperglycemia upon hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) occurs frequently and is associated with adverse outcomes. It is, however, unsettled as to whether an elevated blood glucose level is the cause or consequence of increased myocardial damage....... In addition, whether the cardioprotective effect of exenatide, a glucose-lowering drug, is dependent on hyperglycemia remains unknown. The objectives of this substudy were to evaluate the association between hyperglycemia and infarct size, myocardial salvage, and area at risk, and to assess the interaction...... between exenatide and hyperglycemia. A total of 210 STEMI patients were randomized to receive intravenous exenatide or placebo before percutaneous coronary intervention. Hyperglycemia was associated with larger area at risk and infarct size compared with patients with normoglycemia, but the salvage index...

  10. Frequency of isolation of polioviruses and non polio enteroviruses from patients with acute flaccid paralysis, enterovirus infection and children from groups at risk

    Directory of Open Access Journals (Sweden)

    N. I. Romanenkova

    2012-01-01

    Full Text Available The article describes the frequency of isolation of polioviruses and non polio enteroviruses from different categories of the investigated children. The percentage of detection of polioviruses from the patients with acute flaccid paralysis was lower than that from the children from groups at risk. Among the patients with the enterovirus infection the polioviruses were rarely revealed. The frequency of isolation of non polio enteroviruses from these patients was significantly higher than that from the other categories of investigated persons. The improvement of poliomyelitis surveillance and the reinforcement of virological surveillance of children from groups at risk and those with enterovirus infection will provide the important data for Global Polio Eradication Initiative and the maintenance of polio free status of the Russian Federation.

  11. Delineating organs at risk in radiation therapy

    CERN Document Server

    Ausili Cèfaro, Giampiero; Perez, Carlos A

    2014-01-01

    This book offers an invaluable guide to the delineation of organs at risk of toxicity in patients undergoing radiotherapy. It details the radiological anatomy of organs at risk as seen on typical radiotherapy planning CT scans.

  12. Undiagnosed airflow limitation in patients at cardiovascular risk.

    Science.gov (United States)

    Bérard, Emilie; Bongard, Vanina; Roche, Nicolas; Perez, Thierry; Brouquières, Dany; Taraszkiewicz, Dorota; Fievez, Stéphane; Denis, François; Escamilla, Roger; Ferrières, Jean

    2011-12-01

    Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVD) share risk factors and impair each other's prognosis. To assess the prevalence of airflow limitation (AL) compatible with COPD in a population at cardiovascular risk and to identify determinants of AL. All consecutive patients referred to the cardiovascular prevention unit of a university hospital in 2009 were studied in a cross-sectional analysis. Patients answered questionnaires on socioeconomic status, medical history and lifestyle, and underwent extensive physical examinations, biological measures and spirometry testing. AL was defined as FEV1/FVC20%) for 10%. Prevalence of AL was 5.9% (95% confidence interval [CI] 4.0-8.3%) in the whole population and 4.3% (2.6-6.6%) among subjects in primary cardiovascular prevention. AL was independently associated with CVD (adjusted odds ratio 4.18, 95% CI 1.72-10.15; P=0.002) but not with Framingham CHD risk. More than 80% of patients screened with AL had not been diagnosed previously and more than one in two patients was asymptomatic. Patients with CVD are at increased risk of AL and thus should benefit from AL screening as they are frequently asymptomatic. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  13. Cardiovascular and noncardiovascular mortality among patients starting dialysis

    DEFF Research Database (Denmark)

    de Jager, Dinanda J; Grootendorst, Diana C; Jager, Kitty J

    2009-01-01

    CONTEXT: Cardiovascular mortality is considered the main cause of death in patients receiving dialysis and is 10 to 20 times higher in such patients than in the general population. OBJECTIVE: To evaluate if high overall mortality in patients starting dialysis is a consequence of increased...... cardiovascular mortality risk only or whether noncardiovascular mortality is equally increased. DESIGN, SETTING, AND PATIENTS: Using data from between January 1, 1994, and January 1, 2007, age-stratified mortality in a European cohort of adults starting dialysis and receiving follow-up for a mean of 1.8 (SD, 1.......1) years (European Renal Association-European Dialysis and Transplant Association [ERA-EDTA] Registry [N = 123,407]) was compared with the European general population (Eurostat). MAIN OUTCOME MEASURES: Cause of death was recorded by ERA-EDTA codes in patients and matching International Statistical...

  14. Cardiovascular Complications in CKD Patients: Role of Oxidative Stress

    Directory of Open Access Journals (Sweden)

    Elvira O. Gosmanova

    2011-01-01

    Full Text Available Starting with the early stages, patients with chronic kidney disease (CKD experience higher burden of cardiovascular disease (CVD. Moreover, CVD complications are the major cause of mortality in CKD patients as compared with complications from chronic kidney failure. While traditional CVD risk factors, including diabetes, hypertension, hyperlipidemia, obesity, physical inactivity, may be more prevalent among CKD patients, these factors seem to underestimate the accelerated cardiovascular disease in the CKD population. Search for additional biomarkers that could explain the enhanced CVD risk in CKD patients has gained increasing importance. Although it is unlikely that any single nontraditional risk factor would fully account for the increased CVD risk in individuals with CKD, oxidative stress appears to play a central role in the development and progression of CVD and its complications. We will review the data that support the contribution of oxidative stress in the pathogenesis of CVD in patients with chronic kidney failure.

  15. [Influence of the arterio-venous fistula on cardiovascular system in patients with particular cardiovascular risk].

    Science.gov (United States)

    Krajewska, Magdalena; Weyde, Wacław; Kosmala, Wojciech; Klinger, Marian

    2006-08-01

    In the population of hemodialysis patients the risk of ischemic heart disease and morbidity related to it, is considerably higher than in general population. In the group of elderly hemodialysed patients and in patients with diabetes this risk is even higher Additional risk factors of cardiovascular disease are those specific for renal insufficiency, including the presence of arterio-venous fistula, which is believed to be an independent risk factor for cardiovascular disease through the promotion of hyperkinetic circulation. In the study the impact of the arterio-venous fistula on heart function in Doppler USG in the group of 16 elderly hemodialysis patients (aged 79, 4 +/- 5,4), 10 diabetics with type 2 diabetes (aged 63,2 +/- 10,4) and 7 hemodialysis patients younger and without diabetes was examined. In all patients arterio-venous fistula was created on the forearm from native vessels. The following hemodynamic USG parameters of heart function were assessed: ejection fraction (EF), shortening fraction (FS), stroke volume (SV) and cardiac output (CO). We conclude that impact of native arterio-venous fistula created on forearm on circulation in the group of elderly and diabetic patients is of the same magnitude as in the group of younger, non diabetic patients.

  16. Diabetic Cardiovascular Autonomic Neuropathy Predicts Recurrent Cardiovascular Diseases in Patients with Type 2 Diabetes.

    Directory of Open Access Journals (Sweden)

    Seon-Ah Cha

    Full Text Available Cardiovascular autonomic neuropathy (CAN is a risk factor for cardiovascular disease (CVD and mortality in patients with type 2 diabetes. This study evaluated the relationship between CAN and recurrent CVD in type 2 diabetes. A total of 206 patients with type 2 diabetes who had a history of CVD within 3 years of enrollment were consecutively recruited from January 2001 to December 2009 and followed-up until December 2015. Cardiovascular autonomic function tests were performed using the following heart rate variability parameters: expiration-to-inspiration ratio, response to Valsalva maneuver and standing. We estimated the recurrence of CVD events during the follow-up period. A total of 159 (77.2% of the 206 patients enrolled completed the follow up, and 78 (49.1% patients had recurrent episodes of CVD, with an incidence rate of 75.6 per 1,000 patient-years. The mean age and diabetes duration were 62.5 ± 8.7 and 9.2 ± 6.9 years, respectively. Patients who developed recurrent CVD also exhibited hypertension (P = 0.004, diabetic nephropathy (P = 0.012, higher mean systolic blood pressure (P = 0.006, urinary albumin excretion (P = 0.015, and mean triglyceride level (P = 0.035 than did patients without recurrent CVD. Multivariable Cox hazard regression analysis revealed that definite CAN was significantly associated with an increased risk of recurrent CVD (hazard ratio [HR] 3.03; 95% confidence interval [CI] 1.39-6.60; P = 0.005. Definite CAN was an independent predictor for recurrent CVD in patients with type 2 diabetes who had a known prior CVD event.

  17. Cardiovascular risk factors in hemodialysis and peritoneal dialysis patients.

    Science.gov (United States)

    Helal, Imed; Smaoui, Wided; Hamida, Fethi Ben; Ouniss, Monder; Aderrahim, Ezzeddine; Hedri, Hafedh; Elyounsi, Fethi; Maiz, Hedi Ben; Abdallah, Taieb Ben; Kheder, Adel

    2010-01-01

    Cardiovascular diseases are a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). The aim of our investigation was the evaluation of an extensive cardiovascular profile in hemodialysis (HD) and peritoneal dialysis (PD) patients. We studied 74 patients with ESRD (38 males, 36 females), maintained either on chronic HD (n= 50) or chronic PD (n= 24) and age and sex matched 20 healthy subjects as controls. The lipid profile, homocysteine (Hcy) and C reactive protein (CRP) were measured. When compared to a healthy population, HD patients displayed a marked atherogenic profile, as attested by increased levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C), apolipoprotein A (Apo A), CRP, Hcy and lower concentrations of high-density lipoprotein-cholesterol (HDL-C), Apo B, albumin (ALB). A significant difference was noted concerning the rates of Apo B, HDL-C, TC, ALB and Hcy. Same biological disorders that those found at HD patients were noted in these PD patients. One also noted lower concentration in Apo A. there were a significant difference with the reference group concerning the rates of albumin, Apo A, HDL-Cl and Hcy. When compared to PD patients, HD patients had significantly decreased concentration of LDL-C. The peculiar metabolic changes observed in the present study confirm the marked tendency of patients with impaired renal function for developing cardiovascular diseases, irrespectively of the type of dialysis. We suggest including uremia-related risk factors in the panel for evaluation of cardiovascular risk in dialysis patients.

  18. Cardiovascular risk factors in hemodialysis and peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Helal Imed

    2010-01-01

    Full Text Available Cardiovascular diseases are a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD. The aim of our investigation was the evaluation of an extensive cardiovascular profile in hemodialysis (HD and peritoneal dialysis (PD patients. We studied 74 patients with ESRD (38 males, 36 females, maintained either on chronic HD (n= 50 or chronic PD (n= 24 and age and sex matched 20 healthy subjects as controls. The lipid profile, homo-cysteine (Hcy and C reactive protein (CRP were measured. When compared to a healthy popu-lation, HD patients displayed a marked atherogenic profile, as attested by increased levels of total cholesterol (TC, triglycerides (TG, low-density lipoprotein-cholesterol (LDL-C, apolipoprotein A (Apo A, CRP, Hcy and lower concentrations of high-density lipoprotein-cholesterol (HDL-C, Apo B, albumin (ALB. A significant difference was noted concerning the rates of Apo B, HDL-C, TC, ALB and Hcy. Same biological disorders that those found at HD patients were noted in these PD patients. One also noted lower concentration in Apo A. there were a significant diffe-rence with the reference group concerning the rates of albumin, Apo A, HDL-Cl and Hcy. When compared to PD patients, HD patients had significantly decreased concentration of LDL-C. The peculiar metabolic changes observed in the present study confirm the marked tendency of patients with impaired renal function for developing cardiovascular diseases, irrespectively of the type of dialysis. We suggest including uremia-related risk factors in the panel for evaluation of cardio-vascular risk in dialysis patients.

  19. risk factors for cardiovascular diseases among diabetic patients in ...

    African Journals Online (AJOL)

    user

    BACKGROUND: Studies on cardiovascular risk factors among diabetic ... Age ≥ 45 years, type 2 diabetes and obesity were predictors of hypertension. ... worldwide; two thirds of whom are in developing countries. By the year 2030, ... Ethiop J Health Sci. Vol. ... In the west, up to 25% of diabetic patients ..... Since overweight.

  20. Cardiovascular instability and baroreflex activity in a patient with tetanus

    NARCIS (Netherlands)

    van Lieshout, J. J.; Wieling, W.; Settels, J. J.; Karemaker, J. M.

    1991-01-01

    In a patient with tetanus we tested the hypothesis that the hyperadrenergic cardiovascular instability might be due to impairment of the baroreceptor reflex by the tetanus toxin. Baroreflex sensitivity assessed with the phenylephrine method was found to be normal. Changes in arterial pressure

  1. Adherence to nicotine replacement patch therapy in cardiovascular patients

    NARCIS (Netherlands)

    Wiggers, Louise C. W.; Smets, Ellen M. A.; Oort, Frans J.; Storm-Versloot, Marja N.; Vermeulen, Hester; van Loenen, Lucas B. M.; Peters, Ron J. G.; de Haes, Hanneke C. J. M.; Legemate, Dink A.

    2006-01-01

    Nicotine Replacement Therapy (NRT) is the most frequently used pharmacological intervention for smoking cessation. Research on the effect of NRT showed serious nonadherence among users. We investigated adherence to NRT in cardiovascular patients. A number of 174 outpatients (N = 174), who smoked > 5

  2. Patient profiling can identify patients with adult spinal deformity (ASD) at risk for conversion from non-operative to surgical treatment: initial steps to reduce ineffective ASD management.

    Science.gov (United States)

    Passias, Peter G; Jalai, Cyrus M; Line, Breton G; Poorman, Gregory W; Scheer, Justin K; Smith, Justin S; Shaffrey, Christopher I; Burton, Douglas C; Fu, Kai-Ming G; Klineberg, Eric O; Hart, Robert A; Schwab, Frank; Lafage, Virginie; Bess, Shay

    2017-07-05

    pelvic incidence and lumbar lordosis (PI-LL) mismatch than NON (11.9° vs. 3.1°, p=.032). CROSS and OP had similar baseline PROM scores; however, CROSS had worse baseline ODI, PCS, SRS-22r (poperative to operative ASD care. CROSS patients had similar spinal deformity but worse PROMs than NON. CROSS achieved similar 2-year outcome scores as OP. Profiling at first visit for patients at risk of crossover may optimize physician counseling and cost savings. Copyright © 2017. Published by Elsevier Inc.

  3. Cardiovascular health monitoring in patients with psychotic illnesses: A project to investigate and improve performance in primary and secondary care.

    Science.gov (United States)

    Modi, Rakesh Narendra; Ledingham, David

    2013-01-01

    Patients with psychotic illnesses are predicted to die 15 years younger than the national average. The chief cause is cardiovascular disease (1). Evidence-based guidelines including those produced by the National Institute of Health and clinical Excellence and the Quality Outcomes Framework, recommend regular monitoring of their cardiovascular risk (2,3,4). Primary health care audits were undertaken in an urban and a rural setting. These looked at the proportion of patients who had their physical health regularly monitored in line with NICE guidelines. Following an audit in general practice, it became clear that there was a group of patients that were chronic non-attenders. It was not clear whether these patients were the responsibility of the general practices or psychiatric services. An audit in secondary care then looked at the level of cardiovascular health monitoring in that setting, and the communication of results to primary care. These audits demonstrated that monitoring of cardiovascular health did not meet standards as set by NICE. Further to this, communication of findings between primary and secondary care was also poor. Primary care interventions included setting up Alert reminder boxes on the computer system and sending invitations for clinic attendance to 'at risk' patients. In secondary care interventions included redesign of the patient lists to include a way of monitoring cardiovascular health and generation of a new discharge summary to facilitate communication of cardiovascular indicators to primary care. These interventions have resulted in marked improvements in cardiovascular health monitoring in primary care, however, there is still room for considerable improvement. Discussions about further intervention strategies, and further audit cycles, are ongoing.

  4. Are patients at risk for psychological maladjustment during fertility treatment less willing to comply with treatment? Results from the Portuguese validation of the SCREENIVF.

    Science.gov (United States)

    Lopes, V; Canavarro, M C; Verhaak, C M; Boivin, J; Gameiro, S

    2014-02-01

    Do patients at risk for psychological maladjustment during fertility treatment present lower intentions to comply with recommended treatment than patients not at risk? Patients at risk of psychological maladjustment present similar high intentions to comply with recommended fertility treatment to those not at risk but their intentions are conditioned by the degree of control they perceive over their fertility and its treatment and their capacity to accept a future without biological children. Infertile couples refer to the psychological burden of treatment as one of the most important reasons for withdrawal from recommended treatment. The SCREENIVF can be used before treatment to screen patients at risk for psychological maladjustment by assessing five risk factors: anxiety, depression, helplessness and lack of acceptance cognitions and social support. Cross-sectional study. First, we investigated the psychometric properties of the Portuguese version of the SCREENIVF. Secondly, we investigated associations between risk for psychological maladjustment and intentions to comply with treatment. Two hundred and ninety-one women and 92 men undergoing any stage of fertility treatment at Portuguese infertility clinics were recruited online or in the clinical setting (55% response rate). Participants completed questionnaires that assessed their emotional adjustment, quality of life and compliance intentions. The confirmatory factor analysis for the SCREENIVF indicated good fit [χ(2) = 188.50, P 0.05). Cognitive risk factors moderated negative associations found between distress and compliance intentions. Higher anxiety was associated with lower compliance intentions for patients with lower helplessness cognitions (β = -0.45, P = 0.01) and men with higher acceptance cognitions (β = -0.60; P = 0.03), but not for patients with higher helplessness cognitions (β = 0.25, P = 0.13) and men with lower acceptance cognitions (β = 0.38; P = 0.21). Higher depression was associated

  5. Etiology of cardiovascular disease in patients with schizophrenia: current perspectives

    Directory of Open Access Journals (Sweden)

    Emul M

    2015-10-01

    Full Text Available Murat Emul,1 Tevfik Kalelioglu21Department of Psychiatry, Medical School of Cerrahpasa, Istanbul University, 2Department of Psychiatry, Bakirkoy Mental Health Research and Training Hospital, Istanbul, TurkeyAbstract: Cardiovascular morbidity and mortality are important problems among patients with schizophrenia. A wide spectrum of reasons, ranging from genes to the environment, are held responsible for causing the cardiovascular risk factors that may lead to shortening the life expectancy of patients with schizophrenia. Here, we have summarized the etiologic issues related with the cardiovascular risk factors in schizophrenia. First, we focused on heritable factors associated with cardiovascular disease and schizophrenia by mentioning studies about genetics–epigenetics, in the first-episode or drug-naïve patients. In this context, the association and candidate gene studies about metabolic disturbances in schizophrenia are reviewed, and the lack of the effects of epigenetic/posttranscriptional factors such as microRNAs is mentioned. Increased rates of type 2 diabetes mellitus and disrupted metabolic parameters in schizophrenia are forcing clinicians to struggle with metabolic syndrome parameters and related issues, which are also the underlying causes for the risk of having cardiometabolic and cardiovascular etiology. Second, we summarized the findings of metabolic syndrome-related entities and discussed the influence of the illness itself, antipsychotic drug treatment, and the possible disadvantageous lifestyle on the occurrence of metabolic syndrome (MetS or diabetes mellitus. Third, we emphasized on the risk factors of sudden cardiac death in patients with schizophrenia. We reviewed the findings on the arrhythmias such as QT prolongation, which is a risk factor for Torsade de Pointes and sudden cardiac death or P-wave prolongation that is a risk factor for atrial fibrillation. For example, the use of antipsychotics is an important reason

  6. Collagenase matrix metalloproteinase-8 expressed in atherosclerotic carotid plaques is associated with systemic cardiovascular outcome

    NARCIS (Netherlands)

    Peeters, W.; Moll, F.L.; Vink, A.; Spek, P.J. van der; Kleijn, D.P.V. de; Vries, J.-P.P.M. de; Verheijen, J.H.; Newby, A.C.; Pasterkamp, G.

    2011-01-01

    Aims Atherosclerotic plaque rupture and subsequent thrombus formation are the major cause of acute cardiovascular events. Local plaque markers may facilitate detection of the vulnerable plaque and help identify the patient at risk for cardiovascular events. Matrix metalloproteinases (MMPs) are

  7. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes

    DEFF Research Database (Denmark)

    Marso, Steven P; Bain, Stephen C; Consoli, Agostino

    2016-01-01

    BACKGROUND: Regulatory guidance specifies the need to establish cardiovascular safety of new diabetes therapies in patients with type 2 diabetes in order to rule out excess cardiovascular risk. The cardiovascular effects of semaglutide, a glucagon-like peptide 1 analogue with an extended half......-life of approximately 1 week, in type 2 diabetes are unknown. METHODS: We randomly assigned 3297 patients with type 2 diabetes who were on a standard-care regimen to receive once-weekly semaglutide (0.5 mg or 1.0 mg) or placebo for 104 weeks. The primary composite outcome was the first occurrence of cardiovascular.......001 for noninferiority). Nonfatal myocardial infarction occurred in 2.9% of the patients receiving semaglutide and in 3.9% of those receiving placebo (hazard ratio, 0.74; 95% CI, 0.51 to 1.08; P=0.12); nonfatal stroke occurred in 1.6% and 2.7%, respectively (hazard ratio, 0.61; 95% CI, 0.38 to 0.99; P=0.04). Rates...

  8. VARENICLINE IN PATIENTS WITH CARDIOVASCULAR DISEASES – FRIEND OR ENEMY?

    Directory of Open Access Journals (Sweden)

    Yu. V. Lukina

    2015-09-01

    Full Text Available The problem of varenicline use in patients with cardiovascular diseases is discussed. Results of large clinical trials and meta-analyses with varenicline have proven its high efficacy for treatment of nicotine addiction in adults and a small number of side events. Varenicline is the main agent for pharmacotherapy of nicotine addiction due to its high efficacy and advantages of smoking cessation. However careful monitoring of its side effects is needed in these patients.

  9. [Prevalence of cardiovascular diseases in patients with hypothyroidism].

    Science.gov (United States)

    Mitu, F; Cojocaru, Elena; Tamba, B; Leon, Maria-Magdalena

    2012-01-01

    The cardiovascular risk in patients with hypothyroidism is related to an increased risk of functional cardiovascular abnormalities and atherosclerosis. AIMS--The purpose of the present study was to examine a possible association between subclinical and clinical hypothyroidism and cardiovascular disease (CVD). The retrospective study, which covered a 12 months period, had the purpose to establish the prevalence of various risk factors for CVD, within subclinical and clinical hypothyroidism. We have studied 64 subjects with subclinical and clinical hypothyroidism admitted to the Rehabilitation Hospital, in the Cardiovascular Clinic. They were divided by sex, age, living environment (urban, rural), value of cholesterol, heart rate, BMI, blood pressure. CONCLUSIONS--The study revealed an increased risk of cardiovascular abnormalities and an increased risk of atherosclerosis: 65,61% subjects were obese, 90,6% with high blood pressure, 62,5% had dyslipidaemia. Subclinical thyroid dysfunction is common in older people. The identification of subclinical and clinical hypothyroidism earlier, pursuit of markers for subclinical atherosclerosis and deployment of lifestyle changes, are elements that can also be the key in improving clinical and paraclinical parameters.

  10. Which patients with epilepsy are at risk for psychogenic nonepileptic seizures (PNES)? A multicenter case-control study

    NARCIS (Netherlands)

    Wissel, Benjamin D.; Dwivedi, Alok K.; Gaston, Tyler E.; Rodriguez-Porcel, Federico J.; Aljaafari, Danah; Hopp, Jennifer L.; Krumholz, Allan; van der Salm, Sandra M. A.; Andrade, Danielle M.; Borlot, Felippe; Moseley, Brian D.; Cavitt, Jennifer L.; Williams, Stevie; Stone, Jon; LaFrance, W. Curt; Szaflarski, Jerzy P.; Espay, Alberto J.

    2016-01-01

    We sought to examine the clinical and electrographic differences between patients with combined epileptic (ES) and psychogenic nonepileptic seizures (PNES) and age- and gender-matched patients with ES-only and PNES-only. Data from 138 patients (105 women [77%]), including 46 with PNES/ES

  11. Cardiovascular diseases in Patients with Bipolar disease: Pragmatic Management.

    Science.gov (United States)

    Jesus, Cátia; Jesus, Inês; Agius, Mark

    2016-09-01

    Bipolar disorder (BD), also known as manic-depressive illness, is a condition characterized by unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Bipolar disorder is known to be a chronic and disabling disease associated with higher incidence of obesity, diabetes, metabolic syndrome, dyslipidemias, hypertension and tobacco use which all together are known risk factors for the development of Cardiovascular diseases. With this research we wish to collect evidence to show how Cardiovascular diseases (CVD) affect Patients with Bipolar disease, the burden it can have in patients lives, to understand how this problem has been assessed so far and present suggestions that may improve the health care of these patients. Our study is a literature based research. With our study we concluded that patients with BD are at higher risk of CVD and at an earlier age compared with the general population. Also, there is a lack of proper monitoring and consideration of the cardiovascular risk factors in patients with Bipolar disorder whether by primary care physicians or psychiatrists even though it plays a critical role in the general outcome of this patients and also leads to increase in mortality and morbidity rates.

  12. Educational video to improve CPAP use in patients with obstructive sleep apnoea at risk for poor adherence: a randomised controlled trial.

    Science.gov (United States)

    Guralnick, Amy S; Balachandran, Jay S; Szutenbach, Shane; Adley, Kevin; Emami, Leila; Mohammadi, Meelad; Farnan, Jeanne M; Arora, Vineet M; Mokhlesi, Babak

    2017-12-01

    Suboptimal adherence to CPAP limits its clinical effectiveness in patients with obstructive sleep apnoea (OSA). Although rigorous behavioural interventions improve CPAP adherence, their labour-intensive nature has limited widespread implementation. Moreover, these interventions have not been tested in patients at risk of poor CPAP adherence. Our objective was to determine whether an educational video will improve CPAP adherence in patients at risk of poor CPAP adherence. Patients referred by clinicians without sleep medicine expertise to an urban sleep laboratory that serves predominantly minority population were randomised to view an educational video about OSA and CPAP therapy before the polysomnogram, or to usual care. The primary outcome was CPAP adherence during the first 30 days of therapy. Secondary outcomes were show rates to sleep clinic (attended appointment) and 30-day CPAP adherence after the sleep clinic visit date. A total of 212 patients met the eligibility criteria and were randomised to video education (n=99) or to usual care (n=113). There were no differences in CPAP adherence at 30 days (3.3, 95% CI 2.8 to 3.8 hours/day video education; vs 3.5, 95% CI 3.1 to 4.0 hours/day usual care; p=0.44) or during the 30 days after sleep clinic visit. Sleep clinic show rate was 54% in the video education group and 59% in the usual care group (p=0.41). CPAP adherence, however, significantly worsened in patients who did not show up to the sleep clinic. In patients at risk for poor CPAP adherence, an educational video did not improve CPAP adherence or show rates to sleep clinic compared with usual care. ClinicalTrials.gov Identifier: NCT02553694. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Delayed intracranial hemorrhage after blunt trauma: are patients on preinjury anticoagulants and prescription antiplatelet agents at risk?

    Science.gov (United States)

    Peck, Kimberly A; Sise, C Beth; Shackford, Steven R; Sise, Michael J; Calvo, Richard Y; Sack, Daniel I; Walker, Sarah B; Schechter, Mark S

    2011-12-01

    Trauma centers are more frequently evaluating patients who are receiving anticoagulant or prescription antiplatelet (ACAP) therapy at the time of injury. Because there are reports of delayed intracranial hemorrhage (ICH) after blunt trauma in this patient group, we evaluated patients receiving ACAP with a head computed tomography (CT) on admission (CT1) followed by a routine repeat head CT (CT2) in 6 hours. We hypothesized that among patients with no traumatic findings on CT1 and a normal or unchanged interval neurologic examination, the incidence of clinically significant delayed ICH would be zero. We retrospectively reviewed adult blunt trauma patients admitted to our Level I trauma center from January 2006 to August 2009 who were receiving preinjury ACAP therapy. We reviewed medications, mechanism of injury, head CT results, and outcomes. Demographic data, injury severity scores, international normalized ratio, and neurologic examinations were recorded. We determined the incidence of delayed ICH on CT2 for patients with a negative CT1. Five hundred patients qualified for the protocol. Of these, 424 patients (85%) had a negative CT1. Among these patients, mean age was 75 years; 210 (50%) were male. Fall from standing was the most common mechanism of injury found in 357 patients (84%). Warfarin alone was taken in 68%, clopidogrel alone in 24%, and other agents in 2%. Six percent of patients were taking two agents. Mean international normalized ratio for patients on warfarin was 2.5. Among patients with a negative CT1, CT2 was obtained in 362 patients (85%) and was negative in 358 patients (99%). Four patients (1%) with a negative CT1 had a positive (n = 3) or equivocal (n = 1) CT2. All the changes on CT2 were minor and had either resolved or stabilized on third head CT. Of the four patients with positive or equivocal CT2, none had a change in neurologic examination; however, two had symptoms that could be attributed to head injury. Three were discharged home and

  14. Esophageal dysplasias are detected by endoscopy with Lugol in patients at risk for squamous cell carcinoma in southern Brazil.

    Science.gov (United States)

    Freitag, C P; Barros, S G; Kruel, C D; Putten, A C; Dietz, J; Gruber, A C; Diehl, A S; Meurer, L; Breyer, H P; Wolff, F; Vidal, R; Arruda, C A; Luz, L P; Fagundes, R B; Prolla, J C

    1999-01-01

    Diagnosis of squamous cell carcinoma of the esophagus is usually late. Staining of the mucosa with Lugol's solution during endoscopy has been suggested to identify early cancer/dysplasia and may improve prognosis. Lugol was tested during endoscopy in 96 asymptomatic subjects at risk for this tumor, who were found to have atypias after exfoliative cytology in southern Brazil. Biopsies were obtained in Lugol's 'stained' and 'unstained' areas in the esophageal mucosa and the histologic results were compared. 'Unstained' areas were present in 64 (66.7%) instances: 44 'unstained' areas over mucosa with normal appearance revealed seven dysplasias (four high and three low grade), whereas 20 'unstained' areas with visible lesions contained only one dysplasia (low grade). 'Stained' areas in 96 (100%) subjects showed two additional dysplasias (one high and one low grade). In this study, Lugol 'unstained' areas were of great value for detection of dysplasias (sensitivity = 80%; specificity = 63%; p = 0.01, Fisher's exact test; CI = 95%; odds ratio = 6.7).

  15. AUTONOMIC CARDIOVASCULAR REGULATION DISORDERS IN PATIENTS WITH PSORIATIC ARTHRITIS

    Directory of Open Access Journals (Sweden)

    A. P. Rebrov

    2014-07-01

    Full Text Available Aim – to identify disorders of autonomic regulation of cardiac activity in patients with psoriatic arthritis (PsA by determining the heart rate variability (HRV, and also establish the relationship of HRV with systemic inflammation and traditional cardiovascular risk factors.Materials and methods. The study included 53 patients with PsA (mean age 43.64 ± 12.1 years, including 48.2 % men, mean disease durationwas 10.32 ± 10.2 years. The control group included 25 healthy volunteers (average age 46.7 ± 12.45 years, 49.1 % – men. Time andfrequency measures of HRV were analyzed. Active PsA was determined by an index DAS4, rate erythrocyte sedimentation rate (ESR, levels of C-reactive protein (CRP and fibrinogen. Patients with clinical manifestations of cardiovascular disease, and patients with symptomsof carotid atherosclerosis, detected by duplex study were excluded.Results. Deterioration of HRV in patients with PsA compared with those in patients of the control group, the availability of statistically significant reverse relationship of temporal and spectral parameters of HRV with PsA activity (ESR, CRP, entezit score, DAS4, duration of arthritis, the classical factors of cardiovascular risk were established.Conclusion. Patients with PsA had noted a violation of autonomic regulation of cardiac activity in the form of reduced HRV and activation of the sympathetic part of it. Identified changes were associated with activity of systemic inflammation and classical factors of cardiovascular risk.

  16. The effect of multi-professional education on the recognition and outcome of patients at risk on general wards

    DEFF Research Database (Denmark)

    Fuhrmann, L.; Perner, A.; Klausen, T.W.

    2009-01-01

    at Herlev Hospital, Denmark. In the pre-intervention period (June-July 2006) and post-intervention period (November-December 2007), all patients on the wards had vital signs measured in the evening by study personnel, who also asked nursing staff questions about patients with abnormal vital signs....... The mortality of patients with abnormal vital signs was registered from the hospital database. Simplified medical emergency team calling criteria were used to define abnormal vital signs....

  17. The validation of cardiovascular risk scores for patients with type 2 diabetes mellitus

    NARCIS (Netherlands)

    van der Leeuw, J.; van Dieren, S.; Beulens, J. W. J.|info:eu-repo/dai/nl/304815381; Boeing, H.; Spijkerman, A. M. W.; van der Graaf, Y.|info:eu-repo/dai/nl/072825847; van der A, D. L.; Noethlings, U.; Visseren, F. L. J.|info:eu-repo/dai/nl/166267678; Rutten, G. E. H. M.|info:eu-repo/dai/nl/074622781; Moons, K. G. M.|info:eu-repo/dai/nl/152483519; van der Schouw, Y. T.|info:eu-repo/dai/nl/073449253; Peelen, L. M.|info:eu-repo/dai/nl/314038426

    2015-01-01

    Objective Various cardiovascular prediction models have been developed for patients with type 2 diabetes. Their predictive performance in new patients is mostly not investigated. This study aims to quantify the predictive performance of all cardiovascular prediction models developed specifically for

  18. Depression screening and patient outcomes in cardiovascular care : a systematic review

    NARCIS (Netherlands)

    Thombs, Brett D.; de Jonge, Peter; Coyne, James C.; Whooley, Mary A.; Frasure-Smith, Nancy; Mitchell, Alex J.; Zuidersma, Marij; Eze-Nliam, Chete; Lima, Bruno B.; Smith, Cheri G.; Soderlund, Karl; Ziegelstein, Roy C.

    2008-01-01

    Context Several practice guidelines recommend that depression be evaluated and treated in patients with cardiovascular disease, but the potential benefits of this are unclear. Objective To evaluate the potential benefits of depression screening in patients with cardiovascular disease by assessing (

  19. Obesity paradox in elderly patients with cardiovascular diseases.

    Science.gov (United States)

    Dorner, Thomas E; Rieder, Anita

    2012-02-23

    Many elderly people are affected by cardiovascular diseases (CVD) and the majority of CVD patients are elderly people. For both patient populations, studies have shown that a high body mass index (BMI) is associated with lower mortality when compared to normal weight subjects, a fact commonly known as the "obesity paradox". Whether the correlation between obesity and better survival is based on methodological influences and other non-causal factors alone, or whether there is a causal link between obesity and a better survival in these subjects remains widely unexplored. The interrelation between aging, obesity, CVD, frailty and inflammation is a current issue of intensive research. For the elderly, parameters which include measures of body composition, fat and fat-free mass are of greater importance than BMI. Weight management in elderly people with cardiovascular diseases should aim at improvement and maintenance of physical function and quality of life rather than prevention of medical problems associated with obesity in younger and middle aged patients. Although many studies have shown that weight loss in elderly patients is associated with a poor prognosis, recent data demonstrate that intentional weight reduction in obese elderly people ameliorates the cardiovascular risk profile, reduces chronic inflammation and is correlated with an improved quality of life. An individual approach to weight management that includes the participation of the patient, co-morbidity, functional status, and social support should be aspired. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  20. Estimation of Cardiovascular Risk in Patients with Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Belkis Vicente Sánchez

    2015-09-01

    Full Text Available Background: diabetes mellitus accelerates atherosclerotic changes throughout the vascular tree and consequently increases the risk of developing fatal acute events. Objective: to estimate the global cardiovascular risk in patients with type 2 diabetes mellitus. Method: a cross-sectional study of a series of type 2 diabetic patients from the People's Council of Constancia, Abreus municipality, Cienfuegos province was conducted from July to December 2012. The universe comprised the 180 people with diabetes in the area. Variables studied were: age, sex, body mass index, nutritional assessment, blood pressure, toxic habits, associated chronic diseases, blood levels of glucose, lipids (total cholesterol and triglycerides and microalbuminuria. World Health Organization/International Society of Hypertension prediction charts specific to the region of the Americas, in which Cuba is included, were used to estimate the cardiovascular risk. Results: mean age was 61.63 years and females predominated. Relevant risk factors were hypertension followed by obesity, smoking and dyslipidemia. Mean body mass index was 27.66kg/m2; waist circumference was 94.45 cm in women and 96.86 cm in men. Thirty point six percent had more than two uncontrolled risk factors and 28.3 % of the total presented a high to very high cardiovascular risk. Conclusions: cardiovascular risk prediction charts are helpful tools for making clinical decisions, but their interpretation must be flexible and allow the intervention of clinical reasoning.

  1. An operational research approach to identify cardiac surgery patients at risk of severe post-operative bleeding.

    Science.gov (United States)

    Reddy, Brian; Pagel, Christina; Vuylsteke, Alain; Gerrard, Caroline; Nashef, Sam; Utley, Martin

    2011-09-01

    Severe post-operative bleeding can lead to adverse outcomes for cardiac surgery patients and is a relatively common complication of cardiac surgery. One of the most effective drugs to prevent such bleeding, aprotinin, has been withdrawn from the market due to concerns over its safety. Alternative prophylactic drugs which can be given to patients to prevent bleeding can result in significant side effects and are expensive. For this reason it is difficult to make a clinical or economic case for administering these drugs to all cardiac surgery patients, and the prevailing view is that their use should be targeted at patients considered to be at relatively high risk of post-operative bleeding. However, there is currently no objective method for identifying such patients. Over the past 7 years, a team of clinicians and researchers at Papworth Hospital has collected data concerning post-operative blood loss for each cardiac surgery patient, totalling 11,592 consecutive records. They approached a team of operational researchers (MU, ACP, BR) with extensive experience of developing clinical risk models with the aim of devising a risk stratification scheme that could potentially be used to identify a cohort of higher risk patients. Such patients could be treated with the available prophylactic drugs or recruited to studies to evaluate new interventions. This paper is intended to describe the Operational Research process adopted in the development of this scheme. A concise description of the scheme and its clinical interpretation is published elsewhere.

  2. Preoperative protein profiles in cerebrospinal fluid in elderly hip fracture patients at risk for delirium: A proteomics and validation study

    Directory of Open Access Journals (Sweden)

    Dunja Westhoff

    2015-12-01

    General significance: This study highlights the challenges and inconsistent findings in studies of delirium, a serious complication in older patients. We analysed proteins in CSF, the most proximal fluid to the brain. All patients were free from delirium at the time of sampling.

  3. Edoxaban Versus Warfarin in Atrial Fibrillation Patients at Risk of Falling: ENGAGE AF-TIMI 48 Analysis.

    Science.gov (United States)

    Steffel, Jan; Giugliano, Robert P; Braunwald, Eugene; Murphy, Sabina A; Mercuri, Michele; Choi, Youngsook; Aylward, Phil; White, Harvey; Zamorano, Jose Luis; Antman, Elliott M; Ruff, Christian T

    2016-09-13

    Anticoagulation is often avoided in patients with atrial fibrillation who are at an increased risk of falling. This study assessed the relative efficacy and safety of edoxaban versus warfarin in the ENGAGE AF-TIMI 48 (Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis In Myocardial Infarction 48) trial in patients with atrial fibrillation judged to be at increased risk of falling. We performed a pre-specified analysis of the ENGAGE AF-TIMI 48, comparing patients with versus without increased risk of falling. Nine hundred patients (4.3%) were judged to be at increased risk of falling. These patients were older (median, 77 vs. 72 years; p TIMI 48]; NCT00781391). Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  4. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease.

    Science.gov (United States)

    Sabatine, Marc S; Giugliano, Robert P; Keech, Anthony C; Honarpour, Narimon; Wiviott, Stephen D; Murphy, Sabina A; Kuder, Julia F; Wang, Huei; Liu, Thomas; Wasserman, Scott M; Sever, Peter S; Pedersen, Terje R

    2017-05-04

    Evolocumab is a monoclonal antibody that inhibits proprotein convertase subtilisin-kexin type 9 (PCSK9) and lowers low-density lipoprotein (LDL) cholesterol levels by approximately 60%. Whether it prevents cardiovascular events is uncertain. We conducted a randomized, double-blind, placebo-controlled trial involving 27,564 patients with atherosclerotic cardiovascular disease and LDL cholesterol levels of 70 mg per deciliter (1.8 mmol per liter) or higher who were receiving statin therapy. Patients were randomly assigned to receive evolocumab (either 140 mg every 2 weeks or 420 mg monthly) or matching placebo as subcutaneous injections. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. The key secondary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. The median duration of follow-up was 2.2 years. At 48 weeks, the least-squares mean percentage reduction in LDL cholesterol levels with evolocumab, as compared with placebo, was 59%, from a median baseline value of 92 mg per deciliter (2.4 mmol per liter) to 30 mg per deciliter (0.78 mmol per liter) (P<0.001). Relative to placebo, evolocumab treatment significantly reduced the risk of the primary end point (1344 patients [9.8%] vs. 1563 patients [11.3%]; hazard ratio, 0.85; 95% confidence interval [CI], 0.79 to 0.92; P<0.001) and the key secondary end point (816 [5.9%] vs. 1013 [7.4%]; hazard ratio, 0.80; 95% CI, 0.73 to 0.88; P<0.001). The results were consistent across key subgroups, including the subgroup of patients in the lowest quartile for baseline LDL cholesterol levels (median, 74 mg per deciliter [1.9 mmol per liter]). There was no significant difference between the study groups with regard to adverse events (including new-onset diabetes and neurocognitive events), with the exception of injection-site reactions, which were more common with

  5. Feasibility of a self-administered survey to identify primary care patients at risk of medication-related problems.

    Science.gov (United States)

    Makowsky, Mark J; Cave, Andrew J; Simpson, Scot H

    2014-01-01

    Pharmacists working in primary care clinics are well positioned to help optimize medication management of community-dwelling patients who are at high risk of experiencing medication-related problems. However, it is often difficult to identify these patients. Our objective was to test the feasibility of a self-administered patient survey, to facilitate identification of patients at high risk of medication-related problems in a family medicine clinic. We conducted a cross-sectional, paper-based survey at the University of Alberta Hospital Family Medicine Clinic in Edmonton, Alberta, which serves approximately 7,000 patients, with 25,000 consultations per year. Adult patients attending the clinic were invited to complete a ten-item questionnaire, adapted from previously validated surveys, while waiting to be seen by the physician. Outcomes of interest included: time to complete the questionnaire, staff feedback regarding impact on workflow, and the proportion of patients who reported three or more risk factors for medication-related problems. The questionnaire took less than 5 minutes to complete, according to the patient's report on the last page of the questionnaire. The median age (and interquartile range) of respondents was 57 (45-69) years; 59% were women; 47% reported being in very good or excellent health; 43 respondents of 100 had three or more risk factors, and met the definition for being at high risk of a medication-related problem. Distribution of a self-administered questionnaire did not disrupt patients, or the clinic workflow, and identified an important proportion of patients at high risk of medication-related problems.

  6. Feasibility of a self-administered survey to identify primary care patients at risk of medication-related problems

    Directory of Open Access Journals (Sweden)

    Makowsky MJ

    2014-02-01

    Full Text Available Mark J Makowsky,1 Andrew J Cave,2 Scot H Simpson1 1Faculty of Pharmacy and Pharmaceutical Sciences, 2Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada Background and objectives: Pharmacists working in primary care clinics are well positioned to help optimize medication management of community-dwelling patients who are at high risk of experiencing medication-related problems. However, it is often difficult to identify these patients. Our objective was to test the feasibility of a self-administered patient survey, to facilitate identification of patients at high risk of medication-related problems in a family medicine clinic. Methods: We conducted a cross-sectional, paper-based survey at the University of Alberta Hospital Family Medicine Clinic in Edmonton, Alberta, which serves approximately 7,000 patients, with 25,000 consultations per year. Adult patients attending the clinic were invited to complete a ten-item questionnaire, adapted from previously validated surveys, while waiting to be seen by the physician. Outcomes of interest included: time to complete the questionnaire, staff feedback regarding impact on workflow, and the proportion of patients who reported three or more risk factors for medication-related problems. Results: The questionnaire took less than 5 minutes to complete, according to the patient's report on the last page of the questionnaire. The median age (and interquartile range of respondents was 57 (45–69 years; 59% were women; 47% reported being in very good or excellent health; 43 respondents of 100 had three or more risk factors, and met the definition for being at high risk of a medication-related problem. Conclusions: Distribution of a self-administered questionnaire did not disrupt patients, or the clinic workflow, and identified an important proportion of patients at high risk of medication-related problems. Keywords: screening tool, pharmacists, primary

  7. Increasing body mass index identifies Chinese patients with type 2 diabetes mellitus at risk of poor outcomes.

    Science.gov (United States)

    Ji, Linong; Zou, Dajin; Liu, Li; Qian, Lei; Kadziola, Zbigniew; Babineaux, Steven; Zhang, He Na; Wood, Robert

    2015-01-01

    Association between body mass index (BMI) and glycemic control, comorbidities/complications, and health-related quality of life (HRQoL) was assessed in Chinese patients with type 2 diabetes mellitus (T2DM) enrolled in the Diabetes Disease Specific Programme. Surveys of 200 physicians and 2052 patients with T2DM captured demographic, clinical, and HRQoL information. Adjusted and unadjusted analyses were conducted across 3 BMI groups; normal (18.5-9.0% (75mmol/mol; 4.3% vs 10.2%, P=0.002). More obese patients compared with normal BMI patients had hypertension (48.6% vs 35.3%, Pdiabetes on their daily living. Obesity in Chinese patients with T2DM results in poor glycemic control, more comorbidities, and worse HRQoL. Management of these patients should include efforts to reduce weight. Selection of weight-neutral or weight-reducing anti-diabetic medications maybe useful in these patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Endodontic management of nonrestorable teeth in patients at risk of developing osteonecrosis of the jaw: Case series

    Directory of Open Access Journals (Sweden)

    Fahd Alsalleeh

    2016-01-01

    Full Text Available Osteoradionecrosis of the jaws is one of the most serious oral complications of head and neck cancer radiation therapy. It is a self-progressive process of bone destruction that is very difficult to treat. In this report, four patients who are susceptible to osteonecrosis of the jaw presented for endodontic management of nonrestorable teeth. The first patient had two molar teeth with necrotic pulp and was treated with nonsurgical root canal therapy (NSRCT followed by crown amputation and hemisection. The second patient had a molar tooth that was previously treated with acute apical abscess. Crown amputation and hemisection were performed. The third patient had a molar tooth with necrotic pulp and asymptomatic apical periodontitis. NSRCT followed by occlusal reduction were completed. The fourth patient had a molar tooth with necrotic pulp and symptomatic apical periodontitis. NSRCT and crown amputation were performed. All cases had a minimum recall of 12-months. The tooth in case #1 developed a periapical pathosis, and other teeth in case #1–#3 had healing of periapical lesions. The tooth in case #4 was exfoliated. None had developed osteonecrosis. These results suggest that NSRCT is the treatment option to manage nonrestorable teeth in postradiation patients or patients taking bisphosphonate drugs to prevent osteonecrosis.

  9. Is thyroid gland an organ at risk in breast cancer patients treated with locoregional radiotherapy? Results of a pilot study.

    Science.gov (United States)

    Tunio, Mutahir Ali; Al Asiri, Mushabbab; Bayoumi, Yasser; Stanciu, Laura G; Al Johani, Naji; Al Saeed, Eyad Fawzi

    2015-01-01

    Aim was to evaluate the dose distribution within the thyroid gland its association with hypothyroidism in breast cancer (BC) patients receiving supraclavicular (SC) radiation therapy (RT). Consecutive 40 BC patients with baseline normal thyroid function tests (TFTs), were randomized into two groups: (a) Adjuvant chest wall/breast with SC-RT (20 patients) and (b) control group (adjuvant chest wall/breast RT only); 20 patients. The thyroid gland was contoured for each patient. Each patient's dose volume histogram (DVH), mean thyroid volume, the volume percentages of the thyroid absorbing respectively 5, 10, 20, 30, 40, and 50 Gy (V5, V10, V20, V30, V40, and V50), and Dmean (average dose in whole volume of thyroid) were then estimated. TFTs were performed at the time of the last follow-up and compared. Mean thyroid volume of cohort was 19.6 cm(3) (4.02-93.52) and Dmean of thyroid gland in SC-RT and control group was 25.8 Gy (16.4-52.2) and 5.6 Gy (0.7-12.8), respectively. Median values of V5, V10, V20, V30, V40, and V50 were 54%, 51%, 42.8%, 30.8%, 27.8%, and 7.64%, respectively, in SC-RT as compared to control group (V5;4.9%, V10;2.4%, V20;1.75%, V301%, V40;0%, and V50;0%, respectively) with P thyroid function whereas four patients (10%) had hypothyroidism; 3/20 (15%) patients in SC-RT and 1/20 (5%) in control group with P thyroid volume (P = 0.03). The risk of hypothyroidism in BC patients after SC-RT depends on the thyroid gland volume and V30 >50% and the risk can be minimized by thyroid gland shielding during RT.

  10. Gastric impedance spectroscopy in elective cardiovascular surgery patients.

    Science.gov (United States)

    Beltran, N E; Sanchez-Miranda, G; Godinez, M; Diaz, U; Sacristan, E

    2006-03-01

    Impedance spectroscopy has been proposed as a method of monitoring mucosal injury due to hypoperfusion and ischemia in critically ill patients. The present study characterizes human gastric impedance spectral changes under gastric hypoperfusion in patients undergoing cardiovascular surgery, and evaluates spectral differences between patients with no evidence of gastric ischemia and complications, and patients who developed ischemia and complications. Cole and Kun parameters were calculated over time to characterize changes as tissue injury progresses. Gastric ischemia was determined by air tonometry. Impedance spectroscopy spectra were obtained from 63 cardiovascular surgery patients. The recorded spectra were classified into three groups: group 1 for patients without ischemia or complications, group 2 for patients with a short period of ischemia (less than 2 h) and group 3 for patients with more than 4 h of gastric ischemia and complications. Two distinct dispersion regions of the spectra centered at about 316 Hz and 215 kHz become clearer as tissue damage develops. The average spectrum in group 3 shows a significant difference in tissue impedance at all frequencies relative to group 1. The parameters obtained for human gastric tissue show significant changes that occur at different times and at different frequencies as ischemia progresses, and could be correlated with patient outcome. This confirms our hypothesis that hypoperfusion and ischemia cause evident changes in the impedance spectra of the gastric wall. Therefore, this technology may be a useful prognostic and diagnostic monitoring tool.

  11. Role of wearable and automatic external defibrillators in improving survival in patients at risk for sudden cardiac death.

    Science.gov (United States)

    Lee, Byron K; Olgin, Jeffery E

    2009-10-01

    Cardiac arrest is a vexing public health problem. Fortunately, implantable cardioverter-defibrillators (ICDs) have been proven to decrease overall mortality in several populations at high risk for cardiac arrest. However, it is still unclear how to treat patients who have an elevated risk of cardiac arrest but are not in one of the identified high-risk groups proven to benefit from an ICD. It also is uncertain how to manage high-risk patients who have an accepted indication for an ICD but are unable or unwilling to have an ICD. In these clinical situations, the wearable defibrillator and automatic external defibrillator are options that should be considered. Both devices have been shown in small series to be highly effective at restoring sinus rhythm in patients with a ventricular tachyarrhythmia. However, there is still a lack of large-scale trials proving that these devices should be employed routinely in specific high-risk patient populations.

  12. Matrix metalloproteinase 9 is decreased in natalizumab-treated multiple sclerosis patients at risk for progressive multifocal leukoencephalopathy.

    Science.gov (United States)

    Fissolo, Nicolas; Pignolet, Béatrice; Matute-Blanch, Clara; Triviño, Juan Carlos; Miró, Berta; Mota, Miriam; Perez-Hoyos, Santiago; Sanchez, Alex; Vermersch, Patrick; Ruet, Aurélie; de Sèze, Jérôme; Labauge, Pierre; Vukusic, Sandra; Papeix, Caroline; Almoyna, Laurent; Tourbah, Ayman; Clavelou, Pierre; Moreau, Thibault; Pelletier, Jean; Lebrun-Frenay, Christine; Montalban, Xavier; Brassat, David; Comabella, Manuel

    2017-08-01

    To identify biomarkers associated with the development of progressive multifocal leukoencephalopathy (PML) in multiple sclerosis (MS) patients treated with natalizumab (NTZ). Relapsing-remitting MS patients who developed PML under NTZ therapy (pre-PML) and non-PML NTZ-treated patients (NTZ-ctr) were included in the study. Cryopreserved peripheral blood mononuclear cells and serum samples collected at baseline, at 1- and 2-year treated time points, and during PML were analyzed for gene expression by RNA sequencing and for serum protein levels by Luminex and enzyme-linked immunosorbent assays, respectively. Among top differentially expressed genes in the RNA sequencing between pre-PML and NTZ-ctr patients, pathway analysis revealed a high representation of genes belonging to the following categories: proangiogenic factors (MMP9, VEGFA), chemokines (CXCL1, CXCL5, IL8, CCL2), cytokines (IL1B, IFNG), and plasminogen- and coagulation-related molecules (SERPINB2, PLAU, PLAUR, TFPI, THBD). Serum protein levels for these candidates were measured in a 2-step manner in a screening cohort and a validation cohort of pre-PML and NTZ-ctr patients. Only matrix metalloproteinase 9 (MMP9) was validated; in pre-PML patients, MMP9 protein levels were significantly reduced at baseline compared with NTZ-ctr patients, and levels remained lower at later time points during NTZ treatment. The results from this study suggest that the proangiogenic factor MMP9 may play a role as a biomarker associated with the development of PML in MS patients treated with NTZ. Ann Neurol 2017;82:186-195. © 2017 American Neurological Association.

  13. Hemodialysis without systemic anticoagulation: a prospective randomized trial to evaluate 3 strategies in patients at risk of bleeding.

    Directory of Open Access Journals (Sweden)

    Bruno Guéry

    Full Text Available In this clinical trial, we aimed to compare three means of performing chronic hemodialysis in patients with contra-indication to systemic heparinization.This open-label monocentric randomized « n-of-one » trial, conducted in a single tertiary care center, recruited chronic hemodialysis patients with a contra-indication to systemic heparinization for at least 3 consecutive sessions. All patients underwent hemodialysis with an AN69ST dialyzer, and were administered three alternative dialysis procedures in a random sequence: intermittent saline flushes, constant saline infusion, or pre-dialysis heparin coating of the membrane. The primary outcome was the need to interrupt the dialysis session because of clotting events due to either (i a complete coagulation of the circuit; (ii a partial coagulation of the circuit; (iii a>50% rise over baseline in the venous pressure.At the end of the inclusion period (May, 2007 to December, 2008, the number of patients to include (n=75 was not reached: only 46 patients were included and underwent randomization. The study was terminated, and statistical analysis took into account 224 hemodialysis sessions performed in 44 patients with analyzable data. Heparin adsorption was associated with a significant reduction of the need to interrupt the dialysis session because of clotting events: odds ratio 0.3 (CI 95% 0.2 to 0.6; p3 h dialysis sessions and for having complete blood restitution. There were no significant effects of the dialysis procedure on weight loss, online ionic dialysance, and adverse events.Heparin-coated AN69ST dialysis membrane is a safe and effective method to avoid or delay per-dialytic clotting events in patients with contra-indication to systemic anticoagulation. However, results are not generalizable safely to patients with active bleeding, since weak heparinemia, not assessed in this study, may occur.ClinicalTrials.gov NCT00473109.

  14. Cardiovascular risk management in rheumatoid arthritis patients still suboptimal: the Implementation of Cardiovascular Risk Management in Rheumatoid Arthritis project

    NARCIS (Netherlands)

    van den Oever, Inge A. M.; Heslinga, Maaike; Griep, Ed N.; Griep-Wentink, Hanneke R. M.; Schotsman, Rob; Cambach, Walter; Dijkmans, Ben A. C.; Smulders, Yvo M.; Lems, Willem F.; Boers, Maarten; Voskuyl, Alexandre E.; Peters, Mike J. L.; van Schaardenburg, Dirkjan; Nurmohamed, Micheal T.

    2017-01-01

    To assess the 10-year cardiovascular (CV) risk score and to identify treatment and undertreatment of CV risk factors in patients with established RA. Demographics, CV risk factors and prevalence of cardiovascular disease (CVD) were assessed by questionnaire. To calculate the 10-year CV risk score

  15. Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital

    Directory of Open Access Journals (Sweden)

    Sebastian S. Mukka

    2013-06-01

    Full Text Available Dislocation remains a major concern after hip arthroplasty. We asked whether dual mobility cups (DMC would improve early hip stability in patients with high risk of dislocation. We followed 34 patients (21 females, 13 males treated between 2009 and 2012 with cemented DMC for hip revisions caused recurrent hip prosthetic dislocation or as a primary procedure in patients with high risk of instability. Functional outcome and quality of life were evaluated using Harris Hip Score and EQ-5D respectively. We found that the cemented DMC gave stability in 94%. Seven patients (20% were re-operated due to infection. One patient sustained a periprosthetic fracture. At follow-up (6 to 36 months, mean 18, the mean Harris hip score was 67 (standard deviation: 14 and mean EQ-5D was 0.76 (standard deviation: 0.12. We concluded that treating patients with high risk of dislocation with DMC can give good stability. However, complications such as postoperative infection can be frequent and should be managed carefully.

  16. Cardiovascular pathology in veterans of Great Patriotic War and aged patients: spectrum and clinical pattern

    Directory of Open Access Journals (Sweden)

    Denisova Т.Р.

    2011-09-01

    Full Text Available Cardiovascular pathology spectrum and dynamics in veterans of Great Patriotic War and aged patients of Volga agricultural and industrial region were studied. Clinical signs and course of cardiovascular pathology in aged patients were determined. A «dissolution» phenomenon of chronic cardiovascular pathology was revealed in patients aged over 100 years

  17. Identification of bladder cancer patients at risk for recurrence or progression: an immunohistochemical study based on the expression of metallothionein.

    Science.gov (United States)

    Hinkel, Andreas; Schmidtchen, Sonja; Palisaar, Rein-Jueri; Noldus, Joachim; Pannek, Jurgen

    2008-01-01

    Despite similarities in tumor stage and grade the individual outcome of bladder cancer patients is not predictable. The ideal tool for treatment stratification has not yet been found. Metallothionein (MT) overexpression is correlated with poor tumor differentiation, resistance to chemotherapy, and impaired survival in different malignancies. The clinical relevance of MT expression for defining patients at high risk for recurrence or progression was assessed. MT was detected immunohistochemically and evaluated semiquantitively in tumor specimens of 103 male and 19 female patients (transsurethral resection: n = 94, cystectomy: n = 28). Mean age of the patients was 68 (38-87) yr. According to histopathological features, three groups were distinguished for further analysis (pTa-1G1-2, pTis/pT1G3, and muscle invasive tumors). A cutoff value of 50% immunoreactive cells was used for further analysis. The 5-yr tumor specific survival rate was significantly lower in patients with high MT expression (32 vs. 72%). Accordingly, impaired 5-yr recurrence (90 vs. 58%), and progression rates (78 vs. 54%) were associated with high MT expression. All patients suffering from pTis and pT1G3 tumors with MT expression above the cutoff value showed recurrence within less than 40 mo, whereas 26% of those patients with MT expression below the cutoff value remained long-term recurrence free. Long term progression free survival was detected in 75% of pT1G3 patients with MT expression below the cutoff value. In contrast, 68% of pT1G3 tumor patients with MT expression above the cutoff value progressed, all within the first 12 mo after initial tumor resection. A correlation between high MT expression and prognosis was demonstrated especially in pT1G3 and pTis tumors, where >50% MT expression was linked to shorter tumor-specific survival and increased recurrence/progression rates. Thus, MT expression seems to be a promising marker for further risk stratification in the clinical treatment of

  18. Quantitative characterization of myocardial infarction by cardiovascular magnetic resonance predicts future cardiovascular events in patients with ischemic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Pauly John M

    2008-04-01

    Full Text Available Abstract Background Cardiovascular magnetic resonance (CMR can provide quantitative data of the myocardial tissue utilizing high spatial and temporal resolution along with exquisite tissue contrast. Previous studies have correlated myocardial scar tissue with the occurrence of ventricular arrhythmia. This study was conducted to evaluate whether characterization of myocardial infarction by CMR can predict cardiovascular events in patients with ischemic cardiomyopathy (ICM. Results We consecutively studied 86 patients with ICM (LVEF Conclusion Quantification of the scar volume and scar percentage by CMR is superior to LVEDV, LVESV, and LVEF in prognosticating the future likelihood of the development of cardiovascular events in patients with ICM.

  19. Development and evaluation of a patient centered cardiovascular health education program for insured patients in rural Nigeria (QUICK - II)

    NARCIS (Netherlands)

    Odusola, Aina Olufemi; Hendriks, Marleen; Schultsz, Constance; Stronks, Karien; Lange, Joep; Osibogun, Akin; Akande, Tanimola; Alli, Shade; Adenusi, Peju; Agbede, Kayode; Haafkens, Joke

    2011-01-01

    In Sub Saharan Africa, the incidence of hypertension and other modifiable cardiovascular risk factors is growing rapidly. Poor adherence to prescribed prevention and treatment regimens by patients can compromise treatment outcomes. Patient-centered cardiovascular health education is likely to

  20. Development and evaluation of a patient centered cardiovascular health education program for insured patients in rural Nigeria (QUICK-II)

    NARCIS (Netherlands)

    Odusola, A.O.; Hendriks, M.; Schultsz, C.; Stronks, K.; Lange, J.; Osibogun, A.; Akande, T.; Alli, S.; Adenusi, P.; Agbede, K.; Haafkens, J.

    2011-01-01

    BACKGROUND: In Sub Saharan Africa, the incidence of hypertension and other modifiable cardiovascular risk factors is growing rapidly. Poor adherence to prescribed prevention and treatment regimens by patients can compromise treatment outcomes. Patient-centered cardiovascular health education is

  1. Using scores to identify patients at risk of short term mortality at arrival to the acute medical unit

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Hallas, Peter; Hansen, Søren Nygaard

    2017-01-01

    Introduction: "Early warning scores" (EWS) have been developed to quantify levels of vital sign abnormality. However, many scores have not been validated. The aim of this study was to validate six scores that all rely on vital signs: Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine...... Score (REMS) and the National Early Warning Score (NEWS) and the Goodacre, Groarke and Worthing physiological scores. Methods: A posthoc single-center observational cohort study of prospectively collected vital signs on acutely admitted medical patients to a Danish hospital. All adult patients arriving...... at an acute medical unit at a 450-bed regional teaching hospital were included. Upon arrival, we registered initial vital signs and only the first presentation in the study period was included. Patients were included from 1 June to 31 October 2012. All-cause 24-h mortality and overall in-hospital mortality...

  2. Dimethyl fumarate: a possible exit strategy from natalizumab treatment in patients with multiple sclerosis at risk for severe adverse events.

    Science.gov (United States)

    Calabrese, Massimiliano; Pitteri, Marco; Farina, Gabriele; Bajrami, Albulena; Castellaro, Marco; Magliozzi, Roberta; Monaco, Salvatore

    2017-12-01

    Among disease-modifying treatments for multiple sclerosis, natalizumab (NTZ) is highly effective, well tolerated and generally safe. Major concerns regard the risk of developing progressive multifocal leukoencephalopathy (PML), and the occurrence of rebounds or disease activity after its discontinuation. The aim of this study was to explore the efficacy of dimethyl fumarate (DMF) in preventing disease reactivation after NTZ discontinuation. Thirty-nine patients with relapsing remitting multiple sclerosis, at high risk of PML, were switched from NTZ to DMF and underwent neurological and 3T MRI monitoring for 2 years. Clinical and MRI data regarding the 2-year period preceding NTZ treatment, the 2 years of NTZ treatment and the 2 years of DMF were collected. During the DMF phase, among the 39 patients, one or more relapses occurred in five patients (12.8%), increased disability progression in 4 (10.3%) and MRI activity in 8 (20.5%). Post-NTZ rebound effect was observed only in one patient. Overall, only two dropouts (one rebound activity and one gastrointestinal side effect) were registered and almost 80% of the patients have still no evidence of disease activity at the end of DMF treatment. The multiple linear regression model revealed that the number of relapses and MRI parameters before DMF treatment were good predictors of disease activity during treatment with DMF. DMF appeared generally safe and no carryover PML among investigated cases was observed. Although DMF did not eliminate the possibility of disease reactivation, it seems anyway a promising drug for those patients who shall discontinue NTZ. The clinical and radiological activity preceding the DMF treatment might be used as a prognostic marker of therapy response. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Five days of postoperative antimicrobial therapy decreases infectious complications following pancreaticoduodenectomy in patients at risk for bile contamination.

    Science.gov (United States)

    Sourrouille, Isabelle; Gaujoux, Sebastien; Lacave, Guillaume; Bert, François; Dokmak, Safi; Belghiti, Jacques; Paugam-Burtz, Catherine; Sauvanet, Alain

    2013-06-01

    Pancreaticoduodenectomy (PD) is associated with high morbidity, in part as a result of infectious complications increased by preoperative bile contamination. The aim of the present study was to assess the effect on the incidence of infectious complications of short-term antimicrobial therapy (AMT) in high-risk patients. Patients with a high risk for positive intraoperative bile culture (i.e. those with ampulloma or pancreatic adenocarcinoma with preoperative endoscopic procedures) (high-risk group, n = 99) were compared with low-risk patients (i.e. those with pancreatic adenocarcinoma without preoperative endoscopic procedures) (low-risk group, n = 76). The high-risk group received a 5-day course of perioperative AMT secondarily adapted to the bile antibiogram. The low-risk group received only the usual antimicrobial prophylaxis. Positive bile cultures were significantly more frequent in high-risk patients (81% versus 12%; P infectious complications was lower in the high-risk group (29% versus 46%; P = 0.018). The statistically significant decrease in the rate of infectious complications reflected reduced rates of urinary tract infections, pulmonary infections and septicaemia. Rates of wound infection (3% versus 5%; P = 0.639) and intra-abdominal abscess (7% versus 7%; P = 0.886) were similar in the high- and low-risk groups, as was the need for curative AMT. This exploratory study suggests that a postoperative short course of AMT in patients at high risk for biliary contamination reduces the overall rate of infectious complications after PD. The adaptation of perioperative antimicrobial policy to the patient's risk for bile contamination seems promising and should be further evaluated. © 2012 International Hepato-Pancreato-Biliary Association.

  4. Cardiovascular maladaptation to exercise in young hypertensive patients.

    Science.gov (United States)

    Cusmà Piccione, Maurizio; Zito, Concetta; Khandheria, Bijoy; Madaffari, Antonio; Oteri, Alessandra; Falanga, Gabriella; Donato, Domenica; D'Angelo, Myriam; Carerj, Maria Ludovica; Di Bella, Gianluca; Imbalzano, Egidio; Pugliatti, Pietro; Carerj, Scipione

    2017-04-01

    Impairment of the adaptive mechanisms that increase cardiac output during exercise can translate to a reduced functional capacity. We investigated cardiovascular adaptation to exertion in asymptomatic hypertensive patients, aiming to identify the early signs of cardiac and vascular dysfunction. We enrolled 54 subjects: 30 patients (45.1±11.9years, 19 males) and 24 age-matched healthy controls (44.4±9.6years, 14 males). Speckle-tracking echocardiography (STE) and echo-tracking were performed at rest and during exertion to assess myocardial deformation and arterial stiffness. E/E' increased from rest to peak exercise more in patients than in controls (peak stage: p=0.024). Global longitudinal strain increased significantly from rest to peak stage in controls (p=0.011) whereas it remained unchanged in patients (p=0.777). Left atrial (LA) reservoir was significantly increased throughout the exercise only in controls (p=0.001) whereas it was almost unchanged in patients (p=0.293). LA stiffness was significantly higher in patients than in controls both at rest (p=0.023) and during exercise (pexercise in both groups, showing higher values in patients in each step. Our study showed a more pronounced maladaptation during exercise, with respect to rest, of the cardiovascular system with impaired cardiac-vessel coupling in hypertensive patients compared to healthy subjects. Exercise echocardiography implemented by STE and echo-tracking is invaluable in the early detection of these cardiovascular abnormalities. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Cardiovascular effects of radiotherapy on the patient with cancer

    Energy Technology Data Exchange (ETDEWEB)

    Moreira, Leonardo Augusto Robert; Silva, Eduardo Nani; Ribeiro, Mario Luiz; Martins, Wolney de Andrade, E-mail: wolney_martins@hotmail.com [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil)

    2016-03-15

    The incidence of cancer (CA) has increased globally and radiotherapy (RT) is a vital component in its treatment. Cardiovascular injuries induced by RT in the treatment of thoracic and cervical CA have been causing problems in clinical practice for decades, and are among the most serious adverse effects of radiation experienced by the growing number of cancer survivors. This article presents a review on the Lilacs, Scielo and Pubmed databases of the main cardiovascular injuries, their mechanisms, clinical presentations, treatments and prevention proposals. Injuries caused by RT include diseases of the pericardium, coronary artery disease, valvular disease, myocardial disease with systolic and diastolic dysfunction, conduction disorders, and carotid artery and great vessels disease. Thoracic and cervical irradiation increases cardiovascular morbidity and mortality. Despite the great progress in the improvement of RT techniques, totally excluding prime areas of the cardiovascular system from the irradiation field is not yet possible. Guidelines must be created for monitoring, diagnosis and treatment of patients with CA treated with RT. (author)

  6. Identification of patients at risk for colorectal cancer in primary care: an explorative study with routine healthcare data

    NARCIS (Netherlands)

    Koning, N.R; Moons, L.N.G; Büchner, F.L.; Helsper, C.W.; ten Teije, A.C.M.; Numans, M.E.

    2015-01-01

    Background Early diagnosis of colorectal cancer (CRC) is likely to reduce burden of disease and improve treatment success. Estimation of the individual patient risk for CRC diagnostic determinants in a primary care setting has not been very successful as yet. The aim of our study is to improve

  7. The effect of computerized tailored brief advice on at-risk drinking in subcritically injured trauma patients

    DEFF Research Database (Denmark)

    Neumann, Tim; Neuner, Bruno; Weiss-Gerlach, Edith

    2006-01-01

    One-third of injured patients treated in the emergency department (ED) have an alcohol use disorder (AUD). Few are screened and receive counseling because ED staff have little time for additional tasks. We hypothesized that computer technology can screen and provide an intervention that reduces at...

  8. ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part I - Assessment and Management of Various Cardiovascular Risk Factors.

    Science.gov (United States)

    Wang, Angela Yee Moon; Brimble, K Scott; Brunier, Gillian; Holt, Stephen G; Jha, Vivekanand; Johnson, David W; Kang, Shin-Wook; Kooman, Jeroen P; Lambie, Mark; McIntyre, Chris; Mehrotra, Rajnish; Pecoits-Filho, Roberto

    2015-01-01

    Cardiovascular disease contributes significantly to the adverse clinical outcomes of peritoneal dialysis (PD) patients. Numerous cardiovascular risk factors play important roles in the development of various cardiovascular complications. Of these, loss of residual renal function is regarded as one of the key cardiovascular risk factors and is associated with an increased mortality and cardiovascular death. It is also recognized that PD solutions may incur significant adverse metabolic effects in PD patients. The International Society for Peritoneal Dialysis (ISPD) commissioned a global workgroup in 2012 to formulate a series of recommendations regarding lifestyle modification, assessment and management of various cardiovascular risk factors, as well as management of the various cardiovascular complications including coronary artery disease, heart failure, arrhythmia (specifically atrial fibrillation), cerebrovascular disease, peripheral arterial disease and sudden cardiac death, to be published in 2 guideline documents. This publication forms the first part of the guideline documents and includes recommendations on assessment and management of various cardiovascular risk factors. The documents are intended to serve as a global clinical practice guideline for clinicians who look after PD patients. The ISPD workgroup also identifies areas where evidence is lacking and further research is needed. Copyright © 2015 International Society for Peritoneal Dialysis.

  9. Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care.

    Science.gov (United States)

    Kroll, David S; Nieva, Harry Reyes; Barsky, Arthur J; Linder, Jeffrey A

    2016-09-01

    Benzodiazepine use is associated with adverse drug events and higher mortality. Known risk factors for benzodiazepine-related adverse events include lung disease, substance use, and vulnerability to fracture. To determine whether benzodiazepine prescribing is associated with risk factors for adverse outcomes. Longitudinal cohort study between July 1, 2011, and June 30, 2012. Patients who visited hospital- and community-based practices in a primary care practice-based research network. Odds ratio of having a target medical diagnosis for patients who received standard and high-dose benzodiazepine prescriptions; rates per 100 patients for outpatient and emergency department visits and hospitalizations. Among 65,912 patients, clinicians prescribed at least one benzodiazepine to 15 % (9821). Of benzodiazepine recipients, 5 % received high doses. Compared to non-recipients, benzodiazepine recipients were more likely to have diagnoses of depression (OR, 2.7; 95 % CI, 2.6-2.9), substance abuse (OR, 2.2; 95 % CI, 1.9-2.5), tobacco use (OR, 1.7; 95 % CI, 1.5-1.8), osteoporosis (OR, 1.6; 95 % CI, 1.5-1.7), chronic obstructive pulmonary disease (OR, 1.6; 95 % CI, 1.5-1.7), alcohol abuse (OR, 1.5; 95 % CI, 1.3-1.7), sleep apnea (OR, 1.5; 95 % CI, 1.3-1.6), and asthma (OR, 1.5; 95 % CI, 1.4-1.5). Compared to low-dose benzodiazepine recipients, high-dose benzodiazepine recipients were even more likely to have certain medical diagnoses: substance abuse (OR, 7.5; 95 % CI, 5.5-10.1), alcohol abuse (OR, 3.2; 95 % CI, 2.2-4.5), tobacco use (OR, 2.7; 95 % CI, 2.1-3.5), and chronic obstructive pulmonary disease (OR, 1.5; 95 % CI, 1.2-1.9). Benzodiazepine recipients had more primary care visits per 100 patients (408 vs. 323), specialist outpatient visits (815 vs. 578), emergency department visits (47 vs. 29), and hospitalizations (26 vs. 15; p benzodiazepines and high-dose benzodiazepines more frequently to patients at higher risk for benzodiazepine-related adverse events

  10. The Short Physical Performance Battery is a discriminative tool for identifying patients with COPD at risk of disability [Corrigendum

    Directory of Open Access Journals (Sweden)

    Bernabeu-Mora R

    2016-03-01

    Full Text Available Bernabeu-Mora R, Medina-Mirapeix F, Llamazares-Herrán E, et al. Int J Chron Obstruct Pulmon Dis. 2015;10:619–2626.  Page 2626, Acknowledgments section, the text “The authors wish to thank the patients and personnel of the hospital unit for their cooperation during the course of this study. The study was supported by medical manager of AstraZeneca Pharmaceutical Spain, S.A. and Maite Pérez.” Should read “The authors wish to thank the patients and personnel of the hospital unit for their cooperation during the course of this study. The study was supported by medical manager AstraZeneca Pharmaceutical Spain, S.A. Maite Pérez, Pfizer and Menarini.”Read the original article

  11. Association of carotid plaque Lp-PLA(2 with macrophages and Chlamydia pneumoniae infection among patients at risk for stroke.

    Directory of Open Access Journals (Sweden)

    Berna Atik

    Full Text Available BACKGROUND: We previously showed that the burden of Chlamydia pneumoniae in carotid plaques was significantly associated with plaque interleukin (IL-6, and serum IL-6 and C-reactive protein (CRP, suggesting that infected plaques contribute to systemic inflammatory markers in patients with stroke risk. Since lipoprotein-associated phospholipase A2 (Lp-PLA(2 mediates inflammation in atherosclerosis, we hypothesized that serum Lp-PLA(2 mass and activity levels and plaque Lp-PLA(2 may be influenced by plaque C. pneumoniae infection. METHODOLOGY/PRINCIPAL FINDINGS: Forty-two patients underwent elective carotid endarterectomy. Tissue obtained at surgery was stained by immunohistochemistry for Lp-PLA(2 grade, macrophages, IL-6, C. pneumoniae and CD4+ and CD8+ cells. Serum Lp-PLA(2 activity and mass were measured using the colorimetric activity method (CAM and ELISA, respectively. Serum homocysteine levels were measured by HPLC. Eleven (26.2% patients were symptomatic with transient ischemic attacks. There was no correlation between patient risk factors (smoking, coronary artery disease, elevated cholesterol, diabetes, obesity, hypertension and family history of genetic disorders for atherosclerosis and serum levels or plaque grade for Lp-PLA(2. Plaque Lp-PLA(2 correlated with serum homocysteine levels (p = 0.013, plaque macrophages (p<0.01, and plaque C. pneumoniae (p<0.001, which predominantly infected macrophages, co-localizing with Lp-PLA(2. CONCLUSIONS: The significant association of plaque Lp-PLA(2 with plaque macrophages and C. pneumoniae suggests an interactive role in accelerating inflammation in atherosclerosis. A possible mechanism for C. pneumoniae in the atherogenic process may involve infection of macrophages that induce Lp-PLA(2 production leading to upregulation of inflammatory mediators in plaque tissue. Additional in vitro and in vivo research will be needed to advance our understanding of specific C. pneumoniae and Lp-PLA(2

  12. A Proposed Methodology to Control Body Temperature in Patients at Risk of Hypothermia by means of Active Rewarming Systems

    Directory of Open Access Journals (Sweden)

    Silvia Costanzo

    2014-01-01

    Full Text Available Hypothermia is a common complication in patients undergoing surgery under general anesthesia. It has been noted that, during the first hour of surgery, the patient’s internal temperature (Tcore decreases by 0.5–1.5°C due to the vasodilatory effect of anesthetic gases, which affect the body’s thermoregulatory system by inhibiting vasoconstriction. Thus a continuous check on patient temperature must be carried out. The currently most used methods to avoid hypothermia are based on passive systems (such as blankets reducing body heat loss and on active ones (thermal blankets, electric or hot-water mattresses, forced hot air, warming lamps, etc.. Within a broader research upon the environmental conditions, pollution, heat stress, and hypothermia risk in operating theatres, the authors set up an experimental investigation by using a warming blanket chosen from several types on sale. Their aim was to identify times and ways the human body reacts to the heat flowing from the blanket and the blanket’s effect on the average temperature Tskin and, as a consequence, on Tcore temperature of the patient. The here proposed methodology could allow surgeons to fix in advance the thermal power to supply through a warming blanket for reaching, in a prescribed time, the desired body temperature starting from a given state of hypothermia.

  13. Primary care physician management, referral, and relations with specialists concerning patients at risk for cancer due to family history.

    Science.gov (United States)

    Wood, M E; Flynn, B S; Stockdale, A

    2013-01-01

    Risk stratification based on family history is a feature of screening guidelines for a number of cancers and referral guidelines for genetic counseling/testing for cancer risk. Our aim was to describe primary care physician perceptions of their role in managing cancer risk based on family history. Structured interviews were conducted by a medical anthropologist with primary care physicians in 3 settings in 2 north-eastern states. Transcripts were systematically analyzed by a research team to identify major themes expressed by participants. Forty interviews were conducted from May 2003 through May 2006. Physicians provided a diversity of views on roles in management of cancer risk based on family history, management practices and patient responses to risk information. They also provided a wide range of perspectives on criteria used for referral to specialists, types of specialists referred to and expected management roles for referred patients. Some primary care physicians appeared to make effective use of family history information for cancer risk management, but many in this sample did not. Increased focus on efficient assessment tools based on recognized guidelines, accessible guides to management options, and patient education and decision aids may be useful directions to facilitate broader use of family history information for cancer risk management. Copyright © 2013 S. Karger AG, Basel.

  14. Treatment program for erectile dysfunction in patients with cardiovascular diseases.

    Science.gov (United States)

    Israilov, Solomon; Baniel, Jack; Shmueli, Joseph; Niv, Eva; Engelstein, Dov; Segenreich, Ephraim; Livne, Pinhas M

    2004-03-15

    The present study assesses the effectiveness of our progressive treatment program for erectile dysfunction in patients with cardiovascular diseases. The study sample included 453 patients aged 36 to 91 years. Therapy in all patients was begun with sildenafil citrate 25 to 100 mg. Those with contraindications, drug adverse effects, or a negative response (erection insufficient for vaginal penetration) were given intracavernous injections of a cocktail of vasoactive drugs (dimix, trimix, or quadmix), followed by the addition of sildenafil citrate to the trimix in case of failure, and then a penile prosthesis. Patients were followed for 2 years; in cases of treatment ineffectiveness during follow-up, drug dosages were increased or a penile prosthesis was suggested. Sildenafil citrate was offered to 417 patients of whom 205 (49.2%) responded positively. The remaining 248 patients received intracavernous injections: 135 (54.4%) had a positive response to the dimix, 85 (75.2%) to the trimix, and 16 (57.1%) to the quadmix. Four of the other 12 patients (0.9%) responded to sildanefil citrate + trimix, and 2 (0.4%) agreed to a penile prosthesis. At the 2-year follow-up of 447 patients, 131 (29.3%) were successfully treated with sildanefil citrate, 92 (20.6%) with dimix, 122 (27.3%) with trimix, 12 (2.7%) with quadmix, and 2 (0.4%) with sildanefil citrate + trimix; 5 patients (1.1%) had a penile implant. Forty-eight patients (10.7%) achieved spontaneous erection, of whom 46 were taking aspirin. Twenty-six patients (5.8%) stopped treatment because of health and family reasons and 9 (2%) had a negative response. Our progressive treatment program for erectile dysfunction has a high success rate in patients with cardiovascular disease: Overall, 98.7% achieved an erection sufficient for vaginal penetration immediately after the trial and 92.2% on follow-up; 10.7% achieved spontaneous erections.

  15. Practical ways to deal with the high burden of cardiovascular disease in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    José Jayme Galvão de Lima

    Full Text Available Cardiovascular disease is the main cause of death among hemodialysis patients. Although uremia by itself may be considered to be a cardiovascular risk factor, a significant proportion of dialysis patients die because of cardiovascular disease not directly attributable to uremia. Indeed, many of the cardiovascular diseases and cardiovascular risk factors in these patients are common to those occurring in the general population and are amenable to intervention. Lack of proper medical care during the early stages of renal insufficiency and present-day dialysis routines, by failing to correct hypertension, hypervolemia and left ventricular hypertrophy in many patients, may also add to the cardiovascular burden. The author suggests that, in addition to early treatment and referral to a specialist, chronic renal failure patients should undergo intensive cardiovascular screening and treatment, and correction of cardiovascular risk factors based on guidelines established for the general population.

  16. Depression and cardiovascular disease.

    Science.gov (United States)

    Bradley, Steven M; Rumsfeld, John S

    2015-10-01

    There is a wealth of evidence linking depression to increased risk for cardiovascular disease (CVD) and worse outcomes among patients with known CVD. In addition, there are safe and effective treatments for depression. Despite this, depression remains under-recognized and undertreated in patients at risk for or living with CVD. In this review, we first summarize the evidence linking depression to increased risk of CVD and worse patient outcomes. We then review the mechanisms by which depression may contribute to cardiovascular risk and poor cardiovascular outcomes. We then summarize prior studies of depression treatment on cardiovascular outcomes. Finally, we offer guidance in the identification and management of depression among CVD populations. Given that 1 in 4 CVD patients has concurrent depression, application of these best-practices will assist providers in achieving optimal outcomes for their CVD patients. Published by Elsevier Inc.

  17. Who will be lost? Identifying patients at risk of loss to follow-up in Malawi. The DREAM Program Experience.

    Science.gov (United States)

    Mancinelli, S; Nielsen-Saines, K; Germano, P; Guidotti, G; Buonomo, E; Scarcella, P; Lunghi, R; Sangare, H; Orlando, S; Liotta, G; Marazzi, M C; Palombi, L

    2017-09-01

    Retention of subjects in HIV treatment programmes is crucial for the success of treatment. We evaluated retention/loss to follow-up (LTFU) in subjects receiving established care in Malawi. Data for HIV-positive patients registered in Drug Resource Enhancement Against AIDS and Malnutrition centres in Malawi prior to 2014 were reviewed. Visits entailing HIV testing/counselling, laboratory evaluations, nutritional evaluation/supplementation, community support, peer education, and antiretroviral (ART) monitoring/pharmacy were noted. LTFU was defined as > 90 days without an encounter. Parameters potentially associated with LTFU were explored, with univariate/multivariate logistic regression analyses being performed. Fifteen thousand and ninety-nine patients registered before 2014; 202 (1.3%) were lost to follow-up (LTFU) (1.3%). Nine (0.5%) of 1744 paediatric patients were LTFU vs. 1.4% (n = 193) of 13 355 adults (P < 0.001). Subjects who were LTFU had fewer days in care than retained subjects (1338 vs. 1544, respectively; P < 0.001) and a longer duration of ART (1530 vs. 1300 days, respectively; P < 0.001). Subjects who were LTFU had higher baseline HIV viral loads (P = 0.016) and higher body mass indexes (P < 0.001), were more likely to live in urban settings (88% of patients who were LTFU lived in urban settings) with better housing [relative risk (RR) 2.3; 95% confidence interval (CI) 1.67-3.09; P < 0.001], and were more likely to be educated (RR 1.88; 95% CI 1.42-2.50; P < 0.001). Distance to the centre and cost of transportation were associated with LTFU (RR 3.4; 95% CI 2.84-5.37; P < 0.001), as was absence of a maternal figure (RR 1.57; 95% CI 1.17-2.09; P < 0.001). Viral load, distance index, education and a maternal figure were predictive of LTFU. Educated, urbanized HIV-infected adults living far from programme centres are at high risk of LTFU, particularly if there is no maternal figure in the household. These variables must be taken into consideration when

  18. Framingham cardiovascular risk in patients with obesity and periodontitis

    Directory of Open Access Journals (Sweden)

    Juliana Rico Pires

    2014-01-01

    Full Text Available Background: Obesity is a chronic inflammatory condition that has been associated to a risk factor for the development of periodontitis and cardiovascular disease; however, the relationship still needs to be clarified. The objective of this study was to evaluate the cardiovascular risk in obese patients with chronic periodontitis. Materials and Methods: A total of 87 obese patients were evaluated for anthropometric data (body mass index [BMI], waist circumference, body fat, systolic blood pressure (SBP and diastolic blood pressure (DBP, cholesterol, high-density lipoprotein (HDL and low-density lipoprotein (LDL, triglycerides, glycemia and periodontal parameters (visible plaque index (VPI, gingival bleeding index (GBI, bleeding on probing (BOP, periodontal probing depth (PPD and clinical attachment level (CAL. Results: Patients were divided into two groups according to the periodontal characteristics found: Group O-PD: Obese patients with chronic periodontitis (n = 45, 22 men and 23 women; and Group O-sPD: Obese patients without chronic periodontitis (n = 42, 17 men and 25 women. Patients had a BMI mean of 35.2 (±5.1 kg/m 2 . Group O-PD showed a similarity between the genders regarding age, SBP, DBP, cholesterol, HDL, GBI, VPI, PPD ≥4 mm and CAL ≥4 mm. O-PD women showed greater glycemia level and smoking occurrence, but O-PD men presented a 13% - risk over of developing coronary artery disease in 10 years than O-PD women, 9% - risk over than O-sPD men and 15% - risk over than O-sPD women, by the Framingham Score. Conclusions: It was concluded that obesity and periodontal disease are cardiovascular risk factors and that the two associated inflammatory conditions potentially increases the risk for heart diseases.

  19. Resourceful or At Risk

    DEFF Research Database (Denmark)

    Højen-Sørensen, Anna-Katharina

    Introduction: Social categories are used to determine which individuals are at an increased risk of unfavorable outcomes and they are a vital tool for the development of targeted interventions. This presentation takes a critical look at the Resourceful and At Risk categories, that are often...

  20. Identification of patients at risk for preeclampsia with the use of uterine artery Doppler velocimetry and copeptin.

    Science.gov (United States)

    Yeşil, Ali; Kanawati, Ammar; Helvacıoğlu, Çağlar; Kaya, Cihan; Özgün, Çağseli Göksu; Cengiz, Hüseyin

    2017-11-01

    To investigate the relationship between maternal copeptin levels and uterine artery Doppler examination and progress of preeclampsia. A cross-sectional study was designed with women those were screened at 20 + 0 - 24+  6 weeks' gestation between May 2014 and August 2014. The obstetric records of all normotensive women were examined. Uterine artery Doppler velocimetry results and serum copeptin levels were measured. The patients were divided into two groups according to normal (n = 67) and abnormal uterine artery Doppler (n = 21) findings. Maternal age was significantly lower in group 1 (n = 21, 23.9%) than in group 2 (n= 67, 76.1%) (p copeptin levels between the two groups. Maternal serum copeptin levels were higher in women who subsequently developed preeclampsia. There was also a significant correlation between copeptin levels and the presence of preeclampsia. (p = 0.002). Copeptin levels are significantly higher in patients who develop preeclampsia.

  1. GPs' Perceptions of Cardiovascular Risk and Views on Patient Compliance

    DEFF Research Database (Denmark)

    Barfoed, Benedicte Marie Lind; Jarbøl, Dorte Ejg; Paulsen, Maja Skov

    2015-01-01

    Objective. General practitioners' (GPs') perception of risk is a cornerstone of preventive care. The aims of this interview study were to explore GPs' professional and personal attitudes and experiences regarding treatment with lipid-lowering drugs and their views on patient compliance. Methods...... patient compliance, and (3) GPs' own risk management. There were substantial differences in the attitudes concerning all three themes. Conclusions. The substantial differences in the GPs' personal and professional risk perceptions may be a key to understanding why GPs do not always follow cardiovascular...

  2. Patient-specific modeling of human cardiovascular system elements

    Science.gov (United States)

    Kossovich, Leonid Yu.; Kirillova, Irina V.; Golyadkina, Anastasiya A.; Polienko, Asel V.; Chelnokova, Natalia O.; Ivanov, Dmitriy V.; Murylev, Vladimir V.

    2016-03-01

    Object of study: The research is aimed at development of personalized medical treatment. Algorithm was developed for patient-specific surgical interventions of the cardiovascular system pathologies. Methods: Geometrical models of the biological objects and initial and boundary conditions were realized by medical diagnostic data of the specific patient. Mechanical and histomorphological parameters were obtained with the help mechanical experiments on universal testing machine. Computer modeling of the studied processes was conducted with the help of the finite element method. Results: Results of the numerical simulation allowed evaluating the physiological processes in the studied object in normal state, in presence of different pathologies and after different types of surgical procedures.

  3. Positron emission tomography in at risk patients and in the progression of mild cognitive impairment to Alzheimer's disease

    DEFF Research Database (Denmark)

    Rinne, Juha O; Någren, Kjell

    2010-01-01

    Mild cognitive impairment (MCI) is considered a transitional state between the cognitive changes of normal aging and the earliest clinical features of Alzheimer's disease (AD). An important goal is to find features that predict which MCI patients will later convert to AD. Identification....... In the future, multi-tracer imaging or development of agents enabling imaging of other protein aggregations in neurodegenerative diseases could further help in the early and differential diagnostics and evaluation of novel treatments....... of such features will be increasingly important when treatments slowing down the progression of AD become available enabling early intervention. Brain imaging might be one possible predictor of conversion to AD. Functional imaging with positron emission tomography (PET) has shown that either normal elderly people...

  4. The pharmacokinetics of valganciclovir prophylaxis in pediatric solid organ transplant patients at risk for Epstein–Barr virus disease

    Directory of Open Access Journals (Sweden)

    Heather E Vezina

    2009-12-01

    Full Text Available Heather E Vezina1,2, Richard C Brundage2, Thomas E Nevins3, Henry H Balfour Jr1,31Department of Laboratory Medicine and Pathology, 2Department of Experimental and Clinical Pharmacology, 3Department of Pediatrics, University of Minnesota, Minneapolis, MN, USAAbstract: Antiviral prophylaxis with valganciclovir is used frequently in pediatric solid organ transplant patients to prevent Epstein–Barr virus (EBV-induced infections and tissue-invasive disease including post-transplant lymphoproliferative disorder (PTLD. This approach is untested in clinical trials and valganciclovir dosing strategies in children are highly variable. Our objective was to characterize the pharmacokinetics of ganciclovir in the plasma of pediatric kidney and liver transplant patients taking valganciclovir for EBV prophylaxis. Virologic response was also evaluated. Ganciclovir was measured by liquid chromatography/ultraviolet detection. EBV DNA was quantified by TaqMan® polymerase chain reaction. NONMEM® VI was used for data analysis. Ganciclovir plasma profiles were consistent with a one-compartment model. Final model estimates of apparent oral clearance (L/h, apparent volume of distribution (L, and absorption rate constant were 7.33, 35.1, and 0.85, respectively. There was evidence of lower bioavailability in children younger than three years. All eight subjects achieved ganciclovir plasma concentrations above reported in vitro concentrations needed to inhibit EBV replication by 50%. However, four subjects had detectable EBV DNA with a median (range of 18,300 (4,400 to 54,900 copies/mL of whole blood. These findings support the need for further studies of the clinical pharmacology and efficacy of valganciclovir for EBV prophylaxis.Keywords: valganciclovir, ganciclovir, pharmacokinetics, Epstein–Barr virus, pediatrics, solid organ transplantation

  5. COPD Diagnostic Questionnaire (CDQ) for selecting at-risk patients for spirometry: a cross-sectional study in Australian general practice.

    Science.gov (United States)

    Stanley, Anthony J; Hasan, Iqbal; Crockett, Alan J; van Schayck, Onno C P; Zwar, Nicholas A

    2014-07-10

    Using the COPD Diagnostic Questionnaire (CDQ) as a selection tool for spirometry could potentially improve the efficiency and accuracy of chronic obstructive pulmonary disease (COPD) diagnosis in at-risk patients. To identify an optimal single cut point for the CDQ that divides primary care patients into low or high likelihood of COPD, with the latter group undergoing spirometry. Former or current smokers aged 40-85 years with no prior COPD diagnosis were invited to a case-finding appointment with the practice nurse at various general practices in Sydney, Australia. The CDQ was collected and pre- and post-bronchodilator spirometry was performed. Cases with complete CDQ data and spirometry meeting quality standards were analysed (1,054 out of 1,631 patients). CDQ cut points were selected from a receiver operating characteristic (ROC) curve. The area under the ROC curve was 0.713. A cut point of 19.5 had the optimal combination of sensitivity (63%) and specificity (70%) with two-thirds below this cut point. A cut point of 14.5 corresponded to a sensitivity of 91%, specificity of 35% and negative predictive value of 96%, and 31% of patients below this cut point. The CDQ can be used to select patients at risk of COPD for spirometry using one cut point. We consider two possible cut points. The 19.5 cut point excludes a higher proportion of patients from undergoing spirometry with the trade-off of more false negatives. The 14.5 cut point has a high sensitivity and negative predictive value, includes more potential COPD cases but has a higher rate of false positives.

  6. What do cardiovascular nurses know about the hematological management of patients with Eisenmenger syndrome?

    NARCIS (Netherlands)

    Moons, Philip; Fleck, Desiree; Jaarsma, Tiny; Norekval, Tone M.; Smith, Karen; Stromberg, Anna; Thompson, David R.; Budts, Werner

    2009-01-01

    Aim: We investigated the level of knowledge of hematological management of patients with Eisenmenger syndrome among general cardiovascular nurses and nurses who specialize in congenital heart disease (CHD). Methods: We conducted a survey at two international conferences attended by cardiovascular

  7. The impact of gastrointestinal symptoms on health status in patients with cardiovascular disease

    NARCIS (Netherlands)

    Laheij, R J F; Van Rossum, L G M; Krabbe, P F M; Jansen, J B M J; Verheugt, F W A

    2003-01-01

    BACKGROUND: Drugs for the management of cardiovascular disease may provoke gastrointestinal discomfort and complications. AIM: To evaluate whether upper gastrointestinal symptoms affect the health status of patients with cardiovascular disease. METHODS: Two weeks after discharge, 958 consecutive

  8. Cardiovascular risk factors in high-need psoriasis patients and its implications for biological therapies.

    NARCIS (Netherlands)

    Driessen, R.J.B.; Boezeman, J.B.M.; Kerkhof, P.C.M. van de; Jong, E.M.G.J. de

    2009-01-01

    BACKGROUND: The associations between psoriasis and cardiovascular risk factors are reported to be stronger as psoriasis severity increases. This makes studying cardiovascular risk factors in high-need psoriasis patients, eligible for biological therapy, interesting. OBJECTIVE: To survey the

  9. Early Rehospitalization Post-Kidney Transplant Due to Infectious Complications: Can We Predict the Patients at Risk?

    Science.gov (United States)

    Leal, R; Pinto, H; Galvão, A; Rodrigues, L; Santos, L; Romãozinho, C; Macário, F; Alves, R; Campos, M; Mota, A; Figueiredo, A

    2017-05-01

    Rehospitalization early post-kidney transplant is common and has a negative impact in morbidity, graft survival, and health costs. Infection is one the most common causes, and identifying the risk factors for early readmission due to infectious complications may guide a preventive program and improve outcome. The aim of this study was to evaluate the incidence, characterize the population, and identify the risk factors associated with early readmission for infectious complications post-kidney transplantation. We performed a retrospective cohort study of all the kidney transplants performed during 2015. The primary outcome was readmission in the first 3 months post-transplant due to infectious causes defined by clinical and laboratory parameters. We evaluated 141 kidney transplants; 71% of subjects were men, with an overall mean age of 50.8 ± 15.4 years. Prior to transplant, 98% of the patients were dialysis dependent and 2% underwent pre-emptive living donor kidney transplant. The global readmission rate was 49%, of which 65% were for infectious complications. The most frequent infection was urinary tract infection (n = 28, 62%) and the most common agent detected by blood and urine cultures was Klebsiella pneumonia (n = 18, 40%). The risk factors significantly associated with readmission were higher body mass index (P = .03), diabetes mellitus (P = .02), older donor (P = .007), and longer cold ischemia time (P = .04). There were 3 graft losses, but none due to infectious complications. There was a high incidence of early rehospitalization due to infectious complications, especially urinary tract infections to nosocomial agents. The risk factors identified were similar to other series. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. A mismatch between self-reported physical work load and the HAQ: early identification of rheumatoid arthritis patients at risk for loss of work productivity.

    Science.gov (United States)

    Puolakka, K; Kautiainen, H; Möttönen, T; Hannonen, P; Korpela, M; Hakala, M; Viikari-Juntura, E; Solovieva, S; Arkela-Kautiainen, M; Leirisalo-Repo, M

    2009-01-01

    To explore the combination of data on functioning and work load for early identification of patients at risk for diminished work productivity in rheumatoid arthritis (RA). In the FIN-RACo trial, 162 patients with recent onset RA and available for the workforce were treated with either a combination of disease-modifying antirheumatic drugs (DMARDs) or a single DMARD for 2 years. Otherwise, they received routine care and were followed up for 5 years. Data on their individual income and lost work days came from official registers. Loss of productivity was computed by the human capital approach. Self-reported data on physical work demand (Finnish Institute for Occupational Health Questionnaire) at baseline and on functioning (HAQ) at 6 months were linked according to the International Classification of Functioning, Disability and Health. Data on 112 patients were analyzable at 6 months; 35 (31%) of them had diminished capacity in functions required at paid work. Any mismatch between perceived abilities and requirements predicted future (7 through 60 months) loss of productivity - on average Euro 14,040 (95% confidence interval (CI): 9,143-20,511) per year in patients with the mismatch compared to Euro 3,043 (1,623-5,534) in those without any mismatch - and was associated with RA-related permanent work disability (hazard ratio: 11.6; 95%CI: 4.0-33.4). Linking together self-reported data about functioning and work load helps in early identification of the RA patients at risk for loss of working days.

  11. Improving Care for Patients With or at Risk for Chronic Kidney Disease Using Electronic Medical Record Interventions: A Pragmatic Cluster-Randomized Trial Protocol

    Directory of Open Access Journals (Sweden)

    Danielle M. Nash

    2017-04-01

    Full Text Available Background: Many patients with or at risk for chronic kidney disease (CKD in the primary care setting are not receiving recommended care. Objective: The objective of this study is to determine whether a multifaceted, low-cost intervention compared with usual care improves the care of patients with or at risk for CKD in the primary care setting. Design: A pragmatic cluster-randomized trial, with an embedded qualitative process evaluation, will be conducted. Setting: The study population comes from the Electronic Medical Record Administrative data Linked Database®, which includes clinical data for more than 140 000 rostered adults cared for by 194 family physicians in 34 clinics across Ontario, Canada. The 34 primary care clinics will be randomized to the intervention or control group. Intervention: The intervention group will receive resources from the “CKD toolkit” to help improve care including practice audit and feedback, printed educational materials for physicians and patients, electronic decision support and reminders, and implementation support. Measurements: Patients with or at risk for CKD within participating clinics will be identified using laboratory data in the electronic medical records. Outcomes will be assessed after dissemination of the CKD tools and after 2 rounds of feedback on performance on quality indicators have been sent to the physicians using information from the electronic medical records. The primary outcome is the proportion of patients aged 50 to 80 years with nondialysis-dependent CKD who are on a statin. Secondary outcomes include process of care measures such as screening tests, CKD recognition, monitoring tests, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker prescriptions, blood pressure targets met, and nephrologist referral. Hierarchical analytic modeling will be performed to account for clustering. Semistructured interviews will be conducted with a random purposeful sample of

  12. Gastric Impedance Spectroscopy in Cardiovascular Surgery Patients vs. Healthy Volunteers.

    Science.gov (United States)

    Beltran, N; Sanchez-Miranda, G; Godinez, M; Diaz, U; Sacristan, E

    2005-01-01

    Impedance spectroscopy has been proposed as a method of monitoring mucosal injury due to hypoperfusion and ischemia in the critically ill. The present study evaluates spectral differences in elective cardiovascular surgery patients compared with the impedance spectra of the gastric mucosa in healthy adults. An impedance spectroscopy probe and nasogastric tube (ISP/NGT) was placed into the stomach of 77 heart surgery and 21 healthy volunteers. The recorded impedance spectra were classified into 3 groups: group 1 for healthy volunteers; group 2 for patients with neither ischemia nor complications; and group 3 for patients with ischemia and complications during the first 3 days in the recovery unit. There were statistical differences in resistance (p<0.001) and reactance (p<0.001) among the 3 groups. The results show that impedance spectra are distinct and significantly different in patients with probable ischemic mucosal injury compared to healthy subjects, and therefore this technology may be a useful prognostic and diagnostic monitoring tool.

  13. An evidence-based approach to medication preparation for the surgical patient at risk for latex allergy: is it time to stop being stopper poppers?

    Science.gov (United States)

    Heitz, James W; Bader, Stephen O

    2010-09-01

    The prevalence of latex allergy is increasing in surgical patient populations. Avoidance of exposure to the allergen is essential to minimizing perioperative complications in patients suspected to be at risk. Natural rubber latex has historically been ubiquitous in medical devices containing rubber. In 1998, the Food and Drug Administration (FDA) began to require the labeling of medical devices made from natural rubber latex; since that time substantial progress has been made in identifying latex-free alternatives. However, the rubber stoppers commonly found in pharmaceutical vial closures are exempt from FDA labeling requirements. Examination of the clinical and basic science literature regarding pharmaceutical vial closures supports limiting the rubber stopper to a single needle puncture as a safer practice, with the caveat that no strategy exists for the complete elimination of risk as long as stoppers made from natural rubber latex are used in pharmaceutical vials intended for human use. Copyright © 2010 Elsevier Inc. All rights reserved.

  14. History of cardiovascular events and cardiovascular risk factors among patients initiating strontium ranelate for treatment of osteoporosis

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    Yu J

    2015-11-01

    Full Text Available Jingbo Yu,1 Jackson Tang,2 Zhiyi Li,2 Shiva Sajjan,1 Christopher O’Regan,3 Ankita Modi,1 Vasilisa Sazonov11Center for Observational and Real-World Evidence (CORE, Merck & Co., Inc., Kenilworth, NJ, USA; 2Asclepius Analytics Ltd., Wanchai, Hong Kong; 3Merck Sharp & Dohme Corp., Hoddeson, UKPurpose: To estimate the proportion of osteoporosis patients in whom initiating strontium ranelate treatment, under new EMA guidelines, should be contraindicated because of a history of cardiovascular events or risk for cardiovascular events.Materials and methods: This was a retrospective analysis of medical and pharmacy claims using the Clinical Practice Research Datalink database. Patients were included if they had ≥1 prescription of strontium from September 1, 2008 to August 31, 2013, were aged ≥50 as of the index date (the date of the first ever strontium ranelate prescription, and had ≥1 year of medical records pre-index. Cardiovascular events occurring any time pre-index were identified, which included ischemic heart disease, cerebrovascular disease, uncontrolled hypertension, and peripheral arterial disease. Cardiovascular risk factors assessed included 1 diabetes or hypertension any time pre-index; 2 hyperlipidemia in the 12 months pre-index; or 3 obesity in the 12 months pre-index.Results: A total of 7,474 patients were included: 90.4% were women, with an average age of 76.5 years, and 84.5% used osteoporosis therapy, either bisphosphonates or non-bisphosphonates, prior to strontium initiation. A total of 23.6% of patients experienced ≥1 cardiovascular event prior to strontium initiation; the rate was lower among female patients than in male patients (22.4% vs 35.3%, P<0.01. A total of 45.9% had risk factors for cardiovascular events (without cardiovascular event history. Conclusion: More than one-fifth of osteoporosis patients in the UK who used strontium had a cardiovascular event history, and one-half had cardiovascular risk factors

  15. Expression of Prostaglandin E2 Enzymes in the Synovium of Arthralgia Patients at Risk of Developing Rheumatoid Arthritis and in Early Arthritis Patients

    NARCIS (Netherlands)

    de Hair, Maria J. H.; Leclerc, Patrick; Newsum, Elize C.; Maijer, Karen I.; van de Sande, Marleen G. H.; Ramwadhdoebe, Tamara H.; van Schaardenburg, Dirkjan; van Baarsen, Lisa G. M.; Korotkova, Marina; Gerlag, Danielle M.; Tak, Paul-Peter; Jakobsson, Per-Johan

    2015-01-01

    Arthralgia may precede the development of synovial inflammation in autoantibody-positive individuals at risk of developing rheumatoid arthritis (RA). A major pathway involved in pain is the prostaglandin (PG) E2 pathway. We investigated this pathway in the synovium of individuals with RA-specific

  16. Rs895819 in MIR27A improves the predictive value of DPYD variants to identify patients at risk of severe fluoropyrimidine-associated toxicity.

    Science.gov (United States)

    Meulendijks, Didier; Henricks, Linda M; Amstutz, Ursula; Froehlich, Tanja K; Largiadèr, Carlo R; Beijnen, Jos H; de Boer, Anthonius; Deenen, Maarten J; Cats, Annemieke; Schellens, Jan H M

    2016-06-01

    The objective of this study was to determine whether genotyping of MIR27A polymorphisms rs895819A>G and rs11671784C>T can be used to improve the predictive value of DPYD variants to identify patients at risk of severe fluoropyrimidine-associated toxicity (FP-toxicity). Patients treated previously in a prospective study with fluoropyrimidine-based chemotherapy were genotyped for rs895819 and rs11671784, and DPYD c.2846A>T, c.1679T>G, c.1129-5923C>G and c.1601G>A. The predictive value of MIR27A variants for early-onset grade ≥3 FP-toxicity, alone or in combination with DPYD variants, was tested in multivariable logistic regression models. Random-effects meta-analysis was performed, including previously published data. A total of 1,592 patients were included. Allele frequencies of rs895819 and rs11671784 were 0.331 and 0.020, respectively. In DPYD wild-type patients, MIR27A variants did not affect risk of FP-toxicity (OR 1.3 for ≥1 variant MIR27A allele vs. none, 95% CI: 0.87-1.82, p = 0.228). In contrast, in patients carrying DPYD variants, the presence of ≥1 rs895819 variant allele was associated with increased risk of FP-toxicity (OR 4.9, 95% CI: 1.24-19.7, p = 0.023). Rs11671784 was not associated with FP-toxicity (OR 2.9, 95% CI: 0.47-18.0, p = 0.253). Patients carrying a DPYD variant and rs895819 were at increased risk of FP-toxicity compared to patients wild type for rs895819 and DPYD (OR 2.4, 95% CI: 1.27-4.37, p = 0.007), while patients with a DPYD variant but without a MIR27A variant were not (OR 0.3 95% CI: 0.06-1.17, p = 0.081). In meta-analysis, rs895819 remained significantly associated with FP-toxicity in DPYD variant allele carriers, OR 5.4 (95% CI: 1.83-15.7, p = 0.002). This study demonstrates the clinical validity of combined MIR27A/DPYD screening to identify patients at risk of severe FP-toxicity. © 2016 UICC.

  17. Postoperative complications do not influence the pattern of early lung function recovery after lung resection for lung cancer in patients at risk.

    Science.gov (United States)

    Ercegovac, Maja; Subotic, Dragan; Zugic, Vladimir; Jakovic, Radoslav; Moskovljevic, Dejan; Bascarevic, Slavisa; Mujovic, Natasa

    2014-05-19

    The pattern and factors influencing the lung function recovery in the first postoperative days are still not fully elucidated, especially in patients at increased risk. Prospective study on 60 patients at increased risk, who underwent a lung resection for primary lung cancer. complete resection and one or more known risk factors in form of COPD, cardiovascular disorders, advanced age or other comorbidities. Previous myocardial infarction, myocardial revascularization or stenting, cardiac rhythm disorders, arterial hypertension and myocardiopathy determined the increased cardiac risk. The severity of COPD was graded according to GOLD criteria. The trend of the postoperative lung function recovery was assessed by performing spirometry with a portable spirometer. Cardiac comorbidity existed in 55%, mild and moderate COPD in 20% and 35% of patients respectively. Measured values of FVC% and FEV1% on postoperative days one, three and seven, showed continuous improvement, with significant difference between the days of measurement, especially between days three and seven. There was no difference in the trend of the lung function recovery between patients with and without postoperative complications. Whilst pO2 was decreasing during the first three days in a roughly parallel fashion in patients with respiratory, surgical complications and in patients without complications, a slight hypercapnia registered on the first postoperative day was gradually abolished in all groups except in patients with cardiac complications. Extent of the lung resection and postoperative complications do not significantly influence the trend of the lung function recovery after lung resection for lung cancer.

  18. [Is stress cardiovascular magnetic resonance really useful to detect ischemia and predict events in patients with different cardiovascular risk profile?

    Science.gov (United States)

    Esteban-Fernández, Alberto; Coma-Canella, Isabel; Bastarrika, Gorka; Barba-Cosials, Joaquín; Azcárate-Agüero, Pedro M

    The aim of this study was to evaluate the diagnostic and prognostic usefulness of stress cardiovascular magnetic resonance (stress CMR) in patients with different cardiovascular risk profile and to assess if the degree of hypoperfusion is important to guide clinical decisions. We included patients submitted to adenosine stress CMR to rule out myocardial ischemia. We evaluated its diagnostic accuracy with likelihood ratio (LR) and its prognostic value with survival curves and a Cox regression model. 295 patients were studied. The positive LR was 3.40 and the negative one 0.47. The maximal usefulness of the test was found in patients without previous ischemic cardiomyopathy (positive LR 4.85), patients with atypical chest pain (positive LR 8.56), patients with low or intermediate cardiovascular risk (positive LR 3.87) and those with moderate or severe hypoperfusion (positive LR 8.63). Sixty cardiovascular major events were registered. The best survival prognosis was found in patients with a negative result (p=0.001) or mild hypoperfusion (p=0.038). In the multivariate analysis, a moderate or severe hypoperfusion increased cardiovascular event probability (HR=2.2; IC 95% 1.26-3.92), with no differences between a mild positive and a negative result (HR=0.93; IC 95% 0.38-2.28). Stress CMR was specially useful in patients with low or intermediate cardiovascular risk, patients with atypical chest pain, patients without previous ischemic cardiomyopathy and those with moderate or severe hypoperfusion. Hypoperfusion degree was the main issue factor to guide clinical decisions. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  19. Cardiovascular morbidity and mortality risk factors in peritoneal dialysis patients

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    Jovanović Dijana B.

    2008-01-01

    Full Text Available Cardiovascular (CVS morbidity and mortality in the endstage renal disease (ESRD patients on peritoneal dialysis therapy is 10-30 folds higher than in general population. The prevalence of well known traditional risk factors such as age, sex, race, arterial hypertension, hyperlipidaemia, diabetes, smoking, physical inactivity is higher in the uraemic patients. Besides these, there are specific, nontraditional risk factors for dialysis patients. Mild inflammation present in peritoneal dialysis (PD patients which can be confirmed by specific inflammatory markers is the cause of CVS morbidity and mortality in these patients. Hypoalbuminaemia, hyperhomocysteinaemia and a higher level of leptin are important predictors of vascular complications as well as CVS events in the PD patients. Plasma norepinephrine, an indicator of sympathetic activity, is high in the ESRD patients and higher in the PD patients than in the patients on haemodialysis (HD. Therefore, norepinephrine may be a stronger risk factor in the PD patients. The same applies to asymmetric dimethylargine (ADMA, an endogenous inhibitor of nitric oxide synthase, which is an important risk factor of CVS morbidity and mortality 15 % higher in the PD than the HD patients. Hyperphosphataemia, secondary hyperparathyroidism and high calcium x phosphate product have been associated with the progression of the coronary artery calcification and valvular calcifications and predict all-cause CVS mortality in the PD patients. Residual renal function (RRF declines with time on dialysis but is slower in the PD than the HD patients. RRF decline is associated with the rise of proinflammatory cytokines and the onset of hypervolaemia and hypertension which increase the risk of CVS diseases, mortality in general and CVS mortality. In conclusion, it is very important to establish all CVS risk factors in the PD patients to prevent CVS diseases and CVS mortality in this population.

  20. Risco cardiovascular em pacientes submetidos ao transplante hepático Cardiovascular risk in patients submitted to liver transplantation

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    Hélem de Sena Ribeiro

    2012-06-01

    Full Text Available OBJETIVO: Determinar a prevalência de risco cardiovascular em pacientes submetidos ao transplante hepático de acordo com o escore de Framingham e avaliar possíveis associações com fatores de risco tradicionais e não tradicionais. MÉTODOS: Estudo transversal em que pacientes submetidos ao transplante hepático foram estratificados quanto ao risco cardiovascular pelo escore de Framingham. Variáveis demográficas, socioeconômicas, clínicas e antropométricas foram coletadas para verificar associação com risco cardiovascular utilizando-se análises estatísticas uni e multivariada. RESULTADOS: Foram avaliados 115 pacientes, dos quais 46,1% apresentaram médio ou alto risco para ocorrência de eventos cardiovasculares em 10 anos. O risco percentual médio dos pacientes avaliados foi de 9,5% ± 7,8%. Sexo masculino (OR: 4,97; IC 95% 1,92-12,85; p OBJECTIVE: To determine the prevalence of cardiovascular risk in patients undergoing liver transplantation according to the Framingham score, and to evaluate possible associations with traditional and non-traditional risk factors. METHODS: Cross-sectional study in which patients undergoing liver transplantation were stratified by cardiovascular risk according to the Framingham score. Demographic, socioeconomic, clinical, and anthropometric variables were collected to assess the association with cardiovascular risk factors using univariate and multivariate statistical analyses. RESULTS: A total of 115 patients were evaluated, of which 46.1% showed medium or high risk for the occurrence of cardiovascular events over ten years. The mean percentage risk of evaluated patients was of 9.5 ± 7.8%. Male gender (OR: 4.97; CI: 1.92-12.85; p < 0.01, older age (OR: 1,09; CI: 1.04-1.13; p < 0.01, and higher BMI at the moment of assessment (1.09; CI: 0.99-1.20; p = 0.03 were factors associated with medium and high cardiovascular risk. A higher percentage of cardiovascular risk was also associated with

  1. cardiovasculares

    Directory of Open Access Journals (Sweden)

    Cristina Guerrero

    2006-01-01

    Full Text Available Uno de los aspectos que más discusión ha suscitado en los últimos tiempos entre quienes nos dedicamos al estudio de la emoción tiene que ver con la eventual asociación entre percepción, valoración y respuesta fisiológica. Esto es, siguiendo la máxima aristotélica, cabría cuestionar si las cosas son como son o son como cada quien las percibe. El objetivo de este experimento ha sido establecer la existencia de una conexión entre percepción de control y responsividad cardiovascular. La muestra estudiada ha estado conformada por estudiantes de la Universidad de Castellón; todos ellos han participado de forma voluntaria. La prueba de estrés ha consistido en un examen real de una asignatura troncal de la titulación que cursaban los participantes. Así pues, utilizando una situación de estrés real, hipotetizamos que las respuestas cardiovasculares (medidas a través de la tasa cardiaca, la presión sanguínea sistólica y la presión sanguínea diastólica dependen de la percepción de control que el individuo tiene, o cree tener, sobre la situación.

  2. Quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) and St. John Sepsis Surveillance Agent to Detect Patients at Risk of Sepsis: An Observational Cohort Study.

    Science.gov (United States)

    Amland, Robert C; Sutariya, Bharat B

    2017-02-01

    The 2016 Sepsis-3 guidelines included the Quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) tool to identify patients at risk of sepsis. The objective was to compare the utility of qSOFA to the St. John Sepsis Surveillance Agent among patients with suspected infection. The primary outcomes were in-hospital mortality or admission to the intensive care unit. A multiple center observational cohort study design was used. The study population comprised 17 044 hospitalized patients between January and March 2016. For the primary analysis, receiver operator characteristic curves were constructed for patient outcomes using qSOFA and the St. John Sepsis Surveillance Agent, and the areas under the curve were compared against a baseline risk model. Time-to-event clinical process modeling also was applied. The St. John Sepsis Surveillance Agent, when compared to qSOFA, activated earlier and was more accurate in predicting patient outcomes; in this regard, qSOFA fell far behind on both objectives.

  3. Ankylosing spondylitis patients at risk of poor radiographic outcome show diminishing spinal radiographic progression during long-term treatment with TNF-α inhibitors.

    Directory of Open Access Journals (Sweden)

    Fiona Maas

    Full Text Available To investigate the influence of patient characteristics on the course of spinal radiographic progression in a large prospective longitudinal cohort study of ankylosing spondylitis (AS patients treated long-term with TNF-α inhibitors.Consecutive patients from the Groningen Leeuwarden AS (GLAS cohort starting TNF-α inhibitors with spinal radiographs at least available at baseline and 6 years of follow-up were included. Radiographs were scored using mSASSS by two independent readers. Generalized estimating equations (GEE were used to explore the associations between baseline characteristics and spinal radiographic progression. The course of radiographic progression in patients with and without risk factors for poor radiographic outcome was investigated using different time models (linear and non-linear. Single linear imputation was used in case of missing radiographic data at the intermediate (2 or 4 years follow-up visits.80 AS patients were included with mean baseline mSASSS 8.7±13.3. Baseline syndesmophytes, male gender, older age, longer symptom duration, smoking, and higher BMI were significantly associated with more radiographic damage over time. GEE analysis in patients with these risk factors revealed that radiographic progression followed a non-linear course with mean mSASSS progression rates reducing from max. 2.8 units over 0-2 years to min. 0.9 units over 4-6 years. The GEE model revealed a linear course with overall very low progression (≤1 mSASSS units/2yrs in patients without risk factors. Complete case analysis in 53 patients showed similar results.AS patients at risk of poor radiographic outcome showed the highest but diminishing spinal radiographic progression during long-term treatment with TNF-α inhibitors.

  4. Ankylosing spondylitis patients at risk of poor radiographic outcome show diminishing spinal radiographic progression during long-term treatment with TNF-α inhibitors.

    Science.gov (United States)

    Maas, Fiona; Arends, Suzanne; Wink, Freke R; Bos, Reinhard; Bootsma, Hendrika; Brouwer, Elisabeth; Spoorenberg, Anneke

    2017-01-01

    To investigate the influence of patient characteristics on the course of spinal radiographic progression in a large prospective longitudinal cohort study of ankylosing spondylitis (AS) patients treated long-term with TNF-α inhibitors. Consecutive patients from the Groningen Leeuwarden AS (GLAS) cohort starting TNF-α inhibitors with spinal radiographs at least available at baseline and 6 years of follow-up were included. Radiographs were scored using mSASSS by two independent readers. Generalized estimating equations (GEE) were used to explore the associations between baseline characteristics and spinal radiographic progression. The course of radiographic progression in patients with and without risk factors for poor radiographic outcome was investigated using different time models (linear and non-linear). Single linear imputation was used in case of missing radiographic data at the intermediate (2 or 4 years) follow-up visits. 80 AS patients were included with mean baseline mSASSS 8.7±13.3. Baseline syndesmophytes, male gender, older age, longer symptom duration, smoking, and higher BMI were significantly associated with more radiographic damage over time. GEE analysis in patients with these risk factors revealed that radiographic progression followed a non-linear course with mean mSASSS progression rates reducing from max. 2.8 units over 0-2 years to min. 0.9 units over 4-6 years. The GEE model revealed a linear course with overall very low progression (≤1 mSASSS units/2yrs) in patients without risk factors. Complete case analysis in 53 patients showed similar results. AS patients at risk of poor radiographic outcome showed the highest but diminishing spinal radiographic progression during long-term treatment with TNF-α inhibitors.

  5. Glycaemic response after intake of a high energy, high protein, diabetes-specific formula in older malnourished or at risk of malnutrition type 2 diabetes patients.

    Science.gov (United States)

    Laksir, Hamid; Lansink, Mirian; Regueme, Sophie C; de Vogel-van den Bosch, Johan; Pfeiffer, Andreas F H; Bourdel-Marchasson, Isabelle

    2017-10-06

    Several studies with diabetes-specific formulas (DSFs) for hyperglycaemic patients in need of nutritional support have been conducted in non-malnourished patients, mainly comparing products with varying macronutrient compositions. Here, the effect of a high energy, high protein DSF on postprandial responses was compared to a product with a similar macronutrient composition in malnourished or at risk of malnutrition patients with type 2 diabetes. In this randomised, double-blind cross-over study, 20 patients were included. After overnight fasting, patients consumed 200 mL of a DSF or standard supplement (control) (19.6 g protein, 31.2 g carbohydrates and 10.6 g fat), while continuing their anti-diabetic medication. The formulas differed in type of carbohydrates and presence of fibre. The postprandial glucose, insulin and glucagon responses were monitored over 4 h. Data were analysed with a Linear Mixed Model, and results of the modified ITT population (n = 19) are shown. Postprandial glucose response as incremental area under the curve (iAUC), was lower after consumption of DSF compared with control (489.7 ± 268.5 (mean ± SD) vs 581.3 ± 273.9 mmol/L min, respectively; p = 0.008). Also, the incremental maximum concentration of glucose (iCmax) was lower for DSF vs control (3.5 ± 1.4 vs 4.0 ± 1.4 mmol/L; p = 0.007). Postprandial insulin and glucagon levels, expressed as iAUC or iCmax, were not significantly different between groups. Consumption of a high energy, high protein DSF by older malnourished or at risk of malnutrition type 2 diabetes patients resulted in a significantly lower glucose response compared to control. These data suggest that the use of a DSF is preferred for patients with diabetes in need of nutritional support. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. Prevention of peptic ulcers with esomeprazole in patients at risk of ulcer development treated with low-dose acetylsalicylic acid: a randomised, controlled trial (OBERON)

    Science.gov (United States)

    Devereaux, P J; Herlitz, Johan; Katelaris, Peter H; Lanas, Angel; Veldhuyzen van Zanten, Sander; Nauclér, Emma; Svedberg, Lars-Erik

    2011-01-01

    Objective To determine whether once-daily esomeprazole 40 mg or 20 mg compared with placebo reduces the incidence of peptic ulcers over 26 weeks of treatment in patients taking low-dose acetylsalicylic acid (ASA) and who are at risk for ulcer development. Design Multinational, randomised, blinded, parallel-group, placebo-controlled trial. Setting Cardiology, primary care and gastroenterology centres (n=240). Patients Helicobacter pylori-negative patients taking daily low-dose ASA (75–325 mg), who fulfilled one or more of the following criteria: age ≥18 years with history of uncomplicated peptic ulcer; age ≥60 years with either stable coronary artery disease, upper gastrointestinal symptoms and five or more gastric/duodenal erosions, or low-dose ASA treatment initiated within 1 month of randomisation; or age ≥65 years. All patients were ulcer-free at study entry. Interventions Once-daily, blinded treatment with esomeprazole 40 mg, 20 mg or placebo for 26 weeks. Main outcome measures The primary end point was the occurrence of endoscopy-confirmed peptic ulcer over 26 weeks. Results A total of 2426 patients (52% men; mean age 68 years) were randomised. After 26 weeks, esomeprazole 40 mg and 20 mg significantly reduced the cumulative proportion of patients developing peptic ulcers; 1.5% of esomeprazole 40 mg and 1.1% of esomeprazole 20 mg recipients, compared with 7.4% of placebo recipients, developed peptic ulcers (both pEsomeprazole was generally well tolerated. Conclusions Acid-suppressive treatment with once-daily esomeprazole 40 mg or 20 mg reduces the occurrence of peptic ulcers in patients at risk for ulcer development who are taking low-dose ASA. Clinical trial registration number ClinicalTrials.gov identifier: NCT00441727. PMID:21415072

  7. Promoting Cardiovascular Health in Patients Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome.

    Science.gov (United States)

    Harris, Robin

    2018-03-01

    Patients living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLWHA) are at increased risk of cardiovascular disease because of advances in human immunodeficiency virus/acquired immunodeficiency syndrome treatment and increased life expectancy. Cardiovascular health promotion in PLWHA includes strategies for risk factor reduction, disease prevention, early detection, and treatment of cardiovascular disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Cardiovascular disease risk factors: prevalence and management in adult hemophilia patients.

    Science.gov (United States)

    Lim, Ming Y; Pruthi, Rajiv K

    2011-07-01

    With increasing longevity, the prevalence of cardiovascular disease (CVD) risk factors in hemophilia patients is expected to increase; however, evidence-based guidelines on management are lacking. The aim of the study was to determine the prevalence and management of CVD risk factors in hemophilia patients. A retrospective study of 58 adult hemophilia patients (≥35 years) attending Mayo Comprehensive Hemophilia Center between 1 January 2006 and 15 October 2009 were reviewed. The prevalence of CVD risk factors was hypertension 65.5%, diabetes 10.3%, smoking 12.5% and obesity 19.6%. A total of 31% did not have a lipid profile on record. Management of risk factors included antihypertensive medications in 84.2% and lipid-lowering agents in 12.1%. During their medical evaluation, four of seven active smokers received smoking cessation counseling and four of 11 obese patients received lifestyle modification advice. Eight patients (13.8%) experienced a CVD event: myocardial infarction (MI) (n=3), coronary artery disease (n=2), both MI and ischemic stroke (n=1) and hemorrhagic strokes (n=2). Only five of eight patients were on low-dose aspirin, of which aspirin was discontinued in one patient after he was diagnosed with hemophilia following a bleeding work-up. Another patient on dual antiplatelet therapy post stent placement developed epistaxis resulting in clopidogrel cessation. Hemophilia patients are at risk for CVD, similar to the general age-matched male population. Screening for CVD risk factors, with preventive dietary and pharmacologic interventions, play a key role in the prevention and long-term management of CVD. Collaborative efforts between primary care providers, cardiologists and hemophilia center specialists remain essential in managing these complex patients.

  9. A combination of clinical parameters and blood-gas analysis identifies patients at risk of transfer to intensive care upon arrival to the Emergency Department.

    Science.gov (United States)

    Bjørn, Maria; Simonsen, Jakúp W; Mogensen, Christian B

    2016-08-01

    Identifying patients at risk of transfer to the ICU upon arrival to the Emergency Department (ED) might direct early therapy and optimize transfers. However, among the many ED patients, it is difficult to pinpoint the few who insidiously deteriorate to an ICU-requiring level. The aim of this study was to identify predictors in background information, vital values and blood-gas analysis for transfer to ICU 3-36 h after arrival among nontrauma ED patients. A case-control study of 10 007 acute adult patients admitted to ED within 1 year was carried out. The case group consisted of all ICU transfers 3-36 h after arrival who underwent blood-gas analysis and a similar control group not transferred to the ICU. Blood pressure, respiratory frequency, pulse rate, peripheral oxygen saturation and temperature, triage, height, weight, Glasgow Coma Score, drugs, alcohol, tobacco, age, sex, Charlson score and blood-gas results were analysed. A total of 49 medical and 33 surgical patients were transferred to the ICU. For medical cases, 2.3 and surgical cases 3.7 controls were included. For medical patients, low systolic blood pressure [odds ratio (OR) 14.4], elevated heart rate (OR 3.9), severe acidosis (OR 5.1) and hypercapnia (OR 8.4) and for surgical patients age 60-79 years (OR 6.3), low diastolic blood pressure (OR 2.7) and severe acidosis (OR 15.3) were associated significantly with later transfer to the ICU. The predictors identified could be used as part of ED triage to identify high-risk patients for ICU. These findings should be examined in a well-designed prospective cohort study.

  10. A predictive model to identify hospitalized cancer patients at risk for 30-day mortality based on admission criteria via the electronic medical record.

    Science.gov (United States)

    Ramchandran, Kavitha J; Shega, Joseph W; Von Roenn, Jamie; Schumacher, Mark; Szmuilowicz, Eytan; Rademaker, Alfred; Weitner, Bing Bing; Loftus, Pooja D; Chu, Isabella M; Weitzman, Sigmund

    2013-06-01

    This study sought to develop a predictive model for 30-day mortality in hospitalized cancer patients, by using admission information available through the electronic medical record. Observational cohort study of 3062 patients admitted to the oncology service from August 1, 2008, to July 31, 2009. Matched numbers of patients were in the derivation and validation cohorts (1531 patients). Data were obtained on day 1 of admission and included demographic information, vital signs, and laboratory data. Survival data were obtained from the Social Security Death Index. The 30-day mortality rate of the derivation and validation samples were 9.5% and 9.7% respectively. Significant predictive variables in the multivariate analysis included age (P < .0001), assistance with activities of daily living (ADLs; P = .022), admission type (elective/emergency) (P = .059), oxygen use (P < .0001), and vital signs abnormalities including pulse oximetry (P = .0004), temperature (P = .017), and heart rate (P = .0002). A logistic regression model was developed to predict death within 30 days: Score = 18.2897 + 0.6013*(admit type) + 0.4518*(ADL) + 0.0325*(admit age) - 0.1458*(temperature) + 0.019*(heart rate) - 0.0983*(pulse oximetry) - 0.0123 (systolic blood pressure) + 0.8615*(O2 use). The largest sum of sensitivity (63%) and specificity (78%) was at -2.09 (area under the curve = -0.789). A total of 25.32% (100 of 395) of patients with a score above -2.09 died, whereas 4.31% (49 of 1136) of patients below -2.09 died. Sensitivity and positive predictive value in the derivation and validation samples compared favorably. Clinical factors available via the electronic medical record within 24 hours of hospital admission can be used to identify cancer patients at risk for 30-day mortality. These patients would benefit from discussion of preferences for care at the end of life. Copyright © 2013 American Cancer Society.

  11. Prevalence of atherogenic dyslipidemia in primary care patients at moderate-very high risk of cardiovascular disease. Cardiovascular risk perception.

    Science.gov (United States)

    Plana, Nuria; Ibarretxe, Daiana; Cabré, Anna; Ruiz, Emilio; Masana, Lluis

    2014-01-01

    Atherogenic dyslipidemia is an important risk factor for cardiovascular disease. We aim to determine atherogenic dyslipidemia prevalence in primary care patients at moderate-very high cardiovascular risk and its associated cardiovascular risk perception in Spain. This cross-sectional study included 1137 primary care patients. Patients had previous cardiovascular disease, diabetes mellitus, SCORE risk ≥ 3, severe hypertension or dyslipidemia. Atherogenic dyslipidemia was defined as low HDL-C (<40 mg/dL [males], <50 mg/dL [females]) and elevated triglycerides (≥ 150 mg/dL). A visual analog scale was used to define a perceived cardiovascular disease risk score. Mean age was 63.9 ± 9.7 years (64.6% males). The mean BMI was 29.1 ± 4.3 kg/m(2), and mean waist circumference 104.2 ± 12.7 cm (males), and 97.2 ± 14.0 cm (females). 29.4% were smokers, 76.4% had hypertension, 48.0% were diabetics, 24.7% had previous myocardial infarction, and 17.8% peripheral arterial disease. European guidelines classified 83.6% at very high cardiovascular risk. Recommended HDL-C levels were achieved by 50.1% of patients and 37.3% had triglycerides in the reference range. Target LDL-C was achieved by 8.8%. The overall atherogenic dyslipidemia prevalence was 27.1% (34.1% in diabetics). This prevalence in patients achieving target LDL-C was 21.4%. Cardiovascular risk perceived by patients was 4.3/10, while primary care physicians scored 5.7/10. When LDL-C levels are controlled, atherogenic dyslipidemia is more prevalent in those patients at highest cardiovascular risk and with diabetes. This highlights the importance of intervention strategies to prevent the residual vascular risk in this population. Both patients and physicians underestimated cardiovascular risk. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  12. [Why cardiovascular rehabilitation services should include patients with intermittent claudication?].

    Science.gov (United States)

    Carlon, Roberto; Zanchetta, Mario

    2006-12-01

    Chronic peripheral arterial disease represents a frequent and underestimated localization of atherosclerosis and its management often appears to be inadequate. The association with ischemic heart disease, the weighty prevalence of coronary disease risk factors, the high cardiovascular rate of morbidity and mortality, the sharp reduction in the tenor of life and the well-being supervised physical training efficacy constitute the main reasons that transform Cardiac Rehabilitation into an ideal setting for the treatment of patients suffering from intermittent claudication. Thanks to the cultural patrimony of cardiologists, together with other professionals, such as psychologists, dietitians, physiotherapists and nurses, it is possible to initiate an multi-comprehensive treatment program. Besides, this type of management may decrease both morbidity and mortality as well as reduce symptoms and improve the patients' quality of life.

  13. The systemic management of cardiovascular risk patients in dentistry.

    Science.gov (United States)

    Matsuura, H

    1993-01-01

    Recently, dental patients with cardiovascular diseases, especially hypertensive and ischemic heart disease, have been increasing. Performing dental procedures on these patients could bring about the acute exacerbations of preexisting cardiac diseases. Anxiety, tension, pain, and discomfort during dental treatment and the catecholamines contained in local anesthetic solutions are thought to be causative factors. Consequently, it is important to decide whether the procedure concerned could safely be performed by dental staffs in the dental clinic. Systemic management in dental treatment includes the application of psychosedation, proper selection of the vasoconstrictor in the anesthetic solution, and control of blood pressure by vasodilating agents under continuous careful monitoring. By these means, the magnitude of hemodynamic fluctuation should be kept minimal. Management of hypertension, ischemic heart disease, and cardiomyopathies will be explained.

  14. Improving cardiovascular risk management: a randomized, controlled trial on the effect of a decision support tool for patients and physicians.

    NARCIS (Netherlands)

    Steenkiste, B.C. van; Weijden, T. van der; Stoffers, H.E.; Kester, A.D.; Timmermans, D.R.; Grol, R.P.T.M.

    2007-01-01

    BACKGROUND: There is nonoptimal adherence of general practitioners (GPs) and patients to cardiovascular risk reducing interventions. GPs find it difficult to assimilate multiple risk factors into an accurate assessment of cardiovascular risk. In addition, communicating cardiovascular risk to

  15. The corpus-predominant gastritis index may serve as an early marker of Helicobacter pylori-infected patients at risk of gastric cancer.

    Science.gov (United States)

    Tsai, Y-C; Hsiao, W-H; Yang, H-B; Cheng, H-C; Chang, W-L; Lu, C-C; Sheu, B-S

    2013-05-01

    To eradicate Helicobacter pylori before the occurrence of precancerous changes is important to prevent gastric carcinogenesis. To validate whether the corpus-predominant gastritis index (CGI) can serve as an early marker to identify the H. pylori-infected patients at risk of gastric carcinogenesis. This study enrolled 188 subjects, including 43 noncardiac gastric cancer patients, 63 of their first-degree relatives and 82 sex- and age-matched duodenal ulcer patients as controls. All received endoscopy to provide topographic gastric specimens to test for H. pylori infection and its related histological features, translated into the operative link on gastritis assessment (OLGA), operative link on gastric intestinal metaplasia assessment (OLGIM) stages, and the presence of CGI. Spasmolytic polypeptide-expressing metaplasia (SPEM) was assessed by immunohistochemistry staining of trefoil factor 2. Gastric cancer patients had higher prevalence of CGI and OLGIM stage II-IV, but not OLGA stage II-IV, than the controls (P = 0.001, OR = 3.4[95% CI: 1.4-8.1] for CGI; OR = 5.0[95% CI: 2.0-12.8] for OLGIM). In patients with the combined presence of CGI and OLGIM stage II-IV, the risk of gastric cancer increased to 9.8 (P risk of SPEM (P = 0.003, OR = 5.5[95% CI: 1.8-17.0]). The corpus-predominant gastritis index, which is highly correlated to SPEM, may serve as an early marker to identify the H. pylori-infected patients at a higher risk of gastric cancer. © 2013 Blackwell Publishing Ltd.

  16. CBT in the prevention of psychosis and other severe mental disorders in patients with an at risk mental state: A review and proposed next steps.

    Science.gov (United States)

    van der Gaag, Mark; van den Berg, David; Ising, Helga

    2017-08-28

    Patients with an 'At risk mental state' (ARMS) for developing psychosis can be treated successfully with CBT to postpone and prevent the transition to a first psychotic episode. A characteristic of individuals that meet ARMS criteria is that they are still open for multiple explanations for extraordinary experiences. CBT aims to normalize extraordinary experiences with education and to prevent delusional explanations. The treatment is not only effective, but also cost-saving in averting psychosis as well as in reducing disability adjusted life years at 18- and 48-month follow-up. Profiling within the ARMS group results in a personalized treatment. The screening and early treatment for ARMS fulfills all the criteria of the World Health Organization and is ready to be routine screening and treatment in mental health care. At the same time, ARMS patients are complex patients with multi-morbid disorders. Especially childhood trauma is associated to ARMS status, together with co-morbid PTSD, depression, substance abuse and anxiety disorders. Psychotic symptoms appear to be severity markers in other non-psychotic disorders. Preventing psychosis in ARMS patients should be broadened to also address other disorders and aim to reduce chronicity of psychopathology and improve social functioning in general. Several mechanisms play a part in psychopathology in ARMS patients such as stress sensitivity as a result of adverse experiences, dopamine sensitivity that is associated with salience and aggravates several cognitive biases, dissociation mediating between trauma and hallucinations, and low self-esteem and self-stigma. New avenues to treat the complexity of ARMS patients will be proposed. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. A.S.P.E.N. clinical guidelines: support of pediatric patients with intestinal failure at risk of parenteral nutrition-associated liver disease.

    Science.gov (United States)

    Wales, Paul W; Allen, Nancy; Worthington, Patricia; George, Donald; Compher, Charlene; Teitelbaum, Daniel

    2014-07-01

    Children with severe intestinal failure and prolonged dependence on parenteral nutrition are susceptible to the development of parenteral nutrition-associated liver disease (PNALD). The purpose of this clinical guideline is to develop recommendations for the care of children with PN-dependent intestinal failure that have the potential to prevent PNALD or improve its treatment. A systematic review of the best available evidence to answer a series of questions regarding clinical management of children with intestinal failure receiving parenteral or enteral nutrition was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group. A consensus process was used to develop the clinical guideline recommendations prior to external and internal review and approval by the American Society for Parenteral and Enteral Nutrition Board of Directors. (1) Is ethanol lock effective in preventing bloodstream infection and catheter removal in children at risk of PNALD? (2) What fat emulsion strategies can be used in pediatric patients with intestinal failure to reduce the risk of or treat PNALD? (3) Can enteral ursodeoxycholic acid improve the treatment of PNALD in pediatric patients with intestinal failure? (4) Are PNALD outcomes improved when patients are managed by a multidisciplinary intestinal rehabilitation team? © 2014 American Society for Parenteral and Enteral Nutrition.

  18. Identification and characterization of CDH1 germline variants in sporadic gastric cancer patients and in individuals at risk of gastric cancer.

    Directory of Open Access Journals (Sweden)

    Marica Garziera

    Full Text Available OBJECTIVE: To screen and characterize germline variants for E-cadherin (CDH1 in non-hereditary gastric cancer (GC patients and in subjects at risk of GC. METHODS: 59 GCs, 59 first degree relatives (FDRs of GC, 20 autoimmune metaplastic atrophic gastritis (AMAGs and 52 blood donors (BDs were analyzed for CDH1 by direct sequencing, structural modelling and bioinformatics. Functional impact on splicing was assessed for intronic mutations. E-cadherin/β-catenin immunohistochemical staining and E-cadherin mRNA quantification using RT-PCR were performed. RESULTS: In GCs, 4 missense variants (p.G274S; p.A298T; p.T470I; p.A592T, 1 mutation in the 5'UTR (-71C>G and 1 mutation in the intronic IVS12 (c.1937-13T>C region were found. First pathogenic effect of p.A298T mutation was predicted by protein 3D modelling. The novel p.G274S mutation showed a no clear functional significance. Moreover, first, intronic IVS12 (c.1937-13T>C mutation was demonstrated to lead to an aberrant CDH1 transcript with exon 11 deletion. This mutation was found in 2 GCs and in 1 BD. In FDRs, we identified 4 variants: the polymorphic (p.A592T and 3 mutations in untranslated regions with unidentified functional role except for the 5'UTR (-54G>C that had been found to decrease CDH1 transcription. In AMAGs, we detected 2 alterations: 1 missense (p.A592T and 1 novel variant (IVS1 (c.48+7C>T without effect on CDH1 splicing. Several silent and polymorphic substitutions were found in all the groups studied. CONCLUSIONS: Overall our study improves upon the current characterization of CDH1 mutations and their functional role in GC and in individuals at risk of GC. Mutations found in untranslated regions and data on splicing effects deserve a particular attention like associated with a reduced E-cadherin amount. The utility of CDH1 screening, in addition to the identification of other risk factors, could be useful for the early detection of GC in subjects at risk (i.e. FDRs and AMAGs, and

  19. Implementing and evaluating a regional strategy to improve testing rates in VA patients at risk for HIV, utilizing the QUERI process as a guiding framework: QUERI Series

    Directory of Open Access Journals (Sweden)

    Osborn Teresa

    2008-03-01

    Full Text Available Abstract Background We describe how we used the framework of the U.S. Department of Veterans Affairs (VA Quality Enhancement Research Initiative (QUERI to develop a program to improve rates of diagnostic testing for the Human Immunodeficiency Virus (HIV. This venture was prompted by the observation by the CDC that 25% of HIV-infected patients do not know their diagnosis – a point of substantial importance to the VA, which is the largest provider of HIV care in the United States. Methods Following the QUERI steps (or process, we evaluated: 1 whether undiagnosed HIV infection is a high-risk, high-volume clinical issue within the VA, 2 whether there are evidence-based recommendations for HIV testing, 3 whether there are gaps in the performance of VA HIV testing, and 4 the barriers and facilitators to improving current practice in the VA. Based on our findings, we developed and initiated a QUERI step 4/phase 1 pilot project using the precepts of the Chronic Care Model. Our improvement strategy relies upon electronic clinical reminders to provide decision support; audit/feedback as a clinical information system, and appropriate changes in delivery system design. These activities are complemented by academic detailing and social marketing interventions to achieve provider activation. Results Our preliminary formative evaluation indicates the need to ensure leadership and team buy-in, address facility-specific barriers, refine the reminder, and address factors that contribute to inter-clinic variances in HIV testing rates. Preliminary unadjusted data from the first seven months of our program show 3–5 fold increases in the proportion of at-risk patients who are offered HIV testing at the VA sites (stations where the pilot project has been undertaken; no change was seen at control stations. Discussion This project demonstrates the early success of the application of the QUERI process to the development of a program to improve HIV testing rates

  20. Drug treatment of obesity in the cardiovascular patient.

    Science.gov (United States)

    Charakida, Marietta; Tousoulis, Dimitris; Finer, Nicholas

    2013-09-01

    The incidence of obesity and its associated comorbidities have significantly increased over the years with adverse health and financial consequences for society. Lifestyle changes are essential for the prevention and treatment of obesity but their benefit appears limited as inadequate and nonsustained weight loss results have been reported. Pharmacotherapy is frequently advocated as part of a weight loss strategy. In this review, we will discuss the antiobesity drugs with Food and Drug Administration approval and their cardiovascular implications. Orlistat (Xenical) remains the single monotherapy that has approval in Europe. Topiramate (Topamax) and phentermine have long been approved in the United States, whereas lorcaserin and the extended release combination of phentermine with topiramate have recently gained approval. The development of single peptides targeting gut hormones or other host signals related to obesity may represent promising therapeutic options. Despite the recent failures of a number of antiobesity drugs, the pharmacotherapy of obesity is progressing rapidly. Treating the obese cardiovascular patient has proven challenging. Efficacy, safety and the sustainability of weight loss are key areas of focus in drug development strategies.

  1. Cardiovascular Disease Prevention Counseling Program for Systemic Lupus Erythematosus Patients.

    Science.gov (United States)

    Yelnik, Cécile M; Richey, Monica; Haiduc, Virginia; Everett, Sotiria; Zhang, Meng; Erkan, Doruk

    2017-08-01

    To determine if a cardiovascular disease (CVD) prevention counseling program for lupus patients decreases the prevalence of CVD risk factors. The assessment phase of a 3-year CVD prevention counseling program included the evaluation of CVD risk factors, diet, exercise habits, and medications. The education phase included discussion of the above risk factors, as well as CVD and thrombosis prevention strategies. Patients were prospectively followed every 3-6 months for risk assessment and continued education by a nurse practitioner and a medical doctor. Between March 2009 and December 2014, 121 patients were included. At baseline, abnormal blood pressure, blood glucose, cholesterol profile, and body mass index were found in 50 (41%), 7 (6%), 82 (68%), and 77 (64%) patients, respectively. During the 3-year followup, among those with abnormal baseline values, prevalence of abnormal blood pressure significantly decreased (odds ratio [OR] 0.94, 95% confidence interval [95% CI] 0.92-0.96, P lupus patients. © 2016, American College of Rheumatology.

  2. Intrinsic brain activity of cognitively normal older persons resembles more that of patients both with and at risk for Alzheimer's disease than that of healthy younger persons.

    Science.gov (United States)

    Pasquini, Lorenzo; Tonch, Annika; Plant, Claudia; Zherdin, Andrew; Ortner, Marion; Kurz, Alexander; Förstl, Hans; Zimmer, Claus; Grimmer, Timo; Wohlschäger, Afra; Riedl, Valentin; Sorg, Christian

    2014-06-01

    In Alzheimer's disease (AD), recent findings suggest that amyloid-β (Aβ)-pathology might start 20-30 years before first cognitive symptoms arise. To account for age as most relevant risk factor for sporadic AD, it has been hypothesized that lifespan intrinsic (i.e., ongoing) activity of hetero-modal brain areas with highest levels of functional connectivity triggers Aβ-pathology. This model induces the simple question whether in older persons without any cognitive symptoms intrinsic activity of hetero-modal areas is more similar to that of symptomatic patients with AD or to that of younger healthy persons. We hypothesize that due to advanced age and therefore potential impact of pre-clinical AD, intrinsic activity of older persons resembles more that of patients than that of younger controls. We tested this hypothesis in younger (ca. 25 years) and older healthy persons (ca. 70 years) and patients with mild cognitive impairment and AD-dementia (ca. 70 years) by the use of resting-state functional magnetic resonance imaging, distinct measures of intrinsic brain activity, and different hierarchical clustering approaches. Independently of applied methods and involved areas, healthy older persons' intrinsic brain activity was consistently more alike that of patients than that of younger controls. Our result provides evidence for larger similarity in intrinsic brain activity between healthy older persons and patients with or at-risk for AD than between older and younger ones, suggesting a significant proportion of pre-clinical AD cases in the group of cognitively normal older people. The observed link of aging and AD with intrinsic brain activity supports the view that lifespan intrinsic activity may contribute critically to the pathogenesis of AD.

  3. Schizophrenia patients and 22q11.2 deletion syndrome adolescents at risk express the same deviant patterns of resting state EEG microstates: A candidate endophenotype of schizophrenia

    Directory of Open Access Journals (Sweden)

    Miralena I. Tomescu

    2015-09-01

    Full Text Available Schizophrenia is a complex psychiatric disorder and many of the factors contributing to its pathogenesis are poorly understood. In addition, identifying reliable neurophysiological markers would improve diagnosis and early identification of this disease. The 22q11.2 deletion syndrome (22q11DS is one major risk factor for schizophrenia. Here, we show further evidence that deviant temporal dynamics of EEG microstates are a potential neurophysiological marker by showing that the resting state patterns of 22q11DS are similar to those found in schizophrenia patients. The EEG microstates are recurrent topographic distributions of the ongoing scalp potential fields with temporal stability of around 80 ms that are mapping the fast reconfiguration of resting state networks. Five minutes of high-density EEG recordings was analysed from 27 adult chronic schizophrenia patients, 27 adult controls, 30 adolescents with 22q11DS, and 28 adolescent controls. In both patient groups we found increased class C, but decreased class D presence and high transition probabilities towards the class C microstates. Moreover, these aberrant temporal dynamics in the two patient groups were also expressed by perturbations of the long-range dependency of the EEG microstates. These findings point to a deficient function of the salience and attention resting state networks in schizophrenia and 22q11DS as class C and class D microstates were previously associated with these networks, respectively. These findings elucidate similarities between individuals at risk and schizophrenia patients and support the notion that abnormal temporal patterns of EEG microstates might constitute a marker for developing schizophrenia.

  4. Intrinsic Brain Activity of Cognitively Normal Older Persons Resembles More That of Patients Both with and at Risk for Alzheimer's Disease Than That of Healthy Younger Persons

    Science.gov (United States)

    Pasquini, Lorenzo; Tonch, Annika; Plant, Claudia; Zherdin, Andrew; Ortner, Marion; Kurz, Alexander; Förstl, Hans; Zimmer, Claus; Grimmer, Timo; Wohlschäger, Afra; Riedl, Valentin

    2014-01-01

    Abstract In Alzheimer's disease (AD), recent findings suggest that amyloid-β (Aβ)-pathology might start 20–30 years before first cognitive symptoms arise. To account for age as most relevant risk factor for sporadic AD, it has been hypothesized that lifespan intrinsic (i.e., ongoing) activity of hetero-modal brain areas with highest levels of functional connectivity triggers Aβ-pathology. This model induces the simple question whether in older persons without any cognitive symptoms intrinsic activity of hetero-modal areas is more similar to that of symptomatic patients with AD or to that of younger healthy persons. We hypothesize that due to advanced age and therefore potential impact of pre-clinical AD, intrinsic activity of older persons resembles more that of patients than that of younger controls. We tested this hypothesis in younger (ca. 25 years) and older healthy persons (ca. 70 years) and patients with mild cognitive impairment and AD-dementia (ca. 70 years) by the use of resting-state functional magnetic resonance imaging, distinct measures of intrinsic brain activity, and different hierarchical clustering approaches. Independently of applied methods and involved areas, healthy older persons' intrinsic brain activity was consistently more alike that of patients than that of younger controls. Our result provides evidence for larger similarity in intrinsic brain activity between healthy older persons and patients with or at-risk for AD than between older and younger ones, suggesting a significant proportion of pre-clinical AD cases in the group of cognitively normal older people. The observed link of aging and AD with intrinsic brain activity supports the view that lifespan intrinsic activity may contribute critically to the pathogenesis of AD. PMID:24689864

  5. Identification of hospitalized elderly patients at risk for adverse in-hospital outcomes in a university orthopedics and trauma surgery environment.

    Science.gov (United States)

    Gronewold, Janine; Dahlmann, Christian; Jäger, Marcus; Hermann, Dirk M

    2017-01-01

    As a consequence of demographic changes, hospitals are confronted with increasing numbers of elderly patients, who are at high risk of adverse events during hospitalization. Geriatric risk screening followed by comprehensive geriatric assessment (CGA) and treatment has been requested by geriatric societies and task forces to identify patients at risk. Since empirical evidence on factors predisposing to adverse hospital events is scarce, we now prospectively evaluated implications of geriatric risk screening followed by CGA in a university hospital department of orthopedics and trauma surgery. Three hundred and eighty-one patients ≥75 years admitted to the Department of Orthopedics and Trauma Surgery of the University Hospital Essen received Identification of Seniors at Risk (ISAR) Screening followed by CGA via a geriatric liaison service in case of positive screening results. Associations between ISAR, CGA, comorbid risk factors and diseases, length of hospital stay, number of nursing and physiotherapy hours, and falls during hospital stay were analyzed. Of 381 ISAR screenings, 327 (85.8%) were positive, confirming a high percentage of patients at risk of adverse events. Of these, 300 CGAs revealed 82.7% abnormal results, indicating activities of daily living impairment combined with cognitive, emotional or mobility disturbances. Abnormal CGA resulted in a longer hospital stay (14.0±10.3 days in ISAR+/CGA abnormal compared with 7.6±7.0 days in ISAR+/CGA normal and 8.1±5.4 days in ISAR-, both p<0.001), increased nursing hours (3.4±1.1 hours/day in ISAR+/CGA abnormal compared with 2.5±1.0 hours/day in ISAR+/CGA normal and 2.2±0.8 hours/day in ISAR-, both p<0.001), and increased falls (7.3% in ISAR+/CGA abnormal, 0% in ISAR+/CGA normal, 1.9% in ISAR-). Physiotherapy hours were only significantly increased in ISAR+/CGA abnormal (3.0±2.7 hours) compared with in ISAR+/CGA normal (1.6±1.4 hours, p<0.001) whereas the comparison with ISAR- (2.4±2.4 hours) did not

  6. Feasibility of perfusion cardiovascular magnetic resonance in paediatric patients

    Directory of Open Access Journals (Sweden)

    Kellenberger Christian

    2009-01-01

    Full Text Available Abstract Aims As coronary artery disease may also occur during childhood in some specific conditions, we sought to assess the feasibility and accuracy of perfusion cardiovascular magnetic resonance (CMR in paediatric patients. Methods and results First-pass perfusion CMR studies were performed under pharmacological stress with adenosine and by using a hybrid echo-planar pulse sequence with slice-selective saturation recovery preparation. Fifty-six perfusion CMR examinations were performed in 47 patients. The median age was 12 years (1 month-18 years, and weight 42.8 kg (2.6-82 kg. General anaesthesia was required in 18 patients. Mean examination time was 67 ± 19 min. Diagnostic image quality was obtained in 54/56 examinations. In 23 cases the acquisition parameters were adapted to patient's size. Perfusion CMR was abnormal in 16 examinations. The perfusion defects affected the territory of the left anterior descending coronary artery in 11, of the right coronary artery in 3, and of the circumflex coronary artery in 2 cases. Compared to coronary angiography, perfusion CMR showed a sensitivity of 87% (CI 52-97% and a specificity of 95% (CI 79-99%. Conclusion In children, perfusion CMR is feasible and accurate. In very young children (less than 1 year old, diagnostic image quality may be limited.

  7. Patients' experiences managing cardiovascular disease and risk factors in prison.

    Science.gov (United States)

    Thomas, Emily H; Wang, Emily A; Curry, Leslie A; Chen, Peggy G

    Despite greater risk of cardiovascular disease (CVD) mortality in patients with a history of incarceration, little is known about how prisons manage CVD risk factors (CVD-RF) to mitigate this risk. We conducted in-depth interviews with individuals with CVD-RF who had been recently released from prison (n = 26). These individuals were recruited through community flyers and a primary care clinic in Connecticut. Using a grounded theory approach and the constant comparative method, we inductively generated themes about CVD-RF care in prisons. Data collection and analysis occurred iteratively to refine and unify emerging themes. Four themes emerged about care in prison: (1) Participants perceive that their CVD-RFs are managed through acute, rather than chronic, care processes; (2) Prison providers' multiple correctional and medical roles can undermine patient-centered care; (3) Informal support systems can enhance CVD-RF self-management education and skills; and (4) The trade-off between prisoner security and patient autonomy influences opportunities for self-management. Patients develop self-management skills through complex processes that may be compromised by the influence of correctional policies on medical care. Our findings support interventions to engage peers, medical providers, care delivery systems, and correctional staff in cultivating effective self-management strategies tailored to prison settings.

  8. MANAGEMENT OF ORAL AND DENTAL DISEASES IN MEDICALLY COMPROMISED PATIENTS (Patient with Diseases of Cardiovascular System)

    OpenAIRE

    Afi Savitri Sarsito

    2015-01-01

    The treatment of oral and dental diseases in healthy patients can be performed with general standard and usually do not cause problems. On the other hand treatment of oral and dental diseases in medically compromised patients, especially one with disease of cardiovascular system must be performed with specific standard or otherwis emay evoke serious problems. Therefore the treatment needs to be compromised with the condition of the patients as well as the medication they are taking. This pape...

  9. Cardiovascular Risk Stratification in Patients with Metabolic Syndrome Without Diabetes or Cardiovascular Disease: Usefulness of Metabolic Syndrome Severity Score.

    Science.gov (United States)

    Masson, Walter; Epstein, Teo; Huerín, Melina; Lobo, Lorenzo Martín; Molinero, Graciela; Angel, Adriana; Masson, Gerardo; Millán, Diana; De Francesca, Salvador; Vitagliano, Laura; Cafferata, Alberto; Losada, Pablo

    2017-09-01

    The estimated cardiovascular risk determined by the different risk scores, could be heterogeneous in patients with metabolic syndrome without diabetes or vascular disease. This risk stratification could be improved by detecting subclinical carotid atheromatosis. To estimate the cardiovascular risk measured by different scores in patients with metabolic syndrome and analyze its association with the presence of carotid plaque. Non-diabetic patients with metabolic syndrome (Adult Treatment Panel III definition) without cardiovascular disease were enrolled. The Framingham score, the Reynolds score, the new score proposed by the 2013 ACC/AHA Guidelines and the Metabolic Syndrome Severity Calculator were calculated. Prevalence of carotid plaque was determined by ultrasound examination. A Receiver Operating Characteristic analysis was performed. A total of 238 patients were enrolled. Most patients were stratified as "low risk" by Framingham score (64%) and Reynolds score (70.1%). Using the 2013 ACC/AHA score, 45.3% of the population had a risk ≥7.5%. A significant correlation was found between classic scores but the agreement (concordance) was moderate. The correlation between classical scores and the Metabolic Syndrome Severity Calculator was poor. Overall, the prevalence of carotid plaque was 28.2%. The continuous metabolic syndrome score used in our study showed a good predictive power to detect carotid plaque (area under the curve 0.752). In this population, the calculated cardiovascular risk was heterogenic. The prevalence of carotid plaque was high. The Metabolic Syndrome Severity Calculator showed a good predictive power to detect carotid plaque.

  10. SU-F-T-397: Evaluating the Impact of Bladder Filling Status for the Organs at Risk Dose Distribution in Cervical Cancer Patients with Intensity Modulated Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, JY [Cancer Hospital of Shantou University Medical College, Shantou, Guangdong (China); Hong, DL [The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong (China)

    2016-06-15

    Purpose: To investigate the impact of bladder filling status of the organs at risk (OARs) on dose distribution during intensity modulated radiotherapy (IMRT) for cervical cancer patients. Methods: Twelve cervical cancer patients treated with IMRT were selected for this study. The prescription dose was 45Gy/25 fractions with the 6 MV photon beam. All patients performed two CT scans, one with an empty bladder, the other one with bladder filled. For the registration of two CT scans, the fusion was automatically carried out upon the bony anatomy. The OARs (bladder, rectum, pelvic bone and small intestine) were delineated to planning CT to evaluate the dose distributions. These dose distributions were compared between empty bladder and bladder filling. Results: The bladder volume with empty bladder and bladder filling was 403.2±124.13cc and 101.4±87.5cc, respectively. There were no statistical differences between empty bladder and bladder filling in the mean value of pelvic bone V10Gy, V20Gy, V40Gy; rectum V40Gy and V45Gy. The bladder V40Gy and V45Gy were lower in the bladder filling group than in the empty bladder group (63.7%±5.8% vs 87.5%±7.8%, 45.1%±9.5% vs 62.4%±11.8%, respectively). The V45Gy for small intestine in the bladder filling group was significantly less than the empty bladder group (146.7cc±95.3cc vs 245.7cc±101.8cc). Conclusion: Our study finds that the bladder filling status did not have a significant impact on dose distribution in the rectum and pelvic bone. However, the changes of bladder filling have a large impact on bladder and small intestine doses. A full bladder is strongly recommended during treatment for cervical cancer patients.

  11. Manual thrombectomy efficiency in relationship to the area at risk in patients with myocardial infarction with TIMI 0-1 coronary flow: Insights from an all comers registry.

    Science.gov (United States)

    Luz, André; Silveira, Inês; Brochado, Bruno; Rodrigues, Patrícia; João Sousa, Maria; Santos, Raquel; Trêpa, Maria; Santos, Mário; Silveira, João; Torres, Severo; Leite-Moreira, Adelino F; Carvalho, Henrique

    2017-10-01

    To review the effectiveness of manual thrombectomy (MT) in a series of patients with ST-elevation myocardial infarction (STEMI) exclusively presenting with TIMI 0-1 flow undergoing percutaneous coronary intervention (PCI), in accordance to the angiographically estimated area at risk (AAR). Second, to assess major in-hospital clinical events, emphasizing neurological outcomes. The routine utilization of MT in STEMI is not recommended. However, in recent trials, a significant proportion of patients had neither large thrombus burden nor a totally occluded coronary segment, neutralizing the expected benefits of MT. In addition, the efficiency of MT to remove thrombus has rarely been addressed. Finally, MT diminished distal embolization, which has been related to mortality. In 850 consecutive STEMI-patients, MT was utilized in 525 (62%) and it was considered efficient (TIMI 2-3 flow after MT) in 445 (85%). We found a significant interaction between the AAR and the effectiveness of MT to reduce infarct size (P-interaction = 0.014). In patients having AAR ≥ 28% (n = 184), efficient MT conferred lesser infarct size compared to inefficient MT (Ln-transformed peak CK): 7.87 ± 0.86 versus 8.36 ± 0.41 IU/L, P = 0.005, with no impact for AAR <28%. Clinical outcomes including stroke between MT and PCI-only groups were not different. In comparison with the group where MT was inefficient, efficient MT may modestly reduce final infarct size without a significant clinical benefit. In comparison with PCI-only, no difference was found regarding stroke. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  12. Assessment of children's nutritional attitudes before oral food challenges to identify patients at risk of food reintroduction failure: a prospective study.

    Science.gov (United States)

    Polloni, L; Ferruzza, E; Ronconi, L; Toniolo, A; Lazzarotto, F; Bonaguro, R; Celegato, N; Muraro, A

    2017-05-01

    Inappropriate dietary eliminations may impair quality of life, affect children's growth and unnecessarily impact on healthcare costs. Previous retrospective studies reported that around 25% of children continue a food-avoidance diet despite a negative oral food challenge (OFC). A definite pattern has not been found yet for patients not reintroducing the food. This study aimed to examine the role of child's nutritional attitudes and maternal anxiety in reintroducing food after a negative OFC. A prospective study was conducted involving 81 mothers of children with IgE-mediated food allergy. They completed a survey on nutritional behaviour and attitudes and the State-Trait Anxiety Inventory on the day of OFC and 6 months later. In total, 11.1% of children never or rarely ate the food after a negative OFC. Consumption of the reintroduced food is positively correlated to child's interest in tasting new foods before and after OFC and to changes in child's nutritional habits after OFC. It is negatively correlated to monotony of the diet after OFC. No correlations were found with other participants' characteristics or maternal anxiety. State anxiety significantly decreased after the OFC. A correlation was found between trait and state anxiety and the degree of change in nutritional habits after OFC. Evaluating child's approach towards food before the OFC is a promising approach to identify patients at risk of food reintroduction failure. Furthermore, it underlined the importance of reassessing food consumption in all patients after a negative OFC and supporting patients in the reintroduction of food. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Thyroid function and cardiovascular events in chronic kidney disease patients.

    Science.gov (United States)

    Afsar, Baris; Yilmaz, Mahmut Ilker; Siriopol, Dimitrie; Unal, Hilmi Umut; Saglam, Mutlu; Karaman, Murat; Gezer, Mustafa; Sonmez, Alper; Eyileten, Tayfun; Aydin, Ibrahim; Hamcan, Salih; Oguz, Yusuf; Covic, Adrian; Kanbay, Mehmet

    2017-04-01

    Abnormalities of thyroid function are commonly seen in chronic kidney disease (CKD) patients. They are associated with adverse clinical conditions such as atherosclerosis, endothelial dysfunction, inflammation and abnormal blood pressure variability. We investigated the association between thyroid disorders and endothelial function, assessed by flow-mediated dilatation (FMD) and carotid intima-media thickness (CIMT), and cardiovascular events (CVE) in CKD patients. This observational cohort study included 305 CKD (stages 1-5) patients. Routine biochemistry, including free T3, free T4 and thyroid stimulating hormone, fibroblast growth factor-23 (FGF-23) and FMD, CIMT were measured. We divided patients into four groups according to thyroid hormone status: euthyroidism, subclinical hyperthyroidism, subclinical hypothyroidism, and euthyroid sick syndrome. Fatal and composite CVE were recorded for a median 29 months. Patients with subclinical hypothyroidism had a higher prevalence of hypertension and diabetes and also were more likely to have higher values of systolic CIMT, phosphorus, intact parathormone (iPTH), FGF-23, homeostasis model assessment-insulin resistance and lower levels of FMD than euthyroid patients. In the unadjusted survival analysis, subclinical hypothyroidism and euthyroid sick syndrome were associated with an increased risk for the outcome as compared with euthyroidism [hazard ratio 30.63 (95 % confidence interval 12.27-76.48) and 12.17 (3.70-39.98), respectively]. The effects of subclinical hypothyroidism and euthyroid sick syndrome were maintained even in fully adjusted models. We demonstrated that subclinical hypothyroidism and euthyroid sick syndrome are associated with increased CVE in CKD patients. Further studies are needed to explore these issues.

  14. The antioxidant acetylcysteine reduces cardiovascular events in patients with end-stage renal failure: a randomized, controlled trial

    DEFF Research Database (Denmark)

    Tepel, Martin; van der Giet, Markus; Statz, Mario

    2003-01-01

    Patients with end-stage renal failure have increased oxidative stress and show elevated cardiovascular mortality. Whether increased cardiovascular events can be prevented by the administration of antioxidants is unknown.......Patients with end-stage renal failure have increased oxidative stress and show elevated cardiovascular mortality. Whether increased cardiovascular events can be prevented by the administration of antioxidants is unknown....

  15. Elements of patient-health-care provider communication related to cardiovascular rehabilitation referral.

    Science.gov (United States)

    Pourhabib, Sanam; Chessex, Caroline; Murray, Judy; Grace, Sherry L

    2016-04-01

    Cardiovascular rehabilitation has been designed to decrease the burden of cardiovascular disease. This study described (1) patient-health-care provider interactions regarding cardiovascular rehabilitation and (2) which discussion elements were related to patient referral. This was a prospective study of cardiovascular patients and their health-care providers. Discussion utterances were coded using the Roter Interaction Analysis System. Discussion between 26 health-care providers and 50 patients were recorded. Cardiovascular rehabilitation referral was related to greater health-care provider interactivity (odds ratio = 2.82, 95% confidence interval = 1.01-7.86) and less patient concern and worry (odds ratio = 0.64, 95% confidence interval = 0.45-0.89). Taking time for reciprocal discussion and allaying patient anxiety may promote greater referral. © The Author(s) 2014.

  16. Hospitalized cardiovascular events in patients with diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Nguyen-Khoa Bao-Anh

    2012-07-01

    Full Text Available Abstract Background Microvascular and macrovascular complications in diabetes stem from chronic hyperglycemia and are thought to have overlapping pathophysiology. The aim of this study was to investigate the incidence rate of hospitalized myocardial infarctions (MI and cerebrovascular accidents (CVA in patients with diabetic macular edema (DME compared with diabetic patients without retinal diseases. Methods This was a retrospective cohort study of a commercially insured population in an administrative claims database. DME subjects (n = 3519 and diabetes controls without retinal disease (n = 10557 were matched by age and gender. Healthcare claims were analyzed for the study period from 1 January 2002 to 31 December 2005. Incidence and adjusted rate ratios of hospitalized MI and CVA events were then calculated. Results The adjusted rate ratio for MI was 2.50 (95% CI: 1.83-3.41, p  Conclusion Event rates of MI or CVA were higher in patients with DME than in diabetes controls. This study is one of few with sufficient sample size to accurately estimate the relationship between DME and cardiovascular outcomes.

  17. Hospitalized cardiovascular events in patients with diabetic macular edema.

    Science.gov (United States)

    Nguyen-Khoa, Bao-Anh; Goehring, Earl L; Werther, Winifred; Fung, Anne E; Do, Diana V; Apte, Rajendra S; Jones, Judith K

    2012-05-30

    Microvascular and macrovascular complications in diabetes stem from chronic hyperglycemia and are thought to have overlapping pathophysiology. The aim of this study was to investigate the incidence rate of hospitalized myocardial infarctions (MI) and cerebrovascular accidents (CVA) in patients with diabetic macular edema (DME) compared with diabetic patients without retinal diseases. This was a retrospective cohort study of a commercially insured population in an administrative claims database. DME subjects (n = 3519) and diabetes controls without retinal disease (n = 10557) were matched by age and gender. Healthcare claims were analyzed for the study period from 1 January 2002 to 31 December 2005. Incidence and adjusted rate ratios of hospitalized MI and CVA events were then calculated. The adjusted rate ratio for MI was 2.50 (95% CI: 1.83-3.41, p cerebrovascular diseases. Event rates of MI or CVA were higher in patients with DME than in diabetes controls. This study is one of few with sufficient sample size to accurately estimate the relationship between DME and cardiovascular outcomes.

  18. Salivary biomarkers indicate obstructive sleep apnea patients with cardiovascular diseases

    Science.gov (United States)

    Zheng, Hui; Li, Ruoxuan; Zhang, Jieni; Zhou, Shaonan; Ma, Qingwei; Zhou, Yanheng; Chen, Feng; Lin, Jiuxiang

    2014-01-01

    Although obstructive sleep apnea (OSA) patients are at high risk of developing cardiovascular disease (CVD), only a small proportion is currently diagnosed. To explore and identify the differentially expressed proteins/peptides of OSA patients with CVDs, a mass spectrometry-based salivary analysis was performed. In our study, eleven peaks were observed differentially expressed in saliva from the non-CVD and CVD groups. Five masses mass peaks (1594.1, 1673.7, 1196.6, 1290.5, and 1447.0 Da) showed an upregulated trend in the CVD group, whereas six mass peaks (3038.6, 2164.3, 2301.4, 3195.0, 2628.4, and 1721.9 Da) were downregulated in the CVD group. In addition, the alpha-2-HS-glycoprotein (AHSG) levels in saliva were verified to be decreased in CVD group compared to non-CVD group. Analysis of the salivary peptidome provides a promising approach to screening for novel biomarkers before further identification, and may contribute to early diagnosis of CVD patients with OSA. PMID:25395095

  19. Who is at risk for diagnostic discrepancies? Comparison of pre- and postmortal diagnoses in 1800 patients of 3 medical decades in East and West Berlin.

    Directory of Open Access Journals (Sweden)

    Daniel Wittschieber

    Full Text Available BACKGROUND: Autopsy rates in Western countries consistently decline to an average of <5%, although clinical autopsies represent a reasonable tool for quality control in hospitals, medically and economically. Comparing pre- and postmortal diagnoses, diagnostic discrepancies as uncovered by clinical autopsies supply crucial information on how to improve clinical treatment. The study aimed at analyzing current diagnostic discrepancy rates, investigating their influencing factors and identifying risk profiles of patients that could be affected by a diagnostic discrepancy. METHODS AND FINDINGS: Of all adult autopsy cases of the Charité Institute of Pathology from the years 1988, 1993, 1998, 2003 and 2008, the pre- and postmortal diagnoses and all demographic data were analyzed retrospectively. Based on power analysis, 1,800 cases were randomly selected to perform discrepancy classification (class I-VI according to modified Goldman criteria. The rate of discrepancies in major diagnoses (class I was 10.7% (95% CI: 7.7%-14.7% in 2008 representing a reduction by 15.1%. Subgroup analysis revealed several influencing factors to significantly correlate with the discrepancy rate. Cardiovascular diseases had the highest frequency among class-I-discrepancies. Comparing the 1988-data of East- and West-Berlin, no significant differences were found in diagnostic discrepancies despite an autopsy rate differing by nearly 50%. A risk profile analysis visualized by intuitive heatmaps revealed a significantly high discrepancy rate in patients treated in low or intermediate care units at community hospitals. In this collective, patients with genitourinary/renal or infectious diseases were at particularly high risk. CONCLUSIONS: This is the current largest and most comprehensive study on diagnostic discrepancies worldwide. Our well-powered analysis revealed a significant rate of class-I-discrepancies indicating that autopsies are still of value. The identified risk

  20. Non-cardiovascular co-morbidity in elderly patients with heart failure outnumbers cardiovascular co-morbidity.

    NARCIS (Netherlands)

    Wel, M.C. van der; Jansen, R.W.M.M.; Bakx, J.C.; Bor, J.H.J.; Olde Rikkert, M.G.M.; Weel, C. van

    2007-01-01

    BACKGROUND: Patients with heart failure often suffer from multiple co-morbid conditions. However, until now only cardiovascular co-morbidity has been well described. AIMS: To understand heart failure in the context of multi-morbidity, by describing the age and sex specific patterns of

  1. Patients with premature cardiovascular disease and a positive family history for cardiovascular disease are prone to recurrent events

    NARCIS (Netherlands)

    Mulders, Ties A.; Meyer, Zainna; van der Donk, Christel; Kroon, Abraham A.; Ferreira, Isabel; Stehouwer, Coen D. A.; Pinto-Sietsma, Sara-Joan

    2011-01-01

    Background: Premature cardiovascular disease (CVD) is treated in the same way as CVD of advanced age. However, in patients with premature CVD and a family history of CVD, different -possibly genetic-mechanisms may underlie this disease, which current medical treatment is not targeted to. This

  2. Association of anemia with the risk of cardiovascular adverse events in overweight/obese patients

    DEFF Research Database (Denmark)

    Winther, S. A.; Finer, N.; Sharma, A. M.

    2014-01-01

    Objective:Anemia is associated with increased cardiovascular risks. Obesity may cause anemia in several ways, for example, by low-grade inflammation and relative iron deficit. The outcomes associated with anemia in overweight/obese patients at high cardiovascular risk are however not known....... Therefore, we investigated the cardiovascular prognosis in overweight/obese subjects with anemia.Methods:A total of 9 687 overweight/obese cardiovascular high-risk patients from the Sibutramine Cardiovascular OUTcomes trial were studied. Patients were stratified after baseline hemoglobin level and followed...... for the risks of primary event (comprising nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality. Risk estimates (hazard ratios (HR) with 95% confidence intervals (CI)) were calculated using Cox regression models.Results:Anemia...

  3. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Gaede, Peter; Vedel, Pernille; Larsen, Nicolai

    2003-01-01

    Cardiovascular morbidity is a major burden in patients with type 2 diabetes. In the Steno-2 Study, we compared the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment on modifiable risk factors for cardiovascular disease in patients with type 2 diabe...

  4. Rates of cardiovascular disease following smoking cessation in patients with HIV infection

    DEFF Research Database (Denmark)

    Petoumenos, K; Worm, S; Reiss, P

    2011-01-01

    The aim of the study was to estimate the rates of cardiovascular disease (CVD) events after stopping smoking in patients with HIV infection.......The aim of the study was to estimate the rates of cardiovascular disease (CVD) events after stopping smoking in patients with HIV infection....

  5. MANAGEMENT OF ORAL AND DENTAL DISEASES IN MEDICALLY COMPROMISED PATIENTS (Patient with Diseases of Cardiovascular System

    Directory of Open Access Journals (Sweden)

    Afi Savitri Sarsito

    2015-08-01

    Full Text Available The treatment of oral and dental diseases in healthy patients can be performed with general standard and usually do not cause problems. On the other hand treatment of oral and dental diseases in medically compromised patients, especially one with disease of cardiovascular system must be performed with specific standard or otherwis emay evoke serious problems. Therefore the treatment needs to be compromised with the condition of the patients as well as the medication they are taking. This paper explains the management of oral and dental diseases in patients with disease of cardiovascular system usually found such as hypertension, infective endocarditis, rheumatic fever and rheumatic heart diseases where the cooperation between dentist and internist is extremely recommended.

  6. A multi-modal intervention for Activating Patients at Risk for Osteoporosis (APROPOS): Rationale, design, and uptake of online study intervention material.

    Science.gov (United States)

    Danila, Maria I; Outman, Ryan C; Rahn, Elizabeth J; Mudano, Amy S; Thomas, Tammi F; Redden, David T; Allison, Jeroan J; Anderson, Fred A; Anderson, Julia P; Cram, Peter M; Curtis, Jeffrey R; Fraenkel, Liana; Greenspan, Susan L; LaCroix, Andrea Z; Majumdar, Sumit R; Miller, Michael J; Nieves, Jeri W; Safford, Monika M; Silverman, Stuart L; Siris, Ethel S; Solomon, Daniel H; Warriner, Amy H; Watts, Nelson B; Yood, Robert A; Saag, Kenneth G

    2016-12-15

    To develop an innovative and effective educational intervention to inform patients about the need for osteoporosis treatment and to determine factors associated with its online uptake. Postmenopausal women with a prior fracture and not currently using osteoporosis therapy were eligible to be included in the Activating Patients at Risk for OsteoPOroSis (APROPOS). Four nominal groups with a total of 18 racially/ethnically diverse women identified osteoporosis treatment barriers. We used the Information, Motivation, Behavior Skills conceptual model to develop a direct-to-patient intervention to mitigate potentially modifiable barriers to osteoporosis therapy. The intervention included videos tailored by participants' race/ethnicity and their survey responses: ranked barriers to osteoporosis treatment, deduced barriers to treatment, readiness to behavior change, and osteoporosis treatment history. Videos consisted of "storytelling" narratives, based on osteoporosis patient experiences and portrayed by actresses of patient-identified race/ethnicity. We also delivered personalized brief phone calls followed by an interactive voice-response phone messages aimed to promote uptake of the videos. To address the factors associated with online intervention uptake, we focused on participants assigned to the intervention arm (n = 1342). These participants were 92.9% Caucasian, with a mean (SD) age 74.9 (8.0) years and the majority (77.7%) had some college education. Preference for natural treatments was the barrier ranked #1 by most (n = 130; 27%), while concern about osteonecrosis of the jaw was the most frequently reported barrier (at any level; n = 322; 67%). Overall, 28.1% (n = 377) of participants in the intervention group accessed the videos online. After adjusting for relevant covariates, the participants who provided an email address had 6.07 (95% CI 4.53-8.14) higher adjusted odds of accessing their online videos compared to those who did not. We developed and

  7. Personalized vascular medicine: tailoring cardiovascular disease management to the individual patient

    NARCIS (Netherlands)

    Dorresteijn, J.A.N.

    2013-01-01

    Applying group-level findings to individual patients is an absolute requisite for practicing evidence-based cardiovascular medicine. Yet, because individual patient characteristics may influence the pathophysiology and prognosis of disease and the likelihood of response to therapy, such

  8. Serum Osteoprotegerin level and the extent of cardiovascular calcification in haemodialysis patients

    Directory of Open Access Journals (Sweden)

    Waleed Ammar

    2014-03-01

    Conclusion: There is strong positive relationship between osteoprotegerin and both vascular and valvular calcification in hemodialysis patients. This positive correlation may open the gate for routine estimation of this agent as a surrogate marker of cardiovascular calcification in hemodialysis patients.

  9. Cardiovascular outcomes and systemic anti-inflammatory drugs in patients with severe psoriasis

    DEFF Research Database (Denmark)

    Ahlehoff, O; Skov, L; Gislason, G

    2014-01-01

    BACKGROUND: Psoriasis is a common disease and is associated with cardiovascular diseases. Systemic anti-inflammatory drugs may reduce risk of cardiovascular events. We therefore examined the rate of cardiovascular events, i.e. cardiovascular death, myocardial infarction and stroke, in patients......-up of 5 years were included. Incidence rates per 1000 patients-years for cardiovascular events were 4.16, 6.28, 6.08, 18.95 and 14.63 for biological drugs, methotrexate, cyclosporine, retinoid and other therapies respectively. Relative to other therapies, methotrexate (HR 0.53; CI 0...... factor inhibitors (HR 0.46; CI 0.22-0.98) were linked to reduced event rates, whereas the interleukin-12/23 inhibitor ustekinumab (HR 1.52; CI 0.47-4.94) was not. CONCLUSION: Systemic anti-inflammatory treatment with methotrexate was associated with significantly lower rates of cardiovascular events...

  10. Hepatitis C virus coinfection independently increases the risk of cardiovascular disease in HIV-positive patients.

    Science.gov (United States)

    Fernández-Montero, J V; Barreiro, P; de Mendoza, C; Labarga, P; Soriano, V

    2016-01-01

    Patients infected with HIV are at increased risk for cardiovascular disease despite successful antiretroviral therapy. Likewise, chronic hepatitis C virus (HCV) infection is associated with extrahepatic complications, including cardiovascular disease. However the risk of cardiovascular disease has not been formally examined in HIV/HCV-coinfected patients. A retrospective study was carried out to assess the influence of HCV coinfection on the risk of cardiovascular events in a large cohort of HIV-infected patients recruited since year 2004. A composite event of cardiovascular disease was used as an endpoint, including myocardial infarction, angina pectoris, stroke or death due to any of them. A total of 1136 patients (567 HIV-monoinfected, 70 HCV-monoinfected and 499 HIV/HCV-coinfected) were analysed. Mean age was 42.7 years, 79% were males, and 46% were former injection drug users. Over a mean follow-up of 79.4 ± 21 months, 3 patients died due to cardiovascular disease, whereas 29 suffered a first episode of coronary ischaemia or stroke. HIV/HCV-coinfected patients had a greater incidence of cardiovascular disease events and/or death than HIV-monoinfected individuals (4% vs 1.2%, P = 0.004) and HCV-monoinfected persons (4% vs 1.4%, P = 0.5). After adjusting for demographics, virological parameters and classical cardiovascular disease risk factors (smoking, hypertension, diabetes, high LDL cholesterol), both HIV/HCV coinfection (HR 2.91; CI 95%: 1.19-7.12; P = 0.02) and hypertension (HR 3.65; CI 95%: 1.34-9.94; P = 0.01) were independently associated with cardiovascular disease events and/or death in HIV-infected patients. Chronic hepatitis C and hypertension are independently associated with increased cardiovascular disease risk in HIV-infected patients. Therefore, treatment of chronic hepatitis C should be prioritized in HIV/HCV-coinfected patients regardless of any liver fibrosis staging. © 2015 John Wiley & Sons Ltd.

  11. Cardiovascular risk factors in patients with rheumatoid arthritis at ...

    African Journals Online (AJOL)

    Background: Rheumatoid arthritis is associated with excessive cardiovascular morbidity and mortality. This is predominantly due to accelerated coronary artery and cerebrovascular atherosclerosis. Traditional cardiovascular risk factors as well as extra articular disease have been associated with occurrence of myocardial ...

  12. Circulating LH/hCG receptor (LHCGR may identify pre-treatment IVF patients at risk of OHSS and poor implantation

    Directory of Open Access Journals (Sweden)

    Chambers Anne E

    2011-12-01

    Full Text Available Abstract Background Successful pregnancy via in vitro fertilization (IVF depends on the recovery of an adequate number of healthy oocytes and on blastocyst implantation following uterine transfer. Two hormones, LH and hCG, utilize a common LH/hCG receptor (LHCGR, variations in which have profound implications in human reproduction. Soluble LHCGR (sLHCGR is released from experimental cell lines and placental explants and it can be detected in the follicular fluid and serum. Methods To evaluate the impact of circulating soluble LHCGR (sLHCGR in fertility treatment, we measured sLHCGR and LH-sLHCGR complex in serum from women seeking IVF using specifically developed quantitative enzyme-linked immunosorbent assays (ELISA. Following an IVF cycle of treatment, patients were grouped according to oocyte yield into low (lower than or equal to 7 oocytes, intermediate (8-14 oocytes and high (greater than or equal to 15 oocytes responders and pregnancy outcome noted. Results Pre-treatment sLHCGR identified many women at risk of ovarian hyperstimulation. Low levels of sLHCGR were associated with pregnancy in both high and low responders but sLHCGR did not significantly affect the treatment outcome of intermediate responders. Low responders who failed to become pregnant had high levels of circulating sLHCGR bound to LH (LH-sLHCGR. Conclusions Pre-treatment measurement of sLHCGR could be used to tailor individual fertility treatment programs and improve outcomes by avoiding ovarian hyperstimulation and poor embryo implantation.

  13. Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study

    NARCIS (Netherlands)

    Neto, Ary Serpa; Barbas, Carmen S. V.; Simonis, Fabienne D.; Artigas-Raventós, Antonio; Canet, Jaume; Determann, Rogier M.; Anstey, James; Hedenstierna, Goran; Hemmes, Sabrine N. T.; Hermans, Greet; Hiesmayr, Michael; Hollmann, Markus W.; Jaber, Samir; Martin-Loeches, Ignacio; Mills, Gary H.; Pearse, Rupert M.; Putensen, Christian; Schmid, Werner; Severgnini, Paolo; Smith, Roger; Treschan, Tanja A.; Tschernko, Edda M.; Melo, Marcos F. V.; Wrigge, Hermann; de Abreu, Marcelo Gama; Pelosi, Paolo; Schultz, Marcus J.; Bell, Adam; Gecaj-Gashi, Agreta; Dilek, Ahmet; Denker, Ahmet Sukru; Aytulun, Akut; Kienbaum, Peter; Rose, Alastair; Bacuzzi, Alessandro; Cavalcanti, Alexandre Biasi; Chan, Alexandre; Molin, Alexandre; Ghosh, Alison; Roy, Alistair; Cowton, Amanda; Skinner, Amanda; Whileman, Amanda; McInerney, Amy; Peçanha, Ana Carolina; Cortegiani, Andrea; Sribar, Andrej; Bentley, Andrew; Corner, Andrew; Pinder, Angela; Hormis, Anil; Walker, Anna; Dixon, Barry; Creagh-Brown, Ben; Volta, Carlo Alberto; Munhoz, Carlos; Brown, Carly; Scott, Carmen; Wreybrown, Caroline; Plowright, Catherine; Downes, Charlotte; Padilla-Harris, Cheryl; Hughes, Chloe; Frey, Christian; Schlegel, Christian; Boyd, Christine; Ryan, Christine; Muench, Christoph; Smalley, Christopher; Zincircioglu, Çiler; Harris, Clair; Kaloo, Claire; Matthews, Claire; Miller, Claire; Pegg, Claire; Bullock, Clare; Mellis, Clare; Piras, Claudio; Seasman, Colette; Santos, Cristina; Beraldo, Daniel; Collins, Daniel; Hadfield, Daniel; Hull, Daniel; Prado, Daniel; Pogson, David; Rogerson, David; Shaw, David; D'Antini, Davide; Griffin, Dawn Trodd Denise; Weller, Debbie; Smith, Deborah; Wilson, Deborah; Aydin, Demet; Donaldson, Denise; Mestria, Donatella; Lauro, Eduardo Di; Caser, Eliane Bernadete; Seghelini, Elisa; Cirstea, Emanuel; Young, Eoin; Alberts, Erna; Senturk, Evren; Brohi, Farooq; Ulger, Fatma; Kahveci, Feda; da Silva Ramos, Fernando José; van Haren, Frank; Turan, Güldem; Sales, Gabriele; Clifford, Gayle; Cinnella, Gilda; Mecatti, Giovana Colozza; Melchionda, Giuseppe; Eren, Gulay; Crowther, Hannah; Spencer, Hazel; Blaylock, Heather; Green, Helen; Robertson, Helen; Rodgers, Helen; Talbot, Helen; Wong, Helen; Barcraft-Barnes, Helena; Ceunen, Helga; Reschreiter, Henrik; Ulusoy, Hulya; Toman, Huseyin; McCullagh, Iain; White, Ian; Welters, Ingeborg; van den Hul, Ingrid; Gava, Isabela Ambrósio; Reed, Isabelle; Kose, Isil; Maia, Israel; Limb, James; Máca, Jan; Adderly, Jane; Hunt, Jane; Martin, Jane; Montgomery, Jane; Snell, Jane; Salgado, Jean; Ritzema, Jenny; Bewley, Jeremy; Howe, Joanne; Decruyenaere, Johan; Mouland, Johanna; Stickley, Johanna; Mellinghoff, Johannes; Criswell, John; Knighton, John; Cooper, Jonathan; Harrison, Jonathan; Paddle, Jonathan; Pellegrini, Jose Augusto Santos; Needleman, Joseph; Giles, Julian; Camsooksai, Julie; Furneval, Julie; Toms, Julie; Burt, Karen; Simeson, Karen; Williams, Karen; Blenk, Karl; Turner, Kate; Lynch, Katie; Sweet, Katie; Hugill, Keith; Matthews, Kelly; Ruas, Kessia; Clarkson, Kevin; Preller, Kobus; Joyce, Kristen; Ortiz-Ruiz, Laura; Youds, Laura; Tbaily, Lee; Barrell, Lisa; Grimmer, Lisa; Soyoral, Lokman; Peluso, Lorenzo; Murray, Lorna; Niska, Lotta; Tonks, Louise; Fasting, Lousie; DeCrop, Luc; Brazzi, Luca; Mirabella, Lucia; Cooper, Lucy; Falcão, Luis Fernando; Everett, Lynn; Watters, Malcolm; Carnahan, Mandy; Bourgeois, Marc; Abreu, Marcelo Gama de; Romano, Marcelo Luz Pereira; Botteri, Marco; Melo, Marcos F. Vidal; Faulkner, Maria; Krkusek, Marijana; Bahl, Marina; Holliday, Mark; Kol, Mark; Pulletz, Mark; Kozlowski, Marta; Dvorscak, Matea Bogdanovic; Jurjevic, Matija; Koopmans, Matty; Morales, Mauricio; Schaefer, Maximilian; Brazier, Melinda; Harris, Meredith; Devile, Michael; Kuiper, Michael; Parris, Michael; Sharman, Michael; Kratochvil, Milan; Ramali, Mohamed; Dos Santos, Moreno Calcagnotto; Bynorth, Natalie; Wilson, Natalie; Anquez, Nathalie; Huneke, Nathan; Dogan, Nazim; Karanovic, Nenad; Tarmey, Nicholas; Carreño, Nicolás; Fisher, Nicola; Lamb, Nicola; Venner, Nicola; Hollister, Nigel; Akgun, Nur; Ekinci, Osman; Boyd, Owen; Gill, Pardeep; Raimondo, Pasquale; Verrastro, Pasquale; Pulak, Paul; Fitzell, Pauline; Dark, Paulo; Alzugaray, Pedro; Özcan, Perihan Ergin; MacNaughton, Peter; Stourac, Petr; Hopkins, Phil; Tuinman, Pieter Roel; Pearson, Rachel; Walker, Rachel; Santos, Rafaella Souza Dos; Caione, Raffaele; Matsa, Ramprasad; Oliver, Rebecca; Jacob, Reni; Howard-Griffin, Richard; Wilde, Robert Bp de; Plant, Robert; Hollands, Robin; Biondi, Rodrigo; Jaafar, Rola; Avendaño, Rossana; Salt, Ruth; Humphries, Ryan; Pinto, Sérgio Felix; Pearson, Sallyane; Hendry, Sam; Lakhani, Sandeep; Beavis, Sarah; Moreton, Sarah; Prudden, Sarah; Thornthwaite, Sarah; Spadaro, Savino; Saylan, Sedat; Chenna, Shailaja; Gopal, Shammer; James, Shanaz; Suresh, Sheeba; Birch, Sian; Skilijic, Sonja; Aguirre, Stefania; Metherell, Stella; Bell, Stephanie; Janes, Stephanie; Wright, Stephen; Rose, Steve; Windebank, Steve; Glenn, Sue; Melbourne, Susan; Tyson, Susan; Leaver, Susannah; Patel, Tasmin; Simurina, Tatjana; Sewell, Terri-Ann; Macruz, Tiago; Hatton, Tom; Evans, Tracey; Goktas, Ugur; Poultney, Una; Buyukkocak, Unase; Linnett, Vanessa; Oliveira, Vanessa; Russotto, Vincenzo; Klaric, Vlasta; Orak, Yavuz; Demirtürk, Zerrin

    2016-01-01

    Scant information exists about the epidemiological characteristics and outcome of patients in the intensive care unit (ICU) at risk of acute respiratory distress syndrome (ARDS) and how ventilation is managed in these individuals. We aimed to establish the epidemiological characteristics of patients

  14. The potential benefits from respiratory gating for breast cancer patients regarding target coverage and dose to organs at risk when applying strict dose limits to the heart: results from the DBCG HYPO trial

    DEFF Research Database (Denmark)

    Berg, Martin; Lorenzen, Ebbe L; Jensen, Ingelise

    2018-01-01

    PURPOSE: The potential benefits from respiratory gating (RG) compared to free-breathing (FB) regarding target coverage and dose to organs at risk for breast cancer patients receiving post-operative radiotherapy (RT) in the DBCG HYPO multicentre trial are reported. MATERIAL AND METHODS: Patients i...

  15. Evaluation of Total Cardiovascular Risk in Patients with Hypertension and Impaired Glucose Tolerance

    Directory of Open Access Journals (Sweden)

    I.V. Cherniavska

    2017-01-01

    Full Text Available Aim. Timely reveal of the patients at high risk of cardiovascular diseases for whom earlier intervention for cardiovascular risk correction is the most effective. Materials and methods. Seventy patients aged 30–55 years old with stage 2 hypertension, impaired glucose tolerance (IGT and high cardiovascular risk were examined according to Framingham criteria. Cardiovascular risk was compared by SCORE and PROCAM results. Results. Percentage ratio of males with high cardiovascular risk was higher by 52.3 % in comparison to females by SCORE and by 2.3 % in comparison to females by PROCAM. Males did not present any significant discrepancy by evaluation of cardiovascular risk by both scores unlike females. Obtained results showed that total cardiovascular risk in females was twofold higher by PROCAM compared to SCORE scale. Conclusions. Total cardiovascular risk level in patients with stage 2 hypertension and IGT is influenced by age, systolic blood pressure level, smoking, lipid storage disease and carbohydrate metabolism disorder. When we evaluate total cardiovascular risk, we should not be limited only by determination of factors determined in SCORE. It is reasonable to evaluate risk factors by PROCAM, too, especially for females.

  16. Use of Statin Therapy to Reduce Cardiovascular Risk in Older Patients

    Directory of Open Access Journals (Sweden)

    N. K. Wenger

    2010-01-01

    Full Text Available Background. Cardiovascular disease is the principal cause of mortality in older individuals, and more than 80% of deaths due to coronary heart disease or stroke occur in patients over 65 years of age. Hyperlipidemia is one of the main modifiable risk factors for cardiovascular disease. Current guidelines recommend the use of statins to reduce low-density lipoprotein cholesterol to appropriate targets based on an individual's cardiovascular risk, and clearly state that older age should not be a barrier to treatment. Despite extensive evidence demonstrating clear benefit with statin therapy in older individuals, this population remains chronically undertreated. Scope. This paper provides an overview of the current evidence available regarding the efficacy and safety of statin therapy to reduce cardiovascular risk in older patients. We use hypothetical case studies to address some of the questions frequently posed by physicians responsible for the cardiovascular health of older patients. Conclusions. Various factors may account for the failure to provide appropriate treatment, including a lack of awareness of clinical benefits and perceived safety issues. However, if current guidelines are followed and older patients treated to appropriate LDL-C goals, the likelihood of cardiovascular events will be reduced in this high-risk population. Employing an evidence-based approach to the management of cardiovascular risk in older patients is likely to yield benefits in terms of overall cardiovascular burden.

  17. Nursing interventions in tobacco-dependent patients with cardiovascular diseases.

    Science.gov (United States)

    Shishani, Kawkab; Sohn, Min; Okada, Ayako; Froelicher, Erika Sivarajan

    2009-01-01

    Smoking is a well-established risk factor for cardiovascular disease (CVD). This chapter provides an overview of a program of nursing research relevant to tobacco use in patients with CVD. The Women's Initiative for Nonsmoking (WINS) provides a rich demonstration of a key randomized clinical trial (RCT) on the efficacy of smoking cessation in women. The National Institutes of Health priority for data mining of existing RCTs is demonstrated in the numerous presentations of findings from secondary papers from WINS that answer additional research questions relevant to smoking cessation, including the influence of depression on smoking, myths about and underuse of nicotine replacement therapy. The methodological and logistical challenges inherent in tobacco intervention studies are presented, including a discussion of research needed in the measurement of withdrawal symptoms. Additionally, the role and contributions of nurses serving on the federal guideline development process are highlighted. International research activities of the coauthors from Jordan and Korea are also presented, including a discussion of the need for research in waterpipe use.

  18. Patient-reported health status prior to cardiac resynchronisation therapy identifies patients at risk for poor survival and prolonged hospital stays

    DEFF Research Database (Denmark)

    Versteeg, H.; Denollet, J.; Meine, M.

    2016-01-01

    failure-specific health status. Data on patients' demographic, clinical and psychological characteristics at baseline, and on cardiac-related hospitalisations and all-cause deaths during a median follow-up of 3.9 years were obtained from purpose-designed questionnaires and patients' medical records....... RESULTS: Results of multivariable Cox regression analyses showed that poor patient-reported health status (KCCQ score psychological risk...... factors (adjusted hazard ratio 2.46, 95 % confidence interval (CI) 1.30-4.65). Poor health status was not significantly associated with the absolute number of cardiac-related hospital admissions, but with the total number of days spent in hospital during follow-up (adjusted incidence rate ratio 3.20, 95...

  19. Cardiovascular disease morbidity and mortality in patients with type 1 diabetes mellitus: management strategies

    NARCIS (Netherlands)

    Soedamah-Muthu, S.S.; Stehouwer, C.D.A.

    2005-01-01

    There is an increased risk of cardiovascular disease (CVD) mortality and morbidity in patients with type 1 diabetes mellitus compared with the general population as shown by epidemiologic studies measuring cardiovascular endpoints, as well as by autopsy, angiographic, and coronary calcification

  20. [Somatotype of the patients with obesity and associated cardio-vascular patholodgy. Clinical and anthropological bonds].

    Science.gov (United States)

    Bukavneva, N S; Pozdniakov, A L; Nikitiuk, D B

    2008-01-01

    In the article there are presented major anthropometric parameters of patients (male and female) with obesity, combined with cardiovascular pathology, before and after treatment. Constitutional predisposition to obesity is defined. Efficacy of dietary therapy is estimated and with obesity are defined on the basil of associated cardio-vascular pathology.

  1. Determination of prevalence of cardiovascular complications in end-stage renal failure patients

    Directory of Open Access Journals (Sweden)

    Arief Mohammad

    2016-01-01

    Conclusion: This study shows that chronic renal failure accelerates cardiovascular complications, and it is more prominent in patients who have predetermined traditional risk factors such as hypertension, dyslipidemia, and smoking. Prevention and treatment of cardiovascular complications are major considerations in the management of individuals with CKD.

  2. Cardiovascular disease morbidity and mortality in patients with type 1 diabetes mellitus: Management Strategies

    NARCIS (Netherlands)

    Soedamah-Muthu, S.S.; Stehouwer, C.D.A.

    2005-01-01

    There is an increased risk of cardiovascular disease (CVD) mortality and morbidity in patients with type 1 diabetes mellitus compared with the general population as shown by epidemiologic studies measuring cardiovascular endpoints, as well as by autopsy, angiographic, and coronary calcification

  3. Cardiovascular risk factors and diseases precede oral hypoglycaemic therapy in patients with type 2 diabetes mellitus

    NARCIS (Netherlands)

    Erkens, JA; Herings, RMC; Stolk, RP; Spoelstra, JA; Grobbee, DE; Leufkens, HGM

    Although patients with type 2 diabetes mellitus and cardiovascular disease share common risk factors, the link between these diseases remains largely unexplained. In this case-control study, the earlier use of cardiovascular drugs (before the diagnosis of diabetes) was investigated among cases with

  4. Assessment of cardiovascular risk in hypertensive patients: a comparison of commonly used risk scoring programs

    OpenAIRE

    Ulusoy, Şükrü

    2013-01-01

    Several calculation modalities are used today for cardiovascular risk assessment. Cardiovascular risk assessment should be performed in all hypertensive patients. Risk assessment methods being based on the population in which the patient lives and the inclusion of factors such as ethnicity variations, socioeconomic status, and medication use will contribute to improvements in risk assessments. The results should be shared with the patient, and modifiable risk factors must be effectively treated.

  5. EFFECTS OF CARDIOVASCULAR REHABILITATION IN PATIENTS ADMITTED TO THE “Dr Benedek Geza” Hospital of Rehabilitation IN CARDIOVASCULAR Diseases, COVASNA

    Directory of Open Access Journals (Sweden)

    Suceveanu Mihaela

    2015-02-01

    Full Text Available Background. Cardiovascular rehabilitation is an important objective of the treatment of cardiovascular patients in general, and ischemic heart disease patients in particular. The aim of the study is to monitor the effects of long-term cardiovascular rehabilitation in patients readmitted to the “Dr Benedek Geza” Hospital of Rehabilitation in Cardiovascular Diseases Covasna. Material and methods. The study included 92 patients with a mean age of 66.31±9 years, of which 63% women, who had two successive admissions to the “Dr Benedek Geza” Hospital of Rehabilitation in Cardiovascular Diseases, Covasna. At both admissions, all patients were evaluated for the presence of the main cardiovascular risk factors. All patients attended cardiovascular rehabilitation programs, including physical training, climatotherapy, CO2 baths, mofette therapy, aerotherapy, electrotherapy .. We mention that cardioprotective therapy (aspirin, angiotensin enzyme converting inhibitors, beta-blockers and statins did not undergo major changes from one admission to the other. Results. More than half of the patients had the following risk factors: hypertension - 79.35%, dyslipidemia - 64.13%, overweight and obesity - 76.4%. The complex rehabilitation programs attended by the patients consisted of physical training - 33.7%, CO2 baths - 85.9%, mofette therapy - 53.3%, aerotherapy - 96.7%, electrotherapy - 88%. A comparison of the main cardiovascular risk factors during both admissions showed no significant differences between these, except for LDL-cholesterol (3.151.26 vs 2.581.65 mmol/dl, p=0.004 and HDL-cholesterol (1.06±0.61 vs 1.194±0.41 mmol/dl, p=0.075 In conclusion, in cardiovascular patients, obtaining improvements of cardiovascular risk factors requires long-term cardiovascular rehabilitation programs, in parallel to the application of measures for lifestyle change and for secondary drug prevention.

  6. Orosomucoid in urine predicts cardiovascular and over-all mortality in patients with Type II diabetes

    DEFF Research Database (Denmark)

    Christiansen, Merete S; Hommel, E; Magid, E

    2002-01-01

    %) patients had increased urinary orosomucoid excretion rates. During the study period 41 patients died; out of these 23 patients died of cardiovascular diseases. Odds ratio for all-cause mortality was 2.50 (95 % CI 1.00-6.22) and odds ratio for cardiovascular mortality was 9.81 (1.31-73.6) having increased...... urinary orosomucoid excretion rate at baseline (odds ratios adjusted for age, sex, duration of diabetes, cardiovascular diseases, weight, medication, HbA1 c, plasma creatinine and urinary albumin excretion rate). Urinary albumin excretion rate was an independent predictor of all-cause mortality when...

  7. Speech Characteristics of Patients with Pallido-Ponto-Nigral Degeneration and Their Application to Presymptomatic Detection in At-Risk Relatives

    Science.gov (United States)

    Liss, Julie M.; Krein-Jones, Kari; Wszolek, Zbigniew K.; Caviness, John N.

    2006-01-01

    Purpose: This report describes the speech characteristics of individuals with a neurodegenerative syndrome called pallido-ponto-nigral degeneration (PPND) and examines the speech samples of at-risk, but asymptomatic, relatives for possible preclinical detection. Method: Speech samples of 9 members of a PPND kindred were subjected to perceptual…

  8. Primary prevention of cardiovascular disease in patients with systemic lupus erythematosus: case series and literature review.

    Science.gov (United States)

    Fasano, S; Margiotta, D P; Navarini, L; Pierro, L; Pantano, I; Riccardi, A; Afeltra, A; Valentini, G

    2017-12-01

    Background Systemic lupus erythematosus is associated with an increased risk of cardiovascular disease. Low-dose aspirin, hydroxychloroquine and statins have been suggested to play a prophylactic role of cardiovascular events. This study is devoted to reviewing the literature on the topic and assessing the effects of these drugs in preventing a first cardiovascular event in a two-centre Italian series. Methods A PubMed search on cardiovascular prevention in systemic lupus erythematosus was performed. Moreover, systemic lupus erythematosus patients admitted to two centres from 2000-2015, who at admission had not experienced any cardiovascular event, were investigated. Aspirin, hydroxychloroquine and statin use, and the occurrence of any cardiovascular event, were recorded at each visit. Kaplan-Meier and Cox regression analyses were performed to evaluate the role of traditional, disease-related cardiovascular risk factors and of each of the three drugs in the occurrence of new cardiovascular events. Results The literature search produced conflicting results. Two hundred and ninety-one systemic lupus erythematosus patients were included in the study and followed for a median of eight years. During follow-up, 16 cardiovascular events occurred. At multivariate analysis, taking aspirin (hazard ratio: 0.24) and hydroxychloroquine for more than five years (hazard ratio: 0.27) reduced, while antiphospholipid antibody positivity (hazard ratio: 4.32) increased, the risk of a first cardiovascular event. No effect of statins emerged. Conclusion Our study confirms an additive role of aspirin and hydroxychloroquine in the primary prophylaxis of cardiovascular events in Italian patients with systemic lupus erythematosus. The lack of any detected effect in previous reports may depend on the design of studies and their short follow-up period.

  9. A genetic risk score predicts cardiovascular events in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Christiansen, Morten Krogh; Nyegaard, Mette; Larsen, Sanne Bøjet

    2017-01-01

    BACKGROUND: Genetic risk scores (GRSs) may predict cardiovascular risk in community-based populations. However, studies investigating the association with recurrent cardiovascular events in patients with established coronary artery disease (CAD) are conflicting. METHODS: We genotyped 879 patients...... Danish registries. The primary endpoint was a composite of myocardial infarction, coronary revascularisation, and cardiovascular death. RESULTS: Median (interquartile range) follow-up time was 2.8 (2.4-3.8)years. The cumulative incidence proportions of the primary endpoint at 1 and 3years were 6...... GRS was observed on coronary revascularisations (adjusted HR 2.10 [95% CI 1.08-4.07]). Risks of cardiovascular death (adjusted HR 1.07 [95% CI 0.46-2.48]) and all-cause death (adjusted HR 1.15 [95% CI 0.65-2.03]) were unaffected. CONCLUSIONS: A GRS predicts recurrent cardiovascular events in high...

  10. Body composition analysis and adipocytokine concentrations in haemodialysis patients: Abdominal fat gain as an added cardiovascular risk factor. Abdominal fat gain and cardiovascular risk

    Directory of Open Access Journals (Sweden)

    Elena González

    2017-03-01

    Conclusion: HD patients exhibit a gain in fat mass over time, especially in the abdomen, evidenced by an increased A/G ratio. These findings might explain the increased cardiovascular risk in these patients.

  11. Cardiovascular effects of Etanercept in patients with psoriatic arthritis: evidence from the cardiovascular risk in rheumatic diseases database.

    Science.gov (United States)

    Di Minno, Matteo Nicola Dario; Iervolino, Salvatore; Zincarelli, Carmela; Lupoli, Roberta; Ambrosino, Pasquale; Pizzicato, Paolo; Di Minno, Alessandro; Pappone, Nicola; Peluso, Rosario

    2015-01-01

    Many literature data support the possibility of an increased cardiovascular (CV) risk in psoriatic arthritis (PsA) patients compared with the general population. This cannot be entirely explained by the presence of traditional vascular risk factors. It has been suggested that inflammation may act synergistically with traditional vascular risk factors, thus contributing to the atherosclerotic process and to the increased CV risk. In order to evaluate the CV effects of the control of systemic inflammation by Etanercept, in the present study we analyze data recorded in the Cardiovascular Risk in Rheumatic Diseases study group database to perform a further analysis on the effects of Etanercept on primary hemostasis, secondary hemostasis and carotid subclinical atherosclerosis. Platelet reactivity is increased in patients with poorly controlled PsA. Among patients receiving Etanercept, those achieving minimal disease activity show a platelet reactivity comparable to healthy controls. Similarly, the anti-inflammatory effect of Etanercept is associated with a significant improvement of hemostatic and fibrinolytic parameters in PsA subjects, maximal changes being documented in patients achieving minimal disease activity. In addition, the treatment with Etanercept seems to be associated with a carotid intima-media thickness significantly lower as compared with matched patients receiving traditional disease-modifying anti-rheumatic drugs. Our data can be suggestive of the reduction of the CV risk in patients with PsA treated with Etanercept.

  12. Identifying people at risk for undiagnosed type 2 diabetes using the GP's electronic medical record.

    Science.gov (United States)

    Klein Woolthuis, Erwin P; de Grauw, Wim J C; van Gerwen, Willem Hem; van den Hoogen, Henk J M; van de Lisdonk, Eloy H; Metsemakers, Job F M; van Weel, Chris

    2007-06-01

    Screening for type 2 diabetes is recommended in at-risk patients. The GP's electronic medical record (EMR) might be an attractive tool for identifying them. To assess the value of the GP's EMR in identifying patients at risk for undiagnosed type 2 diabetes and the feasibility to use this information in usual care to initiate screening. In 11 Dutch general practices (25 GPs), we performed an EMR-derived risk assessment in all patients aged > or =45 and < or =75 years, without known diabetes, identifying those at risk according to the American Diabetes Association recommendations. Patients with an EMR-derived risk or risk after additional risk assessment during regular consultation were invited for capillary fasting plasma glucose (FPG) measurement. Of 13 581 patients, 3858 (28%) had an EMR-based risk (hypertension, cardiovascular disease, lipid metabolism disorders and/or obesity). Additional risk assessment in those without an EMR-based risk showed that in 51%, greater than one risk factor was present, mainly family history (51.2%) and obesity (59%). Ninety per cent returned for the FPG measurement. In both groups, we found patients with an FPG exceeding the cut point for diabetes (5.9% versus 4.1%). With additional risk assessment during consultation, the GP's EMR was valuable in identifying patients at risk for undiagnosed type 2 diabetes. It was feasible to use this information to initiate screening. At-risk patients were willing to take part in screening. Better registration of family history and obesity will improve the EMR as a tool for identifying at-risk patients in opportunistic screening in general practice.

  13. Cardiovascular risk assessment in hypertensive patients Evaluación del riesgo cardiovascular en hipertensos Avaliação do risco cardiovascular em hipertensos

    Directory of Open Access Journals (Sweden)

    Elaine Amaral de Paula

    2013-06-01

    Full Text Available OBJECTIVE: to assess cardiovascular risk by means of the traditional Framingham score and the version modified through the incorporation of emerging risk factors, such as family history of acute myocardial infarction, metabolic syndrome and chronic kidney disease. METHOD: participants were 50 hypertensive patients under outpatient treatment. The clinical data were collected through a semi-structured interview and the laboratory data from patients' histories. RESULTS: it was verified that the traditional Framingham score was predominantly low (74%, with 14% showing medium risk and 12% high risk. After the inclusion of emerging risk factors, the chance of a coronary event was low in 22% of the cases, medium in 56% and high in 22%. CONCLUSIONS: the comparison between the traditional Framingham risk score and the modified version demonstrated a significant difference in the cardiovascular risk classification, whose correlation shows discreet agreement between the two scales. Lifestyle elements seem to play a determinant role in the increase in cardiovascular risk levels. OBJETIVO: evaluar el riesgo cardiovascular utilizando el puntaje de Framingham tradicional y el modificado por la incorporación de factores de riesgo emergentes como historia familiar de infarto agudo del miocardio, síndrome metabólico y enfermedad renal crónica. MÉTODO: participaron 50 hipertensos que hacen tratamiento en ambulatorio. Los datos clínicos fueron obtenidos por medio de entrevista semiestructurada y los de laboratorio fueron obtenidos de fichas. RESULTADOS: se verificó que el puntaje de Framingham tradicional fue predominantemente bajo (74%, 14% presentó riesgo medio y 12% riesgo alto. Tras la inclusión de factores de riesgo emergentes, la probabilidad de ocurrir un evento coronario fue baja en 22% de los casos, media en 56% y alta en 22% de los casos. CONCLUSIONES: la comparación entre el puntaje de riesgo de Framingham tradicional y el modificado demostr

  14. Cardiovascular responses during a submaximal exercise test in patients with Parkinson's disease.

    NARCIS (Netherlands)

    Speelman, A.D.; Groothuis, J.T.; Nimwegen, M. van; Scheer, E.S. van der; Borm, G.F.; Bloem, B.R.; Hopman, M.T.E.; Munneke, M.

    2012-01-01

    BACKGROUND: Patients with Parkinson's disease (PD) are physically less active than controls, and autonomic dysfunction may contribute to this sedentary lifestyle. Specifically, an altered cardiovascular response to physical effort may restrict physical activities. OBJECTIVE: To assess the

  15. Upper Gastrointestinal Complications and Cardiovascular/ Gastrointestinal Risk Calculator in Patients with Myocardial Infarction Treated with Aspirin

    National Research Council Canada - National Science Library

    Lei Wen

    2017-01-01

    .... How to weigh the benefits and hazards? The current study aimed to assess the feasibility of a cardiovascular/gastrointestinal risk calculator, AsaRiskCalculator, in predicting gastrointestinal events in Chinese patients with myocardial infarction (MI...

  16. Differential Associations Between Specific Depressive Symptoms and Cardiovascular Prognosis in Patients With Stable Coronary Heart Disease

    NARCIS (Netherlands)

    Hoen, Petra W.; Whooley, Mary A.; Martens, Elisabeth J.; Na, Beeya; van Melle, Joost P.; de Jonge, Peter

    2010-01-01

    Objectives The purpose of this research was to evaluate the relationship between cognitive and somatic depressive symptoms and cardiovascular prognosis. Background Depression in patients with stable coronary heart disease (CHD) is associated with poor cardiac prognosis. Whether certain depressive

  17. Prognostic impact of electrocardiographic signs in patients with Type 2 diabetes and cardiovascular disease

    DEFF Research Database (Denmark)

    Pfister, R; Cairns, R; Erdmann, E

    2011-01-01

    Although a resting electrocardiograph is broadly applied in clinical practice for evaluating patients with Type 2 diabetes and cardiovascular disease, the independent prognostic relevance of electrocardiographic signs has not thoroughly been examined....

  18. Increased risk of venous thromboembolism and arterial cardiovascular events in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Kristensen, Søren Lund; Ahlehoff, Ole; Lindhardsen, Jesper

    2012-01-01

    This focused review describes the current knowledge of the association between inflammatory bowel disease (IBD) and cardiovascular disease. Atherosclerosis is a chronic inflammatory disease, and as well as venous thromboembolism this disease shares inflammatory mechanisms with IBD. Patients...

  19. Cardiovascular risk assessment using high-sensitivity C-reactive protein in patients with erectile dysfunction.

    Science.gov (United States)

    Ferrandis-Cortes, Cristina; Martínez-Jabaloyas, José M; Díez-Calzadilla, Nelson A; Hernández-Medina, José A; Chuan-Nuez, Pascual

    2013-01-01

    Erectile dysfunction (ED) is associated with cardiovascular events. High-sensitivity C-reactive protein (hsCRP) is a cardiovascular risk marker. The aim of this study is to determine whether hsCRP is useful in evaluating ED. In 121 patients with ED, age, ED type and severity, time since onset of ED, weight, height, BMI, body fat percentage, waist and hip circumference, hsCRP and hormone profile were studied. Patients were classified as low or moderate-high cardiovascular risk based on hsCRP levels. A descriptive and univariate study was performed. A logistic regression was used to establish factors associated with low versus moderate-high cardiovascular risk and hsCRP. Most patients had moderate-severe ED (70%). 74% had a moderate-high cardiovascular risk based on hsCRP levels, and 33.9 and 34.7% had hypogonadism according to total (TT) and free testosterone. In the univariate analysis, a relationship between hsCRP and TT and physical examination variables was observed (p cardiovascular risk was found in the hypogonadic group (OR: 5.51; 95% CI: 1.185-25.662) and waist- to-hip ratio (p = 0.008; OR: 1.361; 95% CI: 1.075-1.612). A majority of patients with ED have high cardiovascular risk based on hsCRP levels and there is an association with hypogonadism and obesity. © 2013 S. Karger AG, Basel.

  20. Cardiovascular autonomic neuropathy in patients with diabetes mellitus.

    Science.gov (United States)

    Lozano, T; Ena, J

    Cardiovascular autonomic neuropathy associated with diabetes mellitus is caused by an impairment of the autonomic system. The prevalence of this condition ranges from 20% to 65%, depending on the duration of the diabetes mellitus. Clinically, the autonomic function disorder is associated with resting tachycardia, exercise intolerance, orthostatic hypotension, intraoperative cardiovascular instability, silent myocardial ischemia and increased mortality. For the diagnosis, the integrity of the parasympathetic and sympathetic nervous system is assessed. Parasympathetic activity is examined by measuring heart rate variability in response to deep breathing, standing and the Valsalva manoeuvre. Sympathetic integrity is examined by measuring blood pressure in response to standing and isometric exercise. The treatment includes the metabolic control of diabetes mellitus and of the cardiovascular risk factors. Treating symptoms such as orthostatic hypotension requires special attention. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  1. No association between anxiety and depression and adverse clinical outcome among patients with cardiovascular disease

    DEFF Research Database (Denmark)

    Kornerup, Henriette; Zwisler, Ann-Dorthe Olsen; Prescott, Eva

    2011-01-01

    Anxiety and depression have been linked to adverse prognostic outcome in patients with cardiovascular disease (CVD) with mixed results. The timing of anxiety and depression measurement has received little attention so far.......Anxiety and depression have been linked to adverse prognostic outcome in patients with cardiovascular disease (CVD) with mixed results. The timing of anxiety and depression measurement has received little attention so far....

  2. Cardiovascular risk management in rheumatoid arthritis patients still suboptimal: the Implementation of Cardiovascular Risk Management in Rheumatoid Arthritis project.

    Science.gov (United States)

    van den Oever, Inge A M; Heslinga, Maaike; Griep, Ed N; Griep-Wentink, Hanneke R M; Schotsman, Rob; Cambach, Walter; Dijkmans, Ben A C; Smulders, Yvo M; Lems, Willem F; Boers, Maarten; Voskuyl, Alexandre E; Peters, Mike J L; van Schaardenburg, Dirkjan; Nurmohamed, Micheal T

    2017-09-01

    To assess the 10-year cardiovascular (CV) risk score and to identify treatment and undertreatment of CV risk factors in patients with established RA. Demographics, CV risk factors and prevalence of cardiovascular disease (CVD) were assessed by questionnaire. To calculate the 10-year CV risk score according to the Dutch CV risk management guideline, systolic blood pressure was measured and cholesterol levels were determined from fasting blood samples. Patients were categorized into four groups: indication for treatment but not treated; inadequately treated, so not meeting goals (systolic blood pressure ⩽140 mmHg and/or low-density lipoprotein ⩽2.5 mmol/l); adequately treated; or no treatment necessary. A total of 720 consecutive RA patients were included, 375 from Reade and 345 from the Antonius Hospital. The mean age of patients was 59 years (s.d. 12) and 73% were female. Seventeen per cent of the patients had a low 10-year CV risk (management remains a major challenge and better awareness and management are urgently needed to reduce the high risk of CVD in the RA population.

  3. Cardiovascular events in patients with COPD: TORCH study results

    DEFF Research Database (Denmark)

    Calverley, Peter M A; Anderson, Julie A; Celli, Bartolome

    2010-01-01

    BACKGROUND: Previous studies have suggested that long-term use of beta agonists to treat chronic obstructive pulmonary disease (COPD) may increase the risk of cardiovascular adverse events. In this post hoc analysis, data from the TOwards a Revolution in COPD Health (TORCH) study were used.......2% for placebo, 22.7% for salmeterol, 24.3% for fluticasone propionate and 20.8% for SFC. Although a history of myocardial infarction doubled the probability of cardiovascular adverse events, the event rates remained similar across treatment groups. CONCLUSION: Post hoc analysis of the 3-year TORCH dataset...

  4. Quantifying cardiovascular disease risk factors in patients with psoriasis

    DEFF Research Database (Denmark)

    Miller, I M; Skaaby, T; Ellervik, C

    2013-01-01

    BACKGROUND: In a previous meta-analysis on categorical data we found an association between psoriasis and cardiovascular disease and associated risk factors. OBJECTIVES: To quantify the level of cardiovascular disease risk factors in order to provide additional data for the clinical management...... of the increased risk. METHODS: This was a meta-analysis of observational studies with continuous outcome using random-effects statistics. A systematic search of studies published before 25 October 2012 was conducted using the databases Medline, EMBASE, International Pharmaceutical Abstracts, PASCAL and BIOSIS...

  5. Management of Cardiovascular Risk in Patients with Chronic Inflammatory Diseases

    DEFF Research Database (Denmark)

    Lindhardsen, Jesper; Kristensen, Søren Lund; Ahlehoff, Ole

    2016-01-01

    An increased risk of cardiovascular disease (CVD) has been observed in a range of chronic inflammatory diseases (CID), including rheumatoid arthritis (RA), psoriasis, inflammatory bowel diseases (IBD), and systemic lupus erythematosus (SLE). The increased risk of CVDs and reduced life expectancy...... considerable interest in recent years. We briefly summarize the current level of evidence of the association between CIDs and CVD and cardiovascular risk management recommendations. Perspectives of ongoing and planned trials are discussed in consideration of potential ways to improve primary and secondary CVD...

  6. Does training of general practitioners for intensive treatment of people with screen-detected diabetes have a spillover effect on mortality and cardiovascular morbidity in 'at risk' individuals with normoglycaemia?

    DEFF Research Database (Denmark)

    Simmons, Rebecca Kate; Bruun, Niels H; Witte, Daniel R

    2017-01-01

    questionnaire but who were normoglycaemic. METHODS: In the Anglo-Danish-Dutch Study of Intensive Treatment In People with Screen-Detected Diabetes in Primary Care (ADDITION)-Denmark trial, 175 general practices were cluster-randomised into: (1) screening plus routine care of individuals with screen......AIMS/HYPOTHESIS: Within a trial of intensive treatment of people with screen-detected diabetes, we aimed to assess a potential spillover effect of the trial intervention on incident cardiovascular disease (CVD) and all-cause mortality among people who screened positive on a diabetes risk......-detected diabetes (control group); or (2) screening plus training and support in intensive multifactorial treatment of individuals with screen-detected diabetes (intervention group). We identified all individuals who screened positive on a diabetes risk questionnaire in ADDITION-Denmark but were normoglycaemic...

  7. Albuminuria Is Associated with Traditional Cardiovascular Risk Factors and Viral Load in HIV-Infected Patients in Rural South Africa

    NARCIS (Netherlands)

    Wensink, G. Emerens; Schoffelen, Annelot F.; Tempelman, Hugo A.; Rookmaaker, Maarten B.; Hoepelman, Andy I. M.; Barth, Roos E.

    2015-01-01

    Context As life expectancy improves among Human Immunodeficiency Virus (HIV) patients, renal and cardiovascular diseases are increasingly prevalent in this population. Renal and cardiovascular disease are mutual risk factors and are characterized by albuminuria. Understanding the interactions

  8. Effect of weight loss on the cardiovascular risk profile of obese patients with psoriasis

    DEFF Research Database (Denmark)

    Jensen, Peter; Zachariae, Claus; Christensen, Robin

    2014-01-01

    Psoriasis is associated with obesity and other cardiovascular risk factors including endothelial dysfunction. We aimed to investigate the effects of weight loss on the cardiovascular risk profile of obese patients with psoriasis. A randomised controlled study was conducted in which we measured...... the microvascular endothelial function with peripheral arterial tonometry (PAT), selected plasma markers of endothelial function, and traditional cardiovascular risk factors in 60 obese patients with psoriasis. The participants were randomised to either low-energy diet (n = 30) providing 800-1,000 kcal/day for 8...... cholesterol, triglyceride, plasma glucose, glycated haemoglobin, and tissue plasminogen activator inhibitor. Microvascular endothelial function assessed by PAT remained unchanged. We conclude that certain components of the cardiovascular risk profile of obese patients with psoriasis can be significantly...

  9. A genetic risk score predicts cardiovascular events in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Christiansen, Morten Krogh; Nyegaard, Mette; Larsen, Sanne Bøjet

    Background. Genetic risk scores (GRSs) may predict cardiovascular risk in community-based populations. However, studies investigating the association with recurrent cardiovascular events in patients with established coronary artery disease (CAD) are conflicting. Methods. We genotyped 879 patients...... with high-risk stable CAD and created a GRS based on 45 single nucleotide polymorphisms previously reported to be associated with CAD in genome-wide association studies. Patients were categorised into high or low GRS according to the median GRS and followed for recurrent cardiovascular events using national...... Danish registries. The primary endpoint was a composite of myocardial infarction, coronary revascularisation, and cardiovascular death. Results. Median (interquartile range) follow-up time was 2.8 (2.4–3.8) years. The cumulative incidence proportions of the primary endpoint at 1 and 3 years were 6...

  10. Approach to Androgen Deprivation in the Prostate Cancer Patient with Pre-existing Cardiovascular Disease.

    Science.gov (United States)

    Greiman, Alyssa K; Keane, Thomas E

    2017-06-01

    Androgen deprivation therapy (ADT) is a mainstay of treatment for advanced prostate cancer. Several studies have reported an association between ADT and an increase in cardiovascular events, especially in those receiving gonadotropin-releasing hormone (GnRH) agonists compared to GnRH antagonists. We review the body of literature reporting the association of ADT and cardiovascular morbidity, and discuss the proposed mechanism of cardiovascular disease due to ADT including metabolic changes that may promote atherosclerosis and local hormonal effects that may increase plaque rupture and thrombosis. GnRH agonists appear to increase the risk of cardiovascular morbidity by 20-25% in men on these agents compared those who do not receive ADT. GnRH antagonists may appear to have halve this risk while improving PSA progression-free survival. GnRH antagonists may be superior to GnRH agonists for patients with significant cardiovascular disease, significant metastatic disease burden, or severe lower urinary tract symptoms.

  11. Creatine-kinase and dialysis patients, a helpful tool for stratifying cardiovascular risk?

    Science.gov (United States)

    Quiroga, Borja; Vega, Almudena; Abad, Soraya; Villaverde, Maite; Reque, Javier; López-Gómez, Juan Manuel

    2016-01-01

    Hemodialysis patients have an enhanced risk for cardiovascular events. Cardiac biomarkers provide useful information for stratifying their risk. However the prognosis value of creatine kinase MB isoenzyme (CKMB) has not yet been validated in this population. The aim of the present study is to determine the predictable value of CK-MB in hemodialysis. A cohort of 211 hemodialysis patients (58.3% male, median age 73 (60-80) years) were followed for 39 (19-56) months. Cardiac biomarkers including CKMB were recorded at baseline. Factors associated to CKMB and prognosis value of this biomarker was studied. The median value of CKMB was 1 (1-2) ng/mL with no patient exceeding normal laboratory values. Previous heart disease, diabetes mellitus, peripheral vascular disease and systolic and diastolic dysfunction were associated with higher levels of CKMB. Ninety-four patients (44.5%) cardiovascular events were recorded. CKMB levels ≥2ng/mL was independently associated to cardiovascular events during the follow up after adjusting. Adding CKMB to a model including several variables for predicting cardiovascular events, resulted in 17% improvement in risk discrimination (IDI) with a relative IDI of 9.9% (p=0.04). CKMB is a good marker for stratifying cardiovascular risk in hemodialysis patients and adds prognosis information to other well known independent predictors for cardiovascular events. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  12. Real-world cardiovascular assessment of mirabegron treatment in patients with overactive bladder and concomitant cardiovascular disease: Results of a Japanese post-marketing study.

    Science.gov (United States)

    Katoh, Takao; Kuwamoto, Kana; Kato, Daisuke; Kuroishi, Kentarou

    2016-12-01

    To assess the effect of 25 or 50 mg mirabegron on cardiovascular end-points and adverse drug reactions in real-world Japanese patients with overactive bladder and cardiovascular disease. Participants had overactive bladder, a history of/coexisting cardiovascular disease and a 12-lead electrocardiogram carried out ≤7 days before initiating 4 weeks of mirabegron treatment. Patients with "serious cardiovascular disease" (class III or IV on the New York Heart Association functional classification and further confirmed by expert analysis) were excluded. Patient demographics, physical characteristics and cardiovascular history were recorded. After 4 weeks, patients underwent another electrocardiogram. Incidence of cardiovascular adverse drug reactions and change from baseline in electrocardiogram parameters (RR, PR, QRS intervals, Fridericia's corrected QT and heart rate) were assessed. Of 316 patients registered, 236 met criteria and had baseline/post-dose electrocardiograms: 61.9% male; 60.2% aged ≥75 years; 93.6% with coexisting cardiovascular disease, notably, arrhythmia (67.8%) and angina pectoris (19.1%). Starting mirabegron daily doses were 25 mg (19.9%) or 50 mg (80.1%). The incidence of cardiovascular adverse drug reactions was 5.51%. After 4 weeks, the mean heart rate increased by 1.24 b.p.m. (statistically significant, but clinically acceptable as per previous trials). No significant changes were observed in PR, QRS or Fridericia's corrected QT. No significant correlations in the total population or age-/sex-segregated subgroups were observed between baseline Fridericia's corrected QT and change at 4 weeks. No correlation for heart rate versus change from baseline heart rate with treatment was observed. Mirabegron was well tolerated in real-world Japanese patients with overactive bladder and coexisting cardiovascular disease. No unexpected cardiovascular safety concerns were observed. © 2016 The Japanese Urological Association.

  13. Plasma Leptin in Patients at Intermediate to High Cardiovascular Risk With and Without Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Montagnana, Martina; Fava, Cristiano; Targher, Giovanni; Franchini, Massimo; Danese, Elisa; Bonafini, Sara; De Cata, Angela; Salvagno, Gian Luca; Ruzzenente, Orazio; Guidi, Gian Cesare; Lippi, Giuseppe

    2017-03-01

    A number of clinical studies have demonstrated that leptin concentrations are related to the metabolic disturbances that constitute the metabolic syndrome (MetS) and to diabetes mellitus (DM). To investigate possible determinants of leptin concentrations in a sample of patients at high cardiovascular (CV) risk carrying two or more features of the MetS and to investigate if any difference exist between at risk patients with or without DM. Serum leptin concentrations were measured in 60 consecutive male patients affected by at least two CV risk factors which belong to the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) definition of MetS: 30 patients affected by type 2 DM (T2DM) and 30 nondiabetic patients (non-T2DM). Nineteen healthy subjects were included in the study as a control group (HC). Leptin was significantly higher in patients carrying two or more features of the MetS compared with HC (P = 0.02). Stratifying MetS patients for DM, we found that leptin level was higher in non-T2DM patients (7.8 ng/ml), intermediate in T2DM (6.2 ng/ml), and lower in HC (4.6 ng/ml). In MetS patients, a positive correlation was found between leptin and waist, triglycerides, and number of MetS criteria. After stratification for T2DM, the correlations were still significant in the non-T2DM but not in the T2DM group. In our sample of moderate-to-high-risk patients, leptin level is positively associated with waist circumference and triglycerides but only in non-T2DM patients. Our data suggest that diabetic subjects could modulate leptin production in a different way compared with patients carrying other MetS-related anomalies. © 2016 Wiley Periodicals, Inc.

  14. Allopurinol use and the risk of acute cardiovascular events in patients with gout and diabetes.

    Science.gov (United States)

    Singh, Jasvinder A; Ramachandaran, Rekha; Yu, Shaohua; Curtis, Jeffrey R

    2017-03-14

    Few studies, if any, have examined cardiovascular outcomes in patients with diabetes and gout. Both diabetes and gout are risk factors for cardiovascular disease. The objective of this study was to examine the effect of allopurinol on the risk of incident acute cardiovascular events in patients with gout and diabetes. We used the 2007-2010 Multi-Payer Claims Database (MPCD) that linked health plan data from national commercial and governmental insurances, representing beneficiaries with United Healthcare, Medicare, or Medicaid coverage. In patients with gout and diabetes, we assessed the current allopurinol use, defined as a new filled prescription for allopurinol, as the main predictor of interest. Our outcome of interest was the occurrence of the first Incident hospitalized myocardial infarction (MI) or stroke (composite acute cardiovascular event), after which observations were censored. We employed multivariable-adjusted Cox proportional hazards models that simultaneously adjusted for patient demographics, cardiovascular risk factors and other medical comorbidities. We calculated hazard ratios [HR] (95% confidence intervals [CI]) for incident composite (MI or stroke) acute cardiovascular events. We performed sensitivity analyses that additionally adjusted for the presence of immune diseases and colchicine use, as potential confounders. There were 2,053,185 person days (5621.3 person years) of current allopurinol use and 1,671,583 person days (4576.5 person years) of prior allopurinol use. There were 158 incident MIs or strokes in current and 151 in prior allopurinol users, respectively. Compared to previous allopurinol users, current allopurinol users had significantly lower adjusted hazard of incident acute cardiovascular events (incident stroke or MI), with an HR of 0.67 (95% CI, 0.53, 0.84). Sensitivity analyses, additionally adjusted for immune diseases or colchicine use, confirmed this association. Current allopurinol use protected against the occurrence

  15. Depressive Symptoms and Risk of New Cardiovascular Events or Death in Patients with Myocardial Infarction

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær; Christensen, Bo; Søndergaard, Jens

    2013-01-01

    Depressive symptoms is associated with adverse cardiovascular outcomes in patients with myocardial infarction (MI), but the underlying mechanisms are unclear and it remains unknown whether subgroups of patients are at a particularly high relative risk of adverse outcomes. We examined the risk...... of new cardiovascular events and/or death in patients with depressive symptoms following first-time MI taking into account other secondary preventive factors. We further explored whether we could identify subgroups of patients with a particularly high relative risk of adverse outcomes....

  16. Cardiovascular effects of growth hormone in adult hemodialysis patients: results from a randomized controlled trial

    DEFF Research Database (Denmark)

    Køber, Lars; Rustom, Rana; Wiedmann, Jonas

    2010-01-01

    The high morbidity and mortality rates in hemodialysis (HD) patients are due, at least in part, to their increased risk for cardiovascular diseases (CVD). This prospective study evaluated the effect of growth hormone (GH) on a number of CVD risk markers in adult patients on HD.......The high morbidity and mortality rates in hemodialysis (HD) patients are due, at least in part, to their increased risk for cardiovascular diseases (CVD). This prospective study evaluated the effect of growth hormone (GH) on a number of CVD risk markers in adult patients on HD....

  17. Lipoprotein profile, lipoprotein-associated phospholipase A2 and cardiovascular risk in hemodialysis patients.

    Science.gov (United States)

    Rolla, Roberta; De Mauri, Andreana; Valsesia, Ambra; Vidali, Matteo; Chiarinotti, Doriana; Bellomo, Giorgio

    2015-12-01

    Cardiovascular disease is the leading cause of morbidity and mortality in hemodialysis patients; the increased risk of cardiovascular disease is due to accelerated atherosclerosis, inflammation and impaired lipoprotein metabolism. We aimed to evaluate lipoprotein-associated phospholipase A2 (Lp-PLA2) and some pro-inflammatory aspects of the lipoprotein profile in dialyzed patients in order to evaluate the relationship with the accelerated atherosclerosis and vascular accidents. In 102 dialysis patients and 40 non-uremic controls, we investigated the lipoprotein plasma profile, high sensitivity C-reactive protein (CRP), ceruloplasmin and serum amyloid A protein (SAA), and followed patients for 1 year to analyze the risk of acute cardiovascular events. Total cholesterol, low-density lipoprotein and high-density lipoprotein plasma levels were significantly lower in uremic patients than controls, whereas CRP, SAA, ceruloplasmin, Lp-PLA2 and their ratio with apolipoprotein A1 were significantly higher. Patients with Lp-PLA2 levels >194 nmol/min/ml had more acute cardiovascular events than patients with lower values. Our results show that in dialysis subjects: (1) low-density lipoproteins show a more atherogenic phenotype than in the general population; (2) high-density lipoproteins are less anti-inflammatory; (3) Lp-PLA2 could potentially be used to evaluate cardiovascular risk.

  18. Pre-Dialysis Visits to a Nephrology Department and Major Cardiovascular Events in Patients Undergoing Dialysis.

    Science.gov (United States)

    Huang, Chih-Yuan; Hsu, Chia-Wen; Chuang, Chi-Rou; Lee, Ching-Chih

    2016-01-01

    Pre-dialysis care by a nephrology out-patient department (OPD) may affect the outcomes of patients who ultimately undergo maintenance dialysis. This study examined the effect of pre-dialysis care by a nephrology OPD on the incidence of one-year major cardiovascular events after initiation of dialysis. The study consisted of Taiwanese patients with chronic kidney disease (CKD) who commenced dialysis from 2006 to 2008. The number of nephrology OPD visits during the critical care period (within 6 months of initiation of dialysis) and the early care period (6-36 months before initiation of dialysis) were analyzed. The primary outcome measure was one-year major cardiovascular events. A total of 1191 CKD patients who initiated dialysis from 2006 to 2008 were included. Binary logistic regression showed that patients with ≧3 visits during the critical care period and those with ≧11 visits during the early care period had fewer composite major cardiovascular events than those with 0 visits. Patients with early referral are less likely to experience composite major cardiovascular events than those with late referral, with aOR 0.574 (95% CI = 0.43-0.77, Pnephrology OPD visits, not just early referral, may had fewer one-year composite major cardiovascular events after initiation of dialysis. This information may be important to medical care providers and public health policy makers in their efforts to improve the well-being of CKD patients.

  19. [Effects of gastric bypass on estimated cardiovascular risk in morbidly obese patients with metabolic syndrome].

    Science.gov (United States)

    Corcelles, Ricard; Vidal, Josep; Delgado, Salvadora; Ibarzabal, Ainitze; Bravo, Raquel; Momblan, Dulce; Espert, Juanjo; Morales, Xavi; Almenara, Raúl; Lacy, Antonio M

    2014-01-01

    The major goal of surgical treatment in morbid obesity is to decrease morbidity and mortality associated with excess weight. In this sense, the main factors of death are cardiovascular disease and metabolic syndrome. The objective of this study is to evaluate the effects of gastric bypass on cardiovascular risk estimation in patients after bariatric surgery. We retrospectively evaluated pre and postoperative cardiovascular risk estimation of 402 morbidly obese patients who underwent laparoscopic gastric bypass. The major variable studied is the cardiovascular risk estimation that is calculated preoperatively and after 12 months. Cardiovascular risk estimation analysis has been performed with the REGICOR Equation. REGICOR formulation allows calculating a 10 year risk of cardiovascular events adapted to the Spanish population and is expressed in percentages. We reported an overall 4.1±3.0 mean basal REGICOR score. One year after the operation, cardiovascular risk estimation significantly decreased to 2,2±1,6 (Pcardiovascular risk factors included in the REGICOR equation. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  20. Cardiovascular disease in patients with end-stage renal disease on hemodialysis in a developing country

    Directory of Open Access Journals (Sweden)

    Leila S. V. Silva

    2012-01-01

    Full Text Available Cardiovascular disease is the main cause of death among patients with end-stage renal disease (ESRD. The present study was undertaken to identify the main cardiovascular diseases and their risk factors in 160 patients with ESRD on hemodialysis (HD in Brazil. Their mean age was 47 ± 39 years. The main risk factors for cardiovascular diseases were arterial hypertension (89.4%, dyslipidemia (78.3%, low high-density lipoprotein levels (84.2% and low physical activity (64.1%. Family history of coronary insufficiency and high low-density lipoprotein levels were significantly associated with coronary artery disease (P = 0.005 and P = 0.029, respectively. Sedentary life style, diabetes mellitus, secondary hyperparathyroidism and hyperglycemia also showed a significant association with the underlying vascular disease (P = 0.017, P = 0.039, P = 0.037 and P = 0.030, respectively. Hypercalcemia, hypertension and black race were factors significantly associated with left ventricular systolic dysfunction (P = 0.01, P = 0.0013 and P = 0.024, respectively. Our study shows that the most prevalent cardiovascular diseases in patients with ESRD were left ventricular hypertrophy, atherosclerotic disease, valvular disease and coronary artery disease. Hypertension and dyslipidemia were the common risk factors associated with cardiovascular diseases. The present study was undertaken to identify the main cardiovascular diseases and their risk factors in 160 patients with ESRD on HD in a single center in Brazil.

  1. Effects of cinacalcet on atherosclerotic and nonatherosclerotic cardiovascular events in patients receiving hemodialysis: the EValuation Of Cinacalcet HCl Therapy to Lower CardioVascular Events (EVOLVE) trial.

    Science.gov (United States)

    Wheeler, David C; London, Gerard M; Parfrey, Patrick S; Block, Geoffrey A; Correa-Rotter, Ricardo; Dehmel, Bastian; Drüeke, Tilman B; Floege, Jürgen; Kubo, Yumi; Mahaffey, Kenneth W; Goodman, William G; Moe, Sharon M; Trotman, Marie-Louise; Abdalla, Safa; Chertow, Glenn M; Herzog, Charles A

    2014-11-17

    Premature cardiovascular disease limits the duration and quality of life on long-term hemodialysis. The objective of this study was to define the frequency of fatal and nonfatal cardiovascular events attributable to atherosclerotic and nonatherosclerotic mechanisms, risk factors for these events, and the effects of cinacalcet, using adjudicated data collected during the EValuation of Cinacalcet HCl Therapy to Lower CardioVascular Events (EVOLVE) Trial. EVOLVE was a randomized, double-blind, placebo-controlled clinical trial that randomized 3883 hemodialysis patients with moderate to severe secondary hyperparathyroidism to cinacalcet or matched placebo for up to 64 months. For this post hoc analysis, the outcome measure was fatal and nonfatal cardiovascular events reflecting atherosclerotic and nonatherosclerotic cardiovascular diseases. During the trial, 1518 patients experienced an adjudicated cardiovascular event, including 958 attributable to nonatherosclerotic disease. Of 1421 deaths during the trial, 768 (54%) were due to cardiovascular disease. Sudden death was the most frequent fatal cardiovascular event, accounting for 24.5% of overall mortality. Combining fatal and nonfatal cardiovascular events, randomization to cinacalcet reduced the rates of sudden death and heart failure. Patients randomized to cinacalcet experienced fewer nonatherosclerotic cardiovascular events (adjusted relative hazard 0.84, 95% CI 0.74 to 0.96), while the effect of cinacalcet on atherosclerotic events did not reach statistical significance. Accepting the limitations of post hoc analysis, any benefits of cinacalcet on cardiovascular disease in the context of hemodialysis may result from attenuation of nonatherosclerotic processes. Unique identifier: NCT00345839. URL: ClinicalTrials.gov. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  2. [Peculiarities of cardiovascular system pathology depending on psychological profile in patients of senior age groups].

    Science.gov (United States)

    Prokhorenko, I O

    2013-01-01

    Interrelations between peculiarities of psychological profile of patients of senior age groups (according to Cattel), level of stress hormones in blood and background pathology of cardiovascular system were studied. Levels of catecholamine and corticosteroids in dynamics, rate of magnesium in erythrocytes and calcium in plaques of coronary arteries as well as fats, Holter ECG, daily profiles of blood pressure, vasomotor function of endothelium and microcirculation were analysed. It is established that stress hormones indirectly determine original form of stress reaction depending on patients' psychological profile. This contributes to the development of one or another form of cardiovascular system pathology. Excessive alcohol intake also promotes progression of cardiovascular system pathology. Depression, being a reflection of disbalance of stress hormones levels, can be used as a marker of unfavourable course of cardiovascular pathology.

  3. Multifactorial intervention to prevent cardiovascular disease in patients with early rheumatoid arthritis

    DEFF Research Database (Denmark)

    Svensson, Annemarie Lyng; Christensen, Robin; Persson, Frederik

    2016-01-01

    INTRODUCTION: Cardiovascular morbidity is a major burden in patients with rheumatoid arthritis (RA). In this study, we compare the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment of modifiable risk factors for cardiovascular disease (CVD) in pati......INTRODUCTION: Cardiovascular morbidity is a major burden in patients with rheumatoid arthritis (RA). In this study, we compare the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment of modifiable risk factors for cardiovascular disease (CVD.......5 mmol/L, glycated haemoglobin pressure ...) and The Danish Health and Medicines Authority. Dissemination will occur through presentations at National and International conferences and publications in international peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT02246257....

  4. Risk prediction models for mortality in patients with cardiovascular disease: The BioBank Japan project

    Directory of Open Access Journals (Sweden)

    Jun Hata

    2017-03-01

    Full Text Available Background: Cardiovascular disease (CVD is a leading cause of death in Japan. The present study aimed to develop new risk prediction models for long-term risks of all-cause and cardiovascular death in patients with chronic phase CVD. Methods: Among the subjects registered in the BioBank Japan database, 15,058 patients aged ≥40 years with chronic ischemic CVD (ischemic stroke or myocardial infarction were divided randomly into a derivation cohort (n = 10,039 and validation cohort (n = 5019. These subjects were followed up for 8.55 years in median. Risk prediction models for all-cause and cardiovascular death were developed using the derivation cohort by Cox proportional hazards regression. Their prediction performances for 5-year risk of mortality were evaluated in the validation cohort. Results: During the follow-up, all-cause and cardiovascular death events were observed in 2962 and 962 patients from the derivation cohort and 1536 and 481 from the validation cohort, respectively. Risk prediction models for all-cause and cardiovascular death were developed from the derivation cohort using ten traditional cardiovascular risk factors, namely, age, sex, CVD subtype, hypertension, diabetes, total cholesterol, body mass index, current smoking, current drinking, and physical activity. These models demonstrated modest discrimination (c-statistics, 0.703 for all-cause death; 0.685 for cardiovascular death and good calibration (Hosmer-Lemeshow χ2-test, P = 0.17 and 0.15, respectively in the validation cohort. Conclusions: We developed and validated risk prediction models of all-cause and cardiovascular death for patients with chronic ischemic CVD. These models would be useful for estimating the long-term risk of mortality in chronic phase CVD.

  5. Cardiovascular disease among patients with type 2 diabetes: role of homocysteine as an inflammatory marker

    OpenAIRE

    Ashok Sahu; Trapti Gupta; Arvind Kavishwar; Singh, R.K.

    2016-01-01

    It is known that inflammation has a role in the pathogenesis of cardiovascular diseases; measurement of inflammatory markers improves the risk prediction of cardiovascular diseases. Hyperhomocysteinemia has been correlated with the occurrence of blood clots, heart attacks and strokes; though it is unclear whether hyperhomocysteinemia is an independent risk factor for these conditions. In the present study, we aimed to evaluate the role of homocysteine in type 2 diabetes patients with cardiova...

  6. Thyroid functional disease: an under-recognized cardiovascular risk factor in kidney disease patients

    OpenAIRE

    Rhee, Connie M.; Brent, Gregory A; Kovesdy, Csaba P; Soldin, Offie P.; Nguyen, Danh; Budoff, Matthew J; Brunelli, Steven M.; Kalantar-Zadeh, Kamyar

    2015-01-01

    Thyroid functional disease, and in particular hypothyroidism, is highly prevalent among chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. In the general population, hypothyroidism is associated with impaired cardiac contractility, endothelial dysfunction, atherosclerosis and possibly higher cardiovascular mortality. It has been hypothesized that hypothyroidism is an under-recognized, modifiable risk factor for the enormous burden of cardiovascular disease and death in ...

  7. Risk Factors for Cardiovascular Diseases among Diabetic Patients In Southwest Ethiopia

    OpenAIRE

    Tamiru, Solomon; Alemseged, Fessahaye

    2010-01-01

    Background Studies on cardiovascular risk factors among diabetic persons in Ethiopia are lacking. The objective of this study was to determine the prevalence of the cardiovascular risk factors (hypertension, obesity, physical inactivity, dyslipidemia and smoking) among diabetic patients at the diabetic clinic of Jimma University Specialized Hospital. Methods A cross-sectional study was conducted from October to December 2007. Three hundred one individuals were randomly selected from 950 patie...

  8. [Dyslipidemia management in patients with high cardiovascular risk in Spain. ALMA study].

    Science.gov (United States)

    Pintó, Xavier; Trias Vilagut, Ferran; Rius Taruella, Joan; Mairal Sallán, Esther

    2017-06-12

    To assess the attitude of primary care (PCPs) and specialized care (SCPs) physicians towards the general set of patients with dyslipidemia, particularly those with cardiovascular risk factors. Observational, descriptive, multi-center study based on a survey. Different healthcare regions in Spain. 1,402 PCPs, and 596 SCPs. Physician's profile, routine practices in the management of patients with dyslipidemia. 84.3% took the global cardiovascular risk into account when prescribing the treatment. Target LDL-C concentration in patients without cardiovascular risk factors was cardiovascular complication, ischemic cardiopathy or stroke, target LDL-C was cardiovascular risk factors was atorvastatin (66%), whereas in patients with diabetes, kidney disease or metabolic syndrome, most physicians (80-89%) used pitavastatin. SCPs showed a greater trend than PCPs to establish a LDL-C target of <70mg/dL in patients with previous stroke (77.5% vs 66.8%) or coronary disease (92.1% vs 80.6%) (P<.0001), as well as to prescribe a combined treatment in patients not achieving the target LDL-C concentrations (58.1% vs 50.2%, P=.0013). Although CVR assessment is generally accepted, there is broad disagreement in defining the objectives of LDL-C. Most often than PCPs, the SCPs consider more ambitious targets for LDL-C and the association of lipid-lowering drugs. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  9. Cardiovascular risk factors in patients with rheumatoid arthritis in combination with hypertension depending on body weight

    Directory of Open Access Journals (Sweden)

    Sіrenko O.Yu.

    2014-11-01

    Full Text Available The objective was to evaluate the frequency of cardiovascular risk factors and hypertension in patients with rheumatoid arthritis depending on body weight. The study involved 100 patients with rheumatoid arthritis and stably selected therapy for more than 6 months at the age from 45 to 65 years (mean age 53,19 ± 5,40 years. Traditional cardiovascular risk was assessed, taking into account risk factors by SCORE scale and amended for patients with RA. The levels of total cholesterol, triglycerides, C-reactive protein, serum creatinine, body mass index, body area index were determined. Arterial hypertension was diagnosed in 41 (41% patients with rheuma¬toid arthritis and was associated with traditional risk factors (age, obesity, rheumatoid factor, hyperuricemia and the duration of glucocorticoid therapy. Obesity and excess body mass occurred in the majority of patients with rheumatoid arthritis, herewith the highest level of inflammation indicators and risk of cardiovascular events was in overweight patients. Obesity was associated with duration of rheumatoid arthritis, the activity of the inflammatory process, the duration of glucocorticoids taking. It is found that the traditional SCORE scale does not fully reflect the risk of cardiovascular events in rheumatoid arthritis. Identification of hypertension and obesity increases the information content of the risk assessment of cardiovascular events in rheumatoid arthritis.

  10. Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE).

    Science.gov (United States)

    Nendaz, M; Spirk, D; Kucher, N; Aujesky, D; Hayoz, D; Beer, J H; Husmann, M; Frauchiger, B; Korte, W; Wuillemin, W A; Jäger, K; Righini, M; Bounameaux, H

    2014-03-03

    There is a need to validate risk assessment tools for hospitalised medical patients at risk of venous thromboembolism (VTE). We investigated whether a predefined cut-off of the Geneva Risk Score, as compared to the Padua Prediction Score, accurately distinguishes low-risk from high-risk patients regardless of the use of thromboprophylaxis. In the multicentre, prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study, 1,478 hospitalised medical patients were enrolled of whom 637 (43%) did not receive thromboprophylaxis. The primary endpoint was symptomatic VTE or VTE-related death at 90 days. The study is registered at ClinicalTrials.gov, number NCT01277536. According to the Geneva Risk Score, the cumulative rate of the primary endpoint was 3.2% (95% confidence interval [CI] 2.2-4.6%) in 962 high-risk vs 0.6% (95% CI 0.2-1.9%) in 516 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.5% vs 0.8% (p=0.029), respectively. In comparison, the Padua Prediction Score yielded a cumulative rate of the primary endpoint of 3.5% (95% CI 2.3-5.3%) in 714 high-risk vs 1.1% (95% CI 0.6-2.3%) in 764 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.2% vs 1.5% (p=0.130), respectively. Negative likelihood ratio was 0.28 (95% CI 0.10-0.83) for the Geneva Risk Score and 0.51 (95% CI 0.28-0.93) for the Padua Prediction Score. In conclusion, among hospitalised medical patients, the Geneva Risk Score predicted VTE and VTE-related mortality and compared favourably with the Padua Prediction Score, particularly for its accuracy to identify low-risk patients who do not require thromboprophylaxis.

  11. Primary prevention of diabetes mellitus type 2 and cardiovascular diseases using a cognitive behavior program aimed at lifestyle changes in people at risk: Design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Chinapaw Marijke J

    2008-06-01

    Full Text Available Abstract Background The number of people with cardiovascular disease (CVD and diabetes mellitus type 2 (T2DM is growing rapidly. To a large extend, this increase is due to lifestyle-dependent risk factors, such as overweight, reduced physical activity, and an unhealthy diet. Changing these risk factors has the potential to postpone or prevent the development of T2DM and CVD. It is hypothesized that a cognitive behavioral program (CBP, focused in particular on motivation and self-management in persons who are at high risk for CVD and/or T2DM, will improve their lifestyle behavior and, as a result, will reduce their risk of developing T2DM and CVD. Methods 12,000 inhabitants, 30-50 years of age living in several municipalities in the semi-rural region of West-Friesland will receive an invitation from their general practitioner (n = 13 to measure their own waist circumference with a tape measure. People with abdominal obesity (male waist ≥ 102 cm, female waist ≥ 88 cm will be invited to participate in the second step of the screening which includes blood pressure, a blood sample and anthropometric measurements. T2DM and CVD risk scores will then be calculated according to the ARIC and the SCORE formulae, respectively. People with a score that indicates a high risk of developing T2DM and/or CVD will then be randomly assigned to the intervention group (n = 300 or the control group (n = 300. Participants in the intervention group will follow a CBP aimed at modifying their dietary behavior, physical activity, and smoking behavior. The counseling methods that will be used are motivational interviewing (MI and problem solving treatment (PST, which focus in particular on intrinsic motivation for change and self-management of problems of the participants. The CBP will be provided by trained nurse practitioners in the participant's general practice, and will consists of a maximum of six individual sessions of 30 minutes, followed by 3-monthly booster

  12. Psyllium fiber improves glycemic control proportional to loss of glycemic control: a meta-analysis of data in euglycemic subjects, patients at risk of type 2 diabetes mellitus, and patients being treated for type 2 diabetes mellitus.

    Science.gov (United States)

    Gibb, Roger D; McRorie, Johnson W; Russell, Darrell A; Hasselblad, Vic; D'Alessio, David A

    2015-12-01

    A number of health benefits are associated with intake of soluble, viscous, gel-forming fibers, including reduced serum cholesterol and the attenuation of postprandial glucose excursions. We assess the effects of psyllium, which is a soluble, gel-forming, nonfermented fiber supplement, on glycemic control in patients who were being treated for type 2 diabetes mellitus (T2DM) and in patients who were at risk of developing T2DM. A comprehensive search was performed of available published literature (Scopus scientific database) and clinical records stored by Procter & Gamble with the use of key search terms to identify clinical studies that assessed the glycemic effects of psyllium in nondiabetic, pre-T2DM, and T2DM patients. We identified 35 randomized, controlled, clinical studies that spanned 3 decades and 3 continents. These data were assessed in 8 meta-analyses. In patients with T2DM, multiweek studies (psyllium dosed before meals) showed significant improvement in both the fasting blood glucose (FBG) concentration (-37.0 mg/dL; P psyllium would be an effective addition to a lifestyle-intervention program. The degree of psyllium's glycemic benefit was commensurate with the loss of glycemic control. Because the greatest effect was seen in patients who were being treated for T2DM, additional studies are needed to determine how best to incorporate psyllium into existing prevention and treatment algorithms with concomitant hypoglycemic medications. © 2015 American Society for Nutrition.

  13. High cardiovascular event rates in patients with asymptomatic carotid stenosis: the REACH Registry

    DEFF Research Database (Denmark)

    Aichner, F T; Topakian, R; Alberts, M J

    2009-01-01

    BACKGROUND AND PURPOSE: Data on current cardiovascular event rates in patients with asymptomatic carotid artery stenosis (ACAS) are sparse. We compared the 1-year outcomes of patients with ACAS > or =70% versus patients without ACAS in an international, prospective cohort of outpatients.......26%, P = 0.04), cardiovascular death (2.29% vs. 1.52%, P = 0.002), the composite end-point cardiovascular death/myocardial infarction/stroke (6.03% vs. 4.29%, P events (1.41% vs. 0.81%, P = 0.002). In patients with ACAS, Cox regression analyses identified history of cerebrovascular...... ischaemic events as most important predictor of future stroke (HR 3.21, 95% CI 1.82-5.65, P events. Stroke was powerfully predicted by prior cerebrovascular...

  14. Cardiovascular disease event rates in patients with severe psoriasis treated with systemic anti-inflammatory drugs

    DEFF Research Database (Denmark)

    Ahlehoff, O; Skov, L; Gislason, G

    2013-01-01

    OBJECTIVES: Psoriasis is a chronic inflammatory disorder associated with cardiovascular morbidity and mortality. Systemic anti-inflammatory drugs, including biological agents, are widely used in the treatment of patients with moderate to severe psoriasis and may attenuate the risk of cardiovascular...... disease events. We therefore examined the rate of cardiovascular disease events in patients with severe psoriasis treated with systemic anti-inflammatory drugs. DESIGN, SETTING AND PARTICIPANTS: Individual-level linkage of nationwide administrative databases was used to assess the event rates associated...... with use of biological agents, methotrexate or other therapies, including retinoids, cyclosporine and phototherapy, in Denmark from 2007 to 2009. MAIN OUTCOME MEASURE: Death, myocardial infarction and stroke. RESULTS: A total of 2400 patients with severe psoriasis, including 693 patients treated...

  15. Optimal Blood Pressure Goals in Patients With Hypertension at High Risk for Cardiovascular Events.

    Science.gov (United States)

    Aronow, Wilbert S

    2016-01-01

    Existing epidemiologic and clinical trial data suggest that the blood pressure in patients with hypertension at high risk for cardiovascular events because of coronary artery disease, diabetes mellitus, chronic kidney disease, stroke, or heart failure should be reduced to blood pressure be reduced to 140-145 mm Hg if tolerated in patients aged 80 years and older. Studies from patients with coronary artery disease, diabetes mellitus, chronic kidney disease, stroke, and heart failure will be discussed that support a blood pressure goal of high risk for cardiovascular events.

  16. Effects of liraglutide on cardiovascular risk factors in patients with type 1 diabetes

    DEFF Research Database (Denmark)

    Dejgaard, Thomas F; Johansen, Nanna B; Frandsen, Christian S

    2016-01-01

    We investigated the short-term effect of adding liraglutide 1.8 mg once daily to insulin treatment on cardiovascular risk factors in patients with type 1 diabetes. In total, 100 overweight (BMI ≥25 kg/m(2) ) adult patients (age ≥18 years) with type 1 diabetes and HbA1c ≥ 8% (64 mmol/mol) were....... In conclusion, in patients with long-standing type 1 diabetes, liraglutide as add-on to insulin increased heart rate and did not improve other cardiovascular risk factors after 24 weeks of treatment....

  17. Cardiovascular Disease Risk in Patients with Rheumatic Diseases.

    Science.gov (United States)

    Mackey, Rachel H; Kuller, Lewis H; Moreland, Larry W

    2017-02-01

    Evidence suggests the greater than 1.5 increased risk of cardiovascular disease (CVD) in rheumatoid arthritis (RA) is related to an accelerated burden of subclinical atherosclerosis that develops before the diagnosis of RA. Dyslipidemia in RA is better quantified by lipoproteins and apolipoproteins than cholesterol levels. Current risk factors likely underestimate CVD risk partly by underestimating prior risk factor levels. To reduce CVD risk in RA, control disease activity and aggressively treat CVD risk factors. Some of the two-fold higher risk of heart failure and total mortality in RA may be due to myocardial disease caused by inflammation. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Association Between the Presence of Carotid Artery Plaque and Cardiovascular Events in Patients With Genetic Hypercholesterolemia.

    Science.gov (United States)

    Bea, Ana M; Civeira, Fernando; Jarauta, Estíbaliz; Lamiquiz-Moneo, Itziar; Pérez-Calahorra, Sofía; Marco-Benedí, Victoria; Cenarro, Ana; Mateo-Gallego, Rocío

    2017-07-01

    The equations used in the general population to calculate cardiovascular risk are not useful in genetic hypercholesterolemia (GH). Carotid plaque detection has proved useful in cardiovascular prediction and risk reclassification but there have been no studies of its usefulness in GH. The aim of this study was to determine the association between the presence of carotid artery plaque and the occurrence of cardiovascular events in patients with GH. This study included 1778 persons with GH. The mean follow-up until the occurrence of cardiovascular events was 6.26 years. At presentation, the presence of carotid artery plaque was studied by high-resolution ultrasound. Carotid artery plaque was found in 661 (37.2%) patients: 31.9% with familial hypercholesterolemia, 39.8% with familial combined hyperlipidemia, 45.5% with dysbetalipoproteinemia, and 43.2% with polygenic hypercholesterolemia. During follow-up, 58 patients had a cardiovascular event. Event rates were 6354/100 000 (95%CI, 4432.4-8275.6) in the group with plaque and 1432/100 000 (95%CI, 730.6-2134.3) in the group without plaque, with significant differences between the 2 groups (P < .001). The relative risk of an event was 4.34 (95CI%, 2.44-7.71; P < .001) times higher in patients with plaque and was 2.40 (95%CI, 1.27-4.56; P = .007) times higher after adjustment for major risk factors. The number of carotid artery plaques was positively associated with the risk of cardiovascular events. Most cardiovascular events occur in a subgroup of patients who can be identified by carotid plaque detection. These results support the use of plaque screening in this population and should help in risk stratification and treatment in GH. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  19. Labview Based ECG Patient Monitoring System for Cardiovascular Patient Using SMTP Technology.

    Science.gov (United States)

    Singh, Om Prakash; Mekonnen, Dawit; Malarvili, M B

    2015-01-01

    This paper leads to developing a Labview based ECG patient monitoring system for cardiovascular patient using Simple Mail Transfer Protocol technology. The designed device has been divided into three parts. First part is ECG amplifier circuit, built using instrumentation amplifier (AD620) followed by signal conditioning circuit with the operation amplifier (lm741). Secondly, the DAQ card is used to convert the analog signal into digital form for the further process. Furthermore, the data has been processed in Labview where the digital filter techniques have been implemented to remove the noise from the acquired signal. After processing, the algorithm was developed to calculate the heart rate and to analyze the arrhythmia condition. Finally, SMTP technology has been added in our work to make device more communicative and much more cost-effective solution in telemedicine technology which has been key-problem to realize the telediagnosis and monitoring of ECG signals. The technology also can be easily implemented over already existing Internet.

  20. [Ankle-brachial index screening for peripheral artery disease in high cardiovascular risk patients. Prospective observational study of 370 asymptomatic patients at high cardiovascular risk].

    Science.gov (United States)

    Rada, C; Oummou, S; Merzouk, F; Amarir, B; Boussabnia, G; Bougrini, H; Benzaroual, D; Elkarimi, S; Elhattaoui, M

    2016-12-01

    Peripheral arterial disease is a marker of systemic atherosclerosis; it is associated with a high risk of cardiovascular disease. The aim of our study was to assess the prevalence of peripheral arterial disease by measuring the ankle-brachial pressure index in patients at high cardiovascular risk and to study the risk factors associated with this disease. This was a descriptive and analytic cross-sectional study which focused on 370 patients seen at the medical consultation for atherosclerosis prevention. The ankle-brachial index was measured with a portable Doppler (BIDOP 3) using 4 and 8Hz dual frequency probes. The standards were: normal ankle-brachial index 0.9 to 1.3; peripheral artery obstructive disease ankle-brachial index less than 0.9; poorly compressible artery (medial arterial calcification) ankle-brachial index greater than 1.3. Cardiovascular risk factors were also studied. Three hundred and seventy subjects (mean age 65.5±8.7years) were screened Cardiovascular risk factors were: sedentary lifestyle (91.5 %), hypertension (68.1 %), elevated LDL-cholesterolemia (36.3 %), diabetes (48.3 %) and tobacco smoking (33.8 %). The prevalence of peripheral artery disease was 32.4 % of which 77.5 % were asymptomatic. We found a significant correlation with smoking, diabetes, dyslipidemia and the presence of coronary artery disease or vascular cerebral disease. Screening for peripheral arterial disease (PAD) with the ankle-brachial index has increased the percentage of polyvascular patients from 6.2 to 29 %. Factors independently associated with PAD were advanced age, presence of cardiovascular disease, smoking and glycated hemoglobin. PAD is a common condition in people at high cardiovascular risk, the frequency of asymptomatic forms justifies the screening with pocket Doppler which is a simple, inexpensive and effective test to assess the overall cardiovascular risk. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  1. [Analysis of selected risk factors for cardiovascular diseases in patients scheduled for Coronary Artery Bypass Graft].

    Science.gov (United States)

    Szylińska, Aleksandra; Mikońajczyk, Anna; Pytńak, Mateusz; Mosiejczuk, Hanna; Listewnik, Mariusz; Ptak, Magdalena; Rotter, Iwona

    2015-01-01

    Cardiovascular diseases are classified as diseases of civilization, and constitute a major social problem because they are the main cause of death. For this reason, according to the WHO, more than 17.3 million people die every year in developed countries. In the European Union the number of deaths is over 2 million, and represents 42% of total mortality. The aim of the study was analysis of selected risk factors for cardiovascular disease in patients scheduled for surgical revascularization, and an outline of their social profile. The study was conducted among patients scheduled for surgery in Cardiac Surgery Department SPSK no. 2 in Szczecin. Ninety patients were studied. The research was carried out using proprietary diagnostic surveys and data obtained from medical records. The selected modifiable risk factors for diseases of the cardiovascular system were evaluated. In the study group 15 patients (17%) were current smokers. Most patients (38, 42%) had not smoked for more than 2 years. 33 patients (37%) suffered from diabetes. More than half (47, 52%) of the respondents did not follow a balanced diet. Most of the patients were obese (37, 41%), including 18 diabetics and 19 non-diabetics. 58 patients (64%) suffered from hypertension. Diabetes, obesity, and smoking were confirmed as risk factors for coronary heart disease. The educational activity of family doctors should be mainly focused on the prevention of diabetes, stopping smoking, and lifestyle changes in order to prevent diseases of the cardiovascular system, especially among the elderly.

  2. Cardiovascular changes in patients with primary aldosteronism after surgical or medical treatment.

    Science.gov (United States)

    Bernini, G; Bacca, A; Carli, V; Carrara, D; Materazzi, G; Berti, P; Miccoli, P; Pisano, R; Tantardini, V; Bernini, M; Taddei, S

    2012-03-01

    Data on the cardiovascular middle-term follow-up of patients with primary aldosteronism (PA) are scanty. To detect the cardiovascular effects of surgery in patients with aldosterone (ALD)-producing adenoma (APA) and of pharmacotherapy in those with bilateral adrenal hyperplasia (BAH), a prospective study involving 60 consecutive patients with PA was performed. MATERIAL/ METHODS: Clinical, biochemical, and cardiovascular assessment was obtained before and after (31.5±4.4 months) surgery or proper medical treatment (32.1±5.0 months) in 19 and 41 patients, respectively. As expected, plasma ALD normalized in all operated patients, while in the other group it did not change. Systolic and diastolic blood pressure decreased (pbody mass index (p<0.0008), drug number (p<0.03), and ALD/plasma renin activity ratio (p<0.01). Allocating the patients according to plasma ALD and cardiac parameters, patients who presented ALD reduction during the study also had a decrement in cardiac mass (p<0.04). Our data indicate that in patients with PA the removal of ALD excess by surgery in APA is effective in reducing blood pressure and in improving cardiac parameters, while anti-hypertensive therapy in BAH shows less positive impact on cardiovascular system. © 2012, Editrice Kurtis.

  3. Cardiovascular effects of growth hormone in adult hemodialysis patients: results from a randomized controlled trial

    DEFF Research Database (Denmark)

    Køber, Lars; Rustom, Rana; Wiedmann, Jonas

    2010-01-01

    The high morbidity and mortality rates in hemodialysis (HD) patients are due, at least in part, to their increased risk for cardiovascular diseases (CVD). This prospective study evaluated the effect of growth hormone (GH) on a number of CVD risk markers in adult patients on HD....

  4. Co-morbidity of 'clinical trial' versus 'real-world' patients using cardiovascular drugs

    NARCIS (Netherlands)

    Wieringa, N.F.; Vos, Reinder; van der Werf, G.T.; van der Veen, W.J.; de Graeff, P.A.

    2000-01-01

    Purpose - To examine discrepancies between co-morbidity of patients included in pre marketing clinical trials of cardiovascular drugs and patients from daily practice, representing the actual users after marketing, and to investigate the availability of data regarding co-morbidity in registration

  5. Asymmetric dimethylarginine as a prognostic marker for cardiovascular complications in hypertensive patients

    Directory of Open Access Journals (Sweden)

    Osama Tayeh

    2011-06-01

    Conclusions: ADMA is elevated in hypertensive patients. Elevated ADMA concentrations are associated with impaired endothelium functions, which are demonstrated by NO reduction in the sera of hypertensive patients. ADMA is correlated positively with the traditional cardiovascular risk factors. Also there was a strong significant negative correlation between NO and ADMA levels in the whole hypertensive groups.

  6. Cardiovascular Safety of One-Year Escitalopram Therapy in Clinically Nondepressed Patients With Acute Coronary Syndrome

    DEFF Research Database (Denmark)

    Hanash, Jamal A; Hansen, Baiba H; Hansen, Jørgen F

    2012-01-01

    : Selective serotonin reuptake inhibitors are commonly used for treatment of depression in patients with cardiac diseases. However, evidence of cardiovascular (CV) safety from randomized trials is based on studies of no longer than 6-month duration. We examined the CV safety of 1-year treatment w...... with Selective serotonin reuptake inhibitor escitalopram compared with placebo in patients with recent acute coronary syndrome (ACS)....

  7. Carotid Artery End-Diastolic Velocity and Future Cerebro-Cardiovascular Events in Asymptomatic High Risk Patients.

    Science.gov (United States)

    Chung, Hyemoon; Jung, Young Hak; Kim, Ki-Hyun; Kim, Jong-Youn; Min, Pil-Ki; Yoon, Young Won; Lee, Byoung Kwon; Hong, Bum-Kee; Rim, Se-Joong; Kwon, Hyuck Moon; Choi, Eui-Young

    2016-01-01

    Prognostic value of additional carotid Doppler evaluations to carotid intima-media thickness (IMT) and plaque has not been completely evaluated. A total of 1119 patients with risk factors for, but without, overt coronary artery disease (CAD), who underwent both carotid ultrasound and Doppler examination were included in the present study. Parameters of interest included peak systolic and end-diastolic velocities, resistive indices of the carotid arteries, IMT, and plaque measurements. The primary end-point was all-cause cerebro-cardiovascular events (CVEs) including acute myocardial infarction, coronary revascularization therapy, heart failure admission, stroke, and cardiovascular death. Model 1 covariates comprised age and sex; Model 2 also included hypertension, diabetes and smoking; Model 3 also had use of aspirin and statin; and Model 4 also included IMT and plaque. The mean follow-up duration was 1386±461 days and the mean age of the study population was 60±12 years. Amongst 1119 participants, 43% were women, 57% had a history of hypertension, and 23% had diabetes. During follow-up, 6.6% of patients experienced CVEs. Among carotid Doppler parameters, average common carotid artery end-diastolic velocity was the independent predictor for future CVEs after adjustments for all models variables (HR 0.95 per cm/s, 95% confident interval 0.91-0.99, p=0.034 in Model 4) and significantly increased the predictive value of Model 4 (global χ(2)=59.0 vs. 62.8, p=0.029). Carotid Doppler measurements in addition to IMT and plaque evaluation are independently associated with future CVEs in asymptomatic patients at risk for CAD.

  8. Patient Preferences for Biologicals in Psoriasis: Top Priority of Safety for Cardiovascular Patients.

    Directory of Open Access Journals (Sweden)

    Marthe-Lisa Schaarschmidt

    Full Text Available Patients with psoriasis are often affected by comorbidities, which largely influence treatment decisions. Here we performed conjoint analysis to assess the impact of comorbidities on preferences of patients with moderate-to-severe psoriasis for outcome (probability of 50% and 90% improvement, time until response, sustainability of success, probability of mild and severe adverse events (AE, probability of ACR 20 response and process attributes (treatment location, frequency, duration and delivery method of biologicals. The influence of comorbidities on Relative Importance Scores (RIS was determined with analysis of variance and multivariate regression. Among the 200 participants completing the study, 22.5% suffered from psoriatic arthritis, 31.5% from arterial hypertension, 15% from cardiovascular disease (myocardial infarction, stroke, coronary artery disease, and/or arterial occlusive disease, 14.5% from diabetes, 11% from hyperlipidemia, 26% from chronic bronchitis or asthma and 12.5% from depression. Participants with psoriatic arthritis attached greater importance to ACR 20 response (RIS = 10.3 vs. 5.0, p<0.001; β = 0.278, p<0.001 and sustainability (RIS = 5.8 vs. 5.0, p = 0.032 but less value to time until response (RIS = 3.4 vs. 4.8, p = 0.045 than those without arthritis. Participants with arterial hypertension were particularly interested in a low risk of mild AE (RIS 9.7 vs. 12.1; p = 0.033 and a short treatment duration (RIS = 8.0 vs. 9.6, p = 0.002. Those with cardiovascular disease worried more about mild AE (RIS = 12.8 vs. 10, p = 0.027; β = 0.170, p = 0.027 and severe AE (RIS = 23.2 vs. 16.2, p = 0.001; β = 0.203, p = 0.007 but cared less about time until response (β = -0.189, p = 0.013, treatment location (β = -0.153, p = 0.049, frequency (β = -0.20, p = 0.008 and delivery method (β = -0.175, p = 0.023 than others. Patients' concerns should be addressed in-depth when prescribing biologicals to comorbid patients, keeping in

  9. Progression of Blood Pressure and Cardiovascular Outcomes in Hypertensive Patients in a Reference Center

    Energy Technology Data Exchange (ETDEWEB)

    Guimarães Filho, Gilberto Campos, E-mail: camposguimaraes@yahoo.com.br; Sousa, Ana Luiza Lima; Jardim, Thiago de Souza Veiga; Souza, Weimar Sebba Barroso; Jardim, Paulo César Brandão Veiga [Liga de Hipertensão da Faculdade de Medicina da Universidade Federal de Goiânia, Goiás, GO (Brazil)

    2015-04-15

    Hypertension is a public health problem, considering its high prevalence, low control rate and cardiovascular complications. Evaluate the control of blood pressure (BP) and cardiovascular outcomes in patients enrolled at the Reference Center for Hypertension and Diabetes, located in a medium-sized city in the Midwest Region of Brazil. Population-based study comparing patients enrolled in the service at the time of their admission and after an average follow-up of five years. Participants were aged ≥18 years and were regularly monitored at the Center up to 6 months before data collection. We assessed demographic variables, BP, body mass index, risk factors, and cardiovascular outcomes. We studied 1,298 individuals, predominantly women (60.9%), and with mean age of 56.7±13.1 years. Over time, there was a significant increase in physical inactivity, alcohol consumption, diabetes, dyslipidemia, and excessive weight. As for cardiovascular outcomes, we observed an increase in stroke and myocardial revascularization, and a lower frequency of chronic renal failure. During follow-up, there was significant improvement in the rate of BP control (from 29.6% to 39.6%; p = 0.001) and 72 deaths, 91.7% of which were due to cardiovascular diseases. Despite considerable improvements in the rate of BP control during follow-up, risk factors worsened and cardiovascular outcomes increased.

  10. Backtesting Value-at-Risk

    DEFF Research Database (Denmark)

    Nielsen, Thor Pajhede

    2017-01-01

    Testing the validity of value-at-risk (VaR) forecasts, or backtesting, is an integral part of modern market risk management and regulation. This is often done by applying independence and coverage tests developed by Christoffersen (International Economic Review, 1998; 39(4), 841–862) to so...

  11. [Relationship between cystatin C and coronary artery calcification in patients with intermediate cardiovascular risk].

    Science.gov (United States)

    Ruiz-Salas, Amalio; Cortés-Rodríguez, Miriam; Alegre-Bayo, Nieves; Algarra-García, José; de Teresa Galván, Eduardo; Jiménez-Navarro, Manuel F

    2014-12-23

    Cardiovascular disease is the leading cause of morbimortality in industrialized countries. Quantification of coronary artery calcium (CAC) has been shown to have an independent and incremental prognostic value over traditional risk factors for the prediction of mortality and cardiovascular events. The aim of our study was to determine the possible relationship between CAC and cystatin C (CTC). We included 104 patients with stable chest pain, free of cardiovascular disease and nephropathy, with intermediate cardiovascular risk. Both CAC (Agatston) and CTC were determined. CTC was independently associated with the CAC level and the presence of coronary disease. CTC values may be associated with CAC and coronary disease. Further studies are needed to know the importance of these markers in clinical practice. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  12. Short-term effects of weight loss on the cardiovascular risk factors in morbidly obese patients.

    Science.gov (United States)

    Busetto, Luca; Sergi, Giuseppe; Enzi, Giuliano; Segato, Gianni; De Marchi, Francesco; Foletto, Mirto; De Luca, Maurizio; Pigozzo, Sabrina; Favretti, Franco

    2004-08-01

    To analyze the short-term effects of weight loss on the cardiovascular risk factors in morbidly obese patients. Five metabolic cardiovascular risk factors (blood glucose, blood pressure, total cholesterol, high-density lipoprotein (HDL)-cholesterol, and triglycerides) were determined before and 15.3 +/- 2.1 months after laparoscopic gastric banding in 650 morbidly obese patients. Global cardiovascular risk was calculated according to the Prospective Cardiovascular Münster (PROCAM) scoring system. Mean weight loss was 22.7 +/- 20.4 kg. Normalization of the metabolic alteration was observed in 67.3% of patients with diabetes, 38.3% of patients with hypercholesterolemia, 72.5% of patients with low HDL-cholesterol, 72.3% of patients with hypertriglyceridemia, and 46.7% of patients with hypertension. PROCAM score fell from 31.4 +/- 11.6 to 28.0 +/- 12.0 points (p < 0.001). The modifications of total cholesterol and blood pressure were unrelated to percentage weight loss. Percentage weight loss was significantly related to the reductions of fasting blood glucose, triglyceride level, and the PROCAM score and to the increase of HDL-cholesterol concentrations observed after surgery. However, the strength of these four relationships was generally low. The variations of HDL-cholesterol concentrations and blood pressure levels were more influenced by actual energy balance than by the extent of weight loss. Weight loss observed in the first 12 to 18 months after gastric banding was associated with a significant improvement of single cardiovascular risk factors and global risk. On the other hand, the extent of weight loss was poorly related to the magnitude of improvement in cardiovascular risk.

  13. The safety of addition of nitrous oxide to general anaesthesia in at-risk patients having major non-cardiac surgery (ENIGMA-II): a randomised, single-blind trial.

    Science.gov (United States)

    Myles, Paul S; Leslie, Kate; Chan, Matthew T V; Forbes, Andrew; Peyton, Philip J; Paech, Michael J; Beattie, W Scott; Sessler, Daniel I; Devereaux, P J; Silbert, Brendan; Schricker, Thomas; Wallace, Sophie

    2014-10-18

    Nitrous oxide is commonly used in general anaesthesia but concerns exist that it might increase perioperative cardiovascular risk. We aimed to gather evidence to establish whether nitrous oxide affects perioperative cardiovascular risk. We did an international, randomised, assessor-blinded trial in patients aged at least 45 years with known or suspected coronary artery disease having major non-cardiac surgery. Patients were randomly assigned via automated telephone service, stratified by site, to receive a general anaesthetic with or without nitrous oxide. Attending anaesthetists were aware of patients' group assignments, but patients and assessors were not. The primary outcome measure was a composite of death and cardiovascular complications (non-fatal myocardial infarction, stroke, pulmonary embolism, or cardiac arrest) within 30 days of surgery. Our modified intention-to-treat population included all patients randomly assigned to groups and undergoing induction of general anaesthesia for surgery. This trial is registered at ClinicalTrials.gov, number NCT00430989. Of 10,102 eligible patients, we enrolled 7112 patients between May 30, 2008, and Sept 28, 2013. 3543 were assigned to receive nitrous oxide and 3569 were assigned not to receive nitrous oxide. 3483 patients receiving nitrous oxide and 3509 not receiving nitrous oxide were assessed for the primary outcome. The primary outcome occurred in 283 (8%) patients receiving nitrous oxide and in 296 (8%) patients not receiving nitrous oxide (relative risk 0·96, 95% CI 0·83–1·12; p=0·64). Surgical site infection occurred in 321 (9%) patients assigned to nitrous oxide, and in 311 (9%) patients in the no-nitrous oxide group (p=0·61), and severe nausea and vomiting occurred in 506 patients (15%) assigned to nitrous oxide and 378 patients (11%) not assigned to nitrous oxide (pnitrous oxide use in major non-cardiac surgery. Nitrous oxide did not increase the risk of death and cardiovascular complications or

  14. Budget impact analysis of empagliflozin in T2D patients with a previous cardiovascular disease

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    Sergio Iannazzo

    2017-06-01

    Full Text Available Budget impact analysis of empagliflozin in T2D patients with a previous cardiovascular diseaseIntroductionThe EMPA-REG OUTCOME study demonstrated that empagliflozin is effective in reducing cardiovascular morbidity and mortality in T2D patients with high risk linked to a previous cardiovascular condition. The objective of this study is the budget impact analysis of the use of empagliflozin in this population in Italy.MethodsThe analysis was conducted from the cost perspective of the Italian NHS with a 3-year time horizon. The target population, defined as T2D patients with a known cardiovascular disease, was estimated based on epidemiologic and market data. An uptake of empagliflozin growing from 10% to 30% was considered to add up or substitute combinations of metformin, insulin, glitazones and DPP-4. The uptake of 80-100% was considered to substitute sulfonylureas and repaglinide. Costs, including drugs, glycaemia monitoring, management of severe hypoglycaemia events, and cardiovascular and renal events, were estimated based on published literature and current tariffs.ResultsThe target population was estimated in 243,693 in the first year. The incremental cost for drugs (17.6 million Euro is entirely offset by the savings in glycaemia monitoring (8.1 million Euro, cardiovascular and renal events (8.8 million Euro and severe hypoglycaemic events (3.1 million Euro, with a net saving of 2.3 million Euro, approximately corresponding to -0.7% of the total expenditure. The cumulative budget impact in the 3 years was 4.9 million Euro (-0.5%.ConclusionsThe progressive adoption of empagliflozin to treat T2D patients with known cardiovascular disease in Italy, would provide significant clinical benefit without entailing additional expense for the Italian NHS.

  15. Antiplatelet treatment in the primary prophylaxis of cardiovascular disease in patients with arterial hypertension.

    Science.gov (United States)

    Osińska, Angelika; Osiński, Maciej; Krasińska, Aleksandra; Begier-Krasińska, Beata

    2017-06-01

    The benefits of using acetylsalicylic acid (ASA) in the primary prophylaxis of cardiovascular diseases may only slightly exceed the risk of serious bleeding. This warrants the search for alternative, safer preparations with antiaggregatory properties, which could be used in patients burdened with cardiovascular risk factors. Antiaggregatory compounds identified in water-soluble tomato extract include nucleosides, flavonoids, and phenolic acids. The action of standardized tomato extract is multidirectional, reversible, and weaker in comparison to ASA. The European Food Safety Authority (EFSA) has approved this preparation as a dietary agent with antiaggregatory properties. The use of standardized tomato extract appears beneficial in arterial hypertension patients with low or moderate cardiovascular risk and in patients in whom good pressure control cannot be achieved.

  16. Ankle-brachial blood pressure index predicts all-cause and cardiovascular mortality in hemodialysis patients.

    Science.gov (United States)

    Ono, Kumeo; Tsuchida, Akiyasu; Kawai, Hironobu; Matsuo, Hidenori; Wakamatsu, Ryouji; Maezawa, Akira; Yano, Shintarou; Kawada, Tomoyuki; Nojima, Yoshihisa

    2003-06-01

    A reduction in ankle-brachial BP index (ABPI) is associated with generalized atherosclerotic diseases and predicts cardiovascular mortality and morbidity in several patient populations. However, a large-scale analysis of ABPI is lacking for hemodialysis (HD) patients, and its use in this population is not fully validated. A cohort of 1010 Japanese patients undergoing chronic hemodialysis was studied between November 1999 and May 2002. Mean age at entry was 60.6 +/- 12.5 yr, and duration of follow-up was 22.3 +/- 5.6 mo. Patients were stratified into five groups ( or = 0.9 to or = 1.0 to or = 1.1 to or = 1.3) by ABPI measured at entry by an oscillometric method. The frequency distribution of ABPI was 16.5% of patients or = 0.9 to or = to or 1.1 to or = 1.3). The relative risk of a history of diabetes mellitus (DM), cardiovascular, and cerebrovascular disease was significantly higher in patients with lower ABPI than those with ABPI > or = 1.1 to or = 0.9 to or = 1.3) also had poor prognosis (HR, 2.33 [1.11 to 4.89] and 3.04 [1.14 to 8.12] for all-cause and cardiovascular mortality, respectively). Thus, the present findings validate ABPI as a powerful and independent predictor for all-cause and cardiovascular mortality among hemodialysis patients.

  17. Cardiovascular disease and risk factors in patients with psoriasis and psoriatic arthritis.

    LENUS (Irish Health Repository)

    Tobin, Anne-Marie

    2012-02-01

    OBJECTIVE: Patients with psoriasis and psoriatic arthritis (PsA) have an increased incidence of cardiovascular disease (CVD) and cardiovascular risk factors such as smoking, hypertension, and metabolic syndrome compared to the normal population. Patients with psoriasis and PsA may also have increased risk from nonconventional risk factors such as raised levels of homocysteine and excessive alcohol consumption. We conducted a comprehensive review of the literature on CVD and all cardiovascular risk factors in patients with psoriasis and PsA. METHODS: Data sources: All studies identified from a Medline (www.ncbi.nlm.nih.gov) search pertaining to CVD, individual risk factors in psoriasis, and PsA were included. Study selection: Studies included a healthy reference population, were published between 1975 and 2009, and were written in English. RESULTS: Our search yielded 14 studies that documented rates of CVD in patients with psoriasis and PsA compared to controls. Substantial evidence points to elevated risk of CVD in patients with psoriasis and PsA. CONCLUSION: It remains difficult to conclude if risk factors are caused by psoriasis or share a common pathogenesis. Physicians treating patients with psoriasis and PsA must be aware of all potential cardiovascular risk factors in their patients.

  18. GPla Polymorphisms Are Associated with Outcomes in Patients at High Cardiovascular Risk

    Directory of Open Access Journals (Sweden)

    Dominik Rath

    2017-08-01

    Full Text Available BackgroundPlatelet membrane glycoprotein receptors mediate thrombus formation. GP Ia/IIa is an essential platelet integrin receptor. Single-nucleotide polymorphisms (SNPs of the GP Ia/IIa gene alter GP Ia/IIa expression; however, their influence on cardiovascular disease remains unclear. This study aimed to investigate the effect of the GP Ia/IIa SNPs rs1126643 and rs1062535 on clinical outcomes in a large collective including high-risk patients with cardiovascular disease.Methods and resultsGP Ia SNP analysis was performed in 943 patients with symptomatic coronary artery disease. All patients were tracked for all-cause death, myocardial infarction, and ischemic stroke for 360 days. Homozygous carriers of the minor allele showed significantly worse event-free survival when compared with major allele carriers in the complete collective as well as in the subset of high-risk patients (carrying all of the following three risk factors: diabetes type II, hypertension, and hyperlipidemia. There was no significant difference in the subset of low-risk patients (carrying none of the three risk factors.ConclusionsGPla SNPs are associated with cardiovascular prognosis especially in high-risk patients. Identification of GPIa SNPs is of importance to tailor therapies in patients at already high cardiovascular risk.

  19. Cardiovascular Autonomic Dysfunction in Patients with Morbid Obesity

    Energy Technology Data Exchange (ETDEWEB)

    Sant Anna Junior, Maurício de [Programa de Tratamento Multidisciplinar da Obesidade do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro, RJ (Brazil); Departamento de Fisioterapia do Centro Universitário Anhanguera Niterói - UNIAN, Niterói, RJ (Brazil); Programa de pós-graduação em Ciências Médicas, Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Rio de Janeiro, RJ (Brazil); Carneiro, João Regis Ivar; Carvalhal, Renata Ferreira [Programa de Tratamento Multidisciplinar da Obesidade do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro, RJ (Brazil); Torres, Diego de Faria Magalhães [Programa de Tratamento Multidisciplinar da Obesidade do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro, RJ (Brazil); Departamento de Fisioterapia da Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ (Brazil); Cruz, Gustavo Gavina da; Quaresma, José Carlos do Vale [Programa de Tratamento Multidisciplinar da Obesidade do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro, RJ (Brazil); Lugon, Jocemir Ronaldo [Divisão de Nefrologia - Faculdade de Medicina da Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Guimarães, Fernando Silva, E-mail: fguimaraes_pg@yahoo.com.br [Departamento de Fisioterapia da Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ (Brazil); Programa de pós-graduação em Ciências da Reabilitação - Centro Universitário Augusto Motta, Rio de Janeiro, RJ (Brazil)

    2015-12-15

    Morbid obesity is directly related to deterioration in cardiorespiratory capacity, including changes in cardiovascular autonomic modulation. This study aimed to assess the cardiovascular autonomic function in morbidly obese individuals. Cross-sectional study, including two groups of participants: Group I, composed by 50 morbidly obese subjects, and Group II, composed by 30 nonobese subjects. The autonomic function was assessed by heart rate variability in the time domain (standard deviation of all normal RR intervals [SDNN]; standard deviation of the normal R-R intervals [SDNN]; square root of the mean squared differences of successive R-R intervals [RMSSD]; and the percentage of interval differences of successive R-R intervals greater than 50 milliseconds [pNN50] than the adjacent interval), and in the frequency domain (high frequency [HF]; low frequency [LF]: integration of power spectral density function in high frequency and low frequency ranges respectively). Between-group comparisons were performed by the Student’s t-test, with a level of significance of 5%. Obese subjects had lower values of SDNN (40.0 ± 18.0 ms vs. 70.0 ± 27.8 ms; p = 0.0004), RMSSD (23.7 ± 13.0 ms vs. 40.3 ± 22.4 ms; p = 0.0030), pNN50 (14.8 ± 10.4 % vs. 25.9 ± 7.2%; p = 0.0061) and HF (30.0 ± 17.5 Hz vs. 51.7 ± 25.5 Hz; p = 0.0023) than controls. Mean LF/HF ratio was higher in Group I (5.0 ± 2.8 vs. 1.0 ± 0.9; p = 0.0189), indicating changes in the sympathovagal balance. No statistical difference in LF was observed between Group I and Group II (50.1 ± 30.2 Hz vs. 40.9 ± 23.9 Hz; p = 0.9013). morbidly obese individuals have increased sympathetic activity and reduced parasympathetic activity, featuring cardiovascular autonomic dysfunction.

  20. Development and evaluation of a patient centered cardiovascular health education program for insured patients in rural Nigeria (QUICK - II

    Directory of Open Access Journals (Sweden)

    Osibogun Akin

    2011-03-01

    Full Text Available Abstract Background In Sub Saharan Africa, the incidence of hypertension and other modifiable cardiovascular risk factors is growing rapidly. Poor adherence to prescribed prevention and treatment regimens by patients can compromise treatment outcomes. Patient-centered cardiovascular health education is likely to improve shortcomings in adherence. This paper describes a study that aims to develop a cardiovascular health education program for patients participating in a subsidized insurance plan in Nigeria and to evaluate the applicability and effectiveness in patients at increased risk for cardiovascular disease. Methods/Design Design: The study has two parts. Part 1 will develop a cardiovascular health education program, using qualitative interviews with stakeholders. Part 2 will evaluate the effectiveness of the program in patients, using a prospective (pre-post observational design. Setting: A rural primary health center in Kwara State, Nigeria. Population: For part 1: 40 patients, 10 healthcare professionals, and 5 insurance managers. For part 2: 150 patients with uncontrolled hypertension or other cardiovascular risk factors after one year of treatment. Intervention: Part 2: patient-centered cardiovascular health education program. Measurements: Part 1: Semi-structured interviews to identify stakeholder perspectives. Part 2: Pre- and post-intervention assessments including patients' demographic and socioeconomic data, blood pressure, body mass index and self-reporting measures on medication adherence and perception of care. Feasibility of the intervention will be measured using process data. Outcomes: For program development (part 1: overview of healthcare professionals' perceptions on barriers and facilitators to care, protocol for patient education, and protocol implementation plan. For program evaluation (part 2: changes in patients' scores on adherence to medication and life style changes, blood pressure, and other physiological and self

  1. Cardiovascular comorbidity in patients with restless legs syndrome: current perspectives

    Directory of Open Access Journals (Sweden)

    Vargas-Pérez NJ

    2017-05-01

    Full Text Available Noel J Vargas-Pérez, Kanika Bagai, Arthur S Walters Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA Introduction: Restless legs syndrome (RLS is a sensorimotor neurological disorder associated with poor quality of life. Growing evidence links RLS and periodic limb movement in sleep (PLMS with increased risk of cardiovascular and cerebrovascular disease. This article reviews the association of RLS and PLMS with cardiovascular disease (CVD. Methods: PubMed and Medline database (1990 to July 2016 were searched for the terms “restless legs,” “restless legs syndrome,” “periodic limb movements,” “periodic limb movements in sleep” cross-referenced with “cardiovascular disease,” “heart disease,” “coronary artery disease,” “coronary heart disease,” “heart arrhythmia,” “heart failure,” “congestive heart failure,” “echocardiogram,” “echocardiographic,” “hypertension,” “high blood pressure,” “cerebrovascular disease,” “stroke,” “autonomic nervous system,” “heart rate,” “heart rate variability,” “hypoxia,” “microcirculation,” “oxidative stress,” “inflammation,” “chronic kidney disease,” “end-stage renal disease,” “renal disease,” “hemodialysis,” “multiple sclerosis,” “Parkinson,” “Parkinson’s,” “iron deficiency anemia,” and “mortality.” Other relevant articles from the reference list of the above-matched manuscripts were also reviewed. Studies that did not specify the diagnostic criteria for RLS or manuscripts in languages other than English were excluded. Articles with emphasis in RLS secondary to pregnancy were not included in this manuscript.Results: Eighty-six original articles were included in this review. Although mixed results were found regarding the association of RLS and PLMS with CVD, hypertension, stroke and mortality, an informal review of the literature does suggest that the

  2. The "Aachen fall prevention App" - a Smartphone application app for the self-assessment of elderly patients at risk for ground level falls

    OpenAIRE

    Rasche, Peter Wilhelm Victor; Mertens, Alexander Wilhelm; Bröhl, Christina; Theis, Sabine; Seinsch, Tobias; Wille, Matthias; Pape, Hans-Christoph; Knobe, Matthias

    2017-01-01

    Background Fall incidents are a major problem for patients and healthcare. The ?Aachen Fall Prevention App? (AFPA) represents the first mobile Health (mHealth) application (app) empowering older patients (persons 50+ years) to self-assess and monitor their individual fall risk. Self-assessment is based on the ?Aachen Fall Prevention Scale,? which consists of three steps. First, patients answer ten standardized yes?no questions (positive criterion???5 ?Yes? responses). Second, a ten-second tes...

  3. Subclinical inflammation on MRI of hand and foot of anticitrullinated peptide antibody-negative arthralgia patients at risk for rheumatoid arthritis.

    Science.gov (United States)

    van Steenbergen, Hanna W; van Nies, Jessica A B; Huizinga, Tom W J; Reijnierse, Monique; van der Helm-van Mil, Annette H M

    2014-04-10

    It is known that anticitrullinated peptide antibody (ACPA)-positive rheumatoid arthritis (RA) has a preclinical phase. Whether this phase is also present in ACPA-negative RA is unknown. To determine this, we studied ACPA-negative arthralgia patients who were considered prone to progress to RA for local subclinical inflammation observed on hand and foot magnetic resonance imaging (MRI) scans. We studied a total of 64 ACPA-negative patients without clinically detectable arthritis and with arthralgia of the small joints within the previous 1 year. Because of the character of the patients' symptoms, the rheumatologists considered these patients to be prone to progress to RA. For comparisons, we evaluated 19 healthy, symptom-free controls and 20 ACPA-negative RA patients, who were identified according to the 1987 American Rheumatism Association criteria. All participants underwent MRI of unilateral wrist, metacarpophalangeal and metatarsophalangeal joints. Synovitis and bone marrow oedema (BME) were scored according to the OMERACT rheumatoid arthritis magnetic resonance imaging scoring system, and the scores were summed to yield the 'MRI inflammation score'. Scores were compared between groups. Among the ACPA-negative arthralgia patients, MRI inflammation scores were related to C-reactive protein (CRP) levels and the tenderness of scanned joints. MRI inflammation scores increased progressively among the groups of controls and ACPA-negative arthralgia and RA patients (median scores = 0, 1 and 10, respectively; P arthritis. These five patients had higher scores for MRI inflammation (P = 0.001), synovitis (P = 0.002) and BME (P = 0.003) compared to the other patients. Subclinical synovitis was observed in the small joints of ACPA-negative arthralgia patients, and especially in patients whose conditions progressed to clinically detectable arthritis. This finding suggests the presence of a preclinical phase in ACPA-negative RA. Further longitudinal studies

  4. Cardiovascular function and predictors of exercise capacity in patients with colorectal cancer.

    Science.gov (United States)

    Cramer, Larissa; Hildebrandt, Bert; Kung, Thomas; Wichmann, Kristin; Springer, Jochen; Doehner, Wolfram; Sandek, Anja; Valentova, Miroslava; Stojakovic, Tatjana; Scharnagl, Hubert; Riess, Hanno; Anker, Stefan D; von Haehling, Stephan

    2014-09-30

    Patients with colorectal cancer (CRC) often present with dyspnea and fatigue. These are also frequent symptoms in patients with chronic heart failure (CHF). We hypothesized that similar patterns of cardiovascular perturbations are present in CRC and CHF. We prospectively studied 50 patients with CRC, 51 patients with CHF, and 51 control subjects. The CRC group was divided into 2 subgroups: patients who underwent chemotherapy (n = 26) and chemotherapy-naive patients (n = 24). We assessed exercise capacity (spiroergometry), cardiac function (echocardiography), heart rate variability (Holter electrocardiography), body composition (dual-energy x-ray absorptiometry), and blood parameters. Compared with the control arm, the left ventricular ejection fraction (CRC group 59.4%; control group 62.5%) and exercise performance as assessed by peak oxygen consumption (peak VO2) (CRC group 21.8 ml/kg/min; control group 28.0 ml/kg/min) were significantly reduced in CRC patients (both p cardiovascular function were impaired in chemotherapy-treated patients and in the chemotherapy-naive patients, particularly with regard to exercise capacity, left ventricular ejection fraction, lean mass, and heart rate variability (all p cardiovascular function are impaired in patients with CRC. More importantly, our findings were evident independently of whether patients were undergoing chemotherapy. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.