WorldWideScience

Sample records for pre-hospital coronary care

  1. Acute coronary syndromes: is there a place for a real pre-hospital treatment for patients "en route" to the coronary intensive care unit?

    Science.gov (United States)

    Assez, Nathalie; Smith, Grégoire; Adriansen, Christophe; Aboukais, Wissam; Wiel, Eric; Goldstein, Patrick

    2012-08-01

    Acute initial management of patients with acute coronary syndrome (ACS) is based on a precise clinical and electrocardiographic diagnosis. Initial risk stratification in the pre-hospital phase is the key step. The last step, adequate patient routing, is decided based on emergency level and reperfusion strategies, considered right from the pre-hospital phase. The management of a patient with an ACS requires close collaboration between emergency physicians and cardiologists, according to simplified protocols for easier access to catheterisation. The next challenges for the pre-hospital management of ACS are based on: - precise knowledge of new antiplatelet and anticoagulant drugs by the emergency physicians, in order to adjust their prescriptions to the patient profile; - developing co-operation between hospitals, according to regional specificities (geographic considerations and distribution of PCI centres) in order to reduce access time to catheterisation rooms; - organising the healthcare network, where the SAMU has an essential role in coordinating the different medical actors; - regular analysis of the evolution of our professional practices, considering, e.g., the guidelines of the "HAS" (French official healthcare guidelines institute);- integrating pre-hospital medicine in health prevention programmes; - improving our understanding of the population's presentations of coronary artery disease, in order to encourage the patients and their families to call the EMS as soon as possible. The challenge of the emergency physician is to adapt the strategies to the patient's needs.

  2. Pre-hospital and hospital delay in patients with non-ST elevation acute coronary syndromes in tertiary care

    Directory of Open Access Journals (Sweden)

    G.S. Youssef

    2017-09-01

    Conclusion: Pre-hospital delay was mainly patient-related. Hospital delay was mainly related to healthcare resources. Governmental measures to promote ambulance emergency services may reduce the pre-hospital delay, while improving the utilization of healthcare resources may reduce hospital delay.

  3. Pre-hospital Emergency Care

    African Journals Online (AJOL)

    20 Apr 1974 ... lance services, training programmes that are not geared to the needs of these personnel and, not least, a lack of interest on the part of the medical profession, with a few notable exceptions, in the whole question of emergency care. There is a re- luctance on the part of many doctors to assist in the training of ...

  4. PRE-HOSPITAL EMERGENCY CARE IN SWEDEN

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    Ulf BJÖRNSTIG

    2004-01-01

    In Sweden (9 million inhabitants, a sparsely populated country with sometimes long transportation distances to the nearest trauma hospital, 800 ambulances, 7 ambulance helicopters and 3–5 fixed wing ambulance aircraft are the available transport resources. In case of a mass casualty or disaster situation, inside or outside the country, a governmental project (Swedish National Medevac aims to convert a passenger aircraft from Scandinavian Airlines System (SAS to a qualified medical resource for long distance transport, with capacity to nurse six intensive care patients and an additional 6–20 lieing or seated patients during transport.

  5. Pre-hospital critical care by anaesthesiologist-staffed pre-hospital services in Scandinavia

    DEFF Research Database (Denmark)

    Krüger, A J; Lossius, H M; Mikkelsen, S

    2013-01-01

    All Scandinavian countries provide anaesthesiologist-staffed pre-hospital services. Little is known of the incidence of critical illness or injury attended by these services. We aimed to investigate anaesthesiologist-staffed pre-hospital services in Scandinavia with special emphasis on incidence...

  6. Standardised pre-hospital care of acute myocardial infarction patients: MISSION! guidelines applied in practice

    NARCIS (Netherlands)

    Atary, J. Z.; de Visser, M.; van den Dijk, R.; Bosch, J.; Liem, S. S.; Antoni, M. L.; Bootsma, M.; Viergever, E. P.; Kirchhof, C. J.; Padmos, I.; Sedney, M. I.; van Exel, H. J.; Verwey, H. F.; Atsma, D. E.; van der Wal, E. E.; Jukema, J. W.; Schalij, M. J.

    2010-01-01

    Background. To improve acute myocardial infarction (AMI) care in the region 'Hollands-Midden' (the Netherlands), a standardised guideline-based care program was developed (MISSION!). This study aimed to evaluate the outcome of the pre-hospital part of the MISSION! program and to study potential

  7. Psychological consequences of aggression in pre-hospital emergency care: cross sectional survey.

    Science.gov (United States)

    Bernaldo-De-Quirós, Mónica; Piccini, Ana T; Gómez, M Mar; Cerdeira, Jose C

    2015-01-01

    Pre-hospital emergency care is a particularly vulnerable setting for workplace violence. However, there is no literature available to date on the psychological consequences of violence in pre-hospital emergency care. To evaluate the psychological consequences of exposure to workplace violence from patients and those accompanying them in pre-hospital emergency care. A retrospective cross-sectional study. 70 pre-hospital emergency care services located in Madrid region. A randomized sample of 441 health care workers (135 physicians, 127 nurses and 179 emergency care assistants). Data were collected from February to May 2012. The survey was divided into four sections: demographic/professional information, level of burnout determined by Maslach Burnout Inventory (MBI), mental health status using General Health Questionnaire (GHQ-28) and frequency and type of violent behaviour experienced by staff members. The health care professionals who had been exposed to physical and verbal violence presented a significantly higher percentage of anxiety, emotional exhaustion, depersonalization and burnout syndrome compared with those who had not been subjected to any aggression. Frequency of verbal violence (more than five times) was related to emotional exhaustion and depersonalization. Type of violence (i.e. physical aggression) is especially related to high anxiety levels and frequency of verbal aggression is associated with burnout (emotional exhaustion and depersonalization). Psychological counselling should be made available to professional staff who have been subjected to physical aggression or frequent verbal violence. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Medical Decision Algorithm for Pre-Hospital Trauma Care. Phase I.

    Science.gov (United States)

    1996-09-01

    Algorithm for Pre-Hospital Trauma Care PRINCIPAL INVESTIGATOR: Donald K. Wedding, P.E., Ph.D CONTRACTING ORGANIZATION : Photonics Systems, Incorporated... ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER Photonics Systems, Incorporated Northwood, Ohio 43619 9. SPONSORING...three areas: 1) data acquisition, 2) neural network design, and 3) system architechture design. In the first area of this research, a triage database

  9. Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature.

    Science.gov (United States)

    Hood, Natalie; Considine, Julie

    2015-08-01

    Spinal immobilisation has been a mainstay of trauma care for decades and is based on the premise that immobilisation will prevent further neurological compromise in patients with a spinal column injury. The aim of this systematic review was to examine the evidence related to spinal immobilisation in pre-hospital and emergency care settings. In February 2015, we performed a systematic literature review of English language publications from 1966 to January 2015 indexed in MEDLINE and Cochrane library using the following search terms: 'spinal injuries' OR 'spinal cord injuries' AND 'emergency treatment' OR 'emergency care' OR 'first aid' AND immobilisation. EMBASE was searched for keywords 'spinal injury OR 'spinal cord injury' OR 'spine fracture AND 'emergency care' OR 'prehospital care'. There were 47 studies meeting inclusion criteria for further review. Ten studies were case series (level of evidence IV) and there were 37 studies from which data were extrapolated from healthy volunteers, cadavers or multiple trauma patients. There were 15 studies that were supportive, 13 studies that were neutral, and 19 studies opposing spinal immobilisation. There are no published high-level studies that assess the efficacy of spinal immobilisation in pre-hospital and emergency care settings. Almost all of the current evidence is related to spinal immobilisation is extrapolated data, mostly from healthy volunteers. Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

  10. Mental Health and Job Burnout Among Pre-Hospital Emergency Care Personnel

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    Mahsa Haji Mohammad Hoseini

    2017-01-01

    Full Text Available Background: Work environment dictates physical, social and mental tensions each of which affect the staff’s health. Likewise, pre-hospital emergency care staff, due to the special nature of their job, are exposed to the tensions of emergency situations which can affect their health. Therefore, this study was conducted to scrutinize the relationship between the job burnout and mental health in pre-hospital emergencies of Qom Province. Materials and Methods: In this descriptive sectional study, 150 employed personnel of Qom 115 Emergency Care entered the study using census method. Data were gathered using questionnaires of “Background and Clinical Information”, “Mental Health”, and “Job Burnout”, and then based on central indices, Pearson correlation test and multiple linear regression statistical tests were run through software SPSS13 and then analyzed. Results: The average age of the participants was 30.8±5.8. The averages of the values of burnout and mental health were 69.43±12.4 and 60±14.1, respectively. According to Pearson correlation test, the values of the burnout and mental health have a significant negative correlation (r=-0.8. The results of multiple linear regression test showed that the correlation of the burnout and mental health considering the confounding variables is significant. (P=0.05 Conclusion: Pre-hospital employed personnel have desirable mental health and [low] burnout. Furthermore, improved mental health results in decreasing job burnout. Therefore, it is advisable to consider necessary facilities for caring for oneself.

  11. Instrument for assessing the quality of mobile emergency pre-hospital care: content validation

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    Rodrigo Assis Neves Dantas

    2015-06-01

    Full Text Available OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K and Content Validity Index (CVI, considering K> 0.80 and CVI ≥ 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services.

  12. Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines.

    Science.gov (United States)

    Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A; Parkinson, Martin; Dickson, Jon M

    2015-01-01

    Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  13. Characterization of trauma patients treated in a pre-hospital care service

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    Amanda de Ornelas Carvalho

    2004-09-01

    Full Text Available Objectives: To identify the characteristics of trauma patientstreated in a pre-hospital care service, to characterize the factorsrelated to the trauma event and quantify the severity of trauma,according to the Revised Trauma Score. Methods: This is adescriptive, exploratory, retrospective study carried out at thePre-Hospital Care Service of the Military Police - Rescue in thecity of São Paulo. Data comprised a randomized sample of 60nursing charts, distributed among the four advanced life supportunits in the city. Results: Of the occurrences dealt with, 65% arerelated to public streets, 20% are medical cases, 65% are maleindividuals, predominantly young adults. The predominantmechanisms of trauma are crash and run-over. Casa Verde wasthe care unit which obtained the highest Revised Trauma Scoreweighted mean. Conclusions: The results presented here are inconformity with the national statistics on trauma: young adults, ofworking age, involved in road accidents are most frequentlyaffected. Identifying this population is of utmost importance forthe development of preventive and educational measures.

  14. Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Montalescot, Gilles; van 't Hof, Arnoud W; Bolognese, Leonardo

    2016-01-01

    OBJECTIVES: The aim of this landmark exploratory analysis, ATLANTIC-H(24), was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST...... hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min). METHODS: The ATLANTIC-H(24) analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction flow grade 3, ≥ 70% ST...... except death (1.1% vs. 0.2%; p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events. CONCLUSIONS: The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions...

  15. Cost-benefit analysis of telehealth in pre-hospital care.

    Science.gov (United States)

    Langabeer, James R; Champagne-Langabeer, Tiffany; Alqusairi, Diaa; Kim, Junghyun; Jackson, Adria; Persse, David; Gonzalez, Michael

    2017-09-01

    Objective There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. Methods Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost-benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention. The intervention consisted of telehealth-based consultation between the 911 patient and an EMS physician, to evaluate and triage the necessity for patient transport to a hospital emergency department (ED). Patients with non-urgent, primary care-related conditions were then scheduled and transported by alternative means to an affiliated primary care clinic. We measured CBA as both total cost savings and cost per ED visit averted, in US Dollars ($USD). Results In total, 5570 patients were treated over the first full 12 months with a telehealth-enabled care model. We found a 6.7% absolute reduction in potentially medically unnecessary ED visits, and a 44-minute reduction in total ambulance back-in-service times. The average cost for a telehealth patient was $167, which was a statistically significantly $103 less than the control group ( p cost savings from the societal perspective, or $2468 cost savings per ED visit averted (benefit). Conclusion Patient care enabled by telehealth in a pre-hospital environment, is a more cost effective alternative compared to the traditional EMS 'treat and transport to ED' model.

  16. The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration

    Directory of Open Access Journals (Sweden)

    Lockey David

    2011-10-01

    Full Text Available Abstract Background Physician-manned emergency medical teams supplement other emergency medical services in some countries. These teams are often selectively deployed to patients who are considered likely to require critical care treatment in the pre-hospital phase. The evidence base for guidelines for pre-hospital triage and immediate medical care is often poor. We used a recognised consensus methodology to define key priority areas for research within the subfield of physician-provided pre-hospital critical care. Methods A European expert panel participated in a consensus process based upon a four-stage modified nominal group technique that included a consensus meeting. Results The expert panel concluded that the five most important areas for further research in the field of physician-based pre-hospital critical care were the following: Appropriate staffing and training in pre-hospital critical care and the effect on outcomes, advanced airway management in pre-hospital care, definition of time windows for key critical interventions which are indicated in the pre-hospital phase of care, the role of pre-hospital ultrasound and dispatch criteria for pre-hospital critical care services. Conclusion A modified nominal group technique was successfully used by a European expert group to reach consensus on the most important research priorities in physician-provided pre-hospital critical care.

  17. Trauma-informed care for children in the ambulance : international survey among pre-hospital providers

    NARCIS (Netherlands)

    Alisic, Eva; Tyler, Mark P; Giummarra, Melita J; Kassam-Adams, Rahim; Gouweloos, Juul; Landolt, Markus A; Kassam-Adams, Nancy

    2017-01-01

    Background: Pre-hospital providers, such as paramedics and emergency medical technicians, are in a position to provide key emotional support to injured children and their families. Objective: Our goal was to examine (a) pre-hospital providers' knowledge of traumatic stress in children, attitudes

  18. Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, Jacob Thorsted; Terkelsen, Christian Juhl; Nørgaard, Bjarne Linde

    2011-01-01

    Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-elevation myocardial infarction (STEMI). The distance to primary PCI centres and the inherent time delay in delivering primary PCI, however, limit widespread use of this treatment. This study aimed to evaluate...... the impact of pre-hospital diagnosis on time from emergency medical services contact to balloon inflation (system delay) in an unselected cohort of patients with STEMI recruited from a large geographical area comprising both urban and rural districts....

  19. Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review.

    Science.gov (United States)

    Goldstein, Judah P; Andrew, Melissa K; Travers, Andrew

    2012-03-01

    Older adults use more health-care services per capita than younger age groups and the older adult population varies greatly in its needs. Evidence suggests that there is a critical distinction between relative frailty and fitness in older adults. Here, we review how frailty is described in the pre-hospital literature and in the broader emergency medicine literature. PubMed was used as the primary database, but was augmented by searches of CINAHL and EMBASE. Articles were included if they focused on patients 60 years and older and implemented a definition of frailty or risk screening tool in the Emergency Medical Services (EMS) or Emergency Department setting. IN THE BROAD CLINICAL LITERATURE, THREE TYPES OF MEASURES CAN BE IDENTIFIED: frailty index measures, frailty scales, and a phenotypic definition. Each offers advantages and disadvantages for the EMS stakeholder. We identified no EMS literature on frailty conceptualization or management, although some risk measures from emergency medicine use terms that overlap with the frailty literature. There is a paucity of research on frailty in the Emergency Medical Services literature. No research was identified that specifically addressed frailty conceptualization or management in EMS patients. There is a compelling need for further research in this area.

  20. Verbal abuse and mobbing in pre-hospital care services in Chile.

    Science.gov (United States)

    Campo, Varinia Rodríguez; Klijn, Tatiana Paravic

    2018-01-08

    to determine the perception of verbal abuse and mobbing and the associated factors of paramedic technicians (nursing assistants) and professionals (nurses, midwives, kinesiologists) in the pre-hospital care areas of three regions in the south of Chile. descriptive and correlational study was performed within the professional community and a two-stage sample of the paramedic technician population in three regions. The questionnaire "workplace violence in the health sector" (spanish version) was applied after signing the informed consent. 51.4% of professionals and 46.6% of paramedic technicians consider they have been verbally abused during last year. 17.6% of paramedic technicians and 13.5% of professionals perceived mobbing. A low percentage of these events are reported. In only one case of mobbing, the aggressor was legally penalized. No significant differences were found between the job categories and the studied regions. A high percentage of participants in each group perceived verbal abuse and non-minor percentage perceived mobbing, but most of these events are not reported.

  1. Barriers and facilitators to provide effective pre-hospital trauma care for road traffic injury victims in Iran: a grounded theory approach

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    Hasselberg Marie

    2010-11-01

    Full Text Available Abstract Background Road traffic injuries are a major global public health problem. Improvements in pre-hospital trauma care can help minimize mortality and morbidity from road traffic injuries (RTIs worldwide, particularly in low- and middle-income countries (LMICs with a high rate of RTIs such as Iran. The current study aimed to explore pre-hospital trauma care process for RTI victims in Iran and to identify potential areas for improvements based on the experience and perception of pre-hospital trauma care professionals. Methods A qualitative study design using a grounded theory approach was selected. The data, collected via in-depth interviews with 15 pre-hospital trauma care professionals, were analyzed using the constant comparative method. Results Seven categories emerged to describe the factors that hinder or facilitate an effective pre-hospital trauma care process: (1 administration and organization, (2 staff qualifications and competences, (3 availability and distribution of resources, (4 communication and transportation, (5 involved organizations, (6 laypeople and (7 infrastructure. The core category that emerged from the other categories was defined as "interaction and common understanding". Moreover, a conceptual model was developed based on the categories. Conclusions Improving the interaction within the current pre-hospital trauma care system and building a common understanding of the role of the Emergency Medical Services (EMS emerged as key issues in the development of an effective pre-hospital trauma care process.

  2. (Non-)utilization of pre-hospital emergency care by migrants and non-migrants in Germany.

    Science.gov (United States)

    Kietzmann, Diana; Knuth, Daniela; Schmidt, Silke

    2017-01-01

    This study was designed to explore the utilization and non-utilization of pre-hospital emergency care by migrants and non-migrants, and the factors that influence this behaviour. A cross-sectional representative German survey was conducted in a sample of 2.175 people, 295 of whom had a migration background. An additional sample of 50 people with Turkish migration background was conducted, partially in the Turkish language. Apart from socio-demographics, the utilization of emergency services and the reasons for non-utilization were assessed. Migrants had a higher utilization rate of pre-hospital emergency care (RR = 1.492) than non-migrants. Furthermore, migrants who were not born in Germany had a lower utilization rate (RR = 0.793) than migrants who were born in Germany. Regarding non-utilization, the most frequently stated reasons belonged to the categories initial misjudgment of the emergency situation and acting on one's own behalf, with the latter stated more frequently by migrants than by non-migrants. To prevent over-, under-, and lack of supply, it is necessary to transfer knowledge about the functioning of the medical emergency services, including first aid knowledge.

  3. Pre-Hospital Care Management of a Potential Spinal Cord Injured Patient: A Systematic Review of the Literature and Evidence-Based Guidelines

    Science.gov (United States)

    Ahn, Henry; Singh, Jeffrey; Nathens, Avery; MacDonald, Russell D.; Travers, Andrew; Tallon, John; Fehlings, Michael G.

    2011-01-01

    Abstract An interdisciplinary expert panel of medical and surgical specialists involved in the management of patients with potential spinal cord injuries (SCI) was assembled. Four key questions were created that were of significant interest. These were: (1) what is the optimal type and duration of pre-hospital spinal immobilization in patients with acute SCI?; (2) during airway manipulation in the pre-hospital setting, what is the ideal method of spinal immobilization?; (3) what is the impact of pre-hospital transport time to definitive care on the outcomes of patients with acute spinal cord injury?; and (4) what is the role of pre-hospital care providers in cervical spine clearance and immobilization? A systematic review utilizing multiple databases was performed to determine the current evidence about the specific questions, and each article was independently reviewed and assessed by two reviewers based on inclusion and exclusion criteria. Guidelines were then created related to the questions by a national Canadian expert panel using the Delphi method for reviewing the evidence-based guidelines about each question. Recommendations about the key questions included: the pre-hospital immobilization of patients using a cervical collar, head immobilization, and a spinal board; utilization of padded boards or inflatable bean bag boards to reduce pressure; transfer of patients off of spine boards as soon as feasible, including transfer of patients off spinal boards while awaiting transfer from one hospital institution to another hospital center for definitive care; inclusion of manual in-line cervical spine traction for airway management in patients requiring intubation in the pre-hospital setting; transport of patients with acute traumatic SCI to the definitive hospital center for care within 24 h of injury; and training of emergency medical personnel in the pre-hospital setting to apply criteria to clear patients of cervical spinal injuries, and immobilize patients

  4. Pre-hospital care time intervals among victims of road traffic injuries in Iran. A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Bigdeli Maryam

    2010-07-01

    Full Text Available Abstract Background Road traffic injuries (RTIs are a major public health problem, requiring concerted efforts both for their prevention and a reduction of their consequences. Timely arrival of the Emergency Medical Service (EMS at the crash scene followed by speedy victim transportation by trained personnel may reduce the RTIs' consequences. The first 60 minutes after injury occurrence - referred to as the "golden hour"- are vital for the saving of lives. The present study was designed to estimate the average of various time intervals occurring during the pre-hospital care process and to examine the differences between these time intervals as regards RTIs on urban and interurban roads. Method A retrospective cross-sectional study was designed and various time intervals in relation to pre-hospital care of RTIs identified in the ambulance dispatch centre in Urmia, Iran from 20 March 2005 to 20 March 2007. All cases which resulted in ambulance dispatches were reviewed and those that had complete data on time intervals were analyzed. Results In total, the cases of 2027 RTI victims were analysed. Of these, 61.5 % of the subjects were injured in city areas. The mean response time for city locations was 5.0 minutes, compared with 10.6 minutes for interurban road locations. The mean on-scene time on the interurban roads was longer than on city roads (9.2 vs. 6.1 minutes, p Conclusion The response, transport and total time intervals among EMS responding to RTI incidents were longer for interurban roads, compared to the city areas. More research should take place on needs-to and access-for EMS on city and interurban roads. The notification interval seems to be a hidden part of the post-crash events and indirectly affects the "golden hour" for victim management and it needs to be measured through the establishment of the surveillance systems.

  5. Are severely injured trauma victims in Norway offered advanced pre-hospital care? National, retrospective, observational cohort.

    Science.gov (United States)

    Wisborg, T; Ellensen, E N; Svege, I; Dehli, T

    2017-08-01

    Studies of severely injured patients suggest that advanced pre-hospital care and/or rapid transportation provides a survival benefit. This benefit depends on the disposition of resources to patients with the greatest need. Norway has 19 Emergency Helicopters (HEMS) staffed by anaesthesiologists on duty 24/7/365. National regulations describe indications for their use, and the use of the national emergency medical dispatch guideline is recommended. We assessed whether severely injured patients had been treated or transported by advanced resources on a national scale. A national survey was conducted collecting data for 2013 from local trauma registries at all hospitals caring for severely injured patients. Patients were analysed according to hospital level; trauma centres or acute care hospitals with trauma functions. Patients with an Injury Severity Score (ISS) > 15 were considered severely injured. Three trauma centres (75%) and 17 acute care hospitals (53%) had data for trauma patients from 2013, a total of 3535 trauma registry entries (primary admissions only), including 604 victims with an ISS > 15. Of these 604 victims, advanced resources were treating and/or transporting 51%. Sixty percent of the severely injured admitted directly to trauma centres received advanced services, while only 37% of the severely injured admitted primarily to acute care hospitals received these services. A highly developed and widely distributed HEMS system reached only half of severely injured trauma victims in Norway in 2013. © 2017 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

  6. Pre-hospital care: Data profile from traumatic brain injury registry

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    Jena Ranjan Kumar

    2017-09-01

    Full Text Available Introduction: There are multiple factors from injury spot till patient reach trauma unit, which affect their outcome. The literature of same from developing country is mere. The present study investigates primary care, mode of transportation and emergency management among TBI patients visiting a tertiary institute.

  7. ATTENTION TO THE EMERGENCY ROOM WITH EMPHASIS ON PRE-HOSPITAL CARE: INTEGRATIVE REVIEW

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    B. S. Santos

    2017-08-01

    Full Text Available The study aims to identify the factors, which influence positively and negatively the implementation of public policies geared to the needs in scope of mobile, found in the publications of brazilian researchers since the implementation of the National Policy of Attention to the Emergency room in Brazil. This is a study of Integrative Literature Review. Composing the basis of methodology, have been used official documents to guide the findings that comprised the conceptual bases of the study and to guide the Integrative Review were used publications that report on the issue in question respecting all steps of the protocol review. The results show the changes in the organizational structure of the Service Mobile Emergency, given the regionalization as something positive for the growth of this service modality and discuss prematurely early articulation between the sectors that make up the public health system in Brazil. In conclusion, the policies of attention to the urgencies, in particular within mobile, have favored beneficially all of the users who require this type of care, in the meantime, make the necessary reflections about this theme in the attempt of a better understanding of the regionalization process and coordination among the municipalities that will offer the mobile care so as to ensure continuity of care through the mechanisms of reference and counter-reference

  8. STRATEGIES FOR ADVANCE IN DEVELOPMENT OF A HEALTH CARE INSTITUTION FOR SPECIALIZED PRE-HOSPITAL MEDICAL AID

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    Desislava Todorova

    2017-12-01

    Full Text Available which brings about a competitive environment for an increase of the quality of services offered. The aim of the study is making evident the recommendatory strategies of a health care institution for specialized pre-hospital medical aid in Sofia City for activity performed in the period from the year 2016 to 2018. The task assigned is an analysis of the opportunities for the widening of the activity, products, and markets of "DCC XXIVth-Sofia" EOOD. The chosen healthcare institution is active in a competitive environment in Sofia City, and in the district that it serves. Data from the health care institution, data from the institutions of National Statistics, and scientific literature on the topic were used in connection with the analysis. Some essential approaches of management were applied - analysis of the market share, and SWOT analysis, for determination of strategy. The conclusions of the analysis performed showed four possible strategies of advance in development and opportunities for activity in each of them. The administration of "DCC XXIVth-Sofia" EOOD had opportunities to all practical purposes for minimization of the negative effects, induced by the weaknesses and threats, and to successfully develop the activity - during the period from the year 2016 to 2018. Both the activity of the healthcare institution and the public health services of the population in the corresponding village/town/city depend on the choice of the administration and on its execution by the personnel.

  9. Pre-hospital care time intervals among victims of road traffic injuries in Iran. A cross-sectional study.

    Science.gov (United States)

    Bigdeli, Maryam; Khorasani-Zavareh, Davoud; Mohammadi, Reza

    2010-07-09

    Road traffic injuries (RTIs) are a major public health problem, requiring concerted efforts both for their prevention and a reduction of their consequences. Timely arrival of the Emergency Medical Service (EMS) at the crash scene followed by speedy victim transportation by trained personnel may reduce the RTIs' consequences. The first 60 minutes after injury occurrence--referred to as the "golden hour"--are vital for the saving of lives. The present study was designed to estimate the average of various time intervals occurring during the pre-hospital care process and to examine the differences between these time intervals as regards RTIs on urban and interurban roads. A retrospective cross-sectional study was designed and various time intervals in relation to pre-hospital care of RTIs identified in the ambulance dispatch centre in Urmia, Iran from 20 March 2005 to 20 March 2007. All cases which resulted in ambulance dispatches were reviewed and those that had complete data on time intervals were analyzed. In total, the cases of 2027 RTI victims were analysed. Of these, 61.5% of the subjects were injured in city areas. The mean response time for city locations was 5.0 minutes, compared with 10.6 minutes for interurban road locations. The mean on-scene time on the interurban roads was longer than on city roads (9.2 vs. 6.1 minutes, p transport times from the scene to the hospital were also significantly longer for interurban incidents (17.1 vs. 6.3 minutes, p transport and total time intervals among EMS responding to RTI incidents were longer for interurban roads, compared to the city areas. More research should take place on needs-to and access-for EMS on city and interurban roads. The notification interval seems to be a hidden part of the post-crash events and indirectly affects the "golden hour" for victim management and it needs to be measured through the establishment of the surveillance systems.

  10. Pre-hospital National Early Warning Score (NEWS is associated with in-hospital mortality and critical care unit admission: A cohort study

    Directory of Open Access Journals (Sweden)

    Tom E.F. Abbott

    2018-03-01

    Conclusion: Pre-hospital NEWS was associated with death or critical care unit escalation within 48 h of hospital admission. NEWS could be used by ambulance crews to assist in the early triage of patients requiring hospital treatment or rapid transport. Further cohort studies or trials in large samples are required before implementation.

  11. Numeracy Predicts Risk of Pre-Hospital Decision Delay: a Retrospective Study of Acute Coronary Syndrome Survival.

    Science.gov (United States)

    Petrova, Dafina; Garcia-Retamero, Rocio; Catena, Andrés; Cokely, Edward; Heredia Carrasco, Ana; Arrebola Moreno, Antonio; Ramírez Hernández, José Antonio

    2017-04-01

    Many patients delay seeking medical attention during acute coronary syndromes (ACS), profoundly increasing their risk for death and major disability. Although research has identified several risk factors, efforts to improve patient decision making have generally been unsuccessful, prompting a call for more research into psychological factors. The purpose of this study is to estimate the relationship between ACS decision delay and numeracy, a factor closely related to general decision making skill and risk literacy. About 5 days after experiencing ACS, 102 survivors (mean age = 58, 32-74) completed a questionnaire including measures of numeracy, decision delay, and other relevant factors (e.g., anxiety, depression, symptom severity, knowledge, demographics). Low patient numeracy was related to longer decision delay, OR = 0.64 [95 % confidence interval (CI) 0.44, 0.92], which was in turn related to higher odds of positive troponin on arrival at the hospital, OR = 1.37 [95 % CI 1.01, 2.01]. Independent of the influence of all other assessed factors, a patient with high (vs. low) numeracy was about four times more likely to seek medical attention within the critical first hour after symptom onset (i.e., OR high-low  = 3.84 [1.127, 11.65]). Numeracy may be one of the largest decision delay risk factors identified to date. Results accord with theories emphasizing potentially pivotal roles of patient deliberation, denial, and outcome understanding during decision making. Findings suggest that brief numeracy assessments may predict which patients are at greater risk for life-threatening decision delay and may also facilitate the design of risk communications that are appropriate for diverse patients who vary in risk literacy.

  12. Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care

    Directory of Open Access Journals (Sweden)

    Maxine Johnson

    2017-01-01

    Full Text Available Abstract Background Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making. Methods The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16 and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded ‘digital diaries’ (155 events. Three staff focus groups (total n = 21 and three service user focus groups (total n = 23 explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified. Results The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service

  13. Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care.

    Science.gov (United States)

    Johnson, Maxine; O'Hara, Rachel; Hirst, Enid; Weyman, Andrew; Turner, Janette; Mason, Suzanne; Quinn, Tom; Shewan, Jane; Siriwardena, A Niroshan

    2017-01-24

    Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures) has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making. The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16) and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded 'digital diaries' (155 events). Three staff focus groups (total n = 21) and three service user focus groups (total n = 23) explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified. The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service users to gain a better understanding of the research

  14. [Emergency care in the autonomous regions of Spain. Improvement in pre-hospital emergency care and welfare coordination. SESPAS Report 2012].

    Science.gov (United States)

    Miguel García, Félix; Fernández Quintana, Ana Isabel; Díaz Prats, Amadeo

    2012-03-01

    The present article describes the general organization of pre-hospital emergency care in the autonomous regions and provides data on activity corresponding to 2010, drawn from the information available in the Primary Care Information System of the Ministry of Health, Social Policy and Equality. Emergency care is provided through various organizational structures covering 24-hour periods. Family medicine attended 17.8 million emergency consultations and nursing attended 10.2 million (year 2010, 14 autonomous communities, 79.7% of the National Health System population). Emergency department utilization ranged between 0.11 and 0.83 urgent family physician consultations per inhabitant/year and between 0.05 and 0.57 nursing consultations per inhabitant/year. Any reform in the management of pre-hospital emergency care will involve organizational changes and aims to produce measurable improvements in healthcare coordination. In the new organizational designs, most of the responsibility lies with human resources in order to achieve the new goals for the future aims to be presented in an operational teamwork structure. Undoubtedly, the main challenge is to achieve optimal coordination with other welfare levels, including the police, social services, nursing homes, etc. If optimal care of the population needs to count on the efforts of all these groups, mobility, individual differences, consistent achievement of high standards, and -most of all- the use of these services by citizens will determine the final result. The results can be quantified in various ways, but evaluation should concentrate on the resources used, the degree of satisfaction among all the parties involved and optimal management of demand, which will help to disseminate the need for a rational resource use. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

  15. The impact of a pre-hospital medical response unit on patient care and emergency department attendances.

    LENUS (Irish Health Repository)

    Deasy, C

    2012-02-03

    A rapid response team was instigated in Cork to improve prehospital care and reduce unnecessary Emergency Department (ED) visits. This consisted of a Specialist Registrar (SpR) in Emergency Medicine and a Paramedic who attended all "999" calls in a designated rapid response vehicle on the allotted study days. Two hundred and sixty-three patients were seen on designated days between Jan 2004 and March 2006. Presentations seen included; road traffic accident (23%) collapse (12%), fall (10%) and seizure (8%). The majority of calls were to houses (36%). The most common medical intervention was intravenous cannulation (25%). Intravenous medications were administered in 21% of these patients--morphine sulphate was the most common drug given. It was possible to safely discharge 31% of patients on scene. In our experience skilled Emergency Medicine doctors attending at scene could provide advanced care and reduce ambulance transportation and patient attendance.

  16. Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin. A position paper of the Acute Cardiovascular Care Association (ACCA) of the ESC.

    Science.gov (United States)

    Beygui, Farzin; Castren, Maaret; Brunetti, Natale Daniele; Rosell-Ortiz, Fernando; Christ, Michael; Zeymer, Uwe; Huber, Kurt; Folke, Fredrik; Svensson, Leif; Bueno, Hector; Van't Hof, Arnoud; Nikolaou, Nikolaos; Nibbe, Lutz; Charpentier, Sandrine; Swahn, Eva; Tubaro, Marco; Goldstein, Patrick

    2015-08-27

    Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up. The objective of the paper is to provide guidance, based on evidence, where available, or on experts' opinions, for all emergency medical services' health providers involved in the pre-hospital management of acute cardiovascular care. © The European Society of Cardiology 2015.

  17. Involving older people in a multi-centre randomised trial of a complex intervention in pre-hospital emergency care: implementation of a collaborative model.

    Science.gov (United States)

    Koniotou, Marina; Evans, Bridie Angela; Chatters, Robin; Fothergill, Rachael; Garnsworthy, Christopher; Gaze, Sarah; Halter, Mary; Mason, Suzanne; Peconi, Julie; Porter, Alison; Siriwardena, A Niroshan; Toghill, Alun; Snooks, Helen

    2015-07-10

    Health services research is expected to involve service users as active partners in the research process, but few examples report how this has been achieved in practice in trials. We implemented a model to involve service users in a multi-centre randomised controlled trial in pre-hospital emergency care. We used the generic Standard Operating Procedure (SOP) from our Clinical Trials Unit (CTU) as the basis for creating a model to fit the context and population of the SAFER 2 trial. In our model, we planned to involve service users at all stages in the trial through decision-making forums at 3 levels: 1) strategic; 2) site (e.g. Wales; London; East Midlands); 3) local. We linked with charities and community groups to recruit people with experience of our study population. We collected notes of meetings alongside other documentary evidence such as attendance records and study documentation to track how we implemented our model. We involved service users at strategic, site and local level. We also added additional strategic level forums (Task and Finish Groups and Writing Days) where we included service users. Service user involvement varied in frequency and type across meetings, research stages and locations but stabilised and increased as the trial progressed. Involving service users in the SAFER 2 trial showed how it is feasible and achievable for patients, carers and potential patients sharing the demographic characteristics of our study population to collaborate in a multi-centre trial at the level which suited their health, location, skills and expertise. A standard model of involvement can be tailored by adopting a flexible approach to take account of the context and complexities of a multi-site trial. Current Controlled Trials ISRCTN60481756. Registered: 13 March 2009.

  18. Pre-hospital treatment of acute poisonings in Oslo

    Science.gov (United States)

    Heyerdahl, Fridtjof; Hovda, Knut E; Bjornaas, Mari A; Nore, Anne K; Figueiredo, Jose CP; Ekeberg, Oivind; Jacobsen, Dag

    2008-01-01

    Background Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients. Aims: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge. Methods A one-year multi-centre study with prospective inclusion of all acutely poisoned patients ≥ 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo. Results A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40%) were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84%) were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%), were frequently comatose (35%), had respiratory depression (37%), and many received naloxone (49%). The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%), fewer were comatose (10%), and they rarely had respiratory depression (4%). Among the hospitalized, pharmaceutical poisonings were most common (58%), 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity. Conclusion More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often caused by drug and

  19. Pre-hospital treatment of acute poisonings in Oslo

    Directory of Open Access Journals (Sweden)

    Nore Anne K

    2008-11-01

    Full Text Available Abstract Background Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients. Aims: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge. Methods A one-year multi-centre study with prospective inclusion of all acutely poisoned patients ≥ 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo. Results A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40% were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84% were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%, were frequently comatose (35%, had respiratory depression (37%, and many received naloxone (49%. The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%, fewer were comatose (10%, and they rarely had respiratory depression (4%. Among the hospitalized, pharmaceutical poisonings were most common (58%, 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity. Conclusion More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often

  20. A consensus-based template for documenting and reporting in physician-staffed pre-hospital services

    DEFF Research Database (Denmark)

    Kruger, Andreas J; Lockey, David; Kurola, Jouni

    2011-01-01

    -staffed pre-hospital services in Europe. METHODS: Using predefined criteria, we recruited sixteen European experts in the field of pre-hospital care. These experts were guided through a four-step modified nominal group technique. The process was carried out using both e-mail-based communication and a plenary...... have established a core data set for documenting and reporting in physician-staffed pre-hospital services. We believe that this template could facilitate future studies within the field and facilitate standardised reporting and future shared research efforts in advanced pre-hospital care....

  1. Coronary CT in Acute Cardiac Care

    NARCIS (Netherlands)

    A. Dedic (Admir)

    2016-01-01

    markdownabstractCoronary CT angiography is a well-established diagnostic modality for stable angina pectoris. It provides an angiographic, non-invasive alternative for the diagnosis of coronary artery disease, exceeding in the ability to exclude important coronary artery disease. Having the ability

  2. Atendimento pré-hospitalar móvel em Fortaleza, Ceará: a visão dos profissionais envolvidos Mobile pre-hospital care in Fortaleza, Ceará: the vision of professionals involved

    Directory of Open Access Journals (Sweden)

    Juliana Guimarães e Silva

    2009-12-01

    Full Text Available Com o objetivo de descrever variáveis sociodemográficas, profissionais e operacionais das diferentes categorias envolvidas no Serviço de Atendimento Móvel de Urgência, bem como a percepção destas quanto à adequação do serviço oferecido às diretrizes da Política Nacional de Atenção às Urgências, foi realizado um estudo transversal, mediante um questionário autoaplicável, em 2007/2008. Os 89 pesquisados apontaram comprometimento da estrutura física (60,7%; escassez de materiais (82,0%; incipiência de recursos humanos (37,1%; mau estado de conservação e número insuficiente de ambulâncias (67,4%. 98,9% admitiram que há integração com outros serviços, com diferença estatística entre as categorias profissionais (p = 0,037. A terceirização predominou entre 71,4% dos médicos e 84,2% dos enfermeiros (p A cross-sectional study based on a self-administered questionnaire was performed in 2007/2008, with the objective of describing sociodemographic, professional, and operating variables of the various professional categories involved in the Mobile Emergency Care Service, and the perception of the compliance of the service offered with the guidelines of the National Emergency Care Policy. All 89 participants indicated deficient physical structure (60.7%; shortage of materials (82.0%; unskilled human resources (37.1%; poor conservation conditions and insufficient number of ambulances (67.4%; 98.9% admitted the existence of integration with other services, with some statistical differences among professional categories (p = 0.037. Outsourcing prevailed among 71.4% of physicians and 84.2% of nurses (p < 0.001. Specific capacity building was confirmed by 79.8%, and update by 88.8% of professionals. Total average response time was 29 minutes (SD ± 14.8, and 65.2% acknowledged knowing the policy. This study showed that pre-hospital care services have structural and planning problems, among which poor working conditions and fragile

  3. Impact of pre-hospital antibiotic use on community-acquired pneumonia.

    Science.gov (United States)

    Simonetti, A F; Viasus, D; Garcia-Vidal, C; Grillo, S; Molero, L; Dorca, J; Carratalà, J

    2014-09-01

    Information on the influence of pre-hospital antibiotic treatment on the causative organisms, clinical features and outcomes of patients with community-acquired pneumonia (CAP) remains scarce. We performed an observational study of a prospective cohort of non-immunosuppressed adults hospitalized with CAP between 2003 and 2012. Patients were divided into two groups: those who had received pre-hospital antibiotic treatment for the same episode of CAP and those who had not. A propensity score was used to match patients. Of 2179 consecutive episodes of CAP, 376 (17.3%) occurred in patients who had received pre-hospital antibiotic treatment. After propensity score matching, Legionella pneumophila was more frequently identified in patients with pre-hospital antibiotic treatment, while Streptococcus pneumoniae was less common (p sensitivity and specificity of the pneumococcal urinary antigen test for diagnosing pneumococcal pneumonia were similar in the two groups. Patients with pre-hospital antibiotic treatment were less likely to present fever (p 0.02) or leucocytosis (p 0.001). Conversely, chest X-ray cavitation was more frequent in these patients (p 0.04). No significant differences were found in the frequency of patients classified into high-risk Pneumonia Severity Index classes, in intensive care unit admission, or in 30-day mortality between the groups. In conclusion, L. pneumophila occurrence was nearly three times higher in patients who received pre-hospital antibiotics. After a propensity-adjusted analysis, no significant differences were found in prognosis between study groups. Pre-hospital antibiotic use should be considered when choosing aetiological diagnostic tests and empirical antibiotic therapy in patients with CAP. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

  4. Pre-hospital aspiration is associated with increased pulmonary complications.

    Science.gov (United States)

    Fawcett, Vanessa J; Warner, Keir J; Cuschieri, Joseph; Copass, Michael; Grabinsky, Andreas; Kwok, Heemun; Rea, Thomas; Evans, Heather L

    2015-04-01

    Rates of ventilator-associated pneumonia (VAP) are highest among patients intubated on an emergency basis following trauma. We reported previously a retrospective analysis demonstrating an association between subjective aspiration and VAP after pre-hospital intubation. We hypothesize that by directing paramedics to note features of aspiration at intubation, we will confirm prospectively the association between pre-hospital aspiration and subsequent pneumonia in trauma patients. Paramedics collected data regarding aspiration at the time of intubation. All intubated patients admitted to a level 1 trauma center intensive care unit (ICU) were included. Data comprised a clinical impression of pre-hospital aspiration, as well as the presence and timing of blood and emesis in the airway. Injury severity, co-morbidities, and outcomes were collected from the trauma registry. Healthcare-associated pneumonia (HAP) was identified by medical record review of both bronchoalveolar lavage culture results and discharge diagnosis. Descriptive statistics and univariate analysis of outcomes by aspiration status, as well as covariable adjustment using propensity scores, were performed. Of the 228 patients, 89 (39%) were determined by paramedics to have aspirated. The majority of those who aspirated (84 [94%]) did so prior to intubation. Patients who aspirated had higher Injury Severity Scores than those who did not aspirate (25.0 ± 1.7 vs. 21.9 ± 1.5 points; p=0.04) and lower preintubation Glasgow Coma Scale scores (8.2 ± 0.50 vs. 9.6 ± 0.40; p=0.02). Of the 89 patients who aspirated around the time of intubation, 14 (16%) developed HAP vs. five (3.6%) of those who did not aspirate (paspiration (deaths: 21 [23.6%] vs. 23 [16.6%]; p=0.19; ICU LOS: 5.3 ± 0.9 vs. 4.1 ± 0.5 days; p=0.13; duration of mechanical ventilation: 5.3 ± 1.2 vs. 3.2 ± 0.5 days; p=0.10). Aspiration prior to intubation was reported commonly by paramedics and was associated with a higher risk of HAP.

  5. Rural emergency medical technician pre-hospital electrocardiogram transmission.

    Science.gov (United States)

    Powell, A M; Halon, J M; Nelson, J

    2014-01-01

    Emergent care of the acute heart attack patient continues to be at the forefront of quality and cost reduction strategies throughout the healthcare industry. Although the average cardiac door-to-balloon (D2B) times have decreased substantially over the past few years, there are still vast disparities found in D2B times in populations that reside in rural areas. Such disparities are mostly related to prolonged travel time and subsequent delays in cardiac catherization lab team activation. Urban ambulance companies that are routinely staffed with paramedic level providers have been successful in the implementation of pre-hospital 12-lead electrocardiogram (ECG) protocols as a strategy to reduce D2B times. The authors sought to evaluate the evidence related to the risk and benefits associated with the replication of an ECG transmission protocol in a small rural emergency medical service. The latter is staffed with emergency medical technician-basics (EMT-B), emergency medical technician-advanced (EMT-A), and emergency medical technician-intermediate (EMT-I) level. The evidence reviewed was limited to studies with relevant data regarding the challenges and complexities of the ECG transmission process, the difficulties associated with ECG transmission in rural settings, and ECG transmission outcomes by provider level. The evidence supports additional research to further evaluate the feasibility of ECG transmission at the non-paramedic level. Multiple variables must be investigated including equipment cost, utilization, and rural transmission capabilities. Clearly, pre-hospital ECG transmission and early activation of the cardiac catheterization laboratory are critical components to successfully decreasing D2B times.

  6. Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain.

    Science.gov (United States)

    Rawshani, Nina; Rawshani, Araz; Gelang, Carita; Herlitz, Johan; Bång, Angela; Andersson, Jan-Otto; Gellerstedt, Martin

    2017-12-01

    In the assessment of patients with chest pain, there is support for the use of pre-hospital ECG in the literature and in the care guidelines. Using propensity score methods, we aim to examine whether the mere acquisition of a pre-hospital ECG among patients with chest pain affects the outcome (30-day mortality). The association between pre-hospital ECG and 30-day mortality was studied in the overall cohort (n=13151), as well as in the one-to-one matched cohort with 2524 patients not examined with pre-hospital ECG and 2524 patients examined with pre-hospital ECG. In the overall cohort, 21% (n=2809) did not undergo an ECG tracing in the pre-hospital setting. Among those who had pain during transport, 14% (n=1159) did not undergo a pre-hospital ECG while 32% (n=1135) of those who did not have pain underwent an ECG tracing. In the overall cohort, the OR for 30-day mortality in patients who had a pre-hospital ECG, as compared with those who did not, was 0.63 (95% CI 0.05-0.79; pECG was used. The PH-ECG is underused among patients with chest discomfort and the mere acquisition of a pre-hospital ECG may reduce mortality. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Patient stress in intensive care: comparison between a coronary care unit and a general postoperative unit

    Science.gov (United States)

    Dias, Douglas de Sá; Resende, Mariane Vanessa; Diniz, Gisele do Carmo Leite Machado

    2015-01-01

    Objective To evaluate and compare stressors identified by patients of a coronary intensive care unit with those perceived by patients of a general postoperative intensive care unit. Methods This cross-sectional and descriptive study was conducted in the coronary intensive care and general postoperative intensive care units of a private hospital. In total, 60 patients participated in the study, 30 in each intensive care unit. The stressor scale was used in the intensive care units to identify the stressors. The mean score of each item of the scale was calculated followed by the total stress score. The differences between groups were considered significant when p < 0.05. Results The mean ages of patients were 55.63 ± 13.58 years in the coronary intensive care unit and 53.60 ± 17.47 years in the general postoperative intensive care unit. For patients in the coronary intensive care unit, the main stressors were “being in pain”, “being unable to fulfill family roles” and “being bored”. For patients in the general postoperative intensive care unit, the main stressors were “being in pain”, “being unable to fulfill family roles” and “not being able to communicate”. The mean total stress scores were 104.20 ± 30.95 in the coronary intensive care unit and 116.66 ± 23.72 (p = 0.085) in the general postoperative intensive care unit. When each stressor was compared separately, significant differences were noted only between three items. “Having nurses constantly doing things around your bed” was more stressful to the patients in the general postoperative intensive care unit than to those in the coronary intensive care unit (p = 0.013). Conversely, “hearing unfamiliar sounds and noises” and “hearing people talk about you” were the most stressful items for the patients in the coronary intensive care unit (p = 0.046 and 0.005, respectively). Conclusion The perception of major stressors and the total stress score were similar between patients

  8. Digital remote viewing system for coronary care unit

    International Nuclear Information System (INIS)

    Cho, P.S.; Tillisch, J.; Huang, H.K.

    1987-01-01

    A digital remote viewing system developed for the coronary care unit at the UCLA Medical Center has been in clinical operation since March 1, 1987. The present system consists of three 512-line monitors, VAX 11/750, Gould IP8500 image processor and a broad-band communication system. The patients' images are acquired with a computed radiography system and are transmitted to the coronary care unit, which is five floors above the radiology department. This exhibit presents the architecture and the performance characteristics of the system. Also, the second-generation system, which consists of an intelligent local work station with three 1,024-line monitors and a fast digital communication network, will be introduced

  9. Pre-hospital haemostatic dressings: a systematic review.

    Science.gov (United States)

    Granville-Chapman, J; Jacobs, N; Midwinter, M J

    2011-05-01

    Kingdom Armed Forces; retrospective clinical data supports their efficacy. However, in some recent animal models of lethal haemorrhage, WoundStat(mucoadhesive), Celox (mucoadhesive) and CombatGauze (procoagulant supplementor) have all outperformed both HemCon and QuikClot products. HemCon and QuikClot have augmented the haemostatic capabilities of the military first aid responder, but newer products demonstrate potential to be more effective and should be considered as replacements for current in service systems. These products could have utility for civilian pre-hospital care. 2010 Elsevier Ltd. All rights reserved.

  10. Atendimento pré-hospitalar: caracterização das ocorrências de acidente de trânsito Atención prehospitalaria: caracterización de las ocurrencias de accidentes de tránsito Pre-hospital care: characteristics of traffic accidents

    Directory of Open Access Journals (Sweden)

    Waleska Antunes da Porciúncula Pereira

    2006-09-01

    destacan el involucramiento del equipo de soporte básico en la atención prehospitalaria e indican la necesidad de prevención de esos daños y de calificación de los trabajadores para la estructuración del trabajo basado en la interdisciplinaridad.OBJECTIVES: to identify types of occurrence registered by a pre-hospital care unit and to characterize occurrences from traffic accidents. METHODS: a descriptive cross-sectional study was used to analyze 6,430 pre-hospital calls from July to September, 2003. RESULTS: the occurrences were classified as trauma (35.2 %, or traffic accidents (57.9%. Most occurrences took place in the afternoon and were common in all days of the week. The basic pre-hospital care team, consisting of a licensed practical nurse or associate degree nurse and an ambulance driver, was the team that answered most emergency calls (84.5%. A professional nurse participated in only 11.2% of the occurrences, and great part of these occurrences (4.27% was answered by the advanced pre-hospital care team. A physician participated in only 8.3% of occurrences. CONCLUSION: the basic pre-hospital care team was involved in the majority of emergency calls. This suggests a need of new strategies for preventing victim's complications and better ways to qualify pre-hospital care team members for a quality interdisciplinary-based work.

  11. Smoking cessation following admission to a coronary care unit.

    Science.gov (United States)

    Rigotti, N A; Singer, D E; Mulley, A G; Thibault, G E

    1991-01-01

    To determine the impact of an episode of serious cardiovascular disease on smoking behavior and to identify factors associated with smoking cessation in this setting. Prospective observational study in which smokers admitted to a coronary care unit (CCU) were followed for one year after hospital discharge to determine subsequent smoking behavior. Coronary care unit of a teaching hospital. Preadmission smoking status was assessed in all 828 patients admitted to the CCU during one year. The 310 smokers surviving to hospital discharge were followed and their smoking behaviors assessed by self-report at six and 12 months. None. Six months after discharge, 32% of survivors were not smoking; the rate of sustained cessation at one year was 25%. Smokers with a new diagnosis of coronary heart disease (CHD) made during hospitalization had the highest cessation rate (53% vs. 31%, p = 0.01). On multivariate analysis, smoking cessation was more likely if patients were discharged with a diagnosis of CHD, had no prior history of CHD, were lighter smokers (less than 1 pack/day), and had congestive heart failure during hospitalization. Among smokers admitted because of suspected myocardial infarction (MI), cessation was more likely if the diagnosis was CHD than if it was noncoronary (37% vs. 19%, p less than 0.05), but a diagnosis of MI led to no more smoking cessation than did coronary insufficiency. Hospitalization in a CCU is a stimulus to long-term smoking cessation, especially for lighter smokers and those with a new diagnosis of CHD. Admission to a CCU may represent a time when smoking habits are particularly susceptible to intervention. Smoking cessation in this setting should improve patient outcomes because cessation reduces cardiovascular mortality, even when quitting occurs after the onset of CHD.

  12. Pre-Hospital ECG E-Transmission for Patients with Suspected Myocardial Infarction in the Highlands of Scotland

    Directory of Open Access Journals (Sweden)

    Gordon F. Rushworth

    2014-02-01

    Full Text Available Patients with ST elevation myocardial infarction (STEMI require prompt treatment, best done by primary percutaneous coronary intervention (PPCI. However, for patients unable to receive PPCI, immediate pre-hospital thrombolysis (PHT is the best alternative. Evidence indicates that diagnostic and management support for staff increases the use of PHT. This study aimed to describe the patient demographics and management of patients, to determine any potential inter-area differences in referral rates to the ECG e-transmission service and to explore the views and experiences of key staff involved in ECG e-transmission within NHS Highland. Data from 2,025 patient episodes of ECG e-transmission identified a statistically significant geographical variation in ECG e-transmission and PHT delivery. Scottish Ambulance Service (SAS staff were more likely than GPs to deliver PHT overall, however, GPs were more likely to deliver in remote areas. Interviews with six Cardiac Care Unit (CCU nurses and six SAS staff highlighted their positive views of ECG e-transmission, citing perceived benefits to patients and interprofessional relationships. Poor access to network signal was noted to be a barrier to engaging in the system. This study has demonstrated that a specialist triage service based on e-transmission of ECGs in patients with suspected STEMI can be implemented in a diverse geographical setting. Work is needed to ensure equity of the service for all patients.

  13. Pre-hospital transport times and survival for Hypotensive patients with penetrating thoracic trauma

    Directory of Open Access Journals (Sweden)

    Mamta Swaroop

    2013-01-01

    Full Text Available Background: Achieving definitive care within the "Golden Hour" by minimizing response times is a consistent goal of regional trauma systems . This study hypothesizes that in urban Level I Trauma Centers, shorter pre-hospital times would predict outcomes in penetrating thoracic injuries. Materials and Methods: A retrospective cohort study was performed using a statewide trauma registry for the years 1999-2003 . Total pre-hospital times were measured for urban victims of penetrating thoracic trauma. Crude and adjusted mortality rates were compared by pre-hospital time using STATA statistical software. Results: During the study period, 908 patients presented to the hospital after penetrating thoracic trauma, with 79% surviving . Patients with higher injury severity scores (ISS were transported more quickly. Injury severity scores (ISS ≥16 and emergency department (ED hypotension (systolic blood pressure, SBP <90 strongly predicted mortality (P < 0.05 for each . In a logistic regression model including age, race, and ISS, longer transport times for hypotensive patients were associated with higher mortality rates (all P values <0.05. This was seen most significantly when comparing patient transport times 0-15 min and 46-60 min (P < 0.001. Conclusion: In victims of penetrating thoracic trauma, more severely injured patients arrive at urban trauma centers sooner . Mortality is strongly predicted by injury severity, although shorter pre-hospital times are associated with improved survival . These results suggest that careful planning to optimize transport time-encompassing hospital capacity and existing resources, traffic patterns, and trauma incident densities may be beneficial in areas with a high burden of penetrating trauma.

  14. A validation of ground ambulance pre-hospital times modeled using geographic information systems.

    Science.gov (United States)

    Patel, Alka B; Waters, Nigel M; Blanchard, Ian E; Doig, Christopher J; Ghali, William A

    2012-10-03

    Evaluating geographic access to health services often requires determining the patient travel time to a specified service. For urgent care, many research studies have modeled patient pre-hospital time by ground emergency medical services (EMS) using geographic information systems (GIS). The purpose of this study was to determine if the modeling assumptions proposed through prior United States (US) studies are valid in a non-US context, and to use the resulting information to provide revised recommendations for modeling travel time using GIS in the absence of actual EMS trip data. The study sample contained all emergency adult patient trips within the Calgary area for 2006. Each record included four components of pre-hospital time (activation, response, on-scene and transport interval). The actual activation and on-scene intervals were compared with those used in published models. The transport interval was calculated within GIS using the Network Analyst extension of Esri ArcGIS 10.0 and the response interval was derived using previously established methods. These GIS derived transport and response intervals were compared with the actual times using descriptive methods. We used the information acquired through the analysis of the EMS trip data to create an updated model that could be used to estimate travel time in the absence of actual EMS trip records. There were 29,765 complete EMS records for scene locations inside the city and 529 outside. The actual median on-scene intervals were longer than the average previously reported by 7-8 minutes. Actual EMS pre-hospital times across our study area were significantly higher than the estimated times modeled using GIS and the original travel time assumptions. Our updated model, although still underestimating the total pre-hospital time, more accurately represents the true pre-hospital time in our study area. The widespread use of generalized EMS pre-hospital time assumptions based on US data may not be appropriate in a

  15. Pre-hospital Management of the Fractured Femur Using the ...

    African Journals Online (AJOL)

    Two aspects of the early management of the fractured femur are discussed: firstly the immediate treatment in the pre-hospital phase and secondly the transportation of this injury case over a long distance where necessary. In both instances there is considerable room for improvement, and this is discussed, particularly with ...

  16. Teamwork in a coronary care unit: facilitating and hindering aspects

    Directory of Open Access Journals (Sweden)

    Bethania Ferreira Goulart

    2016-06-01

    Full Text Available Abstract OBJECTIVE To identify, within a multidisciplinary team, the facilitating and hindering aspects for teamwork in a coronary care unit. METHOD A descriptive study, with qualitative and quantitative data, was carried out in the coronary care unit of a public hospital. The study population consisted of professionals working in the unit for at least one year. Those who were on leave or who were not located were excluded. The critical incident technique was used for data collection, by means of semi-structured interviews. For data analysis, content analysis and the critical incident technique were applied. RESULTS Participants were 45 professionals: 29 nursing professionals; 11 physicians; 4 physical therapists; and 1 psychologist. A total of 49 situations (77.6% with negative references; 385 behaviors (54.2% with positive references; and 182 consequences emerged (71.9% with negative references. Positive references facilitate teamwork, whereas negative references hinder it. A collaborative/communicative interprofessional relationship was evidenced as a facilitator; whereas poor collaboration among agents/inadequate management was a hindering aspect. CONCLUSION Despite the prevalence of negative situations and consequences, the emphasis on positive behaviors reveals the efforts the agents make in order to overcome obstacles and carry out teamwork.

  17. Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study

    Science.gov (United States)

    2011-01-01

    Background Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days. Methods The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation. Results The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators. Conclusions The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels. PMID:21575233

  18. Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study.

    Science.gov (United States)

    Djalali, Ahmadreza; Khankeh, Hamidreza; Öhlén, Gunnar; Castrén, Maaret; Kurland, Lisa

    2011-05-16

    Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days. The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation. The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators. The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels.

  19. Variation in Admission Rates of Acute Coronary Syndrome Patients in Coronary Care Unit According to Different Seasons

    International Nuclear Information System (INIS)

    Lashari, M. N.; Soomro, K.

    2015-01-01

    Objective:Environmental stresses, especially extreme cold and hot weathers, have tendency to have more admissions for acute coronary syndromes. Due to scarcity of local data, we studied the variation in patient admission rates with acute coronary syndrome according to different seasons. Study Design: Descriptive study. Place and Duration of Study: Coronary Care Unit, Civil Hospital and Pakistan Steel Hospital, Karachi, from January 2011 to December 2011. Methodology: The study group comprised consecutive patients with acute coronary syndrome (unstable angina, Non ST-Elevation Myocardial Infarction (NSTEMI), ST-Elevation Myocardial Infarction (STEMI) admitted to the coronary care unit. Patients with stable angina and valvular heart disease were excluded. Data was analyzed for admission according to different seasons, (winter, spring, summer and autumn). Results: The mean age of the 428 cases was 48.5 ± 10.4 years (range 27 to 73 years). Among the study group, 261 (61%) and 167 (39%) cases were male and female respectively. ST-elevation myocardial infarction, non ST-elevation myocardial infarction and unstable angina were present in 206 (48%), 128 (30%) and 94 (22%) respectively. Among the 428 patients, 184 (43%) cases had hypertension, 133 (31%) cases were smokers, 103 (24%) cases had dyslipidemia and diabetes mellitus and 08 (2%) cases had history of premature coronary artery disease. The number of patients admissions with acute coronary syndrome tended to change with sudden change in season. It increased in Winter 158 (36.9%) and Summer 130 (30.3%) in comparison to Spring 80 (18.69%) and Autumn 60 (14.02%) season. Conclusion: It was found variation in admission rates of acute coronary syndrome patients according to different seasons. The number of admissions not only increased in the cold season (winter) but also in hot season (summer) with sudden changes in temperature. (author)

  20. Registered nurses views of caring in coronary care--a deductive and inductive content analysis.

    Science.gov (United States)

    Andersson, Ewa K; Sjöström-Strand, Annica; Willman, Ania; Borglin, Gunilla

    2015-12-01

    To extend nurses' descriptions of how they understood caring, as reflected in the findings of an earlier study (i.e. the hierarchical outcome space) and to gain additional understandings and perspectives of nurses' views of caring in relation to a coronary care patient case. Scientific literature from the 1970s-1990s contains descriptions of caring in nursing. In contrast, the contemporary literature on this topic--particularly in the context of coronary care--is very sparse, and the few studies that do contain descriptions rarely do so from the perspective of nurses. Qualitative descriptive study. Twenty-one nurses were interviewed using the stimulated recall interview technique. The data were analysed using deductive and inductive qualitative content analysis. The results of the iterative and integrated content analysis showed that the data mainly reproduced the content of the hierarchical outcome space describing how nurses could understand caring; however, in the outcome space, the relationship broke up (i.e. flipped). The nurses' views of caring could now also be understood as: person-centredness 'lurking' in the shadows; limited 'potential' for safeguarding patients' best interests; counselling as virtually the 'only' nursing intervention; and caring preceded by the 'almighty' context. Their views offered alternative and, at times, contrasting perspectives of caring, thereby adding to our understanding of it. Caring was described as operating somewhere between the nurses caring values and the contextual conditions in which caring occurred. This challenged their ability to sustain caring in accordance with their values and the patients' preferences. To ensure that the essentials of caring are met at all times, nurses need to plan and deliver caring in a systematic way. The use of systematic structures in caring, as the nursing process, can help nurses to work in a person-centred way, while sustaining their professional values. © 2015 John Wiley & Sons Ltd.

  1. [Burnout syndrome in pre-hospital and hospital emergency. Cognitive study in two cohorts of nurses].

    Science.gov (United States)

    Cicchitti, Chiara; Cannizzaro, Giorgia; Rosi, Fabrizio; Maccaroni, Roberto; Menditto, Vincenzo G

    2014-01-01

    Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The emergency department and the pre-hospital healthcare services are highly stressful environments. Little is known about the BOS in critical care nursing staff. The objective of the study is to compare the incidence of BOS and its three domains, namely, emotional exhaustion, depersonalization and reduced professional accomplishment, in two cohorts of critical care nurses: a pre-hospital and a hospital emergency service. A survey using a questionnaire (the Maslach Burnout Inventory-General Survey, MBI-GS), among nurses of two Italian emergency services has been performed: a hospital emergency service (HES, Emergency Department or "Pronto Soccorso") and a pre-hospital emergency service (PHES, territorial healthcare service or "Centrale Operativa 118"). All 60 nurses surveyed (82% female) filled the questionnaires. BOS-related symptoms have been identified in at least 50% of the nurses in the HES: 50% suffered a medium-high emotional exhaustion, 75% had a medium-high depersonalization and 92.5% had a medium-high reduced professional accomplishment. Among the PEHS nurses, BOS-related symptoms have been identified in at least 60% of the respondents: 60% had a medium-high emotional exhaustion, 70% had a medium-high depersonalization and 95% had a medium-high reduced professional accomplishment. Moreover, the likelihood that a nurse has a severe BOS, that is at least one degree of high burnout or ≥2 degrees of medium burnout, is significantly higher in the group of the PHES than in the HES (90% vs 60%, p nursing staff had a severe BOS. The incidence of BOS appeared to be similar among PHES and HES nurses with a higher trend for the former. Further interventional studies are needed to investigate the determinants of BOS among critical care nurses and the potentially preventive strategies.

  2. Do stable non-ST-segment elevation acute coronary syndromes require admission to coronary care units?

    Science.gov (United States)

    van Diepen, Sean; Lin, Meng; Bakal, Jeffrey A; McAlister, Finlay A; Kaul, Padma; Katz, Jason N; Fordyce, Christopher B; Southern, Danielle A; Graham, Michelle M; Wilton, Stephen B; Newby, L Kristin; Granger, Christopher B; Ezekowitz, Justin A

    2016-05-01

    Clinical practice guidelines recommend admitting patients with stable non-ST-segment elevation acute coronary syndrome (NSTE ACS) to telemetry units, yet up to two-thirds of patients are admitted to higher-acuity critical care units (CCUs). The outcomes of patients with stable NSTE ACS initially admitted to a CCU vs a cardiology ward with telemetry have not been described. We used population-based data of 7,869 patients hospitalized with NSTE ACS admitted to hospitals in Alberta, Canada, between April 1, 2007, and March 31, 2013. We compared outcomes among patients initially admitted to a CCU (n=5,141) with those admitted to cardiology telemetry wards (n=2,728). Patients admitted to cardiology telemetry wards were older (median 69 vs 65years, PST-segment myocardial infarction or unstable angina. There were no differences in clinical outcomes observed between patients with NSTE ACS initially admitted to a ward or a CCU. These findings suggest that stable NSTE ACS may be managed appropriately on telemetry wards and presents an opportunity to reduce hospital costs and critical care capacity strain. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Paramedics' experiences of financial medicine practices in the pre-hospital environment. A pilot study

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    Craig Vincent-Lambert

    2016-10-01

    Objectives: This qualitative pilot study explored and described the experiences of South African Paramedics with regard to the practicing of financial medicine in the local pre-hospital emergency care environment. Method: A sample of South African Paramedics were interviewed either face-to-face or telephonically. The interviews were audio recorded and transcripts produced. Content analysis was conducted to explore, document and describe the participants' experiences with regard to financial medicine practices in the local pre-hospital environment. Results: It emerged that all of the participants had experienced a number of financial medicine practices and associated unethical conduct. Examples included Over-servicing, Selective Patient Treatment, Fraudulent Billing Practices, Eliciting of kickbacks, incentives or benefits and Deliberate Time Wasting. Conclusion: The results of this study are concerning as the actions of service providers described by the participants constitute gross violations of the ethical and professional guidelines for health care professionals. The authors recommend additional studies be conducted to further explore these findings and to establish the reasons for, and ways of, limiting financial medicine practices in the South African emergency care environment.

  4. The impact of self-care education on life expectancy in acute coronary syndrome patients

    Directory of Open Access Journals (Sweden)

    Mahshid Choobdari

    2015-04-01

    Conclusion: Hospitalized acute coronary syndrome patients have a lower levels of life expectancy. Their life expectancy can increase through providing them with self-care education, which will lead to their independence promotion and self-esteem.

  5. Organization-and-technological model of medical care delivered to patients with coronary heart disease

    Directory of Open Access Journals (Sweden)

    Popova Y.V.

    2014-09-01

    Full Text Available Organization-and-technological model of medical care delivered to patients with coronary heart disease based on IDEF0 methodology and corresponded with clinical guidelines is presented.

  6. Association between short sleep and body mass index, hypertension among acute coronary syndrome patients in coronary care unit.

    Science.gov (United States)

    Sepahvand, Elham; Jalali, Rostam; Mirzaei, Maryam; Kargar Jahromi, Marzieh

    2014-11-26

    Patients with coronary diseases admitted to special care unit often suffer from sleep disorders, which may cause physiological changes and adversely affect patient's health. The relationship between sleep disorders and obesity is an important factor in studies on sleep disorders and other chronic diseases in all groups, including cardiovascular diseases. Understanding this relationship may increase the chance of progress in effective medical interventions in sleep disorders and obesity. This study was designed to evaluate the association between short sleep and Body Mass Index (BMI), hypertension among acute coronary syndrome patients. In this descriptive analytical study, 221 coronary patients admitted to coronary care unit and general wards were investigated. Data were collected through a researcher-made questionnaire whose validity and reliability had been confirmed. Data were analyzed with SPSS-16 software. A total of 221 patients with acute coronary diseases (including myocardial infarction and angina pectoris) with a mean age of 61.27 years were studied, of whom 61.5% were male and 38.5% were female. A significant association was observed between short sleep and higher BMI (P=0.000). About half the patients (49.3%) had a history of hypertension, and sleep disorders were also significantly related to hypertension (P=0.006). In this study, sleep disorders were patients' main complaint. Researchers found that patients with less than 5 hours or more than 9 hours sleep at night were more likely to have hypertension compared to patients that slept 7-8 hours. Lack of sleep affects metabolism, and daily energy expenditure reduces with increased immobility. In this study, a significant relationship was observed between BMI and sleep duration among hospitalized patients in coronary care unit (P=0.000), and sleep disorders increased with higher BMI. Short of sleep increases sympathetic tonus, cortisol level, and activation of inflammatory pathways, impairing glucose

  7. The pre-hospital administration of tranexamic acid to patients with multiple injuries and its effects on rotational thrombelastometry: a prospective observational study in pre-hospital emergency medicine.

    Science.gov (United States)

    Kunze-Szikszay, Nils; Krack, Lennart A; Wildenauer, Pauline; Wand, Saskia; Heyne, Tim; Walliser, Karoline; Spering, Christopher; Bauer, Martin; Quintel, Michael; Roessler, Markus

    2016-10-10

    Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED). All patients received 1 g of TxA after the first blood sample was taken. Rotational thrombelastometry (ROTEM) was performed for both blood samples, and the results were compared. HF was defined as a maximum lysis (ML) >15 % in EXTEM. The median (min-max) ISS was 17 points (4-50 points). Four patients (15 %) had HF diagnosed via ROTEM at the scene, and 2 patients (7.5 %) had HF diagnosed via ROTEM on admission to the ED. The median ML before TxA administration was 11 % (3-99 %) vs. 10 % after TxA administration (4-18 %; p > 0.05). TxA was administered 37 min (10-85 min) before ED arrival. The ROTEM results before and after TxA administration did not significantly differ. No adverse drug reactions were observed after TxA administration. HF can be present in severely injured patients during pre-hospital care. Antifibrinolytic therapy administered at the scene is a significant time saver. Even in milder trauma fibrinogen can be decreased to critically low levels. Early administration of TxA cannot reverse or entirely stop this decrease. The pre-hospital use of TxA should be considered for severely injured patients to prevent the worsening of trauma-induced coagulopathy and unnecessarily high fibrinogen consumption. ClinicalTrials.gov ID NCT01938768 (Registered 5 September 2013).

  8. Thallium-201 myocardial imaging as a selection method for the coronary care unit

    International Nuclear Information System (INIS)

    Wackers, F.J.Th.; Lie, K.I.; Sokole, E.B.; Samson, G.; Schoot, J.B. van der

    1980-01-01

    In many patients admitted to the coronary care unit, the diagnosis of acute myocardial infarction is evident at the time of arrival at the hospital. Nevertheless, a substantial group of patients still remains in whom initial evaluation provides a questionable history and a nondiagnostic electrocardiogram. Results suggested that 201 Tl scintigraphy may have potential value to serve as an appropriate means of selecting patients for admission to the coronary care unit. In order to evaluate this possibility, the authors performed a prospective study from September 1975 to September 1976. During this period 1861 patients were refered to the coronary care unit because of presumed acute myocardial infarction. The study concludes that for patients in whom the history and the electrocardiogram are of little help in decision making, thallium-201 scintigraphy can be viewed as an additional and important diagnostic method, which improves efficient management of patients with potential coronary artery disease syndrome. (Auth.)

  9. [The development of a portable life support device for transporting pre-hospital critically ill patients].

    Science.gov (United States)

    Song, Zhen-xing; Wu, Tai-hu; Meng, Xing-ju; Lu, Heng-zhi; Zheng, Jie-wen; Wang, Hai-tao

    2012-06-01

    To describe a portable life support device for transportation of pre-hospital patients with critical illness. The characteristics and requirements for urgent management during transportation of critically ill patients to a hospital were analyzed. With adoption of the original equipment, with the aid of staple of the art soft ware, the overall structure, its installation, fixation, freedom from interference, operational function were studied, and the whole system of life support and resuscitation was designed. The system was composed by different modules, including mechanical ventilation, transfusion, aspiration, critical care, oxygen supply and power supply parts. The system could be fastened quickly to a stretcher to form portable intensive care unit (ICU), and it could be carried by different size vehicles to provide nonstop treatment by using power supply of the vehicle, thus raising the efficiency of urgent care. With characteristics of its small size, lightweight and portable, the device is particularly suitable for narrow space and extreme environment.

  10. Pre-hospital administration of tirofiban in diabetic patients with ST-elevation myocardial infarction undergoing primary angioplasty: a sub-analysis of the On-Time 2 trial.

    NARCIS (Netherlands)

    Timmer, J.R.; Berg, J.; Heestermans, A.A.; Dill, T.; Werkum, J.W. van; Dambrink, J.H.; Suryapranata, H.; Ottervanger, J.P.; Hamm, C.; Hof, A.W. van 't

    2010-01-01

    AIMS: Glycoprotein IIb/IIIa blocking agents seem to improve percutaneous coronary intervention (PCI) results in patients with ST-elevation myocardial infarction (STEMI). We aimed to compare the effect of pre-hospital administration of tirofiban in STEMI patients with and without diabetes mellitus

  11. Pre-Hospital Emergency Medical Services: An Epidemiological Survey in Mashhad, Iran

    Directory of Open Access Journals (Sweden)

    Mohsen Seyyednozadi

    2017-07-01

    Full Text Available Introduction: Providing appropriate care, in the right place and at the right time, is the main goal of emergency medical services (EMS to save lives. The present study aimed to assess the pre-hospital EMS in Mashhad, the second largest metropolis in Iran. Materials and Methods: In this research, data were extracted from the pre-hospital emergency mission forms, which were collected from the EMS stations in Mashhad and suburbs through systematic random sampling. In addition, supplementary information was obtained from the ambulance dispatch cards and emergency communication center forms. Results:Automobile accidents (33.7% and cardiovascular events (17.8% were the most common causes of contacts to the EMS. In the city and road stations, the mean response time was 2.6 and 1.6 minutes, while the mean time of arrival at the scene was 13.2 and 11.4 minutes, and the mean evacuation time was 13.2 and 11.4 minutes, respectively. Individuals aged 20-29 (25.2% and more than 60 years (23.9% constituted the majority of the cases receiving EMS. Conclusion: According to the results, the ‘golden time’ for emergency care was of great importance in the patients injured in car accidents or affected by cardiovascular events. Furthermore, a significant difference was observed in the time indices of EMS in Mashhad city with the EMS standards due to the lack of human resources or EMS facilities. Some contacts to the EMS were unnecessary, and no expert team aid was needed in some cases. It is recommended that citizens be trained on solving the problems associated with road traffic by implementing mobile emergency, while transfer units must be established for the better provision of emergency care by the EMS in Mashhad.

  12. Coronary artery disease in patients undergoing valve replacement at a tertiary care cardiac centre

    International Nuclear Information System (INIS)

    Shaikh, A.H.; Hanif, B.; Hasan, K.; Hashmani, S.

    2011-01-01

    To determine the prevalence of coronary artery disease in patients undergoing valve surgery at a tertiary care cardiac centre. The medical records of 144 consecutive patients who underwent mitral, aortic or dual (mitral and aortic) valve replacement surgery at the Tabba Heart Institute between January 2006 to December 2008 were retrospectively reviewed. All patients underwent coronary angiogram. Significant coronary artery disease (CAD) is defined as coronary stenosis of > 50%. There were 74 (51.4%) males and 70 (48.6%) females in the study. The mean age was 51.64 +- 11 years. Of all, 73 (50.7%) underwent mitral valve replacement, 47 (32.6%) had aortic and 24 (16.7%) had dual valve replacement. Out of 144 patients, 99 (68.8%) had 50% stenosis. In patients who had undergone mitral valve replacement (MVR), significant coronary disease was found in 32.9%, whereas in patients who had undergone aortic valve replacement (AVR) and dual valve replacement (DVR) the prevalence of coronary disease was 31.9% and 25% respectively. Our results suggest that the overall prevalence of coronary artery disease in patients undergoing valve surgery in our population is comparable with prevalence reported in international data. (author)

  13. Pre-hospital physical activity status affects in-hospital course of elderly patients with acute myocardial infarction.

    Science.gov (United States)

    Miyamoto, Takamichi; Obayashi, Tohru; Hattori, Eijirou; Yamauchi, Yasuteru; Niwa, Akihiro; Isobe, Mitsuaki

    2010-03-01

    The clinical course of elderly patients with acute myocardial infarction (AMI) can sometimes unexpectedly result in an adverse outcome even when therapy appears to be successful. We suspect that specific factors may characterize this worsening of status during hospitalization. This study examines whether the pre-hospital physical activity status of the elderly treated with percutaneous coronary intervention (PCI) for AMI affects their in-hospital course. We studied 110 consecutive patients, aged 80 or older, who had undergone emergent PCI for AMI. Patients were divided into two groups based on clinical presentation: Better Killip class (Killip classes I and II) and Worse Killip class (Killip classes III and IV). Patients were also divided into two groups based on pre-hospital physical activity status, determined retrospectively by review of medical records: Good physical activity (n=57) comprising those able to go out alone independently and Poor physical activity comprising those mainly confined to home (n=53). The overall in-hospital mortality rate was 9.1% for the study population. The Worse Killip class group had a higher in-hospital mortality rate than the Better Killip class group (27.8% vs 5.4%, respectively; p=0.0102). In addition, the Poor physical activity group had a higher in-hospital mortality rate than the Good physical activity group (15.1% vs. 3.5%, respectively; p=0.047). These data suggest that pre-hospital physical activity status in elderly patients with AMI may affect in-hospital mortality as well as Killip class.

  14. Factors Impacting Mortality in the Pre-Hospital Period After Road Traffic Accidents in Urban India.

    Science.gov (United States)

    Chandrasekharan, Ananthnarayan; Nanavati, Aditya J; Prabhakar, Sandhya; Prabhakar, Subramaniam

    2016-07-01

    personal safety, and driving vehicles under adverse conditions are some of the leading causes of road traffic accidents. There should be an emphasis on emergency trauma care in the pre-hospital setting.

  15. Regulation and registration as drivers of continuous professional competence for Irish pre-hospital practitioners: a discussion paper.

    Science.gov (United States)

    Knox, S; Dunne, S S; Hughes, M; Cheeseman, S; Dunne, C P

    2016-05-01

    The regulatory body responsible for the registration of Irish pre-hospital practitioners, the Pre-Hospital Emergency Care Council (PHECC), identified the need to implement a continuing professional competence (CPC) framework. The first cycle of CPC (focused on emergency medical technicians) commenced in November 2013 creating for the first time a formal relationship between continuing competence and registration to practice. To review current literature and to describe benefits and challenges relevant to CPC, regulation, registration and their respective contributions to professionalism of pre-hospital practitioners: advanced paramedics, paramedics and emergency medical technicians. Online search of cumulative index to nursing and allied health literature (CINAHL Plus with Full Text), Allied and Complementary Medicine (AMED) and 'Pubmed' databases using: 'Continuous Professional Development'; 'Continuous Professional Development'; 'emergency medical technician'; 'paramedic'; 'registration'; 'regulation'; and "profession' for relevant articles published since 2004. Additional policy documents, discussion papers, and guidance documents were identified from bibliographies of papers found. Reports, governmental policies for other healthcare professions, and professional developments internationally for allied professions (e.g., nursing, physiotherapy and medicine) link maintenance of competence with requirements for registration to practice. We suggest that evolving professionalisation of Irish paramedics should be affirmed through behaviours and competencies that incorporate adherence to professional codes of conduct, reflective practice, and commitment to continuing professional development. While the need for ambulance practitioner CPD was identified in Ireland almost a decade ago, PHECC now has the opportunity to introduce a model of CPD for paramedics linking competence and professionalism to annual registration.

  16. Estresse da equipe de enfermagem do corpo de bombeiros no Atendimento Pré-Hospitalar Móvel El estrés del equipo de enfermería del cuerpo de bomberos en atención pre-hospitalaria móvil Stress at the nursing staff from the fire department in a mobile pre-hospital care

    Directory of Open Access Journals (Sweden)

    Richiére dos Santos Pereira Salvador

    2013-06-01

    profesionales.The research has as subject, the study of the stress at work on a nursing staff from the Fire Department in the pre - hospital care, and aims to identify what are the stressors in the work of professionals who are part of the nursing staff of APH Mobile from the Fire Department; analyze the impact of stress on the health of these professionals. The study characterized itself as qualitative descriptive - exploratory, involving 10 professionals. Data collection was conducted through interviews recorded electronically, using a semi-structured instrument. After transcription of the interviews, the similar aspects and differences found were grouped into analyze categories. It was confirmed that these professionals are subjected to constant stress, having modified their lifestyle habits, with health impact. It is suggested that the identified problems are studied in order to develop strategies in order to generate better working conditions for these professionals.

  17. Risk assessment of pre-hospital trauma airway management by anaesthesiologists using the predictive Bayesian approach

    Directory of Open Access Journals (Sweden)

    Nakstad Anders R

    2010-04-01

    Full Text Available Abstract Introduction Endotracheal intubation (ETI has been considered an essential part of pre-hospital advanced life support. Pre-hospital ETI, however, is a complex intervention also for airway specialist like anaesthesiologists working as pre-hospital emergency physicians. We therefore wanted to investigate the quality of pre-hospital airway management by anaesthesiologists in severely traumatised patients and identify possible areas for improvement. Method We performed a risk assessment according to the predictive Bayesian approach, in a typical anaesthesiologist-manned Norwegian helicopter emergency medical service (HEMS. The main focus of the risk assessment was the event where a patient arrives in the emergency department without ETI despite a pre-hospital indication for it. Results In the risk assessment, we assigned a high probability (29% for the event assessed, that a patient arrives without ETI despite a pre-hospital indication. However, several uncertainty factors in the risk assessment were identified related to data quality, indications for use of ETI, patient outcome and need for special training of ETI providers. Conclusion Our risk assessment indicated a high probability for trauma patients with an indication for pre-hospital ETI not receiving it in the studied HEMS. The uncertainty factors identified in the assessment should be further investigated to better understand the problem assessed and consequences for the patients. Better quality of pre-hospital airway management data could contribute to a reduction of these uncertainties.

  18. Pre-Hospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    James J McCarthy

    2011-05-01

    Full Text Available Introduction: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI. Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI capability for the treatment of acute myocardial infarctions. Given the paucity of hospitals capable of PCI, early identification of more severe myocardial infarction may prompt emergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions. Methods: In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of proximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset. Results: In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n¼35, the mean sum of ST elevation (STE in leads V1 through V6 plus ST depression (STD in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P¼0.007. A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n¼37, there was no significant difference in ST-segment deviation between the 2 groups. Conclusion: The sum STE (V1-V6 and STD (II

  19. What components of chronic care organisation relate to better primary care for coronary heart disease patients? An observational study.

    NARCIS (Netherlands)

    Lieshout, J. van; Frigola Capell, E.; Ludt, S.; Grol, R.P.T.M.; Wensing, M.J.P.

    2012-01-01

    OBJECTIVES: Cardiovascular risk management (CVRM) received by patients shows large variation across countries. In this study we explored the aspects of primary care organisation associated with key components of CVRM in coronary heart disease (CHD) patients. DESIGN: Observational study. SETTING: 273

  20. What components of chronic care organisation relate to better primary care for coronary heart disease patients? An observational study.

    OpenAIRE

    Lieshout, J. van; Frigola Capell, E.; Ludt, S.; Grol, R.P.T.M.; Wensing, M.J.P.

    2012-01-01

    OBJECTIVES: Cardiovascular risk management (CVRM) received by patients shows large variation across countries. In this study we explored the aspects of primary care organisation associated with key components of CVRM in coronary heart disease (CHD) patients. DESIGN: Observational study. SETTING: 273 primary care practices in Austria, Belgium, England, Finland, France, Germany, The Netherlands, Slovenia, Switzerland and Spain. PARTICIPANTS: A random sample of 4563 CHD patients identified by co...

  1. Nationwide trends in use and timeliness of diagnostic coronary angiography in acute coronary syndromes from 2005 to 2011: Does distance to invasive heart centres matter?

    Science.gov (United States)

    Hansen, Kim W; Sørensen, Rikke; Madsen, Mette; Madsen, Jan K; Jensen, Jan S; von Kappelgaard, Lene M; Mortensen, Poul E; Galatius, Søren

    2015-08-01

    To examine trends in the use of diagnostic coronary angiography according to distance from home to the nearest invasive heart centre following implementation of fast-track protocols and extensive pre-hospital triaging of acute coronary syndrome patients. We performed a register-based cohort study of all patients admitted to Danish hospitals with incident acute coronary syndrome in 2005-2011. Diagnostic coronary angiography within 60 days of admission was investigated according to distance tertiles (DTs) calculated as range from each patient's home to the nearest invasive heart centre (short DT: 65 km). Cox proportional hazards models were applied.Among the 52,409 patients included, diagnostic coronary angiography was increasingly used during 2005-2011 (short DT: 76% to 81%; medium DT: 74% to 81%; long DT: 69% to 78%; all p-values for trend coronary angiography, and 60-day mortality decreased in all DT. This nationwide study found significant increases in diagnostic coronary angiography use over time in incident acute coronary syndrome patients with a relatively larger increase in patients residing farthest from an invasive heart centre. Additionally, selected quality of care measures improved in the entire cohort, suggesting a benefit of national clinical protocols. © The European Society of Cardiology 2014.

  2. Pre-hospital intubation factors and pneumonia in trauma patients.

    Science.gov (United States)

    Evans, Heather L; Warner, Keir; Bulger, Eileen M; Sharar, Sam R; Maier, Ronald V; Cuschieri, Joseph

    2011-10-01

    We reported similar rates of ventilator-associated pneumonia (VAP) previously in trauma patients intubated either in a pre-hospital (PH) venue or the emergency department. A subset of PH intubations with continuous quality assessment was re-examined to identify the intubation factors associated with VAP. The subgroup was derived from an existing data set of consecutive adult trauma patients intubated prior to Level I trauma center admission July 2007-July 2008. Intubation details recorded included bag-valve mask ventilation (BVM) and the presence of material in the airway. The diagnosis of VAP was made preferentially by quantitative bronchoalveolar lavage (BAL) cultures (≥ 10⁴ colony-forming units indicating infection). Baseline data, injury characteristics, and circumstances of intubation of patients with and without VAP were compared by univariable analysis. Detailed data were available for 197 patients; 32 (16.2%) developed VAP, on average 6.0±0.7 days after admission. Baseline characteristics were similar in the groups, but diabetes mellitus was more common in the VAP group (4 [12.5%] vs. 5 [3.0%]; p=0.02). There was a higher rate of blunt injury in the VAP patients (28 [87.5%] vs. 106 [64.2%]; p=0.01) and higher injury severity scores (33.1±2.8 vs. 23.0±1.0; p=0.0002) and chest Abbreviated Injury Scores (2.6±0.3 vs. 1.5±0.1; p=0.002). Lower Glasgow Coma Scale scores (7.9±0.9 vs. 9.9±0.4; p=0.04) and greater use of BVM (18 [56.3%] vs. 56 [34.0%]; p=0.02) were observed in patients who developed VAP. Among aspirations, 10 (31.3%) of patients with emesis developed VAP compared with only 4 (12.5%) with blood in the airway (p=0.003). Aspiration, along with depressed consciousness and greater injury severity, may predispose trauma patients to VAP. Prospective studies should focus on the quality and timing of aspiration relative to intubation to determine if novel interventions can prevent aspiration or decrease the risk of VAP after aspiration.

  3. Trend in patients and diseases at the coronary care unit in the Jikei University Hospital

    International Nuclear Information System (INIS)

    Shibata, Takahiro; Yagi, Hidenori; Sakai, Tomohisa

    2005-01-01

    We investigated the total numbers of cases of representative diseases, including acute myocardial infarction (AMI), unstable angina pectoris (uAP) and aortic dissection, treated at our coronary care unit and therapeutic strategies for them. Both AMI and uAP have been considered types of acute coronary syndrome with similar diagnostic criteria. We found, however, that the therapeutic strategies for these conditions differ slightly. Coronary bypass surgery was performed in a higher percentage of cases of uAP (7%) than of AMI (1%) because more time was available for surgery. The mortality rate was higher in cases of AMI. For aortic dissection, emergent surgery was performed in Stanford A cases with an open false lumen. Medical therapy was performed in Stanford B cases. These strategies were recommended in the guideline of the Japanese Society of Cardiology. In contrast, the strategy for Stanford A cases with intramural hematoma has been unclear. Medical control with careful follow-up computed tomography of the chest has been the preferred strategy for Stanford A cases with intramural hematoma in our coronary care unit. We have had good results with this method. (author)

  4. Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis

    DEFF Research Database (Denmark)

    Henriksen, Hanne Herborg; Rahbar, Elaheh; Baer, Lisa A

    2016-01-01

    hypothesized that pre-hospital plasma would improve hemostatic function as evaluated by rapid thrombelastography (rTEG). METHODS: We conducted a prospective observational study recruiting 257 trauma patients admitted to a Level I trauma center having received either blood products pre-hospital or in......BACKGROUND: The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. plasma and/or RBCs) on admission hemostatic properties and patient outcomes. We......-hospital within 6 hours of admission. Clinical data on patient demographics, blood biochemistry, injury severity score and mortality were collected. Admission rTEG was conducted to characterize the coagulation profile and hemostatic function. RESULTS: 75 patients received pre-hospital plasma and/or RBCs (PH group...

  5. The value of the pre-hospital learning environment as part of the emergency nursing programme

    Directory of Open Access Journals (Sweden)

    Sonett van Wyk

    2015-06-01

    Conclusion: The research findings support the value and continuation of utilising the pre-hospital clinical learning environment for placing post-basic emergency nursing students when enrolled in the emergency nursing programme.

  6. Investigating the effect of collaborative care on depression, anxiety, and stress of patients after coronary angioplasty

    Directory of Open Access Journals (Sweden)

    Parastoo Rezapour

    2016-02-01

    Full Text Available Background: Coronary artery disease and its associated treatment interventions such as angioplasty can lead to emotional problems, including depression, anxiety, and stress, in patients and might have adverse effects on the recovery process. This study aimed to evaluate the effect of collaborative care model on depression, anxiety, and stress in patients after coronary angioplasty. Methods: This clinical trial was conducted on 50 patients undergoing coronary angioplasty, who were referred to intensive care unit and surgical ward of one of the hospitals of Isfahan, Iran, in 2015. Samples were selected through randomized convenience sampling and were divided into intervention and control group (n=25 for each group. Collaborative care model, consisting of four stages of motivation, preparation, engagement, and evaluation, was implemented for the intervention group through five 45-60 minute sessions and a three-month telephone follow-up. Data was collected using depression, anxiety, and stress scale (DASS-42 before and one month after the intervention from both groups. Data were analyzed using descriptive statistics, Chi-square, as well as independent and paired t-tests in SPSS, version 18. Results: In this study, mean score of depression was significantly decreased in the intervention group after the implementation of collaborative model (from 31.6±3.7 to 6.3±5.03 (P<0.001, and mean anxiety and stress scores were reduced from 32.6±3.04 and 32.2±3.3 to 6.2±4.1 and 8.5±4.8, respectively (P<0.001. In this regard, a significant difference was observed between the intervention and control groups (P<0.001. Conclusion: Implementation of collaborative care could be associated with lower depression, anxiety, and stress in patients after coronary angioplasty. Therefore, its application is recommended as an effective method for such patients.

  7. Pre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: data from the Bari- Barletta/Andria/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myocardial infarction.

    Science.gov (United States)

    Brunetti, Natale Daniele; Di Pietro, Gaetano; Aquilino, Ambrogio; Bruno, Angela I; Dellegrottaglie, Giulia; Di Giuseppe, Giuseppe; Lopriore, Claudio; De Gennaro, Luisa; Lanzone, Saverio; Caldarola, Pasquale; Antonelli, Gianfranco; Di Biase, Matteo

    2014-09-01

    We report the preliminary data from a regional registry on ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty in Apulia, Italy; the region is covered by a single public health-care service, a single public emergency medical service (EMS), and a single tele-medicine service provider. Two hundred and ninety-seven consecutive patients with STEMI transferred by regional free public EMS 1-1-8 for primary-PCI were enrolled in the study; 123 underwent pre-hospital electrocardiograms (ECGs) triage by tele-cardiology support and directly referred for primary-PCI, those remaining were just transferred by 1-1-8 ambulances for primary percutaneous coronary intervention (PCI) (diagnosis not based on tele-medicine ECG; already hospitalised patients, emergency-room without tele-medicine support). Time from first ECG diagnostic for STEMI to balloon was recorded; a time-to-balloon primary-PCI). Pre-hospital triage with tele-cardiology ECG in an EMS registry from an area with more than one and a half million inhabitants was associated with shorter time-to-balloon and higher rates of timely treated patients, even in 'rural' areas. © The European Society of Cardiology 2014.

  8. The impact of care management information technology model on quality of care after Coronary Artery Bypass Surgery: "Bridging the Divides".

    Science.gov (United States)

    Weintraub, William S; Elliott, Daniel; Fanari, Zaher; Ostertag-Stretch, Jennifer; Muther, Ann; Lynahan, Margaret; Kerzner, Roger; Salam, Tabassum; Scherrer, Herbert; Anderson, Sharon; Russo, Carla A; Kolm, Paul; Steinberg, Terri H

    Reducing readmissions and improving metrics of care are a national priority. Supplementing traditional care with care management may improve outcomes. The Bridges program was an initial evaluation of a care management platform (CareLinkHub), supported by information technology (IT) developed to improve the quality and transition of care from hospital to home after Coronary Artery Bypass Surgery (CABG) and reduce readmissions. CareLink is comprised of care managers, patient navigators, pharmacists and physicians. Information to guide care management is guided by a middleware layer to gather information, PLR (ColdLight Solutions, LLC) and presented to CareLink staff on a care management platform, Aerial™ (Medecision). In addition there is an analytic engine to help evaluate and guide care, Neuron™ (Coldlight Solutions, LLC). The "Bridges" program enrolled a total of 716 CABG patients with 850 admissions from April 2013 through March 2015. The data of the program was compared with those of 1111 CABG patients with 1203 admissions in the 3years prior to the program. No impact was seen with respect to readmissions, Blood Pressure or LDL control. There was no significant improvement in patients' reported outcomes using either the CTM-3 or any of the SAQ-7 scores. Patient follow-up with physicians within 1week of discharge improved during the Bridges years. The CareLink hub platform was successfully implemented. Little or no impact on outcome metrics was seen in the short follow-up time. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. [Determinant factors and conduct in post-accident with biological material among pre-hospital professionals].

    Science.gov (United States)

    Paiva, Maria Henriqueta Rocha Siqueira; Oliveira, Adriana Cristina

    2011-01-01

    This transversal study was carried out with a multiprofessional team in the pre-hospital care in Minas Gerais, Brazil. It aimed to estimate the incidence of occupational accidents by exposure to biological material and post-accidents conductsta. Descriptive analysis and logistic regression were used. Incidence of accidents was 19.8%: 39,1% perforating-cutting materials and 56.5% body fluids. Doctors (33.3%) and drivers (24.0%) were most involved. Inadequate subsequent measures were highly prevalent: no medical assessment (69.6%), no work accident communication issued (91.3%), no measures (52.2%) and no serological follow-up (52.2%). Variables associated with accidents were: age >31 years old (OR = 3,02; IC95%: 1,25 - 7,33; p = 0,014) and working in basic support units (OR = 5,36; IC95%: 1,51 19,08; p = 0,010). The implementation of post-accidents protocols is suggested in order to reduce accidents and under-notification, and increase post-accident follow-up.

  10. Person-centred care after acute coronary syndrome, from hospital to primary care - A randomised controlled trial.

    Science.gov (United States)

    Fors, Andreas; Ekman, Inger; Taft, Charles; Björkelund, Cecilia; Frid, Kerstin; Larsson, Maria Eh; Thorn, Jörgen; Ulin, Kerstin; Wolf, Axel; Swedberg, Karl

    2015-01-01

    To evaluate if person-centred care can improve self-efficacy and facilitate return to work or prior activity level in patients after an event of acute coronary syndrome. 199 patients with acute coronary syndrome < 75 years were randomly assigned to person-centred care intervention or treatment as usual and followed for 6 months. In the intervention group a person-centred care process was added to treatment as usual, emphasising the patient as a partner in care. Care was co-created in collaboration between patients, physicians, registered nurses and other health care professionals and documented in a health plan. A team-based partnership across three health care levels included transparent knowledge about the disease and medical state to achieve agreed goals during recovery. Main outcome measure was a composite score of changes in general self-efficacy ≥ 5 units, return to work or prior activity level and re-hospitalisation or death. The composite score showed that more patients (22.3%, n=21) improved in the intervention group at 6 months compared to the control group (9.5%, n=10) (odds ratio, 2.7; 95% confidence interval: 1.2-6.2; P=0.015). The effect was driven by improved self-efficacy ≥ 5 units in the intervention group. Overall general self-efficacy improved significantly more in the intervention group compared with the control group (P=0.026). There was no difference between groups on re-hospitalisation or death, return to work or prior activity level. A person-centred care approach emphasising the partnership between patients and health care professionals throughout the care chain improves general self-efficacy without causing worsening clinical events. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction?

    DEFF Research Database (Denmark)

    Salam, Idrees; Hassager, Christian; Thomsen, Jakob Hartvig

    2016-01-01

    BACKGROUND: Current guidelines recommend that comatose out-of-hospital cardiac arrest patients with ST-segment elevations (STEs) following return of spontaneous circulation (ROSC) should be referred for an acute coronary angiography. We sought to investigate the diagnostic value of the pre......-hospital ROSC-ECG in predicting ST-elevation myocardial infarction (STEMI). METHOD: ROSC-ECGs of 145 comatose survivors of out-of-hospital cardiac arrest, randomly assigned in the Target Temperature Management trial, were classified according to the current STEMI ECG criteria (third universal definition...... interval (CI) 62-84), specificity of 65% (95% CI 53-75) and a positive and negative predictive value of 65% (95% CI 54-76) and 73% (95% CI 61-83) in predicting STEMI. Time to ROSC was significantly longer (24 minutes vs. 19 minutes, P=0.02) in STE compared with no STE patients. Percutaneous coronary...

  12. ST-segment resolution with bivalirudin versus heparin and routine glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment elevation myocardial infarction patients transported for primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Van't Hof, Arnoud; Giannini, Francesco; Ten Berg, Jurrien

    2017-01-01

    BACKGROUND: Myocardial reperfusion after primary percutaneous coronary intervention (PCI) can be assessed by the extent of post-procedural ST-segment resolution. The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trial compared pre-hospital bivalirudin and pre-hospital heparin o...

  13. Coronary artery disease in patients undergoing cardiac surgery for non-coronary lesions in a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Cholenahally Nanjappa Manjunath

    2014-01-01

    Conclusion: The overall prevalence of CAD among patients undergoing non-coronary cardiac surgery is 8.7%. Coronary artery disease is relatively uncommon in patients with rheumatic VHD (4.9%, while its prevalence is highest in DAVD (23.4%.

  14. Spouses' conceptions of the pre-hospital phase when their partners suffered an acute myocardial infarction--a qualitative analysis.

    Science.gov (United States)

    Johansson, Ingela; Swahn, Eva; Strömberg, Anna

    2008-09-01

    Delay from onset of acute myocardial infarction symptoms to the delivery of medical care is a major determinant of prognosis. Although studies have explored patient reasons for delay, there are only limited data concerning experiences of the spouse. Was to describe spouses' conceptions of the pre-hospital phase when their partners suffered an acute myocardial infarction. A phenomenographic approach was applied. Fifteen spouses were interviewed rational, and consulting others. The category respecting independence contained: accepting the need for control, marital roles and experiences, restraining emotions, and seeking agreement. Our findings suggest that spouses have a strong influence on the course of events. When accepting the partner's need for control through following earlier marital roles and experiences, restraining own emotions and seeking agreement, this seemed to contribute to delay. However, when the spouse was resourceful by sharing the experience, having knowledge, understanding the severity, being rational and consulting others when needed, this seemed to have a positive influence on the pre-hospital time.

  15. Survey of WBSNs for Pre-Hospital Assistance: Trends to Maximize the Network Lifetime and Video Transmission Techniques

    Directory of Open Access Journals (Sweden)

    Enrique Gonzalez

    2015-05-01

    Full Text Available This survey aims to encourage the multidisciplinary communities to join forces for innovation in the mobile health monitoring area. Specifically, multidisciplinary innovations in medical emergency scenarios can have a significant impact on the effectiveness and quality of the procedures and practices in the delivery of medical care. Wireless body sensor networks (WBSNs are a promising technology capable of improving the existing practices in condition assessment and care delivery for a patient in a medical emergency. This technology can also facilitate the early interventions of a specialist physician during the pre-hospital period. WBSNs make possible these early interventions by establishing remote communication links with video/audio support and by providing medical information such as vital signs, electrocardiograms, etc. in real time. This survey focuses on relevant issues needed to understand how to setup a WBSN for medical emergencies. These issues are: monitoring vital signs and video transmission, energy efficient protocols, scheduling, optimization and energy consumption on a WBSN.

  16. Survey of WBSNs for Pre-Hospital Assistance: Trends to Maximize the Network Lifetime and Video Transmission Techniques

    Science.gov (United States)

    Gonzalez, Enrique; Peña, Raul; Vargas-Rosales, Cesar; Avila, Alfonso; Perez-Diaz de Cerio, David

    2015-01-01

    This survey aims to encourage the multidisciplinary communities to join forces for innovation in the mobile health monitoring area. Specifically, multidisciplinary innovations in medical emergency scenarios can have a significant impact on the effectiveness and quality of the procedures and practices in the delivery of medical care. Wireless body sensor networks (WBSNs) are a promising technology capable of improving the existing practices in condition assessment and care delivery for a patient in a medical emergency. This technology can also facilitate the early interventions of a specialist physician during the pre-hospital period. WBSNs make possible these early interventions by establishing remote communication links with video/audio support and by providing medical information such as vital signs, electrocardiograms, etc. in real time. This survey focuses on relevant issues needed to understand how to setup a WBSN for medical emergencies. These issues are: monitoring vital signs and video transmission, energy efficient protocols, scheduling, optimization and energy consumption on a WBSN. PMID:26007741

  17. The impact of care management information technology model on quality of care after percutaneous coronary intervention: "Bridging the Divides".

    Science.gov (United States)

    Weintraub, William S; Fanari, Zaher; Elliott, Daniel; Ostertag-Stretch, Jennifer; Muther, Ann; Lynahan, Margaret; Kerzner, Roger; Salam, Tabassum; Scherrer, Herbert; Anderson, Sharon; Russo, Carla A; Kolm, Paul; Steinberg, Terri H

    2017-07-03

    Reducing readmissions and improving metrics of care are a national priority. Supplementing traditional care with care management may improve outcomes. The Bridges program was an initial evaluation of a care management platform (CareLinkHub), supported by information technology (IT) developed to improve the quality and transition of care from hospital to home after percutaneous coronary intervention (PCI) and reduce readmissions. CareLink is comprised of care managers, patient navigators, pharmacists and physicians. Information to guide care management is guided by a middleware layer to gather information, PLR (ColdLight Solutions, LLC) and presented to CareLink staff on a care management platform, Aerial™ (Medecision). An additional analytic engine [Neuron™ (ColdLight Solutions, LLC)] helps, evaluates and guide care. The "Bridges" program enrolled a total of 2054 PCI patients with 2835 admission from April, 1st 2013 through March 1st, 2015. The data of the program was compared with those of 3691 PCI patients with 4414 admissions in the 3years prior to the program. No impact was seen with respect to inpatient and observation readmission, or emergency department visits. Similarly no change was noticed in LDL control. There was minimal improvement in BP control and only in the CTM-3 and SAQ-7 physical limitation scores in the patients' reported outcomes. Patient follow-up with physicians within 1week of discharge improved during the Bridges years. The CareLink hub platform was successfully implemented. Little or no impact on outcome metrics was seen in the short follow-up time. The Bridges program suggests that population health management must be a long-term goal, improving preventive care in the community. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. An overview of the construction of emergency and pre-hospital first aid platform

    Directory of Open Access Journals (Sweden)

    Song Chen

    2018-01-01

    Full Text Available To further improve the ability of pre-hospital and in-hospital collaborative treatment, strengthen emergency multidisciplinary cooperation and construct a scientific, rational and efficient emergency system, under the support of former chairman Yu Xue-zhong, Dr. Li Chun-sheng and numerous colleagues in the industry, the Emergency Medicine Society of the Chinese Medical Association appeal to us to draft Construction of Emergency and Pre-hospital Platform. Based on this background, the platform of emergency and pre-hospital first aid helps to build a “one horizontal and one Longitudinal” treatment model, using the horizontal and longitudinal patterns to integrate emergency medical resources to satisfy the automatic information integration and intelligent analysis sharing, realizing the emergency management visualization and medical information digitization, simplifying the medical process and establishing a perfect standard for the emergent diseases, thereby ultimately achieving efficient diagnosis and scientific treatment.

  19. Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias

    Directory of Open Access Journals (Sweden)

    Matute-Cruz Petra

    2009-04-01

    Full Text Available Abstract Background Mortality from invasive meningococcal disease (IMD has remained stable over the last thirty years and it is unclear whether pre-hospital antibiotherapy actually produces a decrease in this mortality. Our aim was to examine whether pre-hospital oral antibiotherapy reduces mortality from IMD, adjusting for indication bias. Methods A retrospective analysis was made of clinical reports of all patients (n = 848 diagnosed with IMD from 1995 to 2000 in Andalusia and the Canary Islands, Spain, and of the relationship between the use of pre-hospital oral antibiotherapy and mortality. Indication bias was controlled for by the propensity score technique, and a multivariate analysis was performed to determine the probability of each patient receiving antibiotics, according to the symptoms identified before admission. Data on in-hospital death, use of antibiotics and demographic variables were collected. A logistic regression analysis was then carried out, using death as the dependent variable, and pre-hospital antibiotic use, age, time from onset of symptoms to parenteral antibiotics and the propensity score as independent variables. Results Data were recorded on 848 patients, 49 (5.72% of whom died. Of the total number of patients, 226 had received oral antibiotics before admission, mainly betalactams during the previous 48 hours. After adjusting the association between the use of antibiotics and death for age, time between onset of symptoms and in-hospital antibiotic treatment, pre-hospital oral antibiotherapy remained a significant protective factor (Odds Ratio for death 0.37, 95% confidence interval 0.15–0.93. Conclusion Pre-hospital oral antibiotherapy appears to reduce IMD mortality.

  20. EMS Adherence to a Pre-hospital Cervical Spine Clearance Protocol

    Directory of Open Access Journals (Sweden)

    Johnson, David

    2001-10-01

    Full Text Available Purpose: To determine the degree of adherence to a cervical spine (c-spine clearance protocol by pre-hospital Emergency Medical Services (EMS personnel by both self-assessment and receiving hospital assessment, to describe deviations from the protocol, and to determine if the rate of compliance by paramedic self-assessment differed from receiving hospital assessment. Methods: A retrospective sample of pre-hospital (consecutive series and receiving hospital (convenience sample assessments of the compliance with and appropriateness of c-spine immobilization. The c-spine clearance protocol was implemented for Orange County EMS just prior to the April-November 1999 data collection period. Results: We collected 396 pre-hospital and 162 receiving hospital data forms. From the pre-hospital data sheet. the percentage deviation from the protocol was 4.096 (16/396. Only one out of 16 cases that did not comply with the protocol was due to over immobilization (0.2%. The remaining 15 cases were under immobilized, according to protocol. Nine of the under immobilized cases (66% that should have been placed in c-spine precautions met physical assessment criteria in the protocol, while the other five cases met mechanism of injury criteria. The rate of deviations from protocol did not differ over time. The receiving hospital identified 8.0% (13/162; 6/16 over immobilized, 7/16 under immobilized of patients with deviations from the protocol; none was determined to have actual c-spine injury. Conclusion: The implementation of a pre-hospital c-spine clearance protocol in Orange County was associated with a moderate overall adherence rate (96% from the pre-hospital perspective, and 92% from the hospital perspective, p=.08 for the two evaluation methods. Most patients who deviated from protocol were under immobilized, but no c-spine injuries were missed. The rate of over immobilization was better than previously reported, implying a saving of resources.

  1. Depression in primary care patients with coronary heart disease: baseline findings from the UPBEAT UK study.

    Directory of Open Access Journals (Sweden)

    Paul Walters

    Full Text Available An association between depression and coronary heart disease is now accepted but there has been little primary care research on this topic. The UPBEAT-UK studies are centred on a cohort of primary patients with coronary heart disease assessed every six months for up to four years. The aim of this research was to determine the prevalence and associations of depression in this cohort at baseline.Participants with coronary heart disease were recruited from general practice registers and assessed for cardiac symptoms, depression, quality of life and social problems.803 people participated. 42% had a documented history of myocardial infarction, 54% a diagnosis of ischaemic heart disease or angina. 44% still experienced chest pain. 7% had an ICD-10 defined depressive disorder. Factors independently associated with this diagnosis were problems living alone (OR 5.49, 95% CI 2.11-13.30, problems carrying out usual activities (OR 3.71, 95% CI 1.93-7.14, experiencing chest pain (OR 3.27, 95% CI 1.58-6.76, other pains or discomfort (OR 3.39, 95% CI 1.42-8.10, younger age (OR 0.95 per year 95% CI 0.92-0.98.Problems living alone, chest pain and disability are important predictors of depression in this population.

  2. Pre-hospital management and risk factors in children with acute ...

    African Journals Online (AJOL)

    Background. Diarrhoea remains a major cause of childhood morbidity and mortality in the developing world. Implementation of World Health Organization Integrated Management of Childhood Illness (IMCI) guidelines and pre-hospital use of oral rehydration therapy (ORT) in the Western Cape Province of South Africa are ...

  3. Design of a game-based pre-hospital resuscitation training for first responders

    NARCIS (Netherlands)

    Kalz, Marco; Schmitz, Birgit; Biermann, Henning; Klemke, Roland; Ternier, Stefaan; Specht, Marcus

    2013-01-01

    Kalz, M., Schmitz, B., Biermann, H., Klemke, R., Ternier, S., & Specht, M. (2013). Design of a game-based pre-hospital resuscitation training for first responders. In A. Holzinger, M. Ziefle, & V. Glavinić (Eds.), SouthCHI 2013, LNCS 7946 (pp. 363-372). Germany: Springer, Heidelberg.

  4. Profile of conventional risk factors in patients presenting for coronary angiography in a tertiary care hospital

    International Nuclear Information System (INIS)

    Qureshi, N.S.

    2014-01-01

    The conventional risk factors for coronary artery disease (CAD) include hypertension, diabetes mellitus, hyperlipidaemia and cigarette smoking(1). There is a large body of evidence, which implicates these factors in the causation of coronary artery disease. Objective: To study the attern of the above-mentioned as well as additional risk factors including age, gender, family history, obesity and hepatitis B and C seropositivity in the population of patients undergoing coronary angiography at our tertiary care hospital.Methodology:In this cross-sectional survey, 465 patients undergoing coronary angiography were studied using a questionnaire as well as clinical and laboratory data. The information obtained included age, sex, clinical presentation, past medical history, family history, the presence or absence of previous ischemic heart disease, diabetes, hypertension and a history of smoking. A history of duration of diabetes and hypertension, their treatment and the presence or absence of complications was also noted. A proportion of patients had their fasting blood lipid levels measured. Height, weight and waist circumference as well as HepBsAg and anti-HCV levels were also determined.Results: The 465 patients studied included 383 males and 82 females. The mean age of all patients was 49.68 +- 0.464 years and the difference between genders was not significant. A past history of ischaemic heart disease was present in 31% of patients. Diabetes mellitus was present in 23% of males and 45% of females. A history of hypertension was present in 30.8% males and 70.7% of the females. Of the patients who could be studied, the mean LDL was 110.29 +- 1.706 mg/dL, the mean HDL was 41.01 +- 0.319 mg/dL and the mean TG was 189.67 +- 4.21 mg/dL. The difference in lipid profile values between male and female patients was not significant (p-value >0.05). Waist circumference was increased in 69.7% males and 93.9% females and here the difference between genders was significant, Hep

  5. 45. Nursing care of the patient undergoing coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    M. Bayoumi

    2015-10-01

    The patient undergoing CABG surgery deserves to have confidence that the professional nurse is knowledgeable, caring, efficient, and effective in providing necessary perioperative care. Proper preparation of the patient and significant others, expertise during the intraoperative phase, and a thorough knowledge base combined with skill and compassion of the nursing staff during the postoperative phase increase the likelihood of a positive outcome for the patient. A compassionate, knowledgeable, and skilled nurse caring for the patient after open heart surgery is an asset in the achievement of positive outcomes for the patient and his/her significant others. The care of the CABG patient is intense, complex, and rewarding. The patient is admitted to the intensive care unit unconscious, intubated, and completely dependent on advanced technology as well as the expert care of the health team. Typically 24–48 h after the surgery, the invasive lines have been discontinued, the patient no longer needs to be mechanically ventilated, organ system function is returning to normal, and the patient is now ready to work toward increasing independence. Cardiac surgery is not the cure for coronary artery disease. It gives the patient the opportunity to make needed lifestyle adjustments and achieve the highest degree of health possible. Nurses are a part of the team that makes this return to health a possibility for the patient.

  6. Opportunities for Prevention: Assessing Where Low-Income Patients Seek Care for Preventable Coronary Artery Disease.

    Science.gov (United States)

    Klaiman, Tamar A; Valdmanis, Vivian G; Bernet, Patrick; Moises, James

    2015-10-01

    The Affordable Care Act has many aspects that are aimed at improving health care for all Americans, including mandated insurance coverage for individuals, as well as required community health needs assessments (CHNAs), and reporting of investments in community benefit by nonprofit hospitals in order to maintain tax exemptions. Although millions of Americans have gained access to health insurance, many--often the most vulnerable--remain uninsured, and will continue to depend on hospital community benefits for care. Understanding where patients go for care can assist hospitals and communities to develop their CHNA and implementation plans in order to focus resources where the need for prevention is greatest. This study evaluated patient care-seeking behavior among patients with coronary artery disease (CAD) in Florida in 2008--analyzed in 2013--to assess whether low-income patients accessed specific safety net hospitals for treatment or received care from hospitals that were geographically closer to their residence. This study found evidence that low-income patients went to hospitals that treated more low-income patients, regardless of where they lived. The findings demonstrate that hospitals-especially public safety net hospitals with a tradition of treating low-income patients suffering from CAD-should focus prevention activities where low-income patients reside.

  7. Positive Coping: A Unique Characteristic to Pre-Hospital Emergency Personnel.

    Science.gov (United States)

    Ebadi, Abbas; Froutan, Razieh

    2017-01-01

    It is important to gain a thorough understanding of positive coping methods adopted by medical emergency personnel to manage stressful situations associated with accidents and emergencies. Thus, the purpose of this study was to gain a better understanding of positive coping strategies used by emergency medical service providers. This study was conducted using a qualitative content analysis method. The study participants included 28 pre-hospital emergency personnel selected from emergency medical service providers in bases located in different regions of the city of Mashhad, Iran, from April to November 2016. The purposive sampling method also was used in this study, which was continued until data saturation was reached. To collect the data, semistructured open interviews, observations, and field notes were used. Four categories and 10 subcategories were extracted from the data on the experiences of pre-hospital emergency personnel related to positive coping strategies. The four categories included work engagement, smart capability, positive feedback, and crisis pioneering. All the obtained categories had their own subcategories, which were determined based on their distinctly integrated properties. The results of this study show that positive coping consists of several concepts used by medical emergency personnel, management of stressful situations, and ultimately quality of pre-hospital clinical services. Given the fact that efficient methods such as positive coping can prevent debilitating stress in an individual, pre-hospital emergency authorities should seek to build and strengthen "positive coping" characteristics in pre-hospital medical emergency personnel to deal with accidents, emergencies, and injuries through adopting regular and dynamic policies.

  8. Leveraging data to systematically improve care: coronary artery disease management at Geisinger.

    Science.gov (United States)

    Graf, Thomas; Erskine, Alistair; Steele, Glenn D

    2014-01-01

    Coronary artery disease is complex chronic disease best managed by a team empowered by actionable data and a comprehensive approach, the ability to improve intermediate outcomes was dramatically enhanced after Geisinger created a system of care to do so. Continuous measurement of critical data elements of process and intermediate outcome measures allows the delivery of actionable information to the most appropriate team member, including the patients and family as team members. Continuous monitoring of the overall program looking for trends and opportunities across sites and regions allows for program enhancements. The comprehensive "all-or-none" bundled approach to care, which has already realized a 300% improvement, will be further enhanced by incorporating additional "Big Data" flows.

  9. What components of chronic care organisation relate to better primary care for coronary heart disease patients? An observational study.

    Science.gov (United States)

    van Lieshout, Jan; Frigola Capell, Eva; Ludt, Sabine; Grol, Richard; Wensing, Michel

    2012-01-01

    Cardiovascular risk management (CVRM) received by patients shows large variation across countries. In this study we explored the aspects of primary care organisation associated with key components of CVRM in coronary heart disease (CHD) patients. Observational study. 273 primary care practices in Austria, Belgium, England, Finland, France, Germany, The Netherlands, Slovenia, Switzerland and Spain. A random sample of 4563 CHD patients identified by coded diagnoses in eight countries, based on prescription lists and while visiting the practice in one country each. We performed an audit in primary care practices in 10 European countries. We used six indicators to measure key components of CVRM: risk factor recording, antiplatelet therapy, influenza vaccination, blood pressure levels (systolic organisation based on 39 items. Using multilevel regression analyses we explored the effects of practice organisation on CVRM, controlling for patient characteristics. Better overall organisation of a primary care practice was associated with higher scores on three indicators: risk factor registration (B=0.0307, porganisation was not found to be related with recorded blood pressure or cholesterol levels. Only the organisational domains 'self-management support' and 'use of clinical information systems' were linked to three CVRM indicators. A better organisation of a primary care practice was associated with better scores on process indicators of CVRM in CHD patients, but not on intermediate patient outcome measures. Direct support for patients and clinicians seemed most influential.

  10. Management of patients with coronary heart disease in family medicine: correlates of quality of care.

    Science.gov (United States)

    Tušek-Bunc, Ksenija; Petek, Davorina

    2018-04-10

    Family medicine plays an important role in quality of care (QoC) of coronary heart disease (CHD) patients. This study's aim was to determine the quality of secondary cardiovascular disease prevention in the everyday practice of family physicians. This study was observational cross-sectional. About 36 randomly selected family medicine practices stratified by size and location in Slovenia. CHD patients randomly selected from a patient register available in family medicine practices. The instrument for assessment of quality included a form for collecting data from medical records, a general practice assessment questionnaire and a patient questionnaire. QoC was defined by two composite variables, namely risk factor registration and CHD patient process of care, as the two care outcomes. In multivariate analysis, we performed multilevel regression analysis to identify the associations between QoC, the patient and the practice characteristics. The final sample included 423 CHD patients from 36 family medicine practices. Risk factor registration was associated with the practice organisation score (P = 0.004), practice size (P = 0.042), presence of comorbid atherosclerotic diseases (P = 0.043) and a lower age of CHD patients (P = 0.001). CHD patient process of care was associated with the practice organisation score (0.045) and a lower age of CHD patients (P = 0.035). The most important factors affecting the quality of CHD patient care were linked to the organisational characteristics of the family medicine practices.

  11. Choice of primary anesthetic regimen can influence intensive care unit length of stay after coronary surgery with cardiopulmonary bypass

    NARCIS (Netherlands)

    de Hert, Stefan G.; van der Linden, Philippe J.; Cromheecke, Stefanie; Meeus, Roel; ten Broecke, Pieter W.; de Blier, Ivo G.; Stockman, Bernard A.; Rodrigus, Inez E.

    2004-01-01

    BACKGROUND: Volatile anesthetics protect the myocardium during coronary surgery. This study hypothesized that the use of a volatile agent in the anesthetic regimen would be associated with a shorter intensive care unit (ICU) and hospital length of stay (LOS), compared with a total intravenous

  12. The effect of nursing management development program on clinical competency in coronary care unit

    Directory of Open Access Journals (Sweden)

    Ali Akbar Vaezi

    2011-03-01

    Full Text Available Background: Nurses are the main members in nursing cares and nursing managers can improve their clinical competency by applying better leadership skills. This study carried out to determine the effect of nursing management program on clinical competency of nurses in a coronary care unit (CCU.Methods: A quasi-experimental study was carried out in two educational hospitals in Yazd- Iran. These hospitals were allocated randomly in case and control hospitals. 25 matched nurses were selected by convenience sampling from both case and control hospitals. The clinical competency of nurses was measured by related questioners consisted of two dimensions caring and care management behaviors by self-evaluation and head nurse evaluation in case and control groups. Then, the intervention was implemented in four stages including nurse's development, managers' development, adaptation and supervision period during four months in the case group. After intervention, clinical competency of nurses was measured in both groups.Results: The results showed that before intervention more than 80% of nurses in two groups was in the moderate clinical competency level and they were proficient based on Benner's skill acquisition model. After intervention, nurses' clinical competency improved to higher level in case group but it didn't change in control group (P<0.05. Conclusion: Creating necessary modifications in nursing environments through the management development program by head nurses may improve nurses' clinical competency.

  13. Analysis of occupational accidents with biological material among professionals in pre-hospital services

    OpenAIRE

    Oliveira,Adriana Cristina de; Paiva,Maria Henriqueta Rocha Siqueira

    2013-01-01

    OBJECTIVE: To estimate the prevalence of accidents due to biological material exposure, the characteristics and post-accident conduct among professionals of pre-hospital services of the four municipalities of Minas Gerais, Brazil. METHOD: A cross-sectional study, using a structured questionnaire that was developed to enable the calculation of prevalence, descriptive analysis and analytical analysis using logistic regression. The study included 228 professionals; the prevalence of accidents du...

  14. Pre-hospital management of mass casualty civilian shootings: a systematic literature review

    OpenAIRE

    Turner, Conor D. A.; Lockey, David J.; Rehn, Marius

    2016-01-01

    Background Mass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the background of a rising threat of transnational terrorism worldwide, emergency response strategies are of critical importance. This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future p...

  15. [Cardiorenal syndrome type 1 in the intensive coronary care unit of the Hospital Nacional Arzobispo Loayza].

    Science.gov (United States)

    Preza, Paul M; Hurtado, Abdías; Armas, Victoria; Cárcamo, César P

    2015-01-01

    This study sought to evaluate the incidence of cardiorenal syndrome (CRS) type 1 in a coronary care unit and its association with hospital mortality within 30 days of admission, as well as other epidemiological characteristics. The medical records of all the patients who were hospitalized with the diagnosis of acute heart failure in a 4-year period were reviewed. CRS type 1 was characterized by the presence of acute heart failure and an elevation of serum creatinine ≥0.3mg/dL in comparison to the baseline creatinine calculated by the MDRD75 equation and/or the elevation of ≥50% of the admission serum creatinine within a 48 h period. The incidence of CRS type 1 was 27.87%, 95% CI: 20.13-36.71 (34 of 122). There was a higher frequency of CRS type 1 in those patients who were admitted with the diagnosis of cardiogenic shock (adjusted RR 2.02, 95% CI: 1.20-3.93, p=0.0378) and in those with higher hemoglobin levels (p=0.0412). The CRS type 1 was associated with an increase of 30-day mortality (HR: 4.11, 95% CI: 1.20-14.09, p=0.0244). The incidence of CRS type 1 in the coronary care unit found in our study is similar to those found in foreign studies. The history of stroke and the higher values of hemoglobin were associated with a higher incidence of cardiorenal syndrome type 1. Patients with CRS type 1 had a higher hospital mortality within 30 days of admission. Copyright © 2014 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  16. Pre-hospital advanced airway management by anaesthesiologists: is there still room for improvement?

    Science.gov (United States)

    Sollid, Stephen J M; Heltne, Jon Kenneth; Søreide, Eldar; Lossius, Hans Morten

    2008-07-21

    Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management. Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Of the 17 available respondents, most (88%) felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment. The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.

  17. Pre-hospital advanced airway management by anaesthesiologists: Is there still room for improvement?

    Directory of Open Access Journals (Sweden)

    Søreide Eldar

    2008-07-01

    Full Text Available Abstract Background Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management. Method Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Results Of the 17 available respondents, most (88% felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment. Conclusion The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.

  18. Effect of sleep-inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit.

    Science.gov (United States)

    Ryu, Min-Jung; Park, Jeong Sook; Park, Heeok

    2012-03-01

    The study compared the effect of earplug-delivered sleep-inducing music on sleep in persons with percutaneous transluminal coronary angiography in the cardiac care unit. Diverse types of music have been claimed to improve sleeping elsewhere, but relatively little is known in South Korea. Most studies investigating the effect of sleep-inducing music on sleep have involved persons with insomnia, even though many persons with cardiovascular disease in the intensive care unit suffer from sleeping problems. There is a need to investigate the effect of sleep-inducing music on sleep disorders in persons with percutaneous transluminal coronary angiography in the cardiac care unit. An experimental research design was used. Data collection was conducted in the cardiac care unit of K University Hospital in D city, from 3 September-4 October 2010. Fifty-eight subjects participated and were randomly assigned to the experimental group (earplug-delivered sleep-inducing music for 52 min beginning at 10:00 pm, while wearing an eyeshield, n = 29) and the control group (no music, but earplugs and eyeshield worn, n = 29). The quantity and quality of sleep were measured using questionnaires at 7 am the next morning for each group. Participants in the experimental group reported that the sleeping quantity and quality were significantly higher than control group (t = 3·181, p = 0·002, t = 5·269, p music significantly improved sleep in patients with percutaneous transluminal coronary angiography at a cardiac care unit. Offering earplugs and playing sleep-inducing music may be a meaningful and easily enacted nursing intervention to improve sleep for intensive care unit patients. Nurses working at cardiac care unit can use music to improve sleeping in clients with percutaneous transluminal coronary angiography. © 2011 Blackwell Publishing Ltd.

  19. The role of performing life support courses in rural areas in improving pre-hospital physiologic condition of patients with penetrating injuries

    International Nuclear Information System (INIS)

    Naffisi, N.; Mohebbi, H.A.; Moharamzadeh, Y.

    2008-01-01

    To evaluate the impact of animal model based medical training courses for village healthcare workers on prehospital physiologic condition and prognosis of patients with penetrating injuries. Seventy-six village healthcare workers were trained and equipped to deliver in-field medical first cares. First group (226 patients) consisted of those who received this cares by the trained group and second group (245 patients) were those who received no in-field cares and were transported directly to the trauma center in provincial capital, Ilam. Physiologic Severity Score (PSS) was calculated to determine the physiologic condition of patients in both groups. Results: The most prevalent cause of trauma in both groups was car accidents (61.6%). Controlling of hemorrhage was the most frequent provided initial medical care (40.6%). A significant improvement regarding the PSS score was observed in the first group of patients compared to the second group (7.505 vs. 6.799, 95% CI for difference: 0.3 to 0.9). The mortality rates of the first and second group of patients were 3% and 7.3%, respectively (p=0.051). Performing life support courses in rural areas of low-income countries where there is no pre-hospital triage and emergency medical system and provision of classic resuscitative measures are limited, has a significant impact on improvement of pre-hospital physiologic condition and prognosis of patients with penetrating injuries. (author)

  20. EXPERIENCE OF CORONARY INTERVENTIONS IN OCTOGENARIANS IN A TERTIARY CARDIAC CARE CENTRE IN SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Prashanth Kumar Malkiwodeyar

    2017-03-01

    Full Text Available BACKGROUND There is a paucity of data among octogenarians undergoing coronary interventions in India. These patients have generally been excluded from randomised trials. As a result, there are no evidence-based guidelines regarding PCI in very elderly. The aim of this study is to describe the epidemiology, clinical characteristics, management and the outcomes of patients over the age of 80 years who were undergoing coronary interventions. MATERIALS AND METHODS We evaluated the outcomes of all patients over the age of 80 years admitted in KIMS, Hubli, during the year 2015-16 undergoing coronary interventions including coronary angiography and Percutaneous Coronary Interventions (PCI. RESULTS We identified 36 octogenarians (67% men, 33% women; Mean Age of 84.2 ± SD 3.6 years. 52.3 percent of patients presented with an acute coronary syndrome treated either with thrombolysis or medical stabilisation followed by coronary angiography. One patient in the study was taken for primary Percutaneous Coronary Interventions (PCI. Mean duration of hospitalisation was 6.69 ± 6.8 days. Overall, the frequency of in-hospital death was n=2 (5.5% and both the patients died while awaiting CABG. CONCLUSION Our study shows that coronary interventions are safe and effective and are not associated with any major complications, which are specific to this subset. Thus, advanced age should not be considered a contraindication for coronary interventions when clear indications are present.

  1. Pre-hospital ticagrelor in patients with ST-segment elevation myocardial infarction with long transport time to primary PCI facility.

    Science.gov (United States)

    Lupi, Alessandro; Schaffer, Alon; Lazzero, Maurizio; Tessitori, Massimo; De Martino, Leonardo; Rognoni, Andrea; Bongo, Angelo S; Porto, Italo

    2016-12-01

    Pre-hospital ticagrelor, given less than 1h before coronary intervention (PCI), failed to improve coronary reperfusion in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI. It is unknown whether a longer interval from ticagrelor administration to primary PCI might reveal any improvement of coronary reperfusion. We retrospectively compared 143 patients, pre-treated in spoke centers or ambulance with ticagrelor at least 1.5h before PCI (Pre-treatment Group), with 143 propensity score-matched controls treated with ticagrelor in the hub before primary PCI (Control Group) extracted from RENOVAMI, a large observational Italian registry of more than 1400 STEMI patients enrolled from Jan. 2012 to Oct. 2015 (ClinicalTrials.gov id: NCT01347580). The median time from ticagrelor administration and PCI was 2.08h (95% CI 1.66-2.84) in the Pre-treatment Group and 0.56h (95% CI 0.33-0.76) in the Control Group. TIMI flow grade before primary PCI in the infarct related artery was the primary endpoint. The primary endpoint, baseline TIMI flow grade, was significantly higher in Pre-treatment Group (0.88±1.14 vs 0.53±0.86, P=0.02). However in-hospital mortality, in-hospital stent thrombosis, bleeding rates and other clinical and angiographic outcomes were similar in the two groups. In a real world STEMI network, pre-treatment with ticagrelor in spoke hospitals or in ambulance loading at least 1.5h before primary PCI is safe and might improve pre-PCI coronary reperfusion, in comparison with ticagrelor administration immediately before PCI. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Pre-hospital management and outcome of acute poisonings by ambulances in Yekaterinburg, Russia.

    Science.gov (United States)

    Krayeva, Yulia V; Brusin, Konstantin M; Bushuev, Alexander V; Kondrashov, Dmitriy L; Sentsov, Valentin G; Hovda, Knut Erik

    2013-01-01

    Large, prospective pre-hospital studies of acute poisonings are scarce. We present the epidemiology of the pre-hospital poisonings, the treatment given, the complications of the poisoning itself and the treatment, predictors for hospitalization, and the safety of the present approach in a large industrial Russian city. Data were collected from March 2009 to March 2010. All adult (≥ 16 years) acute poisonings in the city of Yekaterinburg, Russia were included. The prospective cohort inclusion of data included age, gender, simple clinical features (including consciousness, respiratory status, circulatory status, convulsions, etc.), main toxic agent, reason why poisoning was suspected, treatment given, and outcome. Multivariate logistic regression analysis was used to identify the factors associated with hospitalization of the patients. In total, 1795/2536 patients (71%) were brought to hospitals, 736/2536 (29%) were discharged by the ambulance, and 5/2536 (0.2%) died on scene. The most frequent main agents were opioids (25%), ethanol (9%), benzodiazepines (8%), corrosive substances (7%), carbon monoxide (5%), and neuroleptics (5%). Pre-hospital treatment was given to 73% of patients; 3% were intubated, and antidotes were given in 27% (naloxone 24%, atropine 2%, and flumazenil 0.2%). Gastric lavage was performed in 34%, but only 20% within the first hour after ingestion; 49% had a Glasgow Coma Scale (GCS)treatment practice in most places, especially concerning the use of gastric lavage. Whether the current practice led to an increased morbidity and mortality is uncertain, but it justifies the need for thorough evaluation of clinical practice. These findings highlight the importance of studies like the present to improve diagnostics, triage, and treatment in acute poisonings.

  3. EFFECT OF POSITIONING ON BLEEDING COMPLICATION AND LOW BACK PAIN AFTER DIAGNOSTIC CORONARY ANGIOGRAPHY IN PATIENTS WITH CORONARY HEART DISEASE IN AN INTEGRATED HEART CARE CENTER IN INDONESIA

    Directory of Open Access Journals (Sweden)

    Theresia Febriana Christi Tyas Utami

    2018-05-01

    Full Text Available Background: Coronary angiography can cause complications of arterial and subcutaneous bleeding (hematoma and back pain. Changing the position of the patient (positioning in bed can reduce the pain post-diagnostic catheterization complications. Objective: This study was to examine the effect of positioning on bleeding complication and low back pain after diagnostic coronary angiography in patients with coronary heart disease patient in the Integrated Heart Care Center in Indonesia. Methods: This study was a true-experimental study with randomized posttest-only control group design. Thirty respondents were randomly selected using simple random sampling, which 15 respondents were randomly assigned in the experiment group and control group. The experiment group was given a positioning with 150, 300, 450 head-of-bed elevation in left and right lateral position. An arc tool was used to measure the height of head of bed elevation, a measuring cup to measure arterial bleeding using, a perforated transparent plastic with 5 cm diameter to measure subcutaneous bleeding (hematoma, and Numeric Pain Rating Scale to measure low back pain. Data were analyzed using Kolmogorov- Smirnov and Repeated Measured ANOVA. Results: Findings showed that positioning had no effect on arterial hemorrhage (ρ=1.000 and subcutaneous bleeding (hematoma (ρ=0.999. Repeated ANOVA test results revealed that positioning had a significant effect on low back pain (ρ=0.017. Conclusion: There was no significant effect of positioning on the occurrence of arterial and subcutaneous bleeding (hematoma, but there was a significant effect in reducing low back pain.

  4. An application of the MEMbrain training module: Pre-hospital rescue operation

    DEFF Research Database (Denmark)

    Andersen, V.

    1998-01-01

    A system for training in pre-hospital emergency management is being developed and the first version of a prototype has been completed. The training system fulfils the demands from the domain of hospital emergency planning centres and medical attendants concerning increased efficiency of rescue...... efforts. This includes enhanced first aid on site and improved overall co-ordination amongst the organisations involved in coping with emergency situations. The training system is based on the Multi-User System for Training Emergency Response (MUSTER) concept which is used for the training module...

  5. [Scandinavian guidelines on the pre-hospital management of traumatic brain injury

    DEFF Research Database (Denmark)

    Juul, N.; Sollid, S.; Sundstrom, T.

    2008-01-01

    . Evidence-based guidelines already exist that focus on all steps in the management. This article, which was written by members of the Scandinavian Neurotrauma Committee, presents recommendations on the pre-hospital management of traumatic brain injury adapted to the infrastructure of Scandinavia......Head trauma causes the death of many young persons. The number of fatalities can be reduced through systematic management. Preventing secondary brain injury together with the fastest possible transport to a neurosurgical unit has been shown to be effective in reducing mortality and morbidity...

  6. Does a pre-hospital emergency pathway improve early diagnosis and referral in suspected stroke patients? – Study protocol of a cluster randomised trial [ISRCTN41456865

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    Lori Giuliano

    2005-10-01

    Full Text Available Abstract Background Early interventions proved to be able to improve prognosis in acute stroke patients. Prompt identification of symptoms, organised timely and efficient transportation towards appropriate facilities, become essential part of effective treatment. The implementation of an evidence based pre-hospital stroke care pathway may be a method for achieving the organizational standards required to grant appropriate care. We performed a systematic search for studies evaluating the effect of pre-hospital and emergency interventions for suspected stroke patients and we found that there seems to be only a few studies on the emergency field and none about implementation of clinical pathways. We will test the hypothesis that the adoption of emergency clinical pathway improves early diagnosis and referral in suspected stroke patients. We designed a cluster randomised controlled trial (C-RCT, the most powerful study design to assess the impact of complex interventions. The study was registered in the Current Controlled Trials Register: ISRCTN41456865 – Implementation of pre-hospital emergency pathway for stroke – a cluster randomised trial. Methods/design Two-arm cluster-randomised trial (C-RCT. 16 emergency services and 14 emergency rooms were randomised either to arm 1 (comprising a training module and administration of the guideline, or to arm 2 (no intervention, current practice. Arm 1 participants (152 physicians, 280 nurses, 50 drivers attended an interactive two sessions course with continuous medical education CME credits on the contents of the clinical pathway. We estimated that around 750 patients will be met by the services in the 6 months of observation. This duration allows recruiting a sample of patients sufficient to observe a 30% improvement in the proportion of appropriate diagnoses. Data collection will be performed using current information systems. Process outcomes will be measured at the cluster level six months after the

  7. Evaluation of the effect of collaborative care on depression, anxiety and stress of patients after coronary angioplasty

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    Rezapour Parastoo

    2016-08-01

    Full Text Available Background and Objective: Coronary artery disease and its associated treatment interventions such as angioplasty can lead to emotional problems, including depression, anxiety, and stress, in patients and might have adverse effects on the recovery process. This study aimed to evaluate the effect of collaborative care model on depression, anxiety, and stress in patients after coronary angioplasty. Materials and Methods: This clinical trial was conducted on 50 patients undergoing coronary angioplasty, who were referred to intensive care unit and surgical ward of one of the hospitals of Isfahan, Iran, in 2015. Samples were selected through randomized convenience sampling and were divided into intervention and control group (n=25 for each group. Collaborative care model, consisting of four stages of motivation, preparation, engagement, and evaluation, was implemented for the intervention group through five 45-60 minute sessions and a three-month telephone follow-up. Data was collected using depression, anxiety, and stress scale (DASS-42 before and one month after the intervention from both groups. Data were analyzed using descriptive statistics, Chi-square, as well as independent and paired t-tests in SPSS, version 18. Results: In this study, mean score of depression was significantly decreased in the intervention group after the implementation of collaborative model (from 31.6±3.7 to 6.3±5.03 (P <0.001, and mean anxiety and stress scores were reduced from 32.6±3.04 and 32.2±3.3 to 6.2±4.1 and 8.5±4.8, respectively (P<0.001. In this regard, a significant difference was observed between the intervention and control groups (P<0.001. Conclusion: Implementation of collaborative care could be associated with lower depression, anxiety, and stress in patients after coronary angioplasty. Therefore, its application is recommended as an effective method for such patients.

  8. Predictors of image quality of coronary computed tomography in the acute care setting of patients with chest pain

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    Bamberg, Fabian; Abbara, Suhny; Schlett, Christopher L.; Cury, Ricardo C.; Truong, Quynh A.; Rogers, Ian S. [Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Nagurney, John T. [Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Brady, Thomas J. [Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Hoffmann, Udo [Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States)], E-mail: uhoffmann@partners.org

    2010-04-15

    Objective: We aimed to determine predictors of image quality in consecutive patients who underwent coronary computed tomography (CT) for the evaluation of acute chest pain. Method and materials: We prospectively enrolled patients who presented with chest pain to the emergency department. All subjects underwent contrast-enhanced 64-slice coronary multi-detector CT. Two experienced readers determined overall image quality on a per-patient basis and the prevalence and characteristics of non-evaluable coronary segments on a per-segment basis. Results: Among 378 subjects (143 women, age: 52.9 {+-} 11.8 years), 345 (91%) had acceptable overall image quality, while 33 (9%) had poor image quality or were unreadable. In adjusted analysis, patients with diabetes, hypertension and a higher heart rate during the scan were more likely to have exams graded as poor or unreadable (odds ratio [OR]: 2.94, p = 0.02; OR: 2.62, p = 0.03; OR: 1.43, p = 0.02; respectively). Of 6253 coronary segments, 257 (4%) were non-evaluable, most due to severe calcification in combination with motion (35%). The presence of non-evaluable coronary segments was associated with age (OR: 1.08 annually, 95%-confidence interval [CI]: 1.05-1.12, p < 0.001), baseline heart rate (OR: 1.35 per 10 beats/min, 95%-CI: 1.11-1.67, p = 0.003), diabetes, hypertension, and history of coronary artery disease (OR: 4.43, 95%-CI: 1.93-10.17, p < 0.001; OR: 2.27, 95-CI: 1.01-4.73, p = 0.03; OR: 5.12, 95%-CI: 2.0-13.06, p < 0.001; respectively). Conclusion: Coronary CT permits acceptable image quality in more than 90% of patients with chest pain. Patients with multiple risk factors are more likely to have impaired image quality or non-evaluable coronary segments. These patients may require careful patient preparation and optimization of CT scanning protocols.

  9. Area Median Income and Metropolitan Versus Nonmetropolitan Location of Care for Acute Coronary Syndromes: A Complex Interaction of Social Determinants.

    Science.gov (United States)

    Fabreau, Gabriel E; Leung, Alexander A; Southern, Danielle A; James, Matthew T; Knudtson, Merrill L; Ghali, William A; Ayanian, John Z

    2016-02-23

    Metropolitan versus nonmetropolitan status and area median income may independently affect care for and outcomes of acute coronary syndromes. We sought to determine whether location of care modifies the association among area income, receipt of cardiac catheterization, and mortality following an acute coronary syndrome in a universal health care system. We studied a cohort of 14 012 acute coronary syndrome patients admitted to cardiology services between April 18, 2004, and December 31, 2011, in southern Alberta, Canada. We used multivariable logistic regression to determine the odds of cardiac catheterization within 1 day and 7 days of admission and the odds of 30-day and 1-year mortality according to area median household income quintile for patients presenting at metropolitan and nonmetropolitan hospitals. In models adjusting for area income, patients who presented at nonmetropolitan facilities had lower adjusted odds of receiving cardiac catheterization within 1 day of admission (odds ratio 0.22, 95% CI 0.11-0.46, Pcommunities. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  10. Development and Evaluation of Care Programs for the Delirium Management in Patients after Coronary Artery Bypass Graft Surgery (CABG

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    Safoora Fallahpoor

    2016-07-01

    Full Text Available Delirium is one of the common problems of cognitive impairment after coronary artery bypass graft surgery (CABG that its prevention, timely detection, and treatment require a care and management program to be controlled. The present research has studied a care program for the management of delirium in patients after coronary artery bypass graft surgery. This research was performed by action research methodology during a fivestage cycle in two groups of 50 persons (without interference and with intervention. In both groups, the patients were evaluated every 8 hours by CAM-ICU tool in hours (6, 14 and 22 for the occurrence of delirium after surgery until they were in Intensive Care Unit (ICU. In the intervention group, the developed program was implemented in three areas of delirium management before, during, and after the surgery. Then, the collected information was analyzed in two groups using descriptive and analytical statistics in SPSS 20 software. Delirium was observed at least once in 68% of patients without the intervention and 38% of patients with intervention after surgery. The ratio of delirium incidence was significantly lower in the intervention group (P<0.05. In addition, the total number of delirium in ICU was significantly lower for patients in the intervention group (P<0.05.The developed program for reducing the incidence of delirium in hospitalized patients after coronary artery bypass graft surgery (CABG was confirmed. This means that its applying will lead to a reduction in delirium.

  11. Comparison of Accessibility, Cost, and Quality of Elective Coronary Revascularization Between Veterans Affairs and Community Care Hospitals.

    Science.gov (United States)

    Barnett, Paul G; Hong, Juliette S; Carey, Evan; Grunwald, Gary K; Joynt Maddox, Karen; Maddox, Thomas M

    2018-02-01

    The Veterans Affairs (VA) Community Care (CC) Program supplements VA care with community-based medical services. However, access gains and value provided by CC have not been well described. To compare the access, cost, and quality of elective coronary revascularization procedures between VA and CC hospitals and to evaluate if procedural volume or publicly reported quality data can be used to identify high-value care. Observational cohort study of veterans younger than 65 years undergoing an elective coronary revascularization, controlling for differences in risk factors using propensity adjustment. The setting was VA and CC hospitals. Participants were veterans undergoing elective percutaneous coronary intervention (PCI) and veterans undergoing coronary artery bypass graft (CABG) procedures between October 1, 2008, and September 30, 2011. The analysis was conducted between July 2014 and July 2017. Receipt of an elective coronary revascularization at a VA vs CC facility. Access to care as measured by travel distance, 30-day mortality, and costs. In the 3 years ending on September 30, 2011, a total of 13 237 elective PCIs (79.1% at the VA) and 5818 elective CABG procedures (83.6% at the VA) were performed in VA or CC hospitals among veterans meeting study inclusion criteria. On average, use of CC was associated with reduced net travel by 53.6 miles for PCI and by 73.3 miles for CABG surgery compared with VA-only care. Adjusted 30-day mortality after PCI was higher in CC compared with VA (1.54% for CC vs 0.65% for VA, P publicly reported mortality data identified hospitals that provided higher-value care with the exception that CABG mortality was lower in small-volume CC hospitals. In this veteran cohort, PCIs performed in CC hospitals were associated with shorter travel distance but with higher mortality, higher costs, and minimal travel savings compared with VA hospitals. The CABG procedures performed in CC hospitals were associated with shorter travel distance

  12. Nine-year comparison of presentation and management of acute coronary syndromes in Ireland: a national cross-sectional survey

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    Shelley Emer

    2005-02-01

    Full Text Available Abstract Background Shorter time to treatment is associated with lower mortality in acute coronary syndromes (ACS. A previous (1994 survey showed substantial delays for acute myocardial infarction (AMI in Ireland. The present study compared current practice with 1994 and surveyed acute coronary syndromes as a more complete contemporary evaluation of critical cardiac care than assessing AMI alone. Methods Following ethics committee approval, all centres (N = 39 admitting acute cardiac patients to intensive/coronary care unit provided information on 1365 episodes. A cross-sectional survey design was employed. Results Since 1994, median hospital arrival to thrombolysis time was reduced by 41% (76 to 45 minutes. Thrombolysis was delivered more often in the emergency department in 2003 (48% vs 2%. Thrombolysis when delivered in the emergency department was achieved faster than thrombolysis delivered in intensive/coronary care (35 mins v 60 mins; z = 5.62, p Conclusions Substantial improvements in time to thrombolysis have occurred since 1994, probably relating to treatment provision in emergency departments. Patient delay pre-hospital is still the principal impediment to effective treatment of ACS. A recent change of definition of AMI may have precluded an exact comparison between 1994 and 2003 data.

  13. [The PROPRESE trial: results of a new health care organizational model in primary care for patients with chronic coronary heart disease based on a multifactorial intervention].

    Science.gov (United States)

    Ruescas-Escolano, Esther; Orozco-Beltran, Domingo; Gaubert-Tortosa, María; Navarro-Palazón, Ana; Cordero-Fort, Alberto; Navarro-Pérez, Jorge; Carratalá-Munuera, Concepción; Pertusa-Martínez, Salvador; Soler-Bahilo, Enrique; Brotons-Muntó, Francisco; Bort-Cubero, Jose; Núñez-Martínez, Miguel A; Bertomeu-Martínez, Vicente; López-Pineda, Adriana; Gil-Guillén, Vicente F

    2014-06-01

    Comparison of the results from the EUROASPIRE I to the EUROASPIRE III, in patients with coronary heart disease, shows that the prevalence of uncontrolled risk factors remains high. The aim of the study was to evaluate the effectiveness of a new multifactorial intervention in order to improve health care for chronic coronary heart disease patients in primary care. In this randomized clinical trial with a 1-year follow-up period, we recruited patients with a diagnosis of coronary heart disease (145 for the intervention group and 1461 for the control group). An organizational intervention on the patient-professional relationship (centered on the Chronic Care Model, the Stanford Expert Patient Programme and the Kaiser Permanente model) and formative strategy for professionals were carried out. The main outcomes were smoking control, low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP). A multivariate analysis was performed. The characteristics of patients were: age (68.4±11.8 years), male (71.6%), having diabetes mellitus (51.3%), dyslipidemia (68.5%), arterial hypertension (76.7%), non-smokers (76.1%); LDL-C cardiovascular risk factors control (smoking, LDL-C and SBP). Chronic care strategies may be an efficacy tool to help clinicians to involve the patients with a diagnosis of CHD to reach better outcomes. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  14. Measuring professional satisfaction and nursing workload among nursing staff at a Greek Coronary Care Unit

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    Maria Gouzou

    2015-12-01

    Full Text Available ABSTRACT Objective To explore potential associations between nursing workload and professional satisfaction among nursing personnel (NP in Greek Coronary Care Units (CCUs. Method A cross-sectional study was performed involving 66 members of the NP employed in 6 randomly selected Greek CCUs. Job satisfaction was assessed by the IWS and nursing workload by NAS, CNIS and TISS-28. Results The response rate was 77.6%. The reliability of the IWS was α=0.78 and the mean score 10.7 (±2.1, scale range: 0.5-39.7. The most highly valued component of satisfaction was “Pay”, followed by “Task requirements”, “Interaction”, “Professional status”, “Organizational policies” and “Autonomy”. NAS, CNIS and TISS-28 were negatively correlated (p≤0.04 with the following work components: “Autonomy”, “Professional status”, “Interaction” and “Task requirements”. Night shift work independently predicted the score of IWS. Conclusion The findings show low levels of job satisfaction, which are related with nursing workload and influenced by rotating shifts.

  15. Phenomenology of delirium among patients admitted to a coronary care unit.

    Science.gov (United States)

    Lahariya, Sanjay; Grover, Sandeep; Bagga, Shiv; Sharma, Akhilesh

    2016-11-01

    To study the phenomenology and motor sub-types of delirium in patients admitted in a Coronary Care Unit (CCU). Three hundred and nine consecutive patients were screened for delirium, and those found positive for the same were evaluated by a psychiatrist on DSM-IVTR criteria to confirm the diagnosis. Those with a diagnosis of delirium were evaluated on the DRS-R-98 to study the phenomenology and on the amended Delirium Motor Symptom Scale (DMSS) to study the motor sub-types. Eighty-one patients were found to have delirium. Commonly seen symptoms of delirium included: disturbances in sleep-wake cycle, lability of affect, thought abnormality, disturbance in attention, disorientation, short-term memory, and long-term memory. Very few patients had delusions. More than half of the participants were categorized as having hyperactive (n = 46; 56.8%) followed by hypoactive sub-type (n = 21; 26%) and mixed sub-type (n = 9; 11.1%) of delirium. There were minor differences in the frequency and severity of symptoms of delirium between incidence and prevalence cases of delirium and those with different motoric sub-types. Delirium in CCU set-up is characterized by the symptoms of disturbances in sleep-wake cycle, lability of affect, thought abnormality, disturbance in attention, disorientation, short-term memory, and long-term memory. Hyperactive delirium is more common than hypoactive delirium.

  16. Up-Beat UK: A programme of research into the relationship between coronary heart disease and depression in primary care patients

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    Pariante Carmine M

    2011-05-01

    Full Text Available Abstract Background Coronary heart disease and depression are both common health problems and by 2020 will be the two leading causes of disability worldwide. Depression has been found to be more common in patients with coronary heart disease but the nature of this relationship is uncertain. In the United Kingdom general practitioners are now being remunerated for case-finding for depression in patients with coronary heart disease, however it is unclear how general practitioners should manage these patients. We aim to explore the relationship between coronary heart disease and depression in a primary care population and to develop an intervention for patients with coronary heart disease and depression. Methods/design This programme of research will consist of 4 inter-related studies. A 4 year prospective cohort study of primary care patients with coronary heart disease will be conducted to explore the relationship between coronary heart disease and depression. Within this, a nested case-control biological study will investigate genetic and blood-biomarkers as predictors of depression in this sample. Two qualitative studies, one of patients' perspectives of treatments for coronary heart disease and co-morbid depression and one of primary care professionals' views on the management of patients with coronary heart disease and depression will inform the development of an intervention for this patient group. A feasibility study for a randomised controlled trial will then be conducted. Discussion This study will provide information on the relationship between coronary heart disease and depression that will allow health services to determine the efficiency of case-finding for depression in this patient group. The results of the cohort study will also provide information on risk factors for depression. The study will provide evidence on the efficacy and feasibility of a joint patient and professional led intervention and data necessary to plan a

  17. Effect of White Noise on Sleep in Patients Admitted to a Coronary Care.

    Science.gov (United States)

    Farokhnezhad Afshar, Pouya; Bahramnezhad, Fatemeh; Asgari, Parvaneh; Shiri, Mahmoud

    2016-01-01

    Sleep disorders are a common problem in patients in the critical care unit. The objective of the present study was to determine the effect of white noise on the quality of sleep in patients admitted to the CCU. The present study was single-blind, quasi-experimental study. A total of 60 patients were selected using the purposive sampling method. Quality of sleep was measured with PSQI on the first day in admission, then after three nights of admission without any intervention for control group and for the experimental group quality of sleep measured by white noise with intensity of 50-60 dB then Quality of sleep was measured with PSQI. Data were analyzed by SPSS 13 software. The average total sleep time in the control group before the study reached from 7.08 (0.8) to 4.75 (0.66) hours after three nights of hospitalization, while in the experimental group, no significant changes were seen in the average sleep hours (6.69 ± 0.84 vs. 6.92 ± 0.89, P = 0.15).The average minutes of sleep in the control group before the study reached from 12.66 (7.51) to 25.83 (11.75) minutes after a three- night stay, while in the experimental group, no significant changes were observed in the average sleep duration (12.16 ± 7.50 vs. 11 ±6. 07, P = 0.16). The use of white noise is recommended as a method for masking environmental noises, improving sleep, and maintaining sleep in the coronary care unit.

  18. THE WEARING RELATED TO WORK IN THE PERSPECTIVE OF NURSES OF PRE-HOSPITAL CARE

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    Claudia Cristiane Filgueira Martins

    2011-06-01

    Full Text Available Objetivo: Identificar como enfermeiros do Serviço de Atendimento Móvel às Urgências (SAMU percebem o desgaste relacionado ao trabalho cotidiano. Metodologia: Estudo descritivo de abordagem qualitativa, realizado através de entrevistas com enfermeiros que atuam no SAMU e cujos dados foram analisados a luz da análise do discurso. Resultados: Dos discursos emergiram os núcleos de sentido: natureza do serviço; ausência de condições de trabalho; desgaste físico e emocional e risco para a vida profissional. O desgaste foi caracterizado como inerente à natureza do serviço, por lidar com situações de vida e morte, favorecendo estresse físico e emocional. Foi ainda associado aos múltiplos vínculos empregatícios, às condições e as jornadas de trabalho, situações que dificultam atuações resolutivas e potencializam riscos de acidentes para o trabalhador. Conclusões: O desgaste no trabalho, entendido de modo não reflexivo, é naturalizado como inerente a sua dinâmica, mesmo que gere redução do potencial de vida desses profissionais.

  19. HeartCare+: A Smart Heart Care Mobile Application for Framingham-Based Early Risk Prediction of Hard Coronary Heart Diseases in Middle East

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    Hoda Ahmed Galal Elsayed

    2017-01-01

    Full Text Available Background. Healthcare is a challenging, yet so demanding sector that developing countries are paying more attention to recently. Statistics show that rural areas are expected to develop a high rate of heart diseases, which is a leading cause of sudden mortality, in the future. Thus, providing solutions that can assist rural people in detecting the cardiac risks early will be vital for uncovering and even preventing the long-term complications of cardiac diseases. Methodology. Mobile technology can be effectively utilized to limit the cardiac diseases’ prevalence in rural Middle East. This paper proposes a smart mobile solution for early risk detection of hard coronary heart diseases that uses the Framingham scoring model. Results. Smart HeartCare+ mobile app estimates accurately coronary heart diseases’ risk over 10 years based on clinical and nonclinical data and classifies the patient risk to low, moderate, or high. HeartCare+ also directs the patients to further treatment recommendations. Conclusion. This work attempts to investigate the effectiveness of the mobile technology in the early risk detection of coronary heart diseases. HeartCare+ app intensifies the communication channel between the lab workers and patients residing in rural areas and cardiologists and specialist residing in urban places.

  20. Likelihood of treatment in a coronary care unit for a first-time myocardial infarction in relation to sex, country of birth and socioeconomic position in Sweden.

    Science.gov (United States)

    Yang, Dong; James, Stefan; de Faire, Ulf; Alfredsson, Lars; Jernberg, Tomas; Moradi, Tahereh

    2013-01-01

    To examine the relationship between sex, country of birth, level of education as an indicator of socioeconomic position, and the likelihood of treatment in a coronary care unit (CCU) for a first-time myocardial infarction. Nationwide register based study. Sweden. 199 906 patients (114 387 men and 85,519 women) of all ages who were admitted to hospital for first-time myocardial infarction between 2001 and 2009. Admission to a coronary care unit due to myocardial infarction. Despite the observed increasing access to coronary care units over time, the proportion of women treated in a coronary care unit was 13% less than for men. As compared with men, the multivariable adjusted odds ratio among women was 0.80 (95% confidence interval 0.77 to 0.82). This lower proportion of women treated in a CCU varied by age and year of diagnosis and country of birth. Overall, there was no evidence of a difference in likelihood of treatment in a coronary care unit between Sweden-born and foreign-born patients. As compared with patients with high education, the adjusted odds ratio among patients with a low level of education was 0.93 (95% confidence interval 0.89 to 0.96). Foreign-born and Sweden-born first-time myocardial infarction patients had equal opportunity of being treated in a coronary care unit in Sweden; this is in contrast to the situation in many other countries with large immigrant populations. However, the apparent lower rate of coronary care unit admission after first-time myocardial infarction among women and patients with low socioeconomic position warrants further investigation.

  1. Pre-Hospital Fast Positive Cases Identified by DFB Ambulance Paramedics – Final Clinical Diagnosis

    LENUS (Irish Health Repository)

    Feeney, A

    2016-04-01

    Ischaemic stroke clinical outcomes are improved by earlier treatment with intravenous thrombolysis. An existing pathway at the Mater University Hospital for assessment of suspected acute stroke in the Emergency Department was updated, aiming to shorten ‘door to needle time’. This study examines the final clinical diagnosis of Dublin Fire Brigade Ambulance Paramedic identified Face Arm Speech Test (FAST) positive patients presenting to the Emergency Department over a 7 month period. A retrospective analysis was carried out of 177 consecutive FAST positive patients presenting between March and November 2014. The final clinical diagnosis was acute stroke in 57.1% (n=101) of patients. Of these, 76 were ischaemic strokes of whom 56.5% (n=43) were thrombolysed. In the pre-hospital setting Ambulance Paramedics can identify, with reasonable accuracy, acute stroke using the FAST test. Over half of the ischaemic stroke patients presenting via this pathway can be treated with intravenous thrombolysis

  2. Efficacy of a sedo-analgesia protocol in pre-hospital trauma treatment

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    Savino Occhionorelli

    2013-06-01

    Full Text Available Pre-hospital trauma treatment is an important situation in which pain should be appropriately assessed and treated, but there is a great lack of studies about it. Literature has widely pointed out that the underanalgesia problem is spread to all groups of patients. The objective of the study is to verify the efficacy of a sedation-analgesia protocol based on the use of NSAIDs, Fentanyl and Midazolam, for prehospital treatment of trauma patients. The protocol was tested in three Emergency Medical Services for a four month period, in which 30 patients were included in the study. Results evidenced a good management of both pain and anxiety in the majority of patients treated, with the achievement of analgesia target in 80% of the patients and sedation target in 100% of the patients.

  3. Pre-hospital treatment of bee and wasp induced anaphylactic reactions

    DEFF Research Database (Denmark)

    Ruiz Oropeza, Athamaica; Mikkelsen, Søren; Bindslev-Jensen, Carsten

    2017-01-01

    BACKGROUND: Bee and wasp stings are among the most common triggers of anaphylaxis in adults representing around 20% of fatal anaphylaxis from any cause. Data of pre-hospital treatment of bee and wasp induced anaphylactic reactions are sparse. This study aimed to estimate the incidence of bee...... only for Odense and 2009-2014 for the whole region). Discharge summaries with diagnosis related to anaphylaxis according to the International Classification of Diseases 10 (ICD-10) were reviewed to identify bee and wasp induced anaphylactic reactions. The severity of the anaphylactic reaction...... was assessed according to Sampson's severity score and Mueller's severity score. Treatment was evaluated in relation to administration of adrenaline, glucocorticoids and antihistamine. RESULTS: We identified 273 cases (Odense 2008 n = 14 and Region of Southern Denmark 2009-2014 n = 259) of bee and wasp induced...

  4. The value of the pre-hospital learning environment as part of the emergency nursing programme

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    Sonett van Wyk

    2015-10-01

    Objective: The study explored the views of the emergency nurse students regarding the value of rotating through the pre-hospital learning environment during an emergency nursing programme. Methods: A qualitative, explorative, descriptive and contextual research design using an Appreciative Inquiry approach was used to collect the data. Through purposive sampling a total of 45 emergency nursing students participated. Data was collected by means of selfreported Appreciative Inquiry interview guides and individual Appreciative Inquiry interviews.The data was analysed using content analysis. Results: Four major themes were identified: an unpredictable environment, role players in emergency medical services, team work, and competencies. Conclusion: The research findings support the value and continuation of utilising the prehospital clinical learning environment for placing post-basic emergency nursing students when enrolled in the emergency nursing programme.

  5. The Atlantic divide in coronary heart disease: Epidemiology and patient care in the US and Portugal.

    Science.gov (United States)

    Lobo, Mariana F; Azzone, Vanessa; Resnic, Frederic S; Melica, Bruno; Teixeira-Pinto, Armando; Azevedo, Luís Filipe; Freitas, Alberto; Nisa, Cláudia; Bacelar-Nicolau, Leonor; Rocha-Gonçalves, Francisco Nuno; Pereira-Miguel, José; Costa-Pereira, Altamiro; Normand, Sharon-Lise

    2017-09-01

    We aimed to compare access to new health technologies to treat coronary heart disease (CHD) in the health systems of Portugal and the US, characterizing the needs of the populations and the resources available. We reviewed data for 2000 and 2010 on epidemiologic profiles of CHD and on health care available to patients. Thirty health technologies (16 medical devices and 14 drugs) introduced during the period 1980-2015 were identified by interventional cardiologists. Approval and marketing dates were compared between countries. Relative to the US, Portugal has lower risk profiles and less than half the hospitalizations per capita, but fewer centers per capita provide catheterization and cardiothoracic surgery services. More than 70% of drugs were available sooner in the US, whereas 12 out of 16 medical devices were approved earlier in Portugal. Nevertheless, at least five of these devices were adopted first or diffused faster in the US. Mortality due to CHD and myocardial infarction (MI) was lower in Portugal (CHD: 72.8 vs. 168 and MI: 48.7 vs. 54.1 in Portugal and the US, respectively; age- and gender-adjusted deaths per 100000 population, 2010); but only CHD deaths exhibited a statistically significant difference between the countries. Differences in regulatory mechanisms and price regulations have a significant impact on the types of health technologies available in the two countries. However, other factors may influence their adoption and diffusion, and this appears to have a greater impact on mortality, due to acute conditions. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Pre-hospital identification and post-recovery challenges of intoxication with synthetic cannabinoid containing legal high products such as 'Exodus Damnation'.

    Science.gov (United States)

    Fitzpatrick, David; O'Meara, Patrick; Cunningham, Andrew

    2016-11-01

    This short report describes the case of a young adult male who had smoked a synthetic cannabinoid legal high product called 'Exodus Damnation'. The patient's presentation was atypical from that described in the literature, with hypotension and hypoxaemia. Of note was the rapid recovery after pre-hospital intervention with high-flow oxygen therapy and intravenous fluids. The patient refused on-going care, despite repeated advice to attend the Emergency Department. The distinct lack of specialist support and referral to drug treatment for this patient population, with whom ambulance services are coming into contact with increasing frequency, is reported. For those patients with the capacity to refuse on-going care, ambulance services may be in an opportune position to actively promote referral to support services for these vulnerable individuals. © The Author(s) 2016.

  7. Pre-hospital management of mass casualty civilian shootings: a systematic literature review.

    Science.gov (United States)

    Turner, Conor D A; Lockey, David J; Rehn, Marius

    2016-11-08

    Mass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the background of a rising threat of transnational terrorism worldwide, emergency response strategies are of critical importance. This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future practice. Systematic literature searches of PubMed, Cochrane Database of Systematic Reviews and Scopus were conducted in conjunction with simple searches of non-indexed databases; Web of Science, OpenDOAR and Evidence Search. The searches were last carried out on 20 April 2016 and only identified those papers published after the 1 January 1980. Included documents had to contain descriptions, discussions or experiences of the pre-hospital management of civilian mass shootings. From the 494 identified manuscripts, 73 were selected on abstract and title and after full text reading 47 were selected for inclusion in analysis. The search yielded reports of 17 mass shooting events, the majority from the USA with additions from France, Norway, the UK and Kenya. Between 1994 and 2015 the shooting of 1649 people with 578 deaths at 17 separate events are described. Quality appraisal demonstrated considerable heterogeneity in reporting and revealed limited data on mass shootings globally. Key themes were identified to improve future practice: tactical emergency medical support may harmonise inner cordon interventions, a need for inter-service education on effective haemorrhage control, the value of senior triage operators and the need for regular mass casualty incident simulation.

  8. Pre-hospital emergency anaesthesia in awake hypotensive trauma patients: beneficial or detrimental?

    Science.gov (United States)

    Crewdson, K; Rehn, M; Brohi, K; Lockey, D J

    2018-04-01

    The benefits of pre-hospital emergency anaesthesia (PHEA) are controversial. Patients who are hypovolaemic prior to induction of anaesthesia are at risk of severe cardiovascular instability post-induction. This study compared mortality for hypovolaemic trauma patients (without major neurological injury) undergoing PHEA with a patient cohort with similar physiology transported to hospital without PHEA. A retrospective database review was performed to identify patients who were hypotensive on scene [systolic blood pressure (SBP) < 90 mmHg], and GCS 13-15. Patient records were reviewed independently by two pre-hospital clinicians to identify the likelihood of hypovolaemia. Primary outcome measure was mortality defined as death before hospital discharge. Two hundred and thirty-six patients were included; 101 patients underwent PHEA. Fifteen PHEA patients died (14.9%) compared with six non-PHEA patients (4.4%), P = 0.01; unadjusted OR for death was 3.73 (1.30-12.21; P = 0.01). This association remained after adjustment for age, injury mechanism, heart rate and hypovolaemia (adjusted odds ratio 3.07 (1.03-9.14) P = 0.04). Fifty-eight PHEA patients (57.4%) were hypovolaemic prior to induction of anaesthesia, 14 died (24%). Of 43 PHEA patients (42.6%) not meeting hypovolaemia criteria, one died (2%); unadjusted OR for mortality was 13.12 (1.84-578.21). After adjustment for age, injury mechanism and initial heart rate, the odds ratio for mortality remained significant at 9.99 (1.69-58.98); P = 0.01. Our results suggest an association between PHEA and in-hospital mortality in awake hypotensive trauma patients, which is strengthened when hypotension is due to hypovolaemia. If patients are hypovolaemic and awake on scene it might, where possible, be appropriate to delay induction of anaesthesia until hospital arrival. © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  9. Comparative care and outcomes for acute coronary syndromes in Central and Eastern European Transitional countries: A review of the literature.

    Science.gov (United States)

    Smith, Fraser G D; Brogan, Richard A; Alabas, Oras; Laut, Kristina G; Quinn, Tom; Bugiardini, Raffaele; Gale, Chris P

    2015-12-01

    The purpose of this review was to compare quality of care and outcomes following acute coronary syndrome (ACS) in Central and Eastern European Transitional (CEET) countries. This was a review of original ACS articles in CEET countries from PubMed, ISI Web of Science, Medline and Embase databases published in English from November 2003 to February 2014. Seventeen manuscripts fulfilled the search criteria. Of 19 CEET countries studied, there were no published ACS management or outcome data for four countries. In-hospital mortality for patients with acute myocardial infarction (AMI) ranged from 6.3% in the Czech Republic to 15.3% in Latvia. In-hospital mortality for ST-elevation myocardial infarction (STEMI) ranged from 3.0% in Poland to 20.7% in Romania. For STEMI, primary percutaneous coronary intervention (PCI) ranged from 1.0% to over 92.0%, fibrinolytic therapy from 0.0% to 49.6%, and no reperfusion therapy from 7.0% to 63.0%. Many CEET countries do not have published ACS care and outcomes data. Of those that do, there is evidence for substantial geographical variation in early mortality. Wide variation in emergency reperfusion strategies for STEMI suggests that acute cardiac care is likely to be modifiable and if addressed could reduce mortality from ACS in CEET countries. The collection of ACS care and outcomes data across Europe must be prioritised. © The European Society of Cardiology 2014.

  10. The role of performing life support courses in rural areas in improving pre-hospital physiologic conditions of patients with penetrating injuries.

    Science.gov (United States)

    Nia, Masoud Saghafi; Naffisi, Nahid; Mohebbi, Hassan Ali; Moharamzadeh, Yashar

    2008-09-01

    To evaluate the impact of animal model based medical training courses for village healthcare workers on prehospital physiologic condition and prognosis of patients with penetrating injuries. Experimental study. This study was carried out in Mehran city and its neighbouring rural districts in western part of Iran from 2002 to 2004. Seventy-six village healthcare workers were trained and equipped to deliver in-field medical first cares. First group (226 patients) consisted of those who received this cares by the trained group and second group (245 patients) were those who received no in-field cares and were transported directly to the trauma center in provincial capital, Ilam. Physiologic Severity Score (PSS) was calculated to determine the physiologic condition of patients in both groups. The most prevalent cause of trauma in both groups was car accidents (61.6%). Controlling of hemorrhage was the most frequent provided initial medical care (40.6%). A significant improvement regarding the PSS score was observed in the first group of patients compared to the second group (7.505 vs. 6.799, 95% CI for difference: 0.3 to 0.9). The mortality rates of the first and second group of patients were 3% and 7.3%, respectively (p=0.051). Performing life support courses in rural areas of low-income countries where there is no pre-hospital triage and emergency medical system and provision of classic resuscitative measures are limited, has a significant impact on improvement of pre-hospital physiologic condition and prognosis of patients with penetrating injuries.

  11. Retrospective analysis of the role and performance of family medicine versus emergency medical services in the pre-hospital management of patients with AMI in Banja Luka.

    Science.gov (United States)

    Lakić, Biljana; Račić, Maja; Vulić, Duško

    2016-05-01

    The aim of this study was to investigate the differences in pre-hospital care of patients with acute myocardial infarction between emergency medical services and family medicine. This retrospective descriptive study included patients treated for acute myocardial infarction at the University Clinical Centre of Banja Luka, in the period from 1st January to 31st December 2011. The patients were divided into two groups: patients who received a hospital referral from the family medicine service and those who received one from the emergency medical service. The majority of patients (54.8%) received pre-hospital care from emergency medical services, while in 24.8% of cases the care was provided by family medicine physicians. The analysis showed that the time that passed from the onset of symptoms to the visit to the health institution of first medical contact was shorter in the emergency medical service (pfamily practice was 24 hours, and to the emergency service 2 hours. The patients who established their first medical contact with the emergency service reported more severe symptoms than the ones who visited a family practice over the same period of time. The severity of symptoms affected the patients' decisions to seek help in a timely manner and to choose the facility of first medical contact. Interventions to decrease delay must focus on improving public awareness of acute myocardial infarction symptoms and increasing their knowledge of the benefits of early medical contact and treatment. Continuing education of family practitioners in this field is required. Copyright © 2016 by Academy of Sciences and Arts of Bosnia and Herzegovina.

  12. A retrospective quality assessment of pre-hospital emergency medical documentation in motor vehicle accidents in south-eastern Norway

    Directory of Open Access Journals (Sweden)

    Staff Trine

    2011-03-01

    Full Text Available Abstract Background Few studies have evaluated pre-hospital documentation quality. We retrospectively assessed emergency medical service (EMS documentation of key logistic, physiologic, and mechanistic variables in motor vehicle accidents (MVAs. Methods Records from police, Emergency Medical Communication Centers (EMCC, ground and air ambulances were retrospectively collected for 189 MVAs involving 392 patients. Documentation of Glasgow Coma Scale (GCS, respiratory rate (RR, and systolic blood pressure (SBP was classified as exact values, RTS categories, clinical descriptions enabling post-hoc inference of RTS categories, or missing. The distribution of values of exact versus inferred RTS categories were compared (Chi-square test for trend. Results 25% of ground and 11% of air ambulance records were unretrieveable. Patient name, birth date, and transport destination was documented in >96% of ambulance records and 81% of EMCC reports. Only 54% of patient encounter times were transmitted to the EMCC, but 77% were documented in ground and 96% in air ambulance records. Ground ambulance records documented exact values of GCS in 48% and SBP in 53% of cases, exact RR in 10%, and RR RTS categories in 54%. Clinical descriptions made post-hoc inference of RTS categories possible in another 49% of cases for GCS, 26% for RR, and 20% for SBP. Air ambulance records documented exact values of GCS in 89% and SBP in 84% of cases, exact RR in 7% and RR RTS categories in 80%. Overall, for lower RTS categories of GCS, RR and SBP the proportion of actual documented values to inferred values increased (All: p Conclusion EMS documentation of logistic and mechanistic variables was adequate. Patient physiology was frequently documented only as descriptive text. Our finding indicates a need for improved procedures, training, and tools for EMS documentation. Documentation is in itself a quality criterion for appropriate care and is crucial to trauma research.

  13. Samara region experience in organization of emergency care system for patients with acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Duplyakov D.V.

    2015-09-01

    Full Text Available The article presents the general features of healthcare program for patients with acute coronary syndrome which started in Samara region in 2007. Some results and perspectives of future development of Samara “myocardial infarction network” are elucidated.

  14. Art care: A multi-modality coronary 3D reconstruction and hemodynamic status assessment software.

    Science.gov (United States)

    Siogkas, Panagiotis K; Stefanou, Kostas A; Athanasiou, Lambros S; Papafaklis, Michail I; Michalis, Lampros K; Fotiadis, Dimitrios I

    2018-01-01

    Due to the incremental increase of clinical interest in the development of software that allows the 3-dimensional (3D) reconstruction and the functional assessment of the coronary vasculature, several software packages have been developed and are available today. Taking this into consideration, we have developed an innovative suite of software modules that perform 3D reconstruction of coronary arterial segments using different coronary imaging modalities such as IntraVascular UltraSound (IVUS) and invasive coronary angiography images (ICA), Optical Coherence Tomography (OCT) and ICA images, or plain ICA images and can safely and accurately assess the hemodynamic status of the artery of interest. The user can perform automated or manual segmentation of the IVUS or OCT images, visualize in 3D the reconstructed vessel and export it to formats, which are compatible with other Computer Aided Design (CAD) software systems. We employ finite elements to provide the capability to assess the hemodynamic functionality of the reconstructed vessels by calculating the virtual functional assessment index (vFAI), an index that corresponds and has been shown to correlate well to the actual fractional flow reserve (FFR) value. All the modules of the proposed system have been thoroughly validated. In brief, the 3D-QCA module, compared to a successful commercial software of the same genre, presented very good correlation using several validation metrics, with a Pearson's correlation coefficient (R) for the calculated volumes, vFAI, length and minimum lumen diameter of 0.99, 0.99, 0.99 and 0.88, respectively. Moreover, the automatic lumen detection modules for IVUS and OCT presented very high accuracy compared to the annotations by medical experts with the Pearson's correlation coefficient reaching the values of 0.94 and 0.99, respectively. In this study, we have presented a user-friendly software for the 3D reconstruction of coronary arterial segments and the accurate hemodynamic

  15. Analysis of occupational accidents with biological material among professionals in pre-hospital services.

    Science.gov (United States)

    de Oliveira, Adriana Cristina; Paiva, Maria Henriqueta Rocha Siqueira

    2013-02-01

    To estimate the prevalence of accidents due to biological material exposure, the characteristics and post-accident conduct among professionals of pre-hospital services of the four municipalities of Minas Gerais, Brazil. A cross-sectional study, using a structured questionnaire that was developed to enable the calculation of prevalence, descriptive analysis and analytical analysis using logistic regression. The study included 228 professionals; the prevalence of accidents due to biological material exposure was 29.4%, with 49.2% percutaneous, 10.4% mucousal, 6.0% non-intact skin, and 34.4% intact skin. Among the professionals injured, those that stood out were nursing technicians (41.9%) and drivers (28.3%). Notification of the occurrence of the accident occurred in 29.8% of the cases. Percutaneous exposure was associated with time of work in the organization (OR=2.51, 95% CI: 1.18 to 5.35, paccidents with biological material should be encouraged, along with professional evaluation/monitoring.

  16. Using ArcGIS software in the pre-hospital emergency medical system.

    Science.gov (United States)

    Manole, M; Duma, Odetta; Custură, Maria Alexandra; Petrariu, F D; Manole, Alina

    2014-01-01

    To measure the accessibility to healtcare services in order to reveal their quality and to improve the overall coverage, continuity and other features. We used the software ESRI Arc GIS 9.3, the Network Analyst function and data provided by Ambulance Service of Iasi (A.S.I.) with emergencies statistics for the first four months of 2012, processed by Microsoft Office Excel 2010. As examples, we chose "St. Maria" Children's Emergency Hospital and "St. Spiridon" Emergency Hospital. ArcGIS Network Analyst finds the best route to get from one location to another or a route that includes multiple locations. Each route is characterized by three stops. The starting point is always the office of Ambulance Service of Iasi (A.S.I.), a second stop at the case address and the third to the hospital unit chosen according to the patient's diagnosis and age. Spatial distribution of emergency cases for the first four months of 2012 in these two examples is one unequable, with higher concentrations in districts located in two areas of the city. The presented examples highlight the poor coverage of healthcare services for the population of Iasi, Romania, especially the South-West area and its vulnerability in situations of emergency. Implementing such a broad project would lead to more complex analyses that would improve the situation of pre-hospital emergency medical services, with final goal to deserve the population, improve the quality of healthcare and develop the interdisciplinary relationships.

  17. Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service

    Directory of Open Access Journals (Sweden)

    Lossius Hans

    2010-06-01

    Full Text Available Abstract Background Anaesthesiologists are airway management experts, which is one of the reasons why they serve as pre-hospital emergency physicians in many countries. However, limited data are available on the actual quality and safety of anaesthesiologist-managed pre-hospital endotracheal intubation (ETI. To explore whether the general indications for ETI are followed and what complications are recorded, we analysed the use of pre-hospital ETI in severely traumatised patients treated by anaesthesiologists in a Norwegian helicopter emergency medical service (HEMS. Methods A retrospective audit of prospectively registered data concerning patients with trauma as the primary diagnosis and a National Committee on Aeronautics score of 4 - 7 during the period of 1994-2005 from a mixed rural/urban Norwegian HEMS was performed. Results Among the 1255 cases identified, 238 successful pre-hospital ETIs out of 240 attempts were recorded (99.2% success rate. Furthermore, we identified 47 patients for whom ETI was performed immediately upon arrival to the emergency department (ED. This group represented 16% of all intubated patients. Of the ETIs performed in the ED, 43 patients had an initial Glasgow Coma Score (GCS Conclusions We found a very high success rate of pre-hospital ETI and few recorded complications in the studied anaesthesiologist-manned HEMS. However, a substantial number of trauma patients were intubated first on arrival in the ED. This delay may represent a quality problem. Therefore, we believe that more studies are needed to clarify the reasons for and possible clinical consequences of the delayed ETIs.

  18. Effects of Aromatherapy on the Anxiety, Vital Signs, and Sleep Quality of Percutaneous Coronary Intervention Patients in Intensive Care Units

    Science.gov (United States)

    Cho, Mi-Yeon; Min, Eun Sil; Hur, Myung-Haeng; Lee, Myeong Soo

    2013-01-01

    The purpose of this study was to investigate the effects of aromatherapy on the anxiety, sleep, and blood pressure (BP) of percutaneous coronary intervention (PCI) patients in an intensive care unit (ICU). Fifty-six patients with PCI in ICU were evenly allocated to either the aromatherapy or conventional nursing care. Aromatherapy essential oils were blended with lavender, roman chamomile, and neroli with a 6 : 2 : 0.5 ratio. Participants received 10 times treatment before PCI, and the same essential oils were inhaled another 10 times after PCI. Outcome measures patients' state anxiety, sleeping quality, and BP. An aromatherapy group showed significantly low anxiety (t = 5.99, P aromatherapy effectively reduced the anxiety levels and increased the sleep quality of PCI patients admitted to the ICU. Aromatherapy may be used as an independent nursing intervention for reducing the anxiety levels and improving the sleep quality of PCI patients. PMID:23476690

  19. Effects of Self-care Health Behaviors on Quality of Life Mediated by Cardiovascular Risk Factors Among Individuals with Coronary Artery Disease: A Structural Equation Modeling Approach

    Directory of Open Access Journals (Sweden)

    Sukhee Ahn, RN, PhD

    2016-06-01

    Conclusions: The findings indicate that self-efficacy, self-care health behaviors, and modifiable risk factors play an important role in QOL in adults with coronary artery disease. Patients could be more confident in performing self-care health behaviors, leading to a better QOL, by more effectively managing their cardiovascular risk factors. Nursing strategies to improve QOL in this population should include motivating them to perform self-care health behaviors.

  20. Efficacy and safety of zotarolimus-eluting and sirolimus-eluting coronary stents in routine clinical care (SORT OUT III): a randomised controlled superiority trial

    DEFF Research Database (Denmark)

    Rasmussen, Klaus; Maeng, Michael; Kaltoft, Anne

    2010-01-01

    BACKGROUND: In low-risk patients, the zotarolimus-eluting stent has been shown to reduce rates of restenosis without increasing the risk of stent thrombosis. We compared the efficacy and safety of the zotarolimus-eluting stent versus the sirolimus-eluting stent in patients with coronary artery...... disease who were receiving routine clinical care with no direct follow-up. METHODS: We did a single-blind, all-comer superiority trial in adult patients with chronic stable coronary artery disease or acute coronary syndromes, and at least one target lesion. Patients were treated at one of five...... Danish administrative and health-care registries. The primary endpoint was a composite of major adverse cardiac events within 9 months: cardiac death, myocardial infarction, and target vessel revascularisation. Intention-to-treat analyses were done at 9-month and 18-month follow-up. This trial...

  1. Temperature and time stability of whole blood lactate: implications for feasibility of pre-hospital measurement

    Directory of Open Access Journals (Sweden)

    Watkins Timothy R

    2011-05-01

    Full Text Available Abstract Background To determine the time and temperature stability of whole blood lactate using experimental conditions applicable to the out-of-hospital environment. Findings We performed a prospective, clinical laboratory-based study at an academic hospital. Whole blood lactate was obtained by venipuncture from five post-prandial, resting subjects. Blood was stored in lithium heparinized vacutainers in three temperature conditions: 1 room temperature (20°C, 2 wrapped in a portable, instant ice pack (0°C, or 3 wet ice (0°C. Lactate concentrations (mmol/L were measured at 0, 5, 10, 20, and 30 minutes after sampling, and compared using repeated measures analysis of variance. Mean baseline lactate among resting subjects (N = 5 was 1.24 mmol/L (95%CI: 0.49,1.98 mmol/L. After 30 minutes, lactate concentration increased, on average, by 0.08 mmol/L (95%CI: 0.02,0.13 mmol/L, 0.18 mmol/L (95%CI: 0.07,0.28 mmol/L, and 0.36 mmol/L (95%CI: 0.24,0.47 mmol/L when stored in wet ice, ice pack, and room temperature, respectively. The increase in lactate was similar in samples wrapped in portable ice pack or stored in wet ice at all time points (p > 0.05, and met criteria for equivalence at 30 minutes. However, lactate measurements from whole blood stored at room temperature were significantly greater, on average, than wet ice or portable ice pack within five and ten minutes, respectively (p Conclusions Whole blood lactate measurements using samples stored in a portable ice pack are similar to wet ice for up to 30 minutes. These conditions are applicable to the out-of-hospital environment, and should inform future studies of pre-hospital measurement of lactate.

  2. Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment.

    Science.gov (United States)

    Simonsen, Sofie Amalie; Andresen, Morten; Michelsen, Lene; Viereck, Søren; Lippert, Freddy K; Iversen, Helle Klingenberg

    2014-11-13

    Effective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during a five-year period in order to identify potential delays and evaluate the reorganization of EMS in Copenhagen in 2009. We performed a retrospective analysis of ambulance records from stroke patients suitable for thrombolysis from 1 January 2006 to 7 July 2011. We noted response time from dispatch of the ambulance to arrival at the scene, on-scene time and transport time to the hospital-in total, alarm-to-door time. In addition, we noted baseline characteristics. We reviewed 481 records (58% male, median age 66 years). The median (IQR) alarm-to-door time in minutes was 41 (33-52), of which 18 (12-24) minutes were spent on scene. Response time was reduced from the period before to the period after reorganization (7 vs. 5 minutes, p <0.001). In a linear multiple regression model, higher patient age and longer distance to the hospital correlated with significantly longer transportation time (p <0.001). This study shows an unchanged alarm-to-door time of 41 minutes over a five-year period. Response time, but not total alarm-to-door time, was reduced during the five years. On-scene time constituted nearly half of the total alarm-to-door time and is thus a point of focus for improvement.

  3. Indications for coronary angiography

    International Nuclear Information System (INIS)

    Kaltenbach, M.; Vallbracht, C.

    1985-01-01

    Today selective coronary angiography, introduced by Sones in 1957, is used as clinical routine for diagnosing morphological changes in the coronary arteries. Hitherto, more recent techniques such as digital subtraction angiography cannot provide comparable information. Strict criteria for its indication depending on possible therapeutic consequences, have to be applied, although the risk is low with a letality of 0.01 to 0.05 percent. Radionuclear investigations can be used as additional tool in selected cases. The careful indication for coronary angiography usually implies the possible need for coronary bypass graft surgery of balloon angioplasty. (orig./MG) [de

  4. Cardiac Rehabilitation for Patients With Coronary Artery Disease: A Practical Guide to Enhance Patient Outcomes Through Continuity of Care

    Directory of Open Access Journals (Sweden)

    Catherine Giuliano

    2017-06-01

    Full Text Available Coronary artery disease (CAD is a leading cause of disease burden worldwide. Referral to cardiac rehabilitation (CR is a class I recommendation for all patients with CAD based on findings that participation can reduce cardiovascular and all-cause mortality, as well as improve functional capacity and quality of life. However, programme uptake remains low, systematic progression through the traditional CR phases is often lacking, and communication between health care providers is frequently suboptimal, resulting in fragmented care. Only 30% to 50% of eligible patients are typically referred to outpatient CR and fewer still complete the programme. In contemporary models of CR, patients are no longer treated by a single practitioner, but rather by an array of health professionals, across multiples specialities and health care settings. The risk of fragmented care in CR may be great, and a concerted approach is required to achieve continuity and optimise patient outcomes. ‘Continuity of care’ has been described as the delivery of services in a coherent, logical, and timely fashion and which entails 3 specific domains: informational, management, and relational continuity. This is examined in the context of CR.

  5. A consensus-based template for uniform reporting of data from pre-hospital advanced airway management

    DEFF Research Database (Denmark)

    Sollid, Stephen J M; Lockey, David; Lossius, Hans Morten

    2009-01-01

    with airway management have recently propagated the need for guidelines and standards in pre-hospital airway management. Following the path of other initiatives to establish templates for uniform data reporting, like the many Utstein-style templates, we initiated and carried out a structured consensus process......, the group defined 19 optional variables for which a consensus could not be achieved or the data were considered as valuable but not essential. CONCLUSION: We successfully developed an Utstein-style template for documenting and reporting pre-hospital airway management. The core dataset for this template......BACKGROUND: Advanced airway management is a critical intervention that can harm the patient if performed poorly. The available literature on this subject is rich, but it is difficult to interpret due to a huge variability and poor definitions. Several initiatives from large organisations concerned...

  6. The management of hypercholesterolemia in patients with coronary artery disease: guidelines for primary care.

    Science.gov (United States)

    Vogel, R A

    1998-01-01

    More than 10 million individuals in the United States currently have symptomatic coronary artery disease (CAD). Asymptomatic CAD is even more prevalent. CAD in the United States is responsible for approximately 1.5 million myocardial infarctions, 500,000 deaths, and a total economic burden in excess of $120 billion annually. Fortunately, CAD is preventable in many individuals. Our understanding of CAD has steadily progressed throughout the 20th century, and now several lines of evidence support the importance of cholesterol in both the genesis and management of coronary atherosclerosis. Following identification of the presence of cholesterol in atheromas, Anitschkov early this century demonstrated that atherosclerotic lesions can be induced in susceptible animals by high-saturated-fat and cholesterol diets. These lesions regressed when low-fat and cholesterol diets were resumed. In the 1970s and 1980s, findings from the landmark Framingham Heart, Seven Countries, and Multiple Risk Factor Intervention Trial studies firmly established that hypercholesterolemia was a major risk factor for cardiovascular morbidity and mortality. During the 1980s and 1990s, 21 of 22 angiographic trials demonstrated reduced progression of coronary and/or carotid artery disease using lifestyle, drug, and surgical means for reducing cholesterol. The later trials commonly employed hydroxymethylglutaryl coenzyme A reductase inhibitors (statins), reflecting increasing clinical use of these drugs. In 1988, the Adult Treatment Panel of the National Cholesterol Education Program (NCEP) published guidelines on testing and treating hypercholesterolemic patients, which outlined a more aggressive approach to cholesterol lowering than was currently in practice. Since 1994, five large cardiovascular event trials and a large angiographic trial have shown that aggressive cholesterol lowering reduces both cardiac morbidity and mortality, largely substantiating the NCEP guidelines. Although important

  7. Identifying an evidence-based model of therapy for the pre-hospital emergency management of supraventricular tachycardia

    OpenAIRE

    Smith, Gavin

    2017-01-01

    This thesis provides a comprehensive reporting of the work undertaken to identify evidence supporting pre-hospital management of supraventricular tachycardia (SVT), delivering an evidence base for paramedic treatment of these patients. The literature search identified absences in evidence supporting therapies used within existing clinical guidelines. The vagal manoeuvres, the simplest and least invasive therapy to employ in the stable patient, were insufficiently evidenced regarding technique...

  8. Effect of Pre-Hospital Red Blood Cell Transfusion on Mortality and Time of Death in Civilian Trauma Patients.

    Science.gov (United States)

    Rehn, Marius; Weaver, Anne; Brohi, Karim; Eshelby, Sarah; Green, Laura; Røislien, Jo; Lockey, David J

    2018-04-16

    Current management principles of haemorrhagic shock after trauma emphasize earlier transfusion therapy to prevent dilution of clotting factors and correct coagulopathy. London's air ambulance (LAA) was the first UK civilian pre-hospital service to routinely offer pre-hospital red blood cell (RBC) transfusion (phRTx). We investigated the effect of phRTx on mortality. Retrospective trauma database study comparing mortality before-implementation with after-implementation of phRTx in exsanguinating trauma patients. Univariate logistic regression was performed for the unadjusted association between phRTx and mortality was performed, and multiple logistic regression adjusting for potential confounders. We identified 623 subjects with suspected major haemorrhage. We excluded 84 (13.5%) patients due to missing data on survival status. Overall 187 (62.3%) patients died in the before phRTx period and 143 (59.8%) died in the after phRTx group. There was no significant improvement in overall survival after the introduction of phRTx (p = 0.554). Examination of pre-hospital mortality demonstrated 126 deaths in the pre-phRTx group (42.2%) and 66 deaths in the RBC administered group (27.6%) There was a significant reduction in pre-hospital mortality in the group who received RBC (p < 0.001). phRTx was associated with increased survival to hospital, but not overall survival. The "delay death" effect of phRTx carries an impetus to further develop in-hospital strategies to improve survival in severely bleeding patients.

  9. Percutaneous coronary intervention of osteal lesions in newly established tertiary care cardiac hospital

    International Nuclear Information System (INIS)

    Sultana, R.; Sultana, N.; Rasheed, S.J.; Jafary, M.H.; Ishaq, M.; Samad, A.

    2010-01-01

    To assess the outcome of percutanious Angioplasty in patients with osteal lesions in Coronary artery Diseases. This is a retrospective analysis of all coronary angiograms performed at the catheterization laboratory of Karachi Institute of Heart Diseases (KIHD), a tertiary referral center in Karachi, Pakistan, between the periods August 2006 to August 2008. Fifty patients were enrolled which included thirty-five men and fifteen women and all were >40 years of age. Each patient had a single target osteal lesion: twenty nine patients underwent PCI for ostial LAD lesion (among them twenty males and nine females), six had ostial LCX (five males and one female), and fifteen patients had osteal RCA stenosis (10-male patients and 5- female patients). After high-pressure balloon dilatation residual stenosis was reduced. Twelve patients were treated with bare metal stents (BMS) while thirty eight with drug eluting stents (DES). In all cases the procedure was successful without any pre and post procedural complications. A key issue in the treatment of an osteal lesion is to assure that the stent is inserted proximal enough to fully cover the osteal junction. Improvements in technique, equipment, adjunctive drug therapy and better understanding of the procedure have remarkably changed the practice of interventional cardiology. (author)

  10. Investigating the effect of continuous care model on social health status of family caregivers in hospitalized patients undergoing coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    T NasrAbadi

    2016-09-01

    Full Text Available Introduction: Chronic patient care causes  some problems, including pressure or burden of care, reducing the time for routine activities and self care, also causes compatibility decline in deal with stress and disorders of physical and mental health, emotional, social and financial prosperity of caregivers. The aim of this study was to determine the effect of continuous care model on social health status of  family caregivers in patients  underwent coronary artery bypass surgeries. Methods: This study was  one-group clinical trial research, the samples consisted 48 family caregiver of  the patients  underwent coronary artery bypass graft  surgeries, who  were selected using purposive sampling method. Data collection tools included the standard questionnaire Data collection tool was Novak and Guest caring burden inventory (CBI s as well as demographic questionnaire, which  was  measured at the baseline and 8 weeks after intervention.  Data were analyzed using  descriptive  and analytic statistic (paired t-test, and covariance analysis with SPSS version 16. Results: The mean score of  caring burden realated  to  the social health status before intervention was 3.86±6.11 and after intervention was 1.81±2.33. In examining five dimensions burden of care,  continuous care model had an impact on all aspects of the  caring burden and it led to the reduction of the burden of care  in  all aspects.  So,  it had a significant decrease  in the social health status (p <0.01. Conclusion: Implementation of continuous care model as the intervention of cheaper and available,  can be an effective step inreducing the burden of care of the  patients with  coronary artery disease in health status of social.

  11. Coronary Catheterization Laboratory Role for Post-Resuscitation Care Without ST Elevation Myocardial Infarction.

    Science.gov (United States)

    Kumar, Kris; Lotun, Kapildeo

    2018-05-07

    Out of hospital cardiac arrest management of patients with non-ST myocardial infarction per current American Heart Association and European Resuscitation Council guidelines leave the decision in regard to early angiography up to the physician operators. Guidelines are clear on the positive impact of early intervention on survival and improvement on left ventricular function in patients presenting with cardiac arrest and ST elevation myocardial infarction on electrocardiogram. This review aims to analyze the data that current guidelines are based upon in regards to out of hospital cardiac arrest with electrocardiogram findings of non-ST elevation myocardial infarction as well as other clinical trials that support early angiography and reperfusion strategies as well as future studies that are in trial to study the role of the coronary catheterization laboratory in cardiac arrest. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

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

    Science.gov (United States)

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

    2014-11-01

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

  13. Pre-hospital ticagrelor in ST-segment elevation myocardial infarction in the French ATLANTIC population

    DEFF Research Database (Denmark)

    Cayla, Guillaume; Lapostolle, Frederic; Ecollan, Patrick

    2017-01-01

    BACKGROUND: ATLANTIC was a randomized study comparing pre- and in-hospital treatment with a ticagrelor loading dose (LD) in ongoing ST-segment elevation myocardial infarction (STEMI). We sought to compare patient characteristics and clinical outcomes in France with other countries participating...... in ATLANTIC. METHODS: The population comprised 1862 patients, 660 (35.4%) from France and 1202 from 12 other countries. The main endpoints were reperfusion (≥70% ST-segment elevation resolution) and TIMI flow grade 3 before (co-primary endpoints) and after percutaneous coronary intervention (PCI). Other...... endpoints included a composite ischaemic endpoint (death/myocardial infarction/stroke/urgent revascularization/definite stent thrombosis) and bleeding events at 30days. RESULTS: In France, median times from first LD to angiography and between first and second LDs were 49 and 35min, respectively, and were...

  14. Effects of Aromatherapy on the Anxiety, Vital Signs, and Sleep Quality of Percutaneous Coronary Intervention Patients in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mi-Yeon Cho

    2013-01-01

    Full Text Available The purpose of this study was to investigate the effects of aromatherapy on the anxiety, sleep, and blood pressure (BP of percutaneous coronary intervention (PCI patients in an intensive care unit (ICU. Fifty-six patients with PCI in ICU were evenly allocated to either the aromatherapy or conventional nursing care. Aromatherapy essential oils were blended with lavender, roman chamomile, and neroli with a 6 : 2 : 0.5 ratio. Participants received 10 times treatment before PCI, and the same essential oils were inhaled another 10 times after PCI. Outcome measures patients' state anxiety, sleeping quality, and BP. An aromatherapy group showed significantly low anxiety (t=5.99, P<.001 and improving sleep quality (t=−3.65, P=.001 compared with conventional nursing intervention. The systolic BP of both groups did not show a significant difference by time or in a group-by-time interaction; however, a significant difference was observed between groups (F=4.63, P=.036. The diastolic BP did not show any significant difference by time or by a group-by-time interaction; however, a significant difference was observed between groups (F=6.93, P=.011. In conclusion, the aromatherapy effectively reduced the anxiety levels and increased the sleep quality of PCI patients admitted to the ICU. Aromatherapy may be used as an independent nursing intervention for reducing the anxiety levels and improving the sleep quality of PCI patients.

  15. Effects of aromatherapy on the anxiety, vital signs, and sleep quality of percutaneous coronary intervention patients in intensive care units.

    Science.gov (United States)

    Cho, Mi-Yeon; Min, Eun Sil; Hur, Myung-Haeng; Lee, Myeong Soo

    2013-01-01

    The purpose of this study was to investigate the effects of aromatherapy on the anxiety, sleep, and blood pressure (BP) of percutaneous coronary intervention (PCI) patients in an intensive care unit (ICU). Fifty-six patients with PCI in ICU were evenly allocated to either the aromatherapy or conventional nursing care. Aromatherapy essential oils were blended with lavender, roman chamomile, and neroli with a 6 : 2 : 0.5 ratio. Participants received 10 times treatment before PCI, and the same essential oils were inhaled another 10 times after PCI. Outcome measures patients' state anxiety, sleeping quality, and BP. An aromatherapy group showed significantly low anxiety (t = 5.99, P < .001) and improving sleep quality (t = -3.65, P = .001) compared with conventional nursing intervention. The systolic BP of both groups did not show a significant difference by time or in a group-by-time interaction; however, a significant difference was observed between groups (F = 4.63, P = .036). The diastolic BP did not show any significant difference by time or by a group-by-time interaction; however, a significant difference was observed between groups (F = 6.93, P = .011). In conclusion, the aromatherapy effectively reduced the anxiety levels and increased the sleep quality of PCI patients admitted to the ICU. Aromatherapy may be used as an independent nursing intervention for reducing the anxiety levels and improving the sleep quality of PCI patients.

  16. The epidemiology of Scottish trauma: A comparison of pre-hospital and in-hospital deaths, 2000 to 2011.

    Science.gov (United States)

    Morrison, Jonathan J; Yapp, Liam Z; Beattie, Anne; Devlin, Eimar; Samarage, Milan; McCaffer, Craig; Jansen, Jan O

    2016-02-01

    To characterise the temporal trends and urban-rural distribution of fatal injuries in Scotland through the analysis of mortality data collected by the National Records of Scotland. The prospectively collected NRS database was queried using ICD-10 codes for all Scottish trauma deaths during the period 2000 to 2011. Patients were divided into pre-hospital and in-hospital groups depending on the location of death. Incidence was plotted against time and linear regression was used to identify temporal trends. A total of 13,100 deaths were analysed. There were 4755 (36.3%) patients in the pre-hospital group with a median age (IQR) of 42 (28-58) years. The predominant cause of pre-hospital death related to vehicular injury (27.8%), which had a decreasing trend over the study period (p = 0.004). In-hospital, patients had a median age of 80 (58-88) years and the majority (67.0%) of deaths occurred following a fall on the level. This trend was shown to increase over the decade of study (p = 0.020). In addition, the incidence of urban incidents remained static, but the rate of rural fatal trauma decreased (p Scottish trauma patients die prior to hospital admission and the predominant mechanism of injury is due to road traffic accidents. This contrasts with in-hospital deaths, which are mainly observed in elderly patients following a fall from standing height. Further research is required to determine the preventability of fatal traumatic injury in Scotland. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  17. Care and outcomes of Asian-American acute myocardial infarction patients: findings from the American Heart Association Get With The Guidelines-Coronary Artery Disease program.

    Science.gov (United States)

    Qian, Feng; Ling, Frederick S; Deedwania, Prakash; Hernandez, Adrian F; Fonarow, Gregg C; Cannon, Christopher P; Peterson, Eric D; Peacock, W Frank; Kaltenbach, Lisa A; Laskey, Warren K; Schwamm, Lee H; Bhatt, Deepak L

    2012-01-01

    Asian-Americans represent an important United States minority population, yet there are limited data regarding the clinical care and outcomes of Asian-Americans following acute myocardial infarction (AMI). Using data from the American Heart Association Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) program, we compared use of and trends in evidence-based care AMI processes and outcome in Asian-American versus white patients. We analyzed 107,403 AMI patients (4412 Asian-Americans, 4.1%) from 382 United States centers participating in the Get With The Guidelines-Coronary Artery Disease program between 2003 and 2008. Use of 6 AMI performance measures, composite "defect-free" care (proportion receiving all eligible performance measures), door-to-balloon time, and in-hospital mortality were examined. Trends in care over this time period were explored. Compared with whites, Asian-American AMI patients were significantly older, more likely to be covered by Medicaid and recruited in the west region, and had a higher prevalence of diabetes, hypertension, heart failure, and smoking. In-hospital unadjusted mortality was higher among Asian-American patients. Overall, Asian-Americans were comparable with whites regarding the baseline quality of care, except that Asian-Americans were less likely to get smoking cessation counseling (65.6% versus 81.5%). Asian-American AMI patients experienced improvement in the 6 individual measures (P≤0.048), defect-free care (PAsian-Americans and whites. Compared with whites, the adjusted in-hospital mortality rate was higher for Asian-Americans (adjusted relative risk: 1.16; 95% confidence interval: 1.00-1.35; P=0.04). Evidence-based care for AMI processes improved significantly over the period of 2003 to 2008 for Asian-American and white patients in the Get With The Guidelines-Coronary Artery Disease program. Differences in care between Asian-Americans and whites, when present, were reduced over time.

  18. Paramedics' experiences of financial medicine practices in the pre-hospital environment. A pilot study

    Directory of Open Access Journals (Sweden)

    Craig Vincent-Lambert

    2016-12-01

    Conclusion: The results of this study are concerning as the actions of service providers described by the participants constitute gross violations of the ethical and professional guidelines for health care professionals. The authors recommend additional studies be conducted to further explore these findings and to establish the reasons for, and ways of, limiting financial medicine practices in the South African emergency care environment.

  19. Availability and quality of coronary heart disease family history in primary care medical records: implications for cardiovascular risk assessment.

    Directory of Open Access Journals (Sweden)

    Paula Dhiman

    Full Text Available The potential to use data on family history of premature disease to assess disease risk is increasingly recognised, particularly in scoring risk for coronary heart disease (CHD. However the quality of family health information in primary care records is unclear.To assess the availability and quality of family history of CHD documented in electronic primary care records.Cross-sectional study.537 UK family practices contributing to The Health Improvement Network database.Data were obtained from patients aged 20 years or more, registered with their current practice between 1(st January 1998 and 31(st December 2008, for at least one year. The availability and quality of recorded CHD family history was assessed using multilevel logistic and ordinal logistic regression respectively.In a cross-section of 1,504,535 patients, 19% had a positive or negative family history of CHD recorded. Multilevel logistic regression showed patients aged 50-59 had higher odds of having their family history recorded compared to those aged 20-29 (OR:1.23 (1.21 to 1.25, however most deprived patients had lower odds compared to those least deprived (OR: 0.86 (0.85 to 0.88. Of the 140,058 patients with a positive family history recorded (9% of total cohort, age of onset was available in 45%; with data specifying both age of onset and relative affected available in only 11% of records. Multilevel ordinal logistic regression confirmed no statistical association between the quality of family history recording and age, gender, deprivation and year of registration.Family history of CHD is documented in a small proportion of primary care records; and where positive family history is documented the details are insufficient to assess familial risk or populate cardiovascular risk assessment tools. Data capture needs to be improved particularly for more disadvantaged patients who may be most likely to benefit from CHD risk assessment.

  20. Availability and quality of coronary heart disease family history in primary care medical records: implications for cardiovascular risk assessment.

    Science.gov (United States)

    Dhiman, Paula; Kai, Joe; Horsfall, Laura; Walters, Kate; Qureshi, Nadeem

    2014-01-01

    The potential to use data on family history of premature disease to assess disease risk is increasingly recognised, particularly in scoring risk for coronary heart disease (CHD). However the quality of family health information in primary care records is unclear. To assess the availability and quality of family history of CHD documented in electronic primary care records. Cross-sectional study. 537 UK family practices contributing to The Health Improvement Network database. Data were obtained from patients aged 20 years or more, registered with their current practice between 1(st) January 1998 and 31(st) December 2008, for at least one year. The availability and quality of recorded CHD family history was assessed using multilevel logistic and ordinal logistic regression respectively. In a cross-section of 1,504,535 patients, 19% had a positive or negative family history of CHD recorded. Multilevel logistic regression showed patients aged 50-59 had higher odds of having their family history recorded compared to those aged 20-29 (OR:1.23 (1.21 to 1.25)), however most deprived patients had lower odds compared to those least deprived (OR: 0.86 (0.85 to 0.88)). Of the 140,058 patients with a positive family history recorded (9% of total cohort), age of onset was available in 45%; with data specifying both age of onset and relative affected available in only 11% of records. Multilevel ordinal logistic regression confirmed no statistical association between the quality of family history recording and age, gender, deprivation and year of registration. Family history of CHD is documented in a small proportion of primary care records; and where positive family history is documented the details are insufficient to assess familial risk or populate cardiovascular risk assessment tools. Data capture needs to be improved particularly for more disadvantaged patients who may be most likely to benefit from CHD risk assessment.

  1. Coronary artery bypass graft surgery--care globalization: the impact of national care on fatal and nonfatal outcome.

    Science.gov (United States)

    Ott, Elisabeth; Mazer, C David; Tudor, Iulia C; Shore-Lesserson, Linda; Snyder-Ramos, Stephanie A; Finegan, Barry A; Möhnle, Patrick; Hantler, Charles B; Böttiger, Bernd W; Latimer, Ray D; Browner, Warren S; Levin, Jack; Mangano, Dennis T

    2007-05-01

    In an international, prospective, observational study, we contrasted adverse vascular outcomes among four countries and then assessed practice pattern differences that may have contributed to these outcomes. A total of 5065 patients undergoing coronary artery bypass graft surgery were analyzed at 70 international medical centers, and from this pool, 3180 patients from the 4 highest enrolling countries were selected. Fatal and nonfatal postoperative ischemic complications related to the heart, brain, kidney, and gastrointestinal tract were assessed by blinded investigators. In-hospital mortality was 1.5% (9/619) in the United Kingdom, 2.0% (9/444) in Canada, 2.7% (34/1283) in the United States, and 3.8% (32/834) in Germany (P = .03). The rates of the composite outcome (morbidity and mortality) were 12% in the United Kingdom, 16% in Canada, 18% in the United States, and 24% in Germany (P < .001). After adjustment for difference in case-mix (using the European System for Cardiac Operative Risk Evaluation) and practice, country was not an independent predictor for mortality. However, there was an independent effect of country on composite outcome. The practices that were associated with adverse outcomes were the intraoperative use of aprotinin, intraoperative transfusion of fresh-frozen plasma or platelets, lack of use of early postoperative aspirin, and use of postoperative heparin. Significant between-country differences in perioperative outcome exist and appear to be related to hematologic practices, including administration of antifibrinolytics, fresh-frozen plasma, platelets, heparin, and aspirin. Understanding the mechanisms for these observations and selection of practices associated with improved outcomes may result in significant patient benefit.

  2. Impact of presentation and transfer delays on complete ST-segment resolution before primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Fabris, Enrico; van't Hof, Arnoud; Hamm, Christian W.

    2017-01-01

    AIMS: The aim of this study was to identify predictors of complete ST-segment resolution (STR) pre-primary percutaneous coronary intervention (PCI) in patients enrolled in the ATLANTIC trial. METHODS AND RESULTS: ECGs recorded at the time of inclusion (pre-hospital [pre-H]-ECG) and in the cathete...

  3. What influences pre-hospital cannulation intentions in paramedics? An application of the theory of reasoned action.

    Science.gov (United States)

    Banerjee, Smita C; Siriwardena, A Niroshan; Iqbal, Mohammad

    2011-02-01

    Intravenous cannulation is a common and important intervention undertaken by paramedics for administration of fluids and drugs in the pre-hospital setting. This study was a partial application of the theory of reasoned action to the prediction of pre-hospital cannulation intentions as part of an evaluation of an educational intervention to change cannulation behaviour in paramedics in line with national guidance. In 2008 a self-completion questionnaire was sent to paramedics from Nottinghamshire and Lincolnshire divisions of East Midlands Ambulance Service NHS Trust, UK. This included measures of prior behaviour related to cannulation, attitude towards cannulation, normative influence related to cannulation and intention to cannulate as well as demographic information. Of the 323 paramedics sent questionnaires 137 (42.2%) responded. Attitude towards cannulation (but not normative or peer influence) was a necessary factor for prediction of intention to cannulate in respondents. Past cannulation behaviour was indirectly related to intention to cannulate through the mediation of attitude towards cannulation. The theory of reasoned action provides a parsimonious way to predict intentions to cannulate. This study suggests that design and evaluation of interventions to reduce inappropriate cannulation should be targeted towards changing attitudes of paramedics, rather than towards addressing behavioural norms. Future research could utilize social-psychological theories to better understand clinical behaviour prior to implementation of complex educational or organizational interventions. © 2010 Blackwell Publishing Ltd.

  4. Seasonal variation in AF-related admissions to a coronary care unit in a "hot" climate: fact or fiction?

    Science.gov (United States)

    Kiu, Andrew; Horowitz, John D; Stewart, Simon

    2004-01-01

    Seasonal variations in atrial fibrillation (AF)-related morbidity and mortality have been demonstrated in "cold" northern European climates, but there are few data describing such a phenomenon in a "hot" climate. To examine the pattern of AF-related admissions to a coronary care unit (CCU) in South Australia operating within a Mediterranean climate, and to determine potential differences according to mean daily temperatures. PATIENT COHORT AND METHODS: A total of 144 admissions to the CCU during the 30 hottest and coldest days (60 days in total) during the calendar year 2001 were analyzed in respect to the absolute number of admissions and the profile of those admitted during "hot" and "cold" days. Overall, there were significantly more admissions to the CCU on "cold" as opposed to "hot" days (90 vs 54 patients in 30 days, P < or = .001). Of the 24 patients found to be in AF on presentation to hospital, 18 (75%) were admitted on cold days (P < .05). Alternatively, during "hot" days, patients were more likely to be diagnosed with unstable angina rather than acute myocardial infarction (46% vs 30%, P = .07) with proportionately fewer patients in AF at the time (11% vs 20%, P = NS). These preliminary data suggest that the phenomenon of seasonal variations in AF-related morbidity extend beyond colder climates to hotter climates with sufficiently large relative (as opposed to absolute) changes in ambient temperatures during the year.

  5. Emergency patients receiving anaesthesiologist-based pre-hospital treatment and subsequently released at the scene

    DEFF Research Database (Denmark)

    Højfeldt, S G; Sørensen, L P; Mikkelsen, Søren

    2014-01-01

    BACKGROUND: The Mobile Emergency Care Unit in Odense, Denmark consists of a rapid response car, manned with an anaesthesiologist and an emergency medical technician. Eleven per cent of the patients are released at the scene following treatment. The aim of the study was to investigate which...... investigated. In each patient, diagnosis as well as any renewed contact with the Mobile Emergency Care Unit or the hospital within 24 h was registered. RESULTS: ONE THOUSAND SIX HUNDRED NINE: patients were released at the scene. Diagnoses within the category 'examination and investigation' [International...... with the Mobile Emergency Care Unit within 24 h. Of the 143 victims of traffic accidents, 19 (13%) required renewed contact with the emergency department and one required admission to hospital (0.7%). Of all 1609 patients, four died within 24 h of contact (0.2%). CONCLUSION: Patients treated and released...

  6. Influence of inpatient service specialty on care processes and outcomes for patients with non ST-segment elevation acute coronary syndromes.

    Science.gov (United States)

    Roe, Matthew T; Chen, Anita Y; Mehta, Rajendra H; Li, Yun; Brindis, Ralph G; Smith, Sidney C; Rumsfeld, John S; Gibler, W Brian; Ohman, E Magnus; Peterson, Eric D

    2007-09-04

    Since the broad dissemination of practice guidelines, the association of specialty care with the treatment of patients with acute coronary syndromes has not been studied. We evaluated 55 994 patients with non-ST-segment elevation acute coronary syndromes (ischemic ST-segment changes and/or positive cardiac markers) included in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) Quality Improvement Initiative from January 2001 through September 2003 at 301 tertiary US hospitals with full revascularization capabilities. We compared baseline characteristics, the use of American College of Cardiology/American Heart Association guidelines class I recommendations, and in-hospital outcomes by the specialty of the primary in-patient service (cardiology versus noncardiology). A total of 35 374 patients (63.2%) were primarily cared for by a cardiology service, and these patients had lower-risk clinical characteristics, but they more commonly received acute (processes were improved when care was provided by a cardiology service regardless of the propensity to receive cardiology care. The adjusted risk of in-hospital mortality was lower with care provided by a cardiology service (adjusted odds ratio 0.80, 95% confidence interval 0.73 to 0.88), and adjustment for differences in the use of acute medications and invasive procedures partially attenuated this mortality difference (adjusted odds ratio 0.92, 95% confidence interval 0.83 to 1.02). Non-ST-segment elevation acute coronary syndrome patients primarily cared for by a cardiology inpatient service more commonly received evidence-based treatments and had a lower risk of mortality, but these patients had lower-risk clinical characteristics. Results from the present analysis highlight the difficulties with accurately determining how specialty care is associated with treatment patterns and clinical outcomes for patients with acute

  7. Zero Calcium Score as a Filter for Further Testing in Patients Admitted to the Coronary Care Unit with Chest Pain.

    Science.gov (United States)

    Correia, Luis Cláudio Lemos; Esteves, Fábio P; Carvalhal, Manuela; Souza, Thiago Menezes Barbosa de; Sá, Nicole de; Correia, Vitor Calixto de Almeida; Alexandre, Felipe Kalil Beirão; Lopes, Fernanda; Ferreira, Felipe; Noya-Rabelo, Márcia

    2017-06-12

    The accuracy of zero coronary calcium score as a filter in patients with chest pain has been demonstrated at the emergency room and outpatient clinics, populations with low prevalence of coronary artery disease (CAD). To test the gatekeeping role of zero calcium score in patients with chest pain admitted to the coronary care unit (CCU), where the pretest probability of CAD is higher than that of other populations. Patients underwent computed tomography for calcium scoring, and obstructive CAD was defined by a minimum 70% stenosis on invasive angiography. In 146 patients studied, the prevalence of CAD was 41%. A zero calcium score was present in 35% of the patients. The sensitivity and specificity of zero calcium score yielded a negative likelihood ratio of 0.16. After logistic regression adjustment for pretest probability, zero calcium score was independently associated with lower odds of CAD (OR = 0.12, 95%CI = 0.04-0.36), increasing the area under the ROC curve of the clinical model from 0.76 to 0.82 (p = 0.006). Zero calcium score provided a net reclassification improvement of 0.20 (p = 0.0018) over the clinical model when using a pretest probability threshold of 10% for discharging without further testing. In patients with pretest probability zero calcium score had a negative predictive value of 95% (95%CI = 83%-99%), with a number needed to test of 2.1 for obtaining one additional discharge. Zero calcium score substantially reduces the pretest probability of obstructive CAD in patients admitted to the CCU with acute chest pain. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0). A acurácia do escore de cálcio coronário zero como um filtro nos pacientes com dor torácica aguda tem sido demonstrada na sala de emergência e nos ambulatórios, populações com baixa prevalência de doença arterial coronariana (DAC). Testar o papel do escore de cálcio zero como filtro nos pacientes com dor torácica admitidos numa unidade coronariana intensiva (UCI), na

  8. Effect of a comprehensive health education program on pre-hospital delay intentions in high-risk stroke population and caregivers.

    Science.gov (United States)

    Yang, Li; Zhao, Qiuli; Zhu, Xuemei; Shen, Xiaoying; Zhu, Yulan; Yang, Liu; Gao, Wei; Li, Minghui

    2017-08-01

    Many factors influence pre-hospital delays in the event of stroke. This study aimed to develop and evaluate a comprehensive educational program for decreasing pre-hospital delays in high-risk stroke population. We enrolled 220 high-risk stroke population and caregivers from six urban communities in Harbin from May 2013 to May 2015, and randomly divided them into intervention and control groups. We implemented a comprehensive educational program (intervention group), comprising public lectures, instructional brochures, case videos, simulations, and role-playing from May 2013 to May 2015. We delivered conventional oral education in the control group. We compared stroke pre-hospital delay behavioral intention (SPDBI), pre-hospital stroke symptom coping test (PSSCT), and stroke pre-symptoms alert test (SPSAT) results between the groups before and 6, 12, and 18 months after health intervention. There were significant differences between before and after intervention (P educational program was significantly effective in decreasing SPDBI, improving knowledge, enhancing stroke pre-symptoms alert, and reducing the possibility of pre-hospital delays.

  9. Pre-Hospital and Hospital Management Practices and Circumstances behind Venomous Snakebite in Northwestern Part of Bangladesh

    Directory of Open Access Journals (Sweden)

    Ratindra Mondal

    2012-12-01

    Full Text Available Background: Snakebite is the most important cause of envenomation in South Asia particularly in Bangladesh, though there is lack of data from the rural part of the country. About 82 species of snakes (28 venomous exist in Bangladesh. In this study, demographic characteristics of the victim, circumstances behind the bite along with pre-hospital and hospital managements and outcomes were evaluated. Methods: It was a cross-sectional study during January 2010 to June 2012 at Rangpur Medical College Hospital. Only venomous snakebite cases were included and diagnosis was made on clinical syndrome. Descriptive statistics were presented using percentage and proportion. Results: Out of 28 patients (mean age: 31.7 years, 20 (71.4% were males with a significant male-female ratio (2.5:1. Majority were farmers (46.4% and most (50% of the bites happened during household activities. Lag period between bite and hospitalization was ≤5 hours in 50% patients; 6 to 10 hours in 39.2% and >10 hours in 10.7% cases. 82.1% patients received ligature as pre-hospital first aid. Total 21 patients received anti-snake venom (ASV in different dose regimens. 15 (53.5% patients recovered while 13 (46.4% died. Among 13 patients who died, 53.8% died within 2 hours, 15.3% within 3-24 hours and 30.7% after 24 hours post-bite. Conclusion: Snakebite has a significant impact on human health and economy through treatment-related expenditures and loss of productivity. Policy makers of Bangladesh should prioritize the issue to reduce future mortality and morbidity. Keywords: Poisoning, Snakebite, Bangladesh, Envenomation, Management        

  10. Reliability of the CARE rule and the HEART score to rule out an acute coronary syndrome in non-traumatic chest pain patients.

    Science.gov (United States)

    Moumneh, Thomas; Richard-Jourjon, Vanessa; Friou, Emilie; Prunier, Fabrice; Soulie-Chavignon, Caroline; Choukroun, Jacques; Mazet-Guilaumé, Betty; Riou, Jérémie; Penaloza, Andréa; Roy, Pierre-Marie

    2018-03-02

    In patients consulting in the Emergency Department for chest pain, a HEART score ≤ 3 has been shown to rule out an acute coronary syndrome (ACS) with a low risk of major adverse cardiac event (MACE) occurrence. A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may have similar rule-out reliability without troponin assay requirement. We aim to prospectively assess the performance of the CARE rule and of the HEART score to predict MACE in a chest pain population. Prospective two-center non-interventional study. Patients admitted to the ED for non-traumatic chest pain were included, and followed-up at 6 weeks. The main study endpoint was the 6-week rate of MACE (myocardial infarction, coronary angioplasty, coronary bypass, and sudden unexplained death). 641 patients were included, of whom 9.5% presented a MACE at 6 weeks. The CARE rule was negative for 31.2% of patients, and none presented a MACE during follow-up [0, 95% confidence interval: (0.0-1.9)]. The HEART score was ≤ 3 for 63.0% of patients, and none presented a MACE during follow-up [0% (0.0-0.9)]. With an incidence below 2% in the negative group, the CARE rule seemed able to safely rule out a MACE without any biological test for one-third of patients with chest pain and the HEART score for another third with a single troponin assay.

  11. [Pre-hospital management of adults with life-threatening emergencies].

    Science.gov (United States)

    Wattel, Francis; Dubois, François

    2012-01-01

    In France, acute life-threatening situations are handled by the French Secours a Personne (assistance to persons) and emergency medical facilities. An unequivocal success, this early management of life-threatening emergency situations relies upon centralized call reception, medical dispatching, and immediate on-site emergency medical care. We describe the different emergency care providers and steps involved in the response to emergency situations. Each call centre (Samu, phone number 15; Sapeurs-Pompiers, 18) provides a response tailored to the nature of incoming calls for assistance. A check-list of grounds for an "automatic response" by the SDIS (Service Départemental d'Incendie et de Secours--the French fire brigade) is in use, ensuring that firefighters are often the first on the spot, while the knowledge and skills of the dispatching physician are essential to ascertain the patient's needs, to preserve life and vital functions, and to ensure the patient is sent to the appropriate emergency healthcare facility. In life-threatening emergency situations, patients must be brought straight to the appropriate reference emergency healthcare facility, as quickly as possible, without prior admittance to an emergency department. This is the procedure for extremely acute emergency situations in the following areas: trauma (multiple trauma and/or uncontrolled bleeding, spinal cord trauma), delivery bleeding, other life-threatening situations such as ischemic heart disease, cardiac arrest (sudden death), cerebrovascular stroke and ensuing brain damage, some acute respiratory situations such as anaphylactic shock, foreign-body inhalation, electrocution, drowning, drug overdose, certain forms of poisoning, and conditions requiring initial hyperbaric oxygen (diving accidents, acute carbon monoxide and smoke poisoning). The reasons for suboptimal emergency care in life-threatening situations are currently a major issue, with medical facilities being reduced in some areas

  12. Auxetic coronary stent endoprosthesis

    DEFF Research Database (Denmark)

    Amin, Faisal; Ali, Murtaza Najabat; Ansari, Umar

    2014-01-01

    BACKGROUND: Cardiovascular heart disease is one of the leading health issues in the present era and requires considerable health care resources to prevent it. The present study was focused on the development of a new coronary stent based on novel auxetic geometry which enables the stent to exhibit...... a negative Poisson's ratio. Commercially available coronary stents have isotropic properties, whereas the vascular system of the body shows anisotropic characteristics. This results in a mismatch between anisotropic-isotropic properties of the stent and arterial wall, and this in turn is not favorable...... for mechanical adhesion of the commercially available coronary stents with the arterial wall. It is believed that an auxetic coronary stent with inherent anisotropic mechanical properties and negative Poisson's ratio will have good mechanical adhesion with the arterial wall. METHODS: The auxetic design...

  13. Impact of coronary intensive care unit in treatment of myocardial infarction

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    Marcia Cristina Todo

    Full Text Available Summary Introduction: The mortality rate attributed to ST-segment elevation myocardial infarction (STEMI has decreased in the world. However, this disease is still responsible for high costs for health systems. Several factors could decrease mortality in these patients, including implementation of cardiac intensive care units (CICU. The aim of this study was to evaluate the effect of CICU implementation on prescribed recommended treatments and mortality 30 days after STEMI. Method: We performed a retrospective study with patients admitted to CICU between 2005 and 2006 (after group and between 2000 and 2002, before CICU implementation (before group. Results: The after group had 101 patients, while the before group had 143 patients. There were no differences in general characteristics between groups. We observed an increase in angiotensin-converting enzyme inhibitors, clopidogrel and statin prescriptions after CICU implementation. We did not find differences regarding number of patients submitted to reperfusion therapy; however, there was an increase in primary percutaneous angioplasty compared with thrombolytic therapy in the after group. There was no difference in 30-day mortality (before: 10.5%; after: 8.9%; p=0.850, but prescription of recommended treatments was high in both groups. Prescription of angiotensin-converting enzyme inhibitors and beta-blocker decreased mortality risk by 4.4 and 4.9 times, respectively. Conclusion: CICU implementation did not reduce mortality after 30 days in patients with STEMI; however, it increased the prescription of standard treatment for these patients.

  14. Hospital and Pre-Hospital Triage Systems in Disaster and Normal Conditions; a Review Article

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    Saeed Safari

    2015-02-01

    Full Text Available Triage is a priority classification system based on the severity of problem to do the best therapeutic proceedings for patients in the less time. A triage system should be performed in a way which can make a decision with high accuracy and in the least time for each patient. Simplicity and reliability of the performance are the most important features of a standard triage system. An appropriate triage causes to increase the quality of health care services and patients’ satisfaction rate, decrease the waiting time as well as mortality rate, and increase the yield and efficiency of emergency wards along with reducing the related expenses. Considering to the above statements, in the present study the history of triage formation was evaluated and categorizing of all triage systems regarding prehospital and hospital as well as triage in normal and critical conditions were assessed, too.

  15. Relation Between Hospital Length of Stay and Quality of Care in Patients With Acute Coronary Syndromes (from the American Heart Association's Get With the Guidelines--Coronary Artery Disease Data Set).

    Science.gov (United States)

    Tickoo, Sumit; Bhardwaj, Adarsh; Fonarow, Gregg C; Liang, Li; Bhatt, Deepak L; Cannon, Christopher P

    2016-01-15

    Worries regarding short length of stay (LOS) adversely impacting quality of care prompted us to assess the relation between hospital LOS and inpatient guideline adherence in patients with acute coronary syndrome. We used the American Heart Association's Get with The Guidelines (GWTG)--Coronary Artery Disease data set. Data were collected from January 2, 2000, to March 21, 2010, for patients with acute coronary syndrome from 405 different sites. Of the 119,398 patients in the study, the mean LOS was 5.5 days with a median of 4 days. There was no difference in the LOS on the basis of hospital size, hospital type, or cardiac surgery availability. The population with an LOS <4 days were younger (63.8 ± 14.1 vs 70 ± 14.5, p <0.0001), men (63.8% vs 55.3%, p <0.0001) and had fewer clinical co-morbidities. The overall adherence was high in the GWTG participating hospitals. Those with the LOS <4 days were more likely to receive aspirin (adjusted odds ratio [OR] 1.12, 95% CI 1.06 to 1.19; p <0.001), clopidogrel (OR 1.77, 95% CI 1.60 to 1.95; p <0.001), lipid-lowering therapy if indicated (OR 1.13, 95% CI 1.05 to 1.21; p <0.001), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for left ventricular systolic dysfunction (OR 1.10, 95% CI 1.01 to 1.21; p = 0.04) and smoking cessation counseling (OR 1.17, 95% CI 1.1 to 1.24; p <0.001) compared to those with the LOS ≥ 4 days. In contrast, those with the LOS <4 days were less likely to receive beta blockers (OR 0.88, 95% CI 0.84 to 0.93; p <0.001). The odds of receiving defect-free care were greater for patients with the LOS <4 days (OR 1.15, 95% CI 1.1 to 1.21; p <0.001). In conclusion, in GWTG participating hospitals, a shorter LOS did not appear to adversely affect adherence to discharge quality of care measures. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Red Blood Cell Distribution Width is an Independent Predictor of AKI and Mortality in Patients in the Coronary Care Unit.

    Science.gov (United States)

    Hu, Yugang; Liu, Huilan; Fu, Shuai; Wan, Jing; Li, Xiaoning

    2017-01-01

    We investigated the hypothesis that RDW is an independent predictor of acute kidney injury (AKI) and mortality in patients in the coronary care unit (CCU). In this prospective, observational study, we screened 412 adults admitted to the CCU at Zhongnan Hospital of Wuhan University from January 1, 2014 to June 1, 2015. AKI was defined based on the KDIGO-AKI criteria. The survivors were followed up for up to 2 years after hospital discharge. The primary endpoint of the study was the incidence of AKI, while the secondary endpoints of the study were in-hospital mortality and 2-year mortality. RDW was significantly correlated with the acute physiology and chronic health evaluation II (APACHEII) score, hemoglobin, mean corpuscular volume, inflammatory marker levels, nutrition and renal function at the time of CCU admission. The incidence of AKI was much higher in the high RDW group (RDW ≥14.0%) than in the low RDW group, a finding that was confirmed by multivariable logistic regression, which showed that RDW was independently associated with the incidence of AKI (odds ratio (OR), 1.059, 95% coincidence interval (95% CI), 1.024-1.095, P=0.001). A total of 61 patients died during their hospital stay, and baseline RDW was also an independent predictor of in-hospital mortality (hazard ratio (HR), 1.129, 95% CI 1.005-1.268, P=0.041). Patients with a high RDW exhibited significantly higher 2-year mortality than patients with a low RDW during a median follow-up period of 19.8 months (P<0.001), and RDW independently predicted the risk of 2-year mortality (HR, 1.189, 95% CI 1.045 to 1.354, P=0.009) in the multivariate Cox proportional hazard analysis after adjustments for other clinical and laboratory variables. RDW is an independent predictor of AKI and mortality in patients in the CCU. © 2017 The Author(s). Published by S. Karger AG, Basel.

  17. Red Blood Cell Distribution Width is an Independent Predictor of AKI and Mortality in Patients in the Coronary Care Unit

    Directory of Open Access Journals (Sweden)

    Yugang Hu

    2017-12-01

    Full Text Available Background/Aims: We investigated the hypothesis that RDW is an independent predictor of acute kidney injury (AKI and mortality in patients in the coronary care unit (CCU. Methods: In this prospective, observational study, we screened 412 adults admitted to the CCU at Zhongnan Hospital of Wuhan University from January 1, 2014 to June 1, 2015. AKI was defined based on the KDIGO-AKI criteria. The survivors were followed up for up to 2 years after hospital discharge. The primary endpoint of the study was the incidence of AKI, while the secondary endpoints of the study were in-hospital mortality and 2-year mortality. Results: RDW was significantly correlated with the acute physiology and chronic health evaluation II (APACHEII score, hemoglobin, mean corpuscular volume, inflammatory marker levels, nutrition and renal function at the time of CCU admission. The incidence of AKI was much higher in the high RDW group (RDW ≥14.0% than in the low RDW group, a finding that was confirmed by multivariable logistic regression, which showed that RDW was independently associated with the incidence of AKI (odds ratio (OR, 1.059, 95% coincidence interval (95% CI, 1.024-1.095, P=0.001. A total of 61 patients died during their hospital stay, and baseline RDW was also an independent predictor of in-hospital mortality (hazard ratio (HR, 1.129, 95% CI 1.005-1.268, P=0.041. Patients with a high RDW exhibited significantly higher 2-year mortality than patients with a low RDW during a median follow-up period of 19.8 months (P<0.001, and RDW independently predicted the risk of 2-year mortality (HR, 1.189, 95% CI 1.045 to 1.354, P=0.009 in the multivariate Cox proportional hazard analysis after adjustments for other clinical and laboratory variables. Conclusion: RDW is an independent predictor of AKI and mortality in patients in the CCU.

  18. Quality of Care at Hospitals Identified as Outliers in Publicly Reported Mortality Statistics for Percutaneous Coronary Intervention.

    Science.gov (United States)

    Waldo, Stephen W; McCabe, James M; Kennedy, Kevin F; Zigler, Corwin M; Pinto, Duane S; Yeh, Robert W

    2017-05-16

    Public reporting of percutaneous coronary intervention (PCI) outcomes may create disincentives for physicians to provide care for critically ill patients, particularly at institutions with worse clinical outcomes. We thus sought to evaluate the procedural management and in-hospital outcomes of patients treated for acute myocardial infarction before and after a hospital had been publicly identified as a negative outlier. Using state reports, we identified hospitals that were recognized as negative PCI outliers in 2 states (Massachusetts and New York) from 2002 to 2012. State hospitalization files were used to identify all patients with an acute myocardial infarction within these states. Procedural management and in-hospital outcomes were compared among patients treated at outlier hospitals before and after public report of outlier status. Patients at nonoutlier institutions were used to control for temporal trends. Among 86 hospitals, 31 were reported as outliers for excess mortality. Outlier facilities were larger, treating more patients with acute myocardial infarction and performing more PCIs than nonoutlier hospitals ( P fashion (interaction P =0.50) after public report of outlier status. The likelihood of in-hospital mortality decreased at outlier institutions (RR, 0.83; 95% CI, 0.81-0.85) after public report, and to a lesser degree at nonoutlier institutions (RR, 0.90; 95% CI, 0.87-0.92; interaction P <0.001). Among patients that underwent PCI, in-hospital mortality decreased at outlier institutions after public recognition of outlier status in comparison with prior (RR, 0.72; 9% CI, 0.66-0.79), a decline that exceeded the reduction at nonoutlier institutions (RR, 0.87; 95% CI, 0.80-0.96; interaction P <0.001). Large hospitals with higher clinical volume are more likely to be designated as negative outliers. The rates of percutaneous revascularization increased similarly at outlier and nonoutlier institutions after report of outlier status. After outlier

  19. Serum Cystatin C Predicts AKI and the Prognosis of Patients in Coronary Care Unit: a Prospective, Observational Study

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    Yugang Hu

    2017-11-01

    Full Text Available Background/Aims: Acute Kidney Injury (AKI is a serious clinical state associated with high morbidity and mortality, particularly in critical ill patients. We investigated the hypothesis that serum Cystatin C (sCysC is a good predictor for AKI and may affect the short-term prognosis of coronary care unit (CCU patients. Methods: In this prospective, observational study, we screened 412 adults admitted to the CCU from January 1, 2014 to June 1, 2015 at Zhongnan Hospital of Wuhan University. Serum samples were obtained at the time of admission, and sCysC was quantified through nephelometry. AKI was defined based on KDIGO-AKI criteria. After the patients’ hospital discharge, the survivors in this study were followed up for up to 2 years. The primary endpoint was the incidence of AKI stratified by severity stage, while the second endpoints included 2-year mortality, rehospitalization and failure in renal recovery rates, as well as the progression of AKI to CKD. Results: According to the KDIGO-AKI criteria, AKI occurred in 130 (31.6% patients. After multivariate adjustments, the highest quartile of sCysC was associated with a 9-fold increased risk of incident AKI compared with the lowest quartile. For predicting AKI, sCysC [area under the receiver operating characteristic curve (AUC=0.842] outperformed β2-micro globulin (AUC=0.813 and the clinical model (AUC=0.777, and a cutoff of 1.255 mg/L yielded good sensitivity and specificity. After a median 19.8-month follow-up, 112 (27.2% patients died within 2 years after admission. The sCysC independently predicted the risk of 2-year mortality [adjusted odds ratio (OR, 4.955; 95% confidence interval (95% CI, 2.853 to 8.603] and rehospitalization (OR, 3.128; 95% CI, 2.011 to 4.867, as well as renal recovery failure (OR, 3.618, 95% CI, 1.753 to 7.463. Conclusions: Serum CysC is a strong predictor of AKI and the short-term prognosis of CCU patients.

  20. CT coronary angiography vs. invasive coronary angiography in CHD

    Directory of Open Access Journals (Sweden)

    Anja Hagen

    2012-04-01

    identified. The first addressed ethical aspects regarding the principles of beneficence, autonomy and justice, and the second addressed those regarding radiation exposition, especially when used within studies.Discussion: The discriminatory power of CT coronary angiography to identify patients with obstructive (above 50 % coronary stenoses should be regarded as “high diagnostic evidence”, to identify patients without coronary stenoses as “persuasive diagnostic evidence”. The discriminatory power of both types of coronary angiography to identify patients with or without functionally relevant coronary stenoses should be regarded as “weak diagnostic evidence”. It can be assumed that patients with a high pretest probability of CHD will need invasive coronary angiography and patients with a low pretest probability of CHD will not need subsequent revascularisation. Therefore, CT coronary angiography may be used before performing invasive coronary angiography in patients with an intermediate pretest probability of CHD. For identifying or excluding of obstructive coronary stenosis, CT coronary angiography was shown to be more cost-saving at a pretest probability of CHD of 50 % or lower, and invasive coronary angiography at a pretest probability of CHD of 70 % or higher. The use of both types of coronary angiography to identify or to exclude functionally relevant coronary stenoses should be regarded as highly cost-consuming. With regard to ethical, social or legal aspects, the following possible implications were identified: under-provision or over-provision of health care, unnecessary complications, anxiety, social stigmatisation, restriction of self-determination, unequal access to health care, unfair resource distribution and legal disputes.Conclusion: From a medical point of view, CT coronary angiography using scanners with at least 64 slices should be recommended as a test to rule out obstructive coronary stenoses in order to avoid inappropriate invasive coronary

  1. Pre-hospital thrombolytic therapy with either alteplase or streptokinase. : Practical applications, complications and long-term results in 529 patients.

    NARCIS (Netherlands)

    E.W.M. Grijseels (Els); M.J.M. Bouten; J.W. Deckers (Jaap); A.W. Hoes (Arno); J.A.M. Hartman; E. van der Does (Emiel); M.L. Simoons (Maarten); T. Lenderink (Timo)

    1995-01-01

    markdownabstractOBJECTIVE: To assess the practical application, safety and long-term outcome of pre-hospital thrombolytic intervention with either alteplase or streptokinase in patients with extensive myocardial infarction. DESIGN: Prospective study. SUBJECTS: Patients with chest pain of more

  2. Health Gain through Screening--Coronary Heart Disease and Stroke: Developing Primary Health Care Services for People with Intellectual Disability.

    Science.gov (United States)

    Wells, M. B.; Turner, S.; Martin, D. M.; Roy, A.

    1997-01-01

    A study of 120 British adults with intellectual disability found they had higher risk factors of developing coronary heart disease and stroke than the general population. There was a greater incidence of obesity and considerably lower physical activity levels than the general population. Several also had abnormal cholesterol readings. (CR)

  3. Reasons that lead mothers looking for a pre-hospital unit as a first option for attendance - Sorocaba/SP

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    Thais Helena Campos

    2015-06-01

    Full Text Available Objective: to verify the reasons lead mothers to seek the Pre- hospital Unit of Sorocaba Western Zone (UPH-ZO as first option of attendance and quantify the inappropriate motives for this search. Method: it is an exploratory study with quantitative analyze performed at UPH-ZO through the emergence bulletin (BE and the mothers or guardians interview. Results: nine hundred mothers and guardians were interviewed. Four reasons prevailed as motivation for search the UPH-ZO by first option: better and quick resolution with technological resources provided; restrict period for attendance at the Basic Health Unit (UBS; delay for appointment in the UBS; lack of Pediatrician in this Unit. The prevalent diagnostic hypothesis in the sample was acute gastroenterocolitis and superior aerial way infections. Conclusions: for the 68.8% of the sample the looking for UPH-ZO was adequate; 31.2% referred reasons that could be solved at the UBS. This Unit must just be the entrance for the users of the Health Unique System (SUS.

  4. Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction

    DEFF Research Database (Denmark)

    Fakhri, Yama; Ersbøll, Mads; Køber, Lars

    2016-01-01

    OBJECTIVES: System delay (time from first medical contact to primary percutaneous coronary intervention) is associated with heart failure and mortality in patients with ST segment elevation myocardial infarction (STEMI). We evaluated the impact of system delay on left ventricular function (LVF...

  5. Should fee-for-service be for all guideline-advocated acute coronary syndrome (ACS) care? Observations from the Snapshot ACS study.

    Science.gov (United States)

    Briffa, Thomas G; Hammett, Christopher J; Cross, David B; Macisaac, Andrew I; Rankin, James M; Board, Neville; Carr, Bridie; Hyun, Karice K; French, John; Brieger, David B; Chew, Derek P

    2015-09-01

    The aim of the present study was to explore the association of health insurance status on the provision of guideline-advocated acute coronary syndrome (ACS) care in Australia. Consecutive hospitalisations of suspected ACS from 14 to 27 May 2012 enrolled in the Snapshot study of Australian and New Zealand patients were evaluated. Descriptive and logistic regression analysis was performed to evaluate the association of patient risk and insurance status with the receipt of care. In all, 3391 patients with suspected ACS from 247 hospitals (23 private) were enrolled in the present study. One-third of patients declared private insurance coverage; of these, 27.9% (304/1088) presented to private facilities. Compared with public patients, privately insured patients were more likely to undergo in-patient echocardiography and receive early angiography; furthermore, in those with a discharge diagnosis of ACS, there was a higher rate of revascularisation (P fee-for-service. In contrast, proportionately fewer privately insured ACS patients were discharged on selected guideline therapies and were referred to a secondary prevention program (P = 0.056), neither of which directly attracts a fee. Typically, as GRACE (the Global Registry of Acute Coronary Events) risk score rose, so did the level of ACS care; however, propensity-adjusted analyses showed lower in-hospital adverse events among the insured group (odds ratio 0.68; 95% confidence interval 0.52-0.88; P = 0.004). Fee-for-service reimbursement may explain differences in the provision of selected guideline-advocated components of ACS care between privately insured and public patients.

  6. Atendimento pré-hospitalar ao idoso vítima de violência em cinco capitais brasileiras Pre-hospital attendance to elders victims of violence in five Brazilian capitals

    Directory of Open Access Journals (Sweden)

    Suely Ferreira Deslandes

    2010-09-01

    Full Text Available Este artigo analisa as características e a operacionalização no cotidiano da atenção pré-hospitalar aos idosos vítimas de violências e acidentes de cinco capitais (Manaus, Recife, Brasília, Rio de Janeiro e Curitiba, abordando ainda suas capacidades, seus obstáculos e potencialidades. Pautou-se na triangulação de métodos quantitativos e qualitativos. Analisaram-se dados de oitenta serviços da atenção pré-hospitalar móvel e fixa: 32 em Manaus; 18 em Recife; dez em Brasília; 12 no Rio de Janeiro e oito em Curitiba. Entre os achados estão as diferenças (de tamanho e diversidade de categorias profissionais e dificuldades das equipes para identificar, atender e notificar os casos por falta de capacitação; pouca atuação preventiva; quase nenhum envolvimento com a família e orientação a ela; praticamente nenhum atendimento ao autor da agressão; incipiente articulação e parcerias da rede, sobretudo dos serviços pré-hospitalares com os hospitalares.This article reviews the characteristics and operation in the daily routine of a pre-hospital care to the elderly victims of violence and accidents in five capitals (Manaus, Recife, Brasília, Rio de Janeiro and Curitiba. Besides that, it analyses their abilities, and potential obstacles. It was based on the triangulation of quantitative and qualitative methods analyzing data from 80 departments of mobile and fixed pre-hospitals: 32 in Manaus, 18 in Recife, 10 in Brasilia, 12 in Rio de Janeiro and eight in Curitiba. Among the findings are the differences in size and diversity of occupational categories and difficulties of the teams to identify, serve and report cases for lack of training, limited preventive action, almost no involvement and guidance to the family, practically no attention to the perpetrator; incipient articulation and partnership network, especially regarding on pre-hospital services and the hospital.

  7. Effects of a nurse-led transitional care program on clinical outcomes, health-related knowledge, physical and mental health status among Chinese patients with coronary artery disease: A randomized controlled trial.

    Science.gov (United States)

    Zhang, Pan; Hu, Yu-Ding; Xing, Feng-Mei; Li, Chang-Zai; Lan, Wang-Feng; Zhang, Xiao-Li

    2017-09-01

    Coronary artery disease is a major cause of morbidity and mortality among adults worldwide, including China. After a hospital stay, transitional care could help to ensure improved patient care and outcomes, and reduce Medicare costs. Nevertheless, the results of the existing transitional care are not always satisfactory and our knowledge of how to perform effective transitional care for patients with coronary artery disease is limited in mainland China. To examine the effectiveness of a nurse-led transitional care program on clinical outcomes, health-related knowledge, and physical and mental health status among Chinese patients with coronary artery disease. Randomized controlled trial. The Omaha system and Pender's health promoting model were employed in planning and implementing this nurse-led transitional care program. The sample was comprised of 199 Chinese patients with coronary artery disease. The experimental group (n=100) received nurse-led transitional care intervention in addition to routine care. The nurse-led transitional care intervention included a structured assessment and health education, followed by 7 months of individual teaching and coaching (home visits, telephone follow-up and group activity). The control group (n=99) received a comparable length routine care and follow-up contacts. Evaluations were conducted at baseline and completion of the interventions using the perceived knowledge scale for coronary heart disease, the medical outcomes study 36-item short-form health survey and clinical measures (blood pressure, blood glucose, lipids, body mass index). Data were collected between March and October 2014. Compared with the control group, participants in the experimental group showed significant better clinical outcomes (systolic blood pressure, t=5.762, P=0.000; diastolic blood pressure, t=4.250, P=0.000; fasting blood glucose, t=2.249, P=0.027; total cholesterol, t=4.362, P=0.000; triglyceride, t=3.147, P=0.002; low density lipoprotein

  8. Prevention of coronary heart disease in people with severe mental illnesses: a qualitative study of patient and professionals' preferences for care

    Science.gov (United States)

    Wright, Christine A; Osborn, David PJ; Nazareth, Irwin; King, Michael B

    2006-01-01

    Background People with severe mental illness (SMI) are at increased risk of developing coronary heart disease (CHD) and there is growing emphasis on the need to monitor their physical health. However, there is little consensus on how services for the primary prevention of CHD should be organised for this patient group. We explored the views of people with SMI and health professionals from primary care and community mental health teams (CMHTs) on how best to provide these services. Methods In-depth interviews were conducted with a purposive sample of patients with SMI (n = 31) and staff from primary care (n = 10) and community mental health teams (n = 25) in North Central London. Transcripts of the qualitative interviews were analysed using a 'framework' approach to identify the main themes in opinions regarding various service models. Results Cardiovascular risk factors in people with SMI were of concern to participants. However, there was some disagreement about the best way to deliver appropriate care. Although staff felt that primary care should take responsibility for risk factor screening and management, patients favoured CHD screening in their CMHT. Problems with both approaches were identified. These included a lack of familiarity in general practice with SMI and antipsychotic side effects and poor communication of physical health issues to the CMHT. Lack of knowledge regarding CHD risk factor screening and difficulties in interpreting screening results and implementing appropriate interventions exist in secondary care. Conclusion Management of physical health care for people with SMI requires complex solutions that cross the primary-secondary care interface. The views expressed by our participants suggest that neither primary nor secondary care services on their own can provide a comprehensive service for all patients. The increased risk of CHD associated with SMI and antipsychotic medications requires flexible solutions with clear lines of responsibility

  9. Prevention of coronary heart disease in people with severe mental illnesses: a qualitative study of patient and professionals' preferences for care

    Directory of Open Access Journals (Sweden)

    Nazareth Irwin

    2006-04-01

    Full Text Available Abstract Background People with severe mental illness (SMI are at increased risk of developing coronary heart disease (CHD and there is growing emphasis on the need to monitor their physical health. However, there is little consensus on how services for the primary prevention of CHD should be organised for this patient group. We explored the views of people with SMI and health professionals from primary care and community mental health teams (CMHTs on how best to provide these services. Methods In-depth interviews were conducted with a purposive sample of patients with SMI (n = 31 and staff from primary care (n = 10 and community mental health teams (n = 25 in North Central London. Transcripts of the qualitative interviews were analysed using a 'framework' approach to identify the main themes in opinions regarding various service models. Results Cardiovascular risk factors in people with SMI were of concern to participants. However, there was some disagreement about the best way to deliver appropriate care. Although staff felt that primary care should take responsibility for risk factor screening and management, patients favoured CHD screening in their CMHT. Problems with both approaches were identified. These included a lack of familiarity in general practice with SMI and antipsychotic side effects and poor communication of physical health issues to the CMHT. Lack of knowledge regarding CHD risk factor screening and difficulties in interpreting screening results and implementing appropriate interventions exist in secondary care. Conclusion Management of physical health care for people with SMI requires complex solutions that cross the primary-secondary care interface. The views expressed by our participants suggest that neither primary nor secondary care services on their own can provide a comprehensive service for all patients. The increased risk of CHD associated with SMI and antipsychotic medications requires flexible solutions with clear

  10. The effects of health promotion model-based educational program on self-care behaviors in patients undergoing coronary artery bypass grafting in Iran

    Science.gov (United States)

    Mohsenipouya, Hossein; Majlessi, Fereshteh; Ghafari, Rahman

    2018-01-01

    Background and aim Post-operative self-care behaviors, have positive effects on increase in adaptability, and reduce cardiac surgery patients’ disability. The present study is carried out aimed at determining the effect of education based on a health promotion model on the patients’ self-care behaviors after coronary artery bypass surgery. Methods This is a semi-experimental study carried out in Mazandaran (Iran) in 2016. Two hundred and twenty patients who participated in the study were selected using a simple random sampling method from a population of postoperative patients, and divided into control and experimental groups (110 patients in each) using block (AABB) randomization. Self-designed self-care questionnaires based on a health promotion model were distributed among the patients once before and three months after intervention. The data were analyzed by SPSS-22, Chi-Square tests, Mann-Whitney and ANCOVA at the significance level of ppromotion model can enhance self-care behaviors and reduce the number of admissions in patients after cardiac surgery. PMID:29588828

  11. 'The first pulse you take is your own' - but don't forget your colleagues'. Emotion teamwork in pre-hospital emergency medical services.

    Science.gov (United States)

    Henckes, Nicolas; Nurok, Michael

    2015-09-01

    This article examines the way that intense emotions, both positive and negative, are collectively regulated at work by pre-hospital emergency teams. We analyse the collective strategies and solutions that are developed in daily medical work by teams and individuals with a view to furthering the action. After a review of the literature on emotion work in work collectives, we discuss the nature of pre-hospital emergency work and the role of emotions in this work. We then examine the collective management of both disruptive and desired emotions by teams during interventions. The last section reflects on the long-term management of emotions at work using Randall Collins' concepts of interaction ritual and emotional energy. This study relies on fieldwork performed in emergency medical services in New York and Paris. © 2015 Foundation for the Sociology of Health & Illness.

  12. Coronary risk assessment by point-based vs. equation-based Framingham models: significant implications for clinical care.

    Science.gov (United States)

    Gordon, William J; Polansky, Jesse M; Boscardin, W John; Fung, Kathy Z; Steinman, Michael A

    2010-11-01

    US cholesterol guidelines use original and simplified versions of the Framingham model to estimate future coronary risk and thereby classify patients into risk groups with different treatment strategies. We sought to compare risk estimates and risk group classification generated by the original, complex Framingham model and the simplified, point-based version. We assessed 2,543 subjects age 20-79 from the 2001-2006 National Health and Nutrition Examination Surveys (NHANES) for whom Adult Treatment Panel III (ATP-III) guidelines recommend formal risk stratification. For each subject, we calculated the 10-year risk of major coronary events using the original and point-based Framingham models, and then compared differences in these risk estimates and whether these differences would place subjects into different ATP-III risk groups (20% risk). Using standard procedures, all analyses were adjusted for survey weights, clustering, and stratification to make our results nationally representative. Among 39 million eligible adults, the original Framingham model categorized 71% of subjects as having "moderate" risk (20%) risk. Estimates of coronary risk by the original and point-based models often differed substantially. The point-based system classified 15% of adults (5.7 million) into different risk groups than the original model, with 10% (3.9 million) misclassified into higher risk groups and 5% (1.8 million) into lower risk groups, for a net impact of classifying 2.1 million adults into higher risk groups. These risk group misclassifications would impact guideline-recommended drug treatment strategies for 25-46% of affected subjects. Patterns of misclassifications varied significantly by gender, age, and underlying CHD risk. Compared to the original Framingham model, the point-based version misclassifies millions of Americans into risk groups for which guidelines recommend different treatment strategies.

  13. Rationale, design and goals of the HeartFlow assessing diagnostic value of non-invasive FFRCT in Coronary Care (ADVANCE) registry

    DEFF Research Database (Denmark)

    Chinnaiyan, Kavitha M; Akasaka, Takashi; Amano, Tetsuya

    2016-01-01

    ) optimal medical therapy, (b) percutaneous coronary intervention, (c) coronary artery bypass graft surgery, or (d) more information required. The primary endpoint of the registry is the reclassification rate between the management plan based on coronary CTA alone versus CTA plus FFRCT. The secondary...

  14. Clinical impact and predictors of complete ST segment resolution after primary percutaneous coronary intervention: A subanalysis of the ATLANTIC Trial.

    Science.gov (United States)

    Fabris, Enrico; van 't Hof, Arnoud; Hamm, Christian W; Lapostolle, Frédéric; Lassen, Jens F; Goodman, Shaun G; Ten Berg, Jurriën M; Bolognese, Leonardo; Cequier, Angel; Chettibi, Mohamed; Hammett, Christopher J; Huber, Kurt; Janzon, Magnus; Merkely, Béla; Storey, Robert F; Zeymer, Uwe; Cantor, Warren J; Tsatsaris, Anne; Kerneis, Mathieu; Diallo, Abdourahmane; Vicaut, Eric; Montalescot, Gilles

    2017-08-01

    In the ATLANTIC (Administration of Ticagrelor in the catheterization laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery) trial the early use of aspirin, anticoagulation, and ticagrelor coupled with very short medical contact-to-balloon times represent good indicators of optimal treatment of ST-elevation myocardial infarction and an ideal setting to explore which factors may influence coronary reperfusion beyond a well-established pre-hospital system. This study sought to evaluate predictors of complete ST-segment resolution after percutaneous coronary intervention in ST-elevation myocardial infarction patients enrolled in the ATLANTIC trial. ST-segment analysis was performed on electrocardiograms recorded at the time of inclusion (pre-hospital electrocardiogram), and one hour after percutaneous coronary intervention (post-percutaneous coronary intervention electrocardiogram) by an independent core laboratory. Complete ST-segment resolution was defined as ≥70% ST-segment resolution. Complete ST-segment resolution occurred post-percutaneous coronary intervention in 54.9% ( n=800/1456) of patients and predicted lower 30-day composite major adverse cardiovascular and cerebrovascular events (odds ratio 0.35, 95% confidence interval 0.19-0.65; pST-segment resolution were the time from symptoms to pre-hospital electrocardiogram (odds ratio 0.91, 95% confidence interval 0.85-0.98; pST-segment resolution (odds ratio 1.22, 95% confidence interval 0.99-1.51; p=0.06). This study confirmed that post-percutaneous coronary intervention complete ST-segment resolution is a valid surrogate marker for cardiovascular clinical outcomes. In the current era of ST-elevation myocardial infarction reperfusion, patients' delay and diabetes mellitus are independent predictors of poor reperfusion and need specific attention in the future.

  15. Association between gender, process of care measures, and outcomes in ACS in India: results from the detection and management of coronary heart disease (DEMAT registry.

    Directory of Open Access Journals (Sweden)

    Neha J Pagidipati

    Full Text Available Studies from high-income countries have shown that women receive less aggressive diagnostics and treatment than men in acute coronary syndromes (ACS, though their short-term mortality does not appear to differ from men. Data on gender differences in ACS presentation, management, and outcomes are sparse in India.The Detection and Management of Coronary Heart Disease (DEMAT Registry collected data from 1,565 suspected ACS patients (334 women; 1,231 men from ten tertiary care centers throughout India between 2007-2008. We evaluated gender differences in presentation, in-hospital and discharge management, and 30-day death and major adverse cardiovascular event (MACE; death, re-hospitalization, and cardiac arrest rates. Women were less likely to present with STEMI than men (38% vs. 55%, p<0.001. Overall inpatient diagnostics and treatment patterns were similar between men and women after adjustment for potential confounders. Optimal discharge management with aspirin, clopidogrel, beta-blockers, and statin therapy was lower for women than men, (58% vs. 65%, p = 0.03, but these differences were attenuated after adjustment (OR = 0.86 (0.62, 1.19. Neither the outcome of 30-day mortality (OR = 1.40 (0.62, 3.16 nor MACE (OR = 1.00 (0.67, 1.48 differed significantly between men and women after adjustment.ACS in-hospital management, discharge management, and 30-day outcomes did not significantly differ between genders in the DEMAT registry, though consistently higher treatment rates and lower event rates in men compared to women were seen. These findings underscore the importance of further investigation of gender differences in cardiovascular care in India.

  16. Utilization of Mental Health Care, Treatment Patterns, and Course of Psychosocial Functioning in Northern German Coronary Artery Disease Patients with Depressive and/or Anxiety Disorders.

    Science.gov (United States)

    Westermair, Anna Lisa; Schaich, Anja; Willenborg, Bastian; Willenborg, Christina; Nitsche, Stefan; Schunkert, Heribert; Erdmann, Jeanette; Schweiger, Ulrich

    2018-01-01

    Comorbid mental disorders in patients with coronary artery disease (CAD) are common and associated with adverse somatic outcomes. However, data on utilization rates of mental health care and treatment efficiency are scarce and inconsistent, which we tried to remedy with the present preliminary study on Northern German CAD patients. A total of 514 German CAD patients, as diagnosed by cardiac catheterization, were assessed using the Mini International Neuropsychiatric Interview and the Global Assessment of Functioning (GAF) scale. Global utilization of mental health care since onset of CAD was 21.0%. Depressive disorders, younger age, and lower GAF at onset of CAD were associated with higher utilization rates, while anxiety disorders and gender were not. Lower GAF at onset of CAD, female gender, and psychotherapy was positively associated with higher gains in GAF, while younger age and anxiety disorders were negatively associated. The majority of CAD patients with comorbid depression reported to have received mental health treatment and seemed to have benefited from it. However, we found preliminary evidence of insufficiencies in the diagnosis and treatment of anxiety disorders in CAD patients. Further studies, preferably prospective and with representative samples, are needed to corroborate or falsify these findings and explore possible further mediators of health-care utilization by CAD patients such as race, ethnicity, and socioeconomic status.

  17. Differences in symptoms, first medical contact and pre-hospital delay times between patients with ST- and non-ST-elevation myocardial infarction.

    Science.gov (United States)

    Ängerud, Karin H; Sederholm Lawesson, Sofia; Isaksson, Rose-Marie; Thylén, Ingela; Swahn, Eva

    2017-11-01

    In ST-elevation myocardial infarction, time to reperfusion is crucial for the prognosis. Symptom presentation in myocardial infarction influences pre-hospital delay times but studies about differences in symptoms between patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction are sparse and inconclusive. The aim was to compare symptoms, first medical contact and pre-hospital delay times in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction. This multicentre, observational study included 694 myocardial infarction patients from five hospitals. The patients filled in a questionnaire about their pre-hospital experiences within 24 h of hospital admittance. Chest pain was the most common symptom in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction (88.7 vs 87.0%, p=0.56). Patients with cold sweat (odds ratio 3.61, 95% confidence interval 2.29-5.70), jaw pain (odds ratio 2.41, 95% confidence interval 1.04-5.58), and nausea (odds ratio 1.70, 95% confidence interval 1.01-2.87) were more likely to present with ST-elevation myocardial infarction, whereas the opposite was true for symptoms that come and go (odds ratio 0.58, 95% confidence interval 0.38-0.90) or anxiety (odds ratio 0.52, 95% confidence interval 0.29-0.92). Use of emergency medical services was higher among patients admitted with ST-elevation myocardial infarction. The pre-hospital delay time from symptom onset to first medical contact was significantly longer in non-ST-elevation myocardial infarction (2:05 h vs 1:10 h, p=0.001). Patients with ST-elevation myocardial infarction differed from those with non-ST-elevation myocardial infarction regarding symptom presentation, ambulance utilisation and pre-hospital delay times. This knowledge is important to be aware of for all healthcare personnel and the general public especially in order to recognise symptoms suggestive of ST-elevation myocardial infarction and

  18. ST-segment resolution with bivalirudin versus heparin and routine glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment elevation myocardial infarction patients transported for primary percutaneous coronary intervention: The EUROMAX ST-segment resolution substudy.

    Science.gov (United States)

    Van't Hof, Arnoud; Giannini, Francesco; Ten Berg, Jurrien; Tolsma, Rudolf; Clemmensen, Peter; Bernstein, Debra; Coste, Pierre; Goldstein, Patrick; Zeymer, Uwe; Hamm, Christian; Deliargyris, Efthymios; Steg, Philippe G

    2017-08-01

    Myocardial reperfusion after primary percutaneous coronary intervention (PCI) can be assessed by the extent of post-procedural ST-segment resolution. The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trial compared pre-hospital bivalirudin and pre-hospital heparin or enoxaparin with or without GPIIb/IIIa inhibitors (GPIs) in primary PCI. This nested substudy was performed in centres routinely using pre-hospital GPI in order to compare the impact of randomized treatments on ST-resolution after primary PCI. Residual cumulative ST-segment deviation on the single one hour post-procedure electrocardiogram (ECG) was assessed by an independent core laboratory and was the primary endpoint. It was calculated that 762 evaluable patients were needed to show non-inferiority (85% power, alpha 2.5%) between randomized treatments. A total of 871 participated with electrocardiographic data available in 824 patients (95%). Residual ST-segment deviation one hour after PCI was 3.8±4.9 mm versus 3.9±5.2 mm for bivalirudin and heparin+GPI, respectively ( p=0.0019 for non-inferiority). Overall, there were no differences between randomized treatments in any measures of ST-segment resolution either before or after the index procedure. Pre-hospital treatment with bivalirudin is non-inferior to pre-hospital heparin + GPI with regard to residual ST-segment deviation or ST-segment resolution, reflecting comparable myocardial reperfusion with the two strategies.

  19. A randomised, feasibility trial of a tele-health intervention for Acute Coronary Syndrome patients with depression ('MoodCare': Study protocol

    Directory of Open Access Journals (Sweden)

    Hare David L

    2011-02-01

    Full Text Available Abstract Background Coronary heart disease (CHD and depression are leading causes of disease burden globally and the two often co-exist. Depression is common after Myocardial Infarction (MI and it has been estimated that 15-35% of patients experience depressive symptoms. Co-morbid depression can impair health related quality of life (HRQOL, decrease medication adherence and appropriate utilisation of health services, lead to increased morbidity and suicide risk, and is associated with poorer CHD risk factor profiles and reduced survival. We aim to determine the feasibility of conducting a randomised, multi-centre trial designed to compare a tele-health program (MoodCare for depression and CHD secondary prevention, with Usual Care (UC. Methods Over 1600 patients admitted after index admission for Acute Coronary Syndrome (ACS are being screened for depression at six metropolitan hospitals in the Australian states of Victoria and Queensland. Consenting participants are then contacted at two weeks post-discharge for baseline assessment. One hundred eligible participants are to be randomised to an intervention or a usual medical care control group (50 per group. The intervention consists of up to 10 × 30-40 minute structured telephone sessions, delivered by registered psychologists, commencing within two weeks of baseline screening. The intervention focuses on depression management, lifestyle factors (physical activity, healthy eating, smoking cessation, alcohol intake, medication adherence and managing co-morbidities. Data collection occurs at baseline (Time 1, 6 months (post-intervention (Time 2, 12 months (Time 3 and 24 months follow-up for longer term effects (Time 4. We are comparing depression (Cardiac Depression Scale [CDS] and HRQOL (Short Form-12 [SF-12] scores between treatment and UC groups, assessing the feasibility of the program through patient acceptability and exploring long term maintenance effects. A cost-effectiveness analysis of

  20. Consequences of implementing a cardiac troponin assay with improved sensitivity at Swedish coronary care units: an analysis from the SWEDEHEART registry.

    Science.gov (United States)

    Eggers, Kai M; Lindahl, Bertil; Melki, Dina; Jernberg, Tomas

    2016-08-07

    Cardiac troponin (cTn) assays with improved sensitivity are increasingly utilized for the assessment of patients admitted because of suspected acute coronary syndrome (ACS). However, data on the clinical consequences of the implementation of such assays are limited. In a retrospective register-based study (37 710 coronary care unit admissions; SWEDEHEART registry), we compared the case mix, the use of diagnostic procedures, treatments, and 1-year all-cause mortality 1 year before the implementation of a cTn assay with improved sensitivity (study period 1) and 1 year thereafter (study period 2). During study period 2, more at-risk patients were admitted and more patients had cTn levels above the myocardial infarction cut-off (ACS patients +13.1%; non-ACS patients +160.1%). cTn levels above this cut-off exhibited stronger associations with mortality risk in study period 2 (adjusted HR 4.45 [95% confidence interval, CI, 3.36-5.89]) compared with period 1 (adjusted HR 2.43 [95% CI 2.11-2.80]), similar as for the cTn ratio relative to the respective 99th percentile. While there was no multivariable-adjusted increase in the use of diagnostic procedures, significant trends towards more differentiated treatment depending on the cause of cTn elevation, i.e. ACS or non-ACS, were noted. The implementation of a cTn assay with improved sensitivity was associated with an increase in the number of patients who due to their cTn-status were identified as suitable for beneficial therapies. There was no inappropriate increase in hospital resource utilization. As such, cTn assays with improved sensitivity provide an opportunity to improve the clinical management of patients with suspected ACS. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  1. What follow-up care and self-management support do patients with type 2 diabetes want after their first acute coronary event? A qualitative study.

    Science.gov (United States)

    Kasteleyn, Marise J; Gorter, Kees J; van Puffelen, Anne L; Heijmans, Monique; Vos, Rimke C; Jansen, Hanneke; Rutten, Guy E H M

    2014-10-01

    Despite diabetes patients' efforts to control their disease, many of them are confronted with an acute coronary event. This may evoke depressive feelings and self-management may be complicated. According to the American Diabetes Association, the transition from hospital to home after an acute coronary event (ACE) is a high-risk time for diabetes patients; it should be improved. Before developing an intervention for diabetes patients with an ACE in the period after discharge from hospital, we want to gain a detailed understanding of patients' views, perceptions and feelings in this respect. Qualitative design. Two semi-structured focus groups were conducted with 14 T2DM patients (71% male, aged 61-77 years) with a recent ACE. One focus group with partners (67% male, aged 64-75 years) was held. All interviews were transcribed verbatim and analyzed by two independent researchers. Patients believed that coping with an ACE differs between patients with and without T2DM. They had problems with physical exercise, sexuality and pharmacotherapy. Patients and partners were neither satisfied with the amount of information, especially on the combination of T2DM and ACE, nor with the support offered by healthcare professionals after discharge. Participants would appreciate tailored self-management support after discharge from hospital. Patients with T2DM and their partners lack tailored support after a first ACE. Our findings underpin the ADA recommendations to improve the transition from hospital to home. The results of our study will help to determine the exact content of a self-management support program delivered at home to help this specific group of patients to cope with both conditions. Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  2. Variation in critical care unit admission rates and outcomes for patients with acute coronary syndromes or heart failure among high- and low-volume cardiac hospitals.

    Science.gov (United States)

    van Diepen, Sean; Bakal, Jeffrey A; Lin, Meng; Kaul, Padma; McAlister, Finlay A; Ezekowitz, Justin A

    2015-02-27

    Little is known about cross-hospital differences in critical care units admission rates and related resource utilization and outcomes among patients hospitalized with acute coronary syndromes (ACS) or heart failure (HF). Using a population-based sample of 16,078 patients admitted to a critical care unit with a primary diagnosis of ACS (n=14,610) or HF (n=1467) between April 1, 2003 and March 31, 2013 in Alberta, Canada, we stratified hospitals into high (>250), medium (200 to 250), or low (<200) volume based on their annual volume of all ACS and HF hospitalization. The percentage of hospitalized patients admitted to critical care units varied across low, medium, and high-volume hospitals for both ACS and HF as follows: 77.9%, 81.3%, and 76.3% (P<0.001), and 18.0%, 16.3%, and 13.0% (P<0.001), respectively. Compared to low-volume units, critical care patients with ACS and HF admitted to high-volume hospitals had shorter mean critical care stays (56.6 versus 95.6 hours, P<0.001), more critical care procedures (1.9 versus 1.2 per patient, <0.001), and higher resource-intensive weighting (2.8 versus 1.5, P<0.001). No differences in in-hospital mortality (5.5% versus 6.2%, adjusted odds ratio 0.93; 95% CI, 0.61 to 1.41) were observed between high- and low-volume hospitals; however, 30-day cardiovascular readmissions (4.6% versus 6.8%, odds ratio 0.77; 95% CI, 0.60 to 0.99) and cardiovascular emergency-room visits (6.6% versus 9.5%, odds ratio 0.80; 95% CI, 0.69 to 0.94) were lower in high-volume compared to low-volume hospitals. Outcomes stratified by ACS or HF admission diagnosis were similar. Cardiac patients hospitalized in low-volume hospitals were more frequently admitted to critical care units and had longer hospitals stays despite lower resource-intensive weighting. These findings may provide opportunities to standardize critical care utilization for ACS and HF patients across high- and low-volume hospitals. © 2015 The Authors. Published on behalf of the American

  3. Point-of-care heart-type fatty acid binding protein versus high-sensitivity troponin T testing in emergency patients at high risk for acute coronary syndrome.

    Science.gov (United States)

    Kellens, Sebastiaan; Verbrugge, Frederik H; Vanmechelen, Maxime; Grieten, Lars; Van Lierde, Johan; Dens, Joseph; Vrolix, Mathias; Vandervoort, Pieter

    2016-04-01

    High-sensitivity cardiac troponin testing is used to detect myocardial damage in patients with acute chest pain. Heart-type fatty acid binding protein (H-FABP) may be an alternative, available as point-of-care test. Patients (n=203) referred by general practitioners for suspected acute coronary syndrome or presenting with typical chest pain and one major cardiovascular risk factor at the emergency department were prospectively included in a single-centre cohort study. High-sensitivity cardiac troponin T (hs-TnT) and point-of-care H-FABP testing were concomitantly performed at admission and after 6h. Maximal hs-TnT levels above the 99th percentile were observed in 152 patients (75%) with 127 (63%) fulfilling criteria for myocardial infarction. Upon admission, hs-TnT and H-FABP were associated with an area under the curve (95% CI) of 0.83 (0.77-0.89) and 0.79 (0.73-0.85), respectively, to predict myocardial infarction, which increased to 0.93 (0.90-0.97) and 0.88 (0.84-0.93), respectively, after 6h. The diagnostic accuracy for non-ST-segment elevation myocardial infarction was somewhat lower with an area under the curve (95% CI) of 0.80 (0.72-0.87), 0.90 (0.84-0.96), 0.73 (0.64-0.81) and 0.77 (0.67-0.86), respectively. When assessment was performed within 3h of chest pain onset, diagnostic accuracy of H-FABP versus hs-TnT was similar. Each standard deviation increase in admission H-FABP was associated with a 68% relative risk increase of all-cause mortality (p-value=0.027) during 666 ± 155 days of follow-up. Point-of-care H-FABP testing has lower diagnostic accuracy compared with hs-TnT assessment in patients with high pre-test acute coronary syndrome probability, but might be of interest when assessment is possible early after chest pain onset. © The European Society of Cardiology 2015.

  4. The role of point-of-care assessment of platelet function in predicting postoperative bleeding and transfusion requirements after coronary artery bypass grafting.

    Science.gov (United States)

    Mishra, Pankaj Kumar; Thekkudan, Joyce; Sahajanandan, Raj; Gravenor, Mike; Lakshmanan, Suresh; Fayaz, Khazi Mohammed; Luckraz, Heyman

    2015-01-01

    OBJECTIVE platelet function assessment after cardiac surgery can predict postoperative blood loss, guide transfusion requirements and discriminate the need for surgical re-exploration. We conducted this study to assess the predictive value of point-of-care testing platelet function using the Multiplate® device. Patients undergoing isolated coronary artery bypass grafting were prospectively recruited ( n = 84). Group A ( n = 42) patients were on anti-platelet therapy until surgery; patients in Group B ( n = 42) stopped anti-platelet treatment at least 5 days preoperatively. Multiplate® and thromboelastography (TEG) tests were performed in the perioperative period. Primary end-point was excessive bleeding (>2.5 ml/kg/h) within first 3 h postoperative. Secondary end-points included transfusion requirements, re-exploration rates, intensive care unit and in-hospital stays. Patients in Group A had excessive bleeding (59% vs. 33%, P = 0.02), higher re-exploration rates (14% vs. 0%, P function testing was the most significant predictor of excessive bleeding (odds ratio [OR]: 2.3, P = 0.08), need for blood (OR: 5.5, P functional assessment with Multiplate® was the strongest predictor for bleeding and transfusion requirements in patients on anti-platelet therapy until the time of surgery.

  5. Pooled individual patient data from five countries were used to derive a clinical prediction rule for coronary artery disease in primary care.

    Science.gov (United States)

    Aerts, Marc; Minalu, Girma; Bösner, Stefan; Buntinx, Frank; Burnand, Bernard; Haasenritter, Jörg; Herzig, Lilli; Knottnerus, J André; Nilsson, Staffan; Renier, Walter; Sox, Carol; Sox, Harold; Donner-Banzhoff, Norbert

    2017-01-01

    To construct a clinical prediction rule for coronary artery disease (CAD) presenting with chest pain in primary care. Meta-Analysis using 3,099 patients from five studies. To identify candidate predictors, we used random forest trees, multiple imputation of missing values, and logistic regression within individual studies. To generate a prediction rule on the pooled data, we applied a regression model that took account of the differing standard data sets collected by the five studies. The most parsimonious rule included six equally weighted predictors: age ≥55 (males) or ≥65 (females) (+1); attending physician suspected a serious diagnosis (+1); history of CAD (+1); pain brought on by exertion (+1); pain feels like "pressure" (+1); pain reproducible by palpation (-1). CAD was considered absent if the prediction score is data sets based on electronic health records from diverse sites create opportunities for improving their internal and external validity. Our patient-level meta-analysis from five primary care sites should improve external validity. Our strategy for addressing site-to-site systematic variation in missing data should improve internal validity. Using principles derived from decision theory, we also discuss the problem of setting the cutoff prediction score for taking action. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Do low-income coronary artery bypass surgery patients have equal opportunity to access excellent quality of care and enjoy good outcome in Taiwan?

    Science.gov (United States)

    Yu, Tsung-Hsien; Hou, Yu-Chang; Chung, Kuo-Piao

    2014-09-10

    Equity is an important issue in the healthcare research field. Many studies have focused on the relationship between patient characteristics and outcomes of care. These studies, however, have seldom examined whether patients' characteristics affected their access to quality healthcare, which further affected the care outcome. The purposes of this study were to determine whether low-income coronary artery bypass surgery (CABG) patients receive healthcare services with poorer quality, and if such differences in treatment result in different outcomes. A retrospective multilevel study design was conducted using claims data from Taiwan's universal health insurance scheme for 2005-2008. Patients who underwent their CABG surgery between 2006 and 2008 were included in this study. CABG patients who were under 18 years of age or had unknown gender or insured classifications were excluded. Hospital and surgeon's performance indicators in the previous one year were used to evaluate the level of quality via k-means clustering algorithm. Baron and Kenny's procedures for mediation effect were conducted to explore the relationship among patient's income, quality of CABG care, and inpatient mortality. A total of 10,320 patients were included in the study. The results showed that 5.65% of the low-income patients received excellent quality of care, which was lower than that of patients not in the low-income group (5.65% vs.11.48%). The mortality rate of low-income patients (12.10%) was also higher than patients not in the low-income group (5.25%). Also, the mortality of patients who received excellent care was half as low as patients receiving non-excellent care (2.63% vs. 5.68%). Finally, after the procedure of mediation effect testing, the results showed that the relationship between patient income level and CABG mortality was partially mediated by patterns of quality of care. The results of the current study implied that worse outcome in low-income CABG patients might be

  7. Perspective of young drivers towards the care of the road traffic injured

    African Journals Online (AJOL)

    user

    2014-12-09

    Dec 9, 2014 ... Key words: Young driver, road traffic injured, pre-hospital care, training. INTRODUCTION .... Response time is considered an important criterion in assessing the ... safety was a priority ever before attempting to rescue the ...

  8. Evaluation of risk factors in acute myocardial infarction patients admitted to the coronary care unit, Tripoli Medical Centre, Libya.

    Science.gov (United States)

    Abduelkarem, A R; El-Shareif, H J; Sharif, S I

    2012-04-01

    The aim of this study was to provide an overview of the risk factors for acute myocardial infarction in patients attending Tripoli Medical Centre, Libya. Records were reviewed for 622 patients with a mean age of 58.3 (SD 12.9) years. Diabetes mellitus (48.2%), hypertension (35.7%) and smoking (50.6%) were among the risk factors reported. There were 110 patients (17.7%) who died during hospitalization, mainly suffering cardiogenic shock (48.0%). The rate of use of thrombolytic therapy was low in patients who were female (40.4% versus 58.4% for males), older age (31.6% for those > 85 years versus 63.3% for patients < 55 years), diabetics (45.3% versus 62.0% for non-diabetic patients) and hypertensives (47.3% versus 57.8% for non-hypertensive patients). Prevention strategies should be implemented in order to improve the long-term prognosis and decrease overall morbidity and mortality from coronary artery disease in Libyan patients.

  9. Predictive Factors for Delayed Extubation in the Intensive Care Unit after Coronary Artery Bypass Grafting; A Southern Iranian Experience

    Directory of Open Access Journals (Sweden)

    Shahrbanoo Shahbazi

    2012-12-01

    Full Text Available Background: Early extubation is implemented in cardiothoracic units worldwide for its advantages such as decreased mortality, morbidity, and hospitalization costs. We conducted a retrospective study to evaluate potential factors which may affect extubation time. Methods: The records of 334 eligible patients who underwent elective coronary artery bypass grafting (CABG in 2008 in Kowsar Hospital in Shiraz, southern Iran were evaluated to find the factors that can affect the extubation time. The patients were divided to early (equal or less than 6 hours and late extubation groups. The patients’ demographic data and operative variables were extracted from the records. We excluded patients with difficult intubation, severe acid base disturbance, neurological problems, and cardiovascular instability; and those who used intra-aortic balloon pump, had underwent emergency operation, or had another concomitant surgery. Results: Multiple logistic regressions comparing age, sex, number of grafts, ejection fraction, pump time, hematocrit, number of risk factors, and number of inotropic drugs, identified only age as a predictor of delayed extubation (odds ratio=1.07, CI 95%=1.04-1.10, P<0.001. Also, in both studied groups the men to women ratio was higher (P<0.05.Conclusion: Although in our study age was the only predictive factor for delayed extubation, a comprehensive study including preoperative, perioperative, and postoperative factors is recommended in our area.

  10. The Cultural Meaning of Cardiac Illness and Self-Care Among Lebanese Patients With Coronary Artery Disease.

    Science.gov (United States)

    Dumit, Nuhad Yazbik; Magilvy, Joan Kathy; Afifi, Rima

    2016-07-01

    Cardiac disease is the leading cause of death in Lebanon, accounting for 22% to 26% of total deaths in the country. A thorough understanding of perceptions of cardiac illness and related self-care management is critical to the development of secondary prevention programs that are specific to the Lebanese culture. To explore the cultural perceptions of cardiac illness and the associated meaning of self-care among Lebanese patients. Using a qualitative descriptive method, semistructured interviews were conducted with a purposive sample of 15 Lebanese cardiac patients recruited from a medical center in Beirut, Lebanon. The qualitative descriptive analysis yielded one overarching and two other themes describing perceptions of cardiac illness and self-care within the Lebanese cultural context. The overarching cultural theme was, "Lebanese cardiac patients were unfamiliar with the term concept and meaning of self-care." Lebanese cardiac patients thanked God and accepted their fate (Theme I). The participants considered their cardiac incident a life or death warning (Theme II). Health care providers need to consider patients' cultural perception of illness while planning and evaluating cardiac self-care programs. © The Author(s) 2015.

  11. How socioeconomic inequalities impact pathways of care for coronary artery disease among elderly patients: study protocol for a qualitative longitudinal study.

    Science.gov (United States)

    Schröder, Sara L; Fink, Astrid; Schumann, Nadine; Moor, Irene; Plehn, Alexander; Richter, Matthias

    2015-11-09

    Several studies have identified that socioeconomic inequalities in coronary artery disease (CAD) morbidity and mortality lead to a disadvantage in patients with low socioeconomic status (SES). International studies have shown that socioeconomic inequalities also exist in terms of access, utilisation and quality of cardiac care. The aim of this qualitative study is to provide information on the impact of socioeconomic inequalities on the pathway of care for CAD, and to establish which factors lead to socioeconomic inequality of care to form and expand existing scientific theories. A longitudinal qualitative study with 48 patients with CAD, aged 60-80 years, is being conducted. Patients have been recruited consecutively at the University Hospital in Halle/Saale, Germany, and will be followed for a period of 6 months. Patients are interviewed two times face-to-face using semistructured interviews. Data are transcribed and analysed based on grounded theory. Only participants who have been informed and who have signed a declaration of consent have been included in the study. The study complies rigorously with data protection legislation. Approval of the Ethical Review Committee at the Martin-Luther University Halle-Wittenberg, Germany was obtained. The results of the study will be presented at several congresses, and will be published in high-quality peer-reviewed international journals. This study has been registered with the German Clinical Trials Register and assigned DRKS00007839. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. Effectiveness of nurse-led patient-centered care behavioral risk modification on secondary prevention of coronary heart disease: A systematic review.

    Science.gov (United States)

    Chiang, Chung-Yan; Choi, Kai-Chow; Ho, Ka-Ming; Yu, Sau-Fung

    2018-04-22

    Despite establishment of advocacies centered on using patient-centered care to improve disease-related behavioral changes and health outcomes, studies have seldom discussed incorporation of patient-centered care concept in the design of secondary cardiac prevention. This review aimed to identify, appraise, and examine existing evidence on the effectiveness of nurse-led patient-centered care for secondary cardiac prevention in patients with coronary heart disease. A systematic review of randomized controlled trials focusing on nurse-led patient-centered care for secondary cardiac prevention was conducted. Primary outcomes were behavioral risks (e.g. smoking, physical activity), secondary outcomes were clinically relevant physiological parameters (e.g. body weight, blood pressure, blood glucose, blood lipoproteins), health-related quality of life, mortality, and self efficacy. Twenty-three English and seven Chinese electronic databases were searched to identify the trials. The studies' eligibility and methodological quality were assessed by two reviewers independently according to the Joanna Briggs Institute guidelines. Statistical heterogeneities of the included studies were assessed by Higgins I2 and quantitative pooling was performed when studies showed sufficient comparability. 15 articles on 12 randomized controlled trials were included in this review. Methodological quality of the included studies was fair. Based on the Joanna Briggs Institute critical appraisal tool for experimental studies, the included studies had met a mean of six criteria out the ten in this appraisal tool. The meta-analyses of the included studies revealed that nurse-led patient-centered care had significantly improved patients' smoking habits, adherence toward physical activity advices, and total cholesterol level with medical regime optimization, in short- to medium-term. The intervention was also favorable in improving the patients' health-related quality of life in several domains of

  13. Assessing sensitivity and specificity of the Manchester Triage System in the evaluation of acute coronary syndrome in adult patients in emergency care: a systematic review protocol.

    Science.gov (United States)

    Nishi, Fernanda Ayache; de Motta Maia, Flávia Oliveira; de Lopes Monteiro da Cruz, Dina Almeida

    2015-11-01

    The objective of this review is to assess the sensitivity and specificity of the Manchester Triage System in the evaluation of adult patients with acute coronary syndrome in emergency departments. Acute coronary syndrome (ACS) is a group of clinical conditions that include myocardial infarction with or without elevation of the ST segment and unstable angina. The term acute myocardial infarction (AMI) can be applied when there is evidence of myocardium necrosis with a clinical sign compatible with myocardial ischaemia. Acute myocardial infarction can be identified using clinical methods including electrocardiography (ECG), elevation in myocardium necrosis biomarkers, and imaging. Acute myocardial infarction is one of the leading causes of death and disability worldwide, and may be the first manifestation of coronary artery disease.Estimating the prevalence of coronary diseases in the general population is quite a complex task. In 2010, the prevalence of coronary diseases was reported as 6.4% among the general population in the United States.One of the main manifestations of ACS is chest pain. However, even in the presence of this typical symptom, early diagnosis of ACS is a challenge for health care professionals who initially attend to these patients. Several authors have indicated the importance and difficulty of recognizing chest pain of cardiac origin, where immediate medical attention is required.Triage, or risk classification, is a clinical management tool used in emergency services to guide patient flow when the need for medical attention exceeds that available. The Manchester Triage Group was developed in 1994 in the United Kingdom. The aim was to establish a consensus among physicians and nurses in the emergency room by creating a triage pattern focused on the development of the following:Thus, the Manchester Triage System (MTS) was created. The MTS simplifies the clinical management of each patient, and consequently, the whole service, by utilizing a

  14. Impact of mobile intensive care unit use on total ischemic time and clinical outcomes in ST-elevation myocardial infarction patients - real-world data from the Acute Coronary Syndrome Israeli Survey.

    Science.gov (United States)

    Koifman, Edward; Beigel, Roy; Iakobishvili, Zaza; Shlomo, Nir; Biton, Yitschak; Sabbag, Avi; Asher, Elad; Atar, Shaul; Gottlieb, Shmuel; Alcalai, Ronny; Zahger, Doron; Segev, Amit; Goldenberg, Ilan; Strugo, Rafael; Matetzky, Shlomi

    2017-01-01

    Ischemic time has prognostic importance in ST-elevation myocardial infarction patients. Mobile intensive care unit use can reduce components of total ischemic time by appropriate triage of ST-elevation myocardial infarction patients. Data from the Acute Coronary Survey in Israel registry 2000-2010 were analyzed to evaluate factors associated with mobile intensive care unit use and its impact on total ischemic time and patient outcomes. The study comprised 5474 ST-elevation myocardial infarction patients enrolled in the Acute Coronary Survey in Israel registry, of whom 46% ( n=2538) arrived via mobile intensive care units. There was a significant increase in rates of mobile intensive care unit utilization from 36% in 2000 to over 50% in 2010 ( pcare unit use were Killip>1 (odds ratio=1.32, pcare units benefitted from increased rates of primary reperfusion therapy (odds ratio=1.58, pcare unit benefitted from shorter median total ischemic time compared with non-mobile intensive care unit patients (175 (interquartile range 120-262) vs 195 (interquartile range 130-333) min, respectively ( pcare unit use was the most important predictor in achieving door-to-balloon time care unit group (odds ratio=0.79, 95% confidence interval (0.66-0.94), p=0.01). Among patients with ST-elevation myocardial infarction, the utilization of mobile intensive care units is associated with increased rates of primary reperfusion, a reduction in the time interval to reperfusion, and a reduction in one-year adjusted mortality.

  15. Pre-hospitalization, hospitalization, and post-hospitalization costs of patients with neurocysticercosis treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN in Mexico City, Mexico

    Directory of Open Access Journals (Sweden)

    Rachana Bhattarai

    2018-05-01

    Full Text Available ABSTRACT The objective of this study was to estimate the direct costs associated with the diagnosis and treatment of neurocysticercosis (NCC during pre-hospitalization, hospitalization, and post-hospitalization periods for 108 NCC patients treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN in Mexico City, Mexico. Information on clinical manifestations, diagnostic tests, hospitalizations, surgical procedures, prescription medication, and other treatments was collected via medical chart reviews. Uncertain values for costs and frequency of treatments were imputed using bootstrap techniques. The average per-patient pre-hospitalization and hospitalization costs were US$ 257 (95% CI: 185 – 329 and US$ 2,576 (95% CI: 2,244 – 2,908, respectively. Post-hospitalization costs tended to decrease over time, with estimates for the first five years post-hospitalization of US$ 475 (95% CI: 423 – 527, US$ 228 (95% CI: 167 – 288, US$ 157 (95% CI: 111 – 202, US$ 150 (95% CI: 106 – 204, and US$ 91 (95% CI: 27 – 154, respectively. NCC results in a significant economic burden for patients requiring hospitalization, with this burden continuing years post-hospitalization.

  16. Effects of multimedia nursing education on disease-related depression and anxiety in patients staying in a coronary intensive care unit.

    Science.gov (United States)

    Demircelik, Muhammed Bora; Cakmak, Muzaffer; Nazli, Yunus; Şentepe, Esra; Yigit, Derya; Keklik, Mevlude; Arslan, Muzeyyen; Cetin, Mustafa; Eryonucu, Beyhan

    2016-02-01

    We evaluated the effectiveness of an accessibility-enhanced multimedia informational educational program in reducing depression and anxiety increasing satisfaction with the information and materials received by patients in coronary care unit. We selected 100 patients from among the patients who stayed at or who underwent surgery at one of two ICUs for any reason who satisfied the eligibility criteria, and agreed to participate in the research. The participants were included in the control or experimental group by random selection. The patients completed the Hospital Anxiety Depression Scale during ICU admission and 1week after hospital discharge. The difference in HADSA score was significantly greater in patients who received education than in patients who did not receive multimedia nursing education (4.2±0.58 vs. 0.6±0.42; pnursing education (2.2±0.53 vs. 0.64±0.46; pdepression associated with hospital can be reduced with multimedia nursing education. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Effective components of nurse-coordinated care to prevent recurrent coronary events: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Snaterse, Marjolein; Dobber, Jos; Jepma, Patricia; Peters, Ron J. G.; ter Riet, Gerben; Boekholdt, S. Matthijs; Buurman, Bianca M.; Scholte op Reimer, Wilma J. M.

    2016-01-01

    Current guidelines on secondary prevention of cardiovascular disease recommend nurse-coordinated care (NCC) as an effective intervention. However, NCC programmes differ widely and the efficacy of NCC components has not been studied. To investigate the efficacy of NCC and its components in secondary

  18. Epidemiology, recognition and documentation of sepsis in the pre-hospital setting and associated clinical outcomes: a prospective multicenter study

    NARCIS (Netherlands)

    Alam, Nadia; Doerga, Kirtiedevi B. N. S; Hussain, Tahira; Hussain, Sadia; Holleman, Frits; Kramer, Mark H. H.; Nanayakkara, Prabath W. B.

    2016-01-01

    General practitioners (GPs) and the emergency medical services (EMS) personnel have a pivotal role as points of entry into the acute care chain. This study was conducted to investigate the recognition of sepsis by GPs and EMS personnel and to evaluate the associations between recognition of sepsis

  19. Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease

    Directory of Open Access Journals (Sweden)

    Toischer Karl

    2009-09-01

    Full Text Available Abstract Background Despite the existence of controversial debates on the efficiency of coronary endarterectomy (CE, it is still used as an adjunct to coronary artery bypass grafting (CABG. This is particularly true in patients with endstage coronary artery disease. Given the improvements in cardiac surgery and postoperative care, as well as the rising number of elderly patient with numerous co-morbidities, re-evaluating the pros and cons of this technique is needed. Methods Patient demographic information, operative details and outcome data of 104 patients with diffuse calcified coronary artery disease were retrospectively analyzed with respect to functional capacity (NYHA, angina pectoris (CCS and mortality. Actuarial survival was reported using a Kaplan-Meyer analysis. Results Between August 2001 and March 2005, 104 patients underwent coronary artery bypass grafting (CABG with adjunctive coronary endarterectomy (CE in the Department of Thoracic-, Cardiac- and Vascular Surgery, University of Goettingen. Four patients were lost during follow-up. Data were gained from 88 male and 12 female patients; mean age was 65.5 ± 9 years. A total of 396 vessels were bypassed (4 ± 0.9 vessels per patient. In 98% left internal thoracic artery (LITA was used as arterial bypass graft and a total of 114 vessels were endarterectomized. CE was performed on right coronary artery (RCA (n = 55, on left anterior descending artery (LAD (n = 52 and circumflex artery (RCX (n = 7. Ninety-five patients suffered from 3-vessel-disease, 3 from 2-vessel- and 2 from 1-vessel-disease. Closed technique was used in 18%, open technique in 79% and in 3% a combination of both. The most frequent endarterectomized localization was right coronary artery (RCA = 55%. Despite the severity of endstage atherosclerosis, hospital mortality was only 5% (n = 5. During follow-up (24.5 ± 13.4 months, which is 96% complete (4 patients were lost caused by unknown address 8 patients died (cardiac

  20. Coronary Artery Bypass in Octogenarians

    Directory of Open Access Journals (Sweden)

    Chen-Yen Chien

    2012-09-01

    Full Text Available Prevalence of coronary artery disease (CAD has increased with the expansion of life span among the elderly population in the world. Hence, the issue of the coronary artery bypass in octogenarians has attracted more attention. Recent literature about the topic revealed nearly the same excellent results as those in the younger population under the newly developed operative techniques and improving concept in perioperative management and postoperative care. In this article, we review the current status of the procedure that was thought to be dangerous in the earlier era, including its risk factors, result, and benefit.

  1. The UPBEAT nurse-delivered personalized care intervention for people with coronary heart disease who report current chest pain and depression: a randomised controlled pilot study.

    Directory of Open Access Journals (Sweden)

    Elizabeth A Barley

    Full Text Available Depression is common in people with coronary heart disease (CHD and associated with worse outcome. This study explored the acceptability and feasibility of procedures for a trial and for an intervention, including its potential costs, to inform a definitive randomized controlled trial (RCT of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression.Multi-centre, outcome assessor-blinded, randomized parallel group study. CHD patients reporting chest pain and scoring 8 or more on the HADS were randomized to personalized care (PC or treatment as usual (TAU for 6 months and followed for 1 year. Primary outcome was acceptability and feasibility of procedures; secondary outcomes included mood, chest pain, functional status, well being and psychological process variables.1001 people from 17 General Practice CHD registers in South London consented to be contacted; out of 126 who were potentially eligible, 81 (35% female, mean age = 65 SD11 years were randomized. PC participants (n = 41 identified wide ranging problems to work on with nurse-case managers. Good acceptability and feasibility was indicated by low attrition (9%, high engagement and minimal nurse time used (mean/SD = 78/19 mins assessment, 125/91 mins telephone follow up. Both groups improved on all outcomes. The largest between group difference was in the proportion no longer reporting chest pain (PC 37% vs TAU 18%; mixed effects model OR 2.21 95% CI 0.69, 7.03. Some evidence was seen that self efficacy (mean scale increase of 2.5 vs 0.9 and illness perceptions (mean scale increase of 7.8 vs 2.5 had improved in PC vs TAU participants at 1 year. PC appeared to be more cost effective up to a QALY threshold of approximately £3,000.Trial and intervention procedures appeared to be feasible and acceptable. PC allowed patients to work on unaddressed problems and appears cheaper than TAU.Controlled-Trials.com ISRCTN21615909.

  2. Algorithm for the automatic computation of the modified Anderson-Wilkins acuteness score of ischemia from the pre-hospital ECG in ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Fakhri, Yama; Sejersten-Ripa, Maria; Schoos, Mikkel Malby

    2017-01-01

    BACKGROUND: The acuteness score (based on the modified Anderson-Wilkins score) estimates the acuteness of ischemia based on ST-segment, Q-wave and T-wave measurements obtained from the electrocardiogram (ECG) in patients with ST Elevation Myocardial Infarction (STEMI). The score (range 1 (least...... the acuteness score. METHODS: We scored 50 pre-hospital ECGs from STEMI patients, manually and by the automated algorithm. We assessed the reliability test between the manual and automated algorithm by interclass correlation coefficient (ICC) and Bland-Altman plot. RESULTS: The ICC was 0.84 (95% CI 0.......72-0.91), PECGs, all within the upper (1.46) and lower (-1.12) limits...

  3. Patients and acute coronary syndrome - Prehospital delay and mental and emotional delaying responses - a qualitative study

    DEFF Research Database (Denmark)

    Lorentzen, Vibeke; Larsen, Birte Hedegaard

    2016-01-01

    cardinal. Male participants often used expletives and expressed symptoms in concrete terms. Women expressed symptoms in vaguer terms. Both genders used linguistic metaphors. The implications for nursing emphasised the impact of prodromal symptoms, mental and emotional withdrawal, and linguistic...... to identify and discuss patient’s mental and emotional responses, including interpretations and delaying strategies concerning Acute Coronary Syndrome symptoms, with a view to elucidating patterns in the pre-hospital decision-making process of female and male persons to contact medical services...

  4. Patients and acute coronary syndrome - Prehospital delay and mental and emotional delaying responses - a qualitative study

    DEFF Research Database (Denmark)

    Lorentzen, Vibeke; Larsen, Birte Hedegaard

    2016-01-01

    to identify and discuss patient’s mental and emotional responses, including interpretations and delaying strategies concerning Acute Coronary Syndrome symptoms, with a view to elucidating patterns in the pre-hospital decision-making process of female and male persons to contact medical services...... cardinal. Male participants often used expletives and expressed symptoms in concrete terms. Women expressed symptoms in vaguer terms. Both genders used linguistic metaphors. The implications for nursing emphasised the impact of prodromal symptoms, mental and emotional withdrawal, and linguistic...

  5. Paediatric acute care: Highlights from the Paediatric Acute Care-Advanced Paediatric Life Support Conference, Gold Coast, 2017.

    Science.gov (United States)

    Teo, Stephen Ss; Rao, Arjun; Acworth, Jason

    2018-04-25

    The Paediatric Acute Care Conference is an annual conference organised by APLS Australia to advance paediatric acute care topics for clinicians in pre-hospital medicine, EDs, acute paediatrics, intensive care and anaesthesia. The Conference 2017 was held at Surfers Paradise, Queensland. We provide a summary of some of the presentations. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  6. Integral diagnosis of coronary atherosclerosis by coronary multidetector computed tomography and by invasive coronary angiography

    International Nuclear Information System (INIS)

    Llerena Rojas, Luis Roberto; Llerena Rojas, Lorenzo D; Mendoza Rodriguez, Vladimir

    2013-01-01

    Coronary angiography by multidetector computed tomography (CMDCT) visualizes the wall and lumen of coronary arteries. Invasive coronary angiography (INVCA) only visualizes the arterial lumen but with better resolution

  7. Efficacy of topical chamomile on the incidence of phlebitis due to an amiodarone infusion in coronary care patients: a double-blind, randomized controlled trial.

    Science.gov (United States)

    Sharifi-Ardani, Maryam; Yekefallah, Leili; Asefzadeh, Saeed; Nassiri-Asl, Marjan

    2017-09-01

    Amiodarone is a useful antiarrhythmic drug. Phlebitis, caused by intravenous amiodarone, is common in patients in coronary care units (CCUs). The aim of this study was to evaluate the effect of topical chamomile on the incidence of phlebitis due to the administration of an amiodarone infusion into the peripheral vein. This was a randomized, double-blind clinical trial, conducted on 40 patients (n = 20 per group) in two groups-an intervention group (chamomile ointment) and a control group (lanoline, as a placebo), hospitalized in the CCUs and undergoing an amiodarone infusion into the peripheral vein over 24 h. Following the cannulation and commencement of the infusion, placebo or chamomile ointment was rubbed in, up to 10 cm superior to the catheter and repeated every eight hours for three days. The cannula site was then assessed based on the phlebitis checklist. The incidence and time of occurrence of phlebitis, relative risk, severity of phlebitis were the main outcome measures. Nineteen patients (19/20) in the control group had phlebitis on the first day of the study and one patient (20/20) on the second day. In the intervention group, phlebitis occurred in 13 cases (13/20) on the first day and another two (2/7) was found on the second day. The incidence of phlebitis was significantly different between two groups (P = 0.023). The cumulative incidence of phlebitis in the intervention group (15/20) is significantly later and lower than that in the control group (20/20) during two days (P = 0.008). Two patients in the intervention group did not develop phlebitis at all during the 3-day study. Also, the relative risk of phlebitis in the two groups was 0.68 (P = 0.008 5). A significant difference was not observed with regard to phlebitis severity in both groups. It seems that phlebitis occurred to a lesser extent and at a later time frame in the intervention group compared to control group. Topical chamomile may be effective in decreasing the incidence of phlebitis

  8. Efficacy and safety of zotarolimus-eluting and sirolimus-eluting coronary stents in routine clinical care (SORT OUT III): a randomised controlled superiority trial

    DEFF Research Database (Denmark)

    Rasmussen, Klaus; Maeng, Michael; Kaltoft, Anne

    2010-01-01

    In low-risk patients, the zotarolimus-eluting stent has been shown to reduce rates of restenosis without increasing the risk of stent thrombosis. We compared the efficacy and safety of the zotarolimus-eluting stent versus the sirolimus-eluting stent in patients with coronary artery disease who we...

  9. The UPBEAT Nurse-Delivered Personalized Care Intervention for People with Coronary Heart Disease Who Report Current Chest Pain and Depression: A Randomised Controlled Pilot Study

    NARCIS (Netherlands)

    Barley, E.A.; Walters, P.; Haddad, M.; Phillips, R.; Achilla, E.; McCrone, P.; van Marwijk, H.W.J.; Mann, A.; Tylee, A.

    2014-01-01

    Background: Depression is common in people with coronary heart disease (CHD) and associated with worse outcome. This study explored the acceptability and feasibility of procedures for a trial and for an intervention, including its potential costs, to inform a definitive randomized controlled trial

  10. Saving Lives on the Battlefield: A Joint Trauma System Review of Pre-Hospital Trauma Care in Combined Joint Operating Area - Afghanistan (CJOA-A)

    Science.gov (United States)

    2013-01-30

    should perform each procedure, i.e. a combat deployment is not a training environment. Anesthesia always intubates, general surgery always places...CWPP medications with extended shelf life would prove beneficial for some units. 245. Many intraosseous infusion devices are found to be non-functional

  11. The RAPID-CTCA trial (Rapid Assessment of Potential Ischaemic Heart Disease with CTCA) - a multicentre parallel-group randomised trial to compare early computerised tomography coronary angiography versus standard care in patients presenting with suspected or confirmed acute coronary syndrome: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Gray, Alasdair J; Roobottom, Carl; Smith, Jason E; Goodacre, Steve; Oatey, Katherine; O'Brien, Rachel; Storey, Robert F; Na, Lumine; Lewis, Steff C; Thokala, Praveen; Newby, David E

    2016-12-07

    Emergency department attendances with chest pain requiring assessment for acute coronary syndrome (ACS) are a major global health issue. Standard assessment includes history, examination, electrocardiogram (ECG) and serial troponin testing. Computerised tomography coronary angiography (CTCA) enables additional anatomical assessment of patients for coronary artery disease (CAD) but has only been studied in very low-risk patients. This trial aims to investigate the effect of early CTCA upon interventions, event rates and health care costs in patients with suspected/confirmed ACS who are at intermediate risk. Participants will be recruited in about 35 tertiary and district general hospitals in the UK. Patients ≥18 years old with symptoms with suspected/confirmed ACS with at least one of the following will be included: (1) ECG abnormalities, e.g. ST-segment depression >0.5 mm; (2) history of ischaemic heart disease; (3) troponin elevation above the 99 th centile of the normal reference range or increase in high-sensitivity troponin meeting European Society of Cardiology criteria for 'rule-in' of myocardial infarction (MI). The early use of ≥64-slice CTCA as part of routine assessment will be compared to standard care. The primary endpoint will be 1-year all-cause death or recurrent type 1 or type 4b MI at 1 year, measured as the time to such event. A number of secondary clinical, process and safety endpoints will be collected and analysed. Cost effectiveness will be estimated in terms of the lifetime incremental cost per quality-adjusted life year gained. We plan to recruit 2424 (2500 with ~3% drop-out) evaluable patients (1212 per arm) to have 90% power to detect a 20% versus 15% difference in 1-year death or recurrent type 1 MI or type 4b MI, two-sided p Acute Coronary Events score, previous CAD and baseline troponin level. The results will be expressed as a hazard ratio with the corresponding 95% confidence intervals and p value. The Rapid Assessment of

  12. Temporal trends and associated factors for pre-hospital and in-hospital delays of stroke patients over a 16-year period: the Athens study.

    Science.gov (United States)

    Papapanagiotou, Panagiotis; Iacovidou, Nicoletta; Spengos, Konstantinos; Xanthos, Theodoros; Zaganas, Ioannis; Aggelina, Afrodite; Alegakis, Athanasios; Vemmos, Konstantinos

    2011-01-01

    The management and outcome of acute ischemic stroke changed dramatically after the introduction of intravenous thrombolysis. However, relatively few patients have received thrombolytic treatment, mainly due to pre-hospital and/or in-hospital delays. Although the causes of these delays have been adequately studied, their change over a long period has not. All acute first-ever stroke patients (n = 2,746) presenting to our academic center from 1993 to 2008 were prospectively documented in a computerized stroke data bank. The time from symptoms onset to presentation at the emergency room and to acquisition of a brain CT was calculated. Time trends over this period as well as the factors affecting them were analyzed. The final study cohort consisted of 2,326 acute stroke patients after excluding 302 patients with an unknown time of stroke onset and 118 who suffered a stroke during hospitalization for another illness. Over the 16-year period, the median time from stroke onset to presentation at the emergency room decreased significantly from 3.15 h (interquartile range 1.30-10.30) to 2.00 h (range 1.00-4.00) (p best early management of acute stroke patients. Copyright © 2010 S. Karger AG, Basel.

  13. Coronary heart disease

    Science.gov (United States)

    Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD ... buildup of plaque in the arteries to your heart. This may also be called hardening of the ...

  14. Barriers professional competence and its relationship with job satisfaction of nurses' moral distress and pre-hospital emergency city of Bam and Jiroft in 1393

    Directory of Open Access Journals (Sweden)

    Mohammadjavad Rahimzadeh

    2016-05-01

    Full Text Available In order to "protect the health of people" Several organizations have been founded and given its role in saving lives when seconds play, is formed Medical Center Emergency Management Whose duty is satisfactory service in the shortest possible time. Because one of the pre-hospital emergency center nurses work centers and first deal with critical diseases carried by nurses, so they are faced with numerous obstacles which could impact on their job satisfaction has less moral distress. In this study, efficient professional barriers and its relation to moral distress and job satisfaction are studied prehospital emergency nurses. This study is a descriptive - correlation of prehospital emergency personnel Bam on 82 Jiroft who were selected by census was conducted. Data gathering questionnaire, including demographic characteristics, barriers to efficient professional, moral distress, job satisfaction after obtaining the appropriate reliability and validity were used. Analysis of the data in this study using SPSS version 18, using measures of central tendency and dispersion, t-test, Pearson correlation coefficient, ANOVA and regression analysis were used. According to the non-normal distribution efficiency and moral distress two variables obstacles relationship between these two variables with Spearman nonparametric Kruskal-Wallis test other variables and for other variables that were normally distributed parametric tests and ANOVA were used Pearson correlation coefficient. A total of 82 patients with mean age (31.54± 5.66 participated in th e study showed. Results are73.4% married, work experience, most people (% 91.5 were under 15 years old. Most people (52% with traffic and pedestrians as factors impeding efficient professional, fully agreed, the average score of moral distress (o.48 ± 2.13, the level of moral distress was most mid-level and job satisfaction 52. 4% of them were average. The results showed that between moral distress and job

  15. The Field Assessment Stroke Triage for Emergency Destination (FAST-ED): a Simple and Accurate Pre-Hospital Scale to Detect Large Vessel Occlusion Strokes

    Science.gov (United States)

    Lima, Fabricio O.; Silva, Gisele S.; Furie, Karen L.; Frankel, Michael R.; Lev, Michael H.; Camargo, Érica CS; Haussen, Diogo C.; Singhal, Aneesh B.; Koroshetz, Walter J.; Smith, Wade S.; Nogueira, Raul G.

    2016-01-01

    Background and Purpose Patients with large vessel occlusion strokes (LVOS) may be better served by direct transfer to endovascular capable centers avoiding hazardous delays between primary and comprehensive stroke centers. However, accurate stroke field triage remains challenging. We aimed to develop a simple field scale to identify LVOS. Methods The FAST-ED scale was based on items of the NIHSS with higher predictive value for LVOS and tested in the STOPStroke cohort, in which patients underwent CT angiography within the first 24 hours of stroke onset. LVOS were defined by total occlusions involving the intracranial-ICA, MCA-M1, MCA-2, or basilar arteries. Patients with partial, bi-hemispheric, and/or anterior + posterior circulation occlusions were excluded. Receiver operating characteristic (ROC) curve, sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of FAST-ED were compared with the NIHSS, Rapid Arterial oCclusion Evaluation (RACE) scale and Cincinnati Prehospital Stroke Severity Scale (CPSSS). Results LVO was detected in 240 of the 727 qualifying patients (33%). FAST-ED had comparable accuracy to predict LVO to the NIHSS and higher accuracy than RACE and CPSS (area under the ROC curve: FAST-ED=0.81 as reference; NIHSS=0.80, p=0.28; RACE=0.77, p=0.02; and CPSS=0.75, p=0.002). A FAST-ED ≥4 had sensitivity of 0.60, specificity 0.89, PPV 0.72, and NPV 0.82 versus RACE ≥5 of 0.55, 0.87, 0.68, 0.79 and CPSS ≥2 of 0.56, 0.85, 0.65, 0.78, respectively. Conclusions FAST-ED is a simple scale that if successfully validated in the field may be used by medical emergency professionals to identify LVOS in the pre-hospital setting enabling rapid triage of patients. PMID:27364531

  16. Does Pre-hospital Endotracheal Intubation Improve Survival in Adults with Non-traumatic Out-of-hospital Cardiac Arrest? A Systematic Review

    Directory of Open Access Journals (Sweden)

    Ling Tiah

    2014-11-01

    Full Text Available Introduction: Endotracheal intubation (ETI is currently considered superior to supraglottic airway devices (SGA for survival and other outcomes among adults with non-traumatic out-of-hospital cardiac arrest (OHCA. We aimed to determine if the research supports this conclusion by conducting a systematic review. Methods: We searched the MEDLINE, Scopus and CINAHL databases for studies published between January 1, 1980, and 30 April 30, 2013, which compared pre-hospital use of ETI with SGA for outcomes of return of spontaneous circulation (ROSC; survival to hospital admission; survival to hospital discharge; and favorable neurological or functional status. We selected studies using pre-specified criteria. Included studies were independently screened for quality using the Newcastle-Ottawa scale. We did not pool results because of study variability. Study outcomes were extracted and results presented as summed odds ratios with 95% CI. Results: We identified five eligible studies: one quasi-randomized controlled trial and four cohort studies, involving 303,348 patients in total. Only three of the five studies reported a higher proportion of ROSC with ETI versus SGA with no difference reported in the remaining two. None found significant differences between ETI and SGA for survival to hospital admission or discharge. One study reported better functional status at discharge for ETI versus SGA. Two studies reported no significant difference for favorable neurological status between ETI and SGA. Conclusion: Current evidence does not conclusively support the superiority of ETI over SGA for multiple outcomes among adults with OHCA. [West J Emerg Med. 2014;15(7:-0.

  17. Suspected acute coronary syndrome in the emergency room: Limited added value of heart type fatty acid binding protein point of care or ELISA tests: The FAME-ER (Fatty Acid binding protein in Myocardial infarction Evaluation in the Emergency Room) study.

    Science.gov (United States)

    Bank, Ingrid Em; Dekker, Marieke S; Hoes, Arno W; Zuithoff, Nicolaas Pa; Verheggen, Peter Whm; de Vrey, Evelyn A; Wildbergh, Thierry X; Timmers, Leo; de Kleijn, Dominique Pv; Glatz, Jan Fc; Mosterd, Arend

    2016-08-01

    Timely recognition of acute coronary syndrome remains a challenge as many biomarkers, including troponin, remain negative in the first hours following the onset of chest pain. We assessed the diagnostic accuracy of heart-type fatty acid binding protein (H-FABP), a cardiac biomarker with potential value immediately post symptom onset. Prospective monocentre diagnostic accuracy study of H-FABP bedside point of care (CardioDetect®) and ELISA tests in acute coronary syndrome suspected patients presenting within 24 hours of symptom onset to the emergency department, in addition to clinical findings, electrocardiography and the currently recommended biomarker high sensitivity troponin-T (hs-cTnT). The final diagnosis of acute coronary syndrome was adjudicated by two independent cardiologists, blinded to H-FABP results. Acute coronary syndrome was diagnosed in 149 (32.9%) of 453 unselected patients with suspected acute coronary syndrome (56% men, mean age 62.6 years). Negative predictive values were similar for H-FABP point of care and ELISA tests (79% vs. 78% respectively), but inferior to initial hs-cTnT (negative predictive value 86%). The addition of H-FABP point of care results to hs-cTnT increased the negative predictive value to 89%. In a multivariable logistic regression model, H-FABP point of care and ELISA tests yielded relevant diagnostic information in addition to clinical findings and ECG (likelihood ratio test pacute coronary syndrome presenting to the emergency department, H-FABP testing improves diagnostic accuracy in addition to clinical findings and electrocardiography. H-FABP, however, has no additional diagnostic value when hs-cTnT measurements are also available. © The European Society of Cardiology 2015.

  18. Complex Coronary Hemodynamics - Simple Analog Modelling as an Educational Tool.

    Science.gov (United States)

    Parikh, Gaurav R; Peter, Elvis; Kakouros, Nikolaos

    2017-01-01

    Invasive coronary angiography remains the cornerstone for evaluation of coronary stenoses despite there being a poor correlation between luminal loss assessment by coronary luminography and myocardial ischemia. This is especially true for coronary lesions deemed moderate by visual assessment. Coronary pressure-derived fractional flow reserve (FFR) has emerged as the gold standard for the evaluation of hemodynamic significance of coronary artery stenosis, which is cost effective and leads to improved patient outcomes. There are, however, several limitations to the use of FFR including the evaluation of serial stenoses. In this article, we discuss the electronic-hydraulic analogy and the utility of simple electrical modelling to mimic the coronary circulation and coronary stenoses. We exemplify the effect of tandem coronary lesions on the FFR by modelling of a patient with sequential disease segments and complex anatomy. We believe that such computational modelling can serve as a powerful educational tool to help clinicians better understand the complexity of coronary hemodynamics and improve patient care.

  19. [Evaluation of the status of patients with severe infection, criteria for intensive care unit admittance. Spanish Society for Infectious Diseases and Clinical Microbiology. Spanish Society of Intensive and Critical Medicine and Coronary Units].

    Science.gov (United States)

    Olaechea, Pedro M; Alvarez-Lerma, Francisco; Sánchez, Miguel; Torres, Antonio; Palomar, Mercedes; Fernández, Pedro; Miró, José M; Cisneros, José Miguel; Torres, Manuel

    2009-06-01

    Recent studies have shown that early attention in patients with serious infections is associated with a better outcome. Assistance in intensive care units (ICU) can effectively provide this attention; hence patients should be admitted to the ICU as soon as possible, before clinical deterioration becomes irreversible. The objective of this article is to compile the recommendations for evaluating disease severity in patients with infections and describe the criteria for ICU admission, updating the criteria published 10 years ago. A literature review was carried out, compiling the opinions of experts from the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC, Spanish Society for Infectious Diseases and Clinical Microbiology) and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC, Spanish Society for Intensive Medicine, Critical Care and Coronary Units) as well as the working groups for infections in critically ill patients (GEIPC-SEIMC and GTEI-SEMICYUC). We describe the specific recommendations for ICU admission related to the most common infections affecting patients, who will potentially benefit from critical care. Assessment of the severity of the patient's condition to enable early intensive care is stressed.

  20. A pilot randomised controlled trial of personalised care for depressed patients with symptomatic coronary heart disease in South London general practices: the UPBEAT-UK RCT protocol and recruitment

    Directory of Open Access Journals (Sweden)

    Tylee André

    2012-06-01

    Full Text Available Abstract Background Community studies reveal people with coronary heart disease (CHD are twice as likely to be depressed as the general population and that this co-morbidity negatively affects the course and outcome of both conditions. There is evidence for the efficacy of collaborative care and case management for depression treatment, and whilst NICE guidelines recommend these approaches only where depression has not responded to psychological, pharmacological, or combined treatments, these care approaches may be particularly relevant to the needs of people with CHD and depression in the earlier stages of stepped care in primary care settings. Methods This pilot randomised controlled trial will evaluate whether a simple intervention involving a personalised care plan, elements of case management and regular telephone review is a feasible and acceptable intervention that leads to better mental and physical health outcomes for these patients. The comparator group will be usual general practitioner (GP care. 81 participants have been recruited from CHD registers of 15 South London general practices. Eligible participants have probable major depression identified by a score of ≥8 on the Hospital Anxiety and Depression Scale depression subscale (HADS-D together with symptomatic CHD identified using the Modified Rose Angina Questionnaire. Consenting participants are randomly allocated to usual care or the personalised care intervention which involves a comprehensive assessment of each participant’s physical and mental health needs which are documented in a care plan, followed by regular telephone reviews by the case manager over a 6-month period. At each review, the intervention participant’s mood, function and identified problems are reviewed and the case manager uses evidence based behaviour change techniques to facilitate achievement of goals specified by the patient with the aim of increasing the patient’s self efficacy to solve their

  1. Coronary artery aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Koischwitz, D.; Harder, T.; Schuppan, U.; Thurn, P.

    1982-04-01

    Seven saccular coronary artery aneurysms have been demonstrated in the course of 1452 selective coronary artery angiograms. In six patients they were arterio-sclerotic; in one patient the aneurysm must have been congenital or of mycotic-embolic origin. The differential diagnosis between true aneurysms and other causes of vascular dilatation is discussed. Coronary artery aneurysms have a poor prognosis because of the possibility of rupture with resultant cardiac tamponade, or the development of thrombo-embolic myocardial infarction. These aneurysms can only be diagnosed by means of coronary angiography and require appropriate treatment.

  2. Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease

    Science.gov (United States)

    Williams, Michelle C.; Hunter, Amanda; Shah, Anoop S.V.; Assi, Valentina; Lewis, Stephanie; Smith, Joel; Berry, Colin; Boon, Nicholas A.; Clark, Elizabeth; Flather, Marcus; Forbes, John; McLean, Scott; Roditi, Giles; van Beek, Edwin J.R.; Timmis, Adam D.; Newby, David E.

    2016-01-01

    Background In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA). Objectives The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes. Methods In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records. Results Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590) PMID:27081014

  3. Predicting prolonged intensive care unit length of stay in patients undergoing coronary artery bypass surgery--development of an entirely preoperative scorecard.

    Science.gov (United States)

    Herman, Christine; Karolak, Wojtek; Yip, Alexandra M; Buth, Karen J; Hassan, Ansar; Légaré, Jean-Francois

    2009-10-01

    We sought to develop a predictive model based exclusively on preoperative factors to identify patients at risk for PrlICULOS following coronary artery bypass grafting (CABG). Retrospective analysis was performed on patients undergoing isolated CABG at a single center between June 1998 and December 2002. PrlICULOS was defined as initial admission to ICU exceeding 72 h. A parsimonious risk-predictive model was constructed on the basis of preoperative factors, with subsequent internal validation. Of 3483 patients undergoing isolated CABG between June 1998 and December 2002, 411 (11.8%) experienced PrlICULOS. Overall in-hospital mortality was higher among these patients (14.4% vs. 1.2%, Prisk predictive model of PrlICULOS in patients undergoing CABG was constructed. Based on preoperative clinical factors, a scorecard was developed allowing identification of these patients prior to surgery and allowing for strategies aimed at optimizing hospital resources.

  4. Large coronary intramural hematomas

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Thayssen, Per; Jensen, Lisette Okkels

    2015-01-01

    Isolated spontaneous coronary intramural hematoma is a unique subset of spontaneous coronary artery dissection that is characterized by a hemorrhage limited to the medial-adventitial layers, causing subsequent hematoma formation without visible intimal flaps. It is an infrequent and serious...... diagnostics and treatment strategy. Coronary intramural hematomas can also occur iatrogenically, as a complication to percutaneous coronary intervention (PCI). Coronary angiography (CAG) has limited diagnostic value in the absence of intimal dissections, and lesions are often angiographically ambiguous....... Intravascular ultrasound (IVUS) is an important diagnostic tool in establishing the correct diagnosis, as it provides a complete vessel wall assessment, and enables morphometric information regarding the magnitude and severity of the underlying hematoma. Due to the rarity of this clinical scenario...

  5. Invasive Management Strategies and Antithrombotic Treatments in Patients With Non-ST-Segment-Elevation Acute Coronary Syndrome in China: Findings From the Improving CCC Project (Care for Cardiovascular Disease in China).

    Science.gov (United States)

    Yang, Qing; Wang, Ying; Liu, Jing; Liu, Jun; Hao, Yongchen; Smith, Sidney C; Huo, Yong; Fonarow, Gregg C; Ma, Changsheng; Ge, Junbo; Taubert, Kathryn A; Morgan, Louise; Guo, Yang; Wang, Wei; Zhou, Yujie; Zhao, Dong

    2017-06-01

    Early invasive strategies and antithrombotic treatments are key treatments of non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). Few studies have examined the use of these strategies in patients with NSTE-ACS in China. This study aimed to assess the applications of invasive strategies and antithrombotic treatments in patients with NSTE-ACS and compare their outcomes. A nationwide registry study, Improving CCC (Care for Cardiovascular Disease in China) ACS project, was launched in 2014 as a collaborative study of the American Heart Association and Chinese Society of Cardiology (CSC), with 142 participating hospitals reporting details of clinical management and outcomes of patients with NSTE-ACS. The use of invasive strategies and antithrombotic treatments was examined based on updated guidelines. Major adverse cardiovascular events were analyzed. A total of 9953 patients with NSTE-ACS were enrolled. Angiography was performed in 63.1% of these patients, and 58.2% underwent percutaneous coronary intervention (PCI). However, 40.6% of patients did not undergo early risk assessment, and very-high-risk patients had the lowest proportion of PCI (41.7%). PCI was performed within recommended times in 11.1% of very-high-risk patients and 26.3% of high risk patients. Those who underwent PCI within 2 hours had higher mortality in high-risk and very-high-risk patients who received PCI. Early dual antiplatelet treatment was given in 88.3% of patients. There are notable differences between guideline recommendations and the clinical management of patients with NSTE-ACS in China. The reasons for very-high-risk NSTE-ACS patients not undergoing PCI, and the optimal timing of PCI, require further clarification. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02306616. © 2017 American Heart Association, Inc.

  6. Contemporary use of ticagrelor in patients with acute coronary syndrome: insights from Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART).

    Science.gov (United States)

    Sahlén, Anders; Varenhorst, Christoph; Lagerqvist, Bo; Renlund, Henrik; Wallentin, Lars; James, Stefan K; Jernberg, Tomas

    2016-01-01

    The platelet inhibitor ticagrelor is strongly recommended during 12 months post-acute coronary syndrome (ACS) in European guidelines. We analysed clinical characteristics of patients given ticagrelor for ACS in the real world. We studied the use of ticagrelor in patients admitted for ACS in Sweden between 1 January 2012 and 31 December 2013 who were enrolled in the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART). Clinical characteristics were investigated for patients prescribed ticagrelor at discharge as well as for patients undergoing percutaneous coronary intervention who were prescribed ticagrelor. Independent factors associated with selecting ticagrelor were analysed in logistic regression. We found that 44.0% (n = 12 601) out of a total of 28 639 patients had been prescribed ticagrelor at discharge. After adjusting for age and sex, prior cardiovascular disease was less common in patients discharged on ticagrelor (myocardial infarction, ischaemic stroke, and peripheral vascular disease; P for all <0.001). The risk of death as predicted by GRACE score and the risk of major bleeding as predicted by CRUSADE score were both lower in ticagrelor-treated patients vs. others (median 99 vs. 126 and median 23 vs. 25, respectively; P for both < 0.001). The intended treatment duration at discharge was 12 months in 82.5% of patients and <12 months in 9.3%. Ticagrelor is preferentially being used in patients at lower risk. A minority of patients are recommended ticagrelor during <12 months. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  7. [Endarterectomy of the coronary arteries].

    Science.gov (United States)

    Fischer, V; Simkovic, I; Holoman, M; Verchvodko, P; Janotík, P; Galbánek, J; Hulman, M; Kostelnicák, J; Jurco, R; Slezák, J

    1992-02-01

    The authors analyze 50 patients with endarterectomy of the coronary arteries during the periods of 1972-1974 and 1988-1990. The results of endarterectomy of the right and left coronary artery provide evidence of its justification in indicated cases whereby contrary to some departments the results of endarterectomy of the left coronary artery are comparable with endarterectomy of the right coronary artery.

  8. Selective coronary scintigraphy

    International Nuclear Information System (INIS)

    Gambini, D.-J.

    1975-01-01

    Isotopic techniques occupy a leading place amongst examinations practicable on coronary patients because of their reliability and the safety and simplicity of their use. The present work reviews the possible applications of selective coronary scintigraphy in pathology. After a brief discussion on scintigraphy, isotopic techniques for myocardium research, coronarography and other methods to study local myocardium perfusion the theoretical bases for the use of the exploration are studied, the techniques and methods employed are reported and the results discussed. Coronary scintigraphy consists of selective injection in the two coronary arteries previously catheterized during a coronarography, of two different populations of microspheres labelled with two physically short-lived indicators: 15μ 99m Tc-labelled serumalbumin microspheres, 10 to 15μ In-labelled siderophiline microspheres. Various studies have shown the complete harmlessness of the exploration when certain precautions are taken regarding the size and number of the spheres. The microspheres disperse into the downstream arterial territory proportionally to the number of capillaries present in the different parts of the irrigated region, and are temporarily stopped in the precapillaries. The preparation of the different images needed to interpret the Face and OAG examination for the left coronary, then for the right coronary, is carried out at the end of the coronarography and lasts about 45 minutes. It is also possible by selective injection in the aorta-coronary bridges to judge their functional condition by observation of the regions they irrigate. 56 patients of the Necker hospital cardiological clinic have been examined [fr

  9. Congenital coronary artery fistula

    International Nuclear Information System (INIS)

    Oh, Yeon Hee; Kim, Hong; Zeon, Seoc Kil; Suh, Soo Jhi

    1986-01-01

    Congenital coronary artery fistula (CCAF) is communication of a coronary artery or its main branch with one of the atria or ventricles, the coronary sinus, the superior vena cava, or the pulmonary artery. In Korean peoples, only 4 cases of the CCAF were reported as rare as worldwide and authors want to report another case of CCAF, confirmed by operation. 10-year-old girl shows a fistula between sinus node artery of the right coronary artery and right atrium on root aortogram with left-to-right shunt and Qp/Qs=1.58, in which simple ligation of the sinus node artery from right coronary artery was performed. All of the 5 Korean CCAF (4 were previously reported and 1 of authors) were originated from right coronary artery, and of which 4 were opening into right ventricle and 1 of authors were into right atrium. Associated cardiac anomaly was noted in only 1 case as single coronary artery. Ages were from 9 months of age to 10 years old and no adult left case were found. 3 were female and 2 were male patients.

  10. An eHealth Diary and Symptom-Tracking Tool Combined With Person-Centered Care for Improving Self-Efficacy After a Diagnosis of Acute Coronary Syndrome: A Substudy of a Randomized Controlled Trial.

    Science.gov (United States)

    Wolf, Axel; Fors, Andreas; Ulin, Kerstin; Thorn, Jörgen; Swedberg, Karl; Ekman, Inger

    2016-02-23

    Patients with cardiovascular diseases managed by a person-centered care (PCC) approach have been observed to have better treatment outcomes and satisfaction than with traditional care. eHealth may facilitate the often slow transition to more person-centered health care by increasing patients' beliefs in their own capacities (self-efficacy) to manage their care trajectory. eHealth is being increasingly used, but most studies continue to focus on health care professionals' logic of care. Knowledge is lacking regarding the effects of an eHealth tool on self-efficacy when combined with PCC for patients with chronic heart diseases. The objective of our study was to investigate the effect of an eHealth diary and symptom-tracking tool in combination with PCC for patients with acute coronary syndrome (ACS). This was a substudy of a randomized controlled trial investigating the effects of PCC in patients hospitalized with ACS. In total, 199 patients with ACS aged eHealth tool, or both, for at least 2 months after hospital discharge. The primary end point was a composite score of changes in general self-efficacy, return to work or prior activity level, and rehospitalization or death 6 months after discharge. Of the 94 patients in the intervention arm, 37 (39%) used the eHealth tool at least once after the index hospitalization. Most of these (24/37, 65%) used the mobile app and not the Web-based app as the primary source of daily self-rating input. Patients used the eHealth tool a mean of 38 times during the first 8 weeks (range 1-118, SD 33) and 64 times over a 6-month period (range 1-597, SD 104). Patients who used the eHealth tool in combination with the PCC intervention had a 4-fold improvement in the primary end point compared with the control group (odds ratio 4.0, 95% CI 1.5-10.5; P=.005). This improvement was driven by a significant increase in general self-efficacy compared with the control group (P=.011). Patients in the PCC group who did not use the eHealth tool

  11. Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study.

    Science.gov (United States)

    Nakahara, Shinji; Tomio, Jun; Takahashi, Hideto; Ichikawa, Masao; Nishida, Masamichi; Morimura, Naoto; Sakamoto, Tetsuya

    2013-12-10

    To evaluate the effectiveness of pre-hospital adrenaline (epinephrine) administered by emergency medical services to patients with out of hospital cardiac arrest. Controlled propensity matched retrospective cohort study, in which pairs of patients with or without (control) adrenaline were created with a sequential risk set matching based on time dependent propensity score. Japan's nationwide registry database of patients with out of hospital cardiac arrest registered between January 2007 and December 2010. Among patients aged 15-94 with out of hospital cardiac arrest witnessed by a bystander, we created 1990 pairs of patients with and without adrenaline with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) and 9058 pairs among those with non-VF/VT. Overall and neurologically intact survival at one month or at discharge, whichever was earlier. After propensity matching, pre-hospital administration of adrenaline by emergency medical services was associated with a higher proportion of overall survival (17.0% v 13.4%; unadjusted odds ratio 1.34, 95% confidence interval 1.12 to 1.60) but not with neurologically intact survival (6.6% v 6.6%; 1.01, 0.78 to 1.30) among those with VF/VT; and higher proportions of overall survival (4.0% v 2.4%; odds ratio 1.72, 1.45 to 2.04) and neurologically intact survival (0.7% v 0.4%; 1.57, 1.04 to 2.37) among those with non-VF/VT. Pre-hospital administration of adrenaline by emergency medical services improves the long term outcome in patients with out of hospital cardiac arrest, although the absolute increase of neurologically intact survival was minimal.

  12. Coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Dewey, Marc [Charite - Universitaetsmedizin Berlin (Germany). Inst. fuer Radiologie

    2009-07-01

    Coronary CT angiography has attained increasing scientific attention at academic institutions and has become a highly accurate diagnostic modality. Extending this knowledge into a practice setting is the purpose of 'Coronary CT Angiography'. This book will assist you in integrating cardiac CT into your daily practice, while also giving an overview of the current technical status and applications. The specific features of scanners from all four main vendors are also presented providing an objective overview of noninvasive coronary angiography using CT. (orig.)

  13. A Study of Platelet Inhibition, Using a 'Point of Care' Platelet Function Test, following Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction [PINPOINT-PPCI].

    Science.gov (United States)

    Johnson, Thomas W; Mumford, Andrew D; Scott, Lauren J; Mundell, Stuart; Butler, Mark; Strange, Julian W; Rogers, Chris A; Reeves, Barnaby C; Baumbach, Andreas

    2015-01-01

    Rapid coronary recanalization following ST-elevation myocardial infarction (STEMI) requires effective anti-platelet and anti-thrombotic therapies. This study tested the impact of door to end of procedure ('door-to-end') time and baseline platelet activity on platelet inhibition within 24hours post-STEMI. 108 patients, treated with prasugrel and procedural bivalirudin, underwent Multiplate® platelet function testing at baseline, 0, 1, 2 and 24hours post-procedure. Major adverse cardiac events (MACE), bleeding and stent thrombosis (ST) were recorded. Baseline ADP activity was high (88.3U [71.8-109.0]), procedural time and consequently bivalirudin infusion duration were short (median door-to-end time 55minutes [40-70] and infusion duration 30minutes [20-42]). Baseline ADP was observed to influence all subsequent measurements of ADP activity, whereas door-to-end time only influenced ADP immediately post-procedure. High residual platelet reactivity (HRPR ADP>46.8U) was observed in 75% of patients immediately post-procedure and persisted in 24% of patients at 2hours. Five patients suffered in-hospital MACE (4.6%). Acute ST occurred in 4 patients, all were <120mins post-procedure and had HRPR. No significant bleeding was observed. In a post-hoc analysis, pre-procedural morphine use was associated with significantly higher ADP activity following intervention. Baseline platelet function, time to STEMI treatment and opiate use all significantly influence immediate post-procedural platelet activity.

  14. Genome-wide association study of coronary heart disease and its risk factors in 8,090 African Americans: the NHLBI CARe Project.

    Directory of Open Access Journals (Sweden)

    Guillaume Lettre

    2011-02-01

    Full Text Available Coronary heart disease (CHD is the leading cause of mortality in African Americans. To identify common genetic polymorphisms associated with CHD and its risk factors (LDL- and HDL-cholesterol (LDL-C and HDL-C, hypertension, smoking, and type-2 diabetes in individuals of African ancestry, we performed a genome-wide association study (GWAS in 8,090 African Americans from five population-based cohorts. We replicated 17 loci previously associated with CHD or its risk factors in Caucasians. For five of these regions (CHD: CDKN2A/CDKN2B; HDL-C: FADS1-3, PLTP, LPL, and ABCA1, we could leverage the distinct linkage disequilibrium (LD patterns in African Americans to identify DNA polymorphisms more strongly associated with the phenotypes than the previously reported index SNPs found in Caucasian populations. We also developed a new approach for association testing in admixed populations that uses allelic and local ancestry variation. Using this method, we discovered several loci that would have been missed using the basic allelic and global ancestry information only. Our conclusions suggest that no major loci uniquely explain the high prevalence of CHD in African Americans. Our project has developed resources and methods that address both admixture- and SNP-association to maximize power for genetic discovery in even larger African-American consortia.

  15. The prevalence and clinical profile of angiographic coronary ectasia

    International Nuclear Information System (INIS)

    Sultana, R.; Ishaq, M.; Samad, A.

    2011-01-01

    To determine the incidence of Coronary Artery Ectasia (CAE) at our teaching hospital to describe the patients and angiographic characteristics. Methods: A retrospective analysis was conducted on all coronary angiograms performed at the catheterization laboratory of Karachi Institute of Heart Diseases, a tertiary care center, between the period of August 2006 and August 2008. A one year follow up was performed to look for primary and secondary endpoints. Data were collected from catheterization films, and medical records. Results: Five thousand coronary angiograms were performed during the period of of the study. A total of 140 (2.8%) angiograms showed coronary ectasia of both mixed and pure types. Pure ectasia with no coronary obstructive lesions was seen in 75 (1.5%). The left anterior descending artery (LAD) was the most commonly affected vessel (63%) followed by the right coronary artery (RCA) 25% and 10% patients had circumflex artery involvement. The primary composite endpoint showed 6 (4.2%) patients with non-ST elevation MI, 5 (3.6%) with ST elevation inferior wall myocardial infarction, 70 (50%) with unstable angina and 2 (1.4%) deaths due to pulmonary oedema. Secondary endpoints showed 50% of the patients still complaining of chest pain. Conclusion: Prevalence of Coronary ectasia in the population presenting to KIHD during the study period was 1.5%. Majority of patients were males, associated with dyslipidaemia, hypertension and smoking. CAE was associated with obstructive coronary artery disease in about 80% of cases. LAD was the most commonly affected vessel. (author)

  16. Comprehensive electrocardiogram-to-device time for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: A report from the American Heart Association mission: Lifeline program.

    Science.gov (United States)

    Shavadia, Jay S; French, William; Hellkamp, Anne S; Thomas, Laine; Bates, Eric R; Manoukian, Steven V; Kontos, Michael C; Suter, Robert; Henry, Timothy D; Dauerman, Harold L; Roe, Matthew T

    2018-03-01

    Assessing hospital-related network-level primary percutaneous coronary intervention (PCI) performance for ST-segment elevation myocardial infarction (STEMI) is challenging due to differential time-to-treatment metrics based on location of diagnostic electrocardiogram (ECG) for STEMI. STEMI patients undergoing primary PCI at 588 PCI-capable hospitals in AHA Mission: Lifeline (2008-2013) were categorized by initial STEMI identification location: PCI-capable hospitals (Group 1); pre-hospital setting (Group 2); and non-PCI-capable hospitals (Group 3). Patient-specific time-to-treatment categories were converted to minutes ahead of or behind their group-specific mean; average time-to-treatment difference for all patients at a given hospital was termed comprehensive ECG-to-device time. Hospitals were then stratified into tertiles based on their comprehensive ECG-to-device times with negative values below the mean representing shorter (faster) time intervals. Of 117,857 patients, the proportion in Groups 1, 2, and 3 were 42%, 33%, and 25%, respectively. Lower rates of heart failure and cardiac arrest at presentation are noted within patients presenting to high-performing hospitals. Median comprehensive ECG-to-device time was shortest at -9 minutes (25th, 75th percentiles: -13, -6) for the high-performing hospital tertile, 1 minute (-1, 3) for middle-performing, and 11 minutes (7, 16) for low-performing. Unadjusted rates of in-hospital mortality were 2.3%, 2.6%, and 2.7%, respectively, but the adjusted risk of in-hospital mortality was similar across tertiles. Comprehensive ECG-to-device time provides an integrated hospital-related network-level assessment of reperfusion timing metrics for primary PCI, regardless of the location for STEMI identification; further validation will delineate how this metric can be used to facilitate STEMI care improvements. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Acute Coronary Syndrome

    Science.gov (United States)

    ... heart cells are dying. An electrocardiogram (ECG or EKG) can diagnose an acute coronary syndrome by measuring ... Privacy Policy Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

  18. Coronary artery fistula

    Science.gov (United States)

    ... PA: Elsevier Saunders; 2015:chap 84. Friedman AH, Silverman NH. Congenital anomalies of the coronary arteries. In: ... provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the ...

  19. Coronary Artery Disease

    DEFF Research Database (Denmark)

    Christiansen, Morten Krogh

    2017-01-01

    A family history of coronary artery disease (CAD) is an important risk factor for adverse coronary events, in particular if the disease has an early onset. The risk of CAD is influenced by genetic and environmental factors with a greater genetic contribution earlier in life. Through recent years......), and to characterize and quantify subclinical atherosclerosis in their relatives. Furthermore, the aim was to explore the impact of common genetic risk variants on the age of onset, familial clustering and disease severity. In study I, 143 patients with early- onset CAD were recruited from the Western Denmark Heart...... Registry and risk factor control was evaluated. The study revealed that risk factors are common in early-onset CAD and that a large room for risk factor improvement remains. In study II, we used coronary computed tomography angiography to compare the coronary plaque burden and characteristics between 88...

  20. Acute coronary syndrome

    Science.gov (United States)

    ... Have plenty of fruits, veggies, whole grains, and lean meats. Try to limit foods high in cholesterol ... et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary ...

  1. A Study of Platelet Inhibition, Using a 'Point of Care' Platelet Function Test, following Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction [PINPOINT-PPCI].

    Directory of Open Access Journals (Sweden)

    Thomas W Johnson

    Full Text Available Rapid coronary recanalization following ST-elevation myocardial infarction (STEMI requires effective anti-platelet and anti-thrombotic therapies. This study tested the impact of door to end of procedure ('door-to-end' time and baseline platelet activity on platelet inhibition within 24hours post-STEMI.108 patients, treated with prasugrel and procedural bivalirudin, underwent Multiplate® platelet function testing at baseline, 0, 1, 2 and 24hours post-procedure. Major adverse cardiac events (MACE, bleeding and stent thrombosis (ST were recorded. Baseline ADP activity was high (88.3U [71.8-109.0], procedural time and consequently bivalirudin infusion duration were short (median door-to-end time 55minutes [40-70] and infusion duration 30minutes [20-42]. Baseline ADP was observed to influence all subsequent measurements of ADP activity, whereas door-to-end time only influenced ADP immediately post-procedure. High residual platelet reactivity (HRPR ADP>46.8U was observed in 75% of patients immediately post-procedure and persisted in 24% of patients at 2hours. Five patients suffered in-hospital MACE (4.6%. Acute ST occurred in 4 patients, all were <120mins post-procedure and had HRPR. No significant bleeding was observed. In a post-hoc analysis, pre-procedural morphine use was associated with significantly higher ADP activity following intervention.Baseline platelet function, time to STEMI treatment and opiate use all significantly influence immediate post-procedural platelet activity.

  2. Coronary hemodynamics in vasospastic angina

    International Nuclear Information System (INIS)

    Matsumura, Kentaro; Kubota, Shinobu; Serizawa, Takashi; Nakase, Emiko; Kawai, Ichiro; Saito, Takayuki

    1991-01-01

    To evaluate the coronary circulation and myocardial perfusion dynamics, we performed left coronary digital subtraction angiography (DSA) in 35 patients with vasospastic angina. The left coronary circulation time (CCT) measured from the proximal left coronary artery to the coronary sinus was 5.77±0.86 sec, and the left epicardial conducting artery transmission time (CAT) measured from the proximal left coronary artery to the apical area was 2.65±0.82 sec in normal controls. The CCT and CAT were significantly prolonged in patients with vasospastic angina, indicating that the coronary peripheral vascular resistance is probably greater after the cessation of nitrates and Ca ++ -antagonists. After the intracoronary injection of ergonovine malate, the CCT was slightly shortened, but the apical T 1/2 was significantly prolonged in patients with vasospastic angina. This suggested that coronary vasospasm is present not only in the epicardial arteries but also in coronary arteries with peripheral resistance. These phenomena were not observed in normal controls. We performed left coronary DSA after conventional left coronary cineangiography. When the CCT exceeded 6.7 sec, we considered that the coronary circulation was significantly impaired. We concluded that the coronary DSA is very useful for evaluating abnormal coronary circulation in patients with vasospastic angina during myocardial perfusion. (author)

  3. Contribution of inhibitory receptor glycoprotein iib / iiia in coronary angioplasty and acute coronary syndrome, about 152 patients

    International Nuclear Information System (INIS)

    Sellami, Walid

    2007-01-01

    The aim of our study was to evaluate the immediate results and long-term intake of anti-GP IIb / IIIa inhibitors for patients with acute coronary syndrome treated with coronary angioplasty. The use of anti-GP IIb / IIIa is a valid therapeutic option in patients with acute coronary syndrome with signs of severity and for patients undergoing complex angioplasty. Adverse effects of anti-GP IIb / IIIa can be seen to encourage vigilance and careful monitoring during the administration of these molecules and perfect knowledge of their pharmacological properties for appropriate use.

  4. Coronary tortuosity: a long and winding road.

    NARCIS (Netherlands)

    Zegers, E.S.; Meursing, B.T.J.; Oude Ophuis, A.J.M.

    2007-01-01

    Coronary tortuosity is a phenomenon often encountered by cardiologists performing coronary angiography. The aetiology and clinical importance of coronary tortuosity are still unclear. Coronary tortuosity without fixed atherosclerotic stenosis in patients with angina pectoris and an abnormal exercise

  5. Coronary Artery Anomalies in Animals

    Directory of Open Access Journals (Sweden)

    Brian A. Scansen

    2017-04-01

    Full Text Available Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.

  6. [Minimally invasive coronary artery surgery].

    Science.gov (United States)

    Zalaquett, R; Howard, M; Irarrázaval, M J; Morán, S; Maturana, G; Becker, P; Medel, J; Sacco, C; Lema, G; Canessa, R; Cruz, F

    1999-01-01

    There is a growing interest to perform a left internal mammary artery (LIMA) graft to the left anterior descending coronary artery (LAD) on a beating heart through a minimally invasive access to the chest cavity. To report the experience with minimally invasive coronary artery surgery. Analysis of 11 patients aged 48 to 79 years old with single vessel disease that, between 1996 and 1997, had a LIMA graft to the LAD performed through a minimally invasive left anterior mediastinotomy, without cardiopulmonary bypass. A 6 to 10 cm left parasternal incision was done. The LIMA to the LAD anastomosis was done after pharmacological heart rate and blood pressure control and a period of ischemic pre conditioning. Graft patency was confirmed intraoperatively by standard Doppler techniques. Patients were followed for a mean of 11.6 months (7-15 months). All patients were extubated in the operating room and transferred out of the intensive care unit on the next morning. Seven patients were discharged on the third postoperative day. Duplex scanning confirmed graft patency in all patients before discharge; in two patients, it was confirmed additionally by arteriography. There was no hospital mortality, no perioperative myocardial infarction and no bleeding problems. After follow up, ten patients were free of angina, in functional class I and pleased with the surgical and cosmetic results. One patient developed atypical angina on the seventh postoperative month and a selective arteriography confirmed stenosis of the anastomosis. A successful angioplasty of the original LAD lesion was carried out. A minimally invasive left anterior mediastinotomy is a good surgical access to perform a successful LIMA to LAD graft without cardiopulmonary bypass, allowing a shorter hospital stay and earlier postoperative recovery. However, a larger experience and a longer follow up is required to define its role in the treatment of coronary artery disease.

  7. Underutilization of high-intensity statin therapy after hospitalization for coronary heart disease.

    Science.gov (United States)

    Rosenson, Robert S; Kent, Shia T; Brown, Todd M; Farkouh, Michael E; Levitan, Emily B; Yun, Huifeng; Sharma, Pradeep; Safford, Monika M; Kilgore, Meredith; Muntner, Paul; Bittner, Vera

    2015-01-27

    National guidelines recommend use of high-intensity statins after hospitalization for coronary heart disease (CHD) events. This study sought to estimate the proportion of Medicare beneficiaries filling prescriptions for high-intensity statins after hospital discharge for a CHD event and to analyze whether statin intensity before hospitalization is associated with statin intensity after discharge. We conducted a retrospective cohort study using a 5% random sample of Medicare beneficiaries between 65 and 74 years old. Beneficiaries were included in the analysis if they filled a statin prescription after a CHD event (myocardial infarction or coronary revascularization) in 2007, 2008, or 2009. High-intensity statins included atorvastatin 40 to 80 mg, rosuvastatin 20 to 40 mg, and simvastatin 80 mg. Among 8,762 Medicare beneficiaries filling a statin prescription after a CHD event, 27% of first post-discharge fills were for a high-intensity statin. The percent filling a high-intensity statin post-discharge was 23.1%, 9.4%, and 80.7%, for beneficiaries not taking statins pre-hospitalization, taking low/moderate-intensity statins, and taking high-intensity statins before their CHD event, respectively. Compared with beneficiaries not on statin therapy pre-hospitalization, multivariable adjusted risk ratios for filling a high-intensity statin were 4.01 (3.58-4.49) and 0.45 (0.40-0.52) for participants taking high-intensity and low/moderate-intensity statins before their CHD event, respectively. Only 11.5% of beneficiaries whose first post-discharge statin fill was for a low/moderate-intensity statin filled a high-intensity statin within 365 days of discharge. The majority of Medicare beneficiaries do not fill high-intensity statins after hospitalization for CHD. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  8. Continuous ECG Monitoring in Patients With Acute Coronary Syndrome or Heart Failure: EASI Versus Gold Standard.

    Science.gov (United States)

    Lancia, Loreto; Toccaceli, Andrea; Petrucci, Cristina; Romano, Silvio; Penco, Maria

    2018-05-01

    The purpose of the study was to compare the EASI system with the standard 12-lead surface electrocardiogram (ECG) for the accuracy in detecting the main electrocardiographic parameters (J point, PR, QT, and QRS) commonly monitored in patients with acute coronary syndromes or heart failure. In this observational comparative study, 253 patients who were consecutively admitted to the coronary care unit with acute coronary syndrome or heart failure were evaluated. In all patients, two complete 12-lead ECGs were acquired simultaneously. A total of 6,072 electrocardiographic leads were compared (3,036 standard and 3,036 EASI). No significant differences were found between the investigate parameters of the two measurement methods, either in patients with acute coronary syndrome or in those with heart failure. This study confirmed the accuracy of the EASI system in monitoring the main ECG parameters in patients admitted to the coronary care unit with acute coronary syndrome or heart failure.

  9. Calcified Plaque of Coronary Artery: Factors Influencing Overestimation of Coronary Artery Stenosis on Coronary CT Angiography

    International Nuclear Information System (INIS)

    Kim, Mok Hee; Kim, Yun Hyeon; Choi, Song; Seon, Hyun Ju; Jeong, Gwang Woo; Park, Jin Gyoon; Kang, Heoung Keun; Ko, Joon Seok

    2010-01-01

    To assess the influence of calcified plaque characteristics on the overestimation of coronary arterial stenosis on a coronary CT angiography (CCTA). The study included 271 coronary arteries with calcified plaques identified by CCTA, and based on 928 coronary arteries from 232 patients who underwent both CCTA and invasive coronary angiography (ICA). Individual coronary arteries were classified into two groups by agreement based on the degree of stenosis from each CCTA and ICA: 1) group A includes patients with concordant CCTA and ICA results and, 2) group B includes patients with an overestimation of CCTA compared to ICA. Parameters including total calcium score, calcium score of an individual coronary artery, calcium burden number of an individual coronary artery, and the density of each calcified plaque (calcium score / number of calcium burden) for each individual coronary artery were compared between the two groups. Of the 271 coronary arteries, 164 (60.5%) were overestimated on CCTA. The left anterior descending artery (LAD) had a significantly low rate of overestimation (47.1%) compared to the other coronary arteries (p=0.001). No significant differences for total calcium score, calcium score of individual coronary artery, and the density of each calcified plaque from individual coronary arteries between two groups was observed. However, a decreasing tendency for the rate of overestimation on CCTA was observed with an increase in calcium burden of individual coronary arteries (p<0.05). The evaluation of coronary arteries suggests that the degree of coronary arterial stenosis had a tendency to be overestimated by calcified plaques on CCTA. However, the rate of overestimation for the degree of coronary arterial stenosis by calcified plaques was not significantly influenced by total calcium score, calcium score of individual coronary artery, and density of each calcified plaque

  10. Missing left main ostio-proximal coronary artery disease during angiography using tiger catheter

    Directory of Open Access Journals (Sweden)

    Biswajit Majumder

    2016-01-01

    Full Text Available Coronary angiography by right radial artery route using Optitorque Tiger catheter is on the rise given the low rate of local complications and feasibility to perform it as a day-care procedure. We report here a case of coronary angiography performed using Optitorque Tiger catheter (5-French which resulted in a diagnostic error, missing the ostio-proximal left main coronary artery disease which was later detected using EBU 3.5 guide catheter (7-French while performing angioplasty.

  11. Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

    NARCIS (Netherlands)

    Muinck, Ebo Derk de

    1994-01-01

    In this thesis several aspects of passive and active coronary perfusion during coronary angioplasty are investigated. The autoperfusion balloon catheters that were evaluated are the Stack® and the RX-60® catheters (Advanced Cardiovascular Systems, inc., Santa Clara, California, U.S.A). The coronary

  12. Coronary involvement in Churg-Strauss syndrome.

    Science.gov (United States)

    Dendramis, Gregory; Paleologo, Claudia; Piraino, Davide; Arrotti, Salvatore; Assennato, Pasquale

    2015-01-01

    Systemic autoimmune diseases are themselves a relevant and independent risk factor for atherosclerosis and coronary ectasia. We describe a case of a 58-year-old Caucasian man who was admitted to our department for unstable angina. History of asthma, paranasal sinus abnormality, and peripheral eosinophilia given a high suspicion of Churg-Strauss syndrome (CSS). Diagnosis was performed with 5 of the 6 American College of Rheumatology criteria. The knowledge that CSS is often associated with significant coronary artery involvement and the persistence of chest pain led us to performing immediately a coronary angiography. Coronary angiography showed diffuse ectasic lesions, chronic occlusion of left anterior descending artery with homocoronary collateral circulation from left circumflex artery and subocclusive stenosis in the proximal tract of posterior descending artery. The early recognition of CSS, an aggressive invasive diagnostic approach, and an early appropriate therapy are important to prevent the progressive and permanent cardiac damage in these patients. In the setting of a multidisciplinary approach, careful cardiac assessment is an essential step in CSS, even in mildly symptomatic patients. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  13. Perceived social support following percutaneous coronary intervention is a crucial factor in patients with coronary heart disease.

    Science.gov (United States)

    Kähkönen, Outi; Kankkunen, Päivi; Miettinen, Heikki; Lamidi, Marja-Leena; Saaranen, Terhi

    2017-05-01

    To describe perceived social support among patients with coronary heart disease following percutaneous coronary intervention. A low level of social support is considered a risk factor for coronary heart disease in healthy individuals and reduces the likelihood that people diagnosed with coronary heart disease will have a good prognosis. A descriptive cross-sectional study. A survey of 416 patients was conducted in 2013. A self-report instrument, Social Support of People with Coronary Heart Disease, was used. The instrument comprises three dimensions of social support: informational, emotional, functional supports and 16 background variables. Data were analysed using descriptive statistics, factor analysis, mean sum variables and multivariate logistic regression. Perceived informational support was primarily high, but respondents' risk factors were not at the target level. The weakest items of informational support were advice on physical activity, continuum of care and rehabilitation. Regarding the items of emotional support, support from other cardiac patients was the weakest. The weakest item of functional support was respondents' sense of the healthcare professionals' care of patients coping with their disease. Background variables associated with perceived social support were gender, marital status, level of formal education, profession, physical activity, duration of coronary heart disease and previous myocardial infarction. Healthcare professionals should pay extra attention to women, single patients, physically inactive patients, those demonstrating a lower level of education, those with a longer duration of CHD, and respondents without previous acute myocardial infarction. Continuum of care and counselling are important to ensure especially among them. This study provides evidence that healthcare professionals should be more aware of the individual needs for social support among patients with coronary heart disease after percutaneous coronary intervention

  14. Weaknesses and capacities affecting the Prehospital emergency care for victims of road traffic incidents in the greater Kampala metropolitan area: a cross-sectional study.

    Science.gov (United States)

    Balikuddembe, Joseph Kimuli; Ardalan, Ali; Khorasani-Zavareh, Davoud; Nejati, Amir; Raza, Owais

    2017-10-03

    Pre-hospital emergency care is a vital and integral component of health systems particularly in the resource constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities and trauma caused by the road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA). A cross-sectional study was conducted in the GKMA using a three-part structured questionnaire. Data related to the demographics, nature of RTIs and victims' pre-hospital experience and existing Emergency Medical Services (EMS) were collected from victims and EMS specialists in 3 hospitals and 5 EMS institutions respectively. Data was descriptively analyzed, and after the principal component analysis was employed to identify the most influential weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTI in the GKMA. From 459 RTI victims (74.7% males and 25.3% females) and 23 EMS specialists (91.3% males and 8.7% females) who participated in the study between May and June 2016, 4 and 5 key weaknesses and capacities respectively were identified to affect the pre-hospital emergency care for RTI victims in the GKMA. Although some strengths exist like ambulance facilitation, EMS structuring, coordination and others), the key weaknesses affecting the pre-hospital care for victims were noted to relate to absence of predefined EMS systems particularly in the GKMA and Uganda as a whole. They were identified to involve poor quality first aid treatment; insufficient skills/training of the first responders; inadequate EMS resources; and avoidable delays to respond and transport RTI victims to medical facilities. Though some strengths exist, the weaknesses affecting prehospital care for RTI victims primarily emanate from the absence of predefined and well-organized EMS systems in the GKMA and Uganda as a whole.

  15. Nuclear cardiology and coronary surgery

    DEFF Research Database (Denmark)

    Eckardt, R.; Andersen, L.I.; Hesse, B.

    2008-01-01

    Rising age, repeated percutaneous coronary revascularizations, and co-morbidity such as overweight, diabetes, and hypertension, characterize a change over the last 20-30 years in coronary patients referred to coronary artery bypass grafting (CABG). This patient group represents a great part of to...

  16. Resuscitation and post resuscitation care of the very old after out-of-hospital cardiac arrest is worthwhile.

    Science.gov (United States)

    Winther-Jensen, Matilde; Kjaergaard, Jesper; Hassager, Christian; Bro-Jeppesen, John; Nielsen, Niklas; Lippert, Freddy K; Køber, Lars; Wanscher, Michael; Søholm, Helle

    2015-12-15

    Out-of-hospital cardiac arrest (OHCA) is associated with a poor prognosis. As comorbidity and frailty increase with age; ethical dilemmas may arise when OHCA occur in the very old. We aimed to investigate mortality, neurological outcome and post resuscitation care in octogenarians (≥80) to assess whether resuscitation and post resuscitation care should be avoided. During 2007-2011 consecutive OHCA-patients were attended by the physician-based Emergency Medical Services-system in Copenhagen. Pre-hospital data based on Utstein-criteria, and data on post resuscitation care were collected. Primary outcome was successful resuscitation; secondary endpoints were 30-day mortality and neurological outcome (Cerebral Performance Category (CPC)). 2509 OHCA-patients with attempted resuscitation were recorded, 22% (n=558) were octogenarians/nonagenarians. 166 (30% of all octogenarians with resuscitation attempted) octogenarians were successfully resuscitated compared to 830 (43% with resuscitation attempted) patients <80 years. 30-day mortality in octogenarians was significantly higher after adjustment for prognostic factors (HR=1.61 CI: 1.22-2.13, p<0.001). Octogenarians received fewer coronary angiographies (CAG) (14 vs. 37%, p<0.001), and had lower odds of receiving CAG by multivariate logistic regression (OR: 0.19, CI: 0.08-0.44, p<0.001). A favorable neurological outcome (CPC 1/2) in survivors to discharge was found in 70% (n=26) of octogenarians compared to 86% (n=317, p=0.03) in the younger patients. OHCA in octogenarians was associated with a significantly higher mortality rate after adjustment for prognostic factors. However, the majority of octogenarian survivors were discharged with a favorable neurological outcome. Withholding resuscitation and post resuscitation care in octogenarians does not seem justified. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Clinical implementation of an emergency department coronary computed tomographic angiography protocol for triage of patients with suspected acute coronary syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Ghoshhajra, Brian B.; Staziaki, Pedro V.; Vadvala, Harshna; Kim, Phillip; Meyersohn, Nandini M.; Janjua, Sumbal A.; Hoffmann, Udo [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); Takx, Richard A.P. [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Neilan, Tomas G.; Francis, Sanjeev [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); Massachusetts General Hospital and Harvard Medical School, Division of Cardiology, Boston, MA (United States); Bittner, Daniel [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuernberg (FAU), Department of Medicine 2 - Cardiology, Erlangen (Germany); Mayrhofer, Thomas [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); Stralsund University of Applied Sciences, School of Business Studies, Stralsund (Germany); Greenwald, Jeffrey L. [Massachusetts General Hospital and Harvard Medical School, Department of Medicine, Boston, MA (United States); Truong, Quyhn A. [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); Weill Cornell College of Medicine, Department of Radiology, New York, NY (United States); Abbara, Suhny [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Boston, MA (United States); UT Southwestern Medical Center, Department Cardiothoracic Imaging, Dallas, TX (United States); Brown, David F.M.; Nagurney, John T. [Massachusetts General Hospital and Harvard Medical School, Department of Emergency Medicine, Boston, MA (United States); Januzzi, James L. [Massachusetts General Hospital and Harvard Medical School, Division of Cardiology, Boston, MA (United States); Collaboration: MGH Emergency Cardiac CTA Program Contributors

    2017-07-15

    To evaluate the efficiency and safety of emergency department (ED) coronary computed tomography angiography (CTA) during a 3-year clinical experience. Single-center registry of coronary CTA in consecutive ED patients with suspicion of acute coronary syndrome (ACS). The primary outcome was efficiency of coronary CTA defined as the length of hospitalization. Secondary endpoints of safety were defined as the rate of downstream testing, normalcy rates of invasive coronary angiography (ICA), absence of missed ACS, and major adverse cardiac events (MACE) during follow-up, and index radiation exposure. One thousand twenty two consecutive patients were referred for clinical coronary CTA with suspicion of ACS. Overall, median time to discharge home was 10.5 (5.7-24.1) hours. Patient disposition was 42.7 % direct discharge from the ED, 43.2 % discharge from emergency unit, and 14.1 % hospital admission. ACS rate during index hospitalization was 9.1 %. One hundred ninety two patients underwent additional diagnostic imaging and 77 underwent ICA. The positive predictive value of CTA compared to ICA was 78.9 % (95 %-CI 68.1-87.5 %). Median CT radiation exposure was 4.0 (2.5-5.8) mSv. No ACS was missed; MACE at follow-up after negative CTA was 0.2 %. Coronary CTA in an experienced tertiary care setting allows for efficient and safe management of patients with suspicion for ACS. (orig.)

  18. Anomalous origin of right coronary artery from left coronary sinus.

    Science.gov (United States)

    Hamzeh, Gadah; Crespo, Alex; Estarán, Rafael; Rodríguez, Miguel A; Voces, Roberto; Aramendi, José I

    2008-08-01

    Anomalous aortic origin of the coronary arteries is uncommon but clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe 4 patients, aged 34 to 59 years, who were diagnosed with right coronary artery arising from the left sinus of Valsalva, confirmed by coronary angiography, which was surgically repaired. Three patients presented dyspnea and angina, and one with acute myocardial infarction. At operation, the right coronary artery was dissected at the take-off from the intramural course, and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated coronary artery disease that required stent placement postoperatively. This reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives superior results to coronary artery bypass grafting or the unroofing technique.

  19. Visualization of atherosclerosis as detected by coronary artery calcium and carotid intima-media thickness reveals significant atherosclerosis in a cross-sectional study of psoriasis patients in a tertiary care center.

    Science.gov (United States)

    Santilli, S; Kast, D R; Grozdev, I; Cao, L; Feig, R L; Golden, J B; Debanne, S M; Gilkeson, R C; Orringer, C E; McCormick, T S; Ward, N L; Cooper, K D; Korman, N J

    2016-07-22

    Psoriasis is a chronic inflammatory disease of the skin and joints that may also have systemic inflammatory effects, including the development of cardiovascular disease (CVD). Multiple epidemiologic studies have demonstrated increased rates of CVD in psoriasis patients, although a causal link has not been established. A growing body of evidence suggests that sub-clinical systemic inflammation may develop in psoriasis patients, even from a young age. We aimed to evaluate the prevalence of atherosclerosis and identify specific clinical risk factors associated with early vascular inflammation. We conducted a cross-sectional study of a tertiary care cohort of psoriasis patients using coronary artery calcium (CAC) score and carotid intima-media thickness (CIMT) to detect atherosclerosis, along with high sensitivity C-reactive protein (hsCRP) to measure inflammation. Psoriasis patients and controls were recruited from our tertiary care dermatology clinic. Presence of atherosclerosis was defined using validated numeric values within CAC and CIMT imaging. Descriptive data comparing groups was analyzed using Welch's t test and Pearson Chi square tests. Logistic regression was used to analyze clinical factors associated with atherosclerosis, and linear regression to evaluate the relationship between psoriasis and hsCRP. 296 patients were enrolled, with 283 (207 psoriatic and 76 controls) having all data for the hsCRP and atherosclerosis analysis. Atherosclerosis was found in 67.6 % of psoriasis subjects versus 52.6 % of controls; Psoriasis patients were found to have a 2.67-fold higher odds of having atherosclerosis compared to controls [95 % CI (1.2, 5.92); p = 0.016], after adjusting for age, gender, race, BMI, smoking, HDL and hsCRP. In addition, a non-significant trend was found between HsCRP and psoriasis severity, as measured by PASI, PGA, or BSA, again after adjusting for confounders. A tertiary care cohort of psoriasis patients have a high prevalence of early

  20. Balloon angioplasty in acute and chronic coronary artery disease

    International Nuclear Information System (INIS)

    Holmes, D.R. Jr.; Vlietstra, R.E.

    1989-01-01

    Percutaneous transluminal coronary angioplasty has grown exponentially since its introduction. Currently, selection criteria include single-vessel and multivessel disease, stable and unstable angina, and acute infarction. The outcome depends on specific patient and antiographic characteristics. In ideal lesions, success rates should be greater than 90%, with low morbidity and mortality. With more severe and diffuse multivessel disease, success rates are lower and complication rates are higher. In these cases, percutaneous transluminal coronary angioplasty still offers a reasonable option, provided complete revascularization can be achieved or the angina-producing lesion dilated. Numerous issues remain unresolved, including (1) the role of percutaneous transluminal coronary angioplasty vs coronary surgery (currently being tested), (2) restenosis, which occurs in approximately 30% of treated lesions, and (3) organizational adjustments such as training and certification to maintain high standards of care

  1. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M-C. Morice (Marie-Claude); A.P. Kappetein (Arie Pieter); A. Colombo (Antonio); D.R. Holmes Jr (David); M.J. Mack (Michael); E. Stahle (Elisabeth); T.E. Feldman (Ted); M.J.B.M. van den Brand (Marcel); E.J. Bass (Eric); N. van Dyck (Nic); K. Leadly (Katrin); K.D. Dawkins (Keith); F.W. Mohr (Friedrich)

    2009-01-01

    textabstractBACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating

  2. A case of anomalous origin of the left coronary artery presenting with ...

    African Journals Online (AJOL)

    the Left coronary artery with its origin from the pulmonary trunk. He was admitted to the coronary care unit as a case of acute myocardial infarction with cardiovascular collapse. He received fluid resuscitation, inotropic support and standard management of heart failure. Six days later he was discharged home with a plan to ...

  3. Identifying strategies to maximise recruitment and retention of practices and patients in a multicentre randomised controlled trial of an intervention to optimise secondary prevention for coronary heart disease in primary care.

    LENUS (Irish Health Repository)

    Leathem, Claire S

    2009-01-01

    BACKGROUND: Recruitment and retention of patients and healthcare providers in randomised controlled trials (RCTs) is important in order to determine the effectiveness of interventions. However, failure to achieve recruitment targets is common and reasons why a particular recruitment strategy works for one study and not another remain unclear. We sought to describe a strategy used in a multicentre RCT in primary care, to report researchers\\' and participants\\' experiences of its implementation and to inform future strategies to maximise recruitment and retention. METHODS: In total 48 general practices and 903 patients were recruited from three different areas of Ireland to a RCT of an intervention designed to optimise secondary prevention of coronary heart disease. The recruitment process involved telephoning practices, posting information, visiting practices, identifying potential participants, posting invitations and obtaining consent. Retention involved patients attending reviews and responding to questionnaires and practices facilitating data collection. RESULTS: We achieved high retention rates for practices (100%) and for patients (85%) over an 18-month intervention period. Pilot work, knowledge of the setting, awareness of change in staff and organisation amongst participant sites, rapid responses to queries and acknowledgement of practitioners\\' contributions were identified as being important. Minor variations in protocol and research support helped to meet varied, complex and changing individual needs of practitioners and patients and encouraged retention in the trial. A collaborative relationship between researcher and practice staff which required time to develop was perceived as vital for both recruitment and retention. CONCLUSION: Recruiting and retaining the numbers of practices and patients estimated as required to provide findings with adequate power contributes to increased confidence in the validity and generalisability of RCT results. A

  4. Identifying strategies to maximise recruitment and retention of practices and patients in a multicentre randomised controlled trial of an intervention to optimise secondary prevention for coronary heart disease in primary care

    Directory of Open Access Journals (Sweden)

    Houlihan Ailish

    2009-06-01

    Full Text Available Abstract Background Recruitment and retention of patients and healthcare providers in randomised controlled trials (RCTs is important in order to determine the effectiveness of interventions. However, failure to achieve recruitment targets is common and reasons why a particular recruitment strategy works for one study and not another remain unclear. We sought to describe a strategy used in a multicentre RCT in primary care, to report researchers' and participants' experiences of its implementation and to inform future strategies to maximise recruitment and retention. Methods In total 48 general practices and 903 patients were recruited from three different areas of Ireland to a RCT of an intervention designed to optimise secondary prevention of coronary heart disease. The recruitment process involved telephoning practices, posting information, visiting practices, identifying potential participants, posting invitations and obtaining consent. Retention involved patients attending reviews and responding to questionnaires and practices facilitating data collection. Results We achieved high retention rates for practices (100% and for patients (85% over an 18-month intervention period. Pilot work, knowledge of the setting, awareness of change in staff and organisation amongst participant sites, rapid responses to queries and acknowledgement of practitioners' contributions were identified as being important. Minor variations in protocol and research support helped to meet varied, complex and changing individual needs of practitioners and patients and encouraged retention in the trial. A collaborative relationship between researcher and practice staff which required time to develop was perceived as vital for both recruitment and retention. Conclusion Recruiting and retaining the numbers of practices and patients estimated as required to provide findings with adequate power contributes to increased confidence in the validity and generalisability of RCT

  5. Coronary artery anatomy and variants

    Energy Technology Data Exchange (ETDEWEB)

    Malago, Roberto; Pezzato, Andrea; Barbiani, Camilla; Alfonsi, Ugolino; Nicoli, Lisa; Caliari, Giuliana; Pozzi Mucelli, Roberto [Policlinico G.B. Rossi, University of Verona, Department of Radiology, Verona (Italy)

    2011-12-15

    Variants and congenital anomalies of the coronary arteries are usually asymptomatic, but may present with severe chest pain or cardiac arrest. The introduction of multidetector CT coronary angiography (MDCT-CA) allows the detection of significant coronary artery stenosis. Improved performance with isotropic spatial resolution and higher temporal resolution provides a valid alternative to conventional coronary angiography (CCA) in many patients. MDCT-CA is now considered the ideal tool for three-dimensional visualization of the complex and tortuous anatomy of the coronary arteries. With multiplanar and volume-rendered reconstructions, MDCT-CA may even outperform CCA in determining the relative position of vessels, thus providing a better view of the coronary vascular anatomy. The purpose of this review is to describe the normal anatomy of the coronary arteries and their main variants based on MDCT-CA with appropriate reconstructions. (orig.)

  6. [Pregnancy and coronary artery dissection].

    Science.gov (United States)

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Acute myocardial infarction during pregnancy is associated with high maternal and fetal mortality. Coronary atherosclerosis is the most common cause due to an increase in the age of the patients and the association with cardiovascular risk factors such as smoking, hypertension, diabetes mellitus, preeclampsia, and the existence of family history of coronary disease. However, thrombosis, coronary dissection or coronary vasospasms are other causes that may justify it. We report the case of a 33 weeks pregnant first-time mother, without cardiovascular risk factors, who presented an acute coronary event in the context of atherosclerotic disease and coronary dissection after percutaneous coronary intervention. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  7. Coronary MR angiography: current status

    International Nuclear Information System (INIS)

    Danias, P.G.; Manning, W.J.

    2000-01-01

    Since first described in the early 1990s, coronary magnetic resonance angiography (MRA) has evolved as a promising noninvasive modality for imaging of the coronary arteries and evaluation of coronary artery disease. Despite technical limitations, coronary MRA has established value for imaging of anomalous coronary arteries and assessment of bypass graft patency. Current research focuses on the development of optimal respiratory compensation strategies, improved spatial and temporal resolution and faster acquisition of image data. The accurate detection of stenoses and assessment of the severity of coronary atherosclerosis is presently being evaluated with large multi-center studies. With further technique enhancements and more clinical experience, coronary MRA is likely to become the dominant noninvasive modality in clinical cardiology. (orig.) [de

  8. Prevalence of Atherosclerotic Coronary Stenosis in Asymptomatic North Indian Population: A Post-mortem Coronary Angiography Study.

    Science.gov (United States)

    Bansal, Yogender Singh; Mandal, Shatrugan Prasad; Kumar, Senthil; Setia, Puneet

    2015-09-01

    A preliminary study of coronaries using post-mortem angiography was undertaken to see the prevalence of atherosclerotic coronary stenosis in non-cardiac unnatural deaths. This study was conducted in a tertiary care centre located in Chandigarh. A total of 128 medico-legal cases were studied comprising 88 males and 40 females. Post-mortem examinations of these MLC cases were conducted in the Department of Forensic Medicine, PGIMER, Chandigarh. All hearts were visually screened by post-mortem coronary angiography first and then grossly examined using serial transverse incision technique in positive screening cases to find the degree of narrowing. Of the study group, 34% males and 20% females showed evidence of narrowing on angiography. Of the males showing coronary stenosis, 83% had single vessel disease and 13% had double vessel disease, while only one individual had triple vessel disease. In cases of female, all the cases of coronary stenosis were single vessel disease. Left anterior descending coronary artery (LAD) was the most common vessel involved, followed by right coronary artery (RCA) & Left circumflex artery (LCX) and in cases of double vessel disease, LAD in combination with LCX was responsible for 75% of the cases. Remarkably 23.6% of study population in the age group of less than 40 years showed appreciable narrowing in at least one of the coronaries. In general, the prevalence of CAD is on the rise, particularly in younger population owing to the changes in their lifestyle and food habits. This preliminary study revealed evidence of narrowing of at least one coronary in 34% male and 20% female population and 23.6% subjects were less than 40 years old. Further detailed studies are needed especially in younger age group and to support the need for preventive cardiology in the early years of life.

  9. Las vivencias del paciente coronario en la unidad de cuidados críticos The experience of the coronary patient in critical care

    Directory of Open Access Journals (Sweden)

    Mª del Carmen Solano Ruiz

    2005-03-01

    Full Text Available El objetivo de este estudio es describir la experiencia vivida de los pacientes que sufren una cardiopatía isquémica en la unidad de cuidados intensivos. Se trata de un diseño cualitativo de tipo fenomenológico descriptivo realizado en una muestra de 10 pacientes que padecían infarto agudo de miocardio o angina de pecho. La recogida de datos se realizó a través de una entrevista semiestructurada. Para el análisis de los datos se utilizó el método de Giorgi (1985. Tras el análisis la descripción general recoge dos temas principales: las sensaciones vividas por los pacientes en el momento del ingreso en la unidad, así como los principales sentimientos de desánimo, frustración, injusticia, miedo y de carga familiar entre otros que aparecen durante la estancia en la misma. Estos hallazgos permitirán establecer unas actuaciones de enfermería dirigidas a minimizar sentimientos negativos y favorecer una evolución más satisfactoria de su proceso de enfermedad.The objective describe the experience that patients with isquemic cardiopathy in the unit of intensive cares.This study is developed with a qualitative design of descriptive and phenomenologycal type, made in a sample of 10 patients who suffered acute infarct of myocardium or angina of chest. The collection of data was made through a interview semiestructured and the information was recorded in a magnetic tape. The data analysis process was developed with the method of Giorgi (1985. After the analysis the general description developed two main subjects: the sensations that had lived by the patients at the moment of the entrance in the unit, as well as the main feelings: downheart, frustration, injustice, fear and familiar load. These feelings appear during the stay in the same one. In this study we have been able to know with depth the experience felt by the patients with isquemic cardiopathy in the critical cares units, these findings will allow implementing the changes in order

  10. The study of diagnosis status and, transfer time of stroke patients transferred by pre-hospital emergency medical system (EMS to Vali-Asr hospital in Arak City

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    Saiedeh Bahrampouri

    2013-08-01

    Full Text Available Introduction: Stroke is main cause of death and disability in worldwide and emergency care can decrease complications. Emergency Medical System transferred half of stroke patients to hospital, so improve accuracy of diagnosis may accelerated treatment. This study aimed to determine diagnosis status and, transfer time of stroke patients transferred by prehospital Emergency Medical System to hospital in Arak City. Methods: This study was descriptive -analytic study and all 43 patient’s records with a diagnosis of stroke that transferred by Emergency Medical System to hospital in Arak City was selected. The study Checklist was contained information about age, sex, type of accident prehospital, response time, scene time, transfer time and total time from inpatients records and Emergency Center statistics .Regarding data analysis,SPSS19 software and descriptive statistical tests were used. Results: Mean (SD of age all patients were 73/7±3/8 and 51/2% were women. Ambulance paramedics' stroke diagnosis was correct in 15 (34/9%,20(46/5%of false and 8(18/6% not diagnosed for stroke patients who initially presented to them. The most common non stroke conditions were confusion. Mean response time and scene time, transfer time and total time were 6/9,16/9,9/1 and 35/3 minutes, respectively. In patients with correct diagnose stroke, mean response, scene, transfer and total time were 7,17/1,3/9 and 35/7 minutes. The people with the wrong diagnosis or no diagnosis of stroke by emergency medical personnel were taken to hospital, Mean response, scene, transfer and total time were 6/9, 16/8,9/7 and 33/5 minutes. Conclusions: The results of this study showed that, the correct diagnosis by EMS personnel could be resulted faster transferring patient to definite treatment center.It is recommended to develop prehospital diagnosis tool of stroke, which is contextually adapted and appropriate to facilitate diagnose of strokes and improve the quality of care.

  11. Resposta circulatória à caminhada de 50 m na unidade coronariana, na síndrome coronariana aguda Respuesta circulatoria a la caminata de 50m en la unidad coronaria, en la síndrome coronaria aguda Circulatory response to a 50-m walk in the coronary care unit in acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Cristiane Maria Carvalho Costa Dias

    2009-02-01

    ños. Caminata con inicio 45 ± 23 horas post internación. Se calcularon la presión arterial sistólica (PAS mmHg y diastólica (PAD mmHg, la frecuencia cardiaca (FC bpm, el doble producto (PAS mmHg X FC bpm, la saturación periférica de oxígeno (SpO2%, el tiempo de caminata y la percepción del esfuerzo a través de la escala de Borg (EB. Se obtuvieron mediciones en las posiciones supina, sentada y ortostasis (fase 1 - estrés gravitacional, al final de la caminata y del post reposo de 5 minutos (fase 2 - estrés físico. RESULTADOS: Se observó un aumento de la frecuencia cardiaca (FC al estrés gravitacional en la posición sentada (Δ = 4,18 y en ortostasis (Δ = 2,69, (p 142 mmHg al sentarse se asoció al aumento significativo (p = 0,031 de 11 mmHg al ejercicio en 13 pacientes con sobrepeso/obesidad y el 85% con hipertensión. Se verificaron efectos adversos en 19 (29,2% pacientes, vértigos en el 23,1%, con interrupción de la caminata en tres de ellos. CONCLUSIÓN: En esta muestra, tras 24 horas del evento coronario, no se verificaron efectos colaterales graves a la C50m.BACKGROUND: Lack of a standardized and monitored technique to start rehabilitation of patients with acute coronary syndrome (ACS in the coronary care unit. OBJECTIVE: To describe the technique of and circulatory response to a 50-m walk (W50m. METHODS: Experimental cross-sectional study of 65 patients with ACS; of these, 36 (54% with acute myocardial infarction (AMI, Killip I, 29 (45.2% with unstable angina (UA, 61.5% males with age of 62.8 ± 12.7 years. Walk was started 45±23h after hospitalization. Parameters measured: systolic blood pressure (SBP mmHg, diastolic blood pressure (DBP mmHg, heart rate (HR bpm, double product (SBP mmHg X HR bpm, peripheral oxygen saturation (SpO2%, walking time, and exercise tolerance by Borg scale (BS. Measurements were taken while supine, sitting, in orthostasis (phase 1 [gravitational stress], end of the walk, and after a 5-minute rest (phase 2 [exercise stress

  12. Coronary CT Angiography in the Quantitative Assessment of Coronary Plaques

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    Zhonghua Sun

    2014-01-01

    Full Text Available Coronary computed tomography angiography (CCTA has been recently evaluated for its ability to assess coronary plaque characteristics, including plaque composition. Identification of the relationship between plaque composition by CCTA and patient clinical presentations may provide insight into the pathophysiology of coronary artery plaque, thus assisting identification of vulnerable plaques which are associated with the development of acute coronary syndrome. CCTA-generated 3D visualizations allow evaluation of both coronary lesions and lumen changes, which are considered to enhance the diagnostic performance of CCTA. The purpose of this review is to discuss the recent developments that have occurred in the field of CCTA with regard to its diagnostic accuracy in the quantitative assessment of coronary plaques, with a focus on the characterization of plaque components and identification of vulnerable plaques.

  13. Adesão às precauções padrão pela equipe do atendimento pré-hospitalar móvel de Belo Horizonte, Minas Gerais, Brasil Adherence to standard precautions by the public pre-hospital health team in Belo Horizonte, Minas Gerais State, Brazil

    Directory of Open Access Journals (Sweden)

    Aline Cristine Souza Lopes

    2008-06-01

    Full Text Available Estudo transversal com profissionais do Serviço de Atendimento Pré-hospitalar de Belo Horizonte, Minas Gerais, Brasil, com o objetivo de avaliar a adesão às precauções padrão. Instrumento constou de questões sobre conhecimento, atitude e fatores facilitadores à adesão das precauções. Para verificar a adesão considerou-se percentual de adequação: > 75% de respostas corretas. Condutores apresentaram menor e médicos maior grau de conhecimento. No relato das atitudes, profissionais não alcançaram adequação para uso de máscara facial, óculos e equipamento proteção individual (EPI, e, condutores relataram atitude inadequada para todos itens. Na análise univariada, categoria profissional, sexo e unidade de lotação foram associados à adoção das precauções. Já na multivariada, apenas categoria profissional (condutor e técnico/auxiliar enfermagem. Fatores facilitadores mais citados para melhorar adesão foram: treinamentos sobre infecções, riscos ocupacionais e uso de EPI; reuniões periódicas de equipe; e criação de central para limpeza, desinfecção e esterilização de material. Profissionais do Serviço de Atendimento Pré-hospitalar demonstraram atitudes compatíveis com conhecimento. No entanto, a profissão interferiu no conhecimento das medidas de precaução e no relato de atitudes adequadas.This was a cross-sectional study of workers in the pre-hospital care team in Belo Horizonte, Minas Gerais State, Brazil, aimed at evaluating adherence to precautions. The study instrument included questions on knowledge, attitudes, and facilitating factors for adherence to standard precautions. Adherence was verified by percentage of adequacy: > 75% correct answers. Drivers showed the lowest degree of knowledge and physicians the highest. In self-reported answers, none of the workers demonstrated adequate use of face masks, goggles, or personal protective equipment (PPE, and drivers reported inadequate attitudes on all

  14. Improving prehospital trauma care in Rwanda through continuous quality improvement: an interrupted time series analysis.

    Science.gov (United States)

    Scott, John W; Nyinawankusi, Jeanne D'Arc; Enumah, Samuel; Maine, Rebecca; Uwitonze, Eric; Hu, Yihan; Kabagema, Ignace; Byiringiro, Jean Claude; Riviello, Robert; Jayaraman, Sudha

    2017-07-01

    Injury is a major cause of premature death and disability in East Africa, and high-quality pre-hospital care is essential for optimal trauma outcomes. The Rwandan pre-hospital emergency care service (SAMU) uses an electronic database to evaluate and optimize pre-hospital care through a continuous quality improvement programme (CQIP), beginning March 2014. The SAMU database was used to assess pre-hospital quality metrics including supplementary oxygen for hypoxia (O2), intravenous fluids for hypotension (IVF), cervical collar placement for head injuries (c-collar), and either splinting (splint) or administration of pain medications (pain) for long bone fractures. Targets of >90% were set for each metric and daily team meetings and monthly feedback sessions were implemented to address opportunities for improvement. These five pre-hospital quality metrics were assessed monthly before and after implementation of the CQIP. Met and unmet needs for O2, IVF, and c-collar were combined into a summative monthly SAMU Trauma Quality Scores (STQ score). An interrupted time series linear regression model compared the STQ score during 14 months before the CQIP implementation to the first 14 months after. During the 29-month study period 3,822 patients met study criteria. 1,028 patients needed one or more of the five studied interventions during the study period. All five endpoints had a significant increase between the pre-CQI and post-CQI periods (pRwanda. This programme may be used as an example for additional efforts engaging frontline staff with real-time data feedback in order to rapidly translate data collection efforts into improved care for the injured in a resource-limited setting. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Acute Right Coronary Ostial Stenosis during Aortic Valve Replacement

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    Sarwar Umran

    2012-01-01

    Full Text Available We report a rare case of acute right coronary artery stenosis developing in a patient undergoing aortic valve replacement. We present a case report with a brief overview of the literature relating to coronary artery occlusion associated with cardiac valve surgery - the theories and treatments are discussed. A 85 year-old female was admitted under the care of the cardiothoracic team with signs and symptoms of heart failure. Investigations, including cardiac echocardiography and coronary angiography, indicated a critical aortic valve stenosis. Intraoperative right ventricular failure ensued post aortic valve replacement. Subsequent investigations revealed an acute occlusion of the proximal right coronary artery with resultant absence of distal flow supplying the right ventricle. An immediate right coronary artery bypass procedure was performed with resolution of the right ventricular failure. Subsequent weaning off cardiopulmonary bypass was uneventful and the patient continued to make excellent recovery in the postoperative phase. To our knowledge this is one of the few documented cases of intraoperative acute coronary artery occlusion developing during valve surgery. However, surgeons should be aware of the potential for acute occlusion so that early recognition and rapid intervention can be instituted.

  16. Motivation is a crucial factor for adherence to a healthy lifestyle among people with coronary heart disease after percutaneous coronary intervention.

    Science.gov (United States)

    Kähkönen, Outi; Kankkunen, Päivi; Saaranen, Terhi; Miettinen, Heikki; Kyngäs, Helvi; Lamidi, Marja-Leena

    2015-10-01

    To test the Theory of Adherence of People with Chronic Disease with regard to adherence to treatment among patients with coronary heart disease after a percutaneous coronary intervention. Increased knowledge of the concept of adherence is needed for the development of nursing interventions and nursing guidelines for patients with coronary heart disease. A cross-sectional, multi-centre study. This study was conducted from February-December 2013 with 416 patients with coronary heart disease 4 months after undergoing a percutaneous coronary intervention. A self-reported questionnaire was used to assess their adherence to treatment. Data were analysed using structural equation modelling. The theory explained 45% of the adherence to a healthy lifestyle and 7% of the adherence to medication. Structural equation modelling confirmed that motivation and results of care had the highest association with adherence to a healthy lifestyle. Responsibility was associated with adherence to medication. Support from next of kin, support from nurses and physicians, and motivation, co-operation, fear of complications and a sense of normality were associated with adherence. Patients who are motivated to perform self-care and consider the results of care to be important were more likely to adhere to a healthy lifestyle. Responsible patients were more likely to adhere to their medication. It is important to account for these elements as a part of secondary prevention strategies among patients with coronary heart disease after a percutaneous coronary intervention. © 2015 John Wiley & Sons Ltd.

  17. Does pre-hospital telephone communication with a clinician result in more appropriate medication administration by parents during childhood asthma exacerbations?

    Science.gov (United States)

    Garro, A C; Fearon, D; Koinis-Mitchell, D; McQuaid, E L

    2009-11-01

    The National Heart, Lung and Blood Institute asthma guidelines recommend that parents communicate with a clinician during childhood asthma exacerbations when symptoms worsen or do not improve with initial therapy. This study tested the hypothesis that communication by parents with a clinician before an Emergency Department visit was associated with more appropriate medication administration for children with asthma exacerbations. This was a retrospective cohort study using data gathered from parents of children presenting with an asthma exacerbation to the emergency department. The communicating cohort included parents who communicated by telephone with a clinician during the exacerbation and the non-communicating cohort included parents who did not. Multivariate logistic regression models were used to test three hypotheses; communication with a clinician is associated with (1) administration of short-acting beta-agonists (SABAs), (2) increased dosing frequency of SABAs, and (3) administration of an oral corticosteroid. A total of 199 subjects were enrolled, with 104 (52.3%) in the communicating and 95 (47.7%) in the non-communicating cohort. There was an association between communication and provider practice type, with children who received routine care from a private practice provider more likely to communicate with the clinician than children in hospital-based clinics or community health centers (Adjusted OR 1.9, 95% CI 1.0-3.7). Impoverished children and children insured by Medicaid were less likely to communicate with a clinician (controlling for provider type). Parents who communicated with a clinician were more likely to administer a SABA (adjusted OR 3.6, 95% CI 1.3-9.4) and an oral corticosteroid (adjusted OR 3.3, 95% CI 1.3-8.4) but were not more likely to administer a SABA with increased dosing frequency (adjusted OR 0.9, 95% CI 0.5-1.6). Parents of children with asthma exacerbations who communicated with clinicians were more likely to administer SABAs

  18. Percutaneous transluminal coronary angioplasty

    International Nuclear Information System (INIS)

    Przybojewski, J.Z.; Weich, H.F.H.

    1984-01-01

    The purpose of this article is to review PTCA, percutaneous transluminal coronary angioplasty, which can be considered to be a truly revolutionary and fairly simple invasive form of intervention to atherosclerotic obstruction. The 'epidemic' of IHD, ischaemic heart disease, in the Republic of South Africa calls for the employment of this technique, which has already been carried out in a few teaching hospitals in this country. Very recently, modified balloon dilatation catheters have been used percutaneously in the non-operative transluminal correction of congenital coarctation of the aorta in infants and children, congenital pulmonary value stenosis, and hypoplasia and stenosis of the pulmonary arteries. It has also been employed for PTCA and for the simultaneous occlusion of coronary-bronchial artery anastomosis using a detachable balloon. The isotopes thallium 201 and technetium 99 were also used in scintiscanning

  19. Meniscotibial (coronary) ligament tears

    International Nuclear Information System (INIS)

    El-Khoury, G.Y.; Usta, H.Y.; Berger, R.A.

    1984-01-01

    Preservation of the meniscus whenever possible is essential in maintaining knee stability and preventing premature osteoarthritis. Peripheral meniscal tears are the most amenable to surgical repair. This study evaluates the peripheral attachments of the medial meniscus and focuses on a specific tear limited to the meniscotibial ligament (coronary ligament). The diagnosis is made arthrographically when the medial meniscus floats above the tibial plateau without separating completely from the capsule. The lateral meniscus is rarely involved in this type of injury. (orig.)

  20. Detecting depression in patients with coronary heart disease: a diagnostic evaluation of the PHQ-9 and HADS-D in primary care, findings from the UPBEAT-UK study.

    Directory of Open Access Journals (Sweden)

    Mark Haddad

    Full Text Available People with coronary heart disease (CHD are at heightened risk of depression, and this co-occurrence of conditions is associated with poorer outcomes including raised mortality. This study compares the diagnostic accuracy of two depression case finding instruments in CHD patients relative to a diagnostic standard, the revised Clinical Interview Schedule (CIS-R.The Patient Health Questionnaire (PHQ-9, the Hospital Anxiety and Depression Scale depression subscale (HADS-D and the CIS-R depression module were administered to 803 patients identified from the CHD registers of GP practices in Greater London.Of 730 recruited patients without previously identified depression, 32 (4.4% met ICD-10 depressive episode criteria according to the CIS-R. For the PHQ-9 and HADS-D lower cut-points than those routinely recommended were associated with improved case identifying properties. The PHQ-9 appeared the superior instrument using a cut-point of ≥8 (sensitivity=94%; specificity=84%. Using categorical scoring the PHQ-9 was 59% sensitive and 95% specific. For the HADS-D using cut-point ≥5, sensitivity was 81% and specificity was 77%. Areas under the curves (AUC (standard error were 0.95 (0.01 and 0.88 (0.02 for the PHQ-9 and HADS-D, and 0.91 (0.02 for PHQ-9 using the categorical algorithm. Statistically significant differences between AUCs of the PHQ-9 and the HADS-D favoured the former. Severity ratings compared across measures indicated inconsistency between recommended bandings: the PHQ-9 categorised a larger proportion of participants with mild and moderate depression.This is the first large-scale investigation of the accuracy of these commonly used measures within a primary care CHD population. Our results suggest that although both scales have acceptable abilities and can be used as case identification instruments for depression in patients with CHD, the PHQ-9 appeared diagnostically superior. Importantly, optimal cut-off points for depression

  1. Spontaneous coronary artery dissection: Case series and review of literature

    Directory of Open Access Journals (Sweden)

    Satyavan Sharma

    2016-07-01

    Implications and practice: The awareness of SCAD is important for all clinicians involved in STEMI care. A prompt suspicion can avoid administration of thrombolytic therapy. Early coronary angiography will provide an accurate diagnosis and help in deciding appropriate therapy. Percutaneous intervention can be challenging.

  2. Dyslipidaemia and coronary heart disease: nature vs nurture.

    Science.gov (United States)

    Hegele, R A

    In order to enhance health care for patients with coronary heart disease (CHD), genetic markers of susceptibility could be incorporated into a formula for risk evaluation that includes traditional factors. Preventive measures could then be targeted towards 'high-risk' subjects. But can the genetic component be dissected from the environmental component in an intermediate CHD phenotype, such as plasma lipoproteins.

  3. CMR diagnosis of coronary graft fistula

    Directory of Open Access Journals (Sweden)

    Bengt Johansson

    2014-01-01

    Full Text Available The patient is a 54-year old man with a previous history of cerebral aqueduct stenosis and hydrocephalus resulting in malignant hypertension who had surgery for permanent ventriculo-peritoneal shunt. At age 41, he had coronary artery bypass graft (CABG surgery with the right internal mammary artery anastomosed to the posterior descending artery and a saphenous vein graft to the first obtuse marginal branch. The patient was recently admitted with pneumonia that rapidly deteriorated and he went in respiratory failure requiring mechanical ventilation. A thoracic CT investigation showed massive bilateral pulmonary infiltrates, pulmonary artery embolism and a large vein graft aneurysm with a maximal diameter of 40 mm (Figure 1 A-B. The management course was complicated with prolonged respiratory failure, persistent infection, despite negative cultures and extended hospital stay. After 50 days of slow recovery the patient was discharged with a need for home oxygen therapy. Ten days later, he was re-admitted with chest pain requiring admission to the coronary care unit where severe pulmonary hypertension was diagnosed with Doppler echocardiography. Troponin-T was mildly elevated, 1,3 ug/L (ref <0,01, CRP was 50 mg/L and chest X-ray showed bilateral lung infiltrates and wide pulmonary vessels. At this point a systo-diastolic murmur was heard at the left lower sternal edge. With a view of potential coronary reintervention and to evaluate the pulmonary hypertension, a coronary angiogram and a pulmonary artery cathetherisation were performed. This showed a new stenosis in the left anterior descending coronary artery and the pulmonary catheterisation showed a “step-up” in oxygen saturation in the pulmonary artery, suggesting a left-to-right shunt. The vein graft aneurysm did not contribute to the coronary circulation. A cardiovascular magnetic resonance scan revealed a communication between the vein graft aneurysm and the left branch pulmonary artery

  4. Coffee consumption and coronary calcification - The Rotterdam Coronary Calcification Study

    NARCIS (Netherlands)

    van Woudenbergh, Geertruida J.; Vliegenthart, Rozemarijn; van Rooij, Frank J. A.; Hofman, Albert; Oudkerk, Matthijs; Witteman, Jacqueline C. M.; Geleijnse, Johanna M.

    Background-The role of coffee in the cardiovascular system is not yet clear. We examined the relation of coffee intake with coronary calcification in a population-based cohort. Methods and Results-The study involved 1570 older men and women without coronary heart disease who participated in the

  5. Coffee consumption and coronary calcification: The Rotterdam coronary calcification study

    NARCIS (Netherlands)

    G.J. van Woudenbergh (Geertruida); R. Vliegenthart (Rozemarijn); F.J.A. van Rooij (Frank); A. Hofman (Albert); M. Oudkerk (Matthijs); J.C.M. Witteman (Jacqueline); J.M. Geleijnse (Marianne)

    2008-01-01

    textabstractBACKGROUND - The role of coffee in the cardiovascular system is not yet clear. We examined the relation of coffee intake with coronary calcification in a population-based cohort. METHODS AND RESULTS - The study involved 1570 older men and women without coronary heart disease who

  6. Coffee Consumption and Coronary Calcification: The Rotterdam Coronary Calcification Study

    NARCIS (Netherlands)

    Woudenbergh, van G.J.; Vliegenthart, R.; Rooij, van F.J.A.; Hofman, A.; Oudkerk, M.; Witteman, J.C.M.; Geleijnse, J.M.

    2008-01-01

    Background¿ The role of coffee in the cardiovascular system is not yet clear. We examined the relation of coffee intake with coronary calcification in a population-based cohort. Methods and Results¿ The study involved 1570 older men and women without coronary heart disease who participated in the

  7. Cost-effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: design of a cluster-randomized controlled trial

    NARCIS (Netherlands)

    van Dijk, S.E.M.; Pols, A.D.; Adriaanse, M.C.; Bosmans, J.E.; Elders, P.J.M.; van Marwijk, H.W.J.; van Tulder, M.W.

    2013-01-01

    Background: Co-morbid major depression is a significant problem among patients with type 2 diabetes mellitus and/or coronary heart disease and this negatively impacts quality of life. Subthreshold depression is the most important risk factor for the development of major depression. Given the highly

  8. Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression : A pragmatic cluster randomized controlled trial

    NARCIS (Netherlands)

    Pols, Alide D.; Van Dijk, Susan E.; Bosmans, Judith E.; Hoekstra, Trynke; van Marwijk, Harm W J; Van Tulder, Maurits W.; Adriaanse, Marcel C.

    2017-01-01

    Purpose: Given the public health significance of poorly treatable co-morbid major depressive disorders (MDD) among patients with type 2 diabetes mellitus (DM2) and coronary heart disease (CHD), we need to investigate whether strategies to prevent the development of major depression could reduce its

  9. The evaluation of a formalized queue management system for coronary angiography waiting lists.

    Science.gov (United States)

    Alter, D A; Newman, Alice M; Cohen, Eric A; Sykora, Kathy; Tu, Jack V

    2005-11-01

    Lengthy waiting lists for coronary angiography have been described in many health care systems worldwide. The extent to which formal queue management systems may improve the prioritization and survival of patients in the angiography queue is unknown. To prospectively evaluate the performance of a formal queue management system for patients awaiting coronary angiography in Ontario. The coronary angiography urgency scale, a formal queue management system developed in 1993 using a modified Delphi panel, allocates recommended maximum waiting times (RMWTs) in accordance with clinical necessity. By using a provincial clinical registry, 35,617 consecutive patients referred into the coronary angiography queue between April 1, 2001, and March 31, 2002, were prospectively tracked. Cox proportional hazards models were used to examined mortality risk across urgency after adjusting for additional clinical and comorbid factors. Good agreement was determined in urgency ratings between scores from the coronary angiography urgency scale and implicit physician judgement, which was obtained independently at the time of the index referral (weighted kappa = 0.49). The overall mortality in the queue was 0.3% (0.47%, 0.26% and 0.13% for urgent, semiurgent and elective patients, respectively). Urgency, as specified by the coronary angiography urgency scale, was the strongest predictor of death in the queue (Pqueue management system may decrease mortality in the coronary angiography queue. The authors recommend its implementation in health care systems where patients experience excessive waiting time delays for coronary angiography.

  10. [Developments in percutaneous coronary intervention and coronary stents].

    Science.gov (United States)

    Simsek, C; Daemen, J; Zijlstra, F

    2014-01-01

    In The Netherlands, more than 30.000 patients undergo a percutaneous coronary intervention every year, during which a coronary stent implantation will be performed in 90% of the cases. It is estimated that more than 5 million coronary stent implantations will be performed worldwide this year. While these numbers are impressive, however, coronary stents still have as a limitation the possibility of stent thrombosis. This has been and is an important stimulus for the development of both coronary stents, from a bare metal stent via a drug eluting stent to the present-day development of bio-absorbable stents, and anti-platelet drugs,from acenocoumarol to thieropyridines. The possibility of shortening the period of use of this powerful medication by developing new kinds of non-thrombogenic stents would, for example, make it possible to achieve significant reductions in subsequent bleeding during (dental) procedures.

  11. Acute coronary care: Principles and practice

    International Nuclear Information System (INIS)

    Califf, R.M.; Wagner, G.S.

    1985-01-01

    This book contains 58 chapters. Some of the chapter titles are: Radionuclide Techniques for Diagnosing and Sizing of Myocardial Infarction; The Use of Serial Radionuclide Angiography for Monitoring Function during Acute Myocardial Infarction; Hemodynamic Monitoring in Acute Myocardial Infarction; and The Valve of Radionuclide Angiography for Risk Assessment of Patients following Acute Myocardial Infarction

  12. The Coronary Artery Disease-Reporting and Data System (CAD-RADS): Prognostic and Clinical Implications Associated With Standardized Coronary Computed Tomography Angiography Reporting.

    Science.gov (United States)

    Xie, Joe X; Cury, Ricardo C; Leipsic, Jonathon; Crim, Matthew T; Berman, Daniel S; Gransar, Heidi; Budoff, Matthew J; Achenbach, Stephan; Ó Hartaigh, Bríain; Callister, Tracy Q; Marques, Hugo; Rubinshtein, Ronen; Al-Mallah, Mouaz H; Andreini, Daniele; Pontone, Gianluca; Cademartiri, Filippo; Maffei, Erica; Chinnaiyan, Kavitha; Raff, Gilbert; Hadamitzky, Martin; Hausleiter, Joerg; Feuchtner, Gudrun; Dunning, Allison; DeLago, Augustin; Kim, Yong-Jin; Kaufmann, Philipp A; Villines, Todd C; Chow, Benjamin J W; Hindoyan, Niree; Gomez, Millie; Lin, Fay Y; Jones, Erica; Min, James K; Shaw, Leslee J

    2018-01-01

    This study sought to assess clinical outcomes associated with the novel Coronary Artery Disease-Reporting and Data System (CAD-RADS) scores used to standardize coronary computed tomography angiography (CTA) reporting and their potential utility in guiding post-coronary CTA care. Clinical decision support is a major focus of health care policies aimed at improving guideline-directed care. Recently, CAD-RADS was developed to standardize coronary CTA reporting and includes clinical recommendations to facilitate patient management after coronary CTA. In the multinational CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, 5,039 patients without known coronary artery disease (CAD) underwent coronary CTA and were stratified by CAD-RADS scores, which rank CAD stenosis severity as 0 (0%), 1 (1% to 24%), 2 (25% to 49%), 3 (50% to 69%), 4A (70% to 99% in 1 to 2 vessels), 4B (70% to 99% in 3 vessels or ≥50% left main), or 5 (100%). Kaplan-Meier and multivariable Cox models were used to estimate all-cause mortality or myocardial infarction (MI). Receiver-operating characteristic (ROC) curves were used to compare CAD-RADS to the Duke CAD Index and traditional CAD classification. Referrals to invasive coronary angiography (ICA) after coronary CTA were also assessed. Cumulative 5-year event-free survival ranged from 95.2% to 69.3% for CAD-RADS 0 to 5 (p data, 57% of CAD-RADS 3 patients who received 30-day ICA were either asymptomatic or not receiving antianginal therapy at baseline, whereas only 32% had angina and were receiving medical therapy. CAD-RADS effectively identified patients at risk for adverse events. Frequent ICA use was observed among patients without severe CAD, many of whom were asymptomatic or not taking antianginal drugs. Incorporating CAD-RADS into coronary CTA reports may provide a novel opportunity to promote evidence-based care post-coronary CTA. Copyright © 2018 American College of Cardiology

  13. Long-Term Clinical Impact of Coronary CT Angiography in Patients With Recent Acute-Onset Chest Pain

    DEFF Research Database (Denmark)

    Linde, Jesper J; Hove, Jens D; Sørgaard, Mathias

    2015-01-01

    . BACKGROUND: The prognostic implications of a coronary CTA-guided treatment strategy have not been compared in a randomized fashion to standard care in patients referred for acute-onset chest pain. METHODS: Patients with acute chest pain but normal electrocardiograms and troponin values were randomized...... to treatment guided by either coronary CTA or standard care (bicycle exercise electrocardiogram or myocardial perfusion imaging). In the coronary CTA-guided group, a functional test was included in cases of nondiagnostic coronary CTA images or coronary stenoses of borderline severity. The primary endpoint...... electrocardiograms and troponin values compared to standard care with a functional test. (Cardiac-CT in the Treatment of Acute Chest Pain [CATCH]; NCT01534000)....

  14. Non-invasive Heart Team assessment of multivessel coronary disease with coronary computed tomography angiography based on SYNTAX score II treatment recommendations: design and rationale of the randomised SYNTAX III Revolution trial

    NARCIS (Netherlands)

    Cavalcante, Rafael; Onuma, Yoshinobu; Sotomi, Yohei; Collet, Carlos; Thomsen, Brian; Rogers, Campbell; Zeng, Yaping; Tenekecioglu, Erhan; Asano, Taku; Miyasaki, Yosuke; Abdelghani, Mohammad; Morel, Marie-Angèle; Serruys, Patrick W.

    2017-01-01

    The aim of this study was to investigate whether a Heart Team decision-making process regarding the choice of revascularisation strategy based on non-invasive coronary multislice computed tomography angiography (MSCT) assessment of coronary artery disease (CAD) is equivalent to the standard-of-care

  15. Acute organophosphorus poisoning complicated by acute coronary syndrome.

    Science.gov (United States)

    Pankaj, Madhu; Krishna, Kavita

    2014-07-01

    We report a case of 30 year old alcoholic male admitted with vomiting, drowsiness, limb weakness and fasciculations after alleged history of consumption of 30 ml of chlorpyriphos insecticide. He had low serum cholinesterase levels. With standard treatment for organophosphorus poisoning (OPP), he improved gradually until day 5, when he developed neck and limb weakness and respiratory distress. This intermediate syndrome was treated with oximes, atropine and artificial ventilation. During treatment, his ECG showed fresh changes of ST elevation. High CPK & CPK-MB levels, septal hypokinesia on 2D echo suggested acute coronary syndrome. Coronary angiography was postponed due to his bedridden and obtunded status. The patient finally recovered fully by day 15 and was discharged. Acute coronary syndrome is a rare occurrence in OP poisoning. The present case thus emphasises the need for careful electrocardiographic and enzymatic monitoring of all patients of organophosphorus poisoning to prevent potential cardiac complication which can prove fatal.

  16. FORMATION OF SIX SIGMA INFRASTRUCTURE FOR THE CORONARY STENTING PROCESS

    Directory of Open Access Journals (Sweden)

    Mehmet Tolga Taner

    2013-10-01

    Full Text Available The purpose of this study is to show how a tertiary care center in Turkey operating mainly in cardiology initiated Six Sigma principles to reduce the number of complications occuring during coronary stent insertion process. A Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC model for coronary stent insertion is suggested. Data were collected for 24-months. Twenty-two Critical-to-Quality (CTQ factors were identified for successful coronary stent insertion. The most frequent causes of complications in the process were found to be patients with previous bypass surgery or PCI, inexperience of staff members, highly damaged vessel structure, thin and/or long vessel diameter, inappropriate selection of stent type, inappropriate selection of balloon type and poor image quality.

  17. A rare anomaly: Double right coronary artery

    Directory of Open Access Journals (Sweden)

    Dursun Çayan Akkoyun

    2013-01-01

    Full Text Available Coronary artery anomalies are rare anomalies. Theseare usually asymptomatic and are discovered incidentally.Double right coronary artery (RCA is a rare coronaryartery anomaly. Although there is controversy aboutidentification and classification of double RCA, it is oftena benign condition, but it can be complicated by atherosclerosisand can lead to serious conditions such asmyocardial infarction (MI and may be accompanied byother anomalies. In our case, double RCA were detectedin coronary angiography for acute anterior MI, and in thenext session successful percutaneous coronary interventionwas performed.Key words: Coronary anomaly, coronary angiography,coronary stenosis

  18. Current status of hybrid coronary revascularization.

    Science.gov (United States)

    Jaik, Nikhil P; Umakanthan, Ramanan; Leacche, Marzia; Solenkova, Natalia; Balaguer, Jorge M; Hoff, Steven J; Ball, Stephen K; Zhao, David X; Byrne, John G

    2011-10-01

    Hybrid coronary revascularization combines coronary artery bypass surgery with percutaneous coronary intervention techniques to treat coronary artery disease. The potential benefits of such a technique are to offer the patients the best available treatments for coronary artery disease while minimizing the risks of the surgery. Hybrid coronary revascularization has resulted in the establishment of new 'hybrid operating suites', which incorporate and integrate the capabilities of a cardiac surgery operating room with that of an interventional cardiology laboratory. Hybrid coronary revascularization has greatly augmented teamwork and cooperation between both fields and has demonstrated encouraging as well as good initial outcomes.

  19. Simultaneous nephrectomy and coronary artery bypass grafting through extended sternotomy

    Directory of Open Access Journals (Sweden)

    Budrikis Algimantas

    2012-08-01

    Full Text Available Abstract Background The advances in surgical techniques, resuscitation and anesthesiology support over the last years have allowed simultaneous thoracic and abdominal operations to be made for cancer and concomitant severe heart vessel disease relieving the patient from several diseases simultaneously and achieving long lasting remission or cure. Clinical case A simultaneous nephrectomy and coronary artery bypass grafting procedure through extended sternotomy is reported. A 63-year-old man with severe coronary artery disease was found to have renal carcinoma. Diagnosis Postoperative pathological investigation of the tumor revealed the presence of renal cell carcinoma pT3a N0 M0, G2. Coronarography revealed advanced three-vessel coronary artery disease. Treatment We successfully performed a simultaneous curative surgery for renal carcinoma and coronary artery bypass graft surgery under cardiopulmonary bypass using a novel technique of extended sternotomy. Simultaneous surgery thus appears to be a beneficial and safe approach for the treatment of coronary artery disease and resectable renal cancer in carefully selected patients.

  20. CT coronary angiographic evaluation of suspected anginal chest pain.

    Science.gov (United States)

    Moss, Alastair J; Newby, David E

    2016-02-15

    Non-invasive imaging plays a critical role in the assessment of patients presenting with suspected angina chest pain. However, wide variations in practice across Europe and North America highlight the lack of consensus in selecting the appropriate first-line test for the investigation of coronary artery disease (CAD). CT coronary angiography (CTCA) has a high negative predictive value for excluding the presence of CAD. As such, it serves as a potential 'gatekeeper' to downstream testing by reducing the rate of inappropriate invasive coronary angiography. Two recent large multicentre randomised control trials have provided insights into whether CTCA can be incorporated into chest pain care pathways to improve risk stratification of CAD. They demonstrate that using CTCA enhances diagnostic certainty and improves the targeting of appropriate invasive investigations and therapeutic interventions. Importantly, reductions in cardiac death and non-fatal myocardial infarction appear to be attained through the more appropriate use of preventative therapy and coronary revascularisation when guided by CTCA. With this increasing portfolio of evidence, CTCA should be considered the non-invasive investigation of choice in the evaluation of patients with suspected angina pectoris due to coronary heart disease. NCT01149590, post-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. Non-invasive assessment of coronary calcification

    International Nuclear Information System (INIS)

    Vliegenthart, Rozemarijn; Oei, Hok-Hay S.; Hofman, Albert; Oudkerk, Matthijs; Witteman, Jackqueline C. M.

    2004-01-01

    Electron-beam tomography (EBT) and multi-detector computed tomography (MDCT) enable the noninvasive assessment of coronary calcification. The amount of coronary calcification, as detected by EBT, has a close relation with the amount of coronary atherosclerosis, which is the substrate for the occurrence of myocardial infarction and sudden cardiac death. Calcification of the coronary arteries can be seen as a cumulative measure of life-time exposure to cardiovascular risk factors. Several studies have shown that the amount of coronary calcification is associated with the risk of coronary heart disease. Therefore, coronary calcification is a promising method for non-invasive detection of asymptomatic subjects at high risk of developing coronary heart disease. Whether measurement of coronary calcification also increases the predictive power of coronary events based on cardiovascular risk factors is topic of current research

  2. Coronary artery disease in Brazil: contemporary management and future perspectives.

    Science.gov (United States)

    Polanczyk, C A; Ribeiro, J P

    2009-06-01

    Cardiovascular diseases are responsible for 32% of total mortality in Brazil, mostly due to cerebrovascular and coronary artery disease. Epidemiological and socio-economical factors play a pivotal role on the distribution, severity and management of coronary artery disease, and the burden is greater in the southeast and south regions of the country, with a higher mortality in low-income populations. The Brazilian healthcare structure is divided into two complementary systems-public and private-but 75% of the population is covered exclusively by the public system. Some Brazilian institutions offer state-of-the-art care to patients with acute and chronic coronary artery disease, but regional inequalities in medical care are still significant. National policies will have to be implemented to fight risk factors, to ensure primary prevention strategies, including assistance on drugs with known protective effects, areas to be tackled by both the private and the public health sectors. Finally, large investments will have to be made to improve tertiary care, to reorganise systems of care for acute patients and mainly to ensure prompt access and continuity of cardiac care and secondary prevention strategies for the whole population.

  3. Diagnosing coronary artery disease after a positive coronary computed tomography angiography

    DEFF Research Database (Denmark)

    Nissen, L; Winther, S; Westra, J

    2018-01-01

    Aims: Perfusion scans after coronary computed tomography angiography (CCTA) in patients with suspected coronary artery disease (CAD) may reduce unnecessary invasive coronary angiographies (ICAs). However, the diagnostic accuracy of perfusion scans after primary CCTA is unknown. The aim...

  4. Vessel dilatation in coronary angiograms

    International Nuclear Information System (INIS)

    Hinterauer, L.; Goebel, N.

    1983-01-01

    Amongst 166 patients with aneurysms, ectasia or megaloarteries shown on coronary angiograms, 86.1% had dilated vessels as part of generalised coronary sclerosis (usually in patients with three-vessel disease). In 9%, dilatation was of iatrogenic origin and in 4.8% it was idiopathic. One patient had Marfan's syndrome. Amongst 9 000 patients, there were eight with megalo-arteries without stenosis; six of these had atypical angina and three suffered an infarct. Patients with definite dilatation of the coronary artery and stagnation of contrast flow required treatment. (orig.) [de

  5. Vessel dilatation in coronary angiograms

    Energy Technology Data Exchange (ETDEWEB)

    Hinterauer, L.; Goebel, N.

    1983-11-01

    Amongst 166 patients with aneurysms, ectasia or megaloarteries shown on coronary angiograms, 86.1% had dilated vessels as part of generalised coronary sclerosis (usually in patients with three-vessel disease). In 9%, dilatation was of iatrogenic origin and in 4.8% it was idiopathic. One patient had Marfan's syndrome. Amongst 9 000 patients, there were eight with megalo-arteries without stenosis; six of these had atypical angina and three suffered an infarct. Patients with definite dilatation of the coronary artery and stagnation of contrast flow required treatment.

  6. Management of coronary artery disease

    Science.gov (United States)

    Safri, Z.

    2018-03-01

    Coronary Artery Disease (CAD) is associated with significant morbidity and mortality, therefore it’s important to early and accurate detection and appropriate management. Diagnosis of CAD include clinical examination, noninvasive techniques such as biochemical testing, a resting ECG, possibly ambulatory ECG monitoring, resting echocardiography, chest X-ray in selected patients; and catheterization. Managements of CAD patients include lifestyle modification, control of CAD risk factors, pharmacologic therapy, and patient education. Revascularization consists of percutaneous coronary angioplasty and coronary artery bypass grafting. Cardiac rehabilitation should be considered in all patients with CAD. This comprehensive review highlights strategies of management in patients with CAD.

  7. PLACENTAL GROWTH FACTOR AND CORONARY NEOANGIOGENESIS IN CORONARY HEART DISEASE

    Directory of Open Access Journals (Sweden)

    M. V. Tulikov

    2013-01-01

    Full Text Available Neoangiogenesis in coronary heart disease is a protective reaction aimed to improve ischemic myocardial perfusion, by increasing the number and size of arterial collaterals. Placental growth factor (PlGF is one of the key peptides regulating angiogenic processes in atherosclerosis. In particular, a number of investigators have shown that injection of recombinant PlGF into the system or regional blood flow can stimulate neoangiogenesis. On the other hand, there is evidence confirming the involvement of PlGF in the progression of atherosclerosis and in the development of acute coronary syndrome. In this connection, the problem of investigating the efficiency and safety of possible use of PlGF preparations, as well as its place in the diagnosis of coronary heart disease and acute coronary syndrome remains urgent

  8. Current trauma care system and trauma care training in China

    Directory of Open Access Journals (Sweden)

    Lian-Yang Zhang

    2018-04-01

    Full Text Available Trauma is a life-threatening “modern disease”. The outcomes could only be optimized by cost-efficient and prompt trauma care, which embarks on the improvement of essential capacities and conceptual revolution in addition to the disruptive innovation of the trauma care system. According to experiences from the developed countries, systematic trauma care training is the cornerstone of the generalization and the improvement on the trauma care, such as the Advance Trauma Life Support (ATLS. Currently, the pre-hospital emergency medical services (EMS has been one of the essential elements of infrastructure of health services in China, which is also fundamental to the trauma care system. Hereby, the China Trauma Care Training (CTCT with independent intellectual property rights has been initiated and launched by the Chinese Trauma Surgeon Association to extend the up-to-date concepts and techniques in the field of trauma care as well to reinforce the generally well-accepted standardized protocols in the practices. This article reviews the current status of the trauma care system as well as the trauma care training. Keywords: Trauma care system, Trauma care training, China

  9. Coronary angiography using synchrotron radiation

    International Nuclear Information System (INIS)

    Akatsuka, Takao; Hiranaka, Yukio; Takeda, Tohru; Hyodo, Kazuyuki.

    1990-01-01

    Invasive coronary angiography is the imaging technique of choice for diagnosis of ischemic heart disease. Recently, the application of synchrotron radiation in coronary angiography has been investigated in the world, with the aim of developing the noninvasive technique for visualizing the heart. In this article, backgrounds and present situation of coronary angiography using synchrotron radiation are reviewed. Firstly, visual imaging techniques of the cardiovascular system are discussed in terms of angiography and digital subtraction angiography (DSA). Conventional temporal, energy, and hybrid subtraction modes used in DSA are referred to. Secondly, the application of synchrotron radiation is presented, focusing on the property of synchrotron radiation and K-edge subtraction angiography. Two kinds of synchrotron radiation beam methods are outlined. Interpretation of image data and various subtraction procedures remain unestablished. There is much to be done before coronary angiography using synchrotron radiation comes into a clinical practice. (N.K.)

  10. Depression following acute coronary syndrome

    DEFF Research Database (Denmark)

    Joergensen, Terese Sara Hoej; Maartensson, Solvej; Ibfelt, Else Helene

    2016-01-01

    PURPOSE: Depression is common following acute coronary syndrome, and thus, it is important to provide knowledge to improve prevention and detection of depression in this patient group. The objectives of this study were to examine: (1) whether indicators of stressors and coping resources were risk...... factors for developing depression early and later after an acute coronary syndrome and (2) whether prior depression modified these associations. METHODS: The study was a register-based cohort study, which includes 87,118 patients with a first time diagnosis of acute coronary syndrome during the period...... 2001-2009 in Denmark. Cox regression models were used to analyse hazard ratios (HRs) for depression. RESULTS: 1.5 and 9.5 % develop early (≤30 days) and later (31 days-2 years) depression after the acute coronary syndrome. Among all patients with depression, 69.2 % had first onset depression, while 30...

  11. Coronary Computed Tomography Angiography (CTA)

    Science.gov (United States)

    ... coronary arteries, may also be administered as a tablet or spray underneath your tongue. While lying on ... the scanner at one time such as with MRI. If an intravenous contrast material is used, you ...

  12. Pronounced Coronary Arteriosclerosis in Cirrhosis

    DEFF Research Database (Denmark)

    Danielsen, Karen V; Wiese, Signe; Hove, Jens

    2018-01-01

    factors including smoking, type 2 diabetes, hypertension, gender, or hypercholesterolemia. Coronary artery calcium-score was associated with diastolic dysfunction, lateral e´ (p = 0.025), but not with other markers of cardiac dysfunction. During a median follow-up of 25 months 12 patients (21%) died......BACKGROUND: The relation between excessive alcohol consumption and coronary arteriosclerosis has remained controversial. The etiology of cirrhosis has been considered a substantial risk factor for development of arteriosclerotic lesions. The coronary artery calcium-score derived from coronary CT...... and women: 136 vs. 0 HU; p alcohol-related cirrhosis was significantly higher than in nonalcohol-related cirrhosis (362 vs. 46 HU, p 

  13. A inserção da enfermeria no atendimento pré-hospitalar: histórico e perspectivas atuais La inserción de la enfermera en la atención pre-hospitalaria: reseña historica y perspectivas actuales Nurse integration into pre-hospital medical services: historical outline and current perspectives

    Directory of Open Access Journals (Sweden)

    Viviane Oliveira Ramos

    2005-06-01

    Full Text Available Estudo bibliográfico de caráter histórico que tem por objetivos identificar marcos históricos da inserção da enfermeira no atendimento pré-hospitalar, identificar as transformações ocorridas em sua atuação e as conexões com os aspectos legais do exercício profissional. Foram analisados três teses e seis artigos de periódicos, encontrados na consulta às bases de dados LILACS, BEDENF E DEDALUS, mais seis documentos legais encontrados em sites de organizações governamentais e Associações de Classe. Os resultados encontrados permitiram apreciar os marcos históricos, a atuação da enfermeira nesta área e os aspectos legais que envolvem seu exercício.Estudio bibliográfico de carácter histórico que tuvo por objetivo identificar el marco que permitió la inserción de la enfermera en la atención pre-hospitalaria, las transformaciones que se dieron en su participación en este tipo de atención y las conexiones con los aspectos legales del ejercicio profesional. Fueron analizados seis artículos de periódicos y tres tesis, que se encontraron consultando las bases de datos LILAS, BEDENF y DEDALUS, y seis documentos legales, que se consiguieron en sitios de Internet de organizaciones governamentales y Asociaciones Profesionales. Los resultados encontrados permitieron apreciar el marco histórico, la participación de la enfermera en esta área y la conexión con los aspectos legales que regulan su ejercicio.This historical and bibliographic study aimed to identify the background that enabled the nurse integration into pre-hospital care, the transformations and the underwent involvement after his/her integration and the link to legal aspects of professional practice. The analysis considered six journal articles and three thesis found in LILAS, BEDENF and DEDALUS databases , and six legal documents downloaded from government organizations' official websites and professional associations. Results allowed in an understanding of the

  14. Physiologic assessment of coronary artery fistula

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, N.C.; Beauvais, J. (Creighton Univ., Omaha, NE (USA))

    1991-01-01

    Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery.

  15. Physiologic assessment of coronary artery fistula

    International Nuclear Information System (INIS)

    Gupta, N.C.; Beauvais, J.

    1991-01-01

    Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery

  16. Correlation between coronary computed tomographic angiography and fractional flow reserve

    DEFF Research Database (Denmark)

    Kristensen, Thomas Skaarup; Engstrøm, Thomas; Kelbæk, Henning

    2010-01-01

    Coronary CT angiography (CCTA) has become an important modality to evaluate the presence of coronary artery disease. Coronary artery stenosis of intermediate severity remains a therapeutic dilemma. Measurement of fractional flow reserve (FFR) during coronary angiography is the most established...

  17. Lifestyle modification programmes for patients with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials

    NARCIS (Netherlands)

    Janssen, V.; Gucht, V. de; Dusseldorp, E.; Maes, S.

    2012-01-01

    Background: Lifestyle modification programmes for coronary heart disease patients have been shown to effectively improve risk factors and related health behaviours, quality of life, reincidence, and mortality. However, improvements in routine cardiac care over the recent years may offset the

  18. Marijuana use in acute coronary syndromes.

    Science.gov (United States)

    Draz, Eman I; Oreby, Mervat M; Elsheikh, Eman A; Khedr, Lamia A; Atlam, Salwa A

    2017-09-01

    Cannabis is one of the most widely used illicit substances worldwide, and it has the highest prevalence among drugs used in Egypt. The aims were to evaluate whether the use of cannabis is a risk factor of acute coronary heart disease in low-risk, young males and to compare the cardiac pathological changes between cannabis exposed and non-exposed ischemic patients. This was a cross-sectional study that was performed on 138 male patients, aged ≤ 40 years, with acute myocardial infarction who were admitted to the Cardiac Care Unit at the University Hospital. Urine samples were submitted for toxicological analysis using a homogenous enzyme immunoassay technique to determine the substance of use. The patients were divided into three groups: group 1 (n = 23), cannabis-positive only patients; group 2 (n = 28), patients positive for any other substance of use; and group 3 (n = 34), patients negative for any substance of use. Smoking was prominent, whereas group 1 had no other risk factors. In groups 1 and 2, ST-segment elevation myocardial infarction (STEMI) was dominant, whereas no ST-segment elevation myocardial infarction (NSTEMI) was prominent in group 3. Ischemic resting wall motion abnormalities were presented in 47.8% of group 1 and in only 11.8% of group 3. None of group 1 had normal coronaries, whereas 14.3% of group 3 had normal coronaries. Significant changes in echocardiography and angiography were observed between group 1 and other groups. Cannabis smoking could be a potential risk factor for the development of cardiac ischemia.

  19. The minimum coronary artery diameter in which coronary spasm can be identified by synchrotron radiation coronary angiography

    International Nuclear Information System (INIS)

    Matsushita, Shonosuke; Hyodo, Kazuyuki; Imazuru, Tomohiro; Tokunaga, Chiho; Sato, Fujio; Enomoto, Yoshiharu; Hiramatsu, Yuji; Sakakibara, Yuzuru

    2008-01-01

    Background: Coronary vasospasm is defined as a temporary, intense narrowing of the coronary conduit artery. It brings about ischemic chest pain and becomes one of the causes of myocardial infarction. Coronary spasms are divided into two categories. One is the coronary spasm of the conduit artery and the other is the coronary microvascular spasm. Although coronary spasms are diagnosed with the images of coronary angiography, microvascular spasms cannot be diagnosed because of the limitations of conventional angiographic systems. However, synchrotron radiation coronary angiography (SRCA) can identify coronary arteries down to 100 μm in diameter in the beating heart and 50 μm in arrested heart. Aim: The purpose of this study was to confirm whether microvascular spasms could be identified or not using SRCA, and then down that size identification was possible. Methods: The Langendorff perfusion system with isolated rat hearts was employed. Krebs-Henseleit solution (KH solution) was used as a perfusate. 10 mM of 4-aminopyridine (4-AP: a voltage-gated potassium channel blocker; spasm inducer) was added to the KH solution and maintained for 5 min. SRCA was performed at pre-, during and 10 min after cessation of the KH solution with 4-AP. Coronary spasms were defined as a temporal 75% reduction of coronary arterial diameter. Results and conclusion: Multiple sizes of coronary arteries showed coronary spasms. The minimum stenosed coronary artery size was 100 μm. Since coronary microvascular spasms are seen in the arterioles (50-400 μm), coronary microvascular spasms may be diagnosed with the use of synchrotron radiation coronary angiography

  20. CORONARY ARTERY DOMINANCE PATTERN IN EAST-GODAVARI DISTRICT: A CADAVERIC STUDY

    Directory of Open Access Journals (Sweden)

    Arindom

    2016-01-01

    Full Text Available With the advent of coronary angiography, coronary artery diseases can be well combated; but with time sedentary life style and stress as our constant partner have kept coronary artery disease as one of the major causes of death. Revascularization procedures demand a sound knowledge of the course of coronary arteries and their branches, both normal and their quite common variations. In this regard, posterior inter-ventricular artery (PIVA deserves a special importance; PIVA determines the coronary dominance depending on its parent artery. Dominance can be right, left or of balanced type. Balanced type means that PIVA is derived from both right & left coronary arteries. Circulation can occur when both the coronary arteries emit a branch in that area. These and other variations form a very important repertoire of information based on which coronary bypass surgery and angioplasty can be safely and effectively performed. The aim of this study therefore is to document the coronary dominance pattern in this East Godavari district of Andhra-Pradesh. 60 adult human hearts were collected from museum of Anatomy department during the tenure of 5 years (2009 to 2014 and were preserved in 10% formalin. The hearts were dissected carefully to observe the posterior inter-ventricular artery in the posterior inter-ventricular sulcus of each heart and dominance pattern was recorded. In our present study right dominance type was the commonest (46 out of 60 followed by left dominance (10 out of 60. Only 4 out of 60 were of the balanced type. Present study, though not of the only member of its kind will definitely add up to the already existing vast knowledge, based on which various diagnostic and therapeutic intervention of coronary artery diseases can be done effectively and safely

  1. Coronary artery anomalies in Turner Syndrome.

    Science.gov (United States)

    Viuff, Mette H; Trolle, Christian; Wen, Jan; Jensen, Jesper M; Nørgaard, Bjarne L; Gutmark, Ephraim J; Gutmark-Little, Iris; Mortensen, Kristian H; Gravholt, Claus Højbjerg; Andersen, Niels H

    Congenital heart disease, primarily involving the left-sided structures, is often seen in patients with Turner Syndrome. Moreover, a few case reports have indicated that coronary anomalies may be more prevalent in Turner Syndrome than in the normal population. We therefore set out to systematically investigate coronary arterial anatomy by computed tomographic coronary angiography (coronary CTA) in Turner Syndrome patients. Fifty consecutive women with Turner Syndrome (mean age 47 years [17-71]) underwent coronary CTA. Patients were compared with 25 gender-matched controls. Coronary anomaly was more frequent in patients with Turner Syndrome than in healthy controls [20% vs. 4% (p = 0.043)]. Nine out of ten abnormal cases had an anomalous left coronary artery anatomy (absent left main trunk, n = 7; circumflex artery originating from the right aortic sinus, n = 2). One case had a tubular origin of the right coronary artery above the aortic sinus. There was no correlation between the presence of coronary arterial anomalies and karyotype, bicuspid aortic valve, or other congenital heart defects. Coronary anomalies are highly prevalent in Turner Syndrome. The left coronary artery is predominantly affected, with an absent left main coronary artery being the most common anomaly. No hemodynamically relevant coronary anomalies were found. Copyright © 2016 Society of Cardiovascular Computed Tomography. All rights reserved.

  2. Age-dependent interaction of apolipoprotein E gene with eastern birthplace in Finland affects severity of coronary atherosclerosis and risk of fatal myocardial infarction--Helsinki Sudden Death Study.

    Science.gov (United States)

    Tyynelä, Petri; Goebeler, Sirkka; Ilveskoski, Erkki; Mikkelsson, Jussi; Perola, Markus; Lehtimäki, Terho; Karhunen, Pekka J

    2013-05-01

    Mortality from coronary heart disease (CHD) has been constantly higher in eastern late settlement regions compared to western early settlements in Finland, unrelated to classical risk factors. In line with this, eastern birthplace was an age-dependent predictor of severe coronary atherosclerosis and pre-hospital sudden coronary death among male residents of Helsinki. We investigated a possible interaction of apolipoprotein E (APOE) gene with birthplace on the risk of myocardial infarction (MI) and coronary atherosclerosis. APOE genotypes were analyzed in the Helsinki Sudden Death Study series comprising out-of-hospital deaths among males aged 33-70 years (n = 577), who were born in high (east, n = 273) or low (west, n = 304) CHD mortality area. Eastern-born men ≤ 55 years carried 30% more often (P = 0.017) and older men 40% less often (P = 0.022) the APOE ϵ4 allele compared to western-born men (P = 0.003 for birthplace-by-age interaction). In multivariate analysis, the ϵ4 allele associated with the risk of out-of-hospital MI (odds ratio 2.58; 95% CI 1.20-5.55; P = 0.016) only in eastern-born men and with advanced atherosclerosis in both regions of origin, respectively. Birthplace-bound risk of CHD was age-dependently modified by APOE ϵ4 allele, suggesting genetic differences in CHD susceptibility between early and late settlement regions in Finland and providing one explanation for the eastern high mortality.

  3. Italian Chapter of the International Society of Cardiovascular Ultrasound expert consensus document on coronary computed tomography angiography: overview and new insights.

    Science.gov (United States)

    Sozzi, Fabiola B; Maiello, Maria; Pelliccia, Francesco; Parato, Vito Maurizio; Canetta, Ciro; Savino, Ketty; Lombardi, Federico; Palmiero, Pasquale

    2016-09-01

    Coronary computed tomography angiography is a noninvasive heart imaging test currently undergoing rapid development and advancement. The high resolution of the three-dimensional pictures of the moving heart and great vessels is performed during a coronary computed tomography to identify coronary artery disease and classify patient risk for atherosclerotic cardiovascular disease. The technique provides useful information about the coronary tree and atherosclerotic plaques beyond simple luminal narrowing and plaque type defined by calcium content. This application will improve image-guided prevention, medical therapy, and coronary interventions. The ability to interpret coronary computed tomography images is of utmost importance as we develop personalized medical care to enable therapeutic interventions stratified on the bases of plaque characteristics. This overview provides available data and expert's recommendations in the utilization of coronary computed tomography findings. We focus on the use of coronary computed tomography to detect coronary artery disease and stratify patients at risk, illustrating the implications of this test on patient management. We describe its diagnostic power in identifying patients at higher risk to develop acute coronary syndrome and its prognostic significance. Finally, we highlight the features of the vulnerable plaques imaged by coronary computed tomography angiography. © 2016, Wiley Periodicals, Inc.

  4. Coronary ostium occlusion by coronary cusp displacement in Williams syndrome.

    Science.gov (United States)

    Shiohama, Tadashi; Fujii, Katsunori; Ebata, Ryota; Funabashi, Nobusada; Matsumiya, Goro; Saito, Yuko Kazato; Takechi, Fumie; Yonemori, Yoko; Nakatani, Yukio; Shimojo, Naoki

    2016-06-01

    Williams syndrome is a contiguous gene deletion syndrome resulting from a heterozygous deletion on chromosome 7q11.23, and is characterized by distinctive facial features and supravalvular aortic stenosis (SVAS). This syndrome rarely presents unpredictable cardiac death, and yet, as illustrated in the present case, it is still not possible to predict it, even on close monitoring. We herein describe the case of a 6-year-old Japanese girl with Williams syndrome, who had sudden cardiac collapse due to cardiac infarction after pharyngitis. Cardiac failure followed a critical course that did not respond to catecholamine support or heart rest with extracardiac mechanical support. Although marked coronary stenosis was not present, the left coronary cusp abnormally adhered to the aortic wall, which may synergistically cause coronary ostium occlusion with SVAS. Altered hemodynamic state, even that caused by the common cold, may lead to critical myocardial events in Williams syndrome with SVAS. © 2015 Japan Pediatric Society.

  5. NEUROTICISM PROFILE IN CORONARY HEART DISEASE

    OpenAIRE

    Bhargava, S. C.; Sharma, S. N.; Agarwal, B. V.

    1980-01-01

    SUMMARY Thirty seven cases of coronary heart disease and 30 normal healthy controls were administered Hindi version of MHQ. The coronary heart disease patients scored significantly higher on total neuroticism, free-floating anxiety and somatic anxiety subscales of MHQ.

  6. Coronary artery with aberrant origin malignant right

    International Nuclear Information System (INIS)

    Ozcan, E.; Bozlar, U.; Demirkol, S.; Saglam, M.

    2012-01-01

    Full text: Introduction: Congenital anomalies of the coronary arteries is a major cause of sudden death, especially in young patients. Objectives and tasks: In this study we aim to present a young patient with chest pain who had malignant right coronary artery (RCA) with aberrant origin. Materials and methods: 24-year-old man who applied cardiology clinic for chest pain and palpitations especially after exercise, was referred to our clinic for coronary computed tomography (CT) angiography to evaluate coronary artery anomalies. Results: In CT angiography; we detected aberrant RCA with origin of tubularly part of ascendant aorta with a malignant course between aorta and pulmonary artery. Left main coronary artery, left anterior descending and circumflex artery had normal origin and course. Conclusion: Coronary artery with malignant course may cause sudden death especially after exercise. Coronary CT angiography has an important role in diagnosis of congenital coronary artery anomalies, with high resolution multiplanner reformatted images

  7. Coronary Artery Disease

    Science.gov (United States)

    ... Kids and Teens Pregnancy and Childbirth Women Men Seniors Your Health Resources Healthcare Management End-of-Life Issues Insurance & Bills Self Care Working With Your Doctor Drugs, Procedures & Devices Over-the- ...

  8. Coronary spasm induced by dipyridamole

    International Nuclear Information System (INIS)

    Wartski, M.; Caussin, C.; Lancelin, B.

    2001-01-01

    A 59 years old man was admitted at hospital for recurrent instable angina 1 month after coronary artery bypass surgery. Coronary artery disease started with a transmural antero-septo-apical myocardial infarction without thrombolysis and a percutaneous angioplasty with endo-prothesis on proximal left anterior descendant artery (LAD) is performed Because of recurrent rest angina and subacute stent thrombosis, a coronary artery bypass surgery (CABG) is performed with anastomosis of the left internal thoracic artery on LAD. The patient is admitted for recurrent rest angina one month after CABG. On ECG performed during chest pain, a ST-T segment elevation occurred on inferior leads. Coronary angiography showed no significant stenosis on endo-prothesis and no bypass graft dysfunction. Dipyridamole scintigraphy was realized. 2 minutes after the beginning of Dipyridamole infusion, a ST-T elevation occurred on inferior leads and two marked antero-septal and inferior defects were noticed on myocardial scintigraphy. Images at rest showed a clear improvement in the anterior wall and the inferior wall became normally perfused Patient was treated with anti-spastic drugs and a new coronarography with methyl-ergotamine test was performed inducing chest pain, ST-T elevation on inferior leads and tri-truncular coronary spasm. Patient's treatment was then modified with introduction of Nifedipine. The patient did not experienced new recurrent chest pain and remained totally asymptomatic few months later. (authors)

  9. Intensive lifestyle changes for reversal of coronary heart disease.

    Science.gov (United States)

    Ornish, D; Scherwitz, L W; Billings, J H; Brown, S E; Gould, K L; Merritt, T A; Sparler, S; Armstrong, W T; Ports, T A; Kirkeeide, R L; Hogeboom, C; Brand, R J

    1998-12-16

    The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year. To determine the feasibility of patients to sustain intensive lifestyle changes for a total of 5 years and the effects of these lifestyle changes (without lipid-lowering drugs) on coronary heart disease. Randomized controlled trial conducted from 1986 to 1992 using a randomized invitational design. Forty-eight patients with moderate to severe coronary heart disease were randomized to an intensive lifestyle change group or to a usual-care control group, and 35 completed the 5-year follow-up quantitative coronary arteriography. Two tertiary care university medical centers. Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years. Adherence to intensive lifestyle changes, changes in coronary artery percent diameter stenosis, and cardiac events. Experimental group patients (20 [71%] of 28 patients completed 5-year follow-up) made and maintained comprehensive lifestyle changes for 5 years, whereas control group patients (15 [75%] of 20 patients completed 5-year follow-up) made more moderate changes. In the experimental group, the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year (a 4.5% relative improvement) and by 3.1 absolute percentage points after 5 years (a 7.9% relative improvement). In contrast, the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year (a 5.4% relative worsening) and by 11.8 percentage points after 5 years (a 27.7% relative worsening) (P=.001 between groups. Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20]). More regression

  10. Role of coronary CT angiography in asymptomatic patients with type 2 diabetes mellitus

    International Nuclear Information System (INIS)

    Kamimura, Munehiro; Moroi, Masao; Hiroe, Michiaki; Isobe, Mitsuaki

    2012-01-01

    Diabetic patients with coronary artery disease are often asymptomatic, making appropriate care of such patients difficult. The purpose of this study was to investigate the prevalence of coronary lesions in asymptomatic diabetic patients. Coronary computed tomography (CT) angiography was performed in 120 consecutive diabetic patients (90 of whom were men, mean age 65, mean HbA1c 7.2%). Images from patients whose coronary artery calcium scores (CAC scores) were less than 400 were subjected to stenosis and plaque analysis. Significant stenosis was defined as coronary artery stenosis >70%. High-risk plaque was defined as plaque having both a CT density <30 Hounsfield Units (HU) and showing positive remodeling. Significant stenoses were identified in 30.5% of the patients. High-risk plaques were identified in 17.1% of the patients. Less than half of the high-risk plaques were obstructive plaques. There was a statistically significant association between significant stenosis and high-risk plaque by chi-square test (P=0.022). We found significant stenosis even in patients whose CAC score =0 at a rate of 5.0%. Using univariate logistic-regression analysis, we found that coronary risk factors associated with significant stenosis and high-risk plaque were dyslipidemia (P=0.033) and current smoking (P=0.030), respectively. We report for the first time, the prevalence of high-risk plaques in the arteries of patients with asymptomatic diabetes, as assessed by coronary CT angiography. (author)

  11. Detection of coronary calcification in ultrafast CT compared to coronary angiography

    International Nuclear Information System (INIS)

    Koesling, S.; Hoffmann, U.; Rother, T.; Lieberenz, S.; Heywang-Koebrunner, S.H.; Schulz, H.G.

    1994-01-01

    The angiographical findings of 24 patients with coronary artery disease were compared with qualitative and quantitative detection of coronary calcification by ultrafast CT. Doubts concerning the capabilities of the ultrafast CT for a screening of coronary artery disease arise when the results of one third false positive and fase negative findings are considered. Variations in the quantification of coronary calcification were too great to allow a realistic assessment of the degree of stenosis of the coronary arteries. (orig.) [de

  12. HUMAN CORONARY ARTERIES- A STUDY BASED ON GROSS ANATOMY AND CORONARY CAST

    Directory of Open Access Journals (Sweden)

    Vijayamma K. N

    2018-01-01

    Full Text Available BACKGROUND Present study is an attempt to throw light upon the coronary arterial pattern, variations in arterial distribution and extent of intercoronary anastomosis and arterial preponderance in different age groups. MATERIALS AND METHODS Total of 115 hearts were made use for this study. Ninety hearts were dissected for the gross anatomical study of coronary arteries and 25 hearts including three fetal hearts were used for the coronary cast study. The right and left coronary arteries were traced from aortic sinus along the atrioventricular groove to the area of its termination. The atrial ventricular and septal branches were traced and looked for anastomosis. Coronary casts were prepared by injecting coloured liquid latex through the coronary ostia and the branching pattern and anastomosis were studied. The coronary arterial pattern, extent of distribution of its branches, arterial preponderance and variations were observed. RESULTS It was found that 73 % cases of SA nodal branch arise from right coronary artery and 27 % from circumflex branch of left coronary artery. SA node has dual blood supply from both coronary arteries in 4% cases. Right coronary preponderance was observed in 83% of cases and left coronary preponderance in 11 % cases, and balanced supply in 6% cases. Coronary cast was helpful to understand the branching pattern of vessels, and the anastomosis of small capillaries. It was also seen that all 11 % of left preponderance were seen in male hearts and all of the 31 female hearts dissected were right preponderant. CONCLUSION Coronary arteries are called end arteries functionally. Right coronary artery originates from anterior aortic sinus in all cases except one which takes origin from posterior left aortic sinus along with left coronary artery. Right coronary preponderance is observed in 83% cases. Left coronary artery branching pattern shows variability. Left coronary preponderance was observed in 11% and all cases are male

  13. Progress in genetics of coronary artery disease

    African Journals Online (AJOL)

    Radwa Gamal

    To the Editor. Coronary Heart Disease (CHD) is the leading cause of mortality and morbidity worldwide [1] and it is a result of coronary artery disease (CAD). Coronary artery disease refers to the build-up of atherosclerotic plaque in the blood vessels that supply oxygen and nutrients to the heart. Progressive infiltration of the ...

  14. 1-year rehospitalization after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Hansen, Kirstine Nørregaard; Bendix, Kristoffer; Antonsen, Lisbeth

    2018-01-01

    AIMS: To evaluate the incidence and causes of rehospitalization within 1-year after percutaneous coronary intervention (PCI) in a country where the National Health Service provides universal tax-supported health care, guaranteeing residents free hospital access. METHODS AND RESULTS: Between January.......26-1.34) and Charlson Comorbidity Index ≥ 3 (OR 3.03;95% CI 2.71-3.27) Conclusions: In an unselected patient cohort treated with PCI, half of the patients were rehospitalized within 1-year, illuminating the impact of comorbidity in patients with ischemic heart disease....... 2010 and September 2014, 17,111 patients were treated with PCI in two University Hospitals in Western Denmark. Patients who were readmitted within 1-year after PCI were identified. Overall 1-year readmission rate was 50.4%. The cause was angina/myocardial infarction (MI) in 4,282 patients (49...

  15. Homocysteine and coronary heart disease

    DEFF Research Database (Denmark)

    Clarke, Robert; Bennett, Derrick A; Parish, Sarah

    2012-01-01

    Moderately elevated blood levels of homocysteine are weakly correlated with coronary heart disease (CHD) risk, but causality remains uncertain. When folate levels are low, the TT genotype of the common C677T polymorphism (rs1801133) of the methylene tetrahydrofolate reductase gene (MTHFR) appreci......Moderately elevated blood levels of homocysteine are weakly correlated with coronary heart disease (CHD) risk, but causality remains uncertain. When folate levels are low, the TT genotype of the common C677T polymorphism (rs1801133) of the methylene tetrahydrofolate reductase gene (MTHFR...

  16. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial.

    Science.gov (United States)

    2015-06-13

    The benefit of CT coronary angiography (CTCA) in patients presenting with stable chest pain has not been systematically studied. We aimed to assess the effect of CTCA on the diagnosis, management, and outcome of patients referred to the cardiology clinic with suspected angina due to coronary heart disease. In this prospective open-label, parallel-group, multicentre trial, we recruited patients aged 18-75 years referred for the assessment of suspected angina due to coronary heart disease from 12 cardiology chest pain clinics across Scotland. We randomly assigned (1:1) participants to standard care plus CTCA or standard care alone. Randomisation was done with a web-based service to ensure allocation concealment. The primary endpoint was certainty of the diagnosis of angina secondary to coronary heart disease at 6 weeks. All analyses were intention to treat, and patients were analysed in the group they were allocated to, irrespective of compliance with scanning. This study is registered with ClinicalTrials.gov, number NCT01149590. Between Nov 18, 2010, and Sept 24, 2014, we randomly assigned 4146 (42%) of 9849 patients who had been referred for assessment of suspected angina due to coronary heart disease. 47% of participants had a baseline clinic diagnosis of coronary heart disease and 36% had angina due to coronary heart disease. At 6 weeks, CTCA reclassified the diagnosis of coronary heart disease in 558 (27%) patients and the diagnosis of angina due to coronary heart disease in 481 (23%) patients (standard care 22 [1%] and 23 [1%]; pheart disease increased (1·09, 1·02-1·17; p=0·0172), the certainty increased (1·79, 1·62-1·96; pheart disease. This changed planned investigations (15% vs 1%; pheart disease, CTCA clarifies the diagnosis, enables targeting of interventions, and might reduce the future risk of myocardial infarction. The Chief Scientist Office of the Scottish Government Health and Social Care Directorates funded the trial with supplementary awards

  17. The impact of infection on mortality in octogenarians who were admitted due to acute coronary syndrome.

    Science.gov (United States)

    Keskin, Kudret; Çetinkal, Gökhan; Sığırcı, Serhat; Yıldız, Süleyman Sezai; Çetin, Şükrü; Gürdal, Ahmet; Kocaş, Betül Balaban; Kılıçkesmez, Kadriye Orta

    The prevalence of coronary artery disease is on the rise as the life expectancy of the population increases. However, treatment of acute coronary syndrome in the elderly patients has its own problems that have not been thoroughly addressed in the clinical trials. Since these patients are generally fragile and have multiple co-morbidities, the course of acute coronary syndrome can frequently be complicated. Infection, which co-exists either at the initial presentation or is acquired during the hospital stay, is a condition about which there is little published data. Therefore, in our study, we wanted to assess the impact of infection on mortality in octogenarians who have acute coronary syndrome METHODS: We retrospectively analyzed the data of 174 octogenarians who had been admitted to the coronary care unit with acute coronary syndrome. All-cause mortality was defined as the primary endpoint of the study. Overall 53 octogenarian patients (30.5%) had an infection along with acute coronary syndrome. The mean duration of follow-up was 10 months (1-25 months). Both in-hospital and long-term mortality were higher in these patients (18.9% vs 6.6%, p = 0.01; 52.8% vs 27.5%, p < 0.01; respectively). Kaplan-Meier analysis also showed lower cumulative survival. (p [log-rank] = 0.002). In multivariate Cox regression analysis; undergoing coronary angiography, infection (HR 1.96, 95% CI 1.15-3.34, p = 0.01), left ventricular ejection fraction and maximum C reactive protein levels were found as independent predictors of long-term survival. Infection in octogenarians who were admitted due to acute coronary syndrome was frequent and increased their mortality substantially. Copyright © 2018 Elsevier B.V. All rights reserved.

  18. A Prospective Trial of Ayurveda for Coronary Heart Disease: A Pilot Study.

    Science.gov (United States)

    DuBroff, Robert; Lad, Vasant; Murray-Krezan, Cristina

    2015-01-01

    Coronary heart disease is the leading cause of death worldwide, and its incidence is rapidly accelerating in developing nations. Patients often search for therapies that are alternatives to traditional treatments, such as heart medicines, coronary bypass surgery, or coronary stenting. Ayurveda is an ancient, East Indian, holistic approach to health care, and its use has never been formally evaluated for patients with coronary heart disease. The study intended to examine the feasibility and effectiveness of comprehensive ayurvedic therapy-incorporating diet, meditation, breathing exercises, yoga, and herbs-for patients with established coronary heart disease. The study was a prospective, single-group, pilot study. The study took place at the University of New Mexico Cardiology Clinic and at the Ayurvedic Institute in Albuquerque, NM, USA. The participants were adults with a history of a prior heart attack, coronary bypass surgery, or a coronary intervention (ie, a coronary angioplasty and/or stent). All enrolled patients were evaluated by a single ayurvedic physician with >40 y of experience, and each received therapy consisting of a calorically unrestricted ayurvedic diet; instruction in yoga, meditation, and breathing; and use of ayurvedic herbs. The primary endpoint was arterial pulse wave velocity, a marker of arterial function and vascular health. Secondary endpoints included the following measurements: (1) body mass index (BMI); (2) blood pressure (BP) and amount of reduction in BP medications; and (3) levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides. All parameters were measured at baseline and after 90 d of therapy. Twenty-two patients were enrolled in the study, and 19 patients completed it. The research team observed significant improvements in arterial pulse wave velocity (P = .015), and favorable reductions in BMI (P ayurveda on arterial function and multiple risk

  19. Use of corrosion casting techniques to evaluate coronary collateral vessels and anastomoses in hearts of canine cadavers.

    Science.gov (United States)

    Noestelthaller, Arne; Probst, Alexander; Koenig, Horst E

    2005-10-01

    To study and investigate branching patterns of the canine coronary arteries and collateral circulation by use of corrosion casting techniques. 31 hearts obtained from cadavers of clinically normal dogs of various ages and breeds and of either sex. 3-dimensional reproduction of coronary arteries was achieved by postmortem injection and perfusion with casting materials into the aortic sinus via the ascending aorta. Perfused hearts were macerated and carefully irrigated; the air-dried specimens were examined macroscopically and with a magnifying headset. Collateral arteries and inter- and intra-arterial anastomoses were successfully detected in 8 corrosion cast specimens. In total, 9 coronary collateral arteries and 3 interarterial anastomoses were found. Our finding of coronary collateral arteries in canine hearts is in agreement with recent findings in coronary flow study. On the basis of our results, vasodilation treatment to improve collateral vessel remodeling in dogs with myocardial dysfunction may be warranted.

  20. A comparison of hybrid coronary revascularization and off-pump coronary revascularization.

    Science.gov (United States)

    Umakanthan, Ramanan; Leacche, Marzia; Gallion, Anna H; Byrne, John G

    2013-04-01

    Minimally invasive approaches to treat vascular disease have been accruing significant popularity over the last several decades. Due to progressive advances in technology, a variety of techniques are being now utilized in the field of cardiovascular surgery. The objectives of minimally invasive techniques are to curtail operative trauma and minimize perioperative morbidity without decreasing the quality of the treatment. The standard surgical approach for the treatment of coronary artery disease has traditionally been coronary artery bypass grafting surgery via median sternotomy. Off-pump coronary artery bypass grafting surgery offers a less invasive alternative and enables coronary revascularization to be performed without cardiopulmonary bypass. Hybrid coronary revascularization offers an even less invasive option in which minimally invasive direct coronary artery bypass can be combined with percutaneous coronary intervention. In this article, the authors review a recent publication comparing hybrid coronary revascularization and off-pump coronary artery bypass grafting surgery.

  1. Interleukin-10 serum level in acute coronary syndrome patients

    Directory of Open Access Journals (Sweden)

    Idrus Alwi

    2009-09-01

    Full Text Available Aim To compare plasma IL-10 concentrations in patients with Acute Coronary Syndrome (ACS with those in Coronary Artery Disease (CAD.Methods ACS patients hospitalized in intensive coronary care unit (ICCU of Cipto Mangunkusumo Hospital/Faculty of Medicine University of Indonesia (CMH/FMUI, Persahabatan Hospital, MMC Hospital, and Medistra Hospital, Jakarta, between May 2005 and May 2006, were included in this study. The ambulatory CAD patients were taken as comparator. The serum IL-10 level was measured by immunoassay method, and compared by using Independent Student’s t-test. To investigate whether IL-10 serum level could predict ACS, the sensitivity and specificity of this parameter towards ACS in various IL-10 serum levels were calculated as well.Results In this observational study, as many as 146 subjects were analyzed, consisting of 84 ACS patients, and 62 coronary artery disease (CAD. The IL-10 level was higher in the group of ACS patients (7.37 pg/mL + 7.81, CI 95% 5.68-9.07 than that in CAD patients (1.59 pg/mL + 1.55, CI 95% 1.2-1.98. The optimal cut-off point for serum IL-10level is >1.95 pg/mL, with 79.76 % sensitivity and 77.42 % specificity.Conclusion The IL-10 level was higher in the ACS patients compared to that in CAD patients. Serum IL-10 measurement is a quite superior method to distinguish acute and stable condition, eventhough it is not as good as hsCRP for the same purpose. (Med J Indones 2009;18:165-9Key words: Interleukin-10, acute coronary syndrome

  2. Coronary Heart Disease and Exercises

    Directory of Open Access Journals (Sweden)

    Tolga SAKA

    2016-06-01

    Full Text Available Coronary heart disease is a chronic process, of which the progression can rapidly change the functional capacity of patients. In CAD patients, the quality of life can be improved with an appropriate exercise prescription. This article explains how a safe exercise program for CAD patients can be prescribed.

  3. Depressive symptoms in patients with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Débora Maria Mendonça da Cunha

    Full Text Available Objective.To assess the presence of depressive symptoms in patients with coronary artery disease in the preoperative period for coronary artery bypass surgery (CABG in Aracaju, Sergipe, Brazil. Methods. A cross-sectional study with 63 hospitalized patients prior to CABG. Two instruments were used for data collection; one for the sociodemographic and clinical characteristics, and the other to evaluate the presence of depressive symptoms, Beck Depression Inventory (BDI. Results. The mean age was 58 years; most were male (60.3%; with a partner (81% low educational level (71.4% attended school through elementary school. Among the patients, 36.5% were classified with dysphoria, and 25.4% had some degree of depression (6.3% mild, 17.5% moderate, and 1.6% severe. The group of patients with lower educational level presented higher depressive symptoms. Conclusion. Six of every ten patients with coronary artery disease showed dysphoria or some degree of depression. The results of this study can support the planning of nursing care for patients before and after CABG, as well as the development of public health policies to ensure complete, quality care for these patients, understanding depression as a variable that can interfere with recovery after cardiac surgery.

  4. European Consensus on Primary Prevention of Coronary Heart Disease.

    Science.gov (United States)

    Assmann, G

    1988-07-01

    The European Consensus on Primary Prevention of Coronary Heart Disease has recommended that providing care for individuals at particular risk for coronary artery disease (CAD) requires case finding through medical examinations in primary care, hospital and employment health examination settings. Decisions concerning management of elevated lipid levels should be based on overall cardiovascular risk. The goal of reducing cholesterol levels through risk reduction can ultimately be accomplished only with the implementation of health education efforts directed toward all age groups and actions by government and supranational agencies, including adequate food labelling to identify fat content, selective taxation to encourage healthful habits and wider availability of exercise facilities. Only measures directed at the overall population can eventually reach the large proportion of individuals at mildly to moderately increased risk for CAD. The European Policy Statement on the Prevention of Coronary Heart Disease recognizes that the question of lipid elevation as a risk factor for CAD involves assessment, not only of cholesterol level alone, but also of triglycerides and the HDL cholesterol lipid fraction. Five specific categories of dyslipidemia have been identified, with individualized screening and treatment strategies advised for each. It is the consensus of the study group panel members that these procedures are both practical and feasible. They begin the necessary long term process to reduce the unacceptably high levels of morbidity and mortality due to CAD throughout the European community.

  5. Evaluation of early coronary graft patency after coronary artery bypass graft surgery using multislice computed tomography angiography

    Directory of Open Access Journals (Sweden)

    Raissi Kamal

    2009-12-01

    Full Text Available Abstract Background Coronary artery bypass graft (CABG surgery is the standard of care in the treatment of advanced coronary artery disease, and its long-term results are affected by the failure of bypass grafts. The aim of the present study was to evaluate the early patency rate in coronary bypass grafts. Methods A total of 107 consecutive patients who underwent CABG were included in this study. Early graft patency was evaluated via computed tomography (CT angiography in the first week after surgery. Results There were a total of 366 grafts, comprised of 250 venous grafts and 116 arterial grafts. Multi-slice CT detected acute graft occlusions in 32 (8.7% of all the grafts, including 26 (10% of the 250 venous grafts and 6 (5% of the 116 arterial grafts. The patency rates obtained were 97.3% for the left internal mammary (IMA grafts, 50% for the radial artery grafts, and 50% for the right IMA grafts. Additionally, 107 (96.4% grafts to the left anterior descending artery (LAD were classified as patent, whereas 1 (30% of the 3 grafts in the left circumflex (LCX region and 1 (50% of the 2 grafts in the right coronary artery (RCA territory were found to be occluded. In the venous category, 8 (13.7% of the 58 grafts to LAD were found to be occluded. In the LCX region, 9 (8.5% of the 106 grafts were classified as occluded, while the remaining 97 (91.5% grafts were patent. The venous grafts to RCA were occluded in 9 (10.4% of the 86 grafts. Amongst the multiple preoperative, intraoperative, and postoperative factors, pump time was significantly longer in the patients with occluded grafts than in those with patent grafts (P = 0.04. Conclusion The IMA grafts had the highest early patency rate amongst the coronary bypass grafts. However, the other arterial grafts were associated with a high rate of acute occlusions.

  6. Carbon dioxide coronary angiography: A mechanical feasibility study with a cardiovascular simulator

    Directory of Open Access Journals (Sweden)

    Ivan Corazza

    2018-01-01

    Full Text Available The aim of this study was to carry out a bench evaluation of the biomechanical feasibility of carbon dioxide (CO2 coronary arteriography. Many patients among the aging population of individuals requiring cardiac intervention have underlying renal insufficiency making them susceptible to contrast-induced nephropathy. To include those patients, it is imperative to find an alternative and safe technique to perform coronary imaging on cardiac ischemic patients. As CO2 angiography has no renal toxicity, it may be a possible solution offering good imaging with negligible collateral effects. Theoretically, by carefully controlling the gas injection process, new automatic injectors may avoid gas reflux into the aorta and possible cerebral damage. A feasibility study is mandatory. A mechanical mock of the coronary circulation was developed and employed. CO2 was injected into the coronary ostium with 2 catheters (2F and 6F and optical images of bubbles flowing inside the vessels at different injection pressures were recorded. The gas behavior was then carefully studied for quantitative and qualitative analysis. Video recordings showed that CO2 injection at a precise pressure in the interval between the arterial dicrotic notch and the minimum diastolic value does not result in gas reflow into the aorta. Gas reflow was easier to control with the smaller catheter, but the gas bubbles were smaller with different vascular filling. Our simulation demonstrates that carefully selected injection parameters allow CO2 coronary imaging without any risk of gas reflux into the aorta.

  7. Carbon dioxide coronary angiography: A mechanical feasibility study with a cardiovascular simulator

    Science.gov (United States)

    Corazza, Ivan; Taglieri, Nevio; Pirazzini, Edoardo; Rossi, Pier Luca; Lombi, Alessandro; Scalise, Filippo; Caridi, James G.; Zannoli, Romano

    2018-01-01

    The aim of this study was to carry out a bench evaluation of the biomechanical feasibility of carbon dioxide (CO2) coronary arteriography. Many patients among the aging population of individuals requiring cardiac intervention have underlying renal insufficiency making them susceptible to contrast-induced nephropathy. To include those patients, it is imperative to find an alternative and safe technique to perform coronary imaging on cardiac ischemic patients. As CO2 angiography has no renal toxicity, it may be a possible solution offering good imaging with negligible collateral effects. Theoretically, by carefully controlling the gas injection process, new automatic injectors may avoid gas reflux into the aorta and possible cerebral damage. A feasibility study is mandatory. A mechanical mock of the coronary circulation was developed and employed. CO2 was injected into the coronary ostium with 2 catheters (2F and 6F) and optical images of bubbles flowing inside the vessels at different injection pressures were recorded. The gas behavior was then carefully studied for quantitative and qualitative analysis. Video recordings showed that CO2 injection at a precise pressure in the interval between the arterial dicrotic notch and the minimum diastolic value does not result in gas reflow into the aorta. Gas reflow was easier to control with the smaller catheter, but the gas bubbles were smaller with different vascular filling. Our simulation demonstrates that carefully selected injection parameters allow CO2 coronary imaging without any risk of gas reflux into the aorta.

  8. Coronary Anomaly and Coronary Artery Fistula as Cause of Angina Pectoris with Literature Review

    Directory of Open Access Journals (Sweden)

    Jayanth Koneru

    2011-01-01

    Full Text Available Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause symptoms by shunting blood flow away from the myocardial capillary network. We report the case of a 46-year old lady which shows the right coronary cusp giving rise to left main coronary artery called anomalous origin of a coronary artery (AOCA, and also a fistula between the left coronary artery and pulmonary artery. We describe our diagnostic approach and review the literature on the epidemiology, pathophysiology, the diagnostic modalities, and treatment options.

  9. Successful treatment of cardiogenic shock by stenting of the left main coronary artery in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Knežević Božidarka

    2008-01-01

    Full Text Available Introduction. Patients with non-ST elevation acute coronary syndromes (NSTE-ACS are sometimes severely hemodynamicly compromised. Urgent coronary angiography should be performed in these patients in percutaneous coronary intervention (PCI centers according to the ESC NSTE-ACS guidelines to determine suitabilty for percutaneous or surgical revascularization. Case report. We reported a 62-year-old male with chest pain admitted to the Coronary Care Unit. ST segment depression of 2 mm in leads I, L and V4-6 was revealed at electrocardiogram. After following 6 hours the patient had chest pain and signs of cardiogenic shock despite of the therapy. Chest x-ray showed pulmonary edema. Echocardiographic examination showed dyskinetic medium and apical segments of septum. The patient underwent coronary angiography immediately which revealed 75% stenosis of the left main coronary artery with thrombus. The use of a GPIIb/III inhibitor-tirofiban and stent implantation resulted in TIMI III flow. After that the patient had no chest pain and acute heart failure subsided in the following days Echocardiography done at the fourth day from PCI showed only hypokinesis medium and apical segment of septum. The patient was discharged at day 11 from admission in a stable condition. Conclusion. Stenting of left main coronary artery stenosis in patients with cardiogenic shock and non- ST segment elevation acute coronary syndromes may be a life saving procedure.

  10. Influence of psychological and coronary parameters on coronary patient rehospitalization

    Directory of Open Access Journals (Sweden)

    Nikolić Gordana

    2010-01-01

    Full Text Available Introduction. Psychological reactions are often comorbid with coronary risk factors and could be important for a six-month outcome. Objective. Determination of anxiety level, depression and aggression, persistence of risk health behaviour, stress life events, and coronary risk factors after coronary event and a predictive value of those parameters for six-month rehospitalization. Methods. In the group with Angina Pectoris (E1=30 and the group with Acute Myocardial Infarction (E2=33, there were applied, at baseline and after 6 months, the following: Semistructured Clinical Interview based on ICD-10, for depressive episode and anxiety disorder, Hamilton Anxiety Scale (HAMA, Hamilton Depression Scale (HAMD, KON-6 sigma Scale for aggression, Holms-Rahe Scale (H-R for stress events and Questionnaire for risk behaviour: alcohol consumption, smoking, lack of physical activity. Group differences were assessed by t-test and chi-square test, p<0.05, regression analysis for assessing initial variables, a predictive value for six month rehospitalization. Results. After acute coronary event, the anxiety and depression levels were mild and aggression was low in E1 and mild in E2. Stress event score was significantly higher in E2 (H-R=115.18 than in E1 (H-R=72.20, p<0.05. After 6 months, the results were the same except for a significantly lower stress event score in E1 (H-R=49.48, and in E2 (H-R=91.65, but still significantly higher than in E1. Coronary parameters were reduced, smokers' rate was increased in E1. Alcohol consumption, hypercholesterolaemia and hereditary tendency were predictive for six- month rehospitalization. Conclusion. After acute cardiac event, hospitalized coronary patients had a mild anxiety, depression and aggression level as well as after six months. The infarct patients had experienced more stress life events in the previous year than the angina patients. Risk health behaviour did not change in the following six months, with the

  11. Clarithromycin for 2 Weeks for Stable Coronary Heart Disease: 6-Year Follow-Up of the CLARICOR Randomized Trial and Updated Meta-Analysis of Antibiotics for Coronary Heart Disease

    DEFF Research Database (Denmark)

    Gluud, Christian; Als-Nielsen, Bodil; Damgaard, Morten

    2008-01-01

    Objectives: We have reported increased 2.6-year mortality in clarithromycin- versus placebo-exposed stable coronary heart disease patients, but meta-analysis of randomized trials in coronary heart disease patients showed no significant effect of antibiotics on mortality. Here we report the 6-year...... disease versus placebo/no intervention (17 trials, 25,271 patients, 1,877 deaths) showed a significantly increased relative risk of death from antibiotics of 1.10 (1.01-1.20) without heterogeneity. Conclusions: Our results stress the necessity to consider carefully the strength of the indication before...... administering antibiotics to patients with coronary heart disease....

  12. Análise diagnóstica do atendimento pré-hospitalar para acidentes e violências contra idosos em Curitiba (PR, Brasil Situational analysis of the pre-hospital health services for attending accidents and violence against the elderly in Curitiba (PR, Brazil

    Directory of Open Access Journals (Sweden)

    Ana Lucia Schaefer Ferreira de Mello

    2010-09-01

    Full Text Available O estudo compõe uma análise situacional dos serviços de atenção a acidentes e violências, em Curitiba, focalizando as condições gerais de infraestrutura, planejamento e apoio no nível de atenção pré-hospitalar, considerando os serviços pré-hospitalares móveis e fixos, dirigidos ao atendimento do idoso vitimizado. Foram evidenciados pontos positivos, lacunas e necessidades de adequação para atender às diretrizes nacionais. A investigação integrou abordagens quantitativas e qualitativas e se pautou nos princípios da triangulação de métodos. Conclui-se que o tema dos acidentes e violência contra idosos comporta importantes melhorias nas ações desenvolvidas pelos serviços pesquisados: (1 ações preventivas não fazem parte da rotina dos serviços; (2 a maioria dos serviços não desenvolve atendimentos específicos, direcionados às demandas particulares dos idosos; (3 a experiência dos entrevistados revela dificuldades de obtenção de leitos hospitalares, para encaminhamento ou transferência de pacientes idosos. O enfrentamento das questões relativas aos acidentes e violências contra idosos em Curitiba impõe considerar a organização de dados, fluxos, capacitação dos profissionais e planejamento no desenvolvimento de programas de prevenção, assistência e reabilitação aos idosos vitimizados.This study is a situational analysis of the health care services for attending accidents and violence, in Curitiba, focusing the general conditions of infrastructure, planning and support at the pre-hospital assistance level, considering mobile and fixed emergency services dedicated to the victimized elderly. Positive points were evidenced as well as gaps and needs to meet the national guidelines. The investigation integrated quantitative and qualitative approaches and it was carried out on the grounds of the triangulation of methods. It is concluded that on the theme of accidents and violence against the elderly still

  13. Coronary artery calcification in Kawasaki disease

    International Nuclear Information System (INIS)

    Ino, T.; Shimazaki, S.; Akimoto, K.; Park, I.; Nishimoto, K.; Yabuta, K.; Tanaka, A.

    1990-01-01

    To evaluate the angiographic features of coronary lesions in Kawasaki disease with coronary artery calcification, cinefluoroscopy and cineangiography were retrospectively reviewed in 116 patients who had undergone coronary angiography between 1982 and 1989. Angiographic abnormalities of coronary arteries were demonstrated in 55 of 116 patients. In 5 (9.1%) of the 55 patients, 9 with calcification were identified by cinefluoroscopy and chest X-ray. Eight of the 9 calcified lesions showed a circular or ring-shape configuration. Coronary angiography revealed a total occlusion of the right coronary artery with collateral circulation from the distal left coronary artery in 2 patients and a severe stenosis of the right coronary artery in 2 patients, in whom anticoagulant therapy had not been continued during the follow-up periods. The remaining patient in whom anticoagulant therapy had been continued had bilateral aneurysms but no significant stenosis. These results indicate that a ring-shape calcification on chest X-ray in 2 patients with a history of Kawasaki disease may suggest an involvement by coronary artery stenosis even when anticoagulant drugs had been given. Therefore, coronary angiography should be performed to evaluate the stenotic lesions if this type of calcification is found by routine radiographic examination. (orig.)

  14. Generating information from electronic patient records in general practice: a description of clinical care and gender inequalities in coronary heart disease using data from over two million patient records

    Directory of Open Access Journals (Sweden)

    Pete Horsfield

    2003-11-01

    • The study provides evidence of feasibility and potential value of remote interrogation of computerized clinical records in primary care to provide detailed information about population health characteristics and clinical activity to both the clinical community and NHS organisations.

  15. Assessing the Risk of Prehospital Administration of Naloxone with Subsequent Refusal of Care.

    Science.gov (United States)

    Levine, Michael; Sanko, Stephen; Eckstein, Marc

    2016-01-01

    EMS providers frequently encounter opioid-toxic patients who receive naloxone and then refuse further medical care. Older studies revealed this practice to be safe. In light of the evolving patterns of opioid abuse, this study attempted to determine the safety of this practice. This is a retrospective review of all patient encounters by the Los Angeles Fire Department (LAFD) between July 1, 2011-December 31, 2013. All LAFD patient encounters are stored electronically. These electronic records were reviewed for subjects who received naloxone had a documented respiratory rate (RR) less than 12, and subsequently refused transport. Data abstracted included name, social security number (SSN), date of birth (DOB), date of EMS encounter, age, and treatment rendered. The names, SSN, and DOB, as available, were supplied to the coroner's office. The Coroner's records were reviewed to determine if a patient with the same or similar name (e.g., Jon vs. Jonathan) had died within 24 hours, 30 days, or 6 months of the initial EMS encounter. The abstractor was blinded to the study hypothesis. 205 subjects were identified; the median (IQR) age was 41 (29-53) years. 27 (13%) were female. One subject (0.49%) died within 24 hours of the initial EMS encounter. The cause of death (COD) was coronary artery disease and heroin use. Two additional subjects (1. %) died within 30 days. One of these subjects died 6 days later; the COD is unknown. The other subject died 20 days after the EMS encounter; the COD was cardiovascular disease and liver cirrhosis. No additional subjects were identified at the 6 month follow up. A third subject died of a heroin overdose 16 months after the initial EMS encounter, but was beyond the pre-defined follow up period. The practice of receiving pre-hospital naloxone by paramedics and subsequently refusing care is associated with an extremely low short- and intermediate-term mortality. Despite an evolving pattern of opioid abuse, the results of this study

  16. Depression and Anxiety following Coronary Artery Bypass Graft: Current Indian Scenario

    Directory of Open Access Journals (Sweden)

    Suprakash Chaudhury

    2016-01-01

    Full Text Available Epidemiological studies have shown a high prevalence of coronary artery disease among the Indian Population. Due to increasing availability and affordability of tertiary care in many parts of India, carefully selected patients undergo coronary artery bypass surgery to improve cardiac function. However, the procedure is commonly associated with depression and anxiety which can adversely affect overall prognosis. The objective of this review is to highlight early identifiable symptoms of depression and anxiety following coronary artery bypass graft (CABG in Indian context so as to facilitate prompt intervention for better outcome. The current review was able to establish firm evidence in support of screening for depression and anxiety following CABG. Management of depression and anxiety following CABG is briefly reviewed.

  17. [Secondary prevention of coronary heart disease is less agressive in patients over 64 years].

    Science.gov (United States)

    Muñoz, Miguel A; Marrugat, Jaume

    2003-06-01

    Although elderly people has a higher incidence of coronary heart disease, this group is seldom included in clinical trials. Studies performed in Spain on elderly coronary heart disease patients have been conducted in hospital settings. The aim of our study was to analyse wether the management of coronary heart disease patients over 64 years of age cared by family physicians differed from that of the rest. Cross-sectional multicentre study embedded in a clinical trial on 1,022 patients with stable coronary heart disease in which socio-demographic variables, comorbidity, treatment and cardiovascular risk- factor control were collected. Mean age was 64 10, 74.0% were men and 53.8% of subjects were over 64 years. Patients over 64 years had a greater cardiovascular comorbidity (87.7 vs 82.6%; p = 0.002) and received lower number of drugs than the rest in the prevention of recurrences (60.4 vs 70.9%; p < 0.001). Probability to receive less than two drugs on secondary prevention by subjects over 64 years was 0.45 (95% CI, 0.30-0.68) despite comorbidity, sex and cardiovascular risk profile.Conclusions. Coronary heart disease patients over 64 years receive less drugs for coronary event recurrence prevention than their younger counterparts despite their worse cardiovascular risk profile.

  18. Association of aortic coarctation and malignant right coronary artery anomaly: an unusual cause of angina pectoris

    Directory of Open Access Journals (Sweden)

    Sirtoli Filho R

    2011-07-01

    Full Text Available Rubens Sirtoli Filho1, Leonardo Cao Cãmbra de Almeida1, Maysa Godoy Gomes Mazurek Sirtoli1, Liliana Pena Pilatti2, Marcelo Valladão de Carvalho2, Marcelo Schafranski31Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, Brazil; 2Department of Hemodynamics, 3Department of Intensive Care, Hospital Bom Jesus, Ponta Grossa, BrazilAbstract: A 53-year-old man with exercise-induced ischemia was referred for investigation. Coronary angiography revealed a right coronary artery originating from the trunk of the left coronary artery, and an aortic coarctation was observed on aortography. A CT angiogram confirmed these findings. Resection of the aortic coarctation and reimplantation of the ostial portion of right coronary artery into its native site was performed, and resulted in a satisfactory outcome. The association of an anomalous right coronary artery with aortic coarctation has rarely been described and represents a critical situation where early diagnosis and prompt intervention are essential.Keywords: coronary anomalies, single ostium, myocardial ischemia, angina pectoris

  19. Gender differences in the prevalence of coronary artery tortuosity and its association with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Joseph Chiha

    2017-03-01

    Conclusion: There is a significant relationship between coronary artery tortuosity and gender. Women with severe tortuosity are more likely to have normal coronary arteries or less severe disease than men despite presenting with chest pain.

  20. Recent activation of the plaque immune response in coronary lesions underlying acute coronary syndromes

    NARCIS (Netherlands)

    van der Wal, A. C.; Piek, J. J.; de Boer, O. J.; Koch, K. T.; Teeling, P.; van der Loos, C. M.; Becker, A. E.

    1998-01-01

    OBJECTIVE: To discriminate between chronic inflammation and acute activation of the plaque immune response in culprit lesions of patients with acute coronary syndromes. DESIGN: Retrospective study. SETTING: Tertiary referral centre. SUBJECTS: 71 patients having coronary atherectomy were classified

  1. Coronary anomalies: what the radiologist should know*

    Science.gov (United States)

    Neves, Priscilla Ornellas; Andrade, Joalbo; Monção, Henry

    2015-01-01

    Coronary anomalies comprise a diverse group of malformations, some of them asymptomatic with a benign course, and the others related to symptoms as chest pain and sudden death. Such anomalies may be classified as follows: 1) anomalies of origination and course; 2) anomalies of intrinsic coronary arterial anatomy; 3) anomalies of coronary termination. The origin and the proximal course of anomalous coronary arteries are the main prognostic factors, and interarterial course or a coronary artery is considered to be malignant due its association with increased risk of sudden death. Coronary computed tomography angiography has become the reference method for such an assessment as it detects not only anomalies in origination of these arteries, but also its course in relation to other mediastinal structures, which plays a relevant role in the definition of the therapeutic management. Finally, it is essential for radiologists to recognize and characterize such anomalies. PMID:26379322

  2. Optimal timing of coronary invasive strategy in non-ST-segment elevation acute coronary syndromes

    DEFF Research Database (Denmark)

    Navarese, Eliano P; Gurbel, Paul A; Andreotti, Felicita

    2013-01-01

    The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations.......The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations....

  3. Coronary artery anomalies in adults: imaging at dual source CT coronary angiography

    International Nuclear Information System (INIS)

    Laspas, Fotios; Roussakis, Arkadios; Mourmouris, Christos; Kritikos, Nikolaos; Efthimiadou, Roxani; Andreou, John

    2013-01-01

    Congenital abnormalities of the coronary arteries have an incidence of 1%, and most of these are benign. However, a small number are associated with myocardial ischaemia and sudden death. Various imaging modalities are available for coronary artery assessment. Recently, multi-detector CT has emerged as an accurate diagnostic tool for defining coronary artery anomalies. The purpose of this pictorial essay is to review the dual source CT appearance of congenital anomalies of the coronary arteries in adults.

  4. MRI in coronary artery disease

    International Nuclear Information System (INIS)

    Barkhausen, Joerg; Hunold, Peter; Waltering, Kai-Uwe

    2004-01-01

    Diagnosis of coronary artery disease (CAD) is a major challenge for medical imaging, because CAD is the leading cause of death in developed nations. Several non-invasive tests are used in clinical routine for the detection of CAD. However, due to limited sensitivity and specificity, the reliable diagnosis as well as the exclusion of CAD can only be established by catheter angiography. In patients with known CAD, therapeutic decisions require accurate information on myocardial function, ischemia and viability. Recently, magnetic resonance (MR) imaging has emerged as a non-invasive cardiac imaging technique that provides information on cardiac morphology, cardiac function, myocardial viability, and coronary morphology. This review discusses technical aspects and the clinical impact of different MR techniques. (orig.)

  5. Left main percutaneous coronary intervention.

    Science.gov (United States)

    Teirstein, Paul S; Price, Matthew J

    2012-10-23

    The introduction of drug-eluting stents and advances in catheter techniques have led to increasing acceptance of percutaneous coronary intervention (PCI) as a viable alternative to coronary artery bypass graft (CABG) for unprotected left main disease. Current guidelines state that it is reasonable to consider unprotected left main PCI in patients with low to intermediate anatomic complexity who are at increased surgical risk. Data from randomized trials involving patients who are candidates for either treatment strategy provide novel insight into the relative safety and efficacy of PCI for this lesion subset. Herein, we review the current data comparing PCI with CABG for left main disease, summarize recent guideline recommendations, and provide an update on technical considerations that may optimize clinical outcomes in left main PCI. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  6. Nanomedicine in coronary artery disease.

    Science.gov (United States)

    Ambesh, Paurush; Campia, Umberto; Obiagwu, Chukwudi; Bansal, Rashika; Shetty, Vijay; Hollander, Gerald; Shani, Jacob

    Nanomedicine is one of the most promising therapeutic modalities researchers are working on. It involves development of drugs and devices that work at the nanoscale (10-9m). Coronary artery disease (CAD) is responsible for more than a third of all deaths in age group >35 years. With such a huge burden of mortality, CAD is one of the diseases where nanomedicine is being employed for preventive and therapeutic interventions. Nanomedicine can effectively deliver focused drug payload at sites of local plaque formation. Non-invasive strategies include thwarting angiogenesis, intra-arterial thrombosis and local inflammation. Invasive strategies following percutaneous coronary intervention (PCI) include anti-restenosis and healing enhancement. However, before practical application becomes widespread, many challenges need to be dealt with. These include manufacturing at the nanoscale, direct nanomaterial cellular toxicity and visualization. Copyright © 2017 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  7. Diagnosis and therapy of coronary artery disease: Second edition

    International Nuclear Information System (INIS)

    Cohn, P.F.

    1985-01-01

    This book contains 18 selections. Some of the titles are: Nuclear cardiology; Diagnosis of acute myocardial infarction; Therapy of angina pectoris; Psychosocial aspects of coronary artery disease; Nonatherosclerotic coronary artery disease; and The epidemiology of coronary artery disease

  8. Costs and clinical outcomes in individuals without known coronary artery disease undergoing coronary computed tomographic angiography from an analysis of Medicare category III transaction codes.

    Science.gov (United States)

    Min, James K; Shaw, Leslee J; Berman, Daniel S; Gilmore, Amanda; Kang, Ning

    2008-09-15

    Multidetector coronary computed tomographic angiography (CCTA) demonstrates high accuracy for the detection and exclusion of coronary artery disease (CAD) and predicts adverse prognosis. To date, opportunity costs relating the clinical and economic outcomes of CCTA compared with other methods of diagnosing CAD, such as myocardial perfusion single-photon emission computed tomography (SPECT), remain unknown. An observational, multicenter, patient-level analysis of patients without known CAD who underwent CCTA or SPECT was performed. Patients who underwent CCTA (n = 1,938) were matched to those who underwent SPECT (n = 7,752) on 8 demographic and clinical characteristics and 2 summary measures of cardiac medications and co-morbidities and were evaluated for 9-month expenditures and clinical outcomes. Adjusted total health care and CAD expenditures were 27% (p cost-efficient alternative to SPECT for the initial coronary evaluation of patients without known CAD.

  9. Bivalirudin in percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Sam J Lehman

    2006-12-01

    Full Text Available Sam J Lehman, Derek P ChewDepartment of Medicine, Flinders University, South Australia, AustraliaAbstract: Bivalirudin is a member of the direct thrombin inhibitor group of anticoagulants. It has been evaluated as an alternative to unfractionated and low-molecular-weight heparins in the settings of percutaneous coronary intervention (PCI and acute coronary syndrome (ACS. Results of clinical trials to date suggest bivalirudin is a viable alternative to the use of a heparin combined with a glycoprotein (GP IIb/IIIa inhibitor in these settings. Thrombin has a central role in coagulation and platelet activation in ACS and during PCI. Its direct inhibition is an attractive target for therapy in these settings. Bivalirudin is a 20 amino acid polypeptide hirudin analog. It displays bivalent and reversible binding to the thrombin molecule, inhibiting its action. Direct inhibition of thrombin with bivalirudin has theoretical pharmacokinetic and pharmacodynamic advantages over the indirect anticoagulants. A reduction in rates of bleeding without loss of anti-thrombotic efficacy has been a consistent finding across multiple clinical trials. There may be economic benefits to the use of bivalirudin if it permits a lower rate of use of the GP IIb/IIIa inhibitors. This article reviews the pharmacology of bivalirudin and clinical trial evidence to date. There are now data from multiple clinical trials and meta-analyses in the setting of ACS and PCI. Early results from the acute catheterization and urgent intervention strategy (ACUITY trial are discussed. Keywords: bivalirudin, direct thrombin inhibitor, acute coronary syndrome, percutaneous coronary intervention

  10. Congenital Heart Defects and Coronary Anatomy

    OpenAIRE

    Mawson, John B.

    2002-01-01

    Coronary artery anomalies are a well recognized feature of many cardiac malformations and have been catalogued in a number of reviews. This overview concentrates on 1) the interplay between congenital heart defects and coronary morphogenesis, examining how some of the embryology fits with the experiments of nature encountered in clinical practice; and 2) the influence of coronary anatomy on patient management. This overview uses, as examples, pulmonary atresia with intact ventricular septum, ...

  11. Behavior patterns and coronary heart disease

    Science.gov (United States)

    Townsend, J. C.; Cronin, J. P.

    1975-01-01

    The relationships between two behavioral patterns, cardiac risk factors, and coronary heart disease are investigated. Risk factors used in the analysis were family history of coronary disease, smoking, cholesterol, obesity, systotic blood pressure, diastolic blood pressure, blood sugar, uric acid, erythrocyte sedimentation rate, and white blood unit. It was found that conventional, non-behavioral pattern risk factors alone were not significantly related to coronary heart disease.

  12. Coronary physiology assessment in the catheterization laboratory

    OpenAIRE

    Díez-delhoyo, Felipe; Gutiérrez-Ibañes, Enrique; Loughlin, Gerard; Sanz-Ruiz, Ricardo; Vázquez-Álvarez, María Eugenia; Sarnago-Cebada, Fernando; Angulo-Llanos, Rocío; Casado-Plasencia, Ana; Elízaga, Jaime; Fernández Avilés Diáz, Francisco

    2015-01-01

    Physicians cannot rely solely on the angiographic appearance of epicardial coronary artery stenosis when evaluating patients with myocardial ischemia. Instead, sound knowledge of coronary vascular physiology and of the methods currently available for its characterization can improve the diagnostic and prognostic accuracy of invasive assessment of the coronary circulation, and help improve clinical decision-making. In this article we summarize the current methods available for a thorough asses...

  13. Role of endothelial function in coronary slow-flow phenomenon with angiographically normal coronaries

    Directory of Open Access Journals (Sweden)

    Srikanth Nathani

    2016-01-01

    Conclusion: Coronary slow flow phenomenon is a marker of atherosclerosis (as documented by carotid intima media thickness and our study has also shown that endothelial function is significantly impaired in patients with coronary slow flow (as documented by impaired endothelial dependent vasodilatation than that of patients with normal epicardial coronaries with normal flow.

  14. Model of the coronary circulation based on pressure dependence of coronary resistance and compliance

    NARCIS (Netherlands)

    Bruinsma, P.; Arts, T.; Dankelman, J.; Spaan, J. A.

    1988-01-01

    The effect of pressure-dependent changes in vascular volume, resistance and capacitance in the coronary micro-circulation, has been studied by a distributed mathematical model of the coronary micro-vasculature in the left ventricular wall. The model does not include regulation of coronary blood flow

  15. Interesting images: Multiple coronary artery aneurysms.

    Science.gov (United States)

    Howard, Jonathon M; Viswanath, Omar; Armas, Alfredo; Santana, Orlando; Rosen, Gerald P

    2017-01-01

    We present the case of a 65-year-old male who presented with stable angina and dyspnea on exertion. His initial workup yielded a positive treadmill stress test for reversible apical ischemia, and transthoracic echocardiogram demonstrated impaired systolic function. Cardiac catheterization was then performed, revealing severe atherosclerotic disease including multiple coronary artery aneurysms. As a result, the patient was advised to and subsequently underwent a coronary artery bypass graft. This case highlights the presence of multiple coronary artery aneurysms and the ability to appreciate these pathologic findings on multiple imaging modalities, including coronary angiogram, transesophageal echocardiography, and direct visualization through the surgical field.

  16. Coronary artery dissection following chest trauma

    Directory of Open Access Journals (Sweden)

    Manoj K Agarwala

    2016-01-01

    Full Text Available Chest trauma has a high rate of mortality. Coronary dissection causing myocardial infarction (MI following blunt chest trauma is rare. We describe the case of an anterior MI following blunt chest trauma. A 39-year-old male was received in our hospital following a motorcycle accident. The patient was asymptomatic before the accident. The patient underwent craniotomy for evacuation of hematoma. He developed severe chest pain and an electrocardiogram (ECG revealed anterior ST segment elevation following surgery. Acute coronary event was medically managed; subsequently, coronary angiogram was performed that showed dissection in the left anterior coronary artery, which was stented.

  17. [Single coronary artery and right aortic arch].

    Science.gov (United States)

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Coronary anomalies are mostly asymptomatic and diagnosed incidentally during coronary angiography or echocardiography. However, they must be taken into account in the differential diagnosis of angina, dyspnea, syncope, acute myocardial infarction or sudden death in young patients. The case is presented of two rare anomalies, single coronary artery originating from right sinus of Valsalva and right aortic arch, in a 65 year-old patient with atherosclerotic coronary artery disease treated percutaneously. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  18. Longitudinal association between lifestyle and coronary heart disease risk factors among individuals with spinal cord injury

    NARCIS (Netherlands)

    de Groot, S.; Post, M. W.; Snoek, G. J.; Schuitemaker, M.; van der Woude, L. H.

    Objective: To investigate: (1) the course of coronary heart disease risk factors (lipid profiles and body mass index (BMI)) in the first five years after discharge from inpatient spinal cord injury (SCI) rehabilitation and (2) the association between lifestyle (physical activity, self-care related

  19. Dual-therapy stent technology for patients with coronary artery disease : A great catch?

    NARCIS (Netherlands)

    Kalkman, D.N.

    2018-01-01

    This thesis investigates the possible advantages of a new stent technology that aims to improve care for patients with coronary artery disease. The COMBO stent (OrbusNeich Medical BV, The Netherlands) contains a dual-therapy stent technology. The stent combines two techniques: a sirolimus-elution

  20. Health care system delay and heart failure in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: follow-up of population-based medical registry data

    DEFF Research Database (Denmark)

    Terkelsen, Christian Juhl; Jensen, Lisette Okkels; Hansen, Hans-Henrik Tilsted

    2011-01-01

    In patients with ST-segment elevation myocardial infarction (STEMI), delay between contact with the health care system and initiation of reperfusion therapy (system delay) is associated with mortality, but data on the associated risk for congestive heart failure (CHF) among survivors are limited....

  1. Ulnar artery: The Ulysses ultimate resort for coronary procedures

    Directory of Open Access Journals (Sweden)

    George Hahalis, MD, PhD

    2016-07-01

    Full Text Available Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA. Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates.

  2. Ulnar artery: The Ulysses ultimate resort for coronary procedures.

    Science.gov (United States)

    Hahalis, George; Deftereos, Spyridon; Bertrand, Olivier F

    2016-08-20

    Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA) only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA). Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO) rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates. Copyright © 2016 Hellenic Cardiological Society. Published by Elsevier B.V. All rights reserved.

  3. Impact of gender on outcome after coronary artery bypass surgery.

    Science.gov (United States)

    Ennker, Ina C; Albert, Alexander; Pietrowski, Detlef; Bauer, Kerstin; Ennker, Juergen; Florath, Ines

    2009-06-01

    Following recent studies concerning the increased risk of coronary artery bypass surgery for women, the impact of sex is still a controversial issue. Between 1996 and 2006, 9,527 men and 3,079 women underwent isolated coronary artery bypass in our institute. To adjust for dissimilarities in preoperative risk profiles, propensity score-based matching was applied. Before adjustment, clinical outcomes in terms of operative mortality, arrhythmias, intensive care unit stay, and maximum creatine kinase-MB levels were significantly different for men and women. After balancing the preoperative characteristics, including height, no significant differences in clinical outcomes were observed. However, there was decreased use of internal mammary artery, less total arterial revascularization, and increasing creatine kinase-MB levels with decreasing height. This study supports the theory that female sex per se does not increase operative risk, but shorter height, which is more common in women, affects the outcome, probably due to technical difficulties in shorter patients with smaller internal mammary arteries and coronary vessels. Thus women may especially benefit from sequential arterial grafting.

  4. Coronary plaque quantification and fractional flow reserve by coronary computed tomography angiography identify ischaemia-causing lesions

    DEFF Research Database (Denmark)

    Gaur, Sara; Øvrehus, Kristian Altern; Dey, Damini

    2016-01-01

    AIMS: Coronary plaque characteristics are associated with ischaemia. Differences in plaque volumes and composition may explain the discordance between coronary stenosis severity and ischaemia. We evaluated the association between coronary stenosis severity, plaque characteristics, coronary computed...... tomography angiography (CTA)-derived fractional flow reserve (FFRCT), and lesion-specific ischaemia identified by FFR in a substudy of the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). METHODS AND RESULTS: Coronary CTA stenosis, plaque volumes, FFRCT, and FFR were assessed...

  5. Multiple giant coronary aneurysms arising from coronary istula to the pulmonary artery revealed in aorta CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Eun Ju; Lee, Ki Nam [Dept. of Radiology, Dong A University Hospital, Dong-A University College of Medicine, Busan (Korea, Republic of); Lee, Jong Min [Dept. of Radiology, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Daegu (Korea, Republic of)

    2015-12-15

    Coronary fistula is a rare coronary abnormality through which blood drains into the cardiac chamber, great vessel or other vessels. In addition, giant aneurysm arising from coronary fistula is rare pathologic manifestation. Herein, we presented a rare case of multiple giant coronary artery aneurysms arising from coronary to pulmonary artery fistula in a 79-year-old woman presenting with sudden loss of consciousness. The aneurysms were detected using thoracic computed tomography angiography and consequently confirmed by invasive coronary angiography.

  6. [« Golden hour » and the Sellick manoeuvre in emergency care: we must not throw out the baby with the bathwater].

    Science.gov (United States)

    Bürki, Lukas; Yersin, Bertrand

    2017-08-09

    This article evaluates 3 controversial subjects of pre-hospital emergency care : 1) The concept of the « Golden hour » predicates an increased morbidity and mortality for injured patients, if pre-hospital care exceeds 1 hour. In the subgroup of patients presenting with severe hemorrhagic injuries or penetrating trauma to the torso, a transport of 60 minutes or less decreases mortality ; 2) The Sellick manoeuvre is used to decrease the risk of bronchoaspiration in patients undergoing an emergency intubation. In view of the low incidence of bronchoaspiration and the inherent risks of cricoid pressure, it should be used only in selected patients ; 3) Improvised cricothyroidotomy using non-medical devices may be feasible if a knife to perform an incision in the cricothyroid membrane and an endotracheal tube of sufficient diameter are available.

  7. Balloon Occlusion Types in the Treatment of Coronary Perforation during Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Xiangfei Wang

    2014-01-01

    Full Text Available Coronary artery perforation is an uncommon complication in patients with coronary heart disease undergoing percutaneous coronary intervention. However, pericardial tamponade following coronary artery perforation may be lethal, and prompt treatment is crucial in managing such patients. Balloon occlusion and the reversal of anticoagulant activity are the common methods used to prevent cardiac tamponade by reducing the amount of bleeding. Herein, we discuss the pros and cons of currently used occlusion types for coronary perforation. Optimal balloon occlusion methods should reduce the amount of bleeding and ameliorate subsequent myocardial ischemia injury, even during cardiac surgery.

  8. Prevalence of conventional risk factors and lipid profiles in patients with acute coronary syndrome and significant coronary disease

    Directory of Open Access Journals (Sweden)

    González-Pacheco H

    2014-10-01

    Full Text Available Héctor González-Pacheco,1 Jesús Vargas-Barrón,2 Maite Vallejo,2 Yigal Piña-Reyna,3 Alfredo Altamirano-Castillo,1 Pedro Sánchez-Tapia,1 Carlos Martínez-Sánchez1 1Coronary Care Unit, National Institute of Cardiology in Mexico City, Mexico City, Mexico; 2Department of Clinical Research, National Institute of Cardiology in Mexico City, Mexico City, Mexico; 3Catheterization Laboratory, National Institute of Cardiology in Mexico City, Mexico City, Mexico Background: Among patients with coronary artery disease (CAD, 80%–90% present at least one conventional risk factor. On the other hand, lipid profile modification after a cardiovascular event related to acute coronary syndrome (ACS has been recognized. The prevalence of conventional risk factors and the lipid profile at the time of admission in patients with ACS and significant CAD (stenosis ≥50% determined through coronary angiography is not well described. Methods: We studied 3,447 patients with a diagnosis of ACS and significant CAD with stenosis ≥50%, as shown on angiography. We recorded the presence of conventional risk factors, including smoking, hypertension, dyslipidemia, and diabetes. In addition, we analyzed the lipid profiles within the first 24 hours of admission. We analyzed the studied population and compared findings according to sex.Results: Most patients (81.7% were male. ST-elevation myocardial infarction was present in 51.3% of patients, and non-ST-elevation acute coronary syndrome was present in 48.7%. The most frequent risk factor was smoking, which was present in 68% of patients, followed by hypertension (57.8%, dyslipidemia (47.5%, and diabetes (37.7%. In women, the most frequent risk factors were hypertension, diabetes, and dyslipidemia, whereas in men, smoking was the most frequent. We identified at least one risk factor in 95.7% of all patients, two or three risk factors in 62%, and four risk factors in 8.6% of patients. The lipid profile analysis revealed that

  9. Moderators of Coronary Vasomotion during Mental Stress in Coronary Artery Disease Patients: Stress Reactivity, Serum Lipoproteins, and Severity of Atherosclerosis

    National Research Council Canada - National Science Library

    Howell, Robert H

    1996-01-01

    Impaired coronary artery vasomotion in response to behavioral triggers such as mental stress may be an important pathophysiological process involved in acute manifestations of coronary artery disease...

  10. Evaluation of the restenosis of coronary artery after percutaneous transluminal coronary angioplasty by three-dimensional coronary magnetic resonance angiography

    International Nuclear Information System (INIS)

    Arisaka, Hiraku

    2000-01-01

    Coronary magnetic resonance angiography (MRA) has been recently brought into clinical use, however, there has not been reports on the comparison with MRA and conventional contrast coronary angiography (CAG) in the detection of the localization and characteristics of coronary restenosis after percutaneous transluminal coronary angioplasty (PTCA). To assess the restenosis of coronary artery after PTCA, this study compared three-dimensional (3D) coronary MRA and CAG. One hundred three patients (76 males and 27 females, average age of 64.6±9.3 years old) were performed coronary MRA at 3-6 months after PTCA. The right coronary artery (RCA) group consist of 21 patients, the left anterior descending branch (LAD) 63 patients and the left circumflex branch (LCX) 19 patients. Coronary MRA was performed with the patients in supine position on a 1.5 T whole body scanner (MAGNETOM VISION, Siemens AG, Germany) using body array coil. The imaging technique used a 3-D gradient echo sequence with respiratory gating and fat suppression. The slice thickness was 2 mm, slab thickness 32 mm, a field of view of 300 mm and a matrix of 128 x 256. Other parameters were an echo time of 2.7 ms and a repetition time of 600 to 1100 msec. The measurement time of 1 imaging slab took 15 to 20 minutes depending on the patient's heart rate. The coronary arteries were reconstructed from the 3-D data set using a multiplanar reconstruction (MPR) technique. According to previous coronary MRA studies, a significant stenosis with a luminal reduction of ≥50% was assumed if a marked signal reduction or signal loss of a vessel segment was visible. In CAG, 57 of 103 patients showed restenosis. In coronary MRA, 37 of 103 patients demonstrated restenosis. The sensitivity, specificity, positive and negative predictive values were 64.9%, 100%, 100% and 69.6%, respectively. Predictive accuracy was 79.6%. Three-dimensional coronary MRA is useful in a noninvasive diagnostic method to evaluate the coronary

  11. Recommendations on pre-hospital & early hospital management of acute heart failure : a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine

    NARCIS (Netherlands)

    Mebazaa, Alexandre; Yilmaz, M. Birhan; Levy, Phillip; Ponikowski, Piotr; Peacock, W. Frank; Laribi, Said; Ristic, Arsen D.; Lambrinou, Ekaterini; Masip, Josep; Riley, Jillian P.; McDonagh, Theresa; Mueller, Christian; deFilippi, Christopher; Harjola, Veli-Pekka; Thiele, Holger; Piepoli, Massimo F.; Metra, Marco; Maggioni, Aldo; McMurray, John; Dickstein, Kenneth; Damman, Kevin; Seferovic, Petar M.; Ruschitzka, Frank; Leite-Moreira, Adelino F.; Bellou, Abdelouahab; Anker, Stefan D.; Filippatos, Gerasimos

    Acute heart failure is a fatal syndrome. Emergency physicians, cardiologists, intensivists, nurses and other health care providers have to cooperate to provide optimal benefit. However, many treatment decisions are opinion-based and few are evidenced-based. This consensus paper provides guidance to

  12. Cardiac nuclear medicine, part II: diagnosis of coronary artery diseas

    International Nuclear Information System (INIS)

    Polak, J.F.; Holman, B.L.

    1981-01-01

    Diagnosing coronary artery disease is difficult and requires careful consideration of the roles and limitations of the tests used. Standard ECG tests are not reliable indicators of the presence of disease in asymptomatic patients. Thallium stress testing to assess ischemia and exercise ventriculography to assess functional status of the heart are limited in sensitivity and specificity. This is the second of a three-part series on cardiac nuclear medicine. Part I (Med. Instrum., May-June, 1981) focused on the commonly used examinations in cardiac physiology and pathophysiology. Part III will focus on myocardial infarction and other cardiac diseases

  13. Single coronary artery; extremely rare coronary anomaly successfully treated surgically in young adult male.

    LENUS (Irish Health Repository)

    Shah, A R

    2010-05-01

    Single coronary artery arising from aortic root, is a rare congenital anomaly. A 30-year-old male presented with acute myocardial infarction (MI) complaining of chest pain and raised troponin levels. Emergency angiography showed no coronary lesions but both left and right coronary arteries arising from single ostium. Patient was operated electively and perioperative findings confirmed the diagnosis of single coronary artery, as left coronary artery after taking origin from right sinus of valsalva runs through the septum, before dividing into left anterior descending and circumflex branches. The single coronary ostium opened with a slit like incision over the course of left main coronary, making the size of ostium three to four times bigger than the native one. In addition left internal mammary artery was harvested and grafted to the left anterior descending branch distally. Patient made successful recovery. Four months follow up dobutamine stress echo showed no inducible ischemia.

  14. COVERED STENTS IN IATROGENIC CORONARY ARTERY FISTULA; A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Masoud Poormoghaddas

    2010-11-01

    Full Text Available Abstract    BACKGROUND: Coronary artery fistula is an abnormal communication between a coronary artery and a cardiac chamber or major cardiac vessels, mostly congenital but some of them are acquired as a consequence of coronary artery perforation.    CASE PRESENTATION: We report a case of cavity spilling coronary artery perforation during percutaneous coronary intervention 7 years ago. Because of continuing symptoms and risk of developing heart failure and pulmonary hypertension we were ought to treat this iatrogenically formed coronary artery fistula. We used stent graft implantation to treat it with acceptable results.    CONCLUSION: Beside their application as a rescue for acute coronary artery perforations, stent grafts can be used with acceptable results in iatrogenically acquired coronary artery coronary artery fistula      Keywords: Coronary artery perforation, Coronary artery fistula, Stent graft.

  15. Design and methods of European Ambulance Acute Coronary Syndrome Angiography Trial (EUROMAX)

    DEFF Research Database (Denmark)

    Steg, Philippe Gabriel; van 't Hof, Arnoud; Clemmensen, Peter

    2013-01-01

    In patients with ST-segment elevation myocardial infarction (STEMI) triaged to primary percutaneous coronary intervention (PCI), anticoagulation often is initiated in the ambulance during transfer to a PCI site. In this prehospital setting, bivalirudin has not been compared with standard-of-care ......In patients with ST-segment elevation myocardial infarction (STEMI) triaged to primary percutaneous coronary intervention (PCI), anticoagulation often is initiated in the ambulance during transfer to a PCI site. In this prehospital setting, bivalirudin has not been compared with standard...

  16. The mechanism of directional coronary atherectomy

    NARCIS (Netherlands)

    V.A.W.M. Umans (Victor); E. Haine; J. Renkin; P.J. de Feyter (Pim); W. Wijns (William); P.W.J.C. Serruys (Patrick)

    1993-01-01

    textabstractAn attempt was made to assess the mechanism of directional coronary atherectomy using different methods of analysis. Quantitative coronary angiography was used as the gold standard to assess the immediate results of atherectomy, and a comparative quantitative analysis of atherectomy and

  17. Noninvasive Diagnostic Technique in Stenotic Coronary Atherosclerosis

    Directory of Open Access Journals (Sweden)

    A. Yu. Vasilyev

    2005-01-01

    Full Text Available Objective: to determine the sensitivity and specificity of combined stress echocardiography (EchoCG using dipyri-damole and dobutamine in diagnosing and defining the extent of stenotic coronary lesions in coronary heart disease (CHD in a group of critically ill patients who are unable to perform a physical exercise.Materials and methods: the study included 57 male patients with suspected acute coronary syndrome who underwent stress EchoCG using dipyridamole in high doses in combination with dobutamine, as well as coronary angiography.Results: stress EchoCG could bring up to the diagnostic criteria in all the patients, of whom 9 patients were found at coronary angiography to have no coronary lesion, 34 and 14 patients had one- and many-vessel lesions, respectively. The sensitivity and specificity of combined stress EchoCG were significantly higher than those of EchoCG used in the diagnosis of CHD.Conclusion: stress EchoCG using dipyridamole in combination with dobutamine is a highly informative safe noninvasive technique for diagnosing CHD, its helps to identify patients with atypical acute coronary syndrome and to form a group of patients to be subject to urgent coronarography and angiosurgical intervention. The pattern of segmental contractile disorders at the height of exercise during combined stress Echo-CG makes it possible to define the site of stenotic coronary atherosclerosis with 97.3% sensitivity and to diagnose many-vessel lesion with 100% sensitivity and 100%specificity.

  18. Multislice CT imaging of anomalous coronary arteries

    International Nuclear Information System (INIS)

    Shi Heshui; Aschoff, Andrik J.; Brambs, Hans-Juergen; Hoffmann, Martin H.K.

    2004-01-01

    The purpose of the present study was to evaluate the role of 16 multislice computed tomography (MSCT) to identify the origin of anomalous coronary arteries and to confirm their anatomic course in relation to the great vessels. Accuracy of coronary artery disease (CAD) detection was a secondary aim and was tested with conventional angiograms (CA) serving as standard of reference. Two hundred and forty-two consecutive patients referred for noninvasive coronary CT imaging were reviewed for the study. Sixteen patients (6.6%) with anomalous coronary arteries were detected and included as the study group. MSCT and CA images were analyzed in a blinded fashion for accuracy of anomalous artery origin and path detection. Results were compared in a secondary consensus evaluation. Accuracy ratios to detect CAD with MSCT in all vessels were calculated. Coronary anomalies for all 16 patients were correctly displayed on MSCT. CA alone achieved correct identification of the abnormality in only 53% (P=0.016). Sensitivity and specificity of MSCT to detect significantly stenosed vessels was 90 and 92%. 16-MSCT is accurate to delineate abnormally branching coronary arteries and allows sufficiently accurate detection of obstructive coronary artery disease in distal branches. It should therefore be considered as a prime non-invasive imaging tool for suspected coronary anomalies. (orig.)

  19. Aneurysmal coronary artery disease: An overview

    Science.gov (United States)

    ElGuindy, Mohamed S.

    Aneurysmal coronary artery disease (ACAD) comprises both coronary artery aneurysms (CAA) and coronary artery ectasia (CAE). The reported prevalence of ACAD varies widely from 0.2 to 10%, with male predominance and a predilection for the right coronary artery (RCA). Atherosclerosis is the commonest cause of ACAD in adults, while Kawasaki disease is the commonest cause in children and adolescents, as well as in the Far East. Most patients are asymptomatic, but when symptoms do exist, they are usually related to myocardial ischemia. Coronary angiography is the mainstay of diagnosis, but follow up is best achieved using noninvasive imaging that does not involve exposure to radiation. The optimal management strategy in patients with ACAD remains controversial. Medical therapy is indicated for the vast majority of patients and includes antiplatelets and/or anticoagulants. Covered stents effectively limit further expansion of the affected coronary segments. Surgical ligation, resection, and coronary artery bypass grafting are appropriate for large lesions and for associated obstructive coronary artery disease. PMID:29564347

  20. Incidence and severity of coronary artery disease in patients with atrial fibrillation undergoing first-time coronary angiography.

    Directory of Open Access Journals (Sweden)

    Stefan Kralev

    Full Text Available In standard reference sources, the incidence of coronary artery disease (CAD in patients with atrial fibrillation (AF ranged between 24 and 46.5%. Since then, the incidence of cardiovascular risk factors (CRF has increased and modern treatment strategies ("pill in the pocket" are only applicable to patients without structural heart disease. The aim of this study was to investigate the incidence and severity of CAD in patients with AF.From January 2005 until December 2009, we included 261 consecutive patients admitted to hospital with paroxysmal, persistent or permanent AF in this prospective study. All patients underwent coronary angiography and the Framingham risk score (FRS was calculated. Patients with previously diagnosed or previously excluded CAD were excluded.The overall incidence of CAD in patients presenting with AF was 34%; in patients >70 years, the incidence of CAD was 41%. The incidence of patients undergoing a percutaneous coronary intervention (PCI or coronary artery bypass graft (CABG was 21%. Patients with CAD were older (73±8 years vs 68±10 years, p = 0.001, had significantly more frequent hypercholesterolemia (60% vs 30%, p<0.001, were more frequent smokers (26% vs 13%, p = 0.017 and suffered from angina more often (37% vs 2%, p<0.001. There was a significant linear trend among the FRS categories in percentage and the prevalence of CAD and PCI/CABG (p<0.0001.The overall incidence of CAD in patients presenting with AF was relatively high at 34%; the incidence of PCI/CABG was 21%. Based upon increasing CRF in the western world, we recommend a careful investigation respecting the FRS to either definitely exclude or establish an early diagnosis of CAD--which could contribute to an early and safe therapeutic strategy considering type Ic antiarrhythmics and oral anticoagulation.

  1. Perioperative outcomes in minimally invasive direct coronary artery bypass versus off-pump coronary artery bypass with sternotomy.

    Science.gov (United States)

    Tekin, Ali İhsan; Arslan, Ümit

    2017-09-01

    Surgical treatment of isolated left anterior descending coronary artery disease can be performed with either minimally invasive direct coronary artery bypass via a left anterior thoracotomy (MIDCAB) or off-pump coronary artery bypass via a median sternotomy (OPCAB). To compare the perioperative outcomes of patients undergoing MIDCAB or OPCAB surgery. Patients who underwent either MIDCAB or OPCAB for isolated left anterior descending (LAD) coronary artery disease between October 2013 and December 2015 were retrospectively evaluated. Operations were carried out by the same surgical team. Preoperative, intraoperative and postoperative data of the patients were recorded for analyses. Twenty-three patients (7 females, 16 males) underwent MIDCAB surgery, and 24 patients (4 female, 20 males) underwent OPCAB surgery. The two groups were comparable regarding preoperative patient characteristics. Duration of mechanical ventilation (5.1 ±0.7 h vs. 6.6 ±0.9 h), intensive care unit stay (19.4 ±2.5 h vs. 45.8 ±5.4 h) and hospital stay (4.3 ±0.4 days vs. 5.6 ±0.8 days) were significantly shorter in the MIDCAB group (p < 0.01). Patients in the OPCAB group required significantly more blood transfusions (1.83 ±0.38 units vs. 0.17 ±0.38 units) and fresh frozen plasma use (2.33 ±0.96 units vs. 0.69 ±0.76 units) (p < 0.01). Conversion to sternotomy was not required in the MIDCAB group. There was no mortality, conversion to cardiopulmonary bypass or serious complication in either group. We believe that the MIDCAB technique is more advantageous than the OPCAB technique in the treatment of patients with a critical LAD lesion.

  2. Time telling devices used in Danish health care are not synchronized

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Hosbond, Susanne; Petersen, Dan Brun

    2012-01-01

    Many patients begin their encounter with the health-care services in an ambulance. In some critical patients, it is pivotal that the timing of treatment and events is registered correctly. When patients are transferred from one health care provider to another, there is a risk that the time telling...... devices used are not synchronized. It has never been examined if this is a problem in Denmark. We performed the present study to examine if time telling devices used in the pre-hospital setting were synchronized with devices used in emergency departments....

  3. Single Coronary Artery with Aortic Regurgitation

    International Nuclear Information System (INIS)

    Katsetos, Manny C.; Toce, Dale T.

    2003-01-01

    An isolated single coronary artery can be associated with normal life expectancy; however, patients are at an increased risk of sudden death. A case is reported of a 54-year-old man with several months of chest pressure with activity. On exercise Sestamibi stress testing, the patient developed a hypotensive response with no symptoms and minimal electrocardiographic changes. Nuclear scanning demonstrated reversible septal and lateral perfusion defects consistent with severe ischemia. Coronary angiography revealed a single coronary artery with the right coronary artery arising from the left main. There were high-grade stenotic lesions in the left anterior descending and circumflex arteries with only moderate atherosclerotic disease in the right coronary artery. An aortogram showed 2-3+ aortic regurgitation, with an ejection fraction of 45% on ventriculography. The patient underwent four-vessel revascularization and aortic valve replacement and did well postoperatively

  4. Updates in management of coronary artery disease

    International Nuclear Information System (INIS)

    Yang, Dong Heon; Chae, Shung Chull

    2005-01-01

    Coronary artery disease (CAD) has been increasing during the last decade and is the one of major causes of death. The management of patients with coronary artery disease has evolved considerably. There are two main strategies in the management of CAD, complementary, not competitive, each other; the pharmacologic therapy to prevent and treat CAD and the percutaneous coronary intervention (PCI) to restore coronary flow. Antiplatelet drugs and cholesterol lowering drugs have central roles in pharmacotherapy. Drug eluting stent (DES) bring about revolutional changes in PCL in the management of patients with ST segment elevation acute myocardial infarction (AMI), there has been a debate on the better strategy for the restoration of coronary flow. Thrombolytic therapy is widely available and easy to administer, whereas primary PCI is less available and more complex, but more complete. Recently published evidences in the pharmacologic therapy including antiplatelet and statin, and PCI including DES and reperfusion therapy in patients with ST segment elevation AMI were reviewed

  5. Updates in management of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Dong Heon; Chae, Shung Chull [Kyungpook National University Medical School, Daegu (Korea, Republic of)

    2005-02-15

    Coronary artery disease (CAD) has been increasing during the last decade and is the one of major causes of death. The management of patients with coronary artery disease has evolved considerably. There are two main strategies in the management of CAD, complementary, not competitive, each other; the pharmacologic therapy to prevent and treat CAD and the percutaneous coronary intervention (PCI) to restore coronary flow. Antiplatelet drugs and cholesterol lowering drugs have central roles in pharmacotherapy. Drug eluting stent (DES) bring about revolutional changes in PCL in the management of patients with ST segment elevation acute myocardial infarction (AMI), there has been a debate on the better strategy for the restoration of coronary flow. Thrombolytic therapy is widely available and easy to administer, whereas primary PCI is less available and more complex, but more complete. Recently published evidences in the pharmacologic therapy including antiplatelet and statin, and PCI including DES and reperfusion therapy in patients with ST segment elevation AMI were reviewed.

  6. Coronary Vasospastic Angina: Assessment by Multidetector CT Coronary Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Koung Mi; Choi, Sang Il; Chun, Eun Ju; Kim, Jeong A; Youn, Tae Jin; Choi, Dong Ju [Seoul National University Bundang Hospital, Sungnam (Korea, Republic of)

    2012-01-15

    We aimed to describe the imaging findings of multidetector CT coronary angiography (MDCTA) in cases of vasospastic angina (VA) and to determine the accuracy of MDCTA in the identification of VA as compared with invasive coronary angiography with an ergonovine provocation test (CAG with an EG test). Fifty-three patients with clinically suspected VA were enrolled in this study. Two radiologists analyzed the stenosis degree, presence or absence of plaque, plaque composition, and a remodeling index of the related-segment in CAG with an EG test, which were used as a gold standard. We evaluated the diagnostic performances of MDCTA by comparing the MDCTA findings with those of CAG with an EG test. Among the 25 patients with positive CAG with an EG test, all 12 patients with significant stenosis showed no definite plaque with the negative arterial remodeling. Of the six patients with insignificant stenosis, three (50%) had non-calcified plaque (NCP), two (33%) had mixed plaque, and one (17%) had calcified plaque. When the criteria for significant stenosis with negative remodeling but no definite evidence of plaque as a characteristic finding of MDCTA were used, results showed sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) of 48%, 100%, 100%, and 68%, respectively. Significant stenosis with negative remodeling, but no definite evidence of plaque, is the characteristic finding on MDCTA of VA. Cardiac MDCTA shows good diagnostic performance with high specificity and PPV as compared with CAG with an EG test.

  7. Spontaneous coronary dissection: case report

    OpenAIRE

    Couto, Gustavo J. Ventura; Deslandes, Alexandre de O.; Santos, Paulo César de Souza; Cruz, Alexandre de Araújo; Saraiva, Roberto Santos

    2007-01-01

    O objetivo do trabalho é demonstrar o caso de um homem de 62 anos, com quadro de dissecção coronariana espontânea, localizada em 1/3 inicial de coronária circunflexa esquerda, tratado cirurgicamente com revascularização miocárdica. A operação realizada com sucesso demonstra, nesse caso, ser o único meio possível de cura.The purpose of the paper is to demonstrate the case of a 62-year-old man, with spontaneous coronary dissection of the left circumflex artery, treated surgically by myocardial ...

  8. Diagnosis of coronary artery disease

    International Nuclear Information System (INIS)

    Pfisterer, M.; Gordon, D.; Battler, A.; Ashburn, W.; Froelicher, V.; Kantonsspital Basel

    1979-01-01

    In order to compare the three non-invasive exercise tests Ecg, Thallium myocardial perfusion imaging and radionuclide angiography in the diagnosis of coronary artery disease, the results of these tests in a consecutive series of 30 patients and 14 controls were analyzed. In all 88 symptom-limited exercise tests a significantly higher double product (heart rate x systolic blood pressure, mm Hg/min) was reached on a treadmill test (for Ecg and Thallium scintigraphy) as compared to the supine bicycle ergometer exercise (for radionuclide angiography): 243.1 +- 61.1 vs. 215.2 +- 46.5 x 10 2 (p [de

  9. Quantitative and qualitative coronary arteriography. 1

    International Nuclear Information System (INIS)

    Brown, B.G.; Simpson, Paul; Dodge, J.T. Jr; Bolson, E.L.; Dodge, H.T.

    1991-01-01

    The clinical objectives of arteriography are to obtain information that contributes to an understanding of the mechanisms of the clinical syndrome, provides prognostic information, facilitates therapeutic decisions, and guides invasive therapy. Quantitative and improved qualitative assessments of arterial disease provide us with a common descriptive language which has the potential to accomplish these objectives more effectively and thus to improve clinical outcome. In certain situations, this potential has been demonstrated. Clinical investigation using quantitative techniques has definitely contributed to our understanding of disease mechanisms and of atherosclerosis progression/regression. Routine quantitation of clinical images should permit more accurate and repeatable estimates of disease severity and promises to provide useful estimates of coronary flow reserve. But routine clinical QCA awaits more cost- and time-efficient methods and clear proof of a clinical advantage. Careful inspection of highly magnified, high-resolution arteriographic images reveals morphologic features related to the pathophysiology of the clinical syndrome and to the likelihood of future progression or regression of obstruction. Features that have been found useful include thrombus in its various forms, ulceration and irregularity, eccentricity, flexing and dissection. The description of such high-resolution features should be included among, rather than excluded from, the goals of image processing, since they contribute substantially to the understanding and treatment of the clinical syndrome. (author). 81 refs.; 8 figs.; 1 tab

  10. Clinical Utility of a Precision Medicine Test Evaluating Outpatients with Suspected Obstructive Coronary Artery Disease.

    Science.gov (United States)

    Ladapo, Joseph A; Budoff, Matt; Sharp, David; Zapien, Michael; Huang, Lin; Maniet, Bruce; Herman, Lee; Monane, Mark

    2017-04-01

    Identifying patients with obstructive coronary artery disease can be challenging for primary care physicians. Advances in precision medicine may help augment clinical tools and redefine the paradigm for evaluating coronary artery disease in the outpatient setting. A blood-based age/sex/gene expression score (ASGES) incorporating key features of precision medicine has shown clinical validity with a 96% negative predictive value and 89% sensitivity in estimating a symptomatic patient's current likelihood of obstructive coronary artery disease. To better characterize the clinical utility of the ASGES and measure its impact on clinician decision-making, a community-based registry was established. The prospective PRESET Registry (NCT01677156) enrolled stable, nonacute adult patients presenting with typical or atypical symptoms suggestive of obstructive coronary artery disease from 21 US primary care practices from August 2012 to August 2014. Demographics, clinical characteristics, and ASGES results (predefined as low [ASGES ≤15] or elevated [ASGES >15]) were collected, as were referrals to Cardiology or further functional/anatomic cardiac testing after ASGES testing. Patients were followed for 1 year post ASGES testing. Among the 566-patient cohort (median age 56 years), clinicians referred 26/252 (10%) of patients with low scores vs 137/314 (44%) of patients with elevated scores to Cardiology or advanced cardiac testing for further evaluation (unadjusted odds ratio 0.15, P precision medicine in the delivery of cardiovascular care. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  11. Current Roles and Future Applications of Cardiac CT: Risk Stratification of Coronary Artery Disease

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Yeonyee Elizabeth [Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Lim, Tae-Hwan [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736 (Korea, Republic of)

    2014-07-01

    Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future.

  12. CLINICAL CASE OF RUSSIAN THROMBOLYTIC AGENT FORTELYZIN® USE IN PATIENTS WITH ACUTE CORONARY ARTERY DISEASE

    Directory of Open Access Journals (Sweden)

    K. A. Kireev

    2015-01-01

    Full Text Available One of the three clinical examples of hospital thrombolysis using Russian thrombolytic agent recombinant protein comprising an amino acid sequence of staphylokinase is described. The trial was held in Chelyabinsk Regional Vascular Centre of specialized medical care for patients with acute coronary syndromes. Each of the three patients had similar reasons for systemic intravenous thrombolysis: hospitalization with ST-segment elevation myocardial infarction, unavailability of coronary interventions due to the X-ray operating room occupancy, high need for the reperfusion therapy in the setting of significant acute myocardial ischemia. In all the cases the pharmacologic reperfusion with recombinant protein comprising an amino acid sequence of staphylokinase was successful, hereafter percutaneous coronary interventions were performed. There were no complications registered.

  13. Determining the proportion of coronary segments assessable on 16-slice CT coronary angiography: a brief report

    International Nuclear Information System (INIS)

    Soon, K. H.; Cox, N.; Eccleston, D.; Lim, Y.; Chaitowitz, I.; Bell, K. W.; Kelly, A-M.

    2007-01-01

    Computed tomography coronary angiography (CT-CA) is becoming a popular non-invasive coronary imaging method. We aimed to determine the proportion of coronary segments assessable on a 16-slice CT in comparison with conventional selective coronary angiography (SCA). We identified all patients who had both 16-slice CT-CA and recent SCA (less than 12 months) from March 2004 to July 2005. Two CT reporters blinded to SCA independently classified coronary segment assessability on CT-CA. A cardiologist blinded to CT findings classified assess-ability of coronary segments on SCA. Data were analysed using descriptive statistics and proportion of agreement. Ninety-five study pairs were included in the analysis. Of those, 1161 coronary segments were deemed assessable on SCA and 1103 segments (95%) were also assessable on CT-CA. Nonassessable segments on CT-CA were predominantly in the distal segments and branches of coronary arteries. Reasons for nonassessability were small calibre (48.3%), motion artefacts (20.7%) and poorly reconstructed segments (22.4%). The 16-slice CT was able to assess a high proportion of but not all coronary segments. Nonassessable segments were predominantly distal segments or branches of coronary arteries. Motion artefacts due to heart-rate changes, small calibre and poorly reconstructed images were main causes of nonassessability on 16-slice CT-CA

  14. [Development of an automated processing method to detect coronary motion for coronary magnetic resonance angiography].

    Science.gov (United States)

    Asou, Hiroya; Imada, N; Sato, T

    2010-06-20

    On coronary MR angiography (CMRA), cardiac motions worsen the image quality. To improve the image quality, detection of cardiac especially for individual coronary motion is very important. Usually, scan delay and duration were determined manually by the operator. We developed a new evaluation method to calculate static time of individual coronary artery. At first, coronary cine MRI was taken at the level of about 3 cm below the aortic valve (80 images/R-R). Chronological change of the signals were evaluated with Fourier transformation of each pixel of the images were done. Noise reduction with subtraction process and extraction process were done. To extract higher motion such as coronary arteries, morphological filter process and labeling process were added. Using these imaging processes, individual coronary motion was extracted and individual coronary static time was calculated automatically. We compared the images with ordinary manual method and new automated method in 10 healthy volunteers. Coronary static times were calculated with our method. Calculated coronary static time was shorter than that of ordinary manual method. And scan time became about 10% longer than that of ordinary method. Image qualities were improved in our method. Our automated detection method for coronary static time with chronological Fourier transformation has a potential to improve the image quality of CMRA and easy processing.

  15. Coronary blood flow and coronary stenosis correlations in ischemic heart patients

    International Nuclear Information System (INIS)

    Manukov, I.

    2003-01-01

    The aim of the study is the assessment of the methodology for the C-TIMI frame count by Gibson for easy and fast determination of the coronary blood flow during a selective coronary angiography. 75 patient have been studied with one-branch affection of the coronary arteries. The criteria for exclusion are: myocardial hypertrophy, valve lesions, myocardial infarction and dyslipidemia. Depending of the characteristics of the coronary stenotic changes, the patients have been divided into two groups: 1) Patients with 'ordinary' stenosis of the coronary artery and 2) Patients with 'complex' stenosis. The severity of the stenotic changes in percents is the same for the two groups - 78%±13% vs 81±12%, respectively. In the first group a pronounced correlation is observed between the severity of the coronary stenosis and the slowing of the coronary blood flow. The 'threshold' stenotic level is 89%. In the second group the lowest value of the coronary stenosis is 73% (p>0.01 vs group 1). No correlation is observed between the severity of the coronary stenosis and the slowing of the coronary blood flow. A conclusion is made that the Gibson method for the assessment of the blood flow is convenient for the daily practice not only for the assessment of the significance of the coronary changes, but also for fast analysis of the achieved reconstruction of the coronary arteries after angioplasty. Additional studies of the significance of the different signs of 'complexity' of the coronary stenosis for the slowing of the blood flow are necessary

  16. Relationship of Hypertension to Coronary Atherosclerosis and Cardiac Events in Patients With Coronary Computed Tomographic Angiography.

    Science.gov (United States)

    Nakanishi, Rine; Baskaran, Lohendran; Gransar, Heidi; Budoff, Matthew J; Achenbach, Stephan; Al-Mallah, Mouaz; Cademartiri, Filippo; Callister, Tracy Q; Chang, Hyuk-Jae; Chinnaiyan, Kavitha; Chow, Benjamin J W; DeLago, Augustin; Hadamitzky, Martin; Hausleiter, Joerg; Cury, Ricardo; Feuchtner, Gudrun; Kim, Yong-Jin; Leipsic, Jonathon; Kaufmann, Philipp A; Maffei, Erica; Raff, Gilbert; Shaw, Leslee J; Villines, Todd C; Dunning, Allison; Marques, Hugo; Pontone, Gianluca; Andreini, Daniele; Rubinshtein, Ronen; Bax, Jeroen; Jones, Erica; Hindoyan, Niree; Gomez, Millie; Lin, Fay Y; Min, James K; Berman, Daniel S

    2017-08-01

    Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent, and severity of coronary atherosclerosis in coronary computed tomographic angiography and cardiac events risk. Of 17 181 patients enrolled in the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) who underwent ≥64-detector row coronary computed tomographic angiography, we identified 14 803 patients without known coronary artery disease. Of these, 1434 hypertensive patients were matched to 1434 patients without hypertension. Major adverse cardiac events risk of hypertension and non-hypertensive patients was evaluated with Cox proportional hazards models. The prognostic associations between hypertension and no-hypertension with increasing degree of coronary stenosis severity (nonobstructive or obstructive ≥50%) and extent of coronary artery disease (segment involvement score of 1-5, >5) was also assessed. Hypertension patients less commonly had no coronary atherosclerosis and more commonly had nonobstructive and 1-, 2-, and 3-vessel disease than the no-hypertension group. During a mean follow-up of 5.2±1.2 years, 180 patients experienced cardiac events, with 104 (2.0%) occurring in the hypertension group and 76 (1.5%) occurring in the no-hypertension group (hazard ratios, 1.4; 95% confidence intervals, 1.0-1.9). Compared with no-hypertension patients without coronary atherosclerosis, hypertension patients with no coronary atherosclerosis and obstructive coronary disease tended to have higher risk of cardiac events. Similar trends were observed with respect to extent of coronary artery disease. Compared with no-hypertension patients, hypertensive patients have increased presence, extent, and severity of coronary atherosclerosis and tend to have an increase in major adverse cardiac events. © 2017 American Heart Association, Inc.

  17. Acute coronary syndrome in a patient with Marfan syndrome following emergent surgical repair of aortic dissection.

    Science.gov (United States)

    Bovolato, Francesca Elisa; Isabella, Giambattista; Rampazzo, Debora; Guglielmi, Cosimo; Gerosa, Gino; Iliceto, Sabino; Bilato, Claudio

    2008-06-01

    We report a case of acute coronary syndrome in a patient with suspect Marfan syndrome, 25 days after emergent modified Bentall-De Bono intervention for acute type I peripartum aortic dissection. She was admitted to our intensive care unit because of unstable angina, caused by critical blood flow reduction in a large portion of the myocardium, according to the severity of the symptoms and the electrocardiographic alterations. Coronary angiography showed a sub-occlusive stenosis of the left main coronary artery as a result of the dissection extension to the coronary ostium. Because of the high risk related to heart surgery, the patient was successfully treated by unprotected angioplasty and drug-eluting stent positioning. Short- and mid-term outcomes were favourable. Subsequent tests confirmed the diagnosis of Marfan syndrome. After 2 years of follow-up, the patient remains asymptomatic and in good health. To our knowledge, this is the first report of a successful percutaneous intervention of the left main coronary artery in a patient with Marfan syndrome who had already undergone ascending aortic root and valve replacement by the Bentall-De Bono procedure for acute dissection.

  18. Premature Coronary Artery Disease due to Homozygous Familial Hypercholesterolemia in a 12-Year-Old Girl

    Directory of Open Access Journals (Sweden)

    Filiz Ekici

    2018-03-01

    Full Text Available Background: Homozygous familial hypercholesterolemia is a rare inherited metabolic disease caused by low-density lipoprotein receptor abnormality. Patients with homozygous familial hypercholesterolemia have an increased risk of cardiovascular complication that usually occurs in the first decade of life. Here, we report a 12-year-old girl with an unpredicted presentation for coronary artery disease and found to have homozygous familial hypercholesterolemia. Case Report: A 12-year-old girl was admitted to our unit with syncope. Chest X-ray showed bilateral diffuse pneumonic consolidation and mild cardiomegaly. We detected stable ST depression by electrocardiography. Echocardiography showed normal systolic functions. Troponin-1 levels were high (66 mcg/dL, upper limit: 0.04 mcg/dL. Influenza A virus DNA was detected by the respiratory viral panel. After her successful treatment for acute pneumonia and myocarditis due to Influenza A virus, her syncope attacks persisted. Marked ST elevation was observed during exercise electrocardiography. Coronary angiography showed severe occlusions in the coronary arteries. High serum levels of total cholesterol (756 mg/dL and low-density lipoprotein-C (556 mg/dL were noticed. She had no tendon xanthomas. Medical histories revealed that her family members were diagnosed with heterozygous familial hypercholesterolemia. A coronary bypass surgery was performed. Statin and ezetimibe treatments were started. We also planned lipid apheresis. Conclusion: Children with homozygous familial hypercholesterolemia may present with symptoms of premature coronary heart disease requiring a routine lipid test and careful anamnesis.

  19. [Prevalence and characteristics of acute coronary syndromes in a sub-Saharan Africa population].

    Science.gov (United States)

    N'Guetta, R; Yao, H; Ekou, A; N'Cho-Mottoh, M P; Angoran, I; Tano, M; Konin, C; Coulibaly, I; Anzouan-Kacou, J B; Seka, R; Adoh, A M

    2016-04-01

    To assess prevalence, characteristics and management of acute coronary syndromes in sub-Saharan Africa population. Prospective survey from January, 2010 to December, 2013, carried out among patients aged 18 years old, admitted to intensive care unit of Abidjan Heart Institute for acute coronary syndrome (ACS). Four hundred and twenty-five (425) patients were enrolled in this study. Prevalence of ACS was 13.5%. Mean age was 55.4±11 years. Clinical presentation was predominantly ST-segment elevation myocardial infarction (STEMI) in 71.5% of subjects, non-ST-segment elevation acute coronary syndrome (NSTE-ACS) accounted for 28.5%. Two hundred and eighty patients (65.9%) were transferred by unsafe transportation. Among the 89 patients admitted within 12hours of the onset of symptoms, primary percutaneous coronary intervention was performed in 20 patients (22.5%), or 6.6% of STEMI as a whole. Twenty-five patients (8.2%) received fibrinolytic therapy with alteplase. In-hospital death rate was 10%. The prevalence of acute coronary syndromes is increasing in sub-Saharan Africa. Excessive delays of admission and limited technical facilities are the major difficulties of their management in our regions. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  20. Implant of permanent pacemaker during acute coronary syndrome: Mortality and associated factors in the ARIAM registry.

    Science.gov (United States)

    Pola-Gallego-de-Guzmán, María Dolores; Ruiz-Bailén, Manuel; Martínez-Arcos, Maria-Angeles; Gómez-Blizniak, Artur; Castillo Rivera, Ana-Maria; Molinos, Jesus Cobo

    2018-04-01

    Patients with acute coronary syndrome complicated with high degree atrioventricular block still have a high mortality. A low percentage of these patients need a permanent pacemaker (PPM) but mortality and associated factors with the PPM implant in acute coronary syndrome patients are not known. We assess whether PPM implant is an independent variable in the mortality of acute coronary syndrome patients. Also, we explored the variables that remain independently associated with PPM implantation. This was an observational study on the Spanish ARIAM register. The inclusion period was from January 2001 to December 2011. This registry included all Andalusian acute coronary syndrome patients. Follow-up for global mortality was until November 2013. We selected 27,608 cases. In 62 patients a PPM was implanted (0.024%). The mean age in PPM patients was 70.71±11.214 years versus 64.46±12.985 years in patients with no PPM. PPM implant was associated independently with age (odds ratio (OR) 1.031, 95% confidence interval (CI) 1.007-1.055), with left ventricular branch block (OR 6.622, 95% CI 2.439-18.181), with any arrhythmia at intensive care unit admission (OR 2.754, 95% CI 1.506-5.025) and with heart failure (OR 3.344, 95% CI 1.78-8.333). PPM implant was independently associated with mortality (OR 11.436, 95% CI 1.576-83.009). In propensity score analysis PPM implant was still associated with mortality (OR 5.79, 95% CI 3.27-25.63). PPM implant is associated with mortality in the acute coronary syndrome population in the ARIAM registry. Advanced age, heart failure, arrhythmias and left ventricular branch block at intensive care unit admission were found associated factors with PPM implant in acute coronary syndrome patient.

  1. Coronary CT angiography: Diagnostic value and clinical challenges.

    Science.gov (United States)

    Sabarudin, Akmal; Sun, Zhonghua

    2013-12-26

    Coronary computed tomography (CT) angiography has been increasingly used in the diagnosis of coronary artery disease due to improved spatial and temporal resolution with high diagnostic value being reported when compared to invasive coronary angiography. Diagnostic performance of coronary CT angiography has been significantly improved with the technological developments in multislice CT scanners from the early generation of 4-slice CT to the latest 320- slice CT scanners. Despite the promising diagnostic value, coronary CT angiography is still limited in some areas, such as inferior temporal resolution, motion-related artifacts and high false positive results due to severe calcification. The aim of this review is to present an overview of the technical developments of multislice CT and diagnostic value of coronary CT angiography in coronary artery disease based on different generations of multislice CT scanners. Prognostic value of coronary CT angiography in coronary artery disease is also discussed, while limitations and challenges of coronary CT angiography are highlighted.

  2. The Angio-Seal™ femoral closure device allows immediate ambulation after coronary angiography and percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Hvelplund, Anders; Jeger, Raban; Osterwalder, Remo

    2011-01-01

    To test the safety of immediate mobilisation of patients undergoing coronary angiography and percutaneous coronary intervention (PCI) closed with Angio-Seal™ -a femoral vascular closure device.......To test the safety of immediate mobilisation of patients undergoing coronary angiography and percutaneous coronary intervention (PCI) closed with Angio-Seal™ -a femoral vascular closure device....

  3. [Multiple coronary arteriovenous fistulae. Hazard or predetermination?].

    Science.gov (United States)

    Rangel, Alberto; Muñoz-Castellanos, Luis; Solorio, Sergio

    2003-01-01

    The authors present the clinical cases of three adult patients (49, 53 and 61 year-old), with rheumatic cardiac valvulopathy, and bilateral coronary arteriovenous fistulae draining in the main pulmonary artery. Based on documental investigation, the authors speculate about the predeterminate origin of coronary arteriovenous fistulae. At first glance, it seems obvious that congenital cardiopathies occur at random, i.e., embryonic development deviate or stops due to unknown reasons, originating the persistence of lacunar blood spaces prior to the development of coronary arteries cords. There are two factors involved in the genesis of congenital malformations: a genomic preexisting factor and the presence of an environmental precipitating factor, i.e., isolated pulmonary valve atresia or left ventricular hypoplastic syndrome, with mitral and aortic valve stenosis, can predispose development of coronary arteriovenous fistulae. Recently, the question has been raised whether there is a relation of coronary arteries fistulae with: ethnic groups, hereditary gigantism, autoimmune diseases, such as polymyositis, hereditary hemorrhagic telangiectasia, and apical hypertrophic myocardiopathy. Coronary arteriovenous fistulae, as well as some congenital cardiopathies, could be due to chromosome alterations or might be related to hereditary diseases, such as hemorrhagic telangiectasia, induced by a disturbed genetic program. Although, there is no concrete evidence that a genetic factor is related to the development of coronary arteriovenous fistulae, there are signs that suggest that such a possibility could be investigated.

  4. Anesthesia for off-pump coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Thomas M Hemmerling

    2013-01-01

    Full Text Available The evolution of techniques and knowledge of beating heart surgery has led anesthesia toward the development of new procedures and innovations to promote patient safety and ensure high standards of care. Off-pump coronary artery bypass (OPCAB surgery has shown to have some advantages compared to on-pump cardiac surgery, particularly the reduction of postoperative complications including systemic inflammation, myocardial injury, and cerebral injury. Minimally invasive surgery for single vessel OPCAB through a limited thoracotomy incision can offer the advantage of further reduction of complications. The anesthesiologist has to deal with different issues, including hemodynamic instability and myocardial ischemia during aorto-coronary bypass grafting. The anesthesiologist and surgeon should collaborate and plan the best perioperative strategy to provide optimal care and ensure a rapid and complete recovery. The use of high thoracic epidural analgesia and fast-track anesthesia offers particular benefits in beating heart surgery. The excellent analgesia, the ability to reduce myocardial oxygen consumption, and the good hemodynamic stability make high thoracic epidural analgesia an interesting technique. New scenarios are entering in cardiac anesthesia: ultra-fast-track anesthesia with extubation in the operating room and awake surgery tend to be less invasive, but can only be performed on selected patients.

  5. Frequency and importance of radiologically visible coronary scleroses

    International Nuclear Information System (INIS)

    Hoyer, B.

    1981-01-01

    The importance of radiologically visible coronary sceleroses for an early diagnosing of coronary heart disease was investigated. In 3 mixed collectives of patients with and without coronary heart diseases who had had a coronary angiography were examined retrospectively for coronary sclerosis (group I: standard films, group II: old X-ray findings, group III: fluoroscopy before beginning coronary angiography). In the retrospective evaluation, the sensitivity to the recognition of coronary heart disease was low. With prospective examination by means of fluoroscopy, coronary calcification could be proven in 37.66% of the patients with coronary diseases (sensitivity); the specificity (no coronary calcification in persons without coronary disease) was 99%. The duration and extent of a calcification do not show a definite influence on the severity of the disease. Several coronary scleroses in one or several vessels mostly indicate a vascular disease. Coronary scleroses are not necessarily located in the same point as coronary stenoses: in 85.5% of the patients with coronary sclerosis of the left truncus, haemodynamically important stenoses were found only in following vascular regions. Considering the high specificity of coronary scleroses in the fluoroscopic picture and the high sensitivity under favourable conditions, this method seems to be suitable as a screening method for early recognition of coronary heart diseases in the asymptomatic stage. A proven coronary sclerosis should in any case be the cause for continuing the search for a coronary heart disease. The radiation exposure during fluoroscopy of coronary sclerosis is low if the adjustment is correct, it takes little time, the patient is not put to discomfort. (orig./MG) [de

  6. [Comparison of 64 MDCT coronary CTA and coronary angiography in the detection of coronary artery stenosis in low risk patients with stable angina and acute coronary syndrome].

    Science.gov (United States)

    Cazalas, G; Sarran, A; Amabile, N; Chaumoitre, K; Marciano-Chagnaud, S; Jacquier, A; Paganelli, F; Panuel, M

    2009-09-01

    To determine the accuracy of 64 MDCT coronary CTA (CCTA) compared to coronary angiography in low risk patients with stable angina and acute coronary syndrome and determine the number of significant coronary artery stenoses ( 50%) in these patients. Materials and methods. Fifty-five patients underwent CCTA using a 32 MDCT unit with z flying focus allowing the acquisition of 64 slices of 0.6 mm thickness as well as coronary angiography (gold standard). Nine patients were excluded due to prior coronary artery bypass surgery (n=4), insufficient breath hold (n=3), calcium scoring>1000 (n=1) and delay between both examinations over 4 months (n=1). Forty-six patients: 27 males and 19 females were included. CCTA results were compared to coronary angiography per segment and artery with threshold detection of stenoses 50%. The degree of correlation between both examinations was performed using a regression analysis with a Pearson correlation coefficient<0.05 considered significant. The overall accuracy of CCTA was 90%; limitations related to the presence of calcifications, motion artifacts or insufficient vessel opacification. The correlation for all analyzed segments was 96.4%. Thirty-eight of 50 significant stenoses seen on coronary angiography were correctly detected on CCTA. Sensitivity, specificity, PPVC and NPV for detection of stenoses 50% were 76%, 98.3%, 80.3% and 97.7% respectively. Evaluation per segment had a NPV of 96.8% (interventricular and diagonal segments) to 100% (main trunk). Our results for specificity and NPV are similar to reports from the literature. This suggests that CCTA in this clinical setting may replace coronary angiography.

  7. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE)

    DEFF Research Database (Denmark)

    Mäkikallio, Timo; Holm, Niels R; Lindsay, Mitchell

    2016-01-01

    Background Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main...... coronary artery disease. Methods In this prospective, randomised, open-label, non-inferiority trial, patients with left main coronary artery disease were enrolled in 36 centres in northern Europe and randomised 1: 1 to treatment with PCI or CABG. Eligible patients had stable angina pectoris, unstable......, and 5% versus 2% (2 . 25, 0 . 93-5 . 48, p= 0 . 073) for stroke. Interpretation The findings of this study suggest that CABG might be better than PCI for treatment of left main stem coronary artery disease....

  8. Subclinical Coronary Plaque Burden in Asymptomatic Relatives of Patients With Documented Premature Coronary Artery Disease

    DEFF Research Database (Denmark)

    Christiansen, Morten Krogh; Jensen, Jesper Møller; Bøtker, Hans Erik

    Introduction: A family history of premature coronary artery disease (CAD) is a well-known risk factor for adverse coronary events with age of onset being inversely related to the degree of heritability. Hypothesis: We hypothesized that asymptomatic first degree relatives, of patients with premature...... CAD, suffer a high burden of subclinical coronary atherosclerosis. Methods: First degree relatives, aged 30-65 years, of patients with a documented coronary revascularization procedure before the age of 40 years, were invited to participate in the study. Participants were matched by age, sex...... and absence of a family history, with patients referred for coronary CT angiography (CTA) because of atypical angina or non-anginal chest pain. A pooled blinded analysis was performed. The main outcome measure was the number of plaque-affected coronary segments. Results: 88 relatives and 88 symptomatic...

  9. Non-obstructive coronary artery disease assessed by coronary computed tomography angiography

    DEFF Research Database (Denmark)

    Nielsen, L.; Bøtker, H. E.; Sorensen, H.

    2015-01-01

    Introduction: Coronary CT angiography (CTA) detects non-obstructive coronary artery disease (CAD) that may not be recognized by functional testing, but the prognostic impact is not well understood. This study aimed to compare the risk of myocardial infarction (MI) and all-cause mortality...... in patients without or with non-obstructive and obstructive CAD assessed by coronary CTA. Methods: Consecutive patients without known coronary artery disease (CAD) and with chest pain who underwent coronary CTA (>64-detector row) between January 2007 and December 2012 in the 10 centers participating...... in the Western Denmark Cardiac Computed Tomography Registry were included. The endpoints were 3-year MI or all-cause mortality. The coronary CTA result was defined as normal (0% luminal stenosis), non-obstructive CAD (1%-49% luminal stenosis) or obstructive CAD (>50% luminal stenosis; 1-vessel, 2-vessel, or 3...

  10. Coronary CT: clinical indications and future directions

    International Nuclear Information System (INIS)

    Nomura, Cesar H.; Serpa, Bruna S.; Kay, Fernando U.; Szarf, Gilberto; Passos, Rodrigo B.; Neto, Roberto S.; Chate, Rodigo C.; Funar, Marcelo B.; Cury, Roberto C.

    2011-01-01

    Multidetector computed tomography (MDCT) has started its implementation in cardiology with calcium quantification of coronary plaques in the study without contrast, using the calcium score, demonstrating an important independent predictor of future cardiac events. The examination with intravenous contrast, coronary angiography, appeared later as a noninvasive method for evaluation of anatomy and obstructive coronary disease, characterizing the degree of stenosis and the presence of non calcified atherosclerotic plaques, assessing not only the lumen, but also the vessel wall. With the advent of new machines with more detectors and higher temporal resolution has been a reduction in radiation dose and the possibility of new applications. (author)

  11. Morphometry of the coronary ostia and the structure of coronary arteries in the shorthair domestic cat

    Science.gov (United States)

    Barszcz, Karolina; Kupczyńska, Marta; Klećkowska-Nawrot, Joanna; Janeczek, Maciej; Goździewska-Harłajczuk, Karolina; Dzierzęcka, Małgorzata; Janczyk, Paweł

    2017-01-01

    The aim of this study was to measure the area of the coronary ostia, assess their localization in the coronary sinuses and to determine the morphology of the stem of the left and right coronary arteries in the domestic shorthair cat. The study was conducted on 100 hearts of domestic shorthair cats of both sexes, aged 2–18 years, with an average body weight of 4.05 kg. A morphometric analysis of the coronary ostia was carried out on 52 hearts. The remaining 48 hearts were injected with a casting material in order to carry out a morphological assessment of the left and right coronary arteries. In all the studied animals, the surface of the left coronary artery ostium was larger than the surface of the right coronary artery ostium. There were four types of the left main coronary artery: type I (23 animals, 49%)–double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch, which in turn gave off the septal branch), type II (12 animals, 26%)–double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch without the septal branch), type III (11 animals, 23%)–triple-branched left main stem (giving off the left circumflex branch, interventricular branch and the septal branch, type IV (1 animal, 2%)–double-branched left main stem (giving off the interventricular paraconal branch and the left circumflex branch, which in turn gave off the septal branch). The left coronary artery ostium is greater than the right one. There is considerable diversity in the branches of proximal segment of the left coronary artery, while the right coronary artery is more conservative. These results can be useful in defining the optimal strategies in the endovascular procedures involving the coronary arteries or the aortic valve in the domestic shorthair cat. PMID:29020103

  12. Morphometry of the coronary ostia and the structure of coronary arteries in the shorthair domestic cat.

    Directory of Open Access Journals (Sweden)

    Karolina Barszcz

    Full Text Available The aim of this study was to measure the area of the coronary ostia, assess their localization in the coronary sinuses and to determine the morphology of the stem of the left and right coronary arteries in the domestic shorthair cat. The study was conducted on 100 hearts of domestic shorthair cats of both sexes, aged 2-18 years, with an average body weight of 4.05 kg. A morphometric analysis of the coronary ostia was carried out on 52 hearts. The remaining 48 hearts were injected with a casting material in order to carry out a morphological assessment of the left and right coronary arteries. In all the studied animals, the surface of the left coronary artery ostium was larger than the surface of the right coronary artery ostium. There were four types of the left main coronary artery: type I (23 animals, 49%-double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch, which in turn gave off the septal branch, type II (12 animals, 26%-double-branched left main stem (giving off the left circumflex branch and the interventricular paraconal branch without the septal branch, type III (11 animals, 23%-triple-branched left main stem (giving off the left circumflex branch, interventricular branch and the septal branch, type IV (1 animal, 2%-double-branched left main stem (giving off the interventricular paraconal branch and the left circumflex branch, which in turn gave off the septal branch. The left coronary artery ostium is greater than the right one. There is considerable diversity in the branches of proximal segment of the left coronary artery, while the right coronary artery is more conservative. These results can be useful in defining the optimal strategies in the endovascular procedures involving the coronary arteries or the aortic valve in the domestic shorthair cat.

  13. Identifying barriers to emergency care services.

    Science.gov (United States)

    Cannoodt, Luk; Mock, Charles; Bucagu, Maurice

    2012-01-01

    This paper aims to present a review of published evidence of barriers to emergency care, with attention towards both financial and other barriers. With the keywords (financial) accessibility, barriers and emergency care services, citations in PubMed were searched and further selected in the context of the objective of this article. Forty articles, published over a period of 15 years, showed evidence of significant barriers to emergency care. These barriers often tend to persist, despite the fact that the evidence was published many years ago. Several publications stressed the importance of the financial barriers in foregoing or delaying potentially life-saving emergency services, both in poor and rich countries. Other publications report non-financial barriers that prevent patients in need of emergency care (pre-hospital and in-patient care) from seeking care, from arriving in the proper emergency department without undue delay or from receiving proper treatment when they do arrive in these departments. It is clear that timely access to life-saving and disability-preventing emergency care is problematic in many settings. Yet, low-cost measures can likely be taken to significantly reduce these barriers. It is time to make an inventory of these measures and to implement the most cost-effective ones worldwide. Copyright © 2011 John Wiley & Sons, Ltd.

  14. Persistence of recruitable coronary collaterals in the absence of coronary vasospasm in a patient with variant angina

    International Nuclear Information System (INIS)

    Yamashita, Kazuhito; Takeuchi, Masaaki; Nakashima, Yasuhide

    1998-01-01

    Recruitable coronary collaterals may appear when spasm suddenly occludes the coronary artery. We report a patient with variant angina who had visible collateral vessels on a control coronary angiogram, despite the presence of normally appearing coronary arteries. These collaterals disappeared after intracoronary administration of nitroglycerin. These findings suggest that recruitable collateral vessels can remain patent long after spontaneous attacks of angina have resolved, and become visible when there is a pressure difference between two small coronary arteries.

  15. Persistence of Recruitable Coronary Collaterals in the Absence of Coronary Vasospasm in a Patient with Variant Angina

    International Nuclear Information System (INIS)

    Yamashita, Kazuhito; Takeuchi, Masaaki; Nakashima, Yasuhide

    1998-01-01

    Recruitable coronary collaterals may appear when spasm suddenly occludes the coronary artery. We report a patient with variant angina who had visible collateral vessels on a control coronary angiogram, despite the presence of normally appearing coronary arteries. These collaterals disappeared after intracoronary administration of nitroglycerin. These findings suggest that recruitable collateral vessels can remain patent long after spontaneous attacks of angina have resolved, and become visible when there is a pressure difference between two small coronary arteries

  16. Left Circumflex Coronary Artery Fistula Connected to the Right Bronchial Artery Associated with Bronchiectasis: Multidetector CT and Coronary Angiography Findings

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Kyung Jin; Choo, Ki Seok [Dept. of Radiology, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan (Korea, Republic of)

    2013-04-15

    Coronary to bronchial artery fistula is a rare vascular anomaly secondary to enlargement of pre-existing vascular anastomosis between the coronary and bronchial arteries. This occurs when there is a constant disturbance of the pressure equilibrium involving either coronary or broncho-pulmonary disorder. Localized bronchiectasis is the most common related condition in patients with a coronary to bronchial artery fistula. Herein, we report on a case of a large left circumflex coronary artery to right bronchial artery fistula associated with bronchiectasis.

  17. Comparison of traditional cardiovascular risk models and coronary atherosclerotic plaque as detected by computed tomography for prediction of acute coronary syndrome in patients with acute chest pain.

    Science.gov (United States)

    Ferencik, Maros; Schlett, Christopher L; Bamberg, Fabian; Truong, Quynh A; Nichols, John H; Pena, Antonio J; Shapiro, Michael D; Rogers, Ian S; Seneviratne, Sujith; Parry, Blair Alden; Cury, Ricardo C; Brady, Thomas J; Brown, David F; Nagurney, John T; Hoffmann, Udo

    2012-08-01

    The objective was to determine the association of four clinical risk scores and coronary plaque burden as detected by computed tomography (CT) with the outcome of acute coronary syndrome (ACS) in patients with acute chest pain. The hypothesis was that the combination of risk scores and plaque burden improved the discriminatory capacity for the diagnosis of ACS. The study was a subanalysis of the Rule Out Myocardial Infarction Using Computer-Assisted Tomography (ROMICAT) trial-a prospective observational cohort study. The authors enrolled patients presenting to the emergency department (ED) with a chief complaint of acute chest pain, inconclusive initial evaluation (negative biomarkers, nondiagnostic electrocardiogram [ECG]), and no history of coronary artery disease (CAD). Patients underwent contrast-enhanced 64-multidetector-row cardiac CT and received standard clinical care (serial ECG, cardiac biomarkers, and subsequent diagnostic testing, such as exercise treadmill testing, nuclear stress perfusion imaging, and/or invasive coronary angiography), as deemed clinically appropriate. The clinical providers were blinded to CT results. The chest pain score was calculated and the results were dichotomized to ≥10 (high-risk) and modeling was performed to examine the association of risk scores and coronary plaque burden to the outcome of ACS. Unadjusted models were individually fitted for the coronary plaque burden and for Goldman, Sanchis, TIMI, and chest pain scores. In adjusted analyses, the authors tested whether the association between risk scores and ACS persisted after controlling for the coronary plaque burden. The prognostic discriminatory capacity of the risk scores and plaque burden for ACS was assessed using c-statistics. The differences in area under the receiver-operating characteristic curve (AUC) and c-statistics were tested by performing the -2 log likelihood ratio test of nested models. A p value capacity for the diagnosis of ACS. Plaque burden was

  18. A Case of Cardiac Cephalalgia Showing Reversible Coronary Vasospasm on Coronary Angiogram

    Science.gov (United States)

    Yang, YoungSoon; Jin, Dong Gyu; Jang, Il Mi; Jang, YoungHee; Na, Hae Ri; Kim, SanYun

    2010-01-01

    Background Under certain conditions, exertional headaches may reflect coronary ischemia. Case Report A 44-year-old woman developed intermittent exercise-induced headaches with chest tightness over a period of 10 months. Cardiac catheterization followed by acetylcholine provocation demonstrated a right coronary artery spasm with chest tightness, headache, and ischemic effect of continuous electrocardiography changes. The patient's headache disappeared following intra-arterial nitroglycerine injection. Conclusions A coronary angiogram with provocation study revealed variant angina and cardiac cephalalgia, as per the International Classification of Headache Disorders (code 10.6). We report herein a patient with cardiac cephalalgia that manifested as reversible coronary vasospasm following an acetylcholine provocation test. PMID:20607049

  19. Acute Thrombotic Coronary Occlusion in a Patient with Coronary Artery Anomaly

    Directory of Open Access Journals (Sweden)

    Beganu Elena

    2017-09-01

    Full Text Available Patients with coronary artery anomalies are more susceptible to develop acute thrombotic coronary occlusions due to the abnormal anatomy of these arteries and the disturbance of the pathophysiological mechanisms that lead to an accele