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Cardiac critical card

Miklos D Kertai, Mary Cooter, Richard J Pollard, William Buhrman, Solomon Aronson, Joseph P Mathew, Mark Stafford-Smith
BACKGROUND: While continuation of β-blockers (BBs) perioperatively has become a national quality improvement measure, the relationship between BB withdrawal and mortality and cardiovascular-related critical quality indicators has not been studied in a contemporary cohort of patients undergoing noncardiac surgery. METHODS: For this retrospective study, the quality assurance database of a large community-based anesthesiology group practice was used to identify 410,288 surgical cases, 18 years of age or older, who underwent elective or emergent noncardiac surgical procedures between January 1, 2009, and December 31, 2014...
November 30, 2017: Anesthesia and Analgesia
Johan N Siebert, Frederic Ehrler, Alain Gervaix, Kevin Haddad, Laurence Lacroix, Philippe Schrurs, Ayhan Sahin, Christian Lovis, Sergio Manzano
BACKGROUND: The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) are nowadays recognized as the world's most authoritative resuscitation guidelines. Adherence to these guidelines optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite their availability, suboptimal quality of CPR is still common. Currently, the median hospital survival rate after pediatric in-hospital cardiac arrest is 36%, whereas it falls below 10% for out-of-hospital cardiac arrest...
May 29, 2017: Journal of Medical Internet Research
Kathleen Dungan, Philip Binkley, Kwame Osei
GlycA is a nuclear magnetic resonance-derived signal that originates from oligosaccharide chains of acute phase proteins. The objective of this study is to characterize GlycA levels in hospitalized non-critically ill patients with type 2 diabetes. This study evaluated traditional and novel (GlycA) inflammatory markers among 121 patients who were stratified by admission diagnoses: congestive heart failure (CHF), cardiac non-CHF (CARD), infection (INF), and other (OTH). HbA1c was similar across groups (8.0-9...
2015: Inflammation
Daisuke Goto, Shintaro Kinugawa, Sanae Hamaguchi, Mamoru Sakakibara, Miyuki Tsuchihashi-Makaya, Takashi Yokota, Satoshi Yamada, Hisashi Yokoshiki, Hiroyuki Tsutsui
BACKGROUND: A subset of patients with hypertrophic cardiomyopathy (HCM) has been reported to progress into dilated-HCM (D-HCM), characterized by left ventricular (LV) systolic dysfunction and cavity dilatation, resembling idiopathic dilated cardiomyopathy (DCM). We compared the characteristics, treatments, and outcomes in patients with heart failure (HF) due to D-HCM vs. DCM by using national registry data in Japan. METHODS AND RESULTS: The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) is a prospective observational study of patients hospitalized due to worsening HF with an average of 2...
January 2013: Journal of Cardiology
T S L Keesen, J A S Gomes, R C G Fares, F F de Araújo, K S Ferreira, A T Chaves, M O C Rocha, R Correa-Oliveira
Although the pathophysiology of Chagas disease is not completely understood, it is widely accepted that involvement of the immune response is critical in determining the outcome of the disease. In this context, CD4⁺ T cells may play an important role in generating different mechanisms of protection. In addition to effector and regulatory functions, CD4⁺ T cells may be also involved with lytic activities against the parasite and may have a relevant role on control of the infection. In this study, we have evaluated CD4⁺ T cells expressing cytotoxic and apoptosis markers in response to Trypanossoma cruzi infection in indeterminate (IND) and cardiac (CARD) patients with Chagas disease and non-infected individuals (NI)...
September 2012: Scandinavian Journal of Immunology
Cinzia Borgognoni, Giordano Cotichelli, Andrea Toccaceli, Alfia Lizzi, Carla Lucertini
BACKGROUND: The introduction of a unique therapeutic card represents a valid tool for the containment of adverse events during the treatment process, from prescribing a drug to its administration. AIMS: This article aims to illustrate the development and implementation (through the application of the Deming Cycle) of a computerized STU in a cardiac care setting referring to a Department of Cardiology. MATERIALS AND METHODS: A multi-professional team was formed and carried out the following steps: a) analysis of existing clinical documentation highlighting the most critical points with respect to the therapeutic-pharmacological process; b) construction of a computerized STU c) sharing information with every member of the professional group involved, d) implementation of the STU in order to assess the areas of improvement...
July 2011: Professioni Infermieristiche
Alexander F Arriaga, Andrew W Elbardissi, Scott E Regenbogen, Caprice C Greenberg, William R Berry, Stuart Lipsitz, Donald Moorman, James Kasser, Andrew L Warshaw, Michael J Zinner, Atul A Gawande
OBJECTIVE: To develop and evaluate an intervention to reduce breakdowns in communication during inpatient surgical care. BACKGROUND: Communication breakdowns are the second most common cause of avoidable surgical adverse events after technical errors. METHODS: In a pre- and postintervention study, a random selection of patients on the surgical services of 4 teaching hospitals were observed according to 3 measures: (1) resident-attending communication of critical patient events (eg, transfer into the intensive care unit, unplanned intubation, cardiac arrest); (2) resident-attending notification regarding routine weekend patient status; and (3) frequency of weekend patient visits by an attending...
May 2011: Annals of Surgery
Jacqueline Araújo Fiuza, Ricardo Toshio Fujiwara, Juliana Assis Silva Gomes, Manoel Otávio das Costa Rocha, Ana Thereza Chaves, Fernanda Fortes de Araújo, Rafaelle Christine Gomes Fares, Andrea Teixeira-Carvalho, Olindo de Assis Martins-Filho, Guilherme Grossi Lopes Cançado, Rodrigo Correa-Oliveira
BACKGROUND: Chronic Chagas disease presents several different clinical manifestations ranging from asymptomatic to severe cardiac and/or digestive clinical forms. Several studies have demonstrated that immunoregulatory mechanisms are important processes for the control of the intense immune activity observed in the chronic phase. T cells play a critical role in parasite specific and non-specific immune response elicited by the host against Trypanosoma cruzi. Specifically, memory T cells, which are basically classified as central and effector memory cells, might have a distinct migratory activity, role and function during the human Chagas disease...
2009: PLoS Neglected Tropical Diseases
Miyuki Tsuchihashi-Makaya, Sanae Hamaguchi, Shintaro Kinugawa, Takashi Yokota, Daisuke Goto, Hisashi Yokoshiki, Norihiro Kato, Akira Takeshita, Hiroyuki Tsutsui et al.
BACKGROUND: Heart failure (HF) with preserved ejection fraction (EF) is common. We compared the characteristics, treatments, and outcomes in HF patients with reduced vs preserved EF by using the national registry database in Japan. METHODS AND RESULTS: The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) is a prospective observational study in a broad sample of patients hospitalized with worsening HF. The study enrolled 2,675 patients from 164 hospitals with an average of 2...
October 2009: Circulation Journal: Official Journal of the Japanese Circulation Society
Isabelle Mercier, Magalis Vuolo, Jean-Francois Jasmin, Christina M Medina, Mark Williams, John M Mariadason, Hong Qian, Xiaonan Xue, Richard G Pestell, Michael P Lisanti, Richard N Kitsis
The ability of cells to escape apoptosis is critical for carcinogenesis as well as resistance to radiation and chemotherapy. ARC (Apoptosis Repressor with CARD (caspase recruitment domain)) is an unusual inhibitor of apoptosis in that it antagonizes both the extrinsic (death receptor) and intrinsic (mitochondrial/ER) apoptosis pathways. ARC is expressed predominantly in terminally differentiated cells such as cardiac and skeletal myocytes and neurons. Recently, however, the abundance of ARC was noted to be markedly increased in the epithelium of primary human breast cancers compared with benign breast tissue and to confer chemo- and radiation-resistance...
June 1, 2008: Cell Cycle
Christopher P Cannon
The Strategies and Therapies for Reducing Ischemic and Vascular Events (STRIVE) acute coronary syndromes (ACS) critical pathway toolkit, developed in 2002, has been revised and updated. The updated toolkit is based on the American College of Cardiology/American Heart Association 2007 guidelines for the management of patients with unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI). This review highlights the major revisions to the UA/NSTEMI guidelines and illustrates and describes the revised STRIVE critical pathway tools, which include pathway flowcharts, standing orders, pocket cards, posters, and form letters...
March 2008: Critical Pathways in Cardiology
Fernanda Fortes Araujo, Juliana Assis Silva Gomes, Manoel Otavio Costa Rocha, Sarah Williams-Blangero, Vladimir Martins Pinheiro, Maria Jose Ferreira Morato, Rodrigo Correa-Oliveira
Several immunoregulatory mechanisms are proposed to be effective both in human and experimental Trypanosoma cruzi infection. However, the role of CD4+CD25high T cells in Chagas disease has not yet been elucidated. These cells are critical for the regulation of immune response to infectious agents and in the control of autoimmune diseases. In this study, the presence of CD4+CD25high regulatory T cells in the whole blood of non-infected individuals (NI), and patients with the indeterminate (IND) and cardiac form (CARD) of Chagas disease was evaluated...
2007: Frontiers in Bioscience: a Journal and Virtual Library
Yi-Qiang Zhang, Brian Herman
Apoptosis repressor with a CARD domain (ARC) has been demonstrated to protect heart cells against ischemia/reperfusion (I/R) injury. In this study, we investigated the mechanism by which ARC protects heart cells against oxidative stress. We monitored the extent of apoptosis and activity of multiple components of the intrinsic apoptotic pathway in rat cardiac myoblast cell line H9c2 with either reduced or increased expression of ARC during oxidative stress. Overexpression of ARC-inhibited oxidative stress-induced caspase-2/3 activation, cytochrome c release, and translocation of Bax to mitochondria...
October 1, 2006: Journal of Cellular Biochemistry
Shawn A Richard, Shail Rawal, Douglas K Martin
BACKGROUND: The recent proliferation of health care report cards, especially in cardiac care, has occurred in the absence of an ethical framework to guide in their development and implementation. An ethical framework is a consistent and comprehensive theoretical foundation in ethics, and is formed by integrating ethical theories, relevant literature, and other critical information (such as the views of stakeholders). An ethical framework in the context of cardiac care provides guidance for developing cardiac report cards (CRCs) that are relevant and legitimate to all stakeholders...
March 28, 2005: BMC Medical Ethics
Timothy Dickinson, Jeffrey Riley, Paul M Zabetakis
PURPOSE: There exists a significant gap between the expected and delivered level of quality received in America's hospitals. As a result, clinical outcomes of critical services such as coronary artery bypass graft (CABG) surgery have received unparalleled scrutiny. Medical information technology companies like Solucient and insurance carriers such as Blue Cross of California have identified and published a list of hospitals that demonstrate superior quality and patient outcomes for CABG procedures...
2004: Perfusion
Young-Jae Nam, Kartik Mani, Anthony W Ashton, Chang-Fu Peng, Barath Krishnamurthy, Yukihiro Hayakawa, Peiyee Lee, Stanley J Korsmeyer, Richard N Kitsis
Death-fold domains constitute an evolutionarily conserved superfamily that mediates apoptotic signaling. These motifs, including CARD (caspase recruitment domain), DD (death domain), and DED (death effector domain), are believed to exert their effects solely through homotypic interactions. Herein we demonstrate that the CARD-containing protein ARC engages in nontraditional death-fold interactions to suppress both extrinsic and intrinsic death pathways. The extrinsic pathway is disrupted by heterotypic interactions between ARC's CARD and the DDs of Fas and FADD, which inhibit Fas-FADD binding and assembly of the death-inducing signaling complex (DISC)...
September 24, 2004: Molecular Cell
David A Alter, Peter C Austin, C David Naylor, Jack V Tu
BACKGROUND: Critics of "scorecard medicine" often highlight the incompleteness of risk-adjustment methods used when accounting for baseline patient differences. Although socioeconomic status is a highly important determinant of adverse outcome for patients admitted to the hospital with acute myocardial infarction, it has not been used in most risk-adjustment models for cardiovascular report cards. OBJECTIVES: To determine the incremental impact of socioeconomic status adjustments on age, sex, and illness severity for hospital-specific 30-day mortality rates after acute myocardial infarction...
January 2002: Medical Care
S R Chipkin, S A Klugh, L Chasan-Taber
As rates of diabetes mellitus and obesity continue to increase, physical activity continues to be a fundamental form of therapy. Exercise influences several aspects of diabetes, including blood glucose concentrations, insulin action and cardiovascular risk factors. Blood glucose concentrations reflect the balance between skeletal muscle uptake and ambient concentrations of both insulin and counterinsulin hormones. Difficulties in predicting the relative impact of these factors can result in either hypoglycemia or hyperglycemia...
August 2001: Cardiology Clinics
D C Cheng
Economic realities of the continuing increased utilization of cardiac surgery in the 1990s have led to the practice of early tracheal extubation and shortening of the length of intensive care unit and hospital stays. In this era of cost-containment and physician report cards, we are held accountable for patients' outcome in terms of mortality, morbidity, quality of life, length of stay, and cost of care. This report outlines the factors that influence costs of cardiac surgery. These include patient risk, anesthesia, surgical, intensive care unit, and health care systems or hospital factors...
December 1998: Journal of Cardiothoracic and Vascular Anesthesia
J S Sahambi, S N Tandon, R K Bhatt
A novel algorithm for detection and analysis of QT interval, a risk factor for sudden cardiac death, is developed using the multiresolution wavelet approach. The characteristic points for detection of QT interval, i.e., the onset and offsets of the QRS complex and the T wave are detected by analyzing the wavelet transform of the ECG at particular scales. The results of the detailed study using standard data base indicate that proposed technique can be used to monitor critical heart patients for localization of problems in the duration of ventricular activation...
1997: Biomedical Sciences Instrumentation
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