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https://www.readbyqxmd.com/read/28431590/delays-in-door-to-needle-time-for-acute-ischemic-stroke-in-the-emergency-department-a-comprehensive-stroke-center-experience
#1
Ashkan Mowla, Jordan Doyle, Navdeep S Lail, Hamidreza Rajabzadeh-Oghaz, Christopher Deline, Peyman Shirani, Marilou Ching, Annemarie Crumlish, Deborah A Steck, David Janicke, Elad I Levy, Robert N Sawyer
BACKGROUND: Current American Stroke Association guidelines recommend initiating intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) within 60min of patient arrival, given the benefits of IVT for AIS are time dependent. This study aimed to identify the delaying factors in door-to-needle time (DTN) in the emergency department of one of the largest comprehensive stroke centers in New York State. We also recommended measures to reduce the delays. METHODS: We retrospectively reviewed the medical charts of all AIS patients who received IVT in our emergency department patients between April 1, 2012 and December 31, 2015 to identify those with a DTN time of >60min...
May 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28427345/variation-in-gp-decisions-on-antihypertensive-treatment-in-oldest-old-and-frail-individuals-across-29-countries
#2
Sven Streit, Marjolein Verschoor, Nicolas Rodondi, Daiana Bonfim, Robert A Burman, Claire Collins, Gerasimovska Kitanovska Biljana, Sandra Gintere, Raquel Gómez Bravo, Kathryn Hoffmann, Claudia Iftode, Kasper L Johansen, Ngaire Kerse, Tuomas H Koskela, Sanda Kreitmayer Peštić, Donata Kurpas, Christian D Mallen, Hubert Maisoneuve, Christoph Merlo, Yolanda Mueller, Christiane Muth, Marija Petek Šter, Ferdinando Petrazzuoli, Thomas Rosemann, Martin Sattler, Zuzana Švadlenková, Athina Tatsioni, Hans Thulesius, Victoria Tkachenko, Peter Torzsa, Rosy Tsopra, Tuz Canan, Rita P A Viegas, Shlomo Vinker, Margot W M de Waal, Andreas Zeller, Jacobijn Gussekloo, Rosalinde K E Poortvliet
BACKGROUND: In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent guidelines, mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not on frailty despite the high prevalence in oldest-old. This may lead to variation how General Practitioners (GPs) treat hypertension. Our aim was to investigate treatment variation of GPs in oldest-olds across countries and to identify the role of frailty in that decision...
April 20, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28356129/the-effects-of-probiotic-and-synbiotic-supplementation-on-metabolic-syndrome-indices-in-adults-at-risk-of-type-2-diabetes-study-protocol-for-a-randomized-controlled-trial
#3
Nazila Kassaian, Ashraf Aminorroaya, Awat Feizi, Parvaneh Jafari, Masoud Amini
BACKGROUND: The incidence of type 2 diabetes, cardiovascular diseases, and obesity has been rising dramatically; however, their pathogenesis is particularly intriguing. Recently, dysbiosis of the intestinal microbiota has emerged as a new candidate that may be linked to metabolic diseases. We hypothesize that selective modulation of the intestinal microbiota by probiotic or synbiotic supplementation may improve metabolic dysfunction and prevent diabetes in prediabetics. In this study, a synthesis and study of synbiotics will be carried out for the first time in Iran...
March 29, 2017: Trials
https://www.readbyqxmd.com/read/28348073/from-benign-adrenal-incidentaloma-to-adrenocortical-carcinoma-an-exceptional-random-event
#4
Ines Belmihoub, Stephane Silvera, Mathilde Sibony, Bertrand Dousset, Paul Legmann, Xavier Bertagna, Jerome Bertherat, Guillaume Assie
New European guidelines for the management of adrenal incidentalomas were recently released. One of the most novel recommendations is to stop following patients when they present a typical, small and non-secreting adenoma. We report here the case of a 71-year-old man with such an adenoma, who developed an adrenocortical carcinoma (ACC) fourteen years later, with subsequent metastases and death. Clinically he had a normal blood pressure and no sign of hormonal hypersecretion. The hormonal work-up showed no hormone excess: urinary free cortisol level was normal, the diurnal cortisol rhythm was respected and urinary catecholamine metabolites levels were normal...
March 27, 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28347475/current-trends-in-vasopressor-use-to-the-operating-room-a-pharmacoepidemiologic-study-in-french-teaching-and-military-hospitals
#5
M Bauducel, V Piriou, C Dussart, G Aulagner, X Armoiry
OBJECTIVES: Phenylephrine, ephedrine and norepinephrine are the vasopressors most commonly used in the operating room to treat anaesthesia-induced hypotension. Two new diluted forms of phenylephrine were released in 2011 (500μg/10mL and 500μg/5mL). We initiated a study to evaluate trends in the use of vasopressors in the operating room in French hospitals over the period 2011-2014. METHODS: We conducted a longitudinal, retrospective, observational study between 2011 and 2014 in French teaching and military hospitals...
March 24, 2017: Annales Pharmaceutiques Françaises
https://www.readbyqxmd.com/read/28341615/design-and-usability-of-a-heart-failure-mhealth-system-a-pilot-study
#6
Nagla Alnosayan, Samir Chatterjee, Ala Alluhaidan, Edward Lee, Linda Houston Feenstra
BACKGROUND: Despite the advances in mobile health (mHealth) systems, little is known about patients' and providers' experiences using a new mHealth system design. OBJECTIVE: This study aimed to understand challenges and provide design considerations for a personalized mHealth system that could effectively support heart failure (HF) patients after they transition into the home environment. METHODS: Following exploratory interviews with nurses and preventive care physicians, an mHealth system was developed...
March 24, 2017: JMIR Human Factors
https://www.readbyqxmd.com/read/28289965/novel-insights-into-the-pathophysiology-and-clinical-aspects-of-diabetic-nephropathy
#7
REVIEW
Zubair Ilyas, Joumana T Chaiban, Armand Krikorian
Diabetic nephropathy (DN) is a well-described complication of diabetes mellitus and the leading cause of end stage renal disease (ESRD). Although increased albuminuria has been the gold standard for screening, data suggests that renal damage starts long before the onset of clinically apparent increases in macro and even micro-albuminuria. Clinical practice guidelines for the prevention of DN have been traditionally focused on the control of serum glucose, blood pressure and dyslipidemia, with some focus on the renin-angiotensin-aldosterone system (RAAS) as a main target for successful therapy...
March 13, 2017: Reviews in Endocrine & Metabolic Disorders
https://www.readbyqxmd.com/read/28285069/sacubitril-valsartan-the-newest-addition-to-the-toolbox-for-guideline-directed-medical-therapy-of-heart-failure
#8
REVIEW
Jo E Rodgers
Sacubitril/valsartan combines a neprilysin inhibitor with an angiotensin receptor blocker. As an inhibitor of neprilysin, an enzyme that degrades biologically active natriuretic peptides, this first-in-class therapy increases levels of circulating natriuretic peptides, resulting in natriuretic, diuretic, and vasodilatory effects. In patients with chronic New York Heart Association class II-IV heart failure with reduced ejection fraction, the PARADIGM-HF trial demonstrated that sacubitril/valsartan significantly reduced the primary endpoint of cardiovascular mortality and heart failure hospitalization, compared with enalapril...
March 9, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28275938/role-of-coronary-calcium-for-risk-stratification-and-prognostication
#9
REVIEW
Negin Nezarat, Michael Kim, Matthew Budoff
A multitude of studies now support the understanding that an increased coronary artery calcium (CAC) score represents advanced atherosclerosis and high risk for cardiovascular disease (CVD) and, as such, should be treated with conventional therapies for those considered high risk. Data is now available to guide treatment with aspirin, statins, and lifestyle management. The new ACC/AHA 2013 guidelines support intensifying statin therapy when the CAC is ≥75th percentile for age, sex, and ethnicity/race or when the calcium score is ≥300 Agatston units...
February 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28237685/evaluation-of-a-new-handheld-point-of-care-blood-gas-analyser-using-100-equine-blood-samples
#10
David Bardell, Eleanor West, J Mark Senior
OBJECTIVES: To determine whether the Enterprise point-of-care blood analysis system (EPOC) produces results in agreement with two other blood gas analysers in regular clinical use (i-STAT and Radiometer ABL77) and to investigate the precision of the new machine when used with equine whole blood. STUDY DESIGN: Prospective, randomized, non-blinded, comparative laboratory analyser study. ANIMALS: Horses admitted to a university teaching hospital requiring arterial or venous blood gas analysis as part of their routine clinical management...
February 22, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28178413/spontaneous-intracerebral-hemorrhage-management
#11
REVIEW
Jun Yup Kim, Hee-Joon Bae
Spontaneous non-traumatic intracerebral hemorrhage (ICH) remains a significant cause of mortality and morbidity throughout the world. To improve the devastating course of ICH, various clinical trials for medical and surgical interventions have been conducted in the last 10 years. Recent large-scale clinical trials have reported that early intensive blood pressure reduction can be a safe and feasible strategy for ICH, and have suggested a safe target range for systolic blood pressure. While new medical therapies associated with warfarin and non-vitamin K antagonist oral anticoagulants have been developed to treat ICH, recent trials have not been able to demonstrate the overall beneficial effects of surgical intervention on mortality and functional outcomes...
January 2017: Journal of Stroke
https://www.readbyqxmd.com/read/28161697/in-the-wake-of-systolic-blood-pressure-intervention-trial-new-targets-for-improving-hypertension-management-in-chronic-kidney-disease
#12
Crystal C Tyson, Thomas M Coffman
Systolic Blood Pressure Intervention Trial (SPRINT) was a multicenter randomized controlled trial showing the significant benefit of intensive reduction of blood pressure to a target of 120 mm Hg in individuals with hypertension and elevated cardiovascular risk. Because SPRINT includes the largest cohort of adults with chronic kidney disease (CKD) to be prospectively studied in a hypertension intervention trial, it has particular relevance to the field of nephrology. Here, we review the findings of SPRINT and assess their potential impact on guidelines for treatment of hypertension in patients with CKD...
2017: Nephron
https://www.readbyqxmd.com/read/28157742/stroke-epidemiology-and-risk-factor-management
#13
Amy Guzik, Cheryl Bushnell
PURPOSE OF REVIEW: Death from stroke has decreased over the past decade, with stroke now the fifth leading cause of death in the United States. In addition, the incidence of new and recurrent stroke is declining, likely because of the increased use of specific prevention medications, such as statins and antihypertensives. Despite these positive trends in incidence and mortality, many strokes remain preventable. The major modifiable risk factors are hypertension, diabetes mellitus, tobacco smoking, and hyperlipidemia, as well as lifestyle factors, such as obesity, poor diet/nutrition, and physical inactivity...
February 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28107274/the-sluscore-a-novel-method-for-detecting-hazardous-hypotension-in-adult-patients-undergoing-noncardiac-surgical-procedures
#14
Wolf H Stapelfeldt, Hui Yuan, Jefferson K Dryden, Kristen E Strehl, Jacek B Cywinski, Jesse M Ehrenfeld, Pamela Bromley
BACKGROUND: It has been suggested that longer-term postsurgical outcome may be adversely affected by less than severe hypotension under anesthesia. However, evidence-based guidelines are unavailable. The present study was designed to develop a method for identifying patients at increased risk of death within 30 days in association with the severity and duration of intraoperative hypotension. METHODS: Intraoperative mean arterial blood pressure recordings of 152,445 adult patients undergoing noncardiac surgery were analyzed for periods of time accumulated below each one of the 31 thresholds between 75 and 45 mm Hg (hypotensive exposure times)...
April 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28095040/consensus-statement-by-the-american-association-of-clinical-endocrinologists-and-american-college-of-endocrinology-on-the-comprehensive-type-2-diabetes-management-algorithm-2017-executive-summary
#15
Alan J Garber, Martin J Abrahamson, Joshua I Barzilay, Lawrence Blonde, Zachary T Bloomgarden, Michael A Bush, Samuel Dagogo-Jack, Ralph A DeFronzo, Daniel Einhorn, Vivian A Fonseca, Jeffrey R Garber, W Timothy Garvey, George Grunberger, Yehuda Handelsman, Irl B Hirsch, Paul S Jellinger, Janet B McGill, Jeffrey I Mechanick, Paul D Rosenblit, Guillermo E Umpierrez
A1C = hemoglobin A1C AACE = American Association of Clinical Endocrinologists ACCORD = Action to Control Cardiovascular Risk in Diabetes ACCORD BP = Action to Control Cardiovascular Risk in Diabetes Blood Pressure ACEI = angiotensin-converting enzyme inhibitor ADVANCE = Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation AGI = alpha-glucosidase inhibitor apo B = apolipoprotein B ASCVD = atherosclerotic cardiovascular disease BAS = bile acid sequestrant BMI = body mass index BP = blood pressure CHD = coronary heart disease CKD = chronic kidney disease CVD = cardiovascular disease DASH = Dietary Approaches to Stop Hypertension DPP-4 = dipeptidyl peptidase 4 eGFR = estimated glomerular filtration rate FDA = Food and Drug Administration GLP-1 = glucagon-like peptide 1 HDL-C = high-density lipoprotein cholesterol IMPROVE-IT = Improved Reduction of Outcomes: Vytorin Efficacy International Trial LDL-C = low-density lipoprotein cholesterol LDL-P = low-density lipoprotein particle Look AHEAD = Look Action for Health in Diabetes NPH = neutral protamine Hagedorn OSA = obstructive sleep apnea SFU = sulfonylurea SGLT-2 = sodium glucose cotransporter-2 SMBG = self-monitoring of blood glucose T2D = type 2 diabetes TZD = thiazolidinedione VADT = Veterans Affairs Diabetes Trial...
February 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28071865/the-impact-of-evidence-based-sepsis-guidelines-on-emergency-department-clinical-practice-a-pre-post-medical-record-audit
#16
Bernadine Romero, Margaret Fry, Michael Roche
AIMS AND OBJECTIVES: The aim of this study was to explore the number of patients presenting with sepsis before and after guideline implementation; the impact of sepsis guidelines on triage assessment, Emergency Department management and time to antibiotics. BACKGROUND: Sepsis remains one of the leading causes of mortality and morbidity within hospitals. Globally, strategies have been implemented to reduce morbidity and mortality rates, which rely on the early recognition and management of sepsis...
January 10, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28056987/blood-pressure-control-in-type-2-diabetic-patients
#17
REVIEW
Alon Grossman, Ehud Grossman
Diabetes mellitus (DM) and essential hypertension are common conditions that are frequently present together. Both are considered risk factors for cardiovascular disease and microvascular complications and therefore treatment of both conditions is essential. Many papers were published on blood pressure (BP) targets in diabetic patients, including several works published in the last 2 years. As a result, guidelines differ in their recommendations on BP targets in diabetic patients. The method by which to control hypertension, whether pharmacological or non-pharmacological, is also a matter of debate and has been extensively studied in the literature...
January 6, 2017: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/28011188/mid-range-ejection-fraction-does-not-permit-risk-stratification-among-patients-hospitalized-for-heart-failure
#18
Inés Gómez-Otero, Andreu Ferrero-Gregori, Alfonso Varela Román, José Seijas Amigo, Domingo A Pascual-Figal, Juan Delgado Jiménez, Jesús Álvarez-García, Francisco Fernández-Avilés, Fernando Worner Diz, Luis Alonso-Pulpón, Juan Cinca, José Ramón Gónzalez-Juanatey
INTRODUCTION AND OBJECTIVES: European Society of Cardiology heart failure guidelines include a new patient category with mid-range (40%-49%) left ventricular ejection fraction (HFmrEF). HFmrEF patient characteristics and prognosis are poorly defined. The aim of this study was to analyze the HFmrEF category in a cohort of hospitalized heart failure patients (REDINSCOR II Registry). METHODS: A prospective observational study was conducted with 1420 patients classified according to ejection fraction as follows: HFrEF, < 40%; HFmrEF, 40%-49%; and HFpEF, ≥ 50%...
December 20, 2016: Revista Española de Cardiología
https://www.readbyqxmd.com/read/27968771/treatment-of-acute-cardiac-failure-in-the-emergency-department-improve-our-practices-data-from-the-resurcor-network
#19
L Belle, G Courtiol, L Lamboley, P Debax, P Pili, G Deschane, M Latappy, J Oberlin, A Drouet, C Ricard, C Morvan, F-X Ageron
BACKGROUND: In 2015, the European Society of cardiology published guidelines on the pre-hospital and early hospital management of acute cardiac failure (ACF), which included: - use of intravenous vasodilators (nitrates) when systolic blood pressure is>110mmHg; - non-invasive ventilation if oxygen saturation is<90% and/or respiratory rate is>25/min despite nasal oxygen; - using a reduced dose of intravenous furosemide (20-40mg or equivalent of the oral morning dose if already on chronic diuretic therapy) and; - early performance of echocardiography...
November 2016: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/27955682/health-effectiveness-and-cost-effectiveness-of-telehealthcare-for-heart-failure-study-protocol-for-a-randomized-controlled-trial
#20
Simon Lebech Cichosz, Lars Holger Ehlers, Ole Hejlesen
BACKGROUND: Several heart failure studies have shown promising results for implementing telehealthcare. These studies have led to clinical and political interest in telehealthcare as a way to improve heart failure outcomes and lower costs. However, there is a need for large-scale clinical trials with cost-effectiveness assessments. METHODS/DESIGN: The present study is known as the TeleCare North Heart Failure Trial in Denmark. We are studying the health effectiveness and cost-effectiveness of a telehealth (Telekit) solution compared with usual care for patients with heart failure...
December 12, 2016: Trials
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