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Satterfield, John M., David R. Larach, and J. Earl Wynands. "Case conference." Journal of Cardiothoracic Anesthesia 4, no. 2 (April 1990): 267–77. http://dx.doi.org/10.1016/0888-6296(90)90248-e.
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Harkin, Nicole, Emily Johnston, Tony Mathews, Yu Guo, Arthur Schwartzbard, Jeffrey Berger, and Eugenia Gianos. "Physicians’ Dietary Knowledge, Attitudes, and Counseling Practices: The Experience of a Single Health Care Center at Changing the Landscape for Dietary Education." American Journal of Lifestyle Medicine 13, no. 3 (November 23, 2018): 292–300. http://dx.doi.org/10.1177/1559827618809934.
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Morbidity and mortality associated with cardiovascular disease can be significantly modified through lifestyle interventions, yet there is little emphasis on nutrition and lifestyle in medical education. Improving nutrition education for future physicians would likely lead to improved preparedness to counsel patients on lifestyle interventions. An online anonymous survey of medical residents, cardiology fellows, and faculty in Internal Medicine and Cardiology was conducted at New York University Langone Health assessing basic nutritional knowledge, self-reported attitudes and practices. A total of 248 physicians responded (26.7% response rate). Nutrition knowledge was fair, but few (13.5%) felt adequately trained to discuss nutrition with patients. A majority (78.4%) agreed that additional training in nutrition would allow them to provide better clinical care. Based on survey responses, a dedicated continuing medical education (CME) conference was developed to improve knowledge and lifestyle counseling skills of healthcare providers. In postconference evaluations, attendees reported improved knowledge of evidence-based lifestyle interventions. Most noted that they would prescribe a Mediterranean or plant-based diet and would make changes to their practice based on the conference. An annual CME conference on diet and lifestyle can effectively help interested providers overcome barriers to lifestyle change in clinical practice through improved nutrition knowledge.
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Valstar, Gideon B., Sophie H. Bots, Floor Groepenhoff, Aisha Gohar, Frans H. Rutten, Tim Leiner, Maarten Jan Maria Cramer, et al. "Discovery of biomarkers for the presence and progression of left ventricular diastolic dysfunction and HEart faiLure with Preserved ejection Fraction in patients at risk for cardiovascular disease: rationale and design of the HELPFul case-cohort study in a Dutch cardiology outpatient clinic." BMJ Open 9, no. 6 (June 2019): e028408. http://dx.doi.org/10.1136/bmjopen-2018-028408.
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IntroductionLeft ventricular diastolic dysfunction (LVDD) is a common condition in both sexes that may deteriorate into heart failure (HF) with preserved ejection fraction (pEF), although this seems to happen more often in women than in men. Both LVDD and HFpEF often go unrecognised, necessitating the discovery of biomarkers that aid both the identification of individuals with LVDD at risk of developing HF and identification of individuals most likely to benefit from treatment.Methods and analysisHELPFul is an ongoing case-cohort study at a Dutch cardiology outpatient clinic enrolling patients aged 45 years and older without history of cardiovascular disease, who were referred by the general practitioner for cardiac evaluation. We included a random sample of patients and enriched the cohort with cases (defined as an E/e’ ≥8 measured with echocardiography). Information about medical history, cardiovascular risk factors, electrocardiography, echocardiography, exercise test performance, common carotid intima-media thickness measurement and standard cardiovascular biomarkers was obtained from the routine care data collected by the cardiology outpatient clinic. Study procedure consists of extensive venous blood collection for biobanking and additional standardised questionnaires. Follow-up will consist of standardised questionnaires by mail and linkage to regional and national registries. We will perform cardiac magnetic resonance imaging and coronary CT angiography in a subgroup of patients to investigate the extent of macrovascular and microvascular coronary disease.Ethics and disseminationThe study protocol was approved by the Institutional Review Board of the University Medical Center Utrecht. Results will be disseminated through national and international conferences and in peer-reviewed journals in cardiovascular disease.Trial registrationNTR6016;Pre-results.
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Уразалина, С. Ж. "PARTNERSHIPS WITH PATIENTS: THE CONCEPT OF SHARED CARE IN CLINICAL PRACTICE OF CARDIOLOGISTS." Vestnik, no. 2 (June 25, 2021): 93–96. http://dx.doi.org/10.53065/kaznmu.2021.64.42.015.
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Целью данной статьи являлось ознакомить кардиологическое сообщество страны с результатами работы ESC Education Conference (2020), которая была посвящена обсуждению проблем и возможности интеграции участия пациентов в совместном ведении их с врачами. ESC создан специальный форум по вовлечению уже пролеченных «старых» пациентов в программу совместного ведения «новых» пациентов, а также привлечению их в программы образования и науки. Конференция подтвердила единодушие участников в том, что интеграция пациентов в разработку их диагностических и лечебных планов требует выделения большего количества времени для обучения пациентов во время каждой встречи, а также сделала акцент о необходимости введения в учебные программы разделов по обучению медицинских работников совместному ведению. Вывод: Таким образом, концепция тесного сотрудничества пациентов и медицинских работников предоставляет огромную возможность для развития программы совместного ведения больных в области медицинского образования. The aim of article was to familiarize the cardiology community of the country with the results of the ESC Education Conference (2020), which was devoted to discussing the problems and the possibility of integrating patient participation in joint management with doctors. ESC created a special forum for the involvement of already treated "old" patients in the program of shared care of "new" patients, as well as their involvement in education and science programs. The Conference confirmed the consensus of the participants that the patients integration in the development of their diagnostic and treatment plans requires more time to train patients during each meeting, and also emphasized the need to introduce sections on training programs of medical professionals in the field of enabling shared care. Conclusion: Thus, the concept of close cooperation between patients and medical professionals provides a huge opportunity for the development of an enabling shared care in medical education.
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Sabanayagam, Aarthi, David Briston, and Ali N. Zaidi. "Attitudes and perceptions of pregnant women with CHD: results of a single-site survey." Cardiology in the Young 27, no. 7 (April 18, 2017): 1257–64. http://dx.doi.org/10.1017/s1047951116002857.
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AbstractIntroductionCHD occurs in about 1% of the United States population, and is now the most common cardiac condition affecting women during pregnancy.MethodsAn anonymous, single-site, cross-sectional, 50-question survey was performed at a national Adult Congenital Heart Disease conference to assess the level of knowledge, attitudes, and perceptions regarding cardiac care during pregnancy in women with CHD.ResultsA total of 77 women completed the survey. Among them, 50% (n=39) had moderate and 38% (n=29) had severely complex disease; 30% (n=23) of women were told that pregnancy was contraindicated given their underlying cardiac condition. Almost two-thirds (n=50) report being categorised as high risk for adverse cardiovascular events. During pregnancy, 84% (n=65) preferred their cardiologist to have trained in adult CHD, 44% (n=34) were satisfied with adult cardiologists, and 36% (n=28) with paediatric cardiologists. Only 48% (n=37) were aware that a fetal echocardiogram was indicated. Only 35% (n=27) discussed modes of delivery with their providers, and 70% (n=54) preferred their prenatal cardiology visits at an adult hospital. Up to 85% (n=64) of them had discussed contraception with their cardiologists, and 72% (n=56) felt they needed high-risk maternal–fetal medicine to be involved with their care.ConclusionsDespite seeking medical care, these pregnant women did not have a full understanding of their condition and their cardiovascular risk during pregnancy. On the basis of these results, further efforts are needed to improve the knowledge, attitudes, and perceptions of women with CHD in relation to their cardiac and obstetric management during pregnancy.
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Massetti, Massimo, and Giovanni Alfonso Chiariello. "The extended heart: cardiac surgery serving more hospitals." European Heart Journal Supplements 22, Supplement_E (March 24, 2020): E91—E95. http://dx.doi.org/10.1093/eurheartj/suaa069.
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Abstract The Heart Team is becoming ever more central in delivering cardiovascular care, embodying a modern aspect of medical practice, designed to place the patient at the ‘center’ of a team with different specialists, all contributing to the definition of the most appropriate therapeutic actions. We prospectively analyzed 200 consecutive patients (2015–2017). Patients were evaluated independently by a cardiologist and a cardiac surgeon, each deciding the most appropriate therapeutic action. At a later time, the same patient, was evaluated by the Heart Team. For the first 100 patients the rate of concurrence between cardiologist and cardiac surgeon as well as among each specialist and the Heart Team, was relatively low (51 and 42% respectively). For the following 100 patients the concurrence rate was significantly higher (75 and 70% respectively). The systematic and collegial discussion of the patients in the contest of the Heart Team, steered toward an evolution of each specialist in the group settings. The Electronic Heart Team (e-Heart Team) employing video conference support, applied to the first 65 patients with promising results, represent a further advancement in the delivery of care, by reducing the distance from the ‘Hub’ center, and the specialist in the ‘Spoke’ facility, who from simple source of the patient, now becomes an essential part of the therapeutic decision process. The Heart Team environment can deeply affect patients management and improve treatment results, by sharing the expertise and overcoming the limitations of the individual disciplines, thus reaching the common goal of the patient's best available treatment.
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Nakazawa, Akiko, Emi Mori, Rikako Koizumi, and Takashi Suzuki. "Our First Case of Multidisciplinary Team Conference for a Severe Heart Failure Patient, That Successfully Lead to Home Medical Care." Journal of Cardiac Failure 22, no. 9 (September 2016): S193. http://dx.doi.org/10.1016/j.cardfail.2016.07.223.
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Vyas, Darshali A., Lucas Marinacci, Thoralf Sundt, Arminder Jassar, Benjamin Bearnot, Virginia A. Triant, Sandra B. Nelson, Sarah E. Wakeman, David M. Dudzinski, and Molly L. Paras. "709. Multidisciplinary Drug Use Endocarditis Team (DUET): Results From an Academic Center Cohort." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S405—S407. http://dx.doi.org/10.1093/ofid/ofaa439.901.
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Abstract Background Guidelines recommend multidisciplinary models for the management of infective endocarditis but have failed to incorporate the unique challenges of treating drug-use associated infective endocarditis (DUA-IE). Given the drug use and overdose epidemic with rising cases of DUA-IE, we created a multidisciplinary Drug Use Endocarditis Team (DUET), which convened monthly case conferences among the specialties involved, including Infectious Diseases, Cardiothoracic Surgery, Cardiology and Addiction Medicine. Objective: To conduct a retrospective cohort study of the patients presented at the DUET conferences from August 2018 to February 2020 to (1) assess clinical and demographic characteristics and (2) describe clinical outcomes. Methods A retrospective chart review was conducted to analyze 57 patient cases, including descriptive statistical analyses of demographics, clinical characteristics, and outcomes. Results Among our DUET cohort, 43.8% represented isolated right-sided endocarditis, and 84% involved native valve. Methicillin-susceptible Staphylococcus aureus was the most common microorganism isolated. ID was consulted in 94.7% of cases and overall 43.9% completed the planned antimicrobial course. The 7 patients who developed relapse/recurrent IE were initially managed medically, and 5 did not complete the initial antimicrobial course. Formal cardiothoracic surgery consultation was obtained in 57.9% and 24.6% were managed operatively. Of the patients managed operatively, 64.3% completed the antimicrobial course. The rate of antibiotic completion was higher among patients managed operatively but did not reach statistical significance (p=0.08). Formal addiction medicine consultation was obtained in 85.9% of cases, with 63.1% discharged on medications for opioid use disorder (MOUD). The rate of MOUD on discharge was not significantly different between patients managed operatively and non-operatively. Figure 1: Patient Characteristics Figure 2: Infection Characteristics Figure 3: Outcome Analyses Conclusion ID is nearly universally involved in the care of patients with DUA-IE, but this patient population requires input from numerous sub-specialties. Multidisciplinary care teams provide a promising framework for DUA-IE to enhance and integrate nuanced decision-making. Disclosures Sarah E. Wakeman, MD, Celero Systems (Advisor or Review Panel member)Optum Labs (Grant/Research Support)UpToDate (Other Financial or Material Support, Author)
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Deschodt, Mieke, Bastiaan Van Grootven, Anthony Jeuris, Els Devriendt, Bernadette Dierckx de Casterlé, Christophe Dubois, Katleen Fagard, et al. "Geriatric CO-mAnagement for Cardiology patients in the Hospital (G-COACH): study protocol of a prospective before-after effectiveness-implementation study." BMJ Open 8, no. 10 (October 2018): e023593. http://dx.doi.org/10.1136/bmjopen-2018-023593.
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IntroductionAlthough the majority of older patients admitted to a cardiology unit present with at least one geriatric syndrome, guidelines on managing heart disease often do not consider the complex needs of frail older patients. Geriatric co-management has demonstrated potential to improve functional status, and reduce complications and length of stay, but evidence on the effectiveness in cardiology patients is lacking. This study aims to determine if geriatric co-management is superior to usual care in preventing functional decline, complications, mortality, readmission rates, reducing length of stay and improving quality of life in older patients admitted for acute heart disease or for transcatheter aortic valve implantation, and to identify determinants of success for geriatric co-management in this population.Methods and analysisThis prospective quasi-experimental before-and-after study will be performed on two cardiology units of the University Hospitals Leuven in Belgium in patients aged ≥75 years. In the precohort (n=227), usual care will be documented. A multitude of implementation strategies will be applied to allow for successful implementation of the model. Patients in the after cohort (n=227) will undergo a comprehensive geriatric assessment within 24 hours of admission to stratify them into one of three groups based on their baseline risk for developing functional decline: low-risk patients receive proactive consultation, high-risk patients will be co-managed by the geriatric nurse to prevent complications and patients with acute geriatric problems will receive an additional medication review and co-management by the geriatrician.Ethics and disseminationThe study protocol was approved by the Medical Ethics Committee UZ Leuven/KU Leuven (S58296). Written voluntary (proxy-)informed consent will be obtained from all participants at the start of the study. Dissemination of results will be through articles in scientific and professional journals both in English and Dutch and by conference presentations.Trial registration numberNCT02890927.
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Dua, Anahita, Sapan S. Desai, and Jennifer A. Heller. "Heterogeneity in venous disease practice patterns amongst primary healthcare practitioners." Vascular 23, no. 4 (September 22, 2014): 391–95. http://dx.doi.org/10.1177/1708538114552011.
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Introduction This study aimed to describe the practice patterns of primary healthcare practitioners who diagnose and manage venous disease to determine differences in clinical evaluation of disease, recognition of venous ulcers, and referral patterns. Methods A survey was distributed at the August 2011 Primary Care Medical Conference (Pri-Med) in Baltimore, Maryland. Pri-med is a medical education company that caters to the continued professional development needs of a variety of physicians. Results A total of 305 surveys were completed. Of the respondents, 91% were physicians and 9% were advanced level practitioners. In all, 93% prescribed compression stockings as first-line treatment. Heterogeneous referral patterns were reported with 81% referring to vascular surgery, 25% to a vein clinic, 10% to interventional radiology, and 3% to interventional cardiology. Up to 35% responded that they met resistance (did not have their referral accepted) when attempting referral to a vascular surgery colleague. There was substantial variation when asked about the treatment of deep vein thrombosis with 88% starting anticoagulation therapy, 54% prescribing compression stockings, 40% doing a thrombophilia workup, and 25% referring for lytic therapy. Conclusion Diagnosis and management aptitude of venous disease is highly variable. Further grassroots education is required to improve diagnosis and treatment in patients with chronic venous disease.
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Colussi, Laura, Marco Sutera, Francesco Rispoli, Egidio Barbi, marco Bobbo, Thomas caiffa, Biancamaria D'Agata Mottolese, et al. "Funzione cardiopolmonare in bambini con pregressa infezione da Covid-19 lieve o asintomatica e ritorno all’attività sportiva." Medico e Bambino pagine elettroniche 24, no. 8 (October 31, 2021): 226. http://dx.doi.org/10.53126/mebxxiv226.
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Aim - To evaluate the cardiopulmonary function in children returning to play sports after mild or asymptomatic SARS-CoV-2 infection. - Methods - This is a consecutive case series conducted at the Institute for Maternal and Child Health, Trieste, Italy. Paediatric patients who accessed the Institute for cardiologic and pneumological evaluation before the return to play competitive sports were recruited. According to the Italian Sports Medical Federation recommendations, echocardiogram, electrocardiogram, treadmill ECG test and pulmonary function tests were performed. - Results - 240 patients (aged 8-17 years old) were recruited. Among these, 233 children were considered for the final analysis. Out of 233, 147 (63.1%) had a mild symptomatic form of SARS-CoV-2 infection, while 86 (36.9%) were asymptomatic. The main referred symptoms were fever (n = 68, 46.3%), headache (n = 42, 28.6%), anosmia (n = 40, 27.2%), rhinitis (n = 34, 23.1%), ageusia (n = 32, 21.8%), cough (n = 22, 15%), asthenia (n = 21, 14.3%), arthralgia-myalgia (n = 20, 13.6%), sore throat (n = 14, 9.5%) and gastrointestinal symptoms (n = 9, 6.1%). No child presented evidence of cardiopulmonary function impairment after an average time of 76.1 days (SD 39.2) from SARS-CoV-2 swab positivity and a median of 68 days (IQ1 49, IQ3 98). - Conclusion - This study suggests that the diagnostic yield of cardiopulmonary tests before returning to play sports may be very low in the absence of specific symptoms.
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Duncan, Lisa D., Keith Gray, James M. Lewis, John L. Bell, Jeremy Bigge, and J. Mark McKinney. "Clinical Integration of Picture Archiving and Communication Systems with Pathology and Hospital Information System in Oncology." American Surgeon 76, no. 9 (September 2010): 982–86. http://dx.doi.org/10.1177/000313481007600934.
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The complexity of our current healthcare delivery system has become an impediment to communication among caregivers resulting in fragmentation of patient care. To address these issues, many hospitals are implementing processes to facilitate clinical integration in an effort to improve patient care and safety. Clinical informatics, including image storage in a Picture Archiving and Communication System (PACS), represents a tool whereby clinical integration can be accomplished. In this study, we obtained intraoperative photographs of 19 cases to document clinical stage, extent of disease, disease recurrence, reconstruction/grafting, intraoperative findings not identified by preoperative imaging, and site verification as part of the Universal Protocol. Photographs from all cases were stored and viewed in PACS. Images from many of the cases were presented at our interdepartmental cancer conferences. The stored images improved communication among caregivers and preserved pertinent intraoperative findings in the patients’ electronic medical record. In the future, pathology, gastroenterology, pulmonology, dermatology, and cardiology are just a few other subspecialties which could accomplish image storage in PACS. Multidisciplinary image storage in a PACS epitomizes the concept of clinical integration and its goal of improving patient care.
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Cleary, John P., Annie Janvier, Barbara Farlow, Meaghann Weaver, James Hammel, and John Lantos. "Cardiac Interventions for Patients With Trisomy 13 and Trisomy 18: Experience, Ethical Issues, Communication, and the Case for Individualized Family-Centered Care." World Journal for Pediatric and Congenital Heart Surgery 13, no. 1 (December 17, 2021): 72–76. http://dx.doi.org/10.1177/21501351211044132.
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This report is informed by the themes of the session Trisomy 13/18, Exploring the Changing Landscape of Interventions at NeoHeart 2020—The Fifth International Conference of the Neonatal Heart Society. The faculty reviewed the present evidence in the management of patients and the support of families in the setting of trisomy 13 and trisomy 18 with congenital heart disease. Until recently medical professionals were taught that T13 and 18 were “lethal conditions” that were “incompatible with life” for which measures to prolong life are therefore ethically questionable and likely futile. While the medical literature painted one picture, family support groups shared stories of the long-term survival of children who displayed happiness and brought joy along with challenges to families. Data generated from such care shows that surgery can, in some cases, prolong survival and increase the likelihood of time at home. The authors caution against a change from never performing heart surgery to always—we suggest that the pendulum of intervention find a balanced position where all therapies including comfort care and surgery can be reviewed. Families and clinicians should typically be supported and empowered to define the best care for their children and patients. Key concepts in communication and case vignettes are reviewed including the importance of supportive relationships and the fact that palliative care may serve as an additional layer of support for decision-making and quality of life interventions. While cardiac surgery may be beneficial in some cases, surgery should not be the primary focus of initial family education and support.
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Marino, Luise V., Mark J. Johnson, Nigel J. Hall, Natalie J. Davies, Catherine S. Kidd, M. Lowri Daniels, Julia E. Robinson, Trevor Richens, Tara Bharucha, and Anne-Sophie E. Darlington. "The development of a consensus-based nutritional pathway for infants with CHD before surgery using a modified Delphi process." Cardiology in the Young 28, no. 7 (April 29, 2018): 938–48. http://dx.doi.org/10.1017/s1047951118000549.
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AbstractIntroductionDespite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.Materials and methodsThe modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation.ResultsPaediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting.ConclusionsNutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.
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Spinler, Sarah A., Ann K. Wittkowsky, Edith A. Nutescu, and Maureen A. Smythe. "Anticoagulation Monitoring Part 2: Unfractionated Heparin and Low-Molecular-Weight Heparin." Annals of Pharmacotherapy 39, no. 7-8 (July 2005): 1275–85. http://dx.doi.org/10.1345/aph.1e524.
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OBJECTIVE To review the availability, mechanisms, limitations, and clinical application of point-of-care (POC) devices used in monitoring anticoagulation with unfractionated heparin (UFH) and low-molecular-weight heparins (LMWHs). DATA SOURCES Articles were identified through a MEDLINE search (1966–August 2004), device manufacturer Web sites, additional references listed in articles and Web sites, and abstracts from scientific meetings. STUDY SELECTION AND DATA EXTRACTION English-language literature from clinical trials was reviewed to evaluate the accuracy, reliability, and clinical application of POC monitoring devices. DATA SYNTHESIS The activated partial thromboplastin time (aPTT) and activated clotting time (ACT) are common tests for monitoring anticoagulation with UFH. Multiple devices are available for POC aPTT, ACT, and heparin concentration testing. The aPTT therapeutic range for UFH will vary depending upon the reagent and instrument employed. Although recommended by the American College of Chest Physicians Seventh Conference on Antithrombotic and Thrombolytic Therapy, establishing a heparin concentration–derived therapeutic range for UFH is rarely performed. Additional research evaluating anti-factor Xa monitoring of LMWHs using POC testing is necessary. CONCLUSIONS Multiple POC devices are available to monitor anticoagulation with UFH. For each test, there is some variability in results between devices and between reagents used in the same device. Despite these limitations, POC anticoagulation monitoring of UFH using aPTT and, more often, ACT is common in clinical practice, particularly when evaluating anticoagulation associated with interventional cardiology procedures and cardiopulmonary bypass surgery.
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Pham, Kiemanh, J. Daryl Thornton, Ruth A. Engelberg, J. Carey Jackson, and J. Randall Curtis. "Alterations During Medical Interpretation of ICU Family Conferences That Interfere With or Enhance Communication*." Chest 134, no. 1 (July 2008): 109–16. http://dx.doi.org/10.1378/chest.07-2852.
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Ye, Runyu, Rufeng Shi, Kai Liu, Xin Zhang, Si Wang, Hang Liao, Xinran Li, et al. "Internet-based patient– primary care physician–cardiologist integrated management model of hypertension in China: study protocol for a multicentre randomised controlled trial." BMJ Open 10, no. 10 (October 2020): e039447. http://dx.doi.org/10.1136/bmjopen-2020-039447.
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IntroductionThe control rate of hypertension is low in China, especially in rural, western and minority areas. This is related to poor medical skills among physicians in primary care institutions and low levels of trust among patients. However, primary healthcare institutions are the main battleground for the prevention and treatment of hypertension. It is worth exploring how to most effectively integrate patients, primary care physicians and cardiologists in tertiary hospitals, to build a long-term mechanism for the prevention and treatment of hypertension. In this study, we aim to evaluate the clinical effectiveness and conduct a health economic evaluation of an internet-based patient–primary care physician–cardiologist integrated management model of hypertension in areas of China with different socioeconomic levels.Methods and analysisThis is a 12-month, multicentre, randomised controlled trial involving patients with hypertension in urban communities and rural areas of Sichuan Province, China. Each primary healthcare institution will cooperate with their tertiary hospital through the Red Shine Chronic Disease Management System (RSCDMS). Patients will be randomly assigned 1:1 to two groups: (1) a traditional care group; (2) an intervention group in which primary care physicians and cardiologists can share patient data and manage patients together through the RSCDMS. Patients can upload their blood pressure (BP) values and communicate with physicians using the system. The primary outcome is the change in systolic BP over a 12-month period. Secondary outcomes are changes in diastolic BP, BP control rate, values of 24-hour ambulatory BP monitoring, difference in cost-effectiveness between the groups, patient satisfaction, medication adherence and home BP monitoring compliance. All data will be recorded and stored in the RSCDMS and analysed using IBM SPSS V.26.0.Ethics and disseminationThis study has been approved by the Biomedical Research Ethics Committee of the West China Hospital of Sichuan University in Sichuan, China (No. 2020-148). Written informed consent will be obtained from all participants. The results of this study will be disseminated to the public through academic conferences and peer-reviewed journals.Trial registration numberChiCTR2000030677.
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Singh, Arun L., Jeffrey C. Klick, Courtney E. McCracken, and Kiran B. Hebbar. "Evaluating Hospice and Palliative Medicine Education in Pediatric Training Programs." American Journal of Hospice and Palliative Medicine® 34, no. 7 (April 26, 2016): 603–10. http://dx.doi.org/10.1177/1049909116643747.
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Background: Hospice and Palliative Medicine (HPM) competencies are of growing importance in training general pediatricians and pediatric sub-specialists. The Accreditation Council for Graduate Medical Education (ACGME) emphasized pediatric trainees should understand the “impact of chronic disease, terminal conditions and death on patients and their families.” Currently, very little is known regarding pediatric trainee education in HPM. Methods: We surveyed all 486 ACGME-accredited pediatric training program directors (PDs) - 200 in general pediatrics (GP), 57 in cardiology (CARD), 64 in critical care medicine (CCM), 69 in hematology-oncology (ONC) and 96 in neonatology (NICU). We collected training program’s demographics, PD’s attitudes and educational practices regarding HPM. Results: The complete response rate was 30% (148/486). Overall, 45% offer formal HPM curriculum and 39% offer a rotation in HPM for trainees. HPM teaching modalities commonly reported included conferences, consultations and bedside teaching. Eighty-one percent of all respondents felt that HPM curriculum would improve trainees’ ability to care for patients. While most groups felt that a HPM rotation would enhance trainees’ education [GP (96%), CARD (77%), CCM (82%) and ONC (95%)], NICU PDs were more divided (55%; p < 0.05 for all comparisons vs. NICU). Conclusion: While most programs report perceived benefit from HPM training, there remains a paucity of opportunities for pediatric trainees. Passive teaching methods are frequently utilized in HPM curricula with minimal diversity in methods utilized to teach HPM. Opportunities to further emphasize HPM in general pediatric and pediatric sub-specialty training remains.
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Ho, Shiaw-Hooi, Rungsun Rerknimitr, Kuriko Kudo, Shunta Tomimatsu, Mohamad Ahmad, Akira Aso, Dong Seo, Khean-Lee Goh, and Shuji Shimizu. "Telemedicine for gastrointestinal endoscopy: The Endoscopic Club E-conference in the Asia Pacific Region." Endoscopy International Open 05, no. 04 (March 31, 2017): E244—E252. http://dx.doi.org/10.1055/s-0043-102935.
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Abstract Background and study aims An Endoscopic Club E-conference (ECE) was set up in May 2014 to cater to increased demand for gastrointestinal endoscopy-related teleconferences in the Asia-Pacific region which were traditionally organized by the medical working group (MWG) of Asia-Pacific Advanced Network. This study describes how the ECE meeting was run, examines the group dynamics, outlines feedback and analyzes factors affecting the enthusiasm of participants. It is hoped that the findings here can serve as guidance for future development of other teleconference groups. Methods The preparation, running of and feedback on the ECE teleconference were evaluated and described. The country’s economic situation, time zone differences, connectivity with a research and education network (REN) and engineering cooperation of each member were recorded and analyzed with regard to their association with participant enthusiasm, which was taken as participation in at least 50 % of the meetings since joining. Associations were calculated using 2-way table with chi-square test to generate odds ratio and P value. Results To date, ECE members have increased from 7 to 29 (increment of 314 %). Feedback received indicated a high level of satisfaction with program content, audiovisual transmission and ease of technical preparation. Upper gastrointestinal luminal endoscopy-related topics were the most favored program content. Those topics were presented mainly via case studies with a focus on management challenges. Time zone differences of more than 6 hours and poor engineering cooperation were independently associated with inactive participation (P values of 0.04 and 0.001 respectively). Conclusions Good program content and high-quality audiovisual transmission are keys to the success of an endoscopic medical teleconference. In our analysis, poor engineering cooperation and discordant time zones contributed to inactive participation while connectivity with REN and a country’s economic situation were not significantly associated with participant enthusiasm.
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Kheiri, Babikir, Ahmed Abdalla, Mohamed Osman, Tarek Haykal, Sai Chintalapati, James Cranford, Sahar Ahmed, Mustafa Hassan, Ghassan Bachuwa, and Deepak L. Bhatt. "Restrictive Versus Liberal Red Blood Cell Transfusion for Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials." Blood 132, Supplement 1 (November 29, 2018): 3821. http://dx.doi.org/10.1182/blood-2018-99-111993.
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Abstract Introduction:Patients undergoing cardiac surgery are among the most common recipients of allogenic red blood cell (RBC) transfusions. However, whether restrictive RBC transfusion strategies for cardiac surgery achieve a similar clinical outcome in comparison with liberal strategies remains unclear. Methods:We searched PubMed, Embase, the Cochrane Collaboration Central Register of Controlled Trials, and conference proceedings from inception to December 2017 for all randomized trials (RCTs). The primary outcome was mortality. Secondary outcomes were stroke, respiratory morbidity, renal morbidity, infections, myocardial infarction (MI), cardiac arrhythmia, gut morbidity, reoperation, intensive care unit (ICU) length of stay (hours), and hospital length of stay (days). We calculated the risk ratios (RR) and weighted mean difference (MD) for the clinical outcomes using a random-effects model. Results:We included 9 RCTs with a total of 9,005 patients. There was no significant difference in mortality between groups (RR 1.03; 95% CI 0.74-1.45; P=0.86). In addition, there were no significant differences between groups in the clinical outcomes of infections (RR 1.09; 95% CI 0.94-1.26; P=0.26), stroke (RR 0.98; 95% CI 0.72-1.35; P=0.91), respiratory morbidity (RR 1.05; 95% CI 0.89-1.24; P=0.58), renal morbidity (RR 1.02; 95% CI 0.94-1.09; P=0.68), myocardial infarction (RR 1.00; 95% CI 0.80-1.24; P=0.99), cardiac arrhythmia (RR 1.05; 95% CI 0.88-1.26; P=0.56), gastrointestinal morbidity (RR 1.93; 95% CI 0.81-4.63; P=0.14), or reoperation (RR 0.90; 95% CI 0.67-1.20; P=0.46). There was a significant difference in the intensive care unit length of stay (hours) (MD 4.29; 95% CI: 2.19-6.39, P<0.01) favoring the liberal group. However, there was no significant difference in the hospital length of stay (days) (MD 0.15; 95% CI -0.18-0.48; P=0.38). Conclusion:This meta-analysis showed that restrictive strategies for RBC transfusion are as safe as liberal strategies in patients undergoing cardiac surgery. Key points: Restrictive strategies for red blood cell transfusion are as safe as liberal approaches in patients undergoing cardiac surgery. Longer duration of stay in the intensive care unit is more common in patients managed with a restrictive transfusion approach. However, the overall hospital length of stay appeared to be similar between both groups. Further studies are needed to ascertain threshold triggers for RBC transfusion. Figure. Figure. Disclosures Hassan: abott: Other: grant. Bhatt:American Heart Association Quality Oversight Committee: Other: chair; Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSof: Membership on an entity's Board of Directors or advisory committees; Medscape Cardiology: Consultancy; Regado Biosciences: Consultancy; Elsevier Practice Update Cardiology: Consultancy, trustee; cardax: Consultancy; Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines: Research Funding; Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic, Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, Population: Other: Data monitoring committee; American College of Cardiology; Unfunded Research: FlowCo, Merck, PLx Pharma, Takeda.: Other: trustee; ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim), Belvoir Publications (Editor in Chief, Harvard Heart Letter),: Other: board member; American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org: Honoraria.
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Kelly, Peter J., Jonathan Rosand, Androniki Plomaritoglou, Yuchiao Chang, J. Philip Kistler, and Karen L. Furie. "Mild-to-moderate hyperhomocyst(e)inemia and risk of stroke. Result of a meta-analysis." Stroke 32, suppl_1 (January 2001): 366. http://dx.doi.org/10.1161/str.32.suppl_1.366.
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P148 Background: Severe hyperhomocyst(e)inemia is associated with premature atherothrombosis and stroke in children with homocystinuria. Epidemiological studies indicate that mild-to-moderate hyperhomocyst(e)inemia is an independent risk factor for coronary artery disease. However, data are conflicting concerning the risk of stroke associated with mild-to-moderate hyperhomocyst(e)inemia. Aim: To describe and quantify the risk of stroke associated with elevated plasma homocyst(e)ine by meta-analysis. Methods: Relevant articles were obtained by search of Medline, Science Citation Index, and abstracts of conference proceedings. Search terms were Homocysteine, stroke, genetics and MTHFR. Exposure was defined as hyper-homocyst(e)inemia, relative to control values in each study population. Outcome was defined as ischemic stroke confirmed by neuroimaging (NI), and stroke without NI. Inclusion criteria: (1) Case-control (C-C) studies with reported odds ratios (OR) (2) Cohort (COH) studies with reported risk ratios (RR). Exclusion criteria: (1) Studies without clearly-defined OR/RR (reviews, C-C without OR, cross-sectional studies, case series, case reports) (2) Studies which defined outcome as carotid atherosclerosis or intima-media thickening. Statistical analyses for between-study heterogeneity and pooled risk estimates were performed using Stata software©. Results: Of 35 studies analyzed in detail, 15 (2 COH, 13 C-C) met inclusion criteria. Of 13 C-C studies (1306 cases, 6793 controls), the adjusted OR ranged 0.99–4.7, two had adjusted OR <=1 and 5 had a lower confidence limit <1. A random-effects model estimated a weighted pooled adjusted OR of 1.69 (95% CI 1.3, 2.2) from the 13 C-C studies. Within the 2 cohort studies (2825 subjects), the average adjusted RR was 1.86 (upper vs lower quantiles) (95% CI 1.14, 3.03). Conclusions: On average, mild-moderate hyperhomocyst(e)inemia is independently associated with a 69% increase in the odds and 86% increase in the risk of stroke.
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Díez, Cristina Castro, Feras Khalil, Michiel Dalinghaus, Marijke van der Meulen, Saskia de Wildt, Ida Jovanović, Milica Bajčetić, Michel Burch, Christoph Male, and Stephanie Läer. "DESIGN OF A EUROPEAN SURVEY ON THE PHARMACOLOGICAL MANAGEMENT OF PAEDIATRIC HEART FAILURE." Archives of Disease in Childhood 101, no. 1 (December 14, 2015): e1.64-e1. http://dx.doi.org/10.1136/archdischild-2015-310148.67.
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BackgroundLittle evidence is presently available to help clinicians guide decisions when tackling the pharmacological management of paediatric heart failure (HF). As a consequence, therapeutic strategies are largely supported by adults' data extrapolation and own expertise. The variability in drug treatment routines across Europe is expected to be high. Nevertheless, there are no epidemiological data that describe the current situation.AimTo develop a survey in the context of the LENA project to characterise the different therapeutic strategies for the management of paediatric HF that are currently practiced across Europe with special focus in the use of Angiotensin Converting Enzyme Inhibitors (ACE-I).MethodsItems to be included in the survey were selected through a thorough literature review and expert group discussions. European hospitals providing paediatric cardiology care were identified using websites of European and national paediatric cardiology associations as well as the ones of congresses and conferences related to the field. Standard recommendations for survey design were followed. The study protocol was approved by a data protection officer and an ethics committee. Web-survey tool EvaSys® was used. The survey was pre- and pilot-tested by a group of experts. A statistical analysis plan for the later processing and analysis of the data to be obtained was elaborated.ResultsA Europe-wide web-based survey was started in January 2015. 203 clinicians were invited via e-mail to participate. The questionnaire consisted of 23 questions addressing different aspects of drug therapy for HF in children. Use patterns of ACE-I (dosage by age group, effectiveness and toxicity assessment, use according to HF aetiology) and drug therapy for dilated cardiomyopathy where explored. Participants' demographic characteristics were also asked.ConclusionsThe procedure followed for the survey development should assure the quality of the tool. The results of this survey will provide an overview of the clinical treatment routine of paediatric heart failure across Europe.The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007–2013) under grant agreement n°602295 (LENA).The following authors will also be included in the later poster: Ingrid Klingmann (PHARMAPLEX BVBA, Germany), András Szatmári (GOTTSEGEN GYORGY ORSZAGOS KARDIOLOGIAI INTEZET, Hungary), László Ablonczy (GOTTSEGEN GYORGY ORSZAGOS KARDIOLOGIAI INTEZET, Hungary), Holger Schwender (HEINRICH-HEINE-UNIVERSITÄT DÜSSELDORF, GERMANY)
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Gupta, Saurabh, Emilie P. Belley-Cote, Puru Panchal, Arjun Pandey, Ameen Basha, Lindsay Pallo, Bram Rochwerg, Shamir Mehta, J. D. Schwalm, and Richard P. Whitlock. "Antiplatelet therapy and coronary artery bypass grafting: a systematic review and network meta-analysis." Interactive CardioVascular and Thoracic Surgery 31, no. 3 (August 9, 2020): 354–63. http://dx.doi.org/10.1093/icvts/ivaa115.
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Abstract OBJECTIVES Acetylsalicylic acid (ASA) monotherapy is the standard of care after coronary artery bypass grafting (CABG), but the benefits of more intense antiplatelet therapy, specifically dual antiplatelet therapy (DAPT), require further exploration in CABG patients. We performed a network meta-analysis to compare the effects of various antiplatelet regimens on saphenous vein graft patency, mortality, major adverse cardiovascular events and bleeding among CABG patients. METHODS We searched Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval Systems Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, American College of Physicians Journal Club and conference proceedings for randomized controlled trials. Screening, data extraction, risk of bias assessment and Grading of Recommendations Assessment, Development and Evaluation were performed in duplicate. We conducted a random effect Bayesian network meta-analysis including both direct and indirect comparisons. RESULTS We included 43 randomized controlled trials studying 15 511 patients. DAPT with low-dose ASA and ticagrelor [odds ratio (OR) 2.53, 95% credible interval (CrI) 1.35–4.72; I2 = 55; low certainty] or clopidogrel (OR 1.56, 95% CrI 1.02–2.39; I2 = 55; very low certainty) improved saphenous vein graft patency when compared to low-dose ASA monotherapy. DAPT with low-dose ASA and ticagrelor was associated with lower mortality (OR 0.52, 95% CrI 0.30–0.87; I2 = 14; high certainty) and lower major adverse cardiovascular events (OR 0.63, 95% CrI 0.44–0.91; I2 = 0; high certainty) when compared to low-dose ASA monotherapy. Based on moderate certainty evidence, DAPT was associated with an increase in major bleeding. CONCLUSIONS Our results suggest that DAPT improves saphenous vein graft patency, mortality and major adverse cardiovascular event. As such, surgeons and physicians should consider re-initiating DAPT for acute coronary syndrome patients after their CABG, at the expense of an increased risk for major bleeding. Clinical trial registration International Prospective Register of Systematic Reviews ID Number CRD42019127695
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Billi, J. E., M. Shuster, L. Bossaert, A. R. de Caen, C. D. Deakin, B. Eigel, M. F. Hazinski, et al. "Part 4: Conflict of Interest Management Before, During, and After the 2010 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations." Circulation 122, no. 16_suppl_2 (October 17, 2010): S291—S297. http://dx.doi.org/10.1161/circulationaha.110.970962.
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Jay, Melissa, and Jason Brown. "How Wearing a Social Justice Lens Can Support You, Your Clients, and the Larger Community: An Intersectionality Workshop With a Twist." Canadian Journal of Counselling and Psychotherapy 55, no. 3 (December 3, 2021): 396–409. http://dx.doi.org/10.47634/cjcp.v55i3.70980.
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Counsellors may not comprehend fully the impact of their blind spots as a result of unconscious cultural encapsulation. The authors propose a self-reflective method by which counsellors can self-examine their assumptions about diversity and intersectionality. They invite readers to engage with the contents of this article to identify their blind spots, biases, and assumptions through self-reflective exercises. This article summarizes an intersectionality workshop with a twist that was offered by Melissa Jay, Jason Brown, and Rebecca Ward at the 2019 conference of the Canadian Counselling and Psychotherapy Association. The intention of the workshop was (a) to raise consciousness about systemic oppression, (b) to explore Collins’s (2018c) culturally responsive and socially just case conceptualization as the framework for the workshop, (c) to bring client intersectionality to life using four vignettes they created, (d) to reflect on client intersectionality and cultural identity, and (e) to propose a method by which counsellors can self-examine their assumptions about diversity and intersectionality, leading to more culturally competent counselling.
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Weber, Alan S., Rebal Turjoman, Yanal Shaheen, Farah Al Sayyed, Mu Ji Hwang, and Faryal Malick. "Systematic thematic review of e-health research in the Gulf Cooperation Council (Arabian Gulf): Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates." Journal of Telemedicine and Telecare 23, no. 4 (May 28, 2016): 452–59. http://dx.doi.org/10.1177/1357633x16647894.
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Introduction The Gulf Cooperation Council (GCC or ‘Arabian Gulf’), comprising Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates, is a political organization sharing a common history and culture. All GCC nations have made substantial investments in telecommunications and electronic health infrastructure since 2000. Methods We conducted a literature search in English and Arabic on peer-reviewed e-health research up to December 2014 originating in the GCC. The objective was to retrieve all research on e-health in the GCC and to categorize and analyse it qualitatively to reveal the current state of e-health research and development in the region. Inclusion criteria included peer-reviewed articles, books, book chapters, conference papers and graduate theses written on e-health in the GCC. Blogs, health websites and non-peer-reviewed literature were excluded. Results Three hundred and six articles were retrieved, categorized and analysed qualitatively to reveal the state of e-health research in the GCC. Both country-specific and GCC-wide major themes were identified using NVivo 10.0 qualitative software and summarized. The most common type of study was an overview (35.0%), with common study designs of case studies (26.8%) and descriptive articles (46.4%). Significant themes were: prospective national benefits from e-health, implementation and satisfaction with electronic health records, online technologies in medical education, innovative systems (case studies), and information security and personal health information. Discussion This is the first comprehensive analytical literature review of e-health in the GCC. Important research gaps were identified: few cost-benefit analyses, controlled interventional studies, or research targeting gender and religious issues were retrieved.
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Jin, Kai, Sahar Khonsari, Robyn Gallagher, Patrick Gallagher, Alexander M. Clark, Ben Freedman, Tom Briffa, Adrian Bauman, Julie Redfern, and Lis Neubeck. "Telehealth interventions for the secondary prevention of coronary heart disease: A systematic review and meta-analysis." European Journal of Cardiovascular Nursing 18, no. 4 (January 22, 2019): 260–71. http://dx.doi.org/10.1177/1474515119826510.
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Background: Coronary heart disease (CHD) is a major cause of death worldwide. Cardiac rehabilitation, an evidence-based CHD secondary prevention programme, remains underutilized. Telehealth may offer an innovative solution to overcome barriers to cardiac rehabilitation attendance. We aimed to determine whether contemporary telehealth interventions can provide effective secondary prevention as an alternative or adjunct care compared with cardiac rehabilitation and/or usual care for patients with CHD. Methods: Relevant randomized controlled trials evaluating telehealth interventions in CHD patients with at least three months’ follow-up compared with cardiac rehabilitation and/or usual care were identified by searching electronic databases. We checked reference lists, relevant conference lists, grey literature and keyword searching of the Internet. Main outcomes included all-cause mortality, rehospitalization/cardiac events and modifiable risk factors. (PROSPERO registration number 77507.) Results: In total, 32 papers reporting 30 unique trials were identified. Telehealth was not significant associated with a lower all-cause mortality than cardiac rehabilitation and/or usual care (risk ratio (RR)=0.60, 95% confidence interval (CI)=0.86 to 1.24, p=0.42). Telehealth was significantly associated with lower rehospitalization or cardiac events (RR=0.56, 95% CI=0.39 to 0.81, p<0.0001) compared with non-intervention groups. There was a significantly lower weighted mean difference (WMD) at medium to long-term follow-up than comparison groups for total cholesterol (WMD= −0.26 mmol/l, 95% CI= −0.4 to −0.11, p <0.001), low-density lipoprotein (WMD= −0.28, 95% CI = −0.50 to −0.05, p=0.02) and smoking status (RR=0.77, 95% CI =0.59 to 0.99, p=0.04]. Conclusions: Telehealth interventions with a range of delivery modes could be offered to patients who cannot attend cardiac rehabilitation, or as an adjunct to cardiac rehabilitation for effective secondary prevention.
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Gazmuri, Raúl J., Vinay M. Nadkarni, Jerry P. Nolan, Hans-Richard Arntz, John E. Billi, Leo Bossaert, Charles D. Deakin, et al. "Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Identified During the 2005 International Consensus Conference on ECC and CPR Science With Treatment Recommendations." Circulation 116, no. 21 (November 20, 2007): 2501–12. http://dx.doi.org/10.1161/circulationaha.107.186228.
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Funder, John W., Robert M. Carey, Franco Mantero, M. Hassan Murad, Martin Reincke, Hirotaka Shibata, Michael Stowasser, and William F. Young. "The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline." Journal of Clinical Endocrinology & Metabolism 101, no. 5 (May 1, 2016): 1889–916. http://dx.doi.org/10.1210/jc.2015-4061.
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Abstract Objective: To develop clinical practice guidelines for the management of patients with primary aldosteronism. Participants: The Task Force included a chair, selected by the Clinical Guidelines Subcommittee of the Endocrine Society, six additional experts, a methodologist, and a medical writer. The guideline was cosponsored by American Heart Association, American Association of Endocrine Surgeons, European Society of Endocrinology, European Society of Hypertension, International Association of Endocrine Surgeons, International Society of Endocrinology, International Society of Hypertension, Japan Endocrine Society, and The Japanese Society of Hypertension. The Task Force received no corporate funding or remuneration. Evidence: We searched for systematic reviews and primary studies to formulate the key treatment and prevention recommendations. We used the Grading of Recommendations, Assessment, Development, and Evaluation group criteria to describe both the quality of evidence and the strength of recommendations. We used “recommend” for strong recommendations and “suggest” for weak recommendations. Consensus Process: We achieved consensus by collecting the best available evidence and conducting one group meeting, several conference calls, and multiple e-mail communications. With the help of a medical writer, the Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and Council successfully reviewed the drafts prepared by the Task Force. We placed the version approved by the Clinical Guidelines Subcommittee and Clinical Affairs Core Committee on the Endocrine Society's website for comments by members. At each stage of review, the Task Force received written comments and incorporated necessary changes. Conclusions: For high-risk groups of hypertensive patients and those with hypokalemia, we recommend case detection of primary aldosteronism by determining the aldosterone-renin ratio under standard conditions and recommend that a commonly used confirmatory test should confirm/exclude the condition. We recommend that all patients with primary aldosteronism undergo adrenal computed tomography as the initial study in subtype testing and to exclude adrenocortical carcinoma. We recommend that an experienced radiologist should establish/exclude unilateral primary aldosteronism using bilateral adrenal venous sampling, and if confirmed, this should optimally be treated by laparoscopic adrenalectomy. We recommend that patients with bilateral adrenal hyperplasia or those unsuitable for surgery should be treated primarily with a mineralocorticoid receptor antagonist.
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Hsu, Tina, Kori LaDonna, and Claire Touchie. "Use of oncology electronic learning resources to learn about geriatric oncology." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 11033. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.11033.
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11033 Background: Despite the aging population driving cancer growth, oncology trainees receive little training in geriatrics. While electronic resources, such as ASCO University, may help meet this gap, use of available geriatric oncology (GO) modules is low. We sought to understand why by exploring how oncology trainees currently learn about GO, their preferred methods for learning about GO, and their attitudes towards e-learning and geriatrics. Methods: Canadian medical oncology residents and recent graduates were electronically surveyed about the following domains: demographics, self-directed learning practices, use of electronic resources, perceived facilitators and barriers to e-learning, and geriatric oncology teaching. Descriptive statistics were used to analyze the data. Results: Respondents (n = 47) were mostly aged < 35 (66%). Respondents felt that learning about older adults was important (mean 4.3±1.0 out of 5) and generally felt comfortable caring for them (mean 3.9±0.9 out of 5) despite minimal training in geriatrics.Almost half (48.9%) received 0-2 hours of teaching in GO during residency, with the majority (59.6%) receiving teaching in clinic, 36.2% through lectures and 21.3% via seminars. Respondents also learned about GO through reading journal articles (42.6%), modelling in clinic (36.2%), reading a textbook (19.2%) or attending a conference (19.2%). Respondents preferred to learn about GO through on-site lectures (46.8%), dinner meetings (42.6%), case discussion (42.6%) and attending conferences (38.3%). Although overall respondents highly valued electronic learning (mean 4.3±0.75 out of 5), only a minority (8.5%) had received GO teaching electronically using e-modules and only 23.4% respondents were aware of e-learning resources in GO. In contrast most respondents (83%) had used an e-learning resource to learn about oncology. The most common oncology e-resources used were ASCO University (61.7%), Oncology Education (61.7%), and ASCO meeting videos (44.7%). Conclusions: Although oncology trainees value and commonly use e-learning resources, e-learning is not a common or preferred way to learn about GO, potentially due to lack of awareness about these resources. Future research will explore whether the current methods of educating oncology learners about older adults are appropriate and sufficient, as well as how trainees value and prioritize learning about topics that are not included in the formal curricula.
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Zamzam, Manal, Hanafy Hafez, Reham Khedr, Sherif Abouelnaga, Mohamed Abdelbaki, Leslie Lehmann, Liliana C. Goumnerova, Kathleen Houlahan, Mark W. Kieran, and Patricia Pruden. "Development of the joint Children’s Cancer Hospital Egypt (CCHE-57357) Dana-Farber Boston Children’s Hospital Pediatric Oncology Fellowship Program." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18226-e18226. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18226.
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e18226 Background: Children diagnosed with cancer in low- and middle-income countries (LMIC) have markedly inferior outcomes compared to those in high income countries. While some of these issues can be resource availability, a major problem is the quality of training and traditional methods of clinical practice where decision making is centered on the most senior person on the team. To ensure real change, highly-trained locally based specialists with a strong emphasis on problem-solving and critical thinking using evidence-based approaches are needed. Methods: The Children’s Cancer Hospital Egypt (CCHE-57357) and Dana-Farber Boston Children’s Hospital (DFBCH) at Harvard Medical School developed a 30 month pediatric oncology fellowship training program following the American Academy of Pediatrics fellowship guidelines. The primary objective of the program was to implement a shared education model to develop highly educated physicians who are able to follow evidence-based approaches and who are committed to sustained practice in LMIC. Results: DFBCH staff provide ongoing education to the fellows through visits to CCHE-57357 every 2-3 months, weekly video sessions with the fellows for case presentation and journal clubs, and weekly conference calls with the fellowship program staff to ensure that the goals and objectives for each fellow and the program are met. Each of the current 15 fellows spend 6 weeks/year in Boston participating in evidence-based multi-disciplinary based rounds; the remainder of the curriculum takes place at CCHE-57357 and incorporates an array of individual, small group and e-learning modules specifically created for the program. Three classes of fellows have been enrolled and the senior class will graduate in the spring of 2017. Conclusions: Training of fellows following the same standards and methods as those applied to North American candidates is feasible and has the potential to advance the quality of education and expertise in LMIC. By focusing on the education of the next generation of clinicians, the opportunity to implement many of the important principles of clinical care can be realized.
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Chen, X., and L. Wang. "AB0540 CLINICAL ANALYSIS OF AORTA INVOLVEMENT IN PATIENTS OF ANCA-ASSOCIATED VASCULITIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1566.3–1567. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2616.
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Background:ANCA-associated vasculitis (AAV) is an autoimmune disease that involves abnormal death of neutrophils and leads to necrotic inflammatory reactions in blood vessels, including microscopic polyangiitis (MPA), Granulomatous polyangiitis (GPA) and Eosinophilic granulomatous polyangiitis (EGPA). AAV is mainly involved in small blood vessels, and intermediate arterial lesions can also occur, but the large arteries and their primary branches are rarely involved.Objectives:To summarize the clinical characteristics of aortic involvement in patients with ANCA-associated vasculitis (AAV).Methods:The clinical manifestations, systemic involvement, laboratory examination, imaging characteristics and treatment of aortic involvement in AAV patients admitted to Peking Union Medical College Hospital from January 2013 to December 2018 were retrospectively analyzed.Results:Nine patients were enrolled in our study. The ratio of male to female was 2:1 and the median age was 47 years old. Of the 9 patients, 4 were GPA (44%), 4 were MPA (44%) and 1 was EGPA (11%). The aorta is involved in an average of 3 locations per case, mainly in 7 locations: 3 ascending aorta and aortic arch, 4 in the head and arm trunk (including carotid and subclavian artery), 2 in the abdominal aorta, and 1 in the abdominal cavity. There were 2 cases of renal artery, 1 case involving brachial radial artery, 2 cases of iliac artery and lower limb artery, and 1 case involving left main coronary artery, anterior descending branch, circumflex branch, and right coronary artery. Aortic lesions: 3 cases had aneurysms, arterial dilatation and / or dissection, 6 cases had arterial stenosis or occlusion and 3 cases had periarteritis.When major arterial involvement was found, the AAV of the patients were mostly active, with an average of 19 points for BVAS vasculitis activity and 1 for FFS score. 6 cases had lung involvement (67%), 6 cases had kidney involvement (67%), 4 cases had ENT involvement (44%), 3 cases had nervous system involvement (33%), and 1 case had gastrointestinal involvement (11%). All patients were treated by steroid and immunosuppressant, while 1 case received the operation of ascending aorta and aortic arch replacement.Conclusion:Mainly involved in small blood vessel inflammation, AAV may also have aorta involvement, which was more common in patients who had active disease and need more positive treatment. The affected aorta areas of these patients were mainly ascending aorta, aortic arch, and head and arm trunk, which can be manifested as aneurysms, dissections, and arterial stenosis Periarteritis, etc. If necessary, surgically treatment of the affected aorta could be considered when the situation of AAV was stable enough.References:[1]Jennette J C, Falk R J, Bacon P A, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides[J]. Arthritis Rheum, 2013,65(1):1-11.DOI:10.1002/art.37715.[2]Eisenberger U, Fakhouri F, Vanhille P, et al. ANCA-negative pauci-immune renal vasculitis: histology and outcome[J]. Nephrol Dial Transplant, 2005,20(7):1392-1399.DOI:10.1093/ndt/gfh830.[3]Guillevin L, Pagnoux C, Seror R, et al. The Five-Factor Score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort[J]. Medicine (Baltimore), 2011,90(1):19-27.DOI:10.1097/MD.0b013e318205a4c6.[4]Chirinos J A, Tamariz L J, Lopes G, et al. Large vessel involvement in ANCA-associated vasculitides: report of a case and review of the literature[J]. Clin Rheumatol, 2004,23(2):152-159.DOI:10.1007/s10067-003-0816-0.[5]Minnee R C, van den Berk G E, Groeneveld J O, et al. Aortic aneurysm and orchitis due to Wegener’s granulomatosis[J]. Ann Vasc Surg, 2009,23(6):715-786.DOI:10.1016/j.avsg.2009.06.011.Disclosure of Interests:None declared
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Donahue, Amy. "Google Wave: Have CTSI-Minded Institutions Caught It?" Evidence Based Library and Information Practice 5, no. 4 (December 17, 2010): 70. http://dx.doi.org/10.18438/b8fw48.
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Background - Google Wave was touted as the next big communication tool—combining e-mail, social networking, and chat within a single “wave”—with the potential to create a new world for collaboration. Information professionals who are knowledgeable of this tool and its capabilities could become uniquely situated to use it, evaluate it, and teach it. This seemed especially true for those working within Clinical and Translational Science Award (CTSA)-minded institutions, given the promise of interdisciplinary collaboration between investigators and the potential for creating new authorship models. This case study on Google Wave users who are affiliated with CTSA-minded institutions, was designed for and presented at the Evidence-Based Scholarly Communication Conference held by the University of New Mexico Health Sciences Library and Information Center. It provides an early evidence based evaluation of Google Wave’s potential.
Methods - Two “waves” were created. The first consisted of five survey questions designed to collect demographic data on the respondents’ roles, a general impression of Wave, the specific tools within Wave that might be useful, and potential collaborators with whom the respondents might use Wave. The second wave was a private, guided discussion on Wave’s collaboration potential. Individuals from CTSA-minded institutions were invited to participate with messages on Twitter, forums, blogs, and electronic mail lists, although there were difficulties reaching out to these institutions as a group.
Results - By the conclusion of the study, only a small number of people (n=11, with a viable n=9) had responded to the survey. Given this small result set, it made sense to group the responses by the respondents’ roles (CTSA staff and researchers, support staff, medical librarian, or general public) and to treat them as individual cases. Most of the respondents were librarians and support staff who felt that Wave might have potential for collaboration; there were no CTSA researcher respondents. For the second part of the study, the discussion wave, only one participant explicitly expressed interest in joining. All were invited to join, but there was no participation in the discussion wave at the conclusion of the study.
Conclusions -The results of this study implied that Google Wave was not on the forefront of CTSA-minded institutions’ communication strategies. However, it was being used, and it did demonstrate new collaboration and authorship capabilities. Being generally aware of these capabilities may be useful to information professionals who seek to be current and informed regarding developing technology and to those interested in scholarly communication practices. In addition, the difficulties encountered during this case study in attempting to reach out to CTSA-minded institutions raised the question of how members currently communicate with each other as institutions and as individuals. There was a lesson learned in the usefulness of doing case-study research to evaluate new technologies; the cost in terms of time was relatively low, and knowledge about the technology itself was gained while establishing a base level of evidence to potentially build on in the future.
Methods: Two “waves” were created. The first consisted of five survey questions designed to collect demographic data on the respondents’ roles, a general impression of Wave, the specific tools within Wave that might be useful, and who the respondents might use Wave to collaborate with. The second wave was a private, guided discussion on Wave’s collaboration potential. Individuals from CTSA-minded institutions were invited to participate from related public waves and by sending out calls for through Twitter, forums, blogs, and e-mail, although there were difficulties reaching out to these institutions as a group.
Results: By the conclusion of the study, only a small number of respondents (n=11, with a viable n=9) had taken the survey. Given this small result set, it made sense to group the responses by the respondents’ roles (CTSA staff/researchers, support staff, medical librarian, or general public) and treat them as individual cases. Most of the respondents were librarians and support staff who felt that Wave might have potential for collaboration; there were no CTSA researcher respondents. For the second part of the study, the discussion wave, only one participant explicitly expressed interest in joining. All were invited to join for the sake of numbers, but there was no participation in the discussion wave by the conclusion of the study.
Conclusions: The results of this study implied that Google Wave was not on the forefront of CTSA-minded institutions’ communication strategies. However, it was being used and it did demonstrate new collaboration and authorship capabilities; being generally aware of these capabilities may be useful to information professionals who seek to stay on top of developing technology and to those interested in scholarly communication practices. In addition, the difficulties encountered during this case study in attempting to reach out to CTSA-minded institutions raised the question of how members currently communicate with each other as institutions and as individuals. There was a lesson learned in the usefulness of doing case-study research to evaluate new technologies; cost in terms of time is relatively low and knowledge can be gained of the technology itself while establishing a base level of evidence to potentially build on in the future.
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Stovold, Elizabeth Margaret. "A Systematic Review of Librarian-Provided Services Delivered in Healthcare Settings Finds a Positive Effect on Clinician and Patient Relevant Outcomes and Identifies Gaps in the Evidence." Evidence Based Library and Information Practice 10, no. 1 (March 6, 2015): 95. http://dx.doi.org/10.18438/b83w45.
Full textAbstract:
A Review of:
Perrier, L., Farrell, A., Ayala, A. P., Lightfoot, D., Kenny, T., Aaronson, E., . . . Weiss, A. ( 2014). Effects of librarian-provided services in healthcare settings: A systematic review. Journal of the American Medical Informatics Association, 21(6), 1118-1124. http://dx.doi.org/10.1136/amiajnl-2014-002825
Abstract
Objective – To assess the effects of librarian-provided services, in any healthcare setting, on outcomes important to patients, healthcare providers, and researchers.
Design – Systematic review and narrative synthesis.
Setting – MEDLINE, CINAHL, ERIC, LISA, and CENTRAL databases; library-related websites, conference proceedings, and reference lists of included studies.
Subjects – Twenty-five studies identified through a systematic literature search.
Methods – In consultation with the review team, a librarian designed a search to be run in MEDLINE that was peer-reviewed against a published checklist. The team then conducted searches in the five identified databases, adapting the search as appropriate for each database. Authors also checked the websites of library and evidence based healthcare organisations, along with abstracts of relevant conference proceedings, to supplement the electronic search. Two authors screened the literature search results for eligible studies, and reached agreement by consensus. Studies of any librarian-delivered service in a healthcare setting, directed at either patients, clinicians of any type, researchers, or students, along with studies reporting outcomes relevant to clinicians, patients, or researchers, were eligible for inclusion. The authors assessed results initially on the titles and abstracts, and then on the full-text of potentially relevant reports. The data from included studies were then extracted into a piloted data extraction form, and each study was assessed for quality using the Cochrane EPOC risk of bias tool or the Newcastle-Ottawa scale. The results were synthesised narratively.
Main Results – The searches retrieved a total of 25 studies that met the inclusion criteria, comprised of 22 primary papers and 3 companion reports. Authors identified 12 randomised trials, 4 controlled before-and-after studies, 3 cohorts, 2 non-randomised trials, and 1 case-control study. They identified three main categories of intervention: librarians teaching search skills; providing literature searching as a service; and a combination of the teaching and provision of search services. The interventions were delivered to a mix of trainees, clinicians, and students. None of the studies examined services delivered directly to patients or to researchers. The quality assessment found most of the studies had a mid- to high-risk of bias due to factors such as lack of random sequence generation, a lack of validated tools for data collection, or a lack of statistical analysis included in the study.
Two studies measured patient relevant outcomes and reported that searches provided by librarians to clinicians had a positive impact on the patient’s length of stay in hospital. Five studies examined the effect of librarian provided services on outcomes important to clinicians, such as whether a literature search influenced a clinical decision. There was a trend towards a positive effect, although two studies found no significant difference.
The majority of studies investigated the impact of training delivered to trainees and students on their literature search skills. Twelve of these studies found a positive effect of training on the recipients’ search skills, while three found no difference. The secondary outcomes considered by this review were satisfaction with the service (8 studies), relevance of the answers provided by librarians (2), and cost (3). The majority reported good satisfaction, and relevance. A cost benefit was found in 2 of 3 studies that reported this outcome.
Conclusion – Authors report a positive effect of training on the literature search skills of trainees and students, and identified a benefit in the small number of studies that examined librarian services to clinicians. Future studies should use validated data collection tools, and further research should be conducted in the area of services provided to clinicians. Research is needed on the effect of librarian-provided services to patients and researchers as no studies meeting the inclusion criteria examining these two groups were identified by the literature search.
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Almunef, Mohammed, Julie Mason, Chris Curtis, and Zahraa Jalal. "P034 Management of chronic illness in young people aged 10-24 years: a systematic review to explore the role of primary care pharmacists." Archives of Disease in Childhood 104, no. 7 (June 19, 2019): e2.39-e2. http://dx.doi.org/10.1136/archdischild-2019-nppc.44.
Full textAbstract:
AimTo explore the role of primary care pharmacists in the management of chronic illnesses in young people aged 10–24 years.MethodsSystematic search of four databases: MEDLINE, EMBASE, Cochrane Library and CINAHL using MeSH (Medical Subject Heading) and Emtree terms covering three main themes, namely, pharmacist, young people and chronic illnesses. Inclusion criteria: articles identifying the role of primary care pharmacists in the management of chronic illness and its acute manifestations in young people aged 10–24 years. Exclusion criteria: articles referring to the hospital, secondary care setting. Chronic conditions such as disability. Acute disease. Conference abstracts, letters and case studies.ResultsEight relevant articles were identified from different countries UK(3), USA(3), Netherlands(1) and Chile(1). All of the articles made reference to community pharmacists only and did not include information on pharmacists working in any other area of primary care (e.g. general practice). Seven of the articles identified included original research studies (1 observational, 2 survey, 2 qualitative interview, 2 intervention). The remaining article was a literature review. The interventional studies utilised pharmacists to manage specific chronic illnesses (i.e. asthma and metabolic disease). Both showed significant results in terms of improvement of a young person’s quality of life and improvement in their knowledge about their disease and its treatment. The research studies gathered the opinions of pharmacists (3) and young people (1) based on their experiences. The most prominent issue arising from the research into pharmacist opinion was the lack of direct communication with the young person because of parents collecting prescription items. In one study,1 around half of participants stated this to be the main cause of medication-related problems, which in the main were non-adherence, in young people. Community pharmacists identified many roles that they felt were of high priority to their practice when dealing with young people. These included supporting young people to develop generic health care skills, build trusting relationships directly with young people, counselling with affirmation on the necessity and benefits of adhering to their medicine regimens, helping young people to find credible online health information and use digital media for educational or reminder purposes, transferring information effectively across care interfaces and provision of specialist services.1 2ConclusionThere is a lack of published literature regarding the role of pharmacists in the management of chronic illness in young people. Where primary care pharmacists have managed chronic illnesses in this patient population, they have been community-based and have had a positive impact on patient outcomes. Pharmacists feel that they have a role to play in supporting young people with chronic illness and have identified many areas where they can provide additional services and support. However, many pharmacists perceive a fundamental communication barrier which hinders provision of this support i.e. lack of access to the patient. This suggests that given the appropriate training and access to these patients pharmacists could have a positive impact on patient outcomes. Further research is necessary to provide more evidence that primary care pharmacists could be further utilised in supporting young people with their medications.ReferencesKoster E, Philbert D, Winters N, et al. Medication adherence in adolescents in current practice: community pharmacy staff’s opinions. International Journal of Pharmacy Practice, 2015;23(3):221–224.Gray N, Shaw K, Smith F, et al. The Role of Pharmacists in Caring for Young People With Chronic Illness. Journal of Adolescent Health, 2017;60(2):219–225.
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Robiatul Adawiah, Laila, and Yeni Rachmawati. "Parenting Program to Protect Children's Privacy: The Phenomenon of Sharenting Children on social media." JPUD - Jurnal Pendidikan Usia Dini 15, no. 1 (April 30, 2021): 162–80. http://dx.doi.org/10.21009/jpud.151.09.
Full textAbstract:
Sharenting is a habit of using social media to share content that disseminates pictures, videos, information, and parenting styles for their children. The purpose of this article is to describe the sharenting phenomenon that occurs among young parents, and the importance of parenting programs, rather than protecting children's privacy. Writing articles use a qualitative approach as a literature review method that utilizes various scientific articles describing the sharenting phenomenon in various countries. The findings show that sharenting behaviour can create the spread of children's identity openly on social media and tends not to protect children's privacy and even seems to exploit children. Apart from that, sharenting can also create pressure on the children themselves and can even have an impact on online crime. This article is expected to provide benefits to parents regarding the importance of maintaining attitudes and behaviour when sharing and maintaining children's privacy and rights on social media.
Keywords: Sharenting on social media, Children's Privacy, Parenting Program
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Suwandayani, Beti Istanti, Kuncahyono, and Ade Ika Anggraini. "POLA IMPLEMENTASI TEORI KONSTRUKTIVISME PADA PEMBELAJARAN TATAP MUKA TERBATAS DI SEKOLAH DASAR." Taman Cendekia: Jurnal Pendidikan Ke-SD-an 5, no. 2 (December 29, 2021): 609–18. http://dx.doi.org/10.30738/tc.v5i2.11472.
Full textAbstract:
This study aimed to examine the implementation pattern of the constructivist theory in limited face-to-face learning (PTMT). The method used was descriptive qualitative with the subject of teachers in the Malang City area. Data was collected by using a survey distributed online through Google Forms. The results showed that the implementation pattern ofconstructivist theory in limited face-to-face learning (PTMT) was carried out through 5 (five) base of learning implementation, namely the application of problem-based learning, the application of project-based learning, the use of digital-based teaching materials and media, the application of psychosocial learning and contextuallearning. Teachers carried out limited face-to-face learning by applying constructivist theory massively and gradually, starting from planning, the process of learning activities, and learning evaluation. In addition to the use of media and 5M learning models in this study, the application of constructivist theory in PTMT learning aimed to help students become more active and teachers as moderators be more innovative. Learning process carried out at the elementary school level was only 50 percent attendance at the maximum. The implementation of student-centered learning showed 45% was very good, 50% was good, 2.5% was good, 2.5% was not good. The results showed that the inhibiting factor for student-centered implementation was the limited duration of time in learning. On the other hand, there were also restrictions on interactions carried out in the classroom so that teachers experienced a decline in exploring the learning process. Keywords: constructivism theory. limited face-to-face learning, elementary school. References: Adiyono, A. 2021. Implementasi Pembelajaran: Peluang dan Tantangan Pembelajaran Tatap Muka Bagi Siswa Sekolah Dasar di Muara Komam. 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Hammi, Sanae, Naima Zimed, Khalid Bouti, and Jamal Eddine Bourkadi. "Paradoxical reactions during Antituberculosis therapy - A single-center prospective analysis." International Journal of Medicine and Surgery 2, no. 2 (December 26, 2015): 32–35. http://dx.doi.org/10.15342/ijms.v2i2.75.
Full textAbstract:
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Ekyana, Luluk, Mohammad Fauziddin, and Nurul Arifiyanti. "Parents’ Perception: Early Childhood Social Behaviour During Physical Distancing in the Covid-19 Pandemic." JPUD - Jurnal Pendidikan Usia Dini 15, no. 2 (November 30, 2021): 258–80. http://dx.doi.org/10.21009/jpud.152.04.
Full textAbstract:
During physical distancing, children do not meet their peers to play or talk together. Peer relationships have a crucial influence on all child development, especially for social skills or behaviour during early childhood. This study aims to determine changes in children's social behaviour during physical distancing during the Covid-19 pandemic. This research method is a descriptive quantitative study designed with the percentage value was used as a score for measuring the results of parental observations of children concerning the child's social behaviour instrument. Quota sampling (150 parents) was used to reach participants from various cities in Indonesia to see cultural differences. Data on children's social behaviour was obtained using the Preschool and Kindergarten Behaviour Scale (PKBS) tests. The data were then analysed using descriptive statistics. The results show that there are changes in children's social behaviour during physical distancing. Children who are less independent (58.9%) are the biggest decline in social behaviour reported by parents, while the one who changes the least is cleaning up the mess that has been made (38.7%). The implication of the results of this study is that parents should continue to pay attention to their children's social behaviour by providing opportunities for children to interact with peers in the house while still paying attention to health protocols.
Keywords: Early Childhood, Social Behaviour, Physical Distancing
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Ahmed, Zeeshan, Clarissa H. H. Lau, Meredith Poole, Danielle Arshinoff, Ryaan El-Andari, Abigail White, Garrett Johnson, et al. "Canadian Conference for the Advancement of Surgical Education (C-CASE) 2021: Post-Pandemic and Beyond Virtual Conference AbstractsBlended learning using augmented reality glasses during the COVID-19 pandemic: the present and the futureActivating emotions enhance surgical simulation performance: a cluster analysisTraining in soft-tissue resection using real-time visual computer navigation feedback from the Surgery Tutor: a randomized controlled trialSonoGames: delivering a point of care ultrasound curriculum through gamificationTeaching heart valve surgery techniques using simulators: a reviewPortable, adjustable simulator for cardiac surgical skillsDesign and validity evidence for a unique endoscopy simulator using a commercial video gameComparison of a novel silicone flexor tendon repair model to a porcine tendon repair modelAssessment system using deep learningChallenges addressed with solutions, simulation in undergraduate and postgraduate surgical education, innovative education or research in surgical educationMachine learning distinguishes between skilled and less-skilled psychological performance in virtual neurosurgical performanceA powerful new tool for learning anatomy as a medical studentDevelopment and effectiveness of a telementoring approach for neurosurgical simulation training of medical studentsA team based learning approach to general otolaryngology in undergraduate medical educationStudent-led surgery interest group outreach for high school mentorship: a diversity driven initiativeRetrospective evaluation of novel case-based teaching series for first year otolaryngology residentsHarassment in surgery: assessing differences in perceptionFactors associated with medical student interest in pursuing a surgical residency: a cross-sectional survey studyUnderstanding surgical education experiences: an examination of 2 mentorship modelsLeadership development programs for surgical residents: a narrative review of the literatureValidation of knee arthroscopy simulator scoring system against subjective video analysis scoringCharacterizing the level of autonomy in Canadian cardiac surgery residentsMentorship patterns among medical students successfully matched to a surgical specialityStaying safe with laparoscopic cholecystectomy: the use of landmarking and intraoperative time-outsEndovascular aneurysm repair has changed the training paradigm of vascular residentsImplementation of a standardized handover in pediatric surgeryProcedure-specific assessment in cardiothoracic and vascular surgery: a scoping reviewLongitudinal mentorship-based programs for junior medical students increases exposure, confidence, and interest in surgeryCreating a green-shift in surgical education: a scoping review of initiatives and methods to make perioperative care more sustainableA novel plastic surgery residency bootcamp: structure and utilityVideo-based coaching for surgical residents: a systematic review and meta-analysisVirtual patient cases aligned with EPAs provide innovative e-learning strategiesAchieving competency in the CanMEDS roles for surgical trainees in the COVID-19 era: What have we learned and where do we go?Profiles of burnout and response to the COVID-19 pandemic among general surgery residents at a large academic training programLearner-driven telemedicine curriculum during the COVID-19 pandemicCentralized basic orthopaedic surgery virtual examinations — assessment of examination environmentEffects of the COVID-19 pandemic on surgical resident training: a nationwide survey of Canadian program directorsExploring the transition to virtual care in surgery and its impact on clinical exposure, teaching, and assessment during the COVID-19 pandemiecImpact of COVID-19 on procedural skills training and career preparation of medical studentsVirtual surgical shadowing for undergraduate medical students amidst the COVID-19 pandemicEducational impact of the COVID-19 third wave on a competency-based orthopedic surgery programVirtualization of postgraduate residency interviews: a ransforming practice in health care educationAn informational podcast about Canadian plastic surgery training programs: “Doctority Canada: Plastic Surgery.”Virtual versus in-person suture training: an evaluation of synchronous and asynchronous teaching paradigmsMerged virtual reality teaching of the fundamentals of laparoscopic surgery: a randomized controlled trialShould surgical skills be evaluated during virtual CaRMS residency interviews? A Canadian survey of CaRMS applicants and selection committee members during the COVID-19 pandemicImpact of the COVID-19 pandemic on surgical education for medical students: perspectives from Canada’s largest faculty of medicine." Canadian Journal of Surgery 64, no. 6 Suppl 1 (November 25, 2021): S65—S79. http://dx.doi.org/10.1503/cjs.018821.
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Beeri, R., F. C. Tanner, O. Ten Cate, M. Ros, and P. Kirchhof. "Trusting our trainees: competency-based training of cardiologists using Entrustable Professional Activities (EPA)." European Heart Journal 41, Supplement_2 (November 1, 2020). http://dx.doi.org/10.1093/ehjci/ehaa946.3533.
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Abstract Assessment of trainees is a core activity of educators, ensuring that trainees can be trusted to provide high quality care with no supervision. Training and the demands on trainees have changed with specialization, need for more technical skills, digitization, needs for teamwork and greater communication skills. Competency-based medical education was introduced to capture these changing needs for trainees. The 7th ESC Education Conference – “From competence to good clinical care” – brought together national directors of training (39), young cardiology representatives (7), patients (7), ESC partners in education (10), and the ESC Education Committee (22) to discuss contemporary challenges in cardiology training and Entrustable Professional Activities (EPAs)-based solutions. Methods Pre- and post-conference surveys were conducted. The different issues were discussed in 4 workshops: core knowledge and evidence, skills and competence, performing into context, and training the trainers. Results Pre-conference, 90% of respondents believed that trainees should be certified only when they can be entrusted to perform in an unsupervised fashion, and 84% thought that specific training for educators should be required. From the workshops 4 themes emerged: 1) Core knowledge and evidence: rotations to different centres are needed to enable trainees to meet EPA requirements. 2) Skills and competence: a learning agreement between trainers and trainees should be established with protected time to achieve EPAs, and patient feedback on trainee performance should be obtained. 3) Performing into context (when is a trainee ready to practice): clinicians do informal assessment on a daily basis; EPAs formalize this with regular observation linked with progression in responsibility. 4) Train the trainer: good doctors are not automatically good trainers and should be required to undergo specific training themselves. We reviewed complex training frameworks such as the Canadian Medical Education Directives for Specialists (CanMEDS) that contains too many components to be useful for clinical teachers. EPAs were identified as a practical way to implement competency-based cardiology training across the ESC. The 2020 ESC Core Curriculum contains EPAs that a cardiologist should be able to perform independently by the end of training. Post-conference there was unanimous agreement (100%) that EPAs are a valuable concept in training. A majority of participants (69%) agreed that EPA's are applicable in practice today. Conclusion Trainee assessment is a daily challenge for educators. The ESC Education Conference identified distinct goals to be achieved before, during and at the completion of a training programs. The EPA concept was widely accepted as an efficient method to monitor trainees progress, while trusting them to perform activities in which they are proficient. Trusting our trainees should be a major educational goals for cardiologists in Europe. Funding Acknowledgement Type of funding source: None
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Schidlow, David N., Kimberlee Gauvreau, Emily M. Bucholz, Amy Bennett, Terra Lafranchi, Jay Pruetz, christina ronai, Jeffrey Vergales, and David W. BROWN. "Abstract 14689: Optimal Prenatal Care Coordination is Associated With Fewer Pre-operative Risk Factors in Babies With a Prenatal Diagnosis of HLHS." Circulation 142, Suppl_3 (November 17, 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.14689.
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Introduction: Prenatal diagnosis (PD) of congenital heart disease permits coordination of care to optimize postnatal outcomes. Using phase II registry data from the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC), we sought to identify associations between prenatal care coordination (PNC) and pre-operative status among infants with HLHS and variants intended for Stage I Norwood or hybrid palliation. Hypothesis: We hypothesized that suboptimal PNC would be associated with worse pre-operative status. Methods: The NPC-QIC database was queried for all instances of prenatally diagnosed HLHS and variants intended for Stage 1 Norwood or hybrid palliation from 2016 through 2019. Demographic and clinical data pertaining to the prenatal period through the first birthday were obtained. Optimal PNC was defined as (1) a completed interdisciplinary case conference prior to delivery and (2) a note in the medical record documenting closed-loop communication between the OB and cardiology teams. Associations between PNC and outcomes were identified. Results: Among 1441 registry patients with HLHS and variants, 1242 (86%) had PD. Among patients with PD, optimal PNC was achieved in 68%. Preoperatively, infants without optimal PNC were more likely to have any adverse event (50% vs 40%, p<0.001), receive inotropes (19% vs 13%, p=0.007), require mechanical ventilation (22% vs 16%, p=0.016), and were less likely to feed enterally (53% vs 67%, p <0.001). Lower socio-economic status (SES) was associated with a lower likelihood of PD (p<0.001), and African-American race was associated with a lower likelihood of optimal PNC (p=0.006). Conclusions: Among prenatally diagnosed infants with HLHS and variants, optimal PNC was associated with fewer preoperative risk factors. There also appear to be disparities in PD related to SES and in PNC related to race. Additional study is required to understand the complex interplay between PNC and clinical outcomes, as well as identify and address barriers to PD and optimal PNC.
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Thorson, Shila, Jeffrey Sather, Jerilyn Alexander, and Mindy Cook. "Abstract 219: Interdisciplinary Education and Relationship Building Improve Communication and Coordination in Stroke Care." Circulation: Cardiovascular Quality and Outcomes 10, suppl_3 (March 2017). http://dx.doi.org/10.1161/circoutcomes.10.suppl_3.219.
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Introduction: Acute stroke care involves collaboration among multiple disciplines across the continuum of care. Interdisciplinary education consist of two or more disciplines collaborating in the learning process with the objective of promoting interprofessional coordination that improves the patient care provided by each discipline. The North Dakota Stroke System of Care (NDSSoC) Taskforce was legislatively was legislatively created in 2009 and is composed of a multidisciplinary group that collaborates to provide recommendations in the development of the North Dakota Stroke System of Care. Hypothesis: Interdisciplinary education and relationship building among hospital nursing staff and emergency medical services (EMS) staff will lead to an increase in advanced notification of stroke patients by EMS to the receiving hospital and result in an increase of stroke patients receiving a computed tomography (CT) scan within 25 minutes of arrival to hospital. Method: EMS and hospital staff is provided education at the statewide level through educational modules, regional conferences, an annual state stroke conference beginning in 2012, and at least sixteen occurrences of Primary Stroke Center stroke coordinator outreach. The NDSSoC Data was analyzed through use of the Get With the Guidelines® Patient Management Tool using 2010 as baseline data and comparing to 2015 data. Results: The percent of stroke cases with advanced notification by EMS for patients transported by EMS from scene in North Dakota increased from 56% in 2010, to 77.4% in 2015, surpassing the national average of 55.9%. Percent of patients arriving via EMS from home/scene who receive brain imaging (CT) within 25 minutes of arrival to hospitals in North Dakota increased from 23.8% in 2010 to 48.8% in 2015. Conclusion: Through providing education to EMS providers and building relationships between EMS and hospitals, there has been a significant increase in pre-notification by EMS therefore improving timeliness of CT scans in acute stroke patients.
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Ladner, Travis R., Jasia Mahdi, Albert Attia, Michael T. Froehler, Truc Le, Amanda Lorinc, J. Mocco, et al. "Abstract T P373: Experience with a Multidisciplinary Pediatric Neurovascular Conference for Complex Disease Management." Stroke 46, suppl_1 (February 2015). http://dx.doi.org/10.1161/str.46.suppl_1.tp373.
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Introduction: In 2013 our institution established a multidisciplinary pediatric neurovascular conference (PNVC) for coordination of care. Here we review our initial experience. Hypothesis: Collaboration yields coordinated care for children with complex cerebrovascular disease and treatment protocols for commonly discussed conditions. Methods: Clinical and demographic data were obtained from medical records for patients presented to PNVC from April 2013 to July 2014. Survey data were collected from PNVC participants. Results: The PNVC met 26 times in the study period. Overall, 78 children were presented a total of 112 times, 41% with history of stroke. Of 64 (82%) with a diagnosed vascular lesion, AVM (30%), cavernous malformation (14%), and moyamoya (11%) were most common. Most discussions were for review of imaging (35%), need for additional imaging (27%), or treatment plan (25%) [Table]. Follow-up angiography was performed in 27%. A surgical operation was employed in 22%; 18% received neurointervention; 9% received radiosurgery. Twenty-three patients (29%) were discussed more than once. Standardized care protocols for AVM and moyamoya were developed from discussions among physicians from 7 different specialties [Figure]. Participants cited PNVC’s greatest utility as facilitation of a collaborative approach to patient care. Conclusion: A multidisciplinary conference among a diverse group of providers guides complex care decisions, helps standardize care protocols, promotes faculty collaboration, and supports continuity of care in pediatric neurovascular disease.
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Messe, Steven R., Michael T. Mullen, Marguerrite Cox, Gregg Fonarow, Eric E. Smith, Jeffrey L. Saver, Mathew J. Reeves, Deepak L. Bhatt, Roland Matsouaka, and Lee H. Schwamm. "Abstract WMP92: Quality of Care and Outcomes for Acute Ischemic Stroke Patients Admitted During the International Stroke Conference." Stroke 48, suppl_1 (February 2017). http://dx.doi.org/10.1161/str.48.suppl_1.wmp92.
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Introduction: Patients who present to the hospital during off-hours receive sub-optimal care and experience worse outcomes, often attributed to reduced staffing. It is unknown whether stroke patients receive less guideline-adherent care and experience worse outcomes when medical providers attend scientific meetings. The AHA International Stroke Conference (ISC) is the premier US conference for cerebrovascular disease and is well attended by stroke clinicians. Methods: The national Get With The Guidelines - Stroke (GWTG-Stroke) dataset was analyzed from 2009-2015 to identify acute ischemic stroke (AIS) patients admitted during: 1) the week of ISC, and 2) the 2 weeks before and 2 weeks after ISC. We compared adherence to GWTG-Stroke quality measures and outcomes for AIS patients admitted during these two time periods using univariable and multivariable analysis, including both patient and hospital level variables. Results: Overall, 69,738 AIS patients were included, mean age 72, 52% female, and 29% non-white. There was no difference between the average weekly number of AIS cases admitted during ISC weeks versus non-ISC weeks (1,984 vs 1,997, p= 0.95). Patient and hospital characteristics were also similar between ISC vs. non-ISC time periods. No significant differences were noted in 14 quality of care metrics and 5 clinical outcomes between AIS patients treated during ISC vs. non-ISC weeks (Table). After adjusting for potential confounders, among patients who presented within 2 hours of onset there was no difference in the likelihood of receiving IV tPA within 3 hours (adjusted odds ratio 0.89, 95% confidence interval [CI] 0.77 - 1.03, p=0.13), nor in the likelihood of receiving IV tPA within 60 minutes of arrival (adjusted odds ratio 0.92, 95% CI 0.83 - 1.02, p=0.13). Conclusions: The treatment and outcome of patients who present with AIS to a GWTG-Stroke participating hospital are not degraded during the week of the International Stroke Conference.
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Piña, Ileana L., Larry A. Allen, and Nihar R. Desai. "Managing the economic challenges in the treatment of heart failure." BMC Cardiovascular Disorders 21, no. 1 (December 2021). http://dx.doi.org/10.1186/s12872-021-02408-5.
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Abstract Background Treatment of heart failure is complex and inherently challenging. Patients traverse multiple practice settings as inpatients and outpatients, often resulting in fragmented care. The Center for Medicare and Medicaid Services is implementing payment programs that reward delivery of high-quality, cost-effective care, and one of the newer programs, the Bundled Payment for Care Improvement Advanced program, attempts to improve the coordination of care across practices for a hospitalization episode and post-acute care. The quality and cost of care contribute to its value, but value may be defined in different ways by different entities. Conclusions The rapidly changing world of digital health may contribute to or detract from the quality and cost of care. Health systems, payers, and patients are all grappling with these issues, which were reviewed at a symposium at the Heart Failure Society of America conference in Philadelphia, Pennsylvania on September 14, 2019. This article constitutes the proceedings from that symposium.
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Kidd, Vasco Deon, Sarah Vanderlinden, and Roderick S. Hooker. "A National Survey of postgraduate physician assistant fellowship and residency programs." BMC Medical Education 21, no. 1 (April 14, 2021). http://dx.doi.org/10.1186/s12909-021-02613-y.
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Abstract Introduction The development of postgraduate programs for physician assistants (PAs) began in 1973 and by 2020 there were approximately 72 programs spread across a broad range of medical and surgical disciplines. PA Post-graduate education programs are voluntary and available to American licensed PAs. Therefore, an assessment of the characteristics of PA post-graduate fellowships and residencies programs was initiated. Method A non-experimental, descriptive research study was designed to obtain information on the characteristics of PA postgraduate education programs in the US. The source of information was from surveyed members of the Association of Postgraduate Physician Assistant Programs (APPAP). Questions were drawn from consensus discussions. Directors of postgraduate programs that were operational in 2020 were eligible to participate. Results Seventy-two postgraduate program directors were invited to the survey and 34 program directors replied. These programs are geographically distributed across the US in 13 states. The respondents represent a wide range of medicine: surgery, emergency medicine, critical care, orthopaedics, hospitalist, psychiatry, oncology, primary care, pediatrics, and cardiology. Most programs are associated with an academic medical center and some institutions have more than one postgraduate specialty track. The curriculum includes bedside teaching, lectures, mentorship, assigned reading, procedures, simulation, and conferences. An average program length is 12 months and awards a certificate. Stipends for PA fellows are $50,000–80,000 (2020 dollars) and benefits include paid time off, health and liability insurance. About half of the programs bill for the services rendered by the PA. Over 90% of graduates are employed within 2 months of completing a PA postgraduate training program. Conclusion A trend is underway in American medicine to include PAs in postgraduate education. PA postgraduate training occurs across a broad spectrum of medical and surgical areas, as well as diverse institutions and organizations overseeing these programs. Most PA postgraduate programs are in teaching hospitals where the PA resident or PA fellow also serves as a house officer alongside a categorical resident. This study sets the stage for more granular economic and social research on this growing phenomenon in American medicine.
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Maruichi-Kawakami, Shiori, Kazuya Nagao, Takenori Kanazawa, and Tsukasa Inada. "Infective endocarditis in pregnancy requiring simultaneous emergent caesarean section and mitral valve replacement: a case report." European Heart Journal - Case Reports 5, no. 12 (December 1, 2021). http://dx.doi.org/10.1093/ehjcr/ytab461.
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Abstract Background Although infective endocarditis (IE) in pregnancy is rare, maternal and foetal mortality rates are very high. We herein report the successful treatment of a case of IE with simultaneous emergent caesarean section and mitral valve replacement performed at 27 weeks of gestation. Case summary A 29-year-old woman at 27 weeks of gestation was referred for congestive heart failure (HF) due to infective endocarditis (IE) with large mobile vegetations and overt disruption of the mitral valve. We held a multi-disciplinary conference and decided to perform mitral valve replacement immediately after caesarean section because of the high risk of embolism and sepsis, worsening and unstable haemodynamics, and sufficient foetal maturity for delivery. Although coronary artery embolization and asymptomatic multiple cerebral infarctions were observed, her post-operative course was uneventful. Ultimately, the patient was discharged 29 days after surgery. The neonate was treated in the NICU until the expected delivery date and was discharged home on Day 95 of life. Discussion Difficulties are associated with the selection of an operative plan and its timing for IE during pregnancy. Heart failure due to IE requires urgent surgery when medical treatment cannot stabilize the patient. However, cardiopulmonary bypass and medicine for pregnant women adversely affect the foetus. Therefore, the timing of surgery and delivery needs to be selected by a multi-disciplinary team and in consideration of the maternal condition and foetal maturity.
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"Venous Congestion Due To Large Arteriovenous Anastomoses." Cardiology: Open Access 1, no. 1 (December 30, 2016). http://dx.doi.org/10.33140/coa/01/01/00001.
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Aims: Mortality from cardiovascular disease (CVD) is very high. Medicine is considered that most of heart diseases have unknown etiology and mechanism. Made is an attempt to analyze the mechanism of the CVD. Why does theoretical cardiology have such a low success rate during more than 100 years? What is the true reason, for example, venous plethora, hemorrhoids, prostatitis, endometriosis and some others? How to prevent hypertension? Methods: Search in the literature, participation in medical conferences in Russia (2012-2016), Australia, Brisbane, Arrhythmia-2016, correspondence with leading Russian cardiologists, publishing of my original articles. Results: My group succeeded in demonstrating the fact that the modern theoretical cardiology has significant errors. With the use of Cardiocode device our group managed to prove the presence of large arteriovenous anastomoses (AVA) in quite healthy individuals. Sudden opening of AVA lumen leads to a sharp decrease in arterial pressure. When closing the AVA, usually in a few seconds, arterial pressure increases again. It seems that such manipulations of AVA are provided by nature to protect the vessels of peak values of arterial pressure. It becomes clear that the long-term incorrect performance of AVA, especially in case of unhealthy lifestyle, usually leds to two big problems. The first problem is a periodic disorder in heart rhythm, sometimes with lethal outcome, caused by heart excitation by means of pulse mechanical waves which pass along the vessels’ contour and return to heart. The second problem: metabolism disorders caused by long-term increase in both system and local venous pressure. An attempt to substantiate the reasons of venous hyperemia and small pelvis organs diseases in humans is made herein. Conclusions: I think that taking into account a great experience accumulated by modern official medicine and a great number of clinical studies and using my theory it will be possible to make a breakthrough in cardiovascular disease treatment including venous hyperemia.
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Rymer, Marilyn, Craig Shipley, Lee Rosterman, Yunxia Wang, Michael Abraham, Tony Nunn, Colleen Lechtenberg, and Janice Sandt. "Abstract TP403: Kansas Initiative for Stroke Survival: a Statewide Program to Improve Stroke Outcomes." Stroke 47, suppl_1 (February 2016). http://dx.doi.org/10.1161/str.47.suppl_1.tp403.
Full textAbstract:
Comprehensive Stroke Centers (CSCs) provide leadership to the surrounding communities they serve. Until state certification is mandated through legislative action, CSCs may be the best actors to create and improve stroke systems of care. Our CSC is in a state with 83 out of 126 Critical Access Hospitals. We launched the Kansas Initiative for Stroke Survival (KISS) in 2012, offering training and resources on quality measures and protocols necessary to recognize and treat stroke. Hospitals were invited to do an assessment of what they needed to do to become “stroke ready” and sign an attestation that acute therapy could be administered with telephonic assistance from a tertiary center and a transfer plan in place. In the first two years, over sixty hospitals participated, but those enrolled in KISS as emergent stroke ready did not show sustained improvement in stroke care. Door to needle time increased 25% in the last year. In response, our CSC created an independent executive board, representing professionals from nursing, emergency medical services, management, and medicine, to lead a broader statewide approach to education and accountability. Our new goals are to develop a statewide capability map, distribute a quarterly newsletter highlighting efforts across the state, and develop a website with links to presentations, protocols, and statewide data. We have already redesigned the data survey to enhance reporting and analysis, community-level boot camps have been implemented, and a statewide peer review has begun. Our CSC leads the quarterly peer review along with education that covers topics impacting outcomes, such as time from door to thrombolytic therapy and endovascular case selection; the first conference had 27 participants across the state. Our experience demonstrates that CSCs can lead statewide improvements in stroke care and that hospitals around the state are receptive to that leadership. Collaboration between hospitals can improve stroke outcomes.