Key Points
Thrombus aspiration in acute coronary syndrome PCI decreased angiographic stenosis and decreased IVUS‐assessed volume of lesions. Decrease in culprit lesion volume correlated with better ...stent expansion.
This non‐randomized single‐center study demonstrated feasibility of thrombus aspiration pre‐PCI in ACS patients, but did not prove superiority to other methods of lesion preparation such as balloon pre‐dilatation. It is unlikely to be adopted into routine practice based on this study.
Randomized studies large enough to compare clinical outcomes (e.g., stroke and death) would be necessary to prove the efficacy of thrombus aspiration in ACS patients.
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2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention Levine, Glenn N., MD, FACC, FAHA; Bates, Eric R., MD, FACC, FAHA; Blankenship, James C., MD, FACC, FSCAI ...
Journal of the American College of Cardiology,
12/2011, Volume:
58, Issue:
24
Journal Article
Peer reviewed
Open access
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To identify a cause for clinical deterioration, examine resuscitation efforts, and identify and correct system issues (thus improving outcomes) via a multidisciplinary code-review process soon after ...cardiopulmonary arrest.
Retrospective analysis of code events in a tertiary pediatric heart center from September 2010 to December 2013 and review of surgical-cardiac data from January 2010 to December 2013.
A multidisciplinary team reviewed 47 code events, 16 of which (34%) were deemed potentially preventable. At least 2 issues were identified during 66% (31/47) of cardiopulmonary arrests reviewed. Key issues identified were related to communication (62%), environment/culture/policy (47%), patient care (including resuscitation, 41%), and equipment (38%). About 60% of reviewed arrests resulted in educational initiatives (eg, mock code, in-service education) and 47% resulted in a new policy or modification of existing policy. Less common were changes in equipment (32%) or modification of staffing needs (11%). Changes most frequently occurred in the unit specific to the event (68%) but some changes occurred throughout the Heart Center (32%) or across the hospital system (13%). Survival to discharge after cardiopulmonary arrest has improved over time (P = .03) to 81% for cardiac surgical patients in our center.
A multidisciplinary code-review committee can identify deficiencies and lead to educational initiatives and improvements in care. When coupled with a hospital-wide "code blue" review process, these changes may benefit the institution as a whole.
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Large clinical studies have demonstrated an unequivocal clinical benefit of antithrombotic therapy with inhibitors of the platelet surface-membrane glycoprotein (GP) IIb-IIIa receptor in a broad ...range of patients with ischemic heart disease. Potent antiplatelet effects of these agents, however, may increase the risk of bleeding complications, as occurred in the first large evaluation of this therapy, the Evaluation of c7E3 for Prevention of Ischemic Complications (EPIC) trial with abciximab (c7E3 Fab; ReoPro
®; Centocor, Malvern, Pa). Although the incidence of bleeding events in subsequent studies has been reduced through the use of a low-dose, weight-adjusted heparin regimen and early removal of vascular sheaths in patients who have undergone percutaneous coronary interventions, hemorrhage continues to be the most common complication of GP IIb-IIIa inhibitor therapy. This review summarizes current experience related to bleeding complications with various GP IIb-IIIa inhibitors and suggests strategies for improved management of bleeding in patients receiving these agents. (Am Heart J 1999;138:S287-S296)
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Key Points
Costs of percutaneous coronary intervention including the index procedure and care in the subsequent 30 days are increased by half for patients who are readmitted, and increased up to ...two‐fold for those who have major adverse events during the initial admission.
Many factors “predicting” adverse events and readmission are not modifiable. However, some are modifiable. Interventionalists should focus on those.
In addition to using strategies to avoid adverse events, interventionalists should lead teams to implement strategies to prevent readmission. This will require a new nonprocedural focus for interventionalists.
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69.
LOSING THEIR "MOJO"? Blankenship, Justin C.
Journalism practice,
11/2016, Volume:
10, Issue:
8
Journal Article
Peer reviewed
Mobile journalism, whereby a single reporter must write, shoot, and edit their own news stories, is a rapidly growing trend among local television news organizations in the United States and around ...the world. Using qualitative case study methodology, specifically in-depth interviews and observation, this study compares "mobile journalists" with journalists working within a traditional television news crew, in which a reporter concentrates on the writing and interviewing aspects of newsgathering and a videographer concentrates on the audio/video production. The research looked at four aspects of "professionalization" found in the sociology of professions literature; expert knowledge, professional autonomy, routinization, and encroachment from outside organizations. Findings suggest that the mobile journalists in this study have less specialized expert knowledge. Also, though the mobile journalists felt that working outside a crew gave them greater autonomy, their increased use of work routines suggests they have given up some control to organizational needs. Additionally, there is evidence that these mobile journalists have allowed some encroachment by other professionals, specifically public relations professionals, in order to accomplish their work tasks within specified deadlines with limited time and resources.
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