Abstract We report the challenges of the Working to Improve Discussions About Defibrillator Management trial, our novel, multicenter trial aimed at improving communication between cardiology ...clinicians and their patients with advanced heart failure (HF) who have implantable cardioverter defibrillators (ICDs). The study objectives are (1) to increase ICD deactivation conversations, (2) to increase the number of ICDs deactivated, and (3) to improve psychological outcomes in bereaved caregivers. The unit of randomization is the hospital, the intervention is aimed at HF clinicians, and the patient and caregiver are the units of analysis. Three hospitals were randomized to usual care and three to intervention. The intervention consists of an interactive educational session, clinician reminders, and individualized feedback. We enroll patients with advanced HF and their caregivers, and then we regularly survey them to evaluate whether the intervention has improved communication between them and their HF providers. We encountered three implementation barriers. First, there were institutional review board concerns at two sites because of the palliative nature of the study. Second, we had difficulty in creating entry criteria that accurately identified an HF population at high risk of dying. Third, we had to adapt our entry criteria to the changing landscape of ventricular assist devices and cardiac transplant eligibility. Here we present our novel solutions to the difficulties we encountered. Our work has the ability to enhance conduct of future studies focusing on improving care for patients with advanced illness.
By listening to the "voice" of patients, Northwell Health, New York's largest healthcare organization, took an evidence-based approach to empowering physicians and advanced care providers. The ...Relationship Centered Communication course utilizes experiential learning to strengthen patient-centered communication and empathy skills to elicit provider-patient relationships grounded in partnership. This case study highlights (1) The pragmatic cultural journey requiring visionary leadership, strong collaborations, and an evolving educational strategy. (2) Over the course of 6 years, 3300+ providers were educated in this evidence-based communication course. (3) As a result, Northwell's Hospital Consumer Assessment of Healthcare Providers and Systems "Communication with Doctors" domain has increased by 22 percentile rank points, when compared nationally to peers, in addition to other notable patient experience metric improvements within ambulatory medical practice.
We describe preemptive placement of a TandemHeart percutaneous left ventricular assist device (CardiacAssist Inc, Pittsburgh, PA) through the axillary artery and vein for temporary postoperative ...support in a patient with severe left ventricular dysfunction undergoing high-risk cardiac reoperation. We believe this approach is preferable to high-dose catecholamines because of preserved early tissue perfusion without excessive vasoconstriction. Axillo-axillary placement is advantageous because patients can sit up and partially mobilize, and there is no need to reopen the chest for explantation.
Cardiac Gene Therapy Chaanine, Antoine H., MD; Kalman, Jill, MD; Hajjar, Roger J., MD
Seminars in thoracic and cardiovascular surgery,
2010, Letnik:
22, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Heart failure is a chronic progressive disorder in which frequent and recurrent hospitalizations are associated with high mortality and morbidity. The incidence and the prevalence of this disease ...will increase with the increase in the number of the aging population of the United States. Understanding the molecular pathology and pathophysiology of this disease will uncover novel targets and therapies that can restore the function or attenuate the damage of malfunctioning cardiomyocytes by gene therapy that becomes an interesting and a promising field for the treatment of heart failure as well as other diseases in the future. Of equal importance are developing vectors and delivery methods that can efficiently transduce most of the cardiomyocytes that can offer a long-term expression and that can escape the host immune response. Recombinant adeno-associated virus vectors have the potential to become a promising novel therapeutic vehicles for molecular medicine in the future.
PDF
