Given the attendant risks of mortality and morbidity, acute MI remains a principal focus of cardiovascular therapeutics. ...30-day mortality and rehospitalization rates for acute MI are publicly ...reported in an effort to promote optimal acute MI care, and aspects of MI care delivery are the focus of local, regional, and national quality initiatives (1-3). Updates or revisions to the American College of Cardiology (ACC)/American Heart Association (AHA) practice guidelines for PCI, ST-segment elevation myocardial infarction (STEMI), and unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI) have been published within the last 3 years, building upon prior versions published earlier in the decade (5-7).
Author Relationships With Industry and Other Entities (Relevant)--2012 ACCF/SCAI Expert Consensus Document on Cardiac Catheterization Laboratory Standards Update... .2304 Preamble This document has ...been developed as an expert consensus document by the American College of Cardiology Foundation (ACCF) and the Society for Cardiovascular Angiography and Interventions (SCAI), in collaboration with the Society of Thoracic Surgeons (STS) and Society for Vascular Medicine (SVM). Topics chosen for coverage by this ECD are so designed because the evidence base, the experience with technology, and/or clinical practice are not considered sufficiently well developed to be evaluated by the formal ACCF/American Heart Association (AHA) Practice Guidelines process. Often the topic is the subject of considerable ongoing investigation. ...the reader should view the ECD as the best attempt of the ACCF and document cosponsors to inform and guide clinical practice in areas where rigorous evidence may not yet be available or evidence to date is not widely applied to clinical practice.\n O'Gara Content Reviewer--ACCF STEMI Guideline None None None Lantheus Medical Imaging None None Steven R. Ramee Content Reviewer Neurointerventions* None Access Closure* Boston Scientific* Abbott Boston Scientific Edwards Lifesciences Medtronic Hot Spur* None Charanjit Rihal Content Reviewer--ACCF Interventional Scientific Council Paieon None None Edwards Lifesciences None None John F. Robb Official Reviewer--ACC Board of Governors None None None None None None John P. Reilly Content Reviewer--SCAI Quality Improvement Committee None Cordis Lilly/Daiichi Sankyo* Johnson & Johnson* Medtronic* None None None James Tcheng Content Reviewer--ACC-NCDR Board None None None NIH* None None Robert Vincent Content Reviewer--ACCF Adult Congenital and Pediatric Cardiology Council None None None AGA None None Grayson Wheatley Content Reviewer--ACCF Surgical Council Boston Scientific Cordis Medtronic Pathway Medical Spectranetics W.L. Gore* None None Bolton Medical Bolton Medical Plaintiff, aortic aneurysm, 2010 Christopher White Content Reviewer--ACCF Interventional Scientific Council None None None St. Jude None None Mathew Williams Organizational Reviewer--STS Abott Edwards Lifesciences Medtronic None None None None None Steven J. Yakubov Organizational Reviewer--SCAI None None None None None Defendant, adequacy and decision process of a PCI, 2010 Defendant, stress testing evaluation, 2010 * This table represents the relationships of reviewers with industry and other entities that were disclosed at the time of peer review and determined to be relevant to this document. A person is deemed to have a significant interest in a business if the interest represents ownership of >=5% of the voting stock or share of the business entity, or ownership of >=$10,000 of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person's gross income for the previous year. Â a) Â The relationship or interest relates to the same or similar subject matter, intellectual property or asset, topic, or issue addressed in the document; or b) The company/entity (with whom the relationship exists) makes a drug, drug class, or device addressed in the document, or makes a competing drug or device addressed in the document; or c) The person or a member of the person's household, has a reasonable potential for financial, professional or other personal gain or loss as a result of the issues/content addressed in the document.ACCF = American College of Cardiology Foundation; SVM = Society for Vascular Medicine; SCAI = Society for Cardiovascular Angiography and Intervention; CECD = Clinical Expert Consensus Documents; CCS = Clinical Competence and Training Statements; UA/NSTEMI = Unstable Angina/Non-ST-Elevation Myocardial Infarction; PCI = Percutaneous Coronary Intervention; NCDR = National Cardiovascular Data Registry; STS = Society of Thoracic Surgeons.
Often the topic is the subject of considerable ongoing investigation. ...the reader should view the ECD as the best attempt of the ACCF and document cosponsors to inform and guide clinical practice ...in areas where rigorous evidence may not yet be available or evidence to date is not widely applied to clinical practice. All participating organizations participated in peer review, resulting in 22 reviewers representing 170 comments.\n Anderson Content Reviewer--ACCF Unstable Angina Guideline BSCI/sanofi None None AstraZeneca (DSMB) Gilead Pharma (DSMB) Hamilton Health Sciences University (DSMB) Harvard (DSMB) NIH (DSMB) Toshiba Deseret Foundation, Intermountain Healthcare NIH Defendant, management of cardiopulmonary arrest post-op, 2010 Defendant, stroke after ablation for AF, 2010 James A. de Lemos Content Reviewer--ACCF Task Force on CECD Johnson & Johnson Tethys Bristol-Myers Squibb/sanofi-aventis partnership* None Bristol-Myers Squibb (DSMB) Roche Diagnostics* AstraZeneca* Daiichi Sankyo None Robert A. Guyton Content Reviewer--ACCF CABG Guideline None None None Edwards Lifesciences NIH None None Richard J. Kovacs Content Reviewer--ACCF Abbott Laboratories Biomedical Systems Cook* ECG Scanning and Medical Services* Eli Lilly* Endocyte Essentialis XenoPort None None None None None Frederick G. Kushner Content Reviewer--ACCF STEMI Guideline FDA None Bristol-Myers Squibb Merck Roche Holding* Daiichi Sankyo Hoffmann La Roche NIH Novartis FDA Science Board None David Lanfear Content Reviewer--ACCF Heart Failure and Transplant Committee Thoratec None None sanofi-aventis* Johnson & Johnson* HFSA None John F. Robb Content Reviewer--ACCF None None None None None None Sidney C. Smith, Jr. Relationships in this table are modest unless otherwise noted.AACC = American Association for Clinical Chemistry; ACCF = American College of Cardiology Foundation; ACCP = American College of Chest Physicians; ACP = American College of Physicians; AF = atrial fibrillation; AHA = American Heart Association; CABG = coronary artery bypass graft surgery; CECD = Clinical Expert Consensus Documents; DSMB = Data and Safety Monitoring Board; FDA = Food and Drug Administration; HFSA = Heart Failure Society of America; NIH = National Institutes of Health; PCI = percutaneous coronary intervention; SCAI = Society for Cardiovascular Angiography and Interventions; STEMI = ST-segment elevation myocardial infarction; UA = unstable angina.
Numerous examples of chemical contamination of food, water, or medication have led to steps by regulatory agencies to maintain the safety of this critical social infrastructure and supply chain. ...Identification of contaminant site is important. Environmental testing and biomonitoring can define the nature and extent of the event and are useful for providing objective information, but may be unavailable in time for clinical care. Clinical diagnosis should be based on toxidrome recognition and assessment of public health implications. There are several resources available to assist and these can be accessed through regional poison control centers or local/state public health departments.
Toxin-induced respiratory distress McKay, Jr, Charles A
Emergency medicine clinics of North America,
02/2014, Letnik:
32, Številka:
1
Journal Article
Recenzirano
This article describes the impact of various toxic substances on the airway and pulmonary system. Pulmonary anatomy and physiology provide the basis for understanding the response to toxin-induced ...injury. Simple asphyxiants displace oxygen from the inspired air. Respiratory irritants include water-soluble and water-insoluble compounds. Several inhaled agents produce direct airway injury, which may be mediated by caustic, thermal, and hydrocarbon exposures. Unique pulmonary toxins and toxicants are discussed, as well as inhaled toxin mixtures. Several inhaled toxins may also impair oxygen transport. The pulmonary system may also provide a mechanism for systemic toxin delivery on respiratory exposure.
Background Recent observational studies show that patients with multivessel coronary disease have a long-term survival advantage with coronary artery bypass grafting (CABG) compared with percutaneous ...coronary intervention (PCI). Important nonfatal outcomes may also affect optimal treatment recommendation. Methods CABG was compared with percutaneous catheter intervention by using a composite of death, myocardial infarction (MI), or stroke. Medicare patients undergoing revascularization for stable multivessel coronary disease from 2004 through 2008 were identified in national registries. Short-term clinical information from the registries was linked to Medicare data to obtain long-term follow-up out to 4 years from the time of the procedure. Propensity scoring with inverse probability weighting was used to adjust for baseline risk factors. Results There were 86,244 CABG and 103,549 PCI patients. The mean age was 74 years, with a median 2.67 years of follow-up. At 4 years, the propensity-adjusted adjusted cumulative incidence of MI was 3.2% in CABG compared with 6.6% in PCI (risk ratio, 0.49; 95% confidence interval, 0.45 to 0.53). At 4 years, the cumulative incidence of stroke was 4.5% in CABG compared with 3.1% in PCI patients (risk ratio, 1.43; 95% confidence interval, 1.31 to 1.54). This difference was primarily due to the higher 30-day stroke rate for CABG (1.55% vs 0.37%). For the composite of death, MI, or stroke, the 4-year adjusted cumulative incidence was 21.6% for CABG and 26.7% for PCI (risk ratio, 0.81; 95% confidence interval, 0.78 to 0.83). Conclusions The 4-year composite event rate of death, MI, and stroke favored CABG, whereas the risk of stroke alone favored PCI.
Abstract Public reporting of health care data continues to proliferate as consumers and other stakeholders seek information on the quality and outcomes of care. Medicare’s Hospital Compare website, ...the U.S. News & World Report hospital rankings, and several state-level programs are well known. Many rely heavily on administrative data as a surrogate to reflect clinical reality. Clinical data are traditionally more difficult and costly to collect, but more accurately reflect patients’ clinical status, thus enhancing the validity of quality metrics. We describe the public reporting effort being launched by the American College of Cardiology and partnering professional organizations using clinical data from the National Cardiovascular Data Registry (NCDR) programs. This hospital-level voluntary effort will initially report process of care measures from the percutaneous coronary intervention (CathPCI) and implantable cardioverter-defibrillator (ICD) registries of the NCDR. Over time, additional process, outcomes, and composite performance metrics will be reported.
An American College of Cardiology (ACC)/American Heart Association (AHA) task force on practice guidelines in 2001 published evidence-based recommendations for performing percutaneous coronary ...interventions (PCIs). These guidelines grouped the indications for PCI into 4 classes (I, IIa, IIb, and III) based on analyses of risks and benefits. In a previous study, we found that clinical success and in-hospital adverse events varied by indications class. However, no adjustment for risk was used in those comparisons. The ACC/National Cardiovascular Data Registry (ACC-NCDR) previously developed a risk-adjustment model for the adverse event of in-hospital PCI mortality. We investigated how the 14 individual risk factors in the ACC-NCDR PCI mortality model might differ across the 4 indications classes and whether estimated mortality for each class approximated the observed mortality for that class. We analyzed the ACC-NCDR PCI database for January 1, 2001 to December 31, 2004. We excluded procedures performed for treatment of acute ST-segment elevation myocardial infarction; all others were included, yielding 559,273 procedures for analysis. An algorithm derived from the 2001 guidelines was used to assign procedures to an indications class. Increasing frequencies of risk components were observed across classes I, IIa, IIb, and III. Expected mortalities for each class calculated by the risk-adjustment model were close to observed values (expected 0.52%, 0.59%, 1.72%, and 1.96%, respectively; observed 0.49%, 0.63%, 1.88%, and 1.60%, respectively). In conclusion, the ACC-NCDR risk-adjusted mortality model can be linked to the ACC/AHA PCI guidelines, and together these produce mortality risk estimates by indications classes that are close to actual observed values. With further refinement, these methods should be able to be used as powerful analytic tools for quality assurance and appropriateness purposes.
The calcium sensing receptor (CaSR) and fibroblast growth factor 23 (FGF-23) play central roles in the regulation of calcium and phosphorus metabolism, respectively. CaSR controls parathyroid hormone ...secretion and renal calcium reabsorption. Inactivating mutations of the CaSR result in conditions characterized by hypercalcemia and hypocalciuria, whereas activating lesions cause hypoparathyroidism and hypercalciuria. Calcimimetics are a group of agonists for the CaSR that have been shown to be powerful agents in the treatment of secondary hyperparathyroidism. FGF-23 acts on the kidney to inhibit the reabsorption of phosphate and the synthesis of 1,25(OH)(2)D. Disorders of increased FGF-23 function are associated with hypophosphatemia, inappropriately low 1,25(OH)(2)D levels, and either rickets or osteomalacia. Conversely, decreased FGF-23 activity results in hyperphosphatemia, increased 1,25(OH)(2)D levels, and abnormal soft-tissue calcification. In chronic kidney disease, increases in FGF-23 are being investigated as markers of disease progression.
PDF
