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Metabolic Cardiology
Published in Stephen T. Sinatra, Mark C. Houston, Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
Pharmaceutical drugs, bypass surgery, angioplasty, stent placements, pacemakers and implantable defibrillators all have their place, and many lives would be lost without these high-tech interventions. Cardiologists face a daily dilemma concerning the best diagnostic procedures to recommend to their patients, and then, based on those test results, which surgical and/or pharmaceutical interventions to select. To complicate the choice, the evaluations we order and the treatments we select may create unnecessary risks for patients – risks that are out of proportion to the benefits they will experience. For example, we recommend angioplasty and stent procedures for too many patients who are asymptomatic. Continuing technological advances, although necessary, add to the complexity of the decision-making process.
Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Today, cardiologists carry out many invasive procedures in the investigation, assessment and treatment of patients with cardiac disease. These include catheterization of the coronary arteries, angiography, percutaneous transluminal coronary angioplasty (PTCA) and insertion of stents into the coronary arteries, which has been covered in Chapter 2. There has also been a dramatic increase in transvascular insertion of valves to replace diseased valves. There has also been a revolution in the application of percutaneous methods to insert occluders for defects in congenital heart disease, balloon dilatation of narrowed vessels and also the replacement or repair of valves. In addition, the use of ablation and surgery for cardiac arrhythmias has also transformed clinical practice.
Unfair trade (1) – exporting health workers
Published in Nigel Crisp, Turning the World Upside Down Again, 2022
There has been a continuing trend towards ever greater specialisation in the USA in particular but also in many other rich countries. This specialisation combined with greater regulation has led to peaks and troughs in the demand and supply of highly trained health workers. We have seen, for example, specialists in these countries becoming redundant as the demand for their skills shifts. A particular example in recent years has been in cardiac surgery, where many more patients who might previously have required surgery are being treated medically by cardiologists.
“Self-management has to be the way of the future”: Exploring the perspectives of speech-language pathologists who work with people with aphasia
Published in International Journal of Speech-Language Pathology, 2023
Leana Nichol, Amy D. Rodriguez, Rachelle Pitt, Sarah J. Wallace, Annie J. Hill
SLPs identified several differences pertaining to aphasia versus other chronic conditions. For instance, some participants perceived that there appears to be an overt expectation that people with other chronic conditions will engage in SM: “if you’ve got any other disorder – if you’ve got a chronic arthritis, they expect you to self-manage” (Danielle). This may explain the availability of SM resources for several chronic conditions whereas these are lacking for aphasia. SLPs expressed that the ongoing reviews and services perceived to exist for other chronic conditions aren’t typically available for aphasia: “That’s where SM for aphasia is really challenging, as opposed to chronic conditions like COPD where they’ll have a regular medical review every 3-6 months and that can be an ongoing service for as long as that’s needed” (Helen). Ella discussed the regular follow up that occurs for other conditions: “if you had a chronic cardiac condition, you’d have a cardiologist that you’d see every 6 months or annually and do constant problem solving and planning”. Many SLPs surmised that a big part of the issue was lack of awareness and knowledge about aphasia and communication disorders in general: “Because communication, as a disability, isn’t even really recognised, we’re miles behind. We really are. Not being facetious” (Danielle).
‘Routine intravascular ultrasound evaluation and change in stenting strategy in primary percutaneous intervention (RIST PCI)’
Published in Acta Cardiologica, 2023
Sajan Narayanan, Stigi Joseph, Anwar Chennakkadan Varghese, Rajesh Govindan Nair, Abish Sudhakar
Patients with a diagnosis of ST elevation myocardial Infarction (STEMI) undergoing primary percutaneous intervention under intravascular ultrasound guidance were included in this study. All three cardiologists had completed performance and assessment of atleast 3000 angiograms and are active primary PCI operators. Cardiologist (cardiologist 3) performing IVUS guided intervention was asked to record angiographic images and IVUS parameters. After the procedure, cardiologists (cardiologists 1 & 2) who were not part of initial management plan, were invited to assess the angiographic images and asked to formulate a procedural plan which included choice of stent diameter, length, and number of stents (1 versus multiple) based on angiographic images alone. The management plan formulated was compared with actual diameter, length & number of stents implanted (by cardiologist 3) according to IVUS guidance (Figure 1). Patients presenting with cardiogenic shock, hemodynamic stability and those patients in whom either pre- or post-IVUS images could not be recorded were excluded. Informed consent was obtained from patients and study protocol was approved by the institutional ethics committee.
A systematic review of disease prevalence, health-related quality of life, and economic outcomes associated with Friedreich’s Ataxia
Published in Current Medical Research and Opinion, 2022
Katharina Buesch, Rongrong Zhang
Two studies that reported HCRU and related costs were eligible for inclusion into the systematic review. Regions represented included the US and Canada55, and the UK and Germany56. Both studies were published in 2013 and reported HCRU and costs, which were obtained via self-report from patients, caregivers, and/or physicians55,56. The mean age of patients across all regions was similar, although other demographic and disease characteristics were not consistently reported. Among all four regions, there was a high frequency of visits to both cardiologists and neurologists, with the majority of patients reporting to have seen either a cardiologist, neurologist, or both. Physiotherapists were also frequently seen in the UK (47% of patients) and Germany (82%) and accounted for the highest number of encounters within all four regions (mean 6.0 − 28.07 encounters per patient). Analyses from the US and Canada indicated that costs were higher for those with more severe disease, although this relationship was not assessed for the UK and Germany.