Hospital Chronicles (E-Journal)
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Counseling Patients with Implanted Cardiac Devices: the Nurse???s Role
Get PDFPatients with implanted cardiac devices constitute a growing segment of the contemporaryhealthcare practice. Taking care of such a rapidly growing patient population constitutes a challenge for all health care providers working in a cardiology ward, operating room or primary care practice. Nurses among them have a unique role by being the most appropriate persons to provide in-hospital and long term health care, education and psychological support to these patients.In-hospital and long-term care will ensure an uneventful procedure and a safe discharge as well as early detection of device malfunction and late complications. Education of the patient will prevent any self or environmental interactions which can adversely affect proper device function and will increase his or her adherence to the follow-up treatment. Finally, by providing psychosocial and emotional support the nursing staff can address the immediate concerns of the patient and help him or her cope successfully with the new life situation. Continuing education is extremely important for nurses counselling patients with implanted devices in order to play successfully their role as the continuous link to the multidisciplinary team of professionals that guide the oftentimes forgotten humanistic care of these patients
Torsade de Pointes related to the co-administration of amiodarone and digoxin
Get PDFA case of acquired long QT syndrome and subsequent torsade de pointes related to the co-administration of amiodarone and digoxin is described in the present case report. The underlying electrophysiologic mechanism of this proarrhythmic event is discussed
Percutaneous Aortic Valve Replacement: Current Status and Future Perspective
Get PDFSurgical valve replacement is the definitive therapy for patients with critical aortic stenosis (AS). However, the risk of surgery may be higher in elderly patients with significant comorbidities. Six years after the first in man, percutaneous aortic valve implantation (PAVI) for the treatment of AS currently represents a dynamic field of research and development. Two devices have a CE marked and are under clinical investigation for PAVI, the Edwards-Sapien valve mounted within a balloon-expandable stent and the self-expanding CoreValve. Since the first in-man PAVI by Alain Cribier in 2002, well over 1000 high-risk patients with severe symptomatic AS have been treated using PAVI (as of January 2008). The currently available results suggest that the technique is feasible and provides hemodynamic and clinical improvement for up to two years in patients with critical AS at high risk or with contraindications for surgery. Pending questions concern mainly safety and long-term durability
A Randomised Comparison of Darbepoetin alfa with Epoetin for Chemotherapy Induced Anaemia in Nonhaematological Tumours
Get PDFBACKGROUND: Although once weekly (QW) Darbepoetin is nowadays used by many for chemotherapy induced anaemia, a head to head comparison with thrice weekly (TIW) Epoetin regimen has not been published so far. PATIENTS AND METHODS: We randomly compared weekly (QW) darbepoetin alfa with thrice weekly (TIW) Epoetin in 50 cancer patients with chemotherapy induced anaemia (Hb ???11gr%). In Group A, Epoetin was administered at 10.000 U TIW (20.000 U in non-responders after 4 weeks). In Group B, Darbepoetin alfa was administered at 150mcg QW (300 mcg as above). Evaluation, including QOL assessment using FACT-An scale, was performed on week 4 and 8. RESULTS: In group A, Hb increased from 9.81?±1.02 at baseline to 10.59?±1.38 at 4 weeks (p=0.007) and to 11,4?±1,99 at 8 weeks (p=0.001). It also increased between week 4 and 8 (p=0.011). In group B, Hb increased from 10,2?±0,87 at baseline to 10,8?±1,93 at 4 weeks (p=0.075) and to 11.57?±2.26 at 8 weeks (p=0.005) without significant increase between week 4 and 8 (p=0.08). In all 50 patients, Hb increased from 10.01?±0.97 at baseline to 10.75?±1.69 at 4 weeks (p=0.003) and to 11.49?±2.11 at 8 weeks (p=0.000). It also increased from 10.84?±1.74 to 11.49?±2.11 (p=0.003) between week 4 and 8. Twelve of 25 patients (48%) in group A had to double the Epoetin dose versus 13 (52%) in group B (P=NS). Three patients in group A required transfusions compared with 4 in group B (p=NS). On an intent-to-treat analysis: RR, at 4 weeks, was 44% for Epoetin versus 44% for Darbepoetin (p=NS). At 8 weeks, it was 48% and 60%, respectively (p=NS). QOL analysis unexpectedly showed that fatigue and emotional scores were worse in Group B than in Group A. Whether this, not easily explainable observation, is just an incidental finding remains to be shown in larger series. CONCLUSIONS: QW Darbepoetin is a convenient therapy and it induced haemoglobin changes of similar magnitude to TIW Epoetin
European Lung Cancer Working Party Clinical Practice Guidelines Non-small Cell Lung Cancer: II. Unresectable Non-metastatic Stages
Get PDFThe present guidelines on the management of unresectable non-metastatic non-small cell lung cancer (NSCLC) were formulated by the ELCWP in October 2005. They are designed to answer the following eight questions: 1) Is chest irradiation curative for NSCLC? 2) What are the contra-indications (anatomical or functional) to chest irradiation? 3) Does the addition of chemotherapy add an advantage to radiotherapy? 4) Does the addition of radiotherapy add an advantage to chemotherapy? 5) Is irradiation as effective as surgery for marginally resectable stage III? 6) How to best combine chemotherapy with radiotherapy: sequentially, concomitantly, as consolidation, as induction, as radiosensitiser? 7) In case of too advanced locoregional disease, is there a role for consolidation (salvage) local treatment (surgery or radiotherapy) after induction chemotherapy? 8) In 2005, what are the technical characteristics of an adequate radiotherapy
Wegener's Granulomatosis: a Comprehensive Review
Get PDFWegener's Granulomatosis (WG) is a systemic multi-organ disease that is specifically characterised by inflammation of small and medium - sized vessels that could lead to tissue damage. Most commonly affected systems are the upper respiratory tract, the pulmonary, renal and ocular systems. Even though no diagnostic criteria have been established, the Chapel Hill Consensus definitions and the American College of Rheumatology classification criteria are widely used in clinical practice to identify WG. Definite diagnosis is confirmed by biopsy of the affected organ. This article reviews the epidemiology, pathophysiology, clinical manifestations, laboratory markers, diagnosis and disease assessment and, finally, the conventional and therapeutic options in WG
European Lung Cancer Working Party Clinical Practice Guidelines. Non-Small Cell Lung Cancer: III. Metastatic disease
Get PDFThe present guidelines on the management of advanced non-small cell lung cancer (NS CLC) were formulated by the ELCWP in October 2006. They are designed to answer the following twelve questions: 1) What benefits can be expected from chemotherapy and what are the treatment objectives? 2) What are the active chemotherapeutic drugs for which efficacy has been shown? 3) Which are the most effective platinum-based regimens? 4) Which is the indicated dosage of cisplatin? 5) Can carboplatin be substituted for cisplatin? 6) Which is the optimal number of cycles to be administered? 7) Can non-platinum based regimens be substituted for platinum based chemotherapy as first-line treatment? 8) Is there an indication for sequential chemotherapy? 9) What is the efficacy of salvage chemotherapy and which drugs should be used in that indication? 10) What is the place of targeted therapies? 11) What is the place of chemotherapy in the management of a patient with brain metastases? 12) Which specific drugs can be used for the patient with bone metastases
Catheter ablation of atrial fibrillation in patients with left ventricular dysfunction
Get PDFThere is a complex interplay between atrial fibrillation and congestive heart failure. These two clinical entities often coexist, resulting in significant morbidity, affecting prognosis and rendering their management even more challenging. New nonpharmacologic therapies are emerging and may alter the management of these patients. Among them, catheter ablation of atrial fibrillation seems to be a promising therapeutic approach as it leads to improvement of cardiac function, symptoms, exercise capacity, and quality of life. This article reviews the role of catheter ablation in contemporary management of atrial fibrillation among patients with left ventricular dysfunction
Surgery after chemotherapy for initially unresectable stage iii non-small cell lung cancer
Get PDFBACKGROUND Stage II non-small cell lung cancer represents a heterogeneous group of diseases for which multimodal therapy is today recommended including surgery, radiotherapy and chemotherapy. PATIENTS AND METHODS The purpose of the study was to retrospectively identify factors predictive of secondary complete resection, in a series of patients with initially unresectacle, non metastatic Non Small Cell Lung Cancer (NS CLC) who were treated with pre-operative chemotherapy. Patients were randomised between 3 courses of MIP (mitomycin C 6mg/m2; ifosfamide 3g/m2; cisplatin 50mg/m2) or SuperMIP (mitomycin C 6mg/m2; ifosfamide 4.5g/m2; cisplatin 60mg/m2, carboplatine 200mg/ m2). If, after 3 courses of chemotherapy, the tumour became resectable, surgery was performed followed by mediastinal irradiation. RESULTS There were 351 ellgible patient: 176 in the MIP arm, 175 in the SuperMIP arm; 43% and 51% with stages II A and II B, respectively. After chemotherapy, surgery was performed in 54 (15%, 95% CI: 12%-20%) patients. Complete resection (R0) was obtained in 40 patients. Two independent predicting factors of complete resection were identified: N status (OR : 0.06 in disfavour of N3; 95% CI: 0.007-0.410; p=0.005) and objective response to chemotherapy (OR : 3.90 in favour of objective response; 95% CI: 1.90-7.98;
Risk Assessment in Adult Cancer Patients with Febrile Neutropenia: A Review of Methods and of Risk-adapted Empiric Treatments
Get PDFFebrile neutropenia is a common complication of antineoplasic chemotherapy. It is a potentially serious event, sometimes lethal. However, it is well recognized that the population of patients with febrile neutropenia is heterogeneous in terms of prognosis. Simplified therapy, for instance oral antibiotic empiric treatment or ambulatory treatment, in comparison to the classical management of intravenously administered empiric antibiotics and in-hospital surveillance, has been the purpose of research for patients predicted at low-risk for serious complications development. However, for such a strategy to be successful an accurate identification of patients at low-risk is required. The objective of the present review is to present the available tools for risk assessment, in adult patients populations and to review the status of our knowledge regarding the efficacy and the safety of risk-adapted therapy