1,720,966 research outputs found
The Current Concept and Role of Intensive Cardiovascular Care Units
Full text linkSince its first establishment in the early 1960s, intensive care for the critically ill cardiac patients had transformed substantially. From a unit designed only to monitor cardiac rhythm and administer electrical therapy to patients with myocardial infarction (MI), the Intensive Cardiovascular Care Units (ICVCU) now provide care for a wide array of patients with cardiovascular conditions needing close observation and hemodynamic support. This shift in role is accompanied with the development of cardiac critical care as an emerging subspecialty of cardiovascular medicine. Cardiac intensivists should have proper training in general cardiology, combined with additional competency in critical care, including mechanical ventilation, renal replacement therapy, mechanical circulatory support and general preventive measures for infections. A high-intensity medical staffing in a closed care system had shown to improve mortality in critically ill cardiac patients in the contemporary ICVCUs. As interventional cardiology, structural heart disease, electrophysiology, advanced heart failure and transplantation continue to offer new treatment options for complex high-risk patients, cardiac critical care is of utmost importance to provide collaborative care among these disciplines.Â
Critical Management of Haemodynamically Unstable Acute Pulmonary Embolism in COVID-19
Full text linkThrombotic events occur in up to one-third of patients with COVID-19, predominantly manifesting as pulmonary emboli (PE), which are associated with higher morbidity and mortality. Acute PE should therefore be one of the main differential diagnoses of COVID-19 patients who develop hemodynamic instability. Early systemic thrombolysis remains the first line of treatment for hemodynamically unstable PE in those infected with COVID-19, particularly considering the risks of infection to other personnel during catheter-directed thrombolysis procedures. This report aims to describe a typical case of hemodynamically unstable acute PE with COVID-19 management in our center. A 66-year-old male presented to ER with shortness of breath and desaturation was suspected of having COVID-19. Despite unremarkable physical examination, he was later confirmed to be COVID-19 positive. While in the isolation ward, he experienced a cardiac arrest. 12-lead ECG showed sign of right ventricular strain and subsequently bedside echocardiography showed a fresh thrombus in the right atria with signs of acute right ventricular dysfunction. The diagnosis of acute PE with hemodynamic instability was made, and systemic thrombolysis was immediately initiated. Despite the bleeding complication, his symptoms and hemodynamic improved and he was discharged safely with oral anticoagulant. Our case demonstrates how early recognition and prompt treatment of acute PE especially in COVID-19 patients with hemodynamic instability, can be life saving. Recognizing the subtle signs of acute PE during emergency improves patients outcome considerably
Hemodynamic impairment of double culprit ST-elevation myocardial infarction, double the trouble: a case report
Full text linkBackground: Multiple culprit artery involvement is rare (2.5%) among ST-segment elevation myocardial infarction (STEMI) patients undergoing primary coronary intervention (PCI). It can occur due to multiple factors and reflects a widespread pathophysiologic process. Most patients present with unstable hemodynamics and cardiogenic shock (CS), which results in a high mortality rate. Currently, there are no guidelines or consensuses on the management of multiple culprit arteries in STEMI patients.
Case Illustration: A 51-year-old man with chest pain in the past 16 hours was referred to the National Cardiovascular Center Harapan Kita. ECG at presentation revealed sinus rhythm with ST elevation in the inferior, posterior, and right leads. He was diagnosed with late-onset infero-posterior STEMI + right ventricle infarction, Killip IV, and thrombolysis in myocardial infarction 6/14, then was prepared for early PCI due to ongoing chest pain and CS. The patient underwent complete revascularization with drug-eluting stents and thrombus aspiration due to the high thrombus burden of the lesion in the right coronary artery and first obtuse marginal artery. After early PCI, his hemodynamic condition improved, and epigastric pain was his only complaint. However, on the following day, the patient experienced acute pulmonary edema and rhythm conversion to total AV block. He was managed conservatively with heparinization, inotropes, vasopressors, diuretics, and noninvasive ventilation. After 14 days of hospitalization, the patient was discharged without any complaints.
Conclusion: Double culprit STEMI is rare and associated with catastrophic hemodynamic impairment, including CS, at presentation. Individualized treatment with early and aggressive revascularization yields relatively good results
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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