14 research outputs found
Percutaneous Ureteric Stricture Dilation (PCUSD)
No full textUreteric stricture dilation as an interventional uroradiological technique was initiated locally in March 1991. In ureteric dilation two approaches are feasible. The retrograde cystoscopic route is undertaken by a uroradiology team in theatre, and the renal antegrade percutaneous route is undertaken in the radiology interventional suite. This study reviewed the results of percutaneous ureteric stricture dilation undertaken over the last five years. Eighteen dilations in 16 patients (10 males : 6 females) were analysed. There was an overall success rate of 61 %. We found the procedure to be safe and effective with minimal complications. No mortality resulted from the procedure. The indications for its use are fully discussed.peer-reviewe
Management and outcome of patients withestablished coronary artery disease: the Euro Heart Survey on coronaryrevascularization.
No full textAIMS:
The purpose of the Euro Heart Survey Programme of the European Society of Cardiology is to evaluate to which extent clinical practice endorses existing guidelines as well as to identify differences in population profiles, patient management, and outcome across Europe. The current survey focuses on the invasive diagnosis and treatment of patients with established coronary artery disease (CAD).
METHODS AND RESULTS:
Between November 2001 and March 2002, 7769 consecutive patients undergoing invasive evaluation at 130 hospitals (31 countries) were screened for the presence of one or more coronary stenosis >50% in diameter. Patient demographics and comorbidity, clinical presentation, invasive parameters, treatment options, and procedural techniques were prospectively entered in an electronic database (550 variables+29 per diseased coronary segment). Major adverse cardiac events (MACE) were evaluated at 30 days and 1 year. Out of 5619 patients with angiographically proven coronary stenosis (72% of screened population), 53% presented with stable angina while ST elevation myocardial infarction (STEMI) was the indication for coronary angiography in 16% and non-ST segment elevation myocardial infarction or unstable angina in 30%. Only medical therapy was continued in 21%, whereas mechanical revascularization was performed in the remainder [percutaneous coronary intervention (PCI) in 58% and coronary artery bypass grafting (CABG) in 21%]. Patients referred for PCI were younger, were more active, had a lower risk profile, and had less comorbid conditions. CABG was performed mostly in patients with left main lesions (21%), two- (25%), or three-vessel disease (67%) with 4.1 diseased segments, on average. Single-vessel PCI was performed in 82% of patients with either single- (45%), two- (33%), or three-vessel disease (21%). Stents were used in 75% of attempted lesions, with a large variation between sites. Direct PCI for STEMI was performed in 410 cases, representing 7% of the entire workload in the participating catheterization laboratories. Time delay was within 90 min in 76% of direct PCI cases. In keeping with the recommendations of practice guidelines, the survey identified under-use of adjunctive medication (GP IIb/IIIa receptor blockers, statins, and angiotensin-converting enzyme-inhibitors). Mortality rates at 30 days and 1 year were low in all subgroups. MACE primarily consisted of repeat PCI (12%).
CONCLUSION:
The current Euro Heart Survey on coronary revascularization was performed in the era of bare metal stenting and provides a global European picture of the invasive approach to patients with CAD. These data will serve as a benchmark for the future evaluation of the impact of drug-eluting stents on the practice of interventional cardiology and bypass surgery
Cardiovascular risk estimation by professionally active cardiovascular nurses : results from Basel 2005 Nurses Cohort
No full textEuropean Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts)
No full textLinee guida per la pratica clinic
A review of health utilities using the EQ-5D in studies of cardiovascular disease
No full textBackground
The EQ-5D has been extensively used to assess patient utility in trials of new treatments within the cardiovascular field. The aims of this study were to review evidence of the validity and reliability of the EQ-5D, and to summarise utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cardiovascular disease.
Methods
A structured literature search was conducted using keywords related to cardiovascular disease and EQ-5D. Original research studies of patients with cardiovascular disease that reported EQ-5D results and its measurement properties were included.
Results
Of 147 identified papers, 66 met the selection criteria, with 10 studies reporting evidence on validity or reliability and 60 reporting EQ-5D responses (VAS or self-classification). Mean EQ-5D index-based scores ranged from 0.24 (SD 0.39) to 0.90 (SD 0.16), while VAS scores ranged from 37 (SD 21) to 89 (no SD reported). Stratification of EQ-5D index scores by disease severity revealed that scores decreased from a mean of 0.78 (SD 0.18) to 0.51 (SD 0.21) for mild to severe disease in heart failure patients and from 0.80 (SD 0.05) to 0.45 (SD 0.22) for mild to severe disease in angina patients.
Conclusions
The published evidence generally supports the validity and reliability of the EQ-5D as an outcome measure within the cardiovascular area. This review provides utility estimates across a range of cardiovascular subgroups and treatments that may be useful for future modelling of utilities and QALYs in economic evaluations within the cardiovascular area.The authors are grateful for the funding support of the EuroQol Group (PI: Buxton)
Alpha-Linolenic Acid Intake and 10-Year Incidence of Coronary Heart Disease and Stroke in 20,000 Middle-Aged Men and Women in The Netherlands
No full textBackground - Whether intake of alpha-linolenic acid (ALA), the plant-derived n-3 polyunsaturated fatty acid (PUFA), could prevent cardiovascular diseases is not yet clear. We examined the associations of ALA intake with 10-year incidence of coronary heart disease (CHD) and stroke in the Netherlands. Methods - Data were collected from a general population of 20,069 generally healthy men and women, aged 20 to 65 years. Habitual diet was assessed at baseline (1993–1997) with a validated 178-item food frequency questionnaire. Incidences of CHD and stroke were assessed through linkage with mortality and morbidity registers. Hazard ratios (HR) were calculated with multivariable Cox proportional hazards models, adjusted for age, gender, lifestyle, and dietary factors. Results - During 8–13 years of follow-up, we observed 280 incident CHD events (19% fatal) and 221 strokes (4% fatal). Intakes of energy-adjusted ALA in quintiles ranged from less than 1.0 g/d in the bottom quintile (Q1) to more than 1.9 g/d in the top quintile (Q5). ALA intake was not associated with incident CHD, with HRs varying between 0.89 and 1.01 (all p>0.05) in Q2–Q5 compared with the bottom quintile of ALA intake. For incident stroke, however, participants in Q2–Q5 had a 35–50% lower risk compared with the reference group. HRs were 0.65 (0.43–0.97), 0.49 (0.31–0.76), 0.53 (0.34–0.83), and 0.65 (0.41–1.04) for Q2–Q5 respectively. Conclusion - In this general Dutch population, ALA intake was not associated with incident CHD. The data suggested that a low intake of ALA may be a risk factor for incident stroke. These results warrant confirmation in other population-based studies and in trial
The potato murrain on the European continent and the revolutions of 1848
No full textThe tale of the Irish Famine, 1845¿1849, following the outbreak of potato late blight, has been told repeatedly, but the parallel story of the Continental Famine, 1845¿1847, has not yet been recorded. The Continental Famine was caused by poor harvests of potatoes, due to the same late blight, but also of grain, due to frost, drought, rust, voles, inopportune rains, floods and hailstorms. The Continental Famine was enhanced by hoarding, speculation, and poor governance. Hunger was followed by infectious diseases. The demographic effects of hunger and diseases are difficult to disentangle. The number of excess deaths due to the Continental Famine cannot yet be determined with any precision, but clearly it approaches that of the Irish Famine. The harvest failures of 1845 and 1846 and the resulting famines came on top of rural pauperisation and urban discontent, and thus contributed to the revolutions of 1848 on the European Continent. The statement `an epidemic of potato late blight caused an epidemic of revolutions¿ is, perhaps, exaggerated but it contains a grain of truth
European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts).
No full textpeer reviewe
Vaccination status of children in Switzerland
No full textDespite being recognized as one of the most effective public health measures, vaccination has
become increasingly controversial as more parents and doctors question the effectiveness and
purpose of this preventive measure, with heightened emphasis on adverse events [Abrahamson
and Pickering, 2002; Campion, 2002]. The goals of our study were to determine immunization
coverage and examine factors influencing vaccination behaviors in 3 different age groups in each
canton by collecting vaccination cards and questionnaires between 1999 and 2003. National
coverage estimates for 3 doses of diphtheria (Di or D), tetanus (Te or T), pertussis (Per or P),
poliomyelitis (Pol) and Haemophilus influenzae type B (Hib) and combined dose of measles (M),
mumps (M), and rubella (R), or simply MMR, were: over 91% for Di, Te, Per, Pol and Hib and
around 81% for MMR for toddlers; they were more than 92%, for 4 doses of Di, Te and Pol,
60.9% and 26.6% for 4 doses of Per and Hib, respectively, and 87% for one dose of MMR for
children at school entry. For children at school departure, coverage estimates at 5 doses of Di, Te
and Pol was over 81% and around 50% for 2 doses of MMR (approximately 93% for 1 dose).
Hepatitis B coverage ranged between 2.3% and 88.3% with the mean at 1 dose being 46.3%, for
2 doses at 40.8%, and 3 doses at 25.9%. Due to methodological difficulties, comparison of
coverage for schoolchildren among the cantons should be done with caution. Comparison of
coverage for toddlers for MMR at one dose and Di, Te, and Pol at 3 doses with those from 1991
and 1998 revealed that coverage has remained relatively unchanged. However, for Per and Hib at
3 and 4 doses and 4 doses of Di, Te, and Pol, coverage levels have increased, with the uptake of
Hib being most apparent, climbing from 77% in 1998 to 91% in our survey at 3 doses and from
47% to 79% at 4 doses.
Vaccination coverage is significantly better in cantons where French or Italian is the predominant
language spoken as compared to their German counterparts, particularly for MMR. Cantons
supplementing their school health services with cantonally employed school nurses or
“Lungenliga” nurses have improved vaccination coverage as compared to those working only
with school doctors. Parental use of alternative medicine is found most often to be strongly
associated with low vaccination coverage, cutting across cantonal differences and types of
vaccines while being more influential by parents of younger kids. Nationality follows suit, with
Swiss children having lower MMR and higher Di and Pol coverage levels than those of foreign
background. Approximately 90% of all those who completed a questionnaire indicated that they
have information concerning vaccination. Of these, 67% are satisfied with what they have, while
17% are not happy, 7% remained undecided and 8% refrained from answering. Future
vaccination campaigns should address the latter 3 groups to effectively increase immunization
coverage.
Finally, doctors are one of the most important resources for parents for obtaining information
regarding vaccination; however, parents prefer that doctors actively share this information, rather
than having to request for it from the doctors themselves. Parents of schoolchildren increasingly
rely on school physicians for this information as their children get older. Health insurance should
also share more information with parents while information distributed by the media is less
desired. Parental attitudes towards vaccination and perception of the dangers of the childhood
preventable diseases and vaccine safety and efficacy are significantly associated with coverage.
Our results show that the most significant predictors of a child being UTD with the recommended
vaccination plan is if parents agree that they follow the doctor’s recommendation, believe in the
effectiveness of vaccination, and think that as many children as possible should be vaccinated for
the benefit of the community. In contrast, toddlers whose parents thought there was too much
social pressure to vaccinate their children and have concerns about possible side effects from
vaccines are less likely to be vaccinated as compared to those who disagree.
In summary, children in Switzerland are sub-optimally vaccinated. Immunization coverage is
affected by demographic and political factors, attitudes towards vaccination and perceptions of
the dangers of the disease, as well as information available to the parents and healthcare
providers. Future vaccination campaigns must address these factors, while providing clear and
transparent resources to the parents and healthcare professionals
The development of recommendations for the implementation of nutrition therapy for coloured women with a type 2 diabetes attending CHC's in the Cape Metropole
No full text
