101,920 research outputs found
Medical training and mini-Delphi approach to implement heart failure treatment with mineralocorticoid receptor antagonists
No full textBackground. Mineralocorticoid receptor antagonists (MRAs) are a class of drugs still underused in heart failure with reduced ejection fraction. Hyperkalemia, worsening of renal function and gynecomastia are the main causes of the MRA missed prescription but also an inadequate knowledge of this class of drugs may represent a reason for their underuse. The aim of this project was to evaluate the possible usefulness of a unique and innovative web-based platform in order to identify the main issues related to the underuse of MRAs and to discuss shared strategies of interventions to overcome the obstacles to MRA prescription. Methods. The “HF Clinical Practice project” enrolled 55 hospital cardiologists. It was based on the development and production of the eCaseTrack platform which was capable of activating a content-sharing system between professionals and specialists, using a mixed-methods study consisting of a survey, shared clinical experiences, training and consensus mini-Delphi method. Results. The results of the survey showed that the respondents substantially agreed about the criteria for MRA prescription (NYHA class, left ventricular ejection fraction, glomerular filtration rate and serum potassium). This agreement was confirmed by mini-Delphi, by which the use of MRAs in patients with hypotension, hyperkalemia and gynecomastia emerged as the most controversial issue. Conclusions. A web-based system of sharing clinical experiences and discussing controversial issues, is useful to implement the introduction of a proven efficacious therapeutic strategy which is still underused in current clinical practice
Trade unions and labour market dualisation : a comparison of policies and attitudes towards agency and migrant workers in Germany and Belgium
No full textThe article compares the role of tripartism during and after democratic transitions in Spain and Poland. In both countries it emerged after a negotiated transition from dictatorship, but it was poorly institutionalised. While it fell short of ‘neocorporatist’ levels of governance, it had a ‘foundational’ function in stabilising both political and economic transitions, and despite its limitations, it endured for decades in the frequent, if unregular, practice of negotiating ‘social pacts’. The comparison reveals some striking similarities despite the contrasting economic systems of origin, and identifies some structural constants in the evolution of post-democratic tripartism, up to the recent crisis
Effetti del propafenone nella sindrome di Wolff-Parkinson-White. Valutazione mediante test elettrofarmacologico transesofageo.
No full textFlexibility and security within European labor markets: the role of local bargaining and the different ‘trade-offs’ within multinationals' subsidiaries in Belgium, Britain and Germany
No full text© The Author(s) 2016. In this comparative qualitative study, the authors examine how local bargaining shapes the trade-off between labor flexibility and employment security policies in four multinational subsidiaries in Belgium, Britain, and Germany. They also consider whether and how union power to shape flexibility and security policies is affected by national institutions, the way that multinationals organize their subsidiaries, and local contextual factors. Findings support this multilevel, interdependent framework. Trade-offs are shaped by differences in workers' structural power in specific local subsidiaries. Differences in inter-subsidiary organizational configurations, markets, and technologies modify how unions can leverage collective resources to wield power in their relationship with management.sponsorship: VALERIA PULIGNANO is a Professor at the Katholieke Universiteit Leuven. NADJA DOERFLINGER is affiliated with Katholieke Universiteit Leuven. FABIO DE FRANCESCHI is affiliated with Katholieke Universiteit Leuven. This research received a grant from the Onderzoektoelage OT/10/015 and the Federale Wetenschappelijk Onderzoek G.0773.11 ("Multinationals in Europe between flexibility and security"). We thank Paul Marginson for his very useful comments on a previous version of this paper. We are very much grateful to the editor and the three reviewers for their insightful comments. We thank also the participants at the ILERA symposium "Collective bargaining and the flexibility-security agenda," Amsterdam, June 20-22, 2013, for their stimulating feedback. Additional results and copies of computer programs used to generate the results presented in this article are available from the lead author at [email protected]. (Onderzoektoelage|OT/10/015, Federale Wetenschappelijk Onderzoek|G.0773.11)status: Publishe
The evolving care of the elderly with heart failure: from the 'high-tech' to the 'high-touch' approach.
No full textSafety and diagnostic accuracy of intravenous accelerated high-dose dipyridamole-atropine stress echocardiography
No full textBackground. In the present study, the safety and diagnostic accuracy of a modified protocol with accelerated high-dose dipyridamole-atropine stress echocardiography, utilized in an attempt to significantly shorten the test imaging time with respect to the standard protocol, were evaluated. Methods. Three hundred and thirty-seven patients (231 men, 106 women, mean age 63 ± 9 years) with known or suspected coronary artery disease underwent 404 tests. The ECG and blood pressure were continuously monitored during constant infusion of 0.21 mg/kg/min of dipyridamole over 4 min; atropine (0.50 mg at 5 and 6 min) was given in order to reach ≥ 85% of the age-predicted heart rate. The wall motion score index and the 16-segment model were used to evaluate contractility. Eighty-nine patients underwent selective coronary angiography. Coronary artery stenosis was considered significant if the vessel diameter was < 50 % of the normal value. Results. Eighty-eight out of 404 tests were positive: 72 for echocardiographic criteria, 11 for ECG criteria, 2 for clinical symptoms, and 3 for combined criteria. Three hundred and sixteen tests were negative. In 303 tests atropine was administered and 380 tests were performed in pharmacological wash-out. The maximal heart rate was 105.8 ± 9 b/min and the maximal blood pressure was 128 ± 19/78 ± 9 mmHg. No major side effects nor life-threatening complications were observed. In 24 tests (5.9%) only minor side effects occurred and in no case did these effects cause premature suspension of the test. The sensitivity, specificity and diagnostic accuracy of angiographically assessed coronary artery disease were 56, 86 and 73% respectively. Conclusions. Accelerated high-dose dipyridamole echocardiography is practical, feasible and safe and allows for a significant reduction in the imaging time, with an increased cost-effectiveness and tolerance of the patients. In our experience the diagnostic accuracy of this new protocol was quite good and similar to that of the standard test
Heart failure in women treated with adjuvant trastuzumab fro breast cancer.
No full textThe amplification of the HER receptor system is present in approximately 20\% of breast cancers and confers a marked malignancy and a poor prognosis. Trastuzumab, a monoclonal antibody directed against the HER2 receptor, has dramatically improved the prognosis of patients with HER2+ metastatic and early breast cancer. However, the use of trastuzumab is associated with the possible development of myocardial dysfunction and heart failure. Trastuzumab-induced cardiac injury may be reversible, and a substantial proportion of patients can complete therapy. For this reason, careful monitoring of cardiac function, an aggressive treatment of hypertension and possibly the use of non-anthracycline-containing chemotherapy protocols are required during trastuzumab treatment. Owing to the selection of patients enrolled in major randomized trials, the safety profile of trastuzumab is currently unclear in elderly women, in patients at high cardiovascular risk and in those with structural heart disease on optimal treatment. Further studies are therefore needed to determine whether this highly effective therapy in breast cancer survival can be extended to such categories of patients
Bibliographie Hilarion G. Petzold 1958 – 2009 mit Anhang als Einführung
No full textDieses Archiv enthält die Gesamtbibliographie der Werke des Autors nebst einiger Texte „Über H. G. Petzold“ im Schlussteil der Bibliographie sowie einen Anhang mit einer Einführung in die Architektur des Werkes in seinem wissenslogischen Aufbau als Ausarbeitung seines „Tree of Science Modells“ (2007).This archive contains the complete bibliography of the author and some texts about H. G. Petzold, moreover an epilogue with an introduction to the architecture of the works in its epistemological structure and composition and as an elaborations of Petzold’s „Tree of Science Modell (2007).https://www.fpi-publikation.de/polyloge/01-2009-petzold-h-g-gesamtbibliographie-h-g-petzold-1958-2009-updating-november2009/peerReviewedpublishedVersio
Dispelling the Myths Behind First-author Citation Counts
No full textWe 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
Role of clinical evaluation and functional testing in the tailored follow-up of chronic heart failure patients
No full textClinical assessment is crucial to monitor chronic heart failure (HF) patients. It allows to tailor follow-up based on clinical severity, symptoms, quality of life and life expectancy. Risk scores, a useful tool for synthetic assessment of patients and intercenter standardization, should be easy to calculate and consider both cardiac conditions and comorbidities. In the elderly, clinical assessment should include indexes of disability and frailty, mandatory to tailor follow-up appropriately. Clinical data should be complemented by objective measures of functional capacity using exercise testing. Exercise tolerance, a comprehensive index of body function, is a pivotal prognostic predictor. The 6-min walking test is simple, well accepted by patients, and provides an objective documentation of exercise tolerance in subjects who cannot perform a maximal stress test. However, there is no evidence to support its role for risk stratification. While the cardiopulmonary exercise test has a definite role in the selection of heart transplant candidates, it also provides important information for risk stratification of the general HF population, the main prognostic predictors being maximal oxygen consumption, periodic breathing, and an enhanced ventilatory response to exercise
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