120 research outputs found
DETECTING ACUTE STRESS DISORDERS IN PATIENTS WITH CORONARY ARTERY DISEASE: A PROGNOSTIC EVALUATION OF THE PHQ-9 IN ACUTE CORONARY CARE: FINDINGS FROM THE ISACS-TC STUDY
No full textUsefulness of coronary flow reserve measured by transthoracic coronary Doppler ultrasound in the elderly
No full textNoninvasive measurement of coronary flow reserve (CFR), defined as the ratio of maximal to baseline coronary blood flow, has been repeatedly shown to be a feasible technique by ultrasound transthoracic Doppler (TTD) both in the LAD and, with some limitations, in the posterior descending (PD) coronary artery. CFR by TTD offers two important pieces of information: information
about patency and flow through the large epicardial coronary artery proximal to the site of CFR assessment and information distal to the site of CFR assessment. CFR by TTD is a valuable research tool for investigating the pathophysiology of coronary circulation. However, CFR by TTD is also an important clinical decision-making instrument, enabling functional assessment of epicardial coronary stenosis, particularly in cases of anatomically borderline stenosis, i.e., 50%–70% of cases. CFR by TTD enables insight downstream into coronary microvascular function that might be impaired due to primary coronary microvascular disease, as a consequence of myocardial diseases with extramural compression and microvascular remodeling and rarefaction (in left ventricular hypertrophy, dilated or hypertrophic cardiomyopathy, or aortic stenosis), or as a consequence of microvascular obstruction due to micro-embolization by plaque and thrombus debris during percutaneous coronary interventions. As a technique that is noninvasive, inexpensive, easily repeatable, and that does not require radiation, TTD CFR may be very useful in the fragile population of the elderly, offering a better understanding of coronary vascular aging as well as clinically important information regarding the diagnosis and prognosis of coronary artery disease
Early Percutaneous Coronary Intervention: Risks and Outcomes in Patients With Cancer
No full textBackground: Patients with malignancies may have high pro-thrombotic status as well as a high risk of hemorrhagic events either due to the tumor or its treatment.For this reason, these patients have always been excluded from randomized clinical trials on percutaneous coronary intervention (PCI).
Aim: To investigate the safety of PCI in patients with malignancies admitted for an AMI.
Methods and Results: Retrospective analysis on an international European ACS registry. Primary endpoint: 30-day mortality. Secondary endpoint: periprocedural complications. There were 273 patients (35% women) with AMI and malignancies. Colon (19%), prostate (14%), breast (13%), lung (8%) and blood (8%) malignancies were the most frequent type of cancer. Women and men had similar age (68 ±11.5 vs 69.1 ±11.5, p=ns). STEMI was in 56% of patients (with no significant gender difference: 51% men vs 65% women, p=0.09). PCI was performed in 64% of patients (with primary PCI in 75% of STEMI). The rate of complications during cardiac catheterization and intervention was 6.5% (2.1% distal embolization, 2.1% no-reflow, 0.7% acute closure, 0.7% dissection, 0.7% perforation, none major bleeding). Nobody among patients that had cardiac catheterization and intervention complications died during hospital stay. In-hospital mortality was 5.9%. The group of patients treated with PCI had a significantly lower rate of death then that of those treated non invasively (1.7% vs 13.1%, p<0.00001). Factors associated with lower probability to receive cardiac catheterization were older age (OR 0.94, 95% CI 0.92-0.97) and absence of typical chest pain at admission (OR: 0.38; 95%CI:0.18-0.81), but the type of malignancy and gender were not. On multivariable model, age (OR 1.1, 95%CI 1.03-1.17) and PCI (OR 0.16 95%CI, 0.04-0.59) were independently associated with the risk of death for ACS (increased and decreased risk, respectively).
Conclusion: These preliminary data from the real world support the safety use of PCI in patients with malignancies and ACS, which have always been excluded from randomized clinical trial
IMPROVING STUDENTS’ LISTENING ABILITY USING SPOT THE DICTOGLOSS TECHNIQUE (A Classroom Action Research at Eighth Year Students of SMPN III Ngargoyoso in the Academic Year of 2010/2011)
No full textEquality hypocrisy, inconsistency, and prejudice: The unequal application of the universal human right to equality
No full textIn addition, the author note should have included a license statement, which is provided in this correction.] In Western culture, there appears to be widespread endorsement of Article 1 of the Universal Declaration of Human Rights (which stresses equality and freedom). But do people really apply their equality values equally, or are their principles and application systematically discrepant, resulting in equality hypocrisy? The present study, conducted with a representative national sample of adults in the United Kingdom (N = 2,895), provides the first societal test of whether people apply their value of “equality for all” similarly across multiple types of status minority (women, disabled people, people aged over 70, Blacks, Muslims, and gay people). Drawing on theories of intergroup relations and stereotyping we examined, relation to each of these groups, respondents’ judgments of how important it is to satisfy their particular wishes, whether there should be greater or reduced equality of employment opportunities, and feelings of social distance. The data revealed a clear gap between general equality values and responses to these specific measures. Respondents prioritized equality more for “paternalized” groups (targets of benevolent prejudice: women, disabled, over 70) than others (Black people, Muslims, and homosexual people), demonstrating significant inconsistency. Respondents who valued equality more, or who expressed higher internal or external motivation to control prejudice, showed greater consistency in applying equality. However, even respondents who valued equality highly showed significant divergence in their responses to paternalized versus nonpaternalized groups, revealing a degree of hypocrisy. Implications for strategies to promote equality and challenge prejudice are discussed
Realizing Learner Autonomy in a Foreign Language Class
No full textThis paper introduces an example of a university language programme developed around the idea that autonomy is an inherent component of true learning. After a brief introduction to the learning context, real-classroom example of how learner autonomy can be fostered over the course of an academic year is presented. Samples of worksheets used for strategy training and the examples of students’ work at the planning, information integration and reflection stages are shared. The paper also discusses some of the challenges that the teacher and the learners faced in their efforts to transform a university language class into an opportunity for true self-actualization and personal growth
Primary percutaneous coronary intervention in octogenarians
No full textLBACKGROUND: Limited data are available on the outcome of primary percutaneous coronary intervention (PCI) in octogenarian patients, as the elderly are under-represented in randomized trials. This study aims to provide insights on clinical characteristics, management and outcome of the elderly and very elderly presenting with STEMI.
METHODS: 2225 STEMI patients ≥70years old (mean age 76.8±5.1years and 53.8% men) were admitted into the network of the ISACS-TC registry. Of these patients, 72.8% were ≥70 to 79years old (elderly) and 27.2% were ≥80years old (very-elderly). The primary end-point was 30-day mortality.
RESULTS: Thirty-day mortality rates were 13.4% in the elderly and 23.9% in the very-elderly. Primary PCI decreased the unadjusted risk of death both in the elderly (OR: 0.32, 95% CI: 0.24-0.43) and very-elderly patients (OR: 0.45, 95% CI 0.30-0.68), without significant difference between groups. In the very-elderly hypertension and Killip class ≥2 were the only independent factors associated with mortality; whereas in the elderly female gender, prior stroke, chronic kidney disease and Killip class ≥2 were all factors independently associated with mortality. Factors associated with the lack of use of reperfusion were female gender and atypical chest pain in the very-elderly and in the elderly; in the elderly, however, there were some more factors, namely: history of diabetes, current smoking, prior stroke, Killip class ≥2 and history chronic kidney disease.
CONCLUSIONS: Age is relevant in the prognosis of STEMI, but its importance should not be considered secondary to other major clinical factors. Primary PCI appears to have beneficial effects in the octogenarian STEMI patients
THE IMPACT OF THE CEFR ON FOREIGN LANGUAGE EDUCATION IN JAPAN
No full textOver the last decade, the Japanese Ministry of Education has undertaken multiple reforms aimed at improving foreign language education and ensuring young Japanese people are ready to respond to the challenges of globalization. Many of the new guidelines have been modelled on the Common European Framework of Reference for Languages (CEFR). The present paper examines the impact that the CEFR has had on the national curricula, teaching practices, and assessment in Japan. After a brief review of the origin and goals of the CEFR, it discusses the development of the CEFR-J project, the introduction of ‘Can-Do’ descriptors in national curricula, and the development of CEFR-based teaching materials and tests. Positive changes as well as challenges are examined, following which recommendations are made for improving current policies. Special attention is given to developing the language competencies of Japanese teachers of English
Time From First Medical Contact to Aspirin in ST Elevation Myocardial Infarction: An International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) Study
No full textBACKGROUND: A significant number of patients who suffer from STEMI do not reach a hospital within the recommended timeframe in the South Eastern European countries. Unequal dispersion of PCI-capable facilities throughout this area results in transport distances that can exceed 100 miles, while response times vary greatly dependent upon volunteer ambulance services.
METHODS: The aim of the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC /NCT01218776 ) registry was to assess whether initial antiplatelet/ anticoagulant treatment at the point of prehospital first medical contact impacts in-hospital outcomes. To assess the value of this strategy were compared: prehospital versus in-hospital first medical contact; those arriving at the hospital by ambulance versus those whose initial hospital care was an ambulatory/community center.
RESULTS: Of the 2295 patients enrolled in the study, 392 received fibrinolysis, 753 primary PCI, 86 facilitated PCI, and 1064 standard medical therapy having overcome the golden hours for reperfusion therapy. Compared with the in-hospital group, patients who underwent facilitated PCI (7%, n=34) experienced 9.6 % reduction in cardiovascular mortality (odd ratio [OR] 0.096 coefficient interval [C.I] 0.012-0.69 P=0.004). Arrival by an ambulatory/community center incurred a substantial delay from first medical contact to reperfusion (fibrinolysis 76 min [63 min to 105 min] and PCI 35 min [224 min to 612 min]) compared with arrival by ambulance (fibrinolysis 47 min [32 min to 68 min] and PCI 108 min [85 min to 150 min]).
CONCLUSIONS: These findings support prehospital antiplatelet/ anticoagulant treatment followed by reperfusion therapy in patients presenting early with STEMI, who do not have access to hospital care within the recommended time-frame of 60 minutes from first medical contact. Those activating the prehospital medical response system without receiving prehospital ambulance assignment experienced the longest delay from first medical contact to reperfusion, indicating a lost opportunity to enhance ST elevation myocardial infarction patient outcomes
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