Gender difference in treatment and mortality of patients with ST-segment elevation myocardial infarction admitted to Victorian public hospitals: A retrospective database study.

BACKGROUND: Death from acute coronary syndrome (ACS) is avoidable with early reperfusion therapy, however, evidence suggests inequity in women's ACS treatment within a number of international healthcare systems, when compared to men's. Research indicates mortality rates are higher in some age groups of women when compared to men for the sub-group of ACS known as ST-segment elevation myocardial infarction (STEMI). OBJECTIVE: To determine whether patient sex was associated with patterns of reperfusion treatment variation or increased inhospital mortality in patients with STEMI. METHODS: We undertook retrospective analyses on a government database for patients admitted to Victorian public hospitals with STEMI. Patients were categorised into two age groups: 18-64 and 65-84 years (inclusive), to determine whether patient sex and these age groups influenced treatment from 2005 to 2008 and mortality from 2005 to 2010. RESULTS: Both younger and older women received less frequent angioplasty with stent and more often received no reperfusion treatment than men in corresponding younger and older age groups (p=0.006 and p<0.001, respectively). Overall, women in both age groups were more likely to die inhospital than men from equivalent age groups with STEMI (p<0.001, both groups). CONCLUSIONS: Proportionately, both younger and older women received less interventional reperfusion therapy for STEMI than their male cohorts, and died more often during admission than men. Further research needs to be undertaken to verify the findings and causes, and guide future research to ensure application of evidence to treatment in patients with STEMI.

Double stent-retriever technique in endovascular treatment of middle cerebral artery saddle embolus

Ischemic stroke is a major public health problem worldwide, considered as the third most costly health condition in developed countries, with urgent reperfusion remaining the paramount goal for its treatment. In line with the results of recent randomized control trials, the introduction of stent retrievers was a major advancement in the treatment of stroke; however, interventionalists sometimes encounter thrombi not-retrievable by applying conventional techniques. In this article, we present a case treated by an innovative double-stent retrieval in Y-configuration that may potentially help other clinicians in similar situations.

FOCUS : frailty management optimisation through EIPAHA commitments and utilisation of stakeholders’ input – an innovative European project in elderly care

The goal of FOCUS, which stands for Frailty Management Optimization through EIPAHA Commitments and Utilization of Stakeholders’ Input, is to reduce the burden of frailty in Europe. The partners are working on advancing knowledge of frailty detection, assessment, and management, including biological, clinical, cognitive and psychosocial markers, in order to change the paradigm of frailty care from acute intervention to prevention. FOCUS partners are working on ways to integrate the best available evidence from frailty-related screening tools, epidemiological and interventional studies into the care of frail people and their quality of life. Frail citizens in Italy, Poland and the UK and their caregivers are being called to express their views and their experiences with treatments and interventions aimed at improving quality of life. The FOCUS Consortium is developing pathways to leverage the knowledge available and to put it in the service of frail citizens. In order to reach out to the broadest audience possible, the FOCUS Platform for Knowledge Exchange and the platform for Scaling Up are being developed with the collaboration of stakeholders. The FOCUS project is a development of the work being done by the European Innovation Partnership on Active and Healthy Ageing (EIPAHA), which aims to increase the average healthy lifespan in Europe by 2020 while fostering sustainability of health/social care systems and innovation in Europe. The knowledge and tools developed by the FOCUS project, with input from stakeholders, will be deployed to all EIPAHA participants dealing with frail older citizens to support activities and optimize performance.

Lost in translation? The potential psychobiotic Lactobacillus rhamnosus (JB-1) fails to modulate stress or cognitive performance in healthy male subjects

Background: Preclinical studies have identified certain probiotics as psychobiotics a live microorganisms with a potential mental health benefit. Lactobacillus rhamnosus (JB-1) has been shown to reduce stress-related behaviour, corticosterone release and alter central expression of GABA receptors in an anxious mouse strain. However, it is unclear if this single putative psychobiotic strain has psychotropic activity in humans. Consequently, we aimed to examine if these promising preclinical findings could be translated to healthy human volunteers. Objectives: To determine the impact of L. rhamnosus on stress-related behaviours, physiology, inflammatory response, cognitive performance and brain activity patterns in healthy male participants. An 8 week, randomized, placebo-controlled, cross-over design was employed. Twenty-nine healthy male volunteers participated. Participants completed self-report stress measures, cognitive assessments and resting electroencephalography (EEG). Plasma IL10, IL1β, IL6, IL8 and TNFα levels and whole blood Toll-like 4 (TLR-4) agonist-induced cytokine release were determined by multiplex ELISA. Salivary cortisol was determined by ELISA and subjective stress measures were assessed before, during and after a socially evaluated cold pressor test (SECPT). Results: There was no overall effect of probiotic treatment on measures of mood, anxiety, stress or sleep quality and no significant effect of probiotic over placebo on subjective stress measures, or the HPA response to the SECPT. Visuospatial memory performance, attention switching, rapid visual information processing, emotion recognition and associated EEG measures did not show improvement over placebo. No significant anti-inflammatory effects were seen as assessed by basal and stimulated cytokine levels. Conclusions: L. rhamnosus was not superior to placebo in modifying stress-related measures, HPA response, inflammation or cognitive performance in healthy male participants. These findings highlight the challenges associated with moving promising preclinical studies, conducted in an anxious mouse strain, to healthy human participants. Future interventional studies investigating the effect of this psychobiotic in populations with stress-related disorders are required.

Cognição e Afeto

Atualmente, tem-se vindo a assistir a um aumento da população idosa relativamente á faixa etária dos jovens. Posto isto, surgiu uma maior necessidade de focar a atenção nas condições de vida dos idosos, quer a nível teórico, quer a nível empírico (Mauritti, 2004). O envelhecimento da população é um fenómeno universal, e além de fenómeno coletivo é também um fenómeno individualizado, que decorre desde o nascer e ao qual se juntam alterações fisiológicas, psicológicas e comportamentais (motivos). Neste contexto, o presente estudo teve como objetivo desenvolver, implementar e avaliar a eficácia de um programa de intervenção na cognição e no afeto em grupo. Este grupo foi constituído por cinco idosos do sexo feminino e institucionalizados. O software estatístico IBM SPSS (Statistical Package for the Social Sciencies) versão 20 permitiu analisar e comparar os resultados obtidos através do MMSE (Mini Mental State Examination); PANAS (Positive and Negative Affect Shedule); e a escala de função cognitiva do ESI-55 (Epilepsy Surgery Inventory) antes e após as 9 sessões de intervenção em grupo. Não se verificaram diferenças estatísticas significativas entre o pré e pós teste, havendo resultados tendencialmente significativos em alguns indicadores de afeto negativo, sugerindo uma melhoria ou estabilidade dos valores iniciais. Nos indicadores de afeto positivo verificou-se uma situação algo semelhante. A nível da memória, a estabilidade das queixas apoia a eficácia da intervenção. A nível de outras queixas cognitivas, também não se evidenciaram resultados estatisticamente significativos, mas houve uma tendência para a diminuição das queixas. Assim, considera-se que a continuação de sessões análogas às implementadas poderia ser benéfica (de modo estatisticamente significativo) para os participantes em termos afetivos e cognitivos.

Partner relationship in couples living with atrial fibrillation

The aim of this thesis was to describe and explore how the partner relationship of patient–partner dyads isaffected following cardiac disease and, in particular, atrial fibrillation (AF) in one of the spouses. The thesis is based on four individual studies with different designs: descriptive (I), explorative (II, IV), and cross-sectional (III). Applied methods comprised a systematic review (I) and qualitative (II, IV) and quantitative methods (III). Participants in the studies were couples in which one of the spouses was afflicted with AF. Coherent with a systemic perspective, the research focused on the dyad as the unit of analysis. To identify and describe the current research position and knowledge base, the data for the systematic review were analyzed using an integrative approach. To explore couples’ main concern, interview data (n=12 couples) in study II were analyzed using classical grounded theory. Associations between patients and partners (n=91 couples) where analyzed through the Actor–Partner Interdependence Model using structural equation modelling (III). To explore couples’ illness beliefs, interview data (n=9 couples) in study IV were analyzed using Gadamerian hermeneutics. Study I revealed five themes of how the partner relationship is affected following cardiac disease: overprotection, communication deficiency, sexual concerns, changes in domestic roles, and adjustment to illness. Study II showed that couples living with AF experienced uncertainty as the common main concern, rooted in causation of AF and apprehension about AF episodes. The theory of Managing Uncertainty revealed the strategies of explicit sharing (mutual collaboration and finding resemblance) and implicit sharing (keeping distance and tacit understanding). Patients and spouses showed significant differences in terms of self-reported physical and mental health where patients rated themselves lower than spouses did (III). Several actor effects were identified, suggesting that emotional distress affects and is associated with perceived health. Patient partner effects and spouse partner effects were observed for vitality, indicating that higher levels of symptoms of depression in patients and spouses were associated with lower vitality in their partners. In study IV, couples’ core and secondary illness beliefs were revealed. From the core illness belief that “the heart is a representation of life,” two secondary illness beliefs were derived: AF is a threat to life, and AF can and must be explained. From the core illness belief that “change is an integral part of life,” two secondary illness beliefs were derived: AF is a disruption in our lives, and AF will not interfere with our lives. Finally, from the core illness belief that “adaptation is fundamental in life,” two secondary illness beliefs were derived: AF entails adjustment in daily life, and AF entails confidence in and adherence to professional care. In conclusion, the thesis result suggests that illness, in terms of cardiac disease and AF, affected and influenced the couple on aspects such as making sense of AF, responding to AF, and mutually incorporating and dealing with AF in their daily lives. In the light of this, the thesis results suggest that clinicians working with persons with AF and their partners should employ a systemic view with consideration of couple’s reciprocity and interdependence, but also have knowledge regarding AF, in terms of pathophysiology, the nature of AF (i.e., cause, consequences, and trajectory), and treatments. A possible approach to achieve this is a clinical utilization of an FSN based framework, such as the FamHC. Even if a formalized FSN framework is not utilized, partners should not be neglected but, rather, be considered a resource and be a part of clinical caring activities. This could be met by inviting partners to take part in rounds, treatment decisions, discharge calls or follow-up visits or other clinical caring activities. Likewise, interventional studies should include the couple as a unit of analysis as well as the target of interventions.

Comparison of 1-year outcome in patients with severe aorta stenosis treated conservatively or by aortic valve replacement or by percutaneous transcatheter aortic valve implantation (data from a multicenter Spanish registry)

The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement [AVR] and transcatheter aortic valve implantation [TAVI]). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p <0.001). The 2 main reasons to choose conservative management were the absence of significant symptoms (136% to 29.1%) and the presence of co-morbidity (128% to 27.4%). During 1-year follow-up, 132 patients died (18.2%). The main causes of death were heart failure (60% to 45.5%) and noncardiac diseases (46% to 34.9%). One-year survival for patients treated conservatively, with TAVI, and with AVR was 76.3%, 94.9%, and 92.5%, respectively, p <0.001. One-year survival of patients treated conservatively in the absence of significant symptoms was 97.1%. In conclusion, most patients with severe AS are treated conservatively. The outcome in asymptomatic patients managed conservatively was acceptable. Management in tertiary hospitals is associated with valve intervention. One-year survival was similar with both interventional strategies.

Left atrial appendage: anatomy and imaging landmarks pertinent to percutaneous transcatheter occlusion

Percutaneous left atrial appendage (LAA) closure represents a complementary option and effective treatment for patients at risk of thromboembolism, especially in patients for whom it may be difficult to achieve satisfactory anticoagulation control or where anticoagulation treatment is not possible or desirable. Effective and safe transcatheter LAA occlusion requires a detailed knowledge of crucial anatomic landmarks and endocardial morphologic variants of the LAA and its neighbouring structures.1 ,2 w1–w3 Our aim in this article is to provide the basic anatomic information that is important for the interventional cardiologist to know when planning an LAA occlusion procedure.

Left atrial anatomy relevant to catheter ablation

The rapid development of interventional procedures for the treatment of arrhythmias in humans, especially the use of catheter ablation techniques, has renewed interest in cardiac anatomy. Although the substrates of atrial fibrillation (AF), its initiation and maintenance, remain to be fully elucidated, catheter ablation in the left atrium (LA) has become a common therapeutic option for patients with this arrhythmia. Using ablation catheters, various isolation lines and focal targets are created, the majority of which are based on gross anatomical, electroanatomical, and myoarchitectual patterns of the left atrial wall. Our aim was therefore to review the gross morphological and architectural features of the LA and their relations to extracardiac structures. The latter have also become relevant because extracardiac complications of AF ablation can occur, due to injuries to the phrenic and vagal plexus nerves, adjacent coronary arteries, or the esophageal wall causing devastating consequences.

Utilization and efficacy of internet-based eHealth technology in gastroenterology: a systematic review.

OBJECTIVE: While there have been several reviews exploring the outcomes of various eHealth studies, none have been gastroenterology-specific. This paper aims to evaluate the research conducted within gastroenterology which utilizes internet-based eHealth technology to promote physical and psychological well-being. MATERIAL AND METHODS: A systematic literature review of internet-based eHealth interventions involving gastroenterological cohorts was conducted. Searched databases included: EbSCOhost Medline, CINAHL, and PsycINFO. Inclusion criteria were studies reporting on eHealth interventions (both to manage mental health problems and somatic symptoms) in gastroenterology, with no time restrictions. Exclusion criteria were non-experimental studies, or studies using only email as primary eHealth method, and studies in language other than English. RESULTS: A total of 17 papers were identified; seven studies evaluated the efficacy of a psychologically oriented intervention (additional two provided follow-up analyses exploring the original published data) and eight studies evaluated disease management programs for patients with either irritable bowel syndrome, inflammatory bowel disease (IBD) or celiac disease. Overall, psychological eHealth interventions were associated with significant reductions in bowel symptoms and improvement in quality of life (QoL) that tended to continue up to 12 months follow up. The eHealth disease management was shown to generally improve QoL, adherence, knowledge about the disease, and reduce healthcare costs in IBD, although the studies were associated with various methodological problems, and thus, this observation should be confirmed in well-designed interventional studies. CONCLUSIONS: Based on the evidence to date, eHealth internet-based technology is a promising tool that can be utilized to both promote and enhance gastrointestinal disease management and mental health.

Experiencia y porcentaje de complicaciones de las derivaciones portosistémicas intrahepáticas transyugulares en la Fundación Cardioinfantil

La derivación portosistémica intrahepática transyugular (TIPS) es una técnica importante en el manejo de las complicaciones de la hipertensión portal, en especial en aquellos pacientes candidatos a trasplante hepático. Se trata de un estudio observacional analítico, sin riesgo, en el cual se emplearon técnicas y métodos de investigación documental retrospectivo, y no se realizó ningún tipo de intervención sobre las variables fisiológicas, psicológicas y sociales de la población incluida. Se realizó la descripción demográfica de los pacientes, características clínicas, hallazgos imageneológicos y aspectos técnicos asociados al procedimiento de los pacientes con hipertensión portal que han sido manejados con TIPS en la Fundación CardioInfantil desde Enero 1 de 2007 hasta Junio 30 de 2016. Se incluyeron 54 pacientes de los cuales el 66,7% no presentaron complicaciones inmediatas, tenidas en cuenta desde la terminación del procedimiento y hasta las siguientes 24 horas; sin embargo, 16,9% debutaron con encefalopatía durante este periodo. De las complicaciones tardías, la más frecuente fue la ascitis con un 66,7%, con una mortalidad de 20,4% de los cuales, el 45% de estos fue por shock séptico y falla orgánica secundaria. Aunque el porcentaje de complicaciones asociadas al procedimiento fue alto en nuestros pacientes, se encuentra dentro de los valores reportados en la literatura. Los resultados presentados son un punto de partida para la evaluación del procedimiento en nuestra población y permiten implementar estrategias de mejora que conlleven a incidir de manera positiva en el porcentaje de complicaciones y mortalidad derivadas del procedimiento.

Factores de riesgo preoperatorios asociados a conversión a técnica abierta en colecistectomía laparoscópica de urgencia

Introducción: la colecistectomía laparoscópica es la técnica de elección en pacientes con indicación de extracción quirúrgica de la vesícula; sin embargo, en promedio 20% de éstos requieren conversión a técnica abierta. En este estudio se evaluaron los factores de riesgo preoperatorios para conversión en colecistectomía laparoscópica de urgencia. Metodología: se realizó un estudio de casos y controles no pareado. Se obtuvo información sociodemográfica y de variables de interés de los registros de historias clínicas de pacientes operados entre el 2013 y 2016. Se identificaron los motivos de conversión de técnica quirúrgica. Se caracterizó la población de estudio y se estimaron asociaciones según la naturaleza de las variables. Mediante un análisis de regresión logística se ajustaron posibles variables de confusión. Resultados: se analizaron los datos de 444 pacientes (111 casos y 333 controles). La causa de conversión más frecuente fue la dificultad técnica (50,5%). Se encontró que la mayor edad, el sexo masculino, el antecedente de cirugía abierta en hemiabdomen superior, el signo de Murphy clínico positivo, la dilatación de la vía biliar, la leucocitosis y la mayor experiencia del cirujano, fueron factores de riesgo para conversión. Se encontró un área bajo la curva ROC= 0,743 (IC95% 0,692–0,794, p= <0,001). Discusión: existen unos factores que se asocian a mayor riesgo de conversión en colecistectomía laparoscópica. La mayoría se relacionan con un proceso inflamatorio más severo, por lo que se debe evitar la prolongación del tiempo de espera entre el inicio de los síntomas y la extirpación quirúrgica de la vesícula.

Curva de aprendizaje para ecografía cardiaca en residentes de primer y segundo año de medicina crítica de la universidad del rosario en el año 2016

La ecografía básica cardiaca (ECB) es una herramienta útil en la Unidad de Cuidados intensivos al facilitar la realización de ciertas intervenciones. No se ha definido el número de repeticiones necesarias para obtener un nivel de competencia adecuado. La evidencia encontrada indica un número mínimo de cincuenta repeticiones, para alcanzar cierto grado de habilidad.

Efectos de una intervención educativa en la promoción de la actividad física, los conocimientos y comportamientos saludables para la prevención del cáncer colorrectal en jóvenes de una institución educativa secundaria en Bogotá Colombia

El cáncer colorrectal es un serio problema de salud pública a nivel mundial. Evidencias epidemiológicas han sugerido que al menos el 50% de la enfermedad puede ser prevenida mediante un estilo de vida saludable. Las intervenciones educativas surgen como una herramienta clave de movilización social para la prevención y han sido sugeridas desde las autoridades nacionales para el control del cáncer en el país.

Revisión sistemática de la literatura de las intervenciones diseñadas para el comportamiento de automedicación no responsable

La automedicación no responsable se ha convertido en un problema de salud pública global en las últimas décadas, por sus consecuencias individuales (por ejemplo, la intoxicación) y colectivas (por ejemplo, la resistencia microbiana a los antibióticos). Las intervenciones orientadas a este comportamiento han sido aisladas y muy diferentes. Aunque se tiene evidencia de que su aplicación puede traer beneficios en diferentes poblaciones, no se halló en la literatura una compilación sistemática de dichas intervenciones. El objetivo de la presente revisión es sistematizar la literatura científica sobre las diferentes alternativas de intervención del comportamiento individual de automedicación no responsable. En cuanto al método, la revisión de literatura involucró la búsqueda sistemática de “automedicación” e “intervención” en las bases de datos académicas internacionales con contenidos de psicología, suscritas por la Biblioteca de la Universidad del Rosario. Como resultado se encontró que las intervenciones orientadas al comportamiento de automedicación no responsable se pueden clasificar en dos grandes grupos: (a) intervenciones regulatorias, con dirección “arriba hacia abajo”, que suponen una acción de los Estados nacionales por medio de sus legislaciones o de entidades internacionales (por ejemplo, Organización Mundial de la Salud); y (b) intervenciones educativas, con dirección “abajo hacia arriba”, que suponen acciones con individuos y comunidades con el fin de enseñar acerca del uso adecuado de los medicamentos. Se concluye acerca de la necesidad de complementar ambos tipos de intervención, los cuales, si bien demuestran resultados positivos, aisladamente son insuficientes para contrarrestar integralmente este fenómeno creciente y complejo.