[The World's Columbian Exposition. Portfolio of views issued by the Department of photography, C.D. Arnold, chief. Chicago and St. Louis, National Chemigraph Company, 1893, 36 phot., don du marquis Davidsard en 1930]

Donateur : Davidsard (18..-18.. ; marquis)

Audit report on the City of St. Charles, Iowa for the year ended June 30, 2012

Audit report on the City of St. Charles, Iowa for the year ended June 30, 2012

[Voyage en Italie : 1824-1830]. , Eglise du St Esprit : détail d'une Chapelle : [élévation intérieure, plan et vue perspective] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 134

[Voyage en Italie : 1825-1830]. , Justice de Paix, via Maggiore ; palais sur la place du St Esprit : [deux plans] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 151

Impact of medical practice guidelines on the assessment of patients with acute coronary syndrome without persistent ST segment elevation.

OBJECTIVE: To assess the impact of introducing clinical practice guidelines on acute coronary syndrome without persistent ST segment elevation (ACS) on patient initial assessment. DESIGN: Prospective before-after evaluation over a 3-month period. SETTING: The emergency ward of a tertiary teaching hospital. PATIENTS: All consecutive patients with ACS evaluated in the emergency ward over the two 3-month periods. INTERVENTION: Implementation of the practice guidelines, and the addition of a cardiology consultant to the emergency team. MAIN OUTCOME MEASURES: Diagnosis, electrocardiogram interpretation, and risk stratification after the initial evaluation. RESULTS: The clinical characteristics of the 328 and 364 patients evaluated in the emergency ward for suspicion of ACS before and after guideline implementation were similar. Significantly more patients were classified as suffering from atypical chest pain (39.6% versus 47.0%; P = 0.006) after guideline implementation. Guidelines availability was associated with significantly more formal diagnoses (79.9% versus 92.9%; P < 0.0001) and risk stratification (53.7% versus 65.4%, P < 0.0001) at the end of initial assessment. CONCLUSION: Guidelines implementation, along with availability of a cardiology consultant in the emergency room had a positive impact on initial assessment of patients evaluated for suspicion of ACS. It led to increased confidence in diagnosis and stratification by risk, which are the first steps in initiating effective treatment for this common condition.

[Voyage en Italie : 1824-1830]. , Chapelle souterraine de St Janvier : [plan, coupe transversale] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 226

[Voyage en Italie : 1824-1830]. , Chapelle souterraine de St Janvier, sur une échelle de 002 P.M. : [coupe longitudinale] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 227

[Voyage en Italie : 1824-1830]. , BAPTISTERE, église de St Jean : [élévation toute hauteur d'une des faces intérieures du Baptistère] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 145

[Voyage en Italie : 1824-1830]. , Baptistère. Eglise de St Jean, Sur une Echelle de 0,005 P.M. : [plan du rez-de-chaussée (partie gauche) et au niveau des tribunes (partie droite)] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 143

[Voyage en Italie : 1824-1830]. , [La basilique et la place] St Pierre : [vue perspective] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 538

[Voyage en Italie : 1824-1830]. , [Préparatifs pour la fête des SS. Pierre et Paul ?] St Pierre de Rome, 28 juin : [face et deux profils d'une femme voilée, vue perspective d'une porte intérieure de la basilique ornée de guirlandes] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 539

[Voyage en Italie : 1824-1830]. , Panoplia Manuscrit grec du Vatican XII[e] Siècle. St François d'Assise. XIII[e] Siècle : [sept motifs : cinq personnages (trois hommes nimbés, une Vierge à l'enfant et un personnage non identifé), une croix, détail ornemental d'un arc] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 614

Acute multivessel revascularization improves 1-year outcome in ST-elevation myocardial infarction: a nationwide study cohort from the AMIS Plus registry.

BACKGROUND: The optimal strategy for percutaneous coronary intervention (PCI) of ST-segment elevation myocardial infarction (STEMI) in multi-vessel disease (MVD), i.e., multi-vessel PCI (MV-PCI) vs. PCI of the infarct-related artery only (IRA-PCI), still remains unknown. METHODS: Patients of the AMIS Plus registry admitted with an acute coronary syndrome were contacted after a median of 378 days (interquartile range 371-409). The primary end-point was all-cause death. The secondary end-point included all major adverse cardiovascular and cerebrovascular events (MACCE) including death, re-infarction, re-hospitalization for cardiac causes, any cardiac re-intervention, and stroke. RESULTS: Between 2005 and 2012, 8330 STEMI patients were identified, of whom 1909 (24%) had MVD. Of these, 442 (23%) received MV-PCI and 1467 (77%) IRA-PCI. While all-cause mortality was similar in both groups (2.7% both, p>0.99), MACCE was significantly lower after MV-PCI vs. IRA-PCI (15.6% vs. 20.0%, p=0.038), mainly driven by lower rates of cardiac re-hospitalization and cardiac re-intervention. Patients undergoing MV-PCI with drug-eluting stents had lower rates of all-cause mortality (2.1% vs. 7.4%, p=0.026) and MACCE (14.1% vs. 25.9%, p=0.042) compared with those receiving bare metal stents (BMS). In multivariate analysis, MV-PCI (odds ratio, OR 0.69, 95% CI 0.51-0.93, p=0.017) and comorbidities (Charlson index ≥ 2; OR 1.42, 95% CI 1.05-1.92, p=0.025) were independent predictors for 1-year MACCE. CONCLUSION: In an unselected nationwide real-world cohort, an approach using immediate complete revascularization may be beneficial in STEMI patients with MVD regarding MACCE, specifically when drug-eluting stents are used, but not regarding mortality. This has to be tested in a randomized controlled trial.