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There was a median (IQR) mortality of 2.5% (1.6-4.3) in the low ratio quartile; 3.1% (1.9-5.3) in the intermediate quartiles; and 5.3% (3.2-9.1) in the high ratio quartile (P < 0.001). On multivariate analysis, the PCICABG ratio was associated with an increased risk for CABG mortality with an adjusted odds ratio of 1.38 (95% CI, 1.14-1.67, P < 0.001) and 2.17 (95% CI, 1.70-2.80, P < 0.001) for hospitals with intermediate and high PCICABG ratios, respectively. There was no significant association between PCICABG ratio and PCI mortality.
The programmatic PCICABG ratio is a valid indicator of optimal case selection. The PCICABG ratio correlates with in-hospital mortality in ACS.
The programmatic PCICABG ratio is a valid indicator of optimal case selection. The PCICABG ratio correlates with in-hospital mortality in ACS.
We aimed to compare the long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) with biodegradable polymer drug-eluting stents (BP-DES) versus durable polymer drug-eluting stents (DP-DES).
Among 11 517 PCIs with second-generation DES performed in our institution between 2007 and 2019, we identified 8042 procedures performed using DP-DES and 3475 using BP-DES. The primary outcome was target lesion failure, the composite target lesion revascularization (TLR), target vessel myocardial infarction and death. Propensity score matching was used to create a well-balanced cohort. Mean follow-up was 4.8 years. Of the 3413 matched pairs, 21% were females, and the mean age was 66 years. At 1 year, the primary outcome occurred in 8.3% patients versus 7.1% (P = 0.07), and TLR rate was 3% versus 2% (P = 0.006) in patients with DP-DES and BP-DES respectively. Within 5 years, the primary outcome occurred in 23.1% versus 23.4% (P = 0.44), and the rate of TLR was 7.2% versus 6.5% (P = 0.07) in patients with DP-DES and BP-DES, respectively.
Similar rates of the composite outcome were observed throughout the entire follow-up. target vessel revascularization rates were lower in the DP-DES group at 1 year but equalized within 5 years.
Similar rates of the composite outcome were observed throughout the entire follow-up. target vessel revascularization rates were lower in the DP-DES group at 1 year but equalized within 5 years.
This review will assess the effectiveness and usability of mobile health applications to improve medication adherence in patients with heart failure.
Inadequate medication adherence by heart failure patients is a major cause of negative clinical outcomes, high rates of hospital readmissions, and death, thus increasing the costs to patients and the health care system. Several studies have shown that the use of mobile health applications improves self-care by heart failure patients, including medication adherence. Therefore, gathering evidence on these studies will help researchers and clinicians understand the impact of such interventions on patient care.
Eligible studies will evaluate medication adherence and include participants aged ≥18 years diagnosed with heart failure who are using app-based (software) interventions. Experimental and observational studies will be included. We will exclude studies with interventions that used mobile applications without functionality to assist the user in organizing and taking their medications.
Articles published to the present day, without restrictions of language, will be selected from Embase, MEDLINE, LILACS, Scopus, Web of Science, CINAHL, and Cochrane Library. Two independent reviewers will perform article screening, assessment of methodological quality, and data extraction using JBI assessment and extraction instruments. Discrepancies will be solved by consensus and a third reviewer will be consulted if necessary. A narrative synthesis of findings will be presented, and statistical analysis will be used only when appropriate.
PROSPERO CRD42020147816.
PROSPERO CRD42020147816.
The aim of this review is to summarize the evidence for determinants of physical activity in older adults.
Physical activity is an important predictor of multi-morbidity, falls, and cognitive decline in older adulthood. Understanding what influences older adults' physical activity behavior is an important first step for guiding effective interventions for promoting physical activity in this population.
This umbrella review will include systematic reviews (including scoping reviews) reporting on the relationship between determinants (also referred to as correlates or factors), measured by either self-report or direct measurement, and physical activity in adults ≥60 years.
A systematic search of six databases will be completed in MEDLINE, Embase, CINAHL, Cochrane Library, PsycINFO, and AgeLine. Two independent reviewers will screen titles, abstracts, and full-text articles, and perform data extraction and quality assessment. Evidence for determinants of physical activity will be synthesized using the socio-ecological model. If possible, evidence will be compared by study design, type of physical activity, outcome measure used, setting, and sex.
PROSPERO CRD42020159332.
PROSPERO CRD42020159332.
Intracardiac thrombi can occur in a variety of locations and are frequently encountered in clinical practice. Yet evidence-based guidance for clinicians managing patients with intracardiac thrombi is often limited. This review summarizes what is known regarding the prevalence of intracardiac thrombus, diagnostic strategies, clinical relevance, and treatment options, focusing on four specific types of thrombus for which recent research has shifted clinical understanding and treatment decisions 1) left atrial appendage thrombus, 2) cardiac implantable electronic device lead thrombus, 3) bioprosthetic aortic valve thrombus, and 4) left ventricular thrombus. Additional studies, ideally prospective, randomized, and head-to-head in design, are needed to better inform best practices in patients with intracardiac thrombi.
Intracardiac thrombi can occur in a variety of locations and are frequently encountered in clinical practice. Yet evidence-based guidance for clinicians managing patients with intracardiac thrombi is often limited. Savolitinib mw This review summarizes what is known regarding the prevalence of intracardiac thrombus, diagnostic strategies, clinical relevance, and treatment options, focusing on four specific types of thrombus for which recent research has shifted clinical understanding and treatment decisions 1) left atrial appendage thrombus, 2) cardiac implantable electronic device lead thrombus, 3) bioprosthetic aortic valve thrombus, and 4) left ventricular thrombus. Additional studies, ideally prospective, randomized, and head-to-head in design, are needed to better inform best practices in patients with intracardiac thrombi.
Erectile dysfunction is a common entity in clinical practice. Primary erectile dysfunction not related to vasculopathy or psychiatric disorder, can be readily treated with phosphodiesterase inhibitors. These drugs have many physiologic effects which can alter a patient's hemodynamic profile considerably, especially in the presence of concomitant structural heart disease, specifically valvular heart disease. While some contraindications to use of PDE5 inhibitors in patients with cardiovascular disease are defined, the effect of these drugs in presence of valvular heart disease is not well documented. The purpose of this review is to analyze the data regarding the safety of PDE5 inhibitors in patients with valvular heart disease.
Erectile dysfunction is a common entity in clinical practice. Primary erectile dysfunction not related to vasculopathy or psychiatric disorder, can be readily treated with phosphodiesterase inhibitors. These drugs have many physiologic effects which can alter a patient's hemodynamic profile considerably, especially in the presence of concomitant structural heart disease, specifically valvular heart disease. While some contraindications to use of PDE5 inhibitors in patients with cardiovascular disease are defined, the effect of these drugs in presence of valvular heart disease is not well documented. The purpose of this review is to analyze the data regarding the safety of PDE5 inhibitors in patients with valvular heart disease.
Continuing health provider education (HPE) is an important intervention supported by health policy to counter the opioid epidemic; knowledge regarding appropriate program design and evaluation is lacking. The authors aim to provide a comprehensive understanding of evaluations of opioid-related continuing HPE programs and their appropriateness as interventions to improve population health.
In January 2020, the authors conducted a systematic search of 7 databases, seeking studies of HPE programs on opioid analgesic prescribing and overdose prevention. Reviewers independently screened the titles and abstracts of all studies and then assessed the full texts of all studies potentially eligible for inclusion. The authors extracted a range of data using categories for evaluating complex programs the use of theory, program purpose, inputs, activities, outputs, outcomes, and industry involvement. Results were reported in a narrative synthesis.
Thirty-nine reports on 32 distinct HPE programs met inclusion criteribenefits.
Continuing HPE has been promoted as an important means of addressing population-level opioid-related harms by policy makers and educators, yet published evaluations of HPE programs focusing on opioid analgesics inadequately evaluate patient- or population-level outcomes. Instead, they primarily focus on self-reported performance outcomes. Conceptual models are needed to guide the development and evaluation of continuing HPE programs intended to have population health benefits.At the outset of the COVID-19 pandemic, many medical students were removed from clinical duties and had their education put on hold. Some found novel ways to join efforts to respond to the pandemic. Georgetown University School of Medicine medical students created Medical Supply Drive (MSD or MedSupplyDrive), a 501(c)(3), on March 17, 2020, in response to the national shortage of personal protective equipment (PPE). This article reviews the formation of a national response to the pandemic, the methods employed to distribute PPE, and the results of MSD's work from March 17, 2020, through June 20, 2020. A focus was placed on equitable distribution, both within local regions and on the national scale by distinguishing COVID-19 hotspots, including Native American reservations. As of June 20, over half a million items were donated, with 1,001 deliveries made to 423 hospitals, 182 clinics, 175 long-term care facilities, 25 homeless shelters, 32 public health departments, and 164 other facilities. From 46 states and the District of Columbia, 1,514 individuals volunteered, and 202 signed up as regional coordinators. MSD formed 2 international organizations, MedSupplyDrive UK and MedSupplyDrive Scotland, and established U.S.-based partnerships with 19 different PPE and aid organizations. MSD gained local, national, and international media attention with over 45 interviews conducted about the organization. While the pandemic temporarily disrupted formal medical education, MSD empowered medical students to actively learn about the needs of their communities and organize ways to address them, while incorporating these values into their professional identities. The 3-step framework this organization employed also provides a potential model for future disaster relief efforts in times of crisis. MSD hopes to motivate budding physicians to collaborate and play an active role in tackling public health inequities outside hospitals and within the communities students will one day serve.
