scholarly journals Synopsis of Guidelines for the Clinical Management of Cerebral Cavernous Malformations: Consensus Recommendations Based on Systematic Literature Review by the Angioma Alliance Scientific Advisory Board Clinical Experts Panel

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 665-680 ◽  
Author(s):  
Amy Akers ◽  
Rustam Al-Shahi Salman ◽  
Issam A. Awad ◽  
Kristen Dahlem ◽  
Kelly Flemming ◽  
...  
Keyword(s):  
Current Knowledge ◽  
Clinical Care ◽  
Heart Association ◽  
The United States ◽  
Current Evidence ◽  
Cerebral Cavernous Malformations ◽  
Class Iii ◽  
Knowledge Gaps ◽  
Cavernous Malformations ◽  
Patient Support Group

Abstract BACKGROUND: Despite many publications about cerebral cavernous malformations (CCMs), controversy remains regarding diagnostic and management strategies. OBJECTIVE: To develop guidelines for CCM management. METHODS: The Angioma Alliance (www.angioma.org), the patient support group in the United States advocating on behalf of patients and research in CCM, convened a multidisciplinary writing group comprising expert CCM clinicians to help summarize the existing literature related to the clinical care of CCM, focusing on 5 topics: (1) epidemiology and natural history, (2) genetic testing and counseling, (3) diagnostic criteria and radiology standards, (4) neurosurgical considerations, and (5) neurological considerations. The group reviewed literature, rated evidence, developed recommendations, and established consensus, controversies, and knowledge gaps according to a prespecified protocol. RESULTS: Of 1270 publications published between January 1, 1983 and September 31, 2014, we selected 98 based on methodological criteria, and identified 38 additional recent or relevant publications. Topic authors used these publications to summarize current knowledge and arrive at 23 consensus management recommendations, which we rated by class (size of effect) and level (estimate of certainty) according to the American Heart Association/American Stroke Association criteria. No recommendation was level A (because of the absence of randomized controlled trials), 11 (48%) were level B, and 12 (52%) were level C. Recommendations were class I in 8 (35%), class II in 10 (43%), and class III in 5 (22%). CONCLUSION: Current evidence supports recommendations for the management of CCM, but their generally low levels and classes mandate further research to better inform clinical practice and update these recommendations. The complete recommendations document, including the criteria for selecting reference citations, a more detailed justification of the respective recommendations, and a summary of controversies and knowledge gaps, was similarly peer reviewed and is available on line www.angioma.org/CCMGuidelines.

scholarly journals Remote monitoring of chronic heart failure patients: invasive versus non-invasive tools for optimising patient management

2019 ◽  
Vol 28 (1) ◽  
pp. 3-13 ◽  
Author(s):  
J. F. Veenis ◽  
J. J. Brugts
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Remote Monitoring ◽  
Heart Association ◽  
The United States ◽  
Pharmacological Therapy ◽  
Functional Class ◽  
Class Iii ◽  
Additional Tool

AbstractExacerbations of chronic heart failure (HF) with the necessity for hospitalisation impact hospital resources significantly. Despite all of the achievements in medical management and non-pharmacological therapy that improve the outcome in HF, new strategies are needed to prevent HF-related hospitalisations by keeping stable HF patients out of the hospital and focusing resources on unstable HF patients. Remote monitoring of these patients could provide the physicians with an additional tool to intervene adequately and promptly. Results of telemonitoring to date are inconsistent, especially those of telemonitoring with traditional non-haemodynamic parameters. Recently, the CardioMEMS device (Abbott Inc., Atlanta, GA, USA), an implantable haemodynamic remote monitoring sensor, has shown promising results in preventing HF-related hospitalisations in chronic HF patients hospitalised in the previous year and in New York Heart Association functional class III in the United States. This review provides an overview of the available evidence on remote monitoring in chronic HF patients and future perspectives for the efficacy and cost-effectiveness of these strategies.

scholarly journals Death from COVID-19 in a Hispanic postpartum woman and review of the literature

2021 ◽  
Vol 14 (7) ◽  
pp. e242819
Author(s):  
Janardhan Mydam ◽  
Laila Younes ◽  
Mohammed Siddiqui ◽  
Thana Tarsha
Keyword(s):  
Pregnancy Outcomes ◽  
Current Knowledge ◽  
Obese Woman ◽  
Clinical Care ◽  
Current Evidence ◽  
Postpartum Woman ◽  
Postpartum Women ◽  
Evidence Based ◽  
Review Of The Literature ◽  
The Impact

There is still much we do not know about the impact of COVID-19 on the health of pregnant and postpartum women and pregnancy outcomes. Current evidence suggests that there is biological plausibility for worse outcomes among this population. This case report details the clinical care given to a postpartum Hispanic and obese woman diagnosed with COVID-19 in April 2020. We report the care she and her newborn received and her progression through the virus. We discuss the current knowledge surrounding COVID-19 among pregnant and postpartum women. While research supports COVID-19 outcomes being comparable to the general population, there is limited research in this area. Clinical trials, acting on the side of caution, have tended to exclude pregnant women from participation. Therefore, there is a need for further research that can inform evidence-based policy decisions related to COVID-19 in pregnant and postpartum women.

scholarly journals Cardiovascular Health Research in the Workplace: A Workshop Report

2021 ◽  
Author(s):  
Chris Calitz ◽  
Charlotte Pratt ◽  
Nicolaas P. Pronk ◽  
Janet E. Fulton ◽  
Kimberly Jinnett ◽  
...  
Keyword(s):  
Health Research ◽  
Data Science ◽  
Occupational Safety ◽  
Cardiovascular Health ◽  
Heart Association ◽  
Cost Effective ◽  
The United States ◽  
Current Evidence ◽  
Future Research ◽  
Workplace Health

Abstract Heart disease and stroke are the first and fifth leading causes of death in the United States, respectively. Employers have a unique opportunity to promote cardiovascular health, because >60% of US adults are employed, and most spend half of their waking hours at work. Despite the scope of the opportunity, <1 in 5 businesses implement evidence‐based, comprehensive workplace health programs, policies, and practices. Integrated, systems‐based workplace health approaches that harness data science and technology may have the potential to reach more employees and be cost‐effective for employers. To evaluate the role of the workplace in promoting cardiovascular health across the lifespan, the National Heart, Lung, and Blood Institute, the National Institute for Occupational Safety and Health, and the American Heart Association convened a workshop on March 7, 2019, to share best practices, and to discuss current evidence and knowledge gaps, practical application, and dissemination of the evidence, and the need for innovation in workplace health research and practice. This report presents the broad themes discussed at the workshop and considerations for promoting worker cardiovascular health, including opportunities for future research.

scholarly journals Clinical Progress Note: Procalcitonin in the Management of Pediatric Lower Respiratory Tract Infection

2019 ◽  
Vol 14 (11) ◽  
pp. 688-690 ◽  
Author(s):  
Sophie E Katz ◽  
Laura F Sartoni ◽  
Derek J Williams
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Lower Respiratory Tract Infection ◽  
Lower Respiratory Tract ◽  
Clinical Care ◽  
The United States ◽  
Current Evidence ◽  
Diagnostic Aid ◽  
Antibiotic Overuse

Procalcitonin (PCT) is a biomarker that has shown promise to identify bacterial etiology in acute infections, including bacterial lower respiratory tract infection (LRTI). In 2017, the United States Food and Drug Administration (FDA) approved the use of PCT as a diagnostic aid to guide the decisions around antibiotic therapy in acute LRTI.1 Although most of the data supporting the use of PCT for LRTI stems from adult studies, the high disease burden, predominance of viral etiologies, and frequent diagnostic uncertainty resulting in antibiotic overuse make pediatric LRTI an ideal target for the use of PCT as a diagnostic aid. This review evaluates and summarizes the current evidence regarding the role of PCT in the clinical care of pediatric LRTI, including its use in guiding antibiotic use and prognosticating disease severity.

The Case for Holistic Review in Communication Sciences and Disorders Admissions

2021 ◽  
pp. 1-6
Author(s):  
Kerry Callahan Mandulak
Keyword(s):  
Faculty Perceptions ◽  
Current Knowledge ◽  
Collaborative Work ◽  
Clinical Care ◽  
Current Evidence ◽  
Speech Language Pathology ◽  
Successful Student ◽  
Holistic Review ◽  
Language Pathology ◽  
Definition Of

Purpose The purpose of this article is to review the foundational tenets and current evidence regarding holistic review for graduate admissions that can be applied specifically to the field of communication sciences and disorders (CSD). Holistic review represents a paradigm shift from expecting the best students as those with the highest academic metrics to those who are a best fit with the mission, values, and goals of any program. This shift may be challenging for widespread adoption by the CSD field. It requires reconsideration of long-standing traditions and beliefs about admissions criteria, and a strong definition of what makes a successful student and future practitioner. Conclusions A comprehensive exploration of current knowledge around holistic review and faculty perceptions or hesitations could inform future policies, create a unified effort across the fields of speech-language pathology and audiology, and inspire collaborative work among graduate programs. We have the opportunity to facilitate changes that will ultimately result in a workforce that reflects the world in which we live and the populations we serve. Graduate CSD programs must be training students who are both academically successful and who provide culturally sensitive, responsive, and competent clinical care.

scholarly journals Cost-impact analysis of baroreflex activation therapy in chronic heart failure patients in the United States

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John Bisognano ◽  
John E. Schneider ◽  
Shawn Davies ◽  
Robert L. Ohsfeldt ◽  
Elizabeth Galle ◽  
...  
Keyword(s):  
New York ◽  
Impact Analysis ◽  
Heart Association ◽  
The United States ◽  
Class Iii ◽  
Heart Transplants ◽  
Baroreflex Activation Therapy ◽  
Reduced Ejection Fraction ◽  
Cost Impact ◽  
Activation Therapy

Abstract Background The study evaluated the cost of baroreflex activation therapy plus guideline directed therapy (BAT + GDT) compared to GDT alone for HF patients with reduced ejection fraction and New York Heart Association Class III or II (with a recent history of III). Baroreflex activation therapy (BAT) is delivered by an implantable device that stimulates the baroreceptors through an electrode attached to the outside of the carotid artery, which rebalances the autonomic nervous system to regain cardiovascular (CV) homeostasis. The BeAT-HF trial evaluated the safety and effectiveness of BAT. Methods A cost impact model was developed from a U.S. health care payer or integrated delivery network perspective over a 3-year period for BAT + GDT versus GDT alone. Expected costs were calculated by utilizing 6-month data from the BeAT-HF trial and existing literature. HF hospitalization rates were extrapolated based on improvement in NT-proBNP. Results At baseline the expected cost of BAT + GDT were $29,526 per patient more than GDT alone due to BAT device and implantation costs. After 3 years, the predicted cost per patient was $9521 less expensive for BAT + GDT versus GDT alone due to lower rates of significant HF hospitalizations, CV non-HF hospitalizations, and resource intensive late-stage procedures (LVADs and heart transplants) among the BAT + GDT group. Conclusions BAT + GDT treatment becomes less costly than GDT alone beginning between years 1 and 2 and becomes less costly cumulatively between years 2 and 3, potentially providing significant savings over time. As additional BeAT-HF trial data become available, the model can be updated to show longer term effects.

Flipping the Pain Care Model: A Sociopsychobiological Approach to High-Value Chronic Pain Care

Pain Medicine ◽  
2020 ◽  
Vol 21 (6) ◽  
pp. 1168-1180 ◽  
Author(s):  
Aram S Mardian ◽  
Eric R Hanson ◽  
Lisa Villarroel ◽  
Anita D Karnik ◽  
John G Sollenberger ◽  
...  
Keyword(s):  
United States ◽  
Chronic Pain ◽  
Clinical Care ◽  
The United States ◽  
Current Evidence ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Practice Gap ◽  
Pain Care

Abstract Objective Much of the pain care in the United States is costly and associated with limited benefits and significant harms, representing a crisis of value. We explore the current factors that lead to low-value pain care within the United States and provide an alternate model for pain care, as well as an implementation example for this model that is expected to produce high-value pain care. Methods From the perspective of aiming for high-value care (defined as care that maximizes clinical benefit while minimizing harm and cost), we describe the current evidence practice gap (EPG) for pain care in the United States, which has developed as current clinical care diverges from existing evidence. A discussion of the biomedical, biopsychosocial, and sociopsychobiological (SPB) models of pain care is used to elucidate the origins of the current EPG and the unconscious factors that perpetuate pain care systems despite poor results. Results An interprofessional pain team within the Veterans Health Administration is described as an example of a pain care system that has been designed to deliver high-value pain care and close the EPG by implementing the SPB model. Conclusions Adopting and implementing a sociopsychobiological model may be an effective approach to address the current evidence practice gap and deliver high-value pain care in the United States. The Phoenix VA Health Care System’s Chronic Pain Wellness Center may serve as a template for providing high-value, evidence-based pain care for patients with high-impact chronic pain who also have medical, mental health, and opioid use disorder comorbidities.

scholarly journals Clinical Application and Educational Training for Pharmacogenomics

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 163 ◽  
Author(s):  
Jason W. Guy ◽  
Isha Patel ◽  
Julie H. Oestreich
Keyword(s):  
Clinical Application ◽  
Health Care Professionals ◽  
Clinical Care ◽  
Healthcare Providers ◽  
The United States ◽  
Current Evidence ◽  
Clinical Settings ◽  
Educational Training ◽  
Secondary Objective ◽  
Medication Selection

Pharmacogenomics—defined as the study of how genes affect a person’s response to drugs—is growing in importance for clinical care. Many medications have evidence and drug labeling related to pharmacogenomics and patient care. New evidence supports the use of pharmacogenomics in clinical settings, and genetic testing may optimize medication selection and dosing. Despite these advantages, the integration of pharmacogenomics into clinical decisions remains variable and challenging in certain practice settings. To ensure consistent application across settings, sufficient education amongst current and future healthcare providers is necessary to further integrate pharmacogenomics into routine clinical practice. This review highlights current evidence supporting clinical application of medications with pharmacogenomic labeling. The secondary objective is to review current strategies for educating health professionals and student trainees. One national organization predicts that most regions in the United States will soon contain at least one healthcare system capable of applying pharmacogenomic information. Applying genotype-guided dosing to several FDA-approved medications may help produce beneficial changes in patient outcomes. Identifying best practices for educating health care professionals and trainees remains vitally important for continuing growth of pharmacogenomic services. As pharmacogenomics continues to expand into more areas of healthcare, current and future practitioners must pursue and maintain competence in pharmacogenomics to ensure better outcomes for patients.

Six-Month Performance of a 3-Dimensional Annuloplasty Ring for Repair of Functional Tricuspid Regurgitation

2018 ◽  
Vol 68 (06) ◽  
pp. 478-485
Author(s):  
Ralf Guenzinger ◽  
Ruediger S. Lange ◽  
Friedrich-Christian Rieß ◽  
Thorsten Hanke ◽  
Nicolas Bischoff ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Nyha Class ◽  
Three Dimensional ◽  
Heart Association ◽  
The United States ◽  
Class Iii ◽  
Term Survival ◽  
Annuloplasty Ring ◽  
Functional Tricuspid Regurgitation ◽  
Mean Pressure

Background Functional tricuspid regurgitation (FTR) secondary to left-sided heart disease may lead to poor quality of life and reduced long-term survival. This study evaluated clinical and functional outcomes of patients undergoing tricuspid valve (TV) repair using a rigid three-dimensional ring (Contour 3D, Medtronic) concomitant with another procedure. Methods From September 2011 to July 2015, 112 patients (mean age 70.9 ± 9.0 years) were enrolled at 10 centers in Europe, Israel, and the United States. Inclusion criteria were FTR ≥ moderate and/or tricuspid annular diameter (TAD) ≥ 40 mm. Echocardiography was planned before surgery and at discharge with echocardiographic and clinical follow-ups performed 6 months postoperatively. Results Three fourths (74.4%) of patients had higher than moderate TR. Mean TAD was 41.0 ± 7.3 mm; 61.7% of patients were in the New York Heart Association (NYHA) class III/IV. The most common concomitant procedure was mitral valve repair (57 patients, 53.3%). The 30-day mortality rate was 0.9% (n = 1). The mean EuroSCORE II was 8.9 ± 8.4% (median: 5.9%; interquartile range: 3.5–11.5%). The observed to expected ratio (O/E) based on the median was 0.1. Six deaths occurred during follow-up (three cardiac related). Mean implanted ring size was 30.3 ± 2.7. At 6 months, 94.4% of patients showed ≤ mild TR, and 92.0% were in NYHA class I/II (p < 0.001 vs baseline for both). Mean pressure gradient across the TV was 2.0 ± 1.1 mm Hg; leaflet coaptation length was 7.5 ± 3.3 mm. Conclusion The Contour 3D annuloplasty ring used for treatment of FTR substantially reduced TR for up to 6 postoperative months with low mean pressure gradients across the TV and significant improvement in NYHA class. Registration www.ClinicalTrials.gov, NCT01532921.

Minimally Invasive Parafascicular Surgery for Resection of Cerebral Cavernous Malformations Utilizing Image-Guided BrainPath System

2018 ◽  
Vol 17 (4) ◽  
pp. 348-353 ◽  
Author(s):  
Oded Goren ◽  
Christoph J Griessenauer ◽  
Christian O Bohan ◽  
Christopher M Berry ◽  
Clemens M Schirmer
Keyword(s):  
Minimally Invasive ◽  
Wound Dehiscence ◽  
The United States ◽  
Cerebral Cavernous Malformations ◽  
Cavernous Malformations ◽  
Minimal Impact ◽  
Image Guided ◽  
Small Series ◽  
Surgical Wound Dehiscence

Abstract BACKGROUND The minimally invasive parafascicular approach provides a surgical corridor to reach deep lesions with minimal impact on the surrounding brain tissue. OBJECTIVE To evaluate the safety and efficacy of this approach utilizing the image-guided tubular BrainPath system (NICO Corp, Indianapolis, Indiana) for the resection of deep and subcortical supratentorial cerebral cavernous malformations (CCMs). METHODS We performed a retrospective analysis of patients who presented with subcortical CCMs treated with the BrainPath system. Patient demographics, clinical presentation, procedural complications, and clinical and imaging follow-up information were assessed. RESULTS Six patients were identified between December 2014 and November 2017 at a large volume academic institution in the United States. There were 3 males and 3 female patients with a median age of 25 yr. Locations included frontal, temporal, and parietal lobes. In selected cases, the fiber-sparing trajectory imposed a longer approach than the closest distance to the brain surface. Except for 1 patient who suffered from surgical wound dehiscence, there were no operative complications in any of the cases. All patients remained neurologically stable postoperatively with a mean follow-up of 20 moh. CONCLUSION This small series suggests that the use of a minimally invasive surgical approach to CCMs utilizing the image-guided parafascicular tubular BrainPath system is feasible, safe, and effective.

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