scholarly journals Esophageal Manometry Testing and Anti-Reflux Surgery: The Preoperative Necessity and Prognostic Utility

2021 ◽  
Vol 1 (3) ◽  
pp. 216-226
Author(s):  
Shahin Ayazi
Keyword(s):  
Risk Stratification ◽  
Antireflux Surgery ◽  
Esophageal Manometry ◽  
Critical Role ◽  
Gastroesophageal Junction ◽  
Adverse Outcomes ◽  
Evidence Based ◽  
Postoperative Dysphagia ◽  
Prognostic Utility

Manometric assessment of the gastroesophageal junction (GEJ) and esophageal body is the key to a better understanding of the mechanics of antireflux surgery (ARS) and maximizing its benefits while minimizing adverse outcomes. However, there is an attitude of uncertainty regarding the necessity of esophageal motility prior to ARS among some surgeons. This evidence-based review highlights the critical role of manometry in the preoperative workup for patients undergoing ARS. It also discusses how manometry can detect findings associated with favorable outcomes or the risk of postoperative dysphagia. Manometric data can be used for risk stratification and the prediction of outcomes, aiding the surgeon in matching an operation to the specific physiology of each individual patient.

Bridging the Knowledge Gaps in Arrhythmogenic Cardiovascular Conditions: The Critical Role of Registries

2016 ◽  
Vol 10 (2) ◽  
pp. 1 ◽  
Author(s):  
Melody Hermel ◽  
Rebecca Duffy ◽  
Alexander Orfanos ◽  
Isabelle Hack ◽  
Shayna McEnteggart ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Natural History ◽  
Risk Stratification ◽  
Critical Role ◽  
Knowledge Gaps ◽  
Level Of Evidence ◽  
The Future

Cardiac registries have filled many gaps in knowledge related to arrhythmogenic cardiovascular conditions. Despite the less robust level of evidence available in registries when compared with clinical trials, registries have contributed a range of clinically useful information. In this review, the authors discuss the role that registries have played – related to diagnosis, natural history, risk stratification, treatment, and genetics of arrhythmogenic cardiovascular conditions – in closing knowledge gaps, and their role in the future.

scholarly journals Assessment of Exercise Intolerance in Patients with Pre-Dialysis CKD with Cardiopulmonary Function Testing: Translation to Everyday Practice

2021 ◽  
pp. 1-15
Author(s):  
Eva Pella ◽  
Afroditi Boutou ◽  
Marieta P. Theodorakopoulou ◽  
Pantelis Sarafidis
Keyword(s):  
Cardiovascular Risk ◽  
Risk Stratification ◽  
Cardiopulmonary Exercise Testing ◽  
Adverse Outcomes ◽  
Exercise Intolerance ◽  
Exercise Limitation ◽  
Integrative Evaluation ◽  
Prognostic Utility ◽  
Risk Potential

<b><i>Background:</i></b> Chronic kidney disease (CKD) is often characterized by increased prevalence of cardiovascular risk factors and increased incidence of cardiovascular events and death. Reduced cardiovascular reserve and exercise intolerance are common in patients with CKD and are associated with adverse outcomes. <b><i>Summary:</i></b> The gold standard for identifying exercise limitation is cardiopulmonary exercise testing (CPET). CPET provides an integrative evaluation of cardiovascular, pulmonary, hematopoietic, neuropsychological, and metabolic function during maximal or submaximal exercise. It is useful in clinical setting for differentiation of the causes of exercise intolerance, risk stratification, and assessment of response to relevant treatments. A number of recent studies have used CPET in patients with pre-dialysis CKD, aiming to assess the cardiovascular reserve of these individuals, as well as the effect of interventions such as exercise training programs on their functional capacity. This review provides an in-depth description of CPET methodology and an overview of studies that utilized CPET technology to assess cardiovascular reserve in patients with pre-dialysis CKD. <b><i>Key Messages:</i></b> CPET can delineate multisystem changes and offer comprehensive phenotyping of factors determining overall cardiovascular risk. Potential clinical applications of CPET in CKD patients range from objective diagnosis of exercise intolerance to preoperative and long-term risk stratification and providing intermediate endpoints for clinical trials. Future studies should delineate the association of CPET indexes, with cardiovascular and respiratory alterations and hard outcomes in CKD patients, to enhance its diagnostic and prognostic utility in this population.

Investigating the Role of Data-Driven Decision-Making Within School Improvement Processes

2021 ◽  
pp. 1707-1725
Author(s):  
Venesser Fernandes
Keyword(s):  
Decision Making ◽  
Organizational Change ◽  
School Improvement ◽  
Critical Role ◽  
Data Driven ◽  
Evidence Based ◽  
Data Driven Decision Making ◽  
Continuous School Improvement ◽  
Decision Making Processes

This chapter provides a detailed literature review exploring the importance of data-driven decision-making processes in current Australian school improvement processes within a context of evidence-based organizational change and development. An investigation into the concept of decision-making and its effect on organizational culture is conducted as change and development are considered to be the new constants in the current discourse around continuous school improvement in schools. In a close examination of literature, this chapter investigates how key factors such as collaboration, communication, and organizational trust are achieved through data-driven decision-making within continuous school improvement processes. The critical role of leadership in sustaining data cultures is also examined for its direct impact on continuous school improvement processes based on evidence-based organizational change and development practices. Future implications of data-driven decision-making to sustain continuous school improvement and accountability processes in Australian schools are discussed.

scholarly journals The Critical Role of Instructional Response for Identifying Dyslexia and Other Learning Disabilities

2020 ◽  
Vol 53 (5) ◽  
pp. 343-353 ◽  
Author(s):  
Jeremy Miciak ◽  
Jack M. Fletcher
Keyword(s):  
Best Practices ◽  
Empirical Evidence ◽  
Critical Role ◽  
Fidelity Of Implementation ◽  
Assessment Process ◽  
Evidence Based ◽  
Inadequate Response ◽  
Identification Process ◽  
Based Instruction

This article addresses the nature of dyslexia and best practices for identification and treatment within the context of multitier systems of support (MTSS). We initially review proposed definitions of dyslexia to identify key commonalities and differences in proposed attributes. We then review empirical evidence for proposed definitional attributes, focusing on key sources of controversy, including the role of IQ, instructional response, as well as issues of etiology and immutability. We argue that current empirical evidence supports a dyslexia classification marked by specific deficits in reading and spelling words combined with inadequate response to evidence-based instruction. We then propose a “hybrid” dyslexia identification process built to gather data relevant to these markers of dyslexia. We argue that this assessment process is best implemented within school-wide MTSS because it leverages data routinely collected in well-implemented MTSS, including documentation of student progress and fidelity of implementation. In contrast with other proposed methods for learning disability (LD) identification, the proposed “hybrid” method demonstrates strong evidence for valid decision-making and directly informs intervention.

scholarly journals Risk stratification of patients with non-Q wave myocardial infarction. The critical role of ST segment depression. The Diltiazem Reinfarction Study Research Group.

Circulation ◽  
1989 ◽  
Vol 80 (5) ◽  
pp. 1148-1158 ◽  
Author(s):  
K B Schechtman ◽  
R J Capone ◽  
R E Kleiger ◽  
R S Gibson ◽  
D J Schwartz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Stratification ◽  
Research Group ◽  
Critical Role ◽  
Study Research ◽  
St Segment ◽  
Q Wave

The nationwide frequency of major adverse outcomes in antireflux surgery and the role of surgeon experience, 1992–1997

2002 ◽  
Vol 195 (5) ◽  
pp. 611-618 ◽  
Author(s):  
David R. Flum ◽  
Thomas Koepsell ◽  
Patrick Heagerty ◽  
Carlos A. Pellegrini
Keyword(s):  
Antireflux Surgery ◽  
Adverse Outcomes ◽  
Surgeon Experience

scholarly journals High-sensitivity troponin I for risk stratification in normotensive pulmonary embolism

2020 ◽  
Vol 6 (4) ◽  
pp. 00625-2020
Author(s):  
Matthias Ebner ◽  
Niklas Guddat ◽  
Karsten Keller ◽  
Marie Christine Merten ◽  
Markus H. Lerchbaumer ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Troponin I ◽  
Adverse Outcome ◽  
High Sensitivity ◽  
Adverse Outcomes ◽  
Prognostic Role ◽  
High Sensitivity Troponin ◽  
All Cause Mortality

While numerous studies have confirmed the prognostic role of high-sensitivity troponin T (hsTnT) in pulmonary embolism (PE), high-sensitivity troponin I (hsTnI) is inappropriately studied. This study aimed to investigate the prognostic relevance of hsTnI in normotensive PE, establish the optimal cut-off value for risk stratification and to compare the prognostic performances of hsTnI and hsTnT.Based on data from 459 consecutive PE patients enrolled in a single-centre registry, receiver operating characteristic analysis was used to identify an optimal hsTnI cut-off value for prediction of in-hospital adverse outcomes (PE-related death, cardiopulmonary resuscitation or vasopressor treatment) and all-cause mortality.Patients who suffered an in-hospital adverse outcome (4.8%) had higher hsTnI concentrations compared with those with a favourable clinical course (57 (interquartile range (IQR) 22–197) versus 15 (IQR 10–86) pg·mL−1, p=0.03). A hsTnI cut-off value of 16 ng·mL−1 provided optimal prognostic performance and predicted in-hospital adverse outcomes (OR 6.5, 95% CI 1.9–22.4) and all-cause mortality (OR 3.7, 95% CI 1.0–13.3). Between female and male patients, no relevant differences in hsTnI concentrations (17 (IQR 10–97) versus 17 (IQR 10–92) pg·mL−1, p=0.79) or optimised cut-off values were observed. Risk stratification according to the 2019 European Society of Cardiology algorithm revealed no differences if calculated based on either hsTnI or hsTnT (p=0.68).Our findings confirm the prognostic role of hsTnI in normotensive PE. HsTnI concentrations >16 pg·mL−1 predicted in-hospital adverse outcome and all-cause mortality; sex-specific cut-off values do not seem necessary. Importantly, our results suggest that hsTnI and hsTnT can be used interchangeably for risk stratification.

scholarly journals The Key Role of Uric Acid in Oxidative Stress, Inflammation, Fibrosis, Apoptosis, and Immunity in the Pathogenesis of Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Yawen Deng ◽  
Fei Liu ◽  
Xiaolei Yang ◽  
Yunlong Xia
Keyword(s):  
Oxidative Stress ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Clinical Evidence ◽  
Scientific Evidence ◽  
Critical Role ◽  
Adverse Outcomes

Atrial fibrillation (AF) is a highly prevalent cardiac arrhythmia that leads to numerous adverse outcomes including stroke, heart failure, and death. Hyperuricemia is an important risk factor that contributes to atrium injury and AF, but the underlying molecular mechanism remains to be elucidated. In this review, we discussed the scientific evidence for clarifying the role of hyperuricemia in the pathogenesis of AF. Experimental and Clinical evidence endorse hyperuricemia as an independent risk factor for the incidence of AF. Various in vivo and in vitro investigations showed that hyperuricemia might play a critical role in the pathogenesis of AF at different UA concentrations through the activation of oxidative stress, inflammation, fibrosis, apoptosis, and immunity.

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