Expanding the role of perfusionists in the era of new treatment options for cardiovascular disease

Perfusion ◽  
2003 ◽  
Vol 18 (4) ◽  
pp. 253-256 ◽  
Author(s):  
Joseph J Sistino
Keyword(s):  
Cardiovascular Disease ◽  
Treatment Options ◽  
Mail Survey ◽  
Surgical Patient ◽  
The Past ◽  
The Future ◽  
The Usa ◽  
Changing Patterns ◽  
New Treatment ◽  
New Applications

Treatment for cardiovascular disease has dramatically changed the surgical patient population over the past 10 years. Advances in medical management and interventional cardiovascular procedures have delayed surgery in many adults, and the surgical pool has begun to decrease despite an aging population. This affects perfusionists in terms of new psychological and technical challenges, and has serious consequences and implications for the future of the profession. This study will review the changing patterns of diagnosis and treatment of cardiovascular disease in the USA over the past 10 years by examining the annual surgical procedure rates and correlating them with the number of practicing perfusionists and new student graduates. The purpose of this review is to project the future employment opportunities for perfusionists. The second part of the paper will look at the alternative roles perfusionists have expanded into as a result of changes in the treatment of cardiovascular disease. The results of an e-mail survey of perfusionists will be presented to identify new applications of perfusion technology.

Epidemiology of cardiovascular disease in the last decade: treatment options and implications for perfusion in the 21st century

Perfusion ◽  
2003 ◽  
Vol 18 (2) ◽  
pp. 73-77 ◽  
Author(s):  
Joseph J Sistino
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Heart Surgery ◽  
Operative Procedure ◽  
Treatment Options ◽  
Population Projections ◽  
Discharge Data ◽  
The Past ◽  
Number Of Patients ◽  
The Usa

Cardiovascular disease (CVD) rates determine, to a large extent, the adult patient population that undergoes heart surgery. Many new treatment options have surfaced over the last decade which delay surgical intervention. The purpose of this study is to review the epidemiology of CVD in the USA over the past decade and project treatment patterns for the future. This information is important for the perfusion profession because it will influence the numbers of perfusionists required to staff open-heart centers in this country. Discharge data from hospitals in the USA were reviewed to determine numbers and rates of patients treated for CVD referenced to age and specific types of CVD. Operative procedure codes were reviewed to determine the volume and rates of cardiac surgical procedures, including catheterization and angioplasty, in the USA between 1990 and 2000. The results of this epidemiological review demonstrate that the surgical treatment rates for ischemic heart disease have not increased significantly over the past 10 years, except in the over-65 population. The large increase in the number of patients admitted for congestive heart failure (CHF) (39.4%) during this time period due to an aging population afford the perfusion profession an opportunity to become more involved in treatment options, such as cardiac assist devices. Cardiac surgeons are facing many of the same challenges that we face as perfusionists due to interventional cardiology, and should focus more attention on improving treatment for the heart failure population in the next decade. The continuation of perfusion education programs at their current rate of output seems justified, based on population projections and the increased incidence of CVD in the elderly population.

New Therapeutics for Ulcerative Colitis

2021 ◽  
Vol 72 (1) ◽  
pp. 199-213
Author(s):  
Robert P. Hirten ◽  
Bruce E. Sands
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Disease ◽  
Clinical Remission ◽  
Treatment Options ◽  
Treatment Modalities ◽  
Therapeutic Approaches ◽  
Stages Of Development ◽  
The Future ◽  
New Treatment ◽  
Novel Therapeutic

Ulcerative colitis (UC) is a relapsing and remitting inflammatory disease of the colon with a variable course. Despite advances in treatment, only approximately 40% of patients achieve clinical remission at the end of a year, prompting the exploration of new treatment modalities. This review explores novel therapeutic approaches to UC, including promising drugs in various stages of development, efforts to maximize the efficacy of currently available treatment options, and non-medication-based modalities. Treatment approaches which show promise in impacting the future of UC management are highlighted.

scholarly journals Adjuvant treatment of colorectal cancer

2002 ◽  
Vol 49 (2) ◽  
pp. 15-18
Author(s):  
J.A. Wils
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Treatment ◽  
Large Scale ◽  
New Drugs ◽  
Morbidity And Mortality ◽  
The Past ◽  
The Future ◽  
The Usa

Colorectal cancer is a leading cause of morbidity and mortality, with approximately 300,000 new cases and 200,000 related deaths in Europe and the USA each year. Adjuvant treatment of colorectal cancer is now widely accepted and can reduce mortality with approximately 10%. This can be considered as one of the major achievements in oncology from the past decade. Current results will be discussed and strategies for the future will be outlined, including on-going or planned large-scale trials with new drugs and approaches.

scholarly journals International Community’s Approach to Western Balkans: In Search of Stability and Security

2019 ◽  
Vol 25 (85) ◽  
pp. 64-88
Author(s):  
Janez Juvan
Keyword(s):  
European Union ◽  
International Institutions ◽  
Holistic Approach ◽  
International Community ◽  
The European Union ◽  
Western Balkans ◽  
The Past ◽  
The Future ◽  
The Usa ◽  
The Stability

Abstract The article presents research on the international community’s engagement in the countries of the Western Balkans in the past and their possible approach in the future. The focus of our research is on the functioning of mechanisms through which the international community performs certain tasks in the region. These interventions are primarily political, in the form of conferences, political programmes, consultations, pressures and continuous persuasion. Economic initiatives follow afterwards. By using different reform approaches, international institutions try to improve cooperation with the European Union (EU) and countries such as the USA, Russia, Turkey and China. Our research attempts to identify possible methods and new solutions for individual cases of conflict in Western Balkans countries, especially where the international community is actively involved. On this basis, we created a more holistic approach. The application of these measures could make the necessary reforms of the future easier. Our approach emphasises all the elements of security that are essential to the stability of the region and for the prevention of conflicts in the future.

scholarly journals Predicting the Future: Art and Algorithms

2020 ◽  
Vol 18 (3) ◽  
pp. 893-911
Author(s):  
Akos Rona-Tas
Keyword(s):  
Social Life ◽  
Consumer Credit ◽  
Social Contexts ◽  
Individual Level ◽  
The Past ◽  
Predictive Algorithms ◽  
The Future ◽  
The Usa ◽  
The Individual ◽  
Political Governance

Abstract Predictive algorithms are replacing the art of human judgement in rapidly growing areas of social life. By offering pattern recognition as forecast, predictive algorithms mechanically project the past onto the future, embracing a peculiar notion of time where the future is different in no radical way from the past and present, and a peculiar world where human agency is absent. Yet, prediction is about agency, we predict the future to change it. At the individual level, the psychological literature has concluded that in the realm of predictions, human judgement is inferior to algorithmic methods. At the sociological level, however, human judgement is often preferred over algorthms. We show how human and algorithmic predictions work in three social contexts—consumer credit, college admissions and criminal justice—and why people have good reasons to rely on human judgement. We argue that mechanical and overly successful local predictions can result in self-fulfilling prophecies and, eventually, global polarization and chaos. Finally, we look at algorithmic prediction as a form of societal and political governance and discuss how it is currently being constructed as a wide net of control by market processes in the USA and by government fiat in China.

More purinergic receptors deserve attention as therapeutic targets for the treatment of cardiovascular disease

2020 ◽  
Vol 319 (4) ◽  
pp. H723-H729 ◽  
Author(s):  
Bernhard Wernly ◽  
Zhichao Zhou (周稚超)
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Diseases ◽  
Purinergic Receptors ◽  
Treatment Options ◽  
Experimental Studies ◽  
Therapeutic Targets ◽  
Independent Effect ◽  
Coronary Syndrome ◽  
Future Drug ◽  
New Treatment

Cardiovascular disease is a major cause of morbidity and mortality worldwide. Innovative new treatment options for this cardiovascular pandemic are urgently needed. Activation of purinergic receptors (PRs) is critically involved in the development and progression of cardiovascular disease including atherosclerosis, ischemic heart disease, hypertension, and diabetes. PRs have been targeted for the treatment of several cardiovascular diseases in a clinical setting. The P2Y12R antagonists such as clopidogrel, ticagrelor, and others are the most successful class of purinergic drugs targeting platelets for the treatment of acute coronary syndrome. In addition to targeting platelets, ticagrelor may exert P2Y12R-independent effect by targeting erythrocyte-mediated purinergic activation. The partial A1R agonist neladenoson and the A2AR agonist regadenoson have been applied in cardiovascular medicine. In experimental studies, many other PRs have been shown to play a significant role in the development and progression of cardiovascular diseases, and targeting these receptors have resulted in promising outcomes. Therefore, many of these PRs including A2BR, A3R, P2X3R, P2X4R, P2X7R, P2Y1R, P2Y4R, P2Y6R, and P2Y11R can be considered as therapeutic targets. However, the multitude of PR subtypes expressed in different cells of the cardiovascular system may constitute a challenge whether single or multiple receptors should be targeted at the same time for the best efficacy. The present review discusses the promising purinergic drugs used in clinical studies for the treatment of cardiovascular disease. We also update experimental evidence for many other PRs that can be considered as therapeutic targets for future drug development.

Immunotherapy of multiple sclerosis

2009 ◽  
Vol 21 (S2) ◽  
pp. 27-34 ◽  
Author(s):  
Sven G. Meuth ◽  
Stefan Bittner ◽  
Heinz Wiendl
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Evidence ◽  
Treatment Options ◽  
Phase Iii ◽  
The Past ◽  
Phase Iii Clinical Trials ◽  
New Treatment ◽  
System Disorder ◽  
Immunomodulatory Therapies ◽  
Ms Therapy

Abstract:Multiple sclerosis (MS) is regarded as a prototypic inflammatory autoimmune central nervous system disorder causing neurological disability in young adults. Recommended basic immunomodulatory therapies of MS are currently interferon beta and glatiramer acetate. Both have proven to be clinically and paraclinically effective and clinical evidence suggests that treatment should be initiated as early as possible.However, despite the fact that therapeutic options for MS have significantly been widened over the past decade there is still tremendous activity in the search for new treatment options for MS.One important development in the field is reflected by the substantial number of promising results for oral therapies. Various phase III clinical trials are currently being initiated or are already underway evaluating the efficacy of a variety of orally administered agents, including cladribine, teriflunomide, laquinimod, fingolimod and fumaric acid. It is hoped that these oral therapies for MS further broaden our armament for MS therapy.

Evidence-Based Treatments

2017 ◽  
Author(s):  
W. Curt LaFrance ◽  
Laura H. Goldstein
Keyword(s):  
Treatment Options ◽  
Controlled Trials ◽  
Limited Sample ◽  
Future Studies ◽  
Psychogenic Nonepileptic Seizures ◽  
The Past ◽  
Evidence Based Treatments ◽  
Nonepileptic Seizures ◽  
New Treatment ◽  
Functional Neurological Disorders

Psychogenic nonepileptic seizures (PNES) have been in the medical literature for centuries. However, treatments were limited, being based on uncontrolled data, until the past decade. Treatment advances published since 2010 have included pilot controlled trials using psychotherapies, psychoeducational approaches, medications, and combined pharmacological and psychotherapeutic approaches that provide new treatment options for patients with PNES. This chapter describes these controlled trials in detail. It also covers studies of treatments for other functional neurological disorders including PNES. One conclusion from this review is that future studies still need to improve on as-yet limited sample sizes and provide insights into predictors of treatment outcome so that rational decisions can be made about which treatments offer the best outcome and who is likely to best respond to which treatment.

Factors That Determine Overall Survival among Patients (Pts) with Multiple Myeloma (MM) Treated with Zoledronic Acid (ZOL): Lack of Skeletal-Related Events (SREs) and Occurrence of Osteonecrosis of the Jaw (ONJ) Predict Improved Survival.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4842-4842
Author(s):  
James R. Berenson ◽  
Ori Yellin ◽  
John Crowley ◽  
Herbert Duvivier ◽  
Youram Nassir ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Serum Creatinine ◽  
Serum Calcium ◽  
Treatment Options ◽  
Elevated Serum ◽  
Time Dependent ◽  
Stage Ii ◽  
The Past ◽  
New Treatment

Abstract New treatment options have greatly improved the overall survival for MM pts. Although many baseline prognostic factors have been identified among pts with MM in the past, few studies have evaluated prognostic factors during the past five years when these new treatment options became available. Included in the newer regimens for myeloma pts is the use of monthly infusions of ZOL to reduce skeletal complications for MM pts. During this time of changes in the therapy for MM pts, complications associated with administration of bisphosphonates have been reported among MM pts. The outcome for patients with these complications has not been well-defined. The goal of this study was to identify baseline and on-treatment prognostic factors for determining overall survival of MM pts treated with ZOL. The inclusion criteria for this study included a diagnosis of MM and having received at least one dose of ZOL in our clinic. One hundred consecutive pts were analyzed in this retrospective study. The median survival of this group was 117 months. Risk factors for an earlier death included occurrence of a SRE (hazard ratio [HR] = 3.06), increased serum creatinine (HR = 3.35), elevated serum calcium (HR = 2.60), and ISS Stage II or III at diagnosis (HR = 2.04). Notably, diabetes was found to be a significant risk factor for SREs but not overall survival (P = 0.022). Ten pts developed ONJ, of whom nine are alive and one died in remission (non-MM-related). The 2-year incidence of ONJ was approximately 5%. There was a trend toward increased risk of ONJ for diabetes, smoking, and alcohol use. When evaluating the course of ONJ, only one pt showed progression, while six improved or resolved, and three remained stable. All but one pt with ONJ remain on monthly ZOL therapy. In regards to the disease status of the nine pts surviving with ONJ, five are in complete remission, two with ongoing partial responses, and two have stable disease. The skeletal morbidity rate (SMR) was only 0.16 SRE/year among all 100 pts analyzed. Notably, pts with ONJ had a lower SMR (0.07 SRE/year) than the 90 pts treated with ZOL who did not develop ONJ (0.18 SRE/year). Importantly, overall survival was superior among pts with ONJ versus pts without ONJ in this study when analyzed both by a landmark analysis and in a time-dependent fashion. Thus, development of new SREs, elevated serum creatinine, increased serum calcium and ISS Stage II or III at diagnosis predicted for an earlier death. With active monitoring for ONJ and early input from dental experts, ONJ has been mild to moderate in severity, had minimal impact on overall quality of life, and improved or healed in the majority of pts. In this study, absence of SREs (time-dependent) and occurrence of ONJ were associated with an improved overall survival (P ≤ .01 for each). These results suggest that with proper management, ONJ is a manageable, infrequent complication of ZOL that may be associated with a reduced SRE risk and improved overall survival. This study also suggests the avoidance of SREs is associated with an increased life expectancy; and, thus, reduction in these events through ongoing bisphosphonate therapy is important in the overall management of MM pts.

The Management of Corneal Neovascularisation – Update on New Clinical Data and Recommendations of Treatment

2016 ◽  
Vol 10 (02) ◽  
pp. 86 ◽  
Author(s):  
Natasha Spiteri ◽  
Vito Romano ◽  
Matthias Brunner ◽  
Bernhard Steger ◽  
Stephen B Kaye ◽  
...  
Keyword(s):  
Gene Therapy ◽  
Risk Factor ◽  
Clinical Data ◽  
Treatment Options ◽  
Experimental Treatment ◽  
Treatment Modalities ◽  
The Past ◽  
Recent Advances ◽  
The Future ◽  
Subsequent Failure

Vascularisation of the cornea may occur as a sight-threatening response to various insults to the cornea, such as infection, trauma and inflammation, and is a well-recognised risk factor for rejection and subsequent failure of corneal grafts. Various different treatment modalities have been used in the past, with varying levels of success. In this review, we discuss the pathogenesis of corneal neovascularisation, look at recent advances in the assessment of these patients and give an overview of currently available treatment options, both medical and surgical. We also discuss current experimental treatment for corneal neovascularisation, such as gene therapy, which may provide further treatment options in the future.

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