Adjunctive Pharmacologic Use in Carotid Endarterectomy: A Review

Vascular ◽  
2006 ◽  
Vol 14 (2) ◽  
pp. 93-102
Author(s):  
David Gortler ◽  
Stephen Maloney ◽  
Reuben Rutland ◽  
Tormod Westvik ◽  
Akihito Muto ◽  
...  
Keyword(s):  
Acetylsalicylic Acid ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Surgical Outcomes ◽  
Randomized Trials ◽  
Improve Patient Care ◽  
Pharmaceutical Agent ◽  
Pharmacologic Agents ◽  
Improve Patient

Although carotid endarterectomy (CEA) is now widely accepted as the surgical therapy for carotid stenosis, the role of and indications and evidence for many pharmacologic agents that are used adjunctively in the perioperative setting have not been conclusively established. Aspirin (acetylsalicylic acid) is the pharmaceutical agent that has been studied most extensively in conjunction with CEA; other than aspirin and dextran, the use of many agents before, during, and after CEA has not been standardized. Prospective randomized trials are still needed to demonstrate efficacy, predict outcome, and determine the optimal use of these medications in their adjunctive use during CEA to improve patient care and obtain optimal surgical outcomes.

Periprocedural Drug Therapy in Carotid Artery Stenting: The Need for More Evidence

Vascular ◽  
2008 ◽  
Vol 16 (6) ◽  
pp. 303-309 ◽  
Author(s):  
David Gortler ◽  
Felix J.V. Schlösser ◽  
Bart E. Muhs ◽  
Michael A. Nelson ◽  
Alan Dardik†
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Randomized Trials ◽  
Dual Antiplatelet Therapy ◽  
Improve Patient Care ◽  
Optimal Time ◽  
Optimal Outcomes ◽  
Pharmacologic Agents ◽  
Improve Patient ◽  
Large Prospective Cohort

Carotid artery stenting (CAS) is a widely accepted alternative for patients at high risk for carotid endarterectomy (CEA). However, the role, indications, and evidence for many pharmacologic agents that are used adjunctively in the periprocedural setting have not been established. Several drugs are commonly used before, during, and after CAS, but their uses have not been standardized. Large prospective cohort studies with good validity or randomized trials are needed to demonstrate efficacy, predict outcome, and determine the optimal use of these medications in patients undergoing CAS to improve patient care and obtain optimal outcomes. Several conclusions can be made: (1) dual-antiplatelet therapy (aspirin and clopidogrel) is commonly used for CAS; (2) the most commonly used regimen is aspirin 325 mg and clopidogrel 75 mg per day, but the optimal time of therapy is unknown; and (3) the dose and regimen of other agents used for CAS are not established.

A-137 Role of Neuropsychology in Framing and Assisting the Development of Recovery Efforts: Education for Providers across Disciplines

2021 ◽  
Vol 36 (6) ◽  
pp. 1189-1190
Author(s):  
Timea Tozser ◽  
Gokce Ergun
Keyword(s):  
Improve Patient Care ◽  
Clinical Population ◽  
Medical Providers ◽  
Data Synthesis ◽  
Recovery Expectations ◽  
Programmatic Evaluation ◽  
Recovery Management ◽  
The Brain ◽  
Improve Patient

Abstract Objective Information regarding differences in concussion and mild TBI recovery management protocols and recovery expectations vary across disciplines. This often leads to imprecise expectations for prognosis and adverse impacts on effective treatment and recovery. National groups and institutions provide training regarding concussion by neuropsychologists and rehabilitation psychologists to psychologists; however, broadband cross-discipline training is limited. Clinically, psychoeducation and clarification fall on Neuropsychologists and Rehabilitation psychologists. The purpose of this poster is to highlight the importance of the role of neuropsychologists in the education of concussion versus TBI recovery to support medical providers, teachers, and educators to facilitate appropriate care. Data Selection The current literature was review and obtained through the search within various databases such as PsycInfo, Google Scholar, and OhioLink. Keywords such as concussion, mild traumatic brain injury, psychoeducation, and neuropsychology were utilized to provide an inclusive review of the current research (2016–2021). Data Synthesis The focus of existing literature supports the education of concussions for patients and their families. Much of the literature supports the role of many disciplines to aid in recovery. There is limited research to support neuropsychology/Rehabilitation psychology’s efficacy to provide didactic training for providers of different fields supporting this population. Conclusion Through research, advocacy, and program development, the field of Neuropsychology and Rehabilitation psychology can utilize the holistic framework of the brain–body relationship to further facilitate the discussion of concussion and TBI recovery for providers of other disciplines serving these populations. Since treatment is multi-disciplinary for this clinical population, further programmatic evaluation provides interdisciplinary didactics to improve patient care.

Anticoagulation in the Treatment of Established Venous Thromboembolism in Patients With Cancer

2009 ◽  
Vol 27 (29) ◽  
pp. 4895-4901 ◽  
Author(s):  
Agnes Y.Y. Lee
Keyword(s):  
Vena Cava ◽  
Improve Patient Care ◽  
Therapeutic Interventions ◽  
Low Molecular Weight ◽  
Patients With Cancer ◽  
Filter Insertion ◽  
Cancer Associated Thrombosis ◽  
Improve Patient ◽  
Population Treatment

Cancer-associated thrombosis is a frequent and costly complication in patients with cancer. Significant morbidity and mortality not only result from thrombotic events, but may also occur as a result of the therapeutic interventions. The established treatment for cancer-associated thrombosis is anticoagulant therapy. Of the few options available, low molecular weight heparin (LMWH) is the preferred agent because of its efficacy, safety, and convenience. Alternatives to LMWH have undesirable limitations and have demonstrated poorer efficacy and safety in the oncology population. Treatment of recurrent thrombosis, patients with concurrent bleeding issues, role of vena cava filter insertion, and duration of therapy are all areas in need of urgent research. Treatment of cancer-associated thrombosis remains a challenging task and is limited by the paucity of evidence-based data. Research is urgently needed to advance current practice and improve patient care.

Pediatric Renal Replacement Therapy

2018 ◽  
Author(s):  
Nathan A. Vaughan ◽  
Faisal G. Qureshi
Keyword(s):  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Kidney Injury ◽  
Improve Patient Care ◽  
Critically Ill Children ◽  
Critically Ill Patient ◽  
Anticoagulation Management ◽  
Improve Patient

Acute kidney injury (AKI) is common in the critically ill patient, including the traumatically injured and postsurgical setting. Renal replacement therapy (RRT) provides an efficacious therapy in the management of AKI. The expanding knowledge of the technique and its challenges have propagated its application to the treatment of critically ill children. RRT utilizes diffusion and convection to manage electrolytes and toxic metabolites to maintain homeostasis. The various components of the dialysis circuit can be arranged to best address the patient’s physiologic derangements during continuous RRT. A knowledge of the anticoagulation management, circuit priming, and dosing in children is required by the intensivist to provide efficacious care. Understanding the technique for venous and peritoneal access facilitates the surgeon to safely provide a means of therapy. Peritoneal dialysis provides a means of therapy when continuous RRT is not available. As with any therapy, the complication profile determines the role of therapy. Comprehension of the associated outcomes with different pediatric pathologies will allow the surgical team to improve patient care. This review contains 5 figures, 7 tables, and 66 references. Key Words: acute renal failure, critical care, hemodialysis, pediatric, renal replacement therapy

scholarly journals Coronary Microvascular Function and Beyond: The Crosstalk between Hormones, Cytokines, and Neurotransmitters

2015 ◽  
Vol 2015 ◽  
pp. 1-17 ◽  
Author(s):  
Carlo Dal Lin ◽  
Francesco Tona ◽  
Elena Osto
Keyword(s):  
Cardiovascular System ◽  
Improve Patient Care ◽  
Therapeutic Strategies ◽  
Entire Body ◽  
Hemodynamic Function ◽  
Novel Therapeutic Strategies ◽  
Fine Tune ◽  
Improve Patient ◽  
Coronary Microvascular Function

Beyond its hemodynamic function, the heart also acts as a neuroendocrine and immunoregulatory organ. A dynamic communication between the heart and other organs takes place constantly to maintain cardiovascular homeostasis. The current understanding highlights the importance of the endocrine, immune, and nervous factors to fine-tune the crosstalk of the cardiovascular system with the entire body. Once disrupted, this complex interorgan communication may promote the onset and the progression of cardiovascular diseases. Thus, expanding our knowledge on how these factors influence the cardiovascular system can lead to novel therapeutic strategies to improve patient care. In the present paper, we review novel concepts on the role of endocrine, immune, and nervous factors in the modulation of microvascular coronary function.

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