bluuebunny/crossref_metadata_2025 huggingface dataset:
The importance of cohesion and enjoyment for the fitness improvement of 8–10‐year‐old children participating in a team and individual sport school‐based physical activity intervention
Authors: Elbe Anne‐Marie , Wikman Johan Michael , Zheng Miky , Larsen Malte Nejst , Nielsen Glen , Krustrup Peter
Published: December 2016

This study investigates the enjoyment and cohesion of school children participating in a school‐based high‐intensity physical activity (PA) intervention. Both enjoyment and cohesion have been found to be important factors for adherence to regular physical and sport activity, an important outcome of PA interventions. The sample consisted of 300 pupils (mean age: 9.3 years; 52.7% female) assigned to a team sport intervention, an individual sport intervention, or a control group for 10 months. The Physical Activity Enjoyment Scale and Youth Sport Environment Questionnaire were used to measure enjoyment and cohesion. The Yo‐Yo IR1C test determined fitness improvements. Results showed that enjoyment and cohesion (social) measured at the beginning of the intervention significantly predict fitness improvements achieved after 10 months. No differing developmental effects over time could be found in the intervention groups with regard to cohesion and enjoyment when comparing them to the control group. However, enjoyment and cohesion (social) significantly decreased in the groups that performed individual sports. Team sports seem to be more advantageous for the development of enjoyment and cohesion, which are both factors that positively impact the health outcomes of the intervention.
Investment Success in Public Health: An Analysis of the Cost-Effectiveness and Cost-Benefit of the Global Programme to Eliminate Lymphatic Filariasis
Authors: Turner Hugo C. , Bettis Alison A. , Chu Brian K. , McFarland Deborah A. , Hooper Pamela J. , Mante Sunny D. , Fitzpatrick Christopher , Bradley Mark H.
Published: December 2016

Background.

It has been estimated that $154 million per year will be required during 2015–2020 to continue the Global Programme to Eliminate Lymphatic Filariasis (GPELF). In light of this, it is important to understand the program’s current value. Here, we evaluate the cost-effectiveness and cost-benefit of the preventive chemotherapy that was provided under the GPELF between 2000 and 2014. In addition, we also investigate the potential cost-effectiveness of hydrocele surgery.

Methods.

Our economic evaluation of preventive chemotherapy was based on previously published health and economic impact estimates (between 2000 and 2014). The delivery costs of treatment were estimated using a model developed by the World Health Organization. We also developed a model to investigate the number of disability-adjusted life years (DALYs) averted by a hydrocelectomy and identified the cost threshold under which it would be considered cost-effective.

Results.

The projected cost-effectiveness and cost-benefit of preventive chemotherapy were very promising, and this was robust over a wide range of costs and assumptions. When the economic value of the donated drugs was not included, the GPELF would be classed as highly cost-effective. We projected that a typical hydrocelectomy would be classed as highly cost-effective if the surgery cost less than $66 and cost-effective if less than $398 (based on the World Bank’s cost-effectiveness thresholds for low income countries).

Conclusions.

Both the preventive chemotherapy and hydrocele surgeries provided under the GPELF are incredibly cost-effective and offer a very good investment in public health.
Risk of Active Tuberculosis in Patients With Cancer: A Systematic Review and Metaanalysis
Authors: Cheng Matthew P. , Chakra Claire Nour Abou , Yansouni Cedric P. , Cnossen Sonya , Shrier Ian , Menzies Dick , Greenaway Christina
Published: December 2016

Background.

Cancer is a known risk factor for developing active tuberculosis. We determined the incidence and relative risk of active tuberculosis in cancer patients compared to the general population.

Methods.

Medline, Medline InProcess, EMBASE, PubMed, the Cochrane Database of Systematic Reviews, Cancerlit, and Web of Science were searched up to December 1, 2015. Studies of pathologically confirmed cancer cases were included if active tuberculosis was identified concurrently or after diagnosis. Cumulative incidence rate/100 000 population (CIR) of new cases of tuberculosis occurring in cancer patients and comparative incidence rate ratios (IRRs) to the general population from the same country of origin were estimated. A random effect meta-analysis was conducted on the CIR and IRR.

Results.

A total of 23 studies reporting 593 tuberculosis cases occurring in 324 041 cancer patients between 1950 and 2011 were identified. In a meta-analysis of 6 studies conducted in the United States in 317 243 cancer patients (98% of all patients), the CIR of tuberculosis decreased by 3-fold and 6.5-fold in hematologic and solid cancers, respectively, before and after 1980. After 1980 the CIR of tuberculosis was highest in hematologic (219/100 000 population; IRR = 26), head and neck (143; 16), lung cancers (83; 9) and was lowest in breast and other solid cancers (38; 4).

Conclusions.

Individuals living in the United States with hematologic, head and neck, and lung cancers had a 9-fold higher rate of developing active tuberculosis compared to those without cancer and would benefit from targeted latent tuberculosis screening and therapy.
Patient-Centered Medicine: Who, What, and How?
Authors: Sullivan Mark D.
Published: December 2016

We don’t have a clear idea where health comes from. Our efforts to reform health care to make it more patient-centered and more responsive to the challenges of chronic illness have been too superficial. Three lessons for chronic illness care are derived: 1) we cannot assume that death and disease are the most important targets for health care, 2) we must draw on the patient’s perspective to define the nature of the clinical problem and the criteria of success for our clinical interventions, and 3) we must always aim toward increasing the patient’s capacity for self-care. The patient-centered care of chronic disease requires that we recognize the patient as the primary perceiver and producer of health. We must move not only from the passive patient to the informed and activated patient, but to the autonomous patient. Patient agency is both the primary means and primary end of health care.
Respecting and Promoting Patient Autonomy in Research, End-of-Life Care, and Chronic Illness Care
Authors: Sullivan Mark D.
Published: December 2016

Bioethics teaches us to respect patients as persons by respecting their decisional autonomy. We respect patient autonomy by seeking patients’ informed consent, a policy was first developed for clinical research, where it has worked reasonably well. In other areas, most notably end-of-life care, it has not worked as well. Respecting patient autonomy is not adequate respect for them as ill persons. Rather than opposing physician beneficence and patient autonomy, as is customary in bioethics, we should consider the promotion of patient autonomy as a part of physician beneficence. This recasts the conflict between beneficence and autonomy as the conflict between respecting and promoting patient autonomy. This autonomy needs to be understood not just as the ability to make decisions but also as the general ability to do and be things of value (i.e. agency). This autonomy is not just a value that qualifies care, but is a goal of care.
Mental illness versus mental disorder: Arguments and forensic implications
Authors: Kröber Hans-Ludwig
Published: December 2016

Modern psychiatry uses a theoretical concept of ‘disorder’: it describes various impaired functions without distinguishing pathological disorders from non-pathological disorders, or even from disorders similar to an illness. Of course, this usage eliminates neither illnesses nor the subjective experience of being ill, but it has implications for forensic psychiatry and for the assessment of a person’s legal responsibility. Having schizophrenic delusions constitutes a categorically different state from having only wishful illusions or a vivid imagination. In the context of medicine and psychiatry, we certainly encounter stages that signal fundamental differences. These differences are easily detected when assessing psychotic disorders or similar states, but a lot of differences also arise when assessing perpetrators with personality disorders or simply antisocial behavior. Where, in these states, are the borders that demarcate full responsibility from substantially reduced social responsibility?
Storage and report
Authors: Droogmans Steven , Salustri Alessandro , Cosyns Bernard
Published: December 2016

Digital storage and structured reporting of an echocardiographic examination lead not only to increased quality of the image acquisition process, an understandable and clinically relevant exam report, but even more importantly to improved patient care. This chapter first describes the many advantages of a digital echocardiographic laboratory and then in a second part how to report the results of a complete echocardiogram, including mandatory items, recommended items, findings and measurements, comments, and conclusions, emphasizing the main findings of the diagnosis and the severity of the heart disease.
Transoesophageal echocardiography
Authors: Flachskampf Frank A. , Pepi Mauro , Gianstefani Silvia
Published: December 2016

Transoesophageal echocardiography (TOE) is a standard echocardiographic technique which uses the oesophagus and upper stomach as echo windows on the heart and thoracic vessels via an endoscopic probe. It is indicated when transthoracic echocardiography is unable or unlikely to answer the clinical question. Typical indications where TOE has a proven superiority include diagnosis of left atrial thrombi, especially in the appendage, morphological evaluation of atrial septal defect, infective endocarditis, mitral valve disease, aortic and prosthetic valves, aortic diseases, and intraoperative monitoring of cardiac surgery or interventions. Indications, technique, typical views, and information to obtain in specific scenarios are presented.
Hand-held echocardiography
Authors: Pellerin Denis , Cardim Nuno , Prinz Christian
Published: December 2016

Pocket-size hand-held echocardiography (PHE) is low cost, portable, user friendly, and battery powered. Studies using PHE do not replace conventional echo studies and do not provide a complete diagnostic echocardiographic examination. PHE should be used for goal-oriented studies that include assessment of left ventricular (LV) cavity size, LV systolic function, detection of pericardial effusion, and haemodynamic compromise. Examinations using PHE have been demonstrated to be feasible and provide additional information to the physical examination. For potential users other than cardiology experts in echocardiography the accuracy of PHE data highly depends on training and competency. Emphasis must be placed on acquisition of good quality images and knowledge of pitfalls and limitations. The challenge is providing efficient training programmes to ensure competency in performing focused studies and have recognition of an appropriate threshold for seeking expert advice and full echo examination. PHE is a useful teaching tool and provides important complementary information for medical education.
Intracardiac and intravascular echocardiography
Authors: Habib Gilbert , di Mario Carlo , Van Camp Guy
Published: December 2016

Intracardiac echocardiography is a relatively new echocardiographic technique, essentially used for monitoring of percutaneous atrial septal defect closure procedures and for electrophysiological catheter-based ablations. It is still limited to a few experienced centres, but presents with several advantages, including the safe guidance of percutaneous interventional treatments, avoidance of general anaesthesia, and reduction in radiation exposure. Intracardiac echocardiography is likely to be more and more used, with the development of new catheter interventional procedures. This chapter discusses the principles, methods, and main indications for intracardiac echocardiography in monitoring and guidance of interventional procedures as well as new developments and its cost-benefit ratio.
Left ventricle: morphology and geometry
Authors: Zhang Peng-Fei , Zhang Yun , Yen Ho Siew
Published: December 2016

The left ventricle is a cone-shaped muscular pump which receives the blood from the left atrium through the inflow tract and ejects it to the aorta through the outflow tract. The double helical myocardial fibre formation is the basis of efficient motion, function, and morphology of the left ventricle. Physiological or pathological changes of these characteristics of the left ventricle can be evaluated by echocardiography. This chapter describes the morphology and geometry of the left ventricle, including the inflow tract, the outflow tract, double helix formation of left ventricle myocardium, and the echocardiographic assessment of left ventricle morphology and geometry.
Left ventricle: systolic function
Authors: Cosyns Bernard , Edvardsen Thor , Hristova Krasimira , Kim Hyung-Kwan
Published: December 2016

The assessment of left ventricular (LV) systolic function is one of the most important parts of correct diagnosis, selection of treatment strategy or medications, and prediction of prognosis. Although cardiac magnetic resonance imaging is generally accepted as the gold standard in vivo imaging modality for assessing LV systolic function, its practical use is limited due to its limited availability, high cost, and the presence of conditions precluding its performance such as a pacemaker, claustrophobia, and severe arrhythmia. Thus, transthoracic echocardiography is a first-line imaging modality employed in daily practice and has been widely used. Since the first attempts with M-mode approach, remarkable improvements have been made with the advent of two-dimensional echocardiography, and more recently three-dimensional echocardiography, with high accuracy and reproducibility. More sophisticated methodologies such as strain imaging, based on Doppler or speckle tracking techniques, provide a more sensitive and quantitative measurement of myocardial contractility, and are gaining a place in common daily practice. This chapter describes different modalities that have been used for assessment of LV systolic function based on echocardiography, and is grossly composed of two parts: LV global systolic function and LV regional or segmental systolic function. For better application of these conventional and novel methods of assessing LV systolic function, strengths and pitfalls of these techniques should be acknowledged.
Left ventricle: diastolic function
Authors: Smiseth Otto A. , Galderisi Maurizio , Oh Jae K.
Published: December 2016

Evaluation of diastolic function by echocardiography is useful to diagnose heart failure with preserved ejection fraction by showing signs of diastolic dysfunction, and regardless of ejection fraction, echocardiography can be used to estimate left ventricular (LV) filling pressure. Diastolic dysfunction occurs in a number of cardiac diseases other than heart failure and mild diastolic dysfunction is part of the normal ageing process. The fundamental disturbances in diastolic dysfunction are slowing of myocardial relaxation, loss of restoring forces, and reduced LV chamber compliance. As a compensatory response there is elevated LV filling pressure. Slowing of relaxation and loss of restoring forces are reflected in reduction in LV early diastolic lengthening velocity (e?) by tissue Doppler. The reduced diastolic compliance is reflected in faster deceleration of early diastolic transmitral velocity by pulsed wave Doppler. Elevated LV filling pressure is reflected in a number of Doppler indices and in enlarged left atrium. This chapter reviews the physiology of diastolic function, the clinical methods and indices which are available, and how these should be applied.
Left atrium
Authors: Rosca Monica , Mondillo Sergio , O’Connor Kim
Published: December 2016

The left atrium (LA) in a close interdependence with the left ventricle plays an essential role in the overall cardiovascular performance. The impact of LA remodelling on prognosis and risk stratification has gathered increasing evidence. With advances in imaging technology, the assessment of LA size and function become more accessible and precise. LA volume provides the most accurate estimate of LA size and superior prognostic information. Accounting for complex geometry and motion, three-dimensional echocardiography emerges as the preferred technique for the assessment of dynamic changes in LA volume. The assessment of LA function, providing important pathophysiological information, can add consistency in establishing the clinical role of LA remodelling. It is essential to fully understand the strengths and weaknesses of conventional and new echocardiographic techniques used to evaluate LA function. Atrial strain and strain rate parameters are less load dependent and have higher sensitivity in assessing LA function than conventional parameters. However, the lack of standardization and incomplete data regarding their prognostic value limits their routine use in current clinical practice.
Heart failure: left ventricular dyssynchrony
Authors: Voigt Jens Uwe , Søgaard Peter , Joyce Emer
Published: December 2016

Echocardiography plays a pivotal role in the management of patients with dilative cardiomyopathy and conduction disease, particularly in the setting of cardiac resynchronization therapy (CRT). Current CRT guidelines recommend the echocardiographic assessment of left ventricular size and function. Furthermore, echocardiography has the potential of analysing regional myocardial mechanics with high temporal resolution and without radiation burden or danger for the patient. Assessment of left ventricular dyssynchrony has therefore become the next challenge. Besides the visual approaches, newer methods of functional imaging such as tissue Doppler and speckle tracking allow the exact quantification of regional myocardial function. This chapter reviews the current status of left ventricular dyssynchrony assessment by echocardiography and introduces emerging techniques which can better link conduction abnormalities and mechanical events and, thus, potentially improve clinical decision-making in this field.
Hypertrophic cardiomyopathy
Authors: Cardim Nuno , Pellerin Denis , Valente Filipa Xavier
Published: December 2016

Hypertrophic cardiomyopathy is a common inherited heart disease caused by genetic mutations in cardiac sarcomeric proteins. Although most patients are asymptomatic and many remain undiagnosed, the clinical presentation and natural history include sudden cardiac death, heart failure, and atrial fibrillation. Echocardiography plays an essential role in the diagnosis, serial monitoring, prognostic stratification, and family screening. Advances in Doppler myocardial imaging and deformation analysis have improved preclinical diagnosis as well as the differential diagnosis of left ventricular hypertrophy. Finally, echocardiography is closely involved in patient selection and in intraoperative guidance and monitoring of septal reduction procedures. This chapter describes the pathophysiology, clinical presentation, role of echocardiography, morphological features, differential diagnosis, diagnostic criteria in first-degree relatives, echo guidance for the treatment of symptomatic left ventricular outflow tract obstruction, and follow-up and monitoring of patients with hypertrophic cardiomyopathy.
Dilated cardiomyopathy
Authors: Rigo Fausto , Fernández-Golfín Covadonga , Pinamonti Bruno
Published: December 2016

Dilated cardiomyopathy (DCM) is characterized by a globally dilated and dysfunctioning left ventricle (LV). Therefore, echocardiographic diagnostic criteria for DCM are a LV end-diastolic diameter greater than 117% predicted value corrected for age and body surface area and a LV ejection fraction less than 45% (and/or fractional shortening less than 25%). Usually, the LV is also characterized by a normal or mildly increased wall thickness with eccentric hypertrophy and increased mass, a spherical geometry (the so-called LV remodelling), a dyssynchronous contraction (typically with left bundle branch block), and diastolic dysfunction with elevated LV filling pressure. Other typical echocardiographic features of DCM include functional mitral and tricuspid regurgitation, right ventricular dysfunction, atrial dilatation, and secondary pulmonary hypertension. Several echocardiographic parameters, measured both at baseline and at follow-up, are valuable for prognostic stratification of DCM patients. Furthermore, re-evaluation of echocardiographic parameters during the disease course under optimal medical therapy is valuable for tailoring medical treatment and confirming indications for invasive treatments at follow-up. The stress echo can play a pivotal role in the different phases of DCM helping us in stratifying the prognosis of these patients. Finally, familial screening is an important tool for early diagnosis of DCM in asymptomatic patients.
Right ventricular dilatation and function
Authors: Nihoyannopoulos Petros , Molina Gustavo Restrepo , La Gerche André
Published: December 2016

Assessing the right ventricle by any imaging modality is a challenge because of the thin wall and crescent shape that wraps around the left ventricle. Structured echocardiographic examination using two-dimensional imaging provides a detailed regional and global qualitative assessment for routine evaluation. Quantitation is possible using one or more methods including tricuspid annulus plane systolic excursion, fractional area change, and myocardial performance index but speckle tracking deformation imaging and three-dimensional echocardiography are emerging as more robust quantitative methods. Right ventricular pressures should also be estimated routinely as long as a clear tricuspid regurgitant jet is identified.
Pericardial disease
Authors: Paelinck Bernard , Lazarević Aleksandar , Fajardo Pedro Gutierrez
Published: December 2016

Echocardiography is the cornerstone for the diagnosis of pericardial disease. It is a portable technique allowing morphological and functional multimodality (M-mode, two-dimensional, Doppler, and tissue Doppler) imaging of pericardial disease. In addition, echocardiography is essential for differential diagnosis (pericardial effusion vs pleural effusion, constrictive pericarditis vs restrictive cardiomyopathy) and allows bedside guiding of pericardiocentesis. This chapter describes normal pericardial anatomy and reviews echocardiographic features of different pericardial diseases and their pathophysiology, including pericarditis, pericardial effusion, constrictive pericarditis, pericardial cyst, and congenital absence of pericardium.
Systemic disease and other conditions: athlete’s heart
Authors: D’Andrea Antonello , La Gerche André , Selton-Suty Christine
Published: December 2016

The term ‘athlete’s heart’ refers to the structural, functional, and electrical adaptations that occur as a result of habitual exercise training. It is characterized by an increase of the internal chamber dimensions and wall thickness of both atria and ventricles. The athlete’s right ventricle also undergoes structural, functional, and electrical remodelling as a result of intense exercise training. Some research suggests that the haemodynamic stress of intense exercise is greater for the right heart and, as a result, right heart remodelling is slightly more profound when compared with the left heart. Echocardiography is the primary tool for the assessment of morphological and functional features of athlete’s heart and facilitates differentiation between physiological and pathological LV hypertrophy. Doppler myocardial and strain imaging can give additional information to the standard indices of global systolic and diastolic function and in selected cases cardiac magnetic resonance imaging may help in the diagnosis of specific myocardial diseases among athletes such as hypertrophic cardiomyopathy, dilated cardiomyopathy, or arrhythmogenic right ventricular cardiomyopathy.
Systemic disease and other conditions: the heart during pregnancy
Authors: Pasquet Agnes , Barbosa Marcia , Liao Jo-Nan
Published: December 2016

Normal pregnancy represents a haemodynamic challenge for the heart. The main changes are increases in blood (plasma) volume and cardiac output, and a decrease in systemic vascular resistance. These change start early during pregnancy and will be maximal around the 24th week of gestation. This translates into echocardiographic changes such as increase in ventricular volume, stroke volume, and changes in geometry. Peripartum cardiomyopathy is a left ventricular dysfunction without any underlying cause, arising near the end of the gestation or in the early postpartum period. Echocardiography is the key to confirm the diagnosis and also to exclude other causes of cardiomyopathy or to explain clinical signs.
Pain: introduction
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

Pain is a subjective and multidimensional phenomenon. Diagnosis, assessment, and evaluation of pain are all complicated in children by the range of diagnoses and developmental levels, and by cultural influences. This chapter summarizes definitions and classifications of pain, including total pain. It looks at ways that children express pain, and measurement of pain severity. Pharmacological treatment of pain is considered, alongside the World Health Organization pain guidelines, which are considered to be the basis of managing pain in palliative care.
Pain: step 3, major opioids
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

Drugs at step 3 are considered major opioids (or sometimes ‘strong opioids’ or ‘opioids for severe pain’). The choice of drugs available on this step is greater than on any of the others. This chapter examines the general guiding principles behind selecting the appropriate opioid for a situation, covering how to choose dosage and route. Both morphine and alternative non-morphine opioids are considered.
Neurological symptoms
Authors: Hain Richard D.W. , Jassal Satbir Singh
Published: December 2016

This chapter covers a range of neurological symptoms commonly encountered in paediatric palliative care. This includes epilepsy, seizures, spasticity, myoclonus, chorea, dystonia, and akathisia. For most of these conditions, both definitions and details of management are provided.
Lost in Dialogue
Authors: Stanghellini Giovanni
Published: December 2016

This book will build on and develop the assumption that to be human means to be in dialogue. Dialogue is a unitary concept that will attempt to address in a coherent way three essential issues for clinical practice: ‘What is a human being?’, ‘What is mental pathology?’, and ‘What is care?’. It will argue that to be human means to be in dialogue with alterity, that mental pathology is the outcome of a crisis of one’s dialogue with alterity, and that care is a method wherein dialogues take place whose aim is to re-enact interrupted dialogue with alterity within oneself and with the external world.

This book is an attempt to re-establish such a fragile dialogue of the soul with herself and with others. Such an attempt is based on two pillars: a dialectic, person-centred understanding of mental disorders, and values-based practice. Building on and extending these two approaches, it aims to improve therapeutic practice in mental health care. Within this framework, care is a dialogue with a method—or better, a method wherein dialogues take place whose aim is to re-enact interrupted dialogue with alterity within oneself and with the external world. The method at issue includes devices and practices that belong both to logic—e.g. the method for unfolding the Other’s life-world and to rescue its fundamental structure—and empathy—e.g. the readiness to offer oneself as a dialoguing person, and the capacity to resonate with the Other’s experience and attune/regulate the emotional field.
Parkinson’s disease and parkinsonism
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter discusses the evidence-based pharmacological management of motor and non-motor (autonomic disease, dementia, psychosis, depression, and sleep disorder) Parkinson’s disease (PD) and Parkinson’s plus syndromes (progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD)). Drugs to use with caution in parkinsonism are highlighted. Clinical features and evidence-based management of impulse control disorders (ICDs), serotonin syndrome, dopamine agonist withdrawal syndrome (DAWS), and neuroleptic malignant syndrome (NMS)/Parkinson’s hyperpyrexia syndrome (PHS) are also reviewed.
Hyperkinetic movement disorders
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter discusses the clinical features and evidence-based pharmacological management of tremor, dystonia (focal, generalized, and dopa-responsive dystonia), tics and Tourette’s syndrome, chorea (Huntington’s disease (HD) and Sydenham’s chorea), ballism and athetosis, myoclonus, and restless legs syndrome (RLS).
Neurological infections
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter reviews the clinical features and management of meningitis (community-acquired bacterial meningitis and chronic meningitis), Mycobacterium tuberculosis, encephalitis and myelitis, Lyme disease, brain abscess and parameningeal infection, neurological infections in the immunocompromised, fungal infection, parasitic infection, and bacterial neurotoxins.
H
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter includes drugs beginning with the letter [H]
N
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter includes drugs beginning with the letter [N]
V
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter includes drugs beginning with the letter [V]
C
Authors: Nageshwaran Sathiji , Wilson Heather C , Dickenson Anthony , Ledingham David
Published: December 2016

This chapter includes drugs beginning with the letter [C]
Computed tomography angiography and other applications of computed tomography
Authors: de Graaf Michiel A , Scholte Arthur JHA , Kroft Lucia , Bax Jeroen J
Published: December 2016

Patients presenting with acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computed tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department; particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computed tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, the non-invasive detection of coronary artery disease by computed tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computed tomography angiography. Conversely, the implementation of coronary computed tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computed tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, the acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computed tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as the evaluation of coronary artery plaque composition, myocardial function and perfusion, or fractional flow reserve, are currently being developed and may also become valuable in the setting of acute chest pain in the future.
Non-invasive ventilation
Authors: Masip Josep , Planas Kenneth , Mas Arantxa
Published: December 2016

During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.
Biomarkers in acute heart failure
Authors: Choudhary Rajiv , Shah Kevin , Maisel Alan
Published: December 2016

Acute heart failure continues to be a worldwide medical problem, associated with frequent readmissions, high mortality, and a profound economic impact on national health care systems. In the past decade, biomarkers have shifted the way in which acute heart failure is managed by the cardiologist. The search for the ideal biomarker to aid in the diagnosis, prognosis, and treatment of acute heart failure is ongoing. The natriuretic peptides have proved extremely useful in determining whether acute dyspnoea has a cardiac aetiology. In addition, recent trials have demonstrated the use of natriuretic peptides in inpatient and outpatient prognosis, as well as in titrating medications in outpatients with chronic heart failure to prevent acute heart failure hospitalizations. Other emerging acute heart failure biomarkers include mid-regional pro-adrenomedullin, mid-regional proatrial natriuretic peptide, troponin, ST2, and neutrophil gelatinase-associated lipocalin.
Systems of care for patients with acute ST elevation myocardial infarction (STEMI networks)
Authors: Huber Kurt , Quinn Tom
Published: December 2016

Although primary percutaneous coronary intervention is the preferred strategy for patients with ST elevation myocardial infarction, offering a fast access to this procedure often remains difficult, because of local resources and capabilities and a lack of cooperation and organization. Accordingly, for most countries worldwide, primary percutaneous coronary intervention can be provided for only part of the population. Moreover, not all patients referred for primary percutaneous coronary intervention receive an optimal mechanical reperfusion within the recommended time intervals with the procedure performed in an experienced centre by an experienced team. Intravenous thrombolytic therapy, preferably administered pre-hospital and as part of a pharmacoinvasive strategy, offers a reasonable therapeutic option in selected cases. Network organization is central to offering fast and optimal reperfusion treatment in the individual case. It has been shown repeatedly that an early recognition of ST elevation myocardial infarction, as well as minimizing time delays, is important for the achievement of optimal clinical results. These findings should encourage the building up of regional networks, according to specific local constraints, and the monitoring of their effectiveness by ongoing registries. Financial, regulatory, and political barriers can be resolved, and a prompt guideline-recommended care becomes feasible and affordable if stakeholders and participants agree and cooperate.
Non-ST-segment elevation acute coronary syndromes
Authors: Bueno Héctor , Barrabés José A
Published: December 2016

Non-ST-segment elevation acute coronary syndromes are life-threatening disorders, usually caused by acute coronary thrombosis and subsequent myocardial ischaemia, presenting without persistent ST-segment elevation in the initial electrocardiogram. According to the occurrence of myocardial necrosis, non-ST-segment elevation acute coronary syndromes are divided into non-ST-segment myocardial infarction or unstable angina. The management of non-ST-segment elevation acute coronary syndromes requires an early diagnosis and risk stratification, urgent hospitalization, monitoring, and medical treatment, including antithrombotic therapy with dual antiplatelet therapy (aspirin plus one P2Y12 inhibitor) and parenteral anticoagulation, anti-ischaemic treatment, and preventative therapies. After the initial medical therapy is established, an invasive strategy, consisting of coronary angiography with coronary revascularization (either percutaneous coronary intervention or coronary bypass graft surgery), as appropriate, should be decided. The timing of the invasive strategy should be adjusted, according to the patient’s risk. Given the high event rate of patients with non-ST-segment elevation acute coronary syndromes after hospital discharge, an aggressive long-term preventative therapy should be put in place to improve prognosis.
Percutaneous coronary interventions in acute coronary syndromes
Authors: Kočka Viktor , Kristensen Steen Dalby , Wijns William , Toušek Petr , Widimský Petr
Published: December 2016

Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following:All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hoursPatients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groupsOther patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentationLow-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testingStents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settingsTriple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk
Coronary artery bypass graft surgery
Authors: Davierwala Piroze M , Mohr Friedrich W
Published: December 2016

The surgical management of acute coronary syndrome still remains a challenge for the cardiac surgeon. Although most patients can be managed by percutaneous coronary intervention, for patients with complex multivessel or left main coronary artery disease (high SYNTAX score), in whom percutaneous coronary intervention is not possible or is unsuccessful, urgent or emergent coronary artery bypass graft surgery is the only available option. It is very important for surgeons to determine the optimum timing of surgical intervention, which is usually based on the clinical presentation, coronary anatomy, and biomarkers. Surgeons should be conversant with the different operative techniques, whether off- or on-pump coronary artery bypass graft surgery, that would help in achieving the best possible outcomes in such situations. Early and late survival of patients depends not only on an efficiently executed operation, but also on the competency of the post-operative care delivered. Modern perioperative management is reinforced by the availability of a variety of mechanical cardiopulmonary assist devices, like the intra-aortic balloon pump, the extracorporeal membrane oxygenation, and an array of ventricular assist devices, which aid us in managing very sick patients presenting with cardiogenic shock. The results of coronary artery bypass graft surgery for acute coronary syndrome, as published in the literature, vary significantly, because of the heterogeneity of patient populations, operative timing, and haemodynamic status, making a comparison of surgical outcomes almost impossible. Only one randomized trial has been conducted to that effect, to date. A heart team approach, involving an interventional cardiologist and a cardiac surgeon, is mandatory to determine the best treatment strategy and achieve the best possible outcomes in patients with acute coronary syndrome.
Cardiogenic shock in patients with acute coronary syndromes
Authors: Thiele Holger , Zeymer Uwe
Published: December 2016

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
Gender considerations in acute coronary syndromes
Authors: Swahn Eva , Alfredsson Joakim , Lawesson Sofia Sederholm
Published: December 2016

It is a very important issue to enlighten on gender differences and similarities regarding the management of patients with acute coronary syndromes. It is a fact that women have not been included in clinical trials in numbers equal to men, for whatever reason. In the future, it will be necessary to individualize, as much as possible, the management of patients, regardless of gender. To get there, it is necessary to have sufficient numbers of patients from both genders included in trials, or otherwise it is not possible to draw proper conclusions. Until now, most results regarding women and acute coronary syndromes have been based on substudy analyses with inadequate statistical power. If gender differences have become evident in studies with gender-mixed populations, it seems obvious that the calculated power to show significant differences is also inadequate for men. There is an urgent need of more research in this area, in order not to harm our patients with our treatment because of a paucity of knowledge. It is also as important not to withdraw proper treatment from certain individuals when they can benefit from it.
Bleeding and haemostasis disorders
Authors: Mannucci Pier Mannuccio
Published: December 2016

The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke). To reduce the need of transfusion, haemostatic agents that decrease blood loss and transfusion requirements (antifibrinolytic amino acids, plasmatic prothrombin complex concentrates, recombinant factor VIIa) may be considered. However, the efficacy of these agents in the control of bleeding complications in acute coronary syndrome is not unequivocally established, and there is concern for an increased risk of re-thrombosis. A low platelet count is another cause of bleeding in the intensive cardiac care unit. The main aetiologies are drugs (unfractionated heparin and glycoprotein IIb/IIIa inhibitors), thrombotic microangiopathies, such as thrombotic thrombocytopenic purpura, and disseminated intravascular coagulation, that are often paradoxically associated with thrombotic manifestations. In conclusion, evidence-based recommendations for the management of bleeding in patients admitted to the intensive cardiac care unit are lacking. Accurate assessments of the risk of bleeding in the individual and prevention measures are the most valid strategies.