2012 June 12 » Page 2

Biochemical markers in heart failure.

Jun 122012

Biochemical markers in heart failure.

J Cardiol. 2012 Jan;59(1):1-7

Authors: Sato Y, Fujiwara H, Takatsu Y

Abstract
In industrialized countries, chronic heart failure (HF) is a major illness and cause of death. However, because of the paucity of specific clinical manifestations of HF, its early diagnosis and management might be challenging. Therefore, biochemical markers of HF are now being closely scrutinized. An ideal biochemical marker should be a prognostic indicator, should assist in the early diagnosis, reflect the therapeutic response, and help grading the risk associated with each stage of HF. This review summarizes our current understanding of biochemical markers of HF.

PMID: 22138007 [PubMed - indexed for MEDLINE]

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Delirium in hospitalized patients: Implications of current evidence on clinical practice and future avenues for research-a systematic evidence review.

J Hosp Med Start a Discussion »

Jun 122012

Delirium in hospitalized patients: Implications of current evidence on clinical practice and future avenues for research-a systematic evidence review.

J Hosp Med. 2012 Jun 8;

Authors: Khan BA, Zawahiri M, Campbell NL, Fox GC, Weinstein EJ, Nazir A, Farber MO, Buckley JD, Maclullich A, Boustani MA

Abstract
BACKGROUND: Despite the significant burden of delirium among hospitalized adults, critical appraisal of systematic data on delirium diagnosis, pathophysiology, treatment, prevention, and outcomes is lacking. PURPOSE: To provide evidence-based recommendations for delirium care to practitioners, and identify gaps in delirium research. DATA SOURCES: Medline, PubMed, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) information systems from January 1966 to April 2011. STUDY SELECTION: All published systematic evidence reviews (SERs) on delirium were evaluated. DATA EXTRACTION: Three reviewers independently extracted the data regarding delirium risk factors, diagnosis, prevention, treatment, and outcomes, and critically appraised each SER as good, fair, or poor using the United States Preventive Services Task Force criteria. DATA SYNTHESIS: Twenty-two SERs graded as good or fair provided the data. Age, cognitive impairment, depression, anticholinergic drugs, and lorazepam use were associated with an increased risk for developing delirium. The Confusion Assessment Method (CAM) is reliable for delirium diagnosis outside of the intensive care unit. Multicomponent nonpharmacological interventions are effective in reducing delirium incidence in elderly medical patients. Low-dose haloperidol has similar efficacy as atypical antipsychotics for treating delirium. Delirium is associated with poor outcomes independent of age, severity of illness, or dementia. CONCLUSION: Delirium is an acute, preventable medical condition with short- and long-term negative effects on a patient's cognitive and functional states. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine.

PMID: 22684893 [PubMed - as supplied by publisher]

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Antioxidant Therapy does not reduce pain in patients with Chronic Pancreatitis: The ANTICIPATE study.

Gastroenterology Start a Discussion »

Jun 122012

Antioxidant Therapy does not reduce pain in patients with Chronic Pancreatitis: The ANTICIPATE study.

Gastroenterology. 2012 Jun 5;

Authors: Siriwardena AK, Mason JM, Sheen AJ, Makin A, Shah N

Abstract
BACKGROUND AND AIMS: We investigated whether antioxidant therapy reduces pain and improves quality of life in patients with chronic pancreatitis. METHODS: We performed a double-blind, randomized controlled trial that compared the effects of antioxidant therapy with placebo in 70 patients with chronic pancreatitis. Patients provided 1 month of baseline data and were followed for 6 months while receiving either Antox version1.2 or matched placebo (2 tablets, 3 times daily). The primary analysis was baseline-adjusted change in pain score at 6 months, assessed by an 11-point numerical rating scale. Secondary analyses included alternative analyses of clinic and diary pain scores, scores on quality of life tests (the EORTC-QLQ-C30, QLQ-PAN28, EuroQOL EQ-5D, and EQ-VAS), levels of antioxidants, use of opiates, and adverse events. Analyses, reported by intention to treat, were prospectively protocol-defined. RESULTS: After 6 months, pain scores reported to the clinic were reduced by 1.97 from baseline in the placebo group and by 2.33 in the antioxidant group but were similar between groups (-0.36, 95%CI: -1.44 to 0.72, p=0.509). Average daily pain scores from diaries were also similar (3.05 for the placebo group, 2.93 for the antioxidant group, a difference of 0.11; 95% CI, 1.05-0.82; P=0.808). Measures of quality of life were similar between groups, as was opiate use and numbers of hospital admissions and outpatient visits. Blood levels of vitamin C and E, ?-carotene, and selenium were significantly increased in the antioxidant group. CONCLUSIONS: In patients with painful chronic pancreatitis of predominantly alcoholic origin, antioxidant therapy did not reduce pain or improve quality of life, despite causing a sustained increase in blood levels of antioxidants.

PMID: 22683257 [PubMed - as supplied by publisher]

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Oral versus intravenous proton pump inhibitors in preventing re-bleeding for patients with peptic ulcer bleeding after successful endoscopic therapy.

BMC Gastroenterol Start a Discussion »

Jun 122012

Oral versus intravenous proton pump inhibitors in preventing re-bleeding for patients with peptic ulcer bleeding after successful endoscopic therapy.

BMC Gastroenterol. 2012 Jun 8;12(1):66

Authors: Yen HH, Yang CW, Su WW, Soon MS, Wu SS, Lin HJ

Abstract
ABSTRACT: BACKGROUND: High dose intravenous proton pump inhibitor after endoscopic therapy for peptic ulcer bleeding has been recommended as adjuvant therapy. Whether oral proton pump inhibitor can replace intravenous proton pump inhibitor in this setting is unknown. This study aims to compare the clinical efficacy of oral and intravenous proton pump inhibitor after endoscopic therapy METHODS: Patients with high-risk bleeding peptic ulcers after successful endoscopic therapy were randomly assigned as oral lansoprazole or intravenous esomeprazole group. Primary outcome of the study was re-bleeding rate within 14 days. Secondary outcome included hospital stay, volume of blood transfusion, surgical intervention and mortality within 1 month. RESULTS: From April 2010 to Feb 2011, 100 patients were enrolled in this study. The re-bleeding rates were 4% (2/50) in the intravenous group and 4% (2/50) in the oral group. There was no difference between the two groups with regards to the hospital stay, volume of blood transfusion, surgery or mortality rate. The mean duration of hospital stay was 1.8 days in the oral lansoprazole group and 3.9 days in the intravenous esomeprazole group (p < 0.01). CONCLUSION: Patients receiving oral proton pump inhibitor have a shorter hospital stay. There is no evidence of a difference in clinical outcomes between oral and intravenous PPI treatment. However, the study was not powered to prove equivalence or non-inferiority. Future studies are still needed. Trial registration NCT01123031.

PMID: 22681960 [PubMed - as supplied by publisher]

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Coronary Computed Tomographic Angiography and Risk of All-Cause Mortality and Non-fatal Myocardial Infarction in Subjects without Chest Pain Syndrome from the CONFIRM Registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry).

Circulation Start a Discussion »

Jun 122012

Coronary Computed Tomographic Angiography and Risk of All-Cause Mortality and Non-fatal Myocardial Infarction in Subjects without Chest Pain Syndrome from the CONFIRM Registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry).

Circulation. 2012 Jun 9;

Authors: Cho I, Chang HJ, Sung JM, Pencina MJ, Lin FY, Dunning AM, Achenbach S, Al-Mallah M, Berman DS, Budoff MJ, Callister TQ, Chow BJ, Delago A, Hadamitzky M, Hausleiter J, Maffei E, Cademartiri F, Kaufmann P, Shaw LJ, Raff GL, Chinnaiyan KM, Villines TC, Cheng V, Nasir K, Gomez M, Min JK

Abstract
BACKGROUND: The predictive value of coronary computed tomographic angiography (cCTA) in subjects without chest pain syndrome (CPS) has not been established. We investigated the prognostic value of coronary artery disease (CAD) detection by cCTA, and determined the incremental risk stratification benefit of cCTA findings as compared to clinical risk factor scoring and coronary artery calcium scoring (CACS) for individuals without CPS. METHODS AND RESULTS: An open-label, 12-center, 6-country observational registry of 27,125 consecutive patients undergoing cCTA and CACS was queried, and 7,590 individuals without CPS or history of CAD met the inclusion criteria. All-cause mortality and composite of all-cause mortality and non-fatal MI were measured. During a median follow-up of 24 months (interquartile range: 18 to 35), all-cause mortality occurred in 136 individuals. After risk adjustment, compared to individuals without evidence of CAD by cCTA, individuals with obstructive 2-VD and 3-VD or left main CAD experienced higher rates of death and composite outcome (P<0.05 for both). Both CACS and cCTA significantly improved the performance of standard risk factor prediction models for all-cause mortality and the composite outcome (likelihood ratio P-value <0.05 for all), but the incremental discriminatory value associated with their inclusion was more pronounced for the composite outcome and for CACS (C statistic for model with risk factors only 0.71, risk factors plus CACS 0.75, risk factors plus CACS plus cCTA 0.77). The net reclassification improvement resulting from the addition of cCTA to a model based on standard risk factors and CACS was negligible. CONCLUSIONS: While prognosis for individuals without CPS is stratified by cCTA, the additional risk-predictive advantage by cCTA is not clinically meaningful compared to risk model based upon CACS. Therefore, at present, the application of cCTA for risk assessment of individuals without CPS should not be justified.

PMID: 22685117 [PubMed - as supplied by publisher]

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Utilization of Primary Prevention ICDs in a Population Based Cohort Is Associated with a Significant Survival Benefit.

Circ Arrhythm Electrophysiol Start a Discussion »

Jun 122012

Utilization of Primary Prevention ICDs in a Population Based Cohort Is Associated with a Significant Survival Benefit.

Circ Arrhythm Electrophysiol. 2012 Jun 8;

Authors: Parkash R, Sapp JL, Basta M, Doucette S, Thompson K, Gardner M, Gray C, Brownell B, Kidwai H, Cox J

Abstract
BACKGROUND: -Under-utilization of implantable defibrillators has been previously noted in patients at risk for sudden cardiac death, as well as survivors of sudden cardiac death. We sought to determine utilization rates in a primary prevention ICD-eligible population and mortality in this group as compared to a group who had undergone implantation of this therapy. METHODS AND RESULTS: -A retrospective cohort of patients from April 1, 2006 until December 31, 2009 was used to define a primary-prevention ICD-eligible population. Two groups were compared based on ICD implantation (No ICD vs ICD). The primary outcome measure was mortality. Of 717 patients found to be potentially eligible for a primary prevention ICD, 116 (16%) were referred. The remaining cohort of 601 patients were compared to an existing cohort of primary prevention ICD patients (n=290). A significant survival benefit was associated with primary prevention ICD implantation (HR 0.46, 95%CI (0.33, 0.64), p<0.0001). When adjusted for prespecified variables known to be associated with overall mortality and propensity score, a similar survival benefit was seen (HR0.59, 95% CI(0.40, 0.87) p=0.01). Appropriate ICD therapy occurred in 26% of those in the ICD group, over a mean follow-up of 2.7 years. CONCLUSIONS: -A significant mortality benefit was observed for patients who underwent primary prevention ICD implantation compared to those who did not. Vigilance is required to ensure that patients eligible for primary prevention ICDs are appropriately referred and assessed to allow such patients to benefit from this life-saving therapy.

PMID: 22685111 [PubMed - as supplied by publisher]

Link to Article at PubMed

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