Adjunctive strategies in the management of resistant, 'undilatable' coronary lesions after successfully crossing a CTO with a guidewire.

Successful revascularisation of chronic total occlusions (CTOs) remains one of the greatest challenges in the era of contemporary percutaneous coronary intervention (PCI). Such lesions are encountered with increasing frequency in current clinical practice. A predictable increase in the future burden of CTO management can be anticipated given the ageing population, increased rates of renal failure, graft failure and diabetes mellitus. Given recent advances and developments in CTO PCI management, successful recanalisation can be anticipated in the majority of procedures undertaken at high-volume centres when performed by expert operators. Despite advances in device technology, the management of resistant, calcific lesions remains one of the greatest challenges in successful CTO intervention. Established techniques to modify calcific lesions include the use of high-pressure non-compliant balloon dilation, cutting-balloons, anchor balloons and high speed rotational atherectomy (HSRA). Novel approaches have proven to be safe and technically feasible where standard approaches have failed. A step-wise progression of strategies is demonstrated, from well-recognised techniques to techniques that should only be considered when standard manoeuvres have proven unsuccessful. These methods will be described in the setting of clinical examples and include use of very high-pressure non-compliant balloon dilation, intentional balloon rupture with vessel dissection or balloon assisted micro-dissection (BAM), excimer coronary laser atherectomy (ECLA) and use of HSRA in various 'offlabel' settings

A Technical Focus on Antegrade Dissection and Re-entry for Coronary Chronic Total Occlusions: a Practice Update for 2019.

Coronary chronic total occlusions (CTOs) are a commonly encountered lesion. These present in a diverse patient population with variable anatomy. Technical success rates of ~90% are achievable for CTO lesions in centers with appropriate expertise. Many lesions can be crossed with wire-based techniques. However, the most anatomically complex and technically challenging lesions will often require more advanced approaches such as retrograde access and/or the application of blunt dissection techniques in the vessel to safely navigate long and/or ambiguous CTO segments. Retrograde dissection and re-entry (RDR) and antegrade dissection and re-entry (ADR) strategies are often needed to treat such lesions. In many circumstances, ADR offers a safe and efficient means to successfully cross a CTO lesion. Therefore, operators must remain cognizant of the risks and benefits of differing technical approaches during CTO percutaneous coronary intervention, particularly when both ADR and RDR are feasible. This article provides an overview of the ADR technique in addition to updated approaches in contemporary clinical practice

Variations in older people\u27s emergency care use by social care setting: a systematic review of international evidence

\ua9 The Author(s) 2023. Published by Oxford University Press. BACKGROUND: Older adults\u27 use of social care and their healthcare utilization are closely related. Residents of care homes access emergency care more often than the wider older population; however, less is known about emergency care use across other social care settings. SOURCES OF DATA: A systematic review was conducted, searching six electronic databases between January 2012 and February 2022. AREAS OF AGREEMENT: Older people access emergency care from a variety of community settings. AREAS OF CONTROVERSY: Differences in study design contributed to high variation observed between studies. GROWING POINTS: Although data were limited, findings suggest that emergency hospital attendance is lowest from nursing homes and highest from assisted living facilities, whilst emergency admissions varied little by social care setting. AREAS TIMELY FOR DEVELOPING RESEARCH: There is a paucity of published research on emergency hospital use from social care settings, particularly home care and assisted living facilities. More attention is needed on this area, with standardized definitions to enable comparisons between studies

Covid-19 and lack of linked datasets for care homes

No abstract available

Current Research: A Pilot Study in the Use of pXRF Analysis of Caddo Ceramics

Wilson Dub Crook III\u27s paper presented to the East Texas Archeological Conference concerning the use of X-ray Fluorescence (XRF) in sourcing turquoise artifacts sparked an interest in utilizing pXRF to resolve an old Caddo ceramic research question. While XRF has been used in archaeology for more than 60 years, and there have been applications in ceramic studies, a recent review of the 9th Edition of The Archaeology, Bioarchaeology, Ethnohistory, and History of the Caddo Indian Peoples of Arkansas, Louisiana, Oklahoma, and Texas, a comprehensive bibliography, did not yield a single reference to a pXRF study in Caddo ceramics. This article will summarize: (1) the research question arising from work at the Morse Mound Site (41SY27), (2) an overview of how pXRF works, and (3) the data analysis from this pilot study

An Evaluation of the Demographics, Characteristics and Healthcare Utilisation of People with Asthma Referred to an Ambulatory Respiratory Hub

BackgroundAsthma is the most treated condition in the Ulster Hospital Ambulatory Respiratory Hub (ARH). This multidisciplinary rapid assessment and treatment centre reviews respiratory patients to prevent hospital admission. This service evaluation (SE) may identify improvements for the service and better outcomes for asthma patients.AimsThe demographics, clinical characteristics including biomarker profile and co-morbidities, alongside subsequent healthcare utilisation of patients with asthma were explored.MethodRetrospective review of electronic healthcare records identified 151 patients with asthma attending the ARH between 1st July 2019 and 31st Dec 2019. Baseline demographics, clinical characteristics, comorbidities and asthma biomarkers were extracted. Patients were characterised according to their T2-biomarker expression and comparisons made. Healthcare utilisation was assessed by collecting data regarding hospital admissions, emergency department attendances and GP out of hours visits 6 months before and after attending the service.ResultsMost patients with asthma were female (73.5%), T2- biomarker low (74.2%) and had a high prevalence of obesity (49%). Prevalent comorbidities included rhinosinusitis, gastro-oesophageal reflux disease, depression and anxiety. Investigations included spirometry, chest x-ray and asthma biomarkers (fraction of exhaled nitric oxide and blood eosinophil count). Hospital admissions were reduced by 93%, ED attendances by 83.4% and GP OOH visits by 71.4% during the 6-month period following attendance.ConclusionsThe identification and management of common asthma comorbidities is important and should be routinely assessed. The ARH reduces healthcare utilisation for patients attending with asthma. It could provide additional support to the regional service enabling quicker access to biologic therapies.<br/

Priorities for the professional development of registered nurses in nursing homes: a Delphi study

Objective: to establish a consensus on the care and professional development needs of registered nurses (RNs) employed by UK care homes. Design: two-stage, online modified Delphi study. Setting and participants: a panel (n = 352) of individuals with experience, expertise or interest in care home nursing: (i) care home nurses and managers; (ii) community healthcare professionals (including general practitioners, geriatricians, specialist and district nurses); and (iii) nurse educators in higher education. Results: RNs employed by nursing homes require particular skills, knowledge, competence and experience to provide high-quality care for older residents. The most important responsibilities for the nursing home nurse were: promoting dignity, personhood and wellbeing, ensuring resident safety and enhancing quality of life. Continuing professional development priorities included personal care, dementia care and managing long-term conditions. The main barrier to professional development was staff shortages. Nursing degree programmes were perceived as inadequately preparing nurses for a nursing home role. Nursing homes could improve by providing supportive learning opportunities for students and fostering challenging and rewarding careers for newly RNs. Conclusion: if nurses employed by nursing homes are not fit for purpose, the consequences for the wider health and social-care system are significant. Nursing homes, the NHS, educational and local authorities need to work together to provide challenging and rewarding career paths for RNs and evaluate them. Without well-trained, motivated staff, a high-quality care sector will remain merely an aspiration

Report: The 62nd Annual Caddo Conference and 27th Annual East Texas Archeological Conference, Tyler, Texas, February 28 and 29, 2020

The 62nd Caddo Conference and 27th East Texas Archeological Conference was held at the University Center on the campus of the University of Texas at Tyler on February 28 and 29, 2020. The conference was dedicated to the rebuilding of public facilities at Caddo Mounds State Historic Site. These facilities had been destroyed by a tornado in 2019. The conference organizers were Thomas Guderjan, Colleen Hanratty, Cory Sills, Christy Simmons (University of Texas at Tyler), Keith Eppich (Tyler Junior College), Anthony Souther (Caddo Mounds State Historic Site), Amanda Regnier (Oklahoma Archeological Survey), Mark Walters (Texas Historical Commission Steward). Sponsors included The Center for Social Science Research and Department of Social Sciences, University of Texas at Tyler, Humanities Texas, Kevin Stingley, Arkansas Archeological Survey, Beta Analytic, Inc., Friends of Northeast Texas Archeology, East Texas Archeological Society, Maya Research Program, Tejas Archeology, Tyler Junior College, Gregg County Historical Museum, the American Indian Heritage Day of Texas organization, and the Caddo Nation. Before the formal program began, a preconference gathering was held at ETX Brewing Company at 221 S Broadway Avenue in Tyler on Thursday evening, February 27th. Approximately 250 people participated in the joint conferences