Riociguat for the treatment of chronic thromboembolic pulmonary hypertension.

BACKGROUND: Riociguat, a member of a new class of compounds (soluble guanylate cyclase stimulators), has been shown in previous clinical studies to be beneficial in the treatment of chronic thromboembolic pulmonary hypertension. METHODS: In this phase 3, multicenter, randomized, double-blind, placebo-controlled study, we randomly assigned 261 patients with inoperable chronic thromboembolic pulmonary hypertension or persistent or recurrent pulmonary hypertension after pulmonary endarterectomy to receive placebo or riociguat. The primary end point was the change from baseline to the end of week 16 in the distance walked in 6 minutes. Secondary end points included changes from baseline in pulmonary vascular resistance, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, World Health Organization (WHO) functional class, time to clinical worsening, Borg dyspnea score, quality-of-life variables, and safety. RESULTS: By week 16, the 6-minute walk distance had increased by a mean of 39 m in the riociguat group, as compared with a mean decrease of 6 m in the placebo group (least-squares mean difference, 46 m; 95% confidence interval [CI], 25 to 67; P<0.001). Pulmonary vascular resistance decreased by 226 dyn · sec · cm-5in the riociguat group and increased by 23 dyn · sec · cm-5in the placebo group (least-squares mean difference, -246 dyn · sec · cm-5; 95% CI, -303 to -190; P<0.001). Riociguat was also associated with significant improvements in the NT-proBNP level (P<0.001) and WHO functional class (P = 0.003). The most common serious adverse events were right ventricular failure (in 3% of patients in each group) and syncope (in 2% of the riociguat group and in 3% of the placebo group). CONCLUSIONS: Riociguat significantly improved exercise capacity and pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension. (Funded by Bayer HealthCare; CHEST-1 and CHEST-2 ClinicalTrials.gov numbers, NCT00855465 and NCT00910429, respectively.) Copyright © 2013 Massachusetts Medical Society

Pulmonary Hypertension in Patients with Chronic Fibrosing Idiopathic Interstitial Pneumonias

Background Pulmonary hypertension (PH) is a common finding in patients with chronic fibrosing idiopathic interstitial pneumonias (IIP). Little is known about the response to pulmonary vasodilator therapy in this patient population. COMPERA is an international registry that prospectively captures data from patients with various forms of PH receiving pulmonary vasodilator therapies. Methods We retrieved data from COMPERA to compare patient characteristics, treatment patterns, response to therapy and survival in newly diagnosed patients with idiopathic pulmonary arterial hypertension (IPAH) and PH associated with IIP (PH-IIP). Results Compared to patients with IPAH (n = 798), patients with PH-IIP (n = 151) were older and predominantly males. Patients with PH-IIP were treated predominantly with phosphodiesterase-5 inhibitors (88% at entry, 87% after 1 year). From baseline to the first follow-up visit, the median improvement in 6MWD was 30 m in patients with IPAH and 24.5 m in patients with PH-IIP (p = 0.457 for the difference between both groups). Improvements in NYHA functional class were observed in 22.4% and 29.5% of these patients, respectively (p = 0.179 for the difference between both groups). Survival rates were significantly worse in PH-IIP than in IPAH (3-year survival 34.0 versus 68.6%; p<0.001). Total lung capacity, NYHA class IV, and mixed-venous oxygen saturation were independent predictors of survival in patients with PH-IIP. Conclusions Patients with PH-IIP have a dismal prognosis. Our results suggest that pulmonary vasodilator therapy may be associated with short-term functional improvement in some of these patients but it is unclear whether this treatment affects survival

Validation of impedance cardiography in pulmonary arterial hypertension

Background: Non-invasive methods of measuring cardiac output are highly desirable in pulmonary arterial hypertension (PAH). We therefore sought to validate impedance cardiography (ICG) against thermodilution (TD) and cardiac magnetic resonance (CMR) in the measurement of cardiac output in patients under investigation for PAH. Methods: A prospective, cross-sectional study was performed to compare single-point measurements of cardiac output obtained by impedance cardiography (COICG) technology (PhysioFlow®) with (i) contemporaneous TD measurements (COTD) at rest and steady-state exercise during right heart catheterization and (ii) CMR measurements (COCMR) at rest obtained within 72 h. Results: Paired COICG and COTD measurements were obtained in 25 subjects at rest and 16 subjects at exercise. COCMR measurements were obtained in 16 subjects at rest. There was unsatisfactory correlation and agreement between COICG and COTD at rest (r = 0·42, P = 0·035; bias: 1·21 l min−1, 95% CI: −2·33 to 4·75 l min−1) and exercise (r = .65, P = .007; bias: 1·41 l min−1; 95% CI: −3·99 to 6·81 l min−1) and in the change in COICG and COTD from rest to exercise (r = 0·53, P = 0·033; bias: 0·76 l min−1, 95% CI: −3·74 to 5·26 l min−1). There was also a lack of correlation and unsatisfactory agreement between resting COICG and COCMR (r = 0·38, P = 0·1; bias: 1·40 l min−1, 95% CI: −2·48 to 5·28 l min−1). In contrast, there was close correlation and agreement between resting COTD and COCMR (r = 0·87, P<0·001; bias: −0·16 l min−1, 95% CI: −1·97 to 1·65). Conclusions: In a representative population of patients under investigation for PAH, ICG showed insufficient qualitative and quantitative value in the measurement of resting and exercise cardiac output when compared with TD and CMR

Mitigating Compassion Fatigue among Child Protection Social Workers

The purpose of this research project was to illuminate possible mitigating factors of compassion fatigue for child protection social workers. The level of trauma that child protection social workers intervene at increases the likelihood that the social worker will experience compassion fatigue. Past research has pointed out mitigating factors of compassion fatigue such as: learning about compassion fatigue, developing supportive relationships and emotional debriefing to name a few. Very little research has been done specific to this phenomenon in child protection. This study used a survey distributed to six Southern Minnesotan county child protection units, to ask questions about respondents‟ understandings of compassion fatigue and what mitigates it and how can their workplaces help support this process in the future. All of the respondents were able to define what compassion fatigue meant to them and the large majority was able to recognize having experienced compassion fatigue within their child protection role. Less than half of the respondents reported currently experiencing compassion fatigue and the mitigating factors that the majority found helpful were developing and maintaining support networks inside and outside of work as well as emotional debriefing

OSAE Can You See? What is it like in Chile?

Students will examine and analyze a set of pictures. Students will hypothesize what life is like in Chile. Students will make conclusions about geographical location or culture in Chile

Getting Acquainted with an Iowa Farmer

Students will compare and contrast past and present life on Iowa farms

Comparing Folk Tales

Students will be similarities and differences between Indian and American folktales. Students will realize that human natures crosses country borders. Students will be able to hypothesize about culture of India

Population Pyramids

Students will be aware of population growth in India compared to the United States

Mitigating Compassion Fatigue among Child Protection Social Workers

The purpose of this research project was to illuminate possible mitigating factors of compassion fatigue for child protection social workers. The level of trauma that child protection social workers intervene at increases the likelihood that the social worker will experience compassion fatigue. Past research has pointed out mitigating factors of compassion fatigue such as: learning about compassion fatigue, developing supportive relationships and emotional debriefing to name a few. Very little research has been done specific to this phenomenon in child protection. This study used a survey distributed to six Southern Minnesotan county child protection units, to ask questions about respondents‟ understandings of compassion fatigue and what mitigates it and how can their workplaces help support this process in the future. All of the respondents were able to define what compassion fatigue meant to them and the large majority was able to recognize having experienced compassion fatigue within their child protection role. Less than half of the respondents reported currently experiencing compassion fatigue and the mitigating factors that the majority found helpful were developing and maintaining support networks inside and outside of work as well as emotional debriefing

What\u27s in a Name?: Oruko lonro ni which means Names affect behavior

Students will be aware that Yoruba people believe the name a child bears can influence his/her behavior; therefore, the names given to a child in Nigeria are chosen for their meaning