Home care utilization and outcomes among Asian and other Canadian patients with heart failure

Article deposited according to publisher policy posted on SHERPA/RoMEO, 16/08/2010.YesFunding provided by the Open Access Authors Fund

Cardio-anesthesiology considerations for the trans-catheter aortic valve implantation (TAVI) procedure

Transcatheter aortic valve implantation (TAVI) has become the mainstay for highrisk or inoperable patients with symptomatic aortic valve stenosis, and research regarding the use of transcatheter valves in intermediate or low-risk patients is currently ongoing. The aim of this article is to provide comprehensive insight into the anesthetic management of patients undergoing TAVI and to highlight possible gaps in the current knowledge. One important procedural characteristic that is imperative to consider is the type of anesthesia being used and its possible complications. Increasingly, experienced centers have changed from general anesthesia with endotracheal intubation to local anesthesia with sedation, especially when the transfemoral access route is used for TAVI. There is still debate regarding what type of anesthesia should be used in the procedure, and the lack of randomized data makes it even more challenging for the operators © 2016 Hellenic Society of Cardiology

Cardiac manifestations of inborn errors of metabolism.

Item does not contain fulltextAIM: The aim of the study was to investigate the frequency and type of cardiac manifestations in a defined group of patients with inborn errors of metabolism. This paper also explores the key role of cardiac manifestations in the diagnosis of inborn errors of metabolism in daily practice. METHODS: Out of the 287 patients with the potential for inborn errors of metabolism who had been referred to the University Hospital of Heraklion (202 children and adolescents and 85 adults), 41 were found to have a variety of cardiac manifestations, including cardiomyopathy, cardiomegaly, atrioventricular conduction disorders and coronary artery disease. RESULTS: In 15 out of the 41 patients a diagnosis of inborn errors of metabolism was established, while the total number of patients with inborn errors of metabolism was 60 out of the 287. In 6 out of the 15 patients the major symptoms were from the cardiovascular system and 7 of them were adults with symptoms initiating in childhood. CONCLUSION: The cardiac findings consist of a neglected area in the diagnosis of the inborn errors of metabolism. Neurologists, pediatricians and internists should cooperate with cardiologists in managing people with unexplained cardiac symptoms and signs and be aware that several inborn errors of metabolism are associated with cardiac abnormalities and mild neurologic findings

Reducing the time-lag between onset of chest pain and seeking professional medical help: a theory-based review

Background: Research suggests that there are a number of factors which can be associated with delay in a patient seeking professional help following chest pain, including demographic and social factors. These factors may have an adverse impact on the efficacy of interventions which to date have had limited success in improving patient action times. Theory-based methods of review are becoming increasingly recognised as important additions to conventional systematic review methods. They can be useful to gain additional insights into the characteristics of effective interventions by uncovering complex underlying mechanisms. Methods: This paper describes the further analysis of research papers identified in a conventional systematic review of published evidence. The aim of this work was to investigate the theoretical frameworks underpinning studies exploring the issue of why people having a heart attack delay seeking professional medical help. The study used standard review methods to identify papers meeting the inclusion criterion, and carried out a synthesis of data relating to theoretical underpinnings. Results: Thirty six papers from the 53 in the original systematic review referred to a particular theoretical perspective, or contained data which related to theoretical assumptions. The most frequently mentioned theory was the self-regulatory model of illness behaviour. Papers reported the potential significance of aspects of this model including different coping mechanisms, strategies of denial and varying models of treatment seeking. Studies also drew attention to the potential role of belief systems, applied elements of attachment theory, and referred to models of maintaining integrity, ways of knowing, and the influence of gender. Conclusions: The review highlights the need to examine an individual’s subjective experience of and response to health threats, and confirms the gap between knowledge and changed behaviour. Interventions face key challenges if they are to influence patient perceptions regarding seriousness of symptoms; varying processes of coping; and obstacles created by patient perceptions of their role and responsibilities. A theoretical approach to review of these papers provides additional insight into the assumptions underpinning interventions, and illuminates factors which may impact on their efficacy. The method thus offers a useful supplement to conventional systematic review methods

Expert consensus statement for the management of patients with embolic stroke of undetermined source and patent foramen ovale: A clinical guide by the working group for stroke of the Hellenic Society of Cardiology and the Hellenic Stroke Organization

[No abstract available

Expert consensus statement for the management of patients with embolic stroke of undetermined source and patent foramen ovale: A clinical guide by the working group for stroke of the Hellenic Society of Cardiology and the Hellenic Stroke Organization

[No abstract available

Funerary Pithoi in Bronze Age Crete: Their Introduction and Significance at the Threshold of Minoan Palatial Society

Toward the end of the third millennium B.C.E., Minoan funerary customs changed, and people began to favor the use of clay receptacles-pithoi or larnakes-for the bodies of the dead. This article offers a comprehensive study of the funerary pithoi of the period, comprising a review of the available material and its classification, distribution, and dating, the relation of container to tomb types, and the specific use of pithoi within funerary ritual. It also assesses the importance of pithoi as an investment in terms of the material wealth that they represent and the knowledge of the complex techniques of handling dead bodies that they require. Finally, it examines the symbolic connotations of the pithos and argues that its wide adoption was part of a general turn toward the concept of the regeneration of life. This concept shifted the emphasis of the funerary realm toward the social dimension-namely, toward the reallocation of the roles and resources of the dead among the living. Such a shift helped people come to terms with contemporary social reality and shaped the agency of emerging elites, which led to the establishment of the first Minoan palaces and transformed Crete from a series of kin-based communities to a group of proto-states

Hospital attendance and admission trends for cardiac diseases during the COVID-19 outbreak and lockdown in Greece

Objectives: The coronavirus disease 2019 (COVID-19) outbreak, along with implementation of lockdown and strict public movement restrictions, in Greece has affected hospital visits and admissions. We aimed to investigate trends of cardiac disease admissions during the outbreak of the pandemic and possible associations with the applied restrictive measures. Study design: This is a retrospective observational study. Methods: Data for 4970 patients admitted via the cardiology emergency department (ED) across 3 large-volume urban hospitals in Athens and 2 regional/rural hospitals from February 3, 2020, up to April 12 were recorded. Data from the equivalent (for the COVID-19 outbreak) time period of 2019 and from the postlockdown time period were also collected. Results: A falling trend of cardiology ED visits and hospital admissions was observed starting from the week when the restrictive measures due to COVID-19 were implemented. Compared with the pre–COVID-19 outbreak time period, acute coronary syndrome (ACS) [145 (29/week) vs. 60 (12/week), −59%, P < 0.001], ST elevation myocardial infarction [46 (9.2/week) vs. 21 (4.2/week), −54%, P = 0.002], and non-ST elevation ACS [99 cases (19.8/week) vs. 39 (7.8/week), −60% P < 0.001] were reduced at the COVID-19 outbreak time period. Reductions were also noted for heart failure worsening and arrhythmias. The ED visits in the postlockdown period were significantly higher than in the COVID-19 outbreak time period (1511 vs 660; P < 0.05). Conclusion: Our data show significant drops in cardiology visits and admissions during the COVID-19 outbreak time period. Whether this results from restrictive measures or depicts a true reduction of cardiac disease cases warrants further investigation. © 2020 The Royal Society for Public Healt