Comparative Analysis of Clinical Trials and Evidence-Based Treatment Algorithm for Pulmonary Arterial Hypertension

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Comparative analysis of clinical trials and evidence-based treatment algorithm for pulmonary arterial hypertension

Evaluation of all clinical trials in pulmonary arterial hypertensio

Pulmonary Arterial Hypertension: The Importance of Accurate Diagnosis

Pulmonary arterial hypertension (PAH) is a chronic and serious disease characterized by a progressive increase in pulmonary vascular resistance. In this article, Dr. Hirani and Dr. Helmersen outline how a high index of clinical suspicion and early diagnosis remain imperative to maintain the best chances of survival for these patients. C o p y r i g h t © N o t f o r S a l e o r C o m m e r c i a l D i s t r i b u t i o n U n a u t h o r i s e d u s e p r o h i b i t e d . A u t h o r i s e d u s e r s c a n d o w n l o a d , d i s p l a y , v i e w a n d p r i n t a s i n g l e c o p y f o r p e r s o n a l u s e P AH is a chronic and serious disease characterized by a progressive increase in pulmonary vascular resistance (PVR) leading ultimately to right ventricular failure and death. Despite the fact that we now have numerous therapeutic options based on advances in our understanding of the underlying pathobiology, there remains no cure for this devastating condition. A high index of clinical suspicion and early diagnosis remain imperative to maintain the best chances of improving and preventing deterioration in exercise tolerance, functional capacity, quality of life and survival for these patients

Bronchoscopic Resection of a Central Typical Carcinoid Tumour

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Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease

Abstract Background Variation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening quality of life. We sought to determine whether an evidence-based computerized AECOPD admission order set could improve quality and reduce length of stay. Methods The order set was designed by a provincial COPD working group and implemented voluntarily among three physician groups in a Canadian tertiary-care teaching hospital. The primary outcome was length of stay for patients admitted during order set implementation period, compared to the previous 12 months. Secondary outcomes included length of stay of patients admitted with and without order set after implementation, all-cause readmissions, and emergency department visits. Results There were 556 admissions prior to and 857 admissions after order set implementation, for which the order set was used in 47%. There was no difference in overall length of stay after implementation (median 6.37 days (95% confidence interval 5.94, 6.81) pre-implementation vs. 6.02 days (95% confidence interval 5.59, 6.46) post-implementation, p = 0.26). In the post-implementation period, order set use was associated with a 1.15-day reduction in length of stay (95% confidence interval − 0.5, − 1.81, p = 0.001) compared to patients admitted without the order set. There was no difference in readmissions. Conclusions Use of a computerized guidelines-based admission order set for COPD exacerbations reduced hospital length of stay without increasing readmissions. Interventions to increase order set use could lead to greater improvements in length of stay and quality of care

Additional file 3: of Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease

Figure S1. Monthly percentage of patients admitted using AECOPD order set during study period. Vertical lines represent implementation start dates for each physician specialty. Respirologist represented by hatched line; general internist represented by black solid line; hospitalist represented by grey solid line. Reported probabilities are for linear trends from time series models for each physician specialty. These models showed no evidence of seasonality or auto-regression (JPG 112 kb

Diagnosis of chronic thromboembolic pulmonary hypertension: A Canadian Thoracic Society clinical practice guideline update

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Additional file 2: of Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease

Screenshot of AECOPD order set (PDF 400 kb

Additional file 1: of Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease

Supplement with additional details on methods and results (DOCX 28 kb

Diagnostic Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension: A Clinical Practice Guideline

BACKGROUND: Pulmonary embolism is a common condition. Some patients subsequently develop chronic thromboembolic pulmonary hypertension (CTEPH). Many care gaps exist in the diagnosis and management of CTEPH patients including lack of awareness, incomplete diagnostic assessment, and inconsistent use of surgical and medical therapies.METHODS: A representative interdisciplinary panel of medical experts undertook a formal clinical practice guideline development process. A total of 20 key clinical issues were defined according to the patient population, intervention, comparator, outcome (PICO) approach. The panel performed an evidence-based, systematic, literature review, assessed and graded the relevant evidence, and made 26 recommendations.RESULTS: Asymptomatic patients postpulmonary embolism should not be screened for CTEPH. In patients with pulmonary hypertension, the possibility of CTEPH should be routinely evaluated with initial ventilation/ perfusion lung scanning, not computed tomography angiography. Pulmonary endarterectomy surgery is the treatment of choice in patients with surgically accessible CTEPH, and may also be effective in CTEPH patients with disease in more ‘distal’ pulmonary arteries. The anatomical extent of CTEPH for surgical pulmonary endarterectomy is best assessed by contrast pulmonary angiography, although positive computed tomography angiography may be acceptable. Novel medications indicated for the treatment of pulmonary hypertension may be effective for selected CTEPH patients.CONCLUSIONS: The present guideline requires formal dissemination to relevant target user groups, the development of tools for implementation into routine clinical practice and formal evaluation of the impact of the guideline on the quality of care of CTEPH patients. Moreover, the guideline will be updated periodically to reflect new evidence or clinical approaches.Peer Reviewe