Prevalence of airflow obstruction in patients with stable systolic heart failure

Abstract Background Chronic obstructive pulmonary disease (COPD) is an important differential diagnosis in heart failure (HF). However, routine use of spirometry in outpatient HF clinics is not implemented. The aim of the present study was to determine the prevalence of both airflow obstruction and non obstructive lung function impairment in patients with HF and to examine the effect of optimal medical treatment for HF on lung function parameters. Methods Consecutive patients with HF (ejection fraction (EF)\u2009<\u200945%) and New York Heart Association (NYHA) functional class II-IV at 10 different outpatient heart failure clinics were examined with spirometry at their first visit and after optimal medical treatment for HF was achieved. airflow obstruction was classified and graded according to the GOLD 2011 revision. Results Baseline spirometry was performed in 593 included patients and 71 (12%) had a clinical diagnosis of COPD. Mean age was 69\u2009\ub1\u200911\ua0years and mean EF was 30\u2009\ub1\u20099%. Thirty-two % of the patients were active smokers and 53% were previous smokers. Mean FEV 1 and FVC was 77.9\u2009\ub1\u20091.7% and 85.4\u2009\ub1\u20091.5% of predicted respectively. Obstructive pattern was observed in 233 (39%) of the patients. Of these, 53 patients (9%) had mild disease (GOLD I) and 180 (30%) patients had moderate to very severe disease (GOLD II-IV). No difference in spirometric variables was observed following up titration of medication. Conclusion In stable patients with HF airflow obstruction is frequent and severely underdiagnosed. Spirometry should be considered in all patients with HF in order to improve diagnosis and treatment for concomitant pulmonary disease

The Copenhagen Triage Algorithm:a randomized controlled trial

BACKGROUND: Crowding in the emergency department (ED) is a well-known problem resulting in an increased risk of adverse outcomes. Effective triage might counteract this problem by identifying the sickest patients and ensuring early treatment. In the last two decades, systematic triage has become the standard in ED’s worldwide. However, triage models are also time consuming, supported by limited evidence and could potentially be of more harm than benefit. The aim of this study is to develop a quicker triage model using data from a large cohort of unselected ED patients and evaluate if this new model is non-inferior to an existing triage model in a prospective randomized trial. METHODS: The Copenhagen Triage Algorithm (CTA) study is a prospective two-center, cluster-randomized, cross-over, non-inferiority trial comparing CTA to the Danish Emergency Process Triage (DEPT). We include patients ≥16 years (n = 50.000) admitted to the ED in two large acute hospitals. Centers are randomly assigned to perform either CTA or DEPT triage first and then use the other triage model in the last time period. The CTA stratifies patients into 5 acuity levels in two steps. First, a scoring chart based on vital values is used to classify patients in an immediate category. Second, a clinical assessment by the ED nurse can alter the result suggested by the score up to two categories up or one down. The primary end-point is 30-day mortality and secondary end-points are length of stay, time to treatment, admission to intensive care unit, and readmission within 30 days. DISCUSSION: If proven non-inferior to standard DEPT triage, CTA will be a faster and simpler triage model that is still able to detect the critically ill. Simplifying triage will lessen the burden for the ED staff and possibly allow faster treatment. TRIAL REGISTRATION: Clinicaltrials.gov: NCT02698319, registered 24. of February 2016, retrospectively registere

FGF23 in hemodialysis patients is associated with left ventricular hypertrophy and reduced ejection fraction

Background: Fibroblast growth factor 23 (FGF23) is known to cause left ventricular hypertrophy (LVH), but controversy exists concerning its effect in dialysis. This study evaluated associations between FGF23 levels, echocardiography and prognosis in patients on hemodialysis (HD). Methods: Patients >18 years on chronic HD were included in this cross-sectional study. Plasma C-terminal FGF23 concentration was measured with ELISA and transthoracic echocardiography was performed, both before and after HD treatment. Results: 239 haemodialysis (HD) patients were included in the study. The FGF23 was median 3560 RU/ml (IQR 1447–9952). The mean left ventricular mass index (LVMI) was 110.2 ± 26.7 g/m2 and the left ventricular ejection fraction (LVEF) was 52.7 ± 9.9%. Defined by LVMI, LVH was found in 110 patients (46%), of which 92 (84%) had hypertension (p  18 años con HD crónica en este estudio transversal. La concentración del FGF23 en el extremo C del plasma se midió con ELISA y se realizó una ecocardiografía transtorácica, antes y después del tratamiento de HD. Resultados: Se incluyeron 239 pacientes en HD en el estudio. El FGF23 tenía una mediana de 3.560 RU/ml (amplitud intercuartílica: 1.447-9.952). El índice de masa ventricular izquierdo (IMVI) medio fue de 110,2 ± 26,7 g/m2 y la fracción de eyección del ventrículo izquierdo (FEVI) fue del 52,7 ± 9,9%. Definida por el IMVI, la HVI se localizó en 110 pacientes (46%), de los cuales 92 (84%) presentaban hipertensión (p < 0,01). Los pacientes con HVI presentaron niveles del FGF23 de 5.319 RU/ml (amplitud intercuartílica: 1.858-12.859) y aquellos sin 2.496 RU/ml (amplitud intercuartílica: 1.141-7.028) (p < 0,01). El FGF23 fue considerablemente positivo correlacionado con el IMVI (p < 0,01) y negativo con la FEVI (p < 0,01). En un análisis multivariante, el FGF23 se correlacionó con la FEVI (p < 0,01), pero solo marginalmente con el IMVI (p < 0,01). Los episodios cardiovasculares en el período de seguimiento no se correlacionaron con el FGF23. Además, el FGF23 se correlacionó independientemente con la mortalidad general (p < 0,001). Conclusión: El FGF23 se correlacionó positivamente con la HVI y negativamente con la FEVI. El FGF23 fue un factor independiente para la mortalidad general. Keywords: Fibroblast growth factor 23, Left ventricular hypertrophy, Left ventricular ejection fraction, Dialysis, End-stage renal disease, Echocardiography, Phosphate, Parathyroid hormone, Palabras clave: Factor de crecimiento fibroblástico 23, Hipertrofia ventricular izquierda, Fracción de eyección ventricular izquierda, Diálisis, Enfermedad renal terminal, Ecocardiografía, Fosfato, Hormona paratiroide

Chapter 22. Two Approaches to the Politics of Identity

The question of the mechanism of internalization of national ideas in constructing people’s self-perception does not have a simple and single answer. Certainly, the language of political declarations, even if it is backed by the corresponding historical narratives, is insufficient for a formation of the national identity space. Following the path of distinguishing two different approaches to defining the “nation”—as a constructed entity or as a cultural whole—one can presume that these are al..