Chronic atrial fibrillation : success rate of serial cardioversion therapy and long-term safety of oral anticoagulation

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Communication between physicians and with patients suffering from breast cancer

BACKGROUND: The communication between GP and specialists is vital for the patient suffering from breast cancer. OBJECTIVES: The aim of this study was to investigate (i) the speed and type of communication between GPs, specialists and patients with breast cancer, and (ii) the problems that GPs encounter in the communication with specialists concerning these patients. METHOD: In April 1995, 246 Dutch GPs from the Zwolle region (600 000 inhabitants) were invited to complete a questionnaire, using the information from the medical record and focusing on the last patient consulted with a confirmed diagnosis of breast cancer. RESULTS: Valid replies were received from 150 (61 %) GPs. The median period between initial referral date and receipt of the definite diagnosis from the surgeon was 4 weeks. After the patient's first appointment with the surgeon, the GPs received reports for 24% of the patients within 3 days; for 31% within 3-7 days; and for 16% of the patients after more than 2 weeks. After the first consultation between patient and surgeon, 68 (45%) of the 150 GPs reported that the patient contacted them; at this stage only 30 (20%) of these GPs had received a report from the surgeon. Thirty-one (21%) GPs did not contact the patient after receival of the definite diagnosis. GPs stated that the communication on patients with breast cancer is too slow (49%), or not frequent enough (25%); 25% of GPs found that the distribution of tasks between them and the specialists are not well described. CONCLUSION: In the diagnostic stage of breast cancer the communication between GPs, specialists and patients varies widely, is too slow and is incomplete. An effect of this unsatisfactory communication is that the patient herself is the messenger of the bad news. Record 30 of 32 - SilverPlatter MEDLINE(R)

Sugammadex

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433. The July 2016 monograph topics are pimavanserin, venetoclax, defibrotide, lifitegrast ophthalmic solution 5%, and atezolizumab. The Safety MUE is on pimavanserin

Left ventricular beat-to-beat performance in atrial fibrillation: Contribution of Frank-Starling mechanism after short rather than long intervals

This study sought to evaluate control mechanisms of the varying left ventricular performance in atrial fibrillation. Atrial fibrillation is characterized by a randomly irregular ventricular response, resulting in continuous variation in left ventricular beat-to-beat mechanical behavior and hemodynamic variables. Fourteen patients with chronic nonvalvular atrial fibrillation were studied, using a nonimaging computerized nuclear probe linked to a personal computer. Left ventricular ejection fraction, end-diastolic and end-systolic volume counts, stroke volume counts and filling time were calculated on a beat-to-beat basis during 500 consecutive RR intervals. Multiple regression analysis was used to assess how ejection fraction was predicted by these variables. The preceding RR interval and end-diastolic volume showed a positive relation, and prepreceding interval and endsystolic 0.0001). Sensitivity analysis suggested that the preceding interval and the end-diastolic volume were equally important in predicting ejection fraction. There was a relatively strong interaction between the preceding interval and end-diastolic volume, indicating that the influence of the end-diastolic volume on ejection fraction was diminished after long intervals. A second interaction showed that the effect of end-diastolic volume on ejection fraction was attenuated after short prepreceding cycles. Cycle length-dependent contractile mechanisms, including postextrasystolic potentiation and mechanical restitution, determine the varying left ventricular systolic performance during atrial fibrillation over the entire range of intervals. Beat-to-beat changes in preload, consistent with the Frank-Starling mechanism, also play a role, but their influence is diminished

Quality of life in patients with paroxysmal atrial fibrillation and its predictors: importance of the autonomic nervous system

Aims To determine the impact of paroxysmal atrial fibrillation on quality of life and to determine the predictors of quality of life, particularly the role of symptomatology and autonomic function.Methods and Results The study group comprised 73 patients with paroxysmal atrial fibrillation (mean age 541 years, 51 males). On average, patients had a 3-year history of one paroxysm per week lasting 2 h. Quality of life was assessed using the SF-36 (Medical Outcomes Study Short-Form Health Survey) and compared with age-matched controls. Autonomic function was assessed using Holter monitoring with analysis of heart rate variability and autonomic function tests. Symptoms during paroxysms of atrial fibrillation were also scored. Multivariate analysis was performed to identify independent predictors of quality of life. Quality of life scores were markedly lower in patients than in controls in four of the eight subscales (P<0.001): physical role function, emotional role function, vitality and general health. Structural heart disease did not predict quality of life, whereas frequency of paroxysms was predictive only of physical role function. In contrast, autonomic variables (baroreflex-sensitivity, total power (heart rate variability), response to deep breathing, 30-15 ratio (standing up)) were predictive in all four respective subscales (P<0.05), depressed vagal function being predictive of low scores. Symptoms, particularly severe perspiration, were also predictive of low scores (P<0.05).Conclusions This study shows that paroxysmal atrial fibrillation causes significant impairment of quality of life. Further, symptomatology and autonomic function are important predictors of quality of life in this patient group. (C) 2001 The European Society of Cardiology