Impact of Sex on Comparative Outcomes of Radial Versus Femoral Access in Patients With Acute Coronary Syndromes Undergoing Invasive Management: Data From the Randomized MATRIX-Access Trial

Objectives

This study sought to assess whether transradial access (TRA) compared with transfemoral access (TFA) is associated with consistent outcomes in male and female patients with acute coronary syndrome undergoing invasive management.

汪明德治疗多囊卵巢综合征经验

汪明德治疗多囊卵巢综合征有独到的见解和用药,临证主张以痰、热、瘀实邪为主,偶夹有肾虚,自拟三黄汤滋肾清热、活血化痰。     

基于数据挖掘探讨宋康教授辨治CVA用药规律

目的：收集整理宋康教授辨治咳嗽变异性哮喘（CVA）医案,通过统计分析及数据挖掘的方法,探索总结其临床经验及用药规律。方法：本研究采用回顾性研究方法,收集宋康教授2015年1月1日至2017年12月31日期间门诊诊断为CVA的病案,根据纳入标准及排除标准,结合随访资料,建立病案数据库。通过一般情况分析,高频药物分布,关联规则分析,系统聚类分析及Liquorice复杂网络分析,挖掘高频药物及其分布规律,核心药对和药组,核心方,整理总结宋康教授临证经验。结果：通过对325份医案的数据挖掘分析,获得宋康教授治疗CVA的30味高频药物,6对核心药对,4组核心药组,839条关联规则,1个核心方。结论：宋康教授治疗CVA,基于“风咳”理论,以祛风、化痰、清肺、平肝为主,补益脾胃为辅,五脏辨咳,治以复法,擅用药对,精于配伍。     

Cerebrovascular Events Post-Transcatheter Aortic Valve Replacement in a Large Cohort of Patients: A FRANCE-2 Registry Substudy

ObjectivesThe aim of this study was to analyze the incidence, impact, and predictors of cerebrovascular events (CVEs) in patients undergoing transcatheter aortic valve replacement (TAVR).BackgroundSeveral issues remain unresolved post-TAVR, including CVEs.MethodsThe FRANCE-2 (French Aortic Nation CoreValve and Edwards-2) registry prospectively included all patients who underwent TAVR in France and Monaco from January 2010 to October 2011. A total of 3,191 patients were analyzed. Six-month follow-up data were obtained. Events were adjudicated according to Valve Academic Research Consortium (VARC)-1 definition.ResultsOf the cohort, 3.98% experienced a CVE: 55% were major strokes, 14.5% minor strokes, and 30.5% transient ischemic attacks. The mean delay for CVE occurrence was 2 days (interquartile range: 0 to 7 days) with 48.5% of CVEs occurring within 2 days. There was no statistically significant difference in CVE rate with regard to the type of valve (p = 0.899) and the access route (p = 0.128). Patients with a CVE more frequently had new-onset paroxysmal atrial fibrillation (13.6% vs. 7.6%; p = 0.015). During follow-up, the unadjusted mortality rate was higher in patients with a CVE (26% vs. 16.5%; p = 0.002). By multivariate analysis, only advanced age (odds ratio: 1.05; 95% confidence interval: 1.02 to 1.08; p = 0.02) and having 2 valves implanted (odds ratio: 3.13; 95 confidence interval: 1.40 to 7.05; p = 0.006) were associated with a significant risk of CVEs.ConclusionsCVEs occur frequently after TAVR and are associated with an increased mortality rate. No difference exists in the CVE rate when exploring the type of valve or the access route. Advanced age and multiple valves implanted during the same procedure are predictors of CVE.     

Transapical Transcatheter Aortic Valve for Severe Aortic Regurgitation: Expanding the Limits

ObjectivesThis study sought to evaluate the self-expandable ACURATE TA device (Symetis SA, Ecublens, Switzerland) in a cohort of patients with pure aortic regurgitation (AR).BackgroundTranscatheter aortic valve replacement (TAVR) has been initially considered as an alternative for high-risk patients with aortic stenosis. Although the current experience is limited, TAVR might be also an alternative to treat patients with pure, severe AR.MethodsBetween April 2012 and December 2013, a total of 8 high-risk patients with pure, severe AR were enrolled (grade III+). Clinical and hemodynamic data as well as data on device and procedure parameters and outcomes were collected.ResultsPatient mean was 72.5 ± 8.4 years, and 37.5% of patients were female. Logistic EuroSCORE was 34.0 ± 7.9% and the Society of Thoracic Surgeons score was 7.3 ± 3.3% on average. Two patients had undergone emergency aortic operation before due to acute type A aortic dissection, and both were treated by replacement of the ascending aorta (including root reconstruction) and the aortic arch combined with or without E-vita Open stent graft (Jotec GmbH, Hechingen, Germany) (January 2011 and March 2012), whereas the other patients experienced primary AR. All patients underwent successful transapical TAVR with the transapical ACURATE TA device (size small, n = 1, size medium, n = 3, size large, n = 4) without any intraprocedural complications according to the Valve Academic Research Consortium 2 criteria. Post-procedure AR grade I+ or lower, as revealed by transoesophageal echocardiography and angiography, was present in all 8 patients. At 30 days, the stroke incidence and all-cause mortality rate were 0%.ConclusionsThis small single-center series demonstrates the feasibility of transapical TAVR with the self-expandable ACURATE TA device in high-risk patients with severe AR.     

Prophylactic academic intervention for children treated with cranial radiation therapy

This single case study investigated the feasibility and effectiveness of a prophylactic intervention for improving academic skills in a child with a brain tumour deemed at high risk for cognitive delay and academic failure because of cranial radiation treatment (CRT). An 8 year old boy participated in a 12 week home and hospital based tutoring programme. Standardized and non-standardized measures of academic achievement were administered at pre- and post-intervention. A follow-up assessment took place 8 months post-intervention (standardized measures only). Pre-test and follow-up neuropsychological data was collected. Significant improvement was observed on the Wechsler Individual Achievement Test–2nd Edition (WIAT-II) pseudoword decoding and spelling sub-tests and on measures of single word and grapheme knowledge. There was no improvement on the WIAT-II math sub-tests. At follow-up, gains were maintained or improved for reading-related sub-tests but declined for math and spelling sub-tests. Overall, neuropsychological data showed decreased performance. The gains in reading skills were made in the context of an overall decline in neuropsychological functioning, suggesting that the intervention helped to preserve reading skills and may be protective against difficulty with skill acquisition, but did not prevent a more global decrease in functioning. This study is the first reported prophylactic intervention delivered concurrently with intensive medical treatment.     

Improving oral healthcare using academic detailing – design of the ADVOCATE Field Studies

Background: Academic detailing (AD) is a defined form of educational outreach that can be deployed to intrinsically motivate practitioners towards improving quality of care. This paper describes the design of the ADVOCATE Field Studies. This proof of concept study aims to evaluate the feasibility, acceptability and usefulness of AD, reinforced with feedback information to promote prevention-oriented, patient-centred and evidence-based oral healthcare delivery by general dental practitioners (GDPs).

Methods: Six groups of GDPs will be recruited; two groups of six to eight GDPs in each of three countries – the Netherlands, Germany and Denmark. GDPs will meet for four Academic Detailing Group (ADG) meetings for open discussions using comparative feedback data to stimulate debate about their dental practice performance and care delivery. Group meetings will be moderated using the AD methodology. Qualitative data will be collected through focus group interviews, an online discussion forum, field notes and debriefs of ADG meetings and analysed by conventional content analysis using MaxQDA software.

Discussion: The results of the study will provide novel information on the feasibility, perceived acceptability and usefulness of AD and feedback data for GDPs to improve oral healthcare delivery.     

Barriers to advancement in academic surgery: views of senior residents and early career faculty

Background

A significant faculty attrition rate exists in academic surgery. The authors hypothesized that senior residents and early-career faculty members have different perceptions of advancement barriers in academic surgery.

Methods

A modified version of the Career Barriers Inventory–Revised was administered electronically to surgical residents and early-career surgical faculty members at 8 academic medical centers.

Results

Residents identified a lack of mentorship as a career barrier about half as often as faculty members. Residents were twice as likely as faculty members to view childbearing as a career barrier.

Conclusions

Many early-career faculty members cite a lack of mentors as a limitation to their career development in academic surgery. Childbearing remains a complex perceived influence for female faculty members in particular. Female faculty members commonly perceive differential treatment and barriers on the basis of their sex. Faculty development programs should address both systemic and sex-specific obstacles if academic surgery is to remain a vibrant field.     

Professional development and leadership training opportunities for healthcare professionals

Background

Formal leadership training is a relatively recent addition to the educational armamentarium of the health care executive. Leadership training opportunities for physicians, surgeons, and scientists have gradually appeared over the past 15 to 20 years, but information about them has been scant, with few comprehensive reviews made available to the community at large. This article describes the major opportunities available to obtain formal and informal leadership training for careers in medical school administration. Programs that are specifically targeted to women are described in detail.

Data Sources

Information was obtained from the author's direct knowledge, direct communication with the leadership of each program, and the Web site of each sponsoring organization, when available.

Conclusions

Many opportunities for leadership training are now available to surgeons, with several specifically designed for women. The author strongly encourages surgeons to avail themselves of these opportunities, as both anecdotal information and published data suggest that these programs are highly effective in enhancing leadership careers.