Telephone counselling—the EDA approach

In 1989 the Eating Disorders Association established a telephone counselling programme for clients with bulimia nervosa. This programme is described in detail. Results of the counselling, conducted over a 2‐year period, on 26 patients, are reported. Results show a significant reduction in binge‐eating, vomiting and laxative abuse. Those remaining bulimic differed significantly from those recovered in that they had a longer history of illness. Patients rated telephone counselling more highly than face‐to‐face counselling in terms of convenience, anonymity and confidentiality. The majority felt trust would be enhanced with personal contact. It would appear that a structured telephone counselling programme for patients with bulimia nervosa may offer a viable, effective to conventional counselling. This may provide one answer to the treatment of these patients in areas where services are lacking. Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association.     

Saline Contrast Echocardiography in the Era of Multimodality Imaging—Importance of “Bubbling It Right”

Saline contrast echocardiography is an established imaging modality. Logical interpretation of a carefully performed study is vital to realize its diagnostic potential. In this review, we discuss utility of saline contrast echocardiography in evaluation of various pathologies within and outside the heart other than a patent foramen ovale.     

Defining extended half‐life rFVIII—A critical review of the evidence

Introduction

Recent haemophilia treatment advances include new recombinant FVIII (rFVIII) products with improved pharmacokinetic (PK) properties that aim to reduce the burden of prophylaxis. These treatments are commonly referred to as extended half‐life rFVIII products (EHL rFVIII). There is no uniform definition of what constitutes an EHL rFVIII. Such a definition would help physicians, patients and funders understand the properties of standard and EHL rFVIIIs and thus provide clarity when selecting an EHL in clinical settings.

Aim

To critically assess the published evidence on new and emerging rFVIII products in order to propose a definition to classify EHL rFVIIIs.

Methods

We systematically searched PubMed, EMBASE and regulatory authorities (FDA/EMA/Health Canada) websites for publications and regulatory submissions describing prospective crossover PK studies evaluating rFVIIIs that demonstrate improved PK parameters in adults and adolescents with severe haemophilia A.

Results

Following critical analyses of the published data, we developed a holistic approach to defining rFVIIIs as EHLs, which requires all of the following: (i) using technology designed to extend rFVIII half‐life; (ii) lacking bioequivalence with a standard rFVIII comparator—above the FDA/EMA cut‐off of 125% for the 90% confidence intervals for area under the curve ratio; and (iii) having an extended half‐life ratio measured in a PK comparator crossover study.

Conclusion

In this systematic review, a pragmatic definition of EHL rFVIII has been proposed that should provide better clarity in clinical discussions surrounding the appropriate use of rFVIII products. At present, only products using PEGylation or Fc fusion half‐life extension technology meet the proposed criteria for definition of EHL rFVIII.     

Fixed‐dose vs free‐dose combinations for the management of hypertension—An analysis of 81 958 patients

Fixed‐dose combinations (FDC) have been developed to reduce the pill burden for hypertensive patients. Data on fixed‐dose or free‐dose (freeDC) ramipril/amlodipine (R/A) or candesartan/amlodipine (C/A) combination treatment initiation were assessed. 71 463 patients were prescribed R/A and 10 495 C/A. For both R/A and C/A, FDC patients were younger (both P < .001) and less comorbid. Prior MI (OR: 0.61 and 0.60), prior stroke (OR: 0.68 and 0.70) and CHD (OR: 0.68 and 0.64) were negatively associated with FDC use, whereas hyperlipidemia was positively associated (OR: 1.26 and 1.19). Use of antihypertensive comedication (OR: 0.78; OR: 0.55) and treatment discontinuation within 12 months (HR: 0.65 and 0.82) were less likely in FDC patients, who also showed superior adherence (mean MPR; both P < .001). Cost of the combination was higher for FDCs (both P < .001). FDCs improve persistence and adherence, although they are more commonly prescribed in patients with less cardiovascular disease.     

Treatment of functional mitral regurgitation by percutaneous annuloplasty using the Carillon Mitral Contour System—Currently available data state

Objective

The purpose of this study is to provide a systematic review of currently available data about the percutaneous trans‐coronary‐venous mitral annuloplasty with the Carillon Mitral Contour System.

Method

A systematic literature search was conducted using the common medical and scientific databases. The documented parameters included among others grade of mitral regurgitation (MR), vena contracta (VC), effective regurgitant orifice area (EROA), 6 minute‐walk‐test (6MWT), NYHA‐classification, and Quality of Life (QoL) at baseline, 30 days and in the long‐term follow‐up.

Results

The exact total number of successfully implantations with available data remains unclear because so many publications are either of the same institution or study group, or they present overlapping results. Reduction of functional mitral regurgitation (FMR) was associated with significant inverse left‐ventricular (LV)) remodeling, improvement in 6MWT, QoL and NYHA‐class during the 12‐month follow‐up. In almost half of the enrolled patients, the Carillon System could not be implanted or had to be removed due to coronary compromission. Adverse advent rate (AE) ranged between 2.8–39%.

Conclusions

Results with regard to reduction of MR and inverse LV remodeling have been remarkable. Indication and selection criteria for suitable patients, the expected complications, and the long‐term results with regard to survival and quality of life still remain unclear. The available results do not establish superiority of the Carillon Mitral Contour System and support the lack of a clear benefit. The approach with the Carillon Mitral Contour System should be limited to participants of prospective and randomized trials.

     

Targeted transendocardial therapeutic delivery guided by mri—x‐ray image fusion

Objectives : To validate a multi‐modality image fusion approach to guide catheter‐based, targeted transendocardial therapeutic delivery in a swine myocardial infarction (MI) model. Background : Biologic agents such as stem cells may curb post MI adverse ventricular remodeling if delivered by a transendocardial catheter directly into the infarct border. 3D visualization of the infarct and other cardiac surfaces is required to perform this task. We propose registering and overlaying magnetic resonance imaging (MRI) roadmaps onto live x‐ray fluoroscopy (XRF) to guide targeted transendocardial delivery. Methods : Custom software was used to register and overlay MRI models of the endocardium and infarct on live XRF by aligning common endocardial border features. In a swine MI model, transendocardial injections of co‐localizing imaging labels were performed, targeting a 20 mm perimeter around the infarct. Directed targeting error (DTE) was defined as the difference between the predicted injection site‐to‐infarct distance calculated by the image fusion system, to the actual distance determined by postprocedure in vivo MRI. The mobile image fusion system was designed to be vendor‐independent for imaging systems and transendocardial catheters. Results : Transendocardial injections were performed in all animals without complications. Mean DTE was 0.9 ± 5.0 mm (n = 8 swine). Time to register the images and establish a high quality roadmap was less than 12 min in all animals. Custom imaging tools to display injection sites and distribution were useful adjuncts during targeted injection procedures. Conclusions : Multi‐modality image fusion is a feasible and accurate platform technology to guide transendocardial injections precisely to the discrete infarct border. © 2011 Wiley‐Liss, Inc.     

Episodic Left Bundle Branch Block—A Comprehensive Review of the Literature

Episodic (transient/ intermittent) left bundle branch block (LBBB) has been associated with different conditions such as bradycardia, tachycardia, anesthesia, acute pulmonary embolism, changes in intrathoracic pressure, chest trauma, cardiac interventional procedures, mad honey poisoning, and in other clinical settings. Of note, exclusion of an acute coronary syndrome in the setting of episodic LBBB is of great importance. Moreover, episodic LBBB is sometimes symptomatic and may be associated with left ventricular systolic and/or diastolic dysfunction or conduction disturbances leading to syncope. This review article provides a comprehensive overview of the conditions associated with episodic LBBB and discusses the clinical impact of this phenomenon.