Gender disparity in emergency department non-ST elevation myocardial infarction management

Background

Many studies have looked at differences between men and women with acute coronary syndrome. These studies demonstrate that women have worse outcomes, receive fewer invasive interventions, and experience delay in the initiation of established medical therapies.

Objective

Using innovative technology, we set out to unveil and resolve any gender disparities in the evaluation and treatment of patients presenting with a positive troponin while in the emergency department. Our goal was to assess the feasibility of using a business management query system to create an automated data report that could identify deficiencies in standards of care and be used to improve the quality of treatment we provide our patients.

Methods

Over a 12-month period, key markers for patients with non-ST elevation myocardial infarction (NSTEMI) were tracked (e.g., time to electrocardiogram, door to medications). During this time, educational endeavors were initiated utilizing McKesson’s Horizon Business Insight™ (McKesson Information Solutions, Alpharetta, GA) to illustrate gender differences in standard therapy. Subsequently, indicators were evaluated for improvement.

Results

Substantial improvements in key indicators for management of NSTEMI were obtained and gender differences minimized where education was provided.

Conclusion

The integration of these information systems allowed us to create a successful performance improvement tool and, as an added benefit, nearly eliminated the need for manual retrospective chart reviews.     

Gender disparity in the use of cardiac resynchronization therapy in the United States

Background: Although several studies have shown the effectiveness of cardiac resynchronization therapy (CRT) for advanced congestive heart failure (CHF), gender differences in utilization of CRT are not known.
Methods: We used the Healthcare Cost and Utilization Project (HCUP) to study national rates for admissions due to CHF along with procedures for initial CRT implantation, including both CRT-defibrillator (CRT-D) and CRT-pacemakers (CRT-P) during the years of 2002–2004. Chi-square tests were used for comparison between number of women and men. A P < 0.05 was considered significant.
Result: Women had consistently higher rates of admission for CHF during each year (574,037 (54%) vs 482,005 (46%), 2002; 601,181 (54%) vs 517,202 (46%), 2003; and 580,913 (53%) vs 521,280 (47%), 2004). The number of initial CRT device implantations (both CRT-D and CRT-P) was significantly lower during each year for women compared to men (659 (25%) vs 1,931 (75%), 2002; 6,928 (26%) vs 19,646 (74%), 2003; and 11,286 (27%) vs 42,196 (73%), 2004; P < 0.01 for all). Both CRT-P and CRT-D were used less frequently in women compared to men; however, this difference was consistently less prominent during each year with CRT-P compared to CRT-D (301 (41%) CRT-P vs 358 (19%) CRT-D, 2002; 659 (39%) CRT-P vs 2,530 (28%) CRT-D, 2003; and 2,891 (39%) CRT-P vs 8,395 (24%) CRT-D, 2004; P < 0.05).
Conclusion: Our data clearly demonstrate a significant gender disparity in utilization of CRT devices. Further studies are needed to find possible reasons behind this disparity.     

A pilot randomised controlled trial of dressing and securement methods to prevent arterial catheter failure in intensive care

BackgroundCritically ill patients in an intensive care setting often require arterial catheters for blood pressure monitoring and arterial blood collection. Arterial catheter failure, which manifests in both mechanical and infective forms, remains common. Dressing and securement inadequacies may impact this failure; however, the best method for dressing and securing arterial catheters is yet to be determined.ObjectivesThe objective of this study was to establish the feasibility of a definitive randomised controlled trial comparing methods for dressing and securing arterial catheters and to prevent device failure in an adult intensive care setting.MethodsA pilot, parallel-group, randomised controlled trial was conducted between April 2017 and June 2018. Patients receiving treatment in two adult intensive care units (Queensland, Australia) were eligible for inclusion and were allocated to receive either (i) an integrated securement dressing or (ii) a simple polyurethane dressing (with gauze/foam), applied to their newly inserted arterial catheters.Main outcome measuresPrimary outcomes were (i) feasibility (defined by pre-established criteria: patient eligibility, consent, protocol adherence, retention, and staff acceptability) and (ii) all-cause arterial catheter failure (a composite of local and bloodstream infection, occlusion, dislodgement, infiltration/extravasation, arterial inflammation, thrombosis, and/or inaccurate trace). Secondary outcomes included: failure type, dwell time, dressing adhesion, adverse event profiles, and staff acceptability.ResultsIn total, 109 patients were studied (n = 53 integrated securement dressing; n = 56 simple polyurethane). The feasibility criterion was met by most patients (including rates of consent [86%], protocol adherence [93%], and retention [100%]); however, the criteria for patient eligibility were not met (73%). All-cause device failure did not differ significantly between the integrated securement device group (n = 12/53, 23%) and the simple polyurethane group (n = 6/56, 11%) (hazard ratio = 2.39, 95% confidence interval = 0.89–6.37, p = 0.083).ConclusionsFindings indicate a larger study is feasible, with minor alterations to recruitment methods required. Arterial catheter failure remains unacceptably common; further research to determine optimal dressing/securement practices is urgently needed.     

持续冲洗法在患儿有创动脉置管中的应用及分析

动脉血压监测的过程中会遇到一些并发症,其中主要的是动脉留置导管内血栓的形成、血管痉挛[1,2]以及更换冲洗液时压力传导系统内出现气泡,影响血压监测准确性并给病人带来医源性损害。为避免这些并发症,在血压监测过程中会持续采用低浓度肝素液对压力传导系统进行冲洗[3]。为阐明连续冲洗的临床效果,我院PICU于2009年11月开始采用微量泵持续输注低浓度肝素液(1U/mL)。就持续肝素液输注对儿童有创血压监测出凝血时间的影响、动脉留置时间、留置部位及其拔管、并发症原因进行回顾性分析。     

Gender differences in patients with heart failure.

AIM: The aim of this literature review was to review and discuss the differences between men and women with heart failure with regard to epidemiology, aetiology, diagnostics, prognosis, pharmacological and non-pharmacological treatment, and the impact of heart failure on psychosocial factors and healthcare utilisation. METHOD: Two primary health care resources, MEDLINE and CINAHL, were selected to review the current literature. In MEDLINE, 234 abstracts dealing with heart failure and gender/sex were found and in CINAHL, 20 abstracts. CONCLUSION: Men have a higher incidence of heart failure, but the overall prevalence rate is similar in both sexes, since women survive longer after the onset of heart failure. Women tend to be older when diagnosed with heart failure and more often have diastolic dysfunction than men. The extent of sex differences in treatment, hospital cost and quality of care can partly be explained by age differences. The life situations for men and women with heart failure are different. Physical and social restrictions affecting daily life activities are experienced as most bothersome for men, whereas restrictions affecting the possibility to support family and friends are most difficult to accept for women. Women with heart failure ascribe more positive meanings to their illness. Despite this, women seem to experience a lower overall quality of life than men. The known gender differences in patients with heart failure need to be highlighted in guidelines as well as implemented in standard care.     

外周动脉置管在197例危重新生儿中的应用研究

动脉置管在重症监护室(NICU)的应用非常广泛,可以连续监测收缩压、舒张压和平均动脉压,抽取血标本,进行血气分析.美国手术室和重症监护病房每年大约放置800多万条动脉导管[1].我院NICU从2003年开始应用外周动脉置管,现在不仅可以从桡动脉置管,还可根据新生儿的特点,选择胫后动脉置管.现将近两年我病房197例外周动脉置管情况总结如下.     

1519例慢性心力衰竭住院患者的性别差异分析

目的分析慢性心力衰竭住院患者在临床特点和转归方面有无性别差异。方法回顾性分析首都医科大学附属复兴医院1990年1月1日到2010年1月1日1519例CHF患者的临床资料,比较分析不同性别患者的病因、转归等特点。结果1519例CHF患者男女比例为1：0.67（P＜0.01）,女性较男性年龄大（63.4±0.4比61.8±0.5,P＜0.01）,患高血压〔69.2%（420/607）比50.4%（460/912）,P＜0.01〕〕、糖尿病〔67.5%（410/601）比52.7%（487/912）,P＜0.01〕、高脂血症〔24.8%（151/607）比16.1%（147/912）,P＜0.01〕和风湿性心脏病〔1.8%（11/607）比0.3%（3/92）,P＜0.01〕更多,左室射血分数也高于男性（0.395±0.130比0.326±0.130, P＜0.01）。男性较女性有吸烟史〔20.5%（187/912）比1.3%（8/601）,P＜0.01〕、心肌梗死病史〔35.4%（323/912）比24.3%（148/607）,P＜0.01〕、冠状动脉旁路移植术病史〔10.8%（98/912）比7.5%（76/607）,P＜0.01〕,以及患急性冠脉综合征〔21.9%（200/912）比15.8%（96/607）,P＜0.01〕的比例要高。男性较女性有更高的好转率〔92.5%（544/912）比87.8%（533/607）,P＜0.01〕,但恶化率或病死率比较差异却无统计学意义〔4.1%（37/912）比6.4%（39/607）,P＝0.21〕。结论 CHF在临床特点和转归方面存在性别差异,治疗时应区别对待。     

Use of proximal side-hole micro-balloon catheter in transcatheter hepatic arterial chemoembolization

We report on a 70-year-old man with unresectable multiple hepatocellular carcinomas who underwent treatment with transcatheter hepatic arterial chemoembolization. In treating a tumor in segment 1 of the liver, the proximal side-hole micro-balloon catheter, which has been newly developed, was useful.     

Sex disparity in the association between hypertriglyceridemic waist phenotype and arterial stiffness in Chinese healthy subjects

Objective: To investigate the association between hypertriglyceridemic waist (HTGW) phenotype and arterial stiffness in a Chinese population without hypertension, diabetes and cardiovascular diseases.

Methods: A total number of 3028 subjects aged 40 years and over were enrolled in this cross-sectional study. All participants provided a clinical history and underwent a physical examination. Brachial-ankle pulse wave velocity (baPWV) was used to evaluate arterial stiffness. HTGW phenotype was defined as the simultaneous presence of waist circumference ≥90/80 cm and triglycerides ≥2.0/1.5 mmol/L in men/women.

Results: The prevalence of HTGW phenotype was 7.5% among healthy participants in China (Beijing), 7.4% in men and 7.5% in women. Women with HTGW phenotype had a higher level of baPWV compared with normal WC and normal triglyceride (NWNT) group (P < 0.05), but no significant difference was observed in men (P > 0.05). Multiple logistic regression analysis showed HTGW phenotype was significantly associated with baPWV after controlling for multiple factors in women. However, no significant relationship was observed in men.

Conclusions: The present study supports that HTGW phenotype is associated with increased arterial stiffness in women but not in men.     

经桡动脉置管持续监测动脉压的护理

有创动脉压监测是经周围动脉插管直接测量动脉内压力的一种方法,可通过换能器测量血管内整个心动周期的压力变化,连续监测收缩压、舒张压及平均动脉压,并将其数值和波形显示于监护仪荧光屏上[1].还可根据动脉波形变化来判断分析心肌的收缩功能.有创动脉压监测为持续的动态变化过程,不受人工加压、袖带宽度及松紧度影响[2].     

A novel external catheter fixation method for chemotherapy using inferior epigastric arterial catheterization for cervical cancer

The aim of this randomized controlled study was to investigate the effects of a novel external catheter fixation method for chemotherapy using inferior epigastric arterial catheterization for cervical cancer.Patients diagnosed with cervical cancer were randomly divided into a control group (n = 32) and a treatment group (n = 33). Patients in the control group underwent a traditional fixation method using a haemostat, elastic band and abdominal bandage. Patients in the treatment group underwent an improved fixation method using an indwelling needle and membrane cover. We used a visual analogue scale (VAS) to evaluate each patient's comfort score and also recorded the incidence of needlestick injury and the length of injection time in each group. The VAS scores measured before and after chemotherapy in the treatment group were lower than in the control group. The incidence of needlestick injury in the treatment group was significantly lower than in the control group. The length of injection time in treatment group was significantly lower than in the control group. Compared with the traditional fixation method, the improved fixation method not only increased patient comfort but also reduced both the risk of needlestick injury and the length of injection time. This improved technique deserves increased clinical use.