A successful anaemia management algorithm that achieves and maintains optimum haemoglobin status

The paper describes the need for the introduction of an anaemia management algorithm. It discussed the problems which the unit had in constant reviewing and re-prescribing ESA to maintain optimum haemoglobin levels for the unit's patients. The method used to create and use the algorithm is explained. The findings demonstrate the beneficial effects of using the algorithm. The paper concludes with the recommendation that algorithms should be more widely used for better treatment outcomes.     

New principles for optimum left ventriculography

Left ventriculography has become the single most important procedure in the evaluation of cardiac function. This study reevaluated the refinements of catheter and power injector technology to assess recommendations of past years and establish new principles for optimum ventriculography. Ventriculograms from 102 patients undergoing left heart catheterization and coronary arteriography for coronary, valvular, and myocardial heart disease served as the test sample. Three styles of #7F high-flow 110-cm pigtail catheters were utilized. One had 12 sideholes while the other two had six sideholes positioned nearer the base of the curl. Analysis of ventriculographic quality of each angiogram was performed by three of the authors independently and subsequently together. Five variables were analyzed for their effect on the diagnostic quality of the angiogram: 6-hole catheters, 12-hole catheters, volume of contrast, flow rate, and location of injection. Once these analyses were complete, the effect of combinations of these variables was tested to determine their effect on angiographic quality. The first combination included contrast volume and flow rate. The second combination compared contrast volume and flow rate when utilized with 6- or 12-hole catheters. The third combination tested the 6- and 12-hole catheters in the apex or inflow locations. A multivariate contingency analysis was used to define relationships between the variables and the quality of the angiogram obtained. As independent variables, catheter style, volume of contrast, flow rate, and location of injection did not influence angiographic quality. However, the apex as a location of injection was the single most consistently important determinant of ventricular angiographic quality.(ABSTRACT TRUNCATED AT 250 WORDS)     

The role of APACHE-II triaging in optimum management of small bowel perforations.

Small bowel perforations with peritonitis pose a serious problem to an emergency surgeon because of the lack of any uniformity of opinion regarding the optimum surgical treatment to be performed. This may be attributed to lack of any common and reliable scoring system. A prospective study to discover the utility of APACHE-II triaging in small bowel perforations was conducted over a period of 14 months on 51 patients with small bowel perforations of various aetiologies. The triaging facilitated definitive surgical treatments based on the predictive value of APACHE-II scoring. The classification of patients into three groups, effectively brought uniformity in the management. A significant reduction in mortality and cost-effective utilization of scarce intensive care unit resources were the dominant outcomes of this study conducted at a busy tertiary centre.     

Progress and prospects for optimum antiarrhythmic drug design

Summary Different class I drugs slow down to differing degrees the rate at which sodium channel availability, hence excitability, recovers after action potentials. Drugs that produce longer recovery half-times generally produce greater proarrhythmic side effects. Increased lipid solubility may improve a drug's potency for blocking channels yet with implications for adverse effects. Drug action may be potentiated in depolarized and acidotic tissue via modulation of the recovery process. A knowledge of molecular properties of antiarrhythmic drugs helps to define these modes of interraction with the sodium channels and, hence, will help in future drug design. Prospects for improving our understanding of ionic events involved in the repolarization phase of cardiac action potentials are also outlined. The development of successful strategies for controlling reentrant arrhythmias will probably require a thorough understanding of both class I and class III drug actions at the level of the membrane ion channel.Supported in part by NIH grants HL 24156, and a gift from the William Coldiron family.     

Barriers to optimum end-of-life care for minority patients

Although major efforts are underway to improve end-of-life care, there is growing evidence that improvements are not being experienced by those at particularly high risk for inadequate care: minority patients. Ethnic disparities in access to end-of-life care have been found that reflect disparities in access to many other kinds of care. Additional barriers to optimum end-of-life care for minority patients include insensitivity to cultural differences in attitudes toward death and end-of-life care and understandable mistrust of the healthcare system due to the history of racism in medicine. These barriers can be categorized as institutional, cultural, and individual. Efforts to better understand and remove each type of barrier are needed. Such efforts should include quality assurance programs to better assess inequalities in access to end-of-life care, political action to address inadequate health insurance and access to medical school for minorities, and undergraduate and continuing medical education in cultural sensitivity.     

Current concepts in optimum nutrition for cardiovascular disease

For the past decade, nutritionists have focused on consensus guidelines (National Cholesterol Education Program) to reduce dietary saturated fatty acids, cholesterol, and excess body weight. However, researchers are looking at other ways that diet may influence the progression of cardiovascular disease, including lipoprotein oxidation, thrombosis progression, cardiac arrhythmia, and medication interaction. Some areas of investigation include the role of various fatty acids and supplements—in the form of vitamins, minerals, herbs, and functional foods—as well as traditional foods and diets from other parts of the world. This review outlines some of the new and relevant nutritional approaches including: specific fatty acids (omega 3, monounsaturated and trans fatty acids), dietary supplements (herbs, antioxidants, vitamins C and E, Coenzyme Q10, B vitamins and homocysteine, L-arginine, Chinese red yeast rice, garlic, soy, flax seed, and dietary fiber), food and drink (tea, nuts, plant-sterol and stanolester-containing spreads, alcohol, and grapefruit juice), and the Mediterranean diet.     

Treatment strategies for co-occurring ADHD and substance use disorders

Attention-deficit hyperactivity disorder (ADHD) is a common co-occurring mental disorder among patients with substance use disorders (SUD). Clinicians must be cognizant of the complicated nature of diagnosis and treatment of ADHD when comorbid with SUD. Pharmacotherapy remains the mainstay of treatment for ADHD, although complementary psychotherapeutic approaches have been developed. Psychostimulant medications are the most commonly used medications to treat ADHD, but many clinicians are reluctant to prescribe stimulants to patients with SUD. Recommendations for treatment planning and clinical management for patients with co-occurring ADHD and SUD are discussed.