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Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit 下载免费PDF全文
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John-Ross D. Clarke MD Jonathan P. Piccini MD MHS Daniel J. Friedman MD 《Journal of cardiovascular electrophysiology》2021,32(9):2567-2576
The left atrial posterior wall has many embryologic, anatomic, and electrophysiologic characteristics, that are important for the initiation and maintenance of persistent atrial fibrillation. The left atrial posterior wall is a potential target for ablation in patients with persistent atrial fibrillation, a population in whom pulmonary vein isolation alone has resulted in unsatisfactory recurrence rates. Published clinical studies report conflicting results on the safety and efficacy of posterior wall isolation. Emerging technologies including optimized use of radiofrequency ablation, pulse field ablation, and combined endocardial/epicardial ablation may optimize approaches to posterior wall isolation and reduce the risk of injury to nearby structures such as the esophagus. Critical evaluation of future and ongoing clinical studies of posterior wall isolation requires careful scrutiny of many characteristics, including intraprocedural definition of posterior wall isolation, concomitant extrapulmonary vein ablation, and study endpoints. 相似文献
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How to Use the American Geriatrics Society 2015 Beers Criteria—A Guide for Patients,Clinicians, Health Systems,and Payors 下载免费PDF全文
Michael A. Steinman MD Judith L. Beizer PharmD CGP Catherine E. DuBeau MD Rosemary D. Laird MD Nancy E. Lundebjerg MPA Paul Mulhausen MD MHS 《Journal of the American Geriatrics Society》2015,63(12):e1-e7
The Beers Criteria are a valuable tool for clinical care and quality improvement but may be misinterpreted and implemented in ways that cause unintended harms. This article describes the intended role of the 2015 American Geriatrics Society (AGS) Beers Criteria and provides guidance on how patients, clinicians, health systems, and payors should use them. A key theme underlying these recommendations is to use common sense and clinical judgment in applying the 2015 AGS Beers Criteria and to remain mindful of nuances in the criteria. The criteria serve as a “warning light” to identify medications that have an unfavorable balance of benefits and harms in many older adults, particularly when compared with pharmacological and nonpharmacological alternatives. However, there are situations in which use of medications included in the criteria can be appropriate. As such, the 2015 AGS Beers Criteria work best not only when they identify potentially inappropriate medications, but also when they educate clinicians and patients about the reasons those medications are included and the situations in which their use may be more or less problematic. The criteria are designed to support, rather than supplant, good clinical judgment. 相似文献
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Prediction of healing progress of pressure ulcers by distribution analysis of protein markers on necrotic tissue: A retrospective cohort study 下载免费PDF全文
Aya Kitamura MHS Mikako Yoshida PhD Takeo Minematsu PhD Gojiro Nakagami PhD Shinji Iizaka PhD Hideki Fujita PhD Ayumi Naito MHS Kazuo Takahashi MD Taketoshi Mori PhD Hiromi Sanada PhD 《Wound repair and regeneration》2015,23(5):772-777
Predicting the short‐term healing progress of pressure ulcers is important for providing timely and appropriate intervention. Although there are some prediction methods available, these are unsuitable for ulcers with abundant necrotic tissue. We aimed to elucidate the relationship between necrotic tissue alteration and protein distributions on ulcers to establish a new prediction method. Thirty‐eight pressure ulcers were retrospectively analyzed. Protein distributions on necrotic tissue were evaluated by the wound blotting at three levels: marker protein positivity, signal patterns (speckled, heterogeneous, or homogeneous), and the occupation of heterogeneous pattern. Peroxidase, alkaline phosphatase, tumor necrosis factor α, and matrix metalloproteinase‐2 were used as marker proteins. One‐week necrotic tissue alteration was classified as liquefaction or nonliquefaction, and associations with protein distributions were analyzed. The peroxidase positivity was significantly higher in the liquefaction than in the nonliquefaction (p = 0.031). In peroxidase‐positive samples, the proportion of nonliquefaction samples was significantly higher in the heterogeneous pattern (p = 0.029). In the heterogeneous‐patterned samples, the proportion of samples with an occupation values greater than the median value tended to be higher in the nonliquefaction (p = 0.087). There was no significant relationship between liquefaction and other markers. Peroxidase positivity predicts 1‐week liquefaction of necrotic tissue, while a heterogeneous pattern indicates nonliquefaction. 相似文献
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Practice patterns and clinical outcomes among non‐ST‐segment elevation acute coronary syndrome (NSTE‐ACS) patients presenting to primary and tertiary hospitals: Insights from the EARLY glycoprotein IIb/IIIa inhibition in NSTE‐ACS (EARLY‐ACS) trial 下载免费PDF全文
Olga Toleva MD Cynthia M. Westerhout PhD Manohara P.J. Senaratne MBBS PhD Christoph Bode MD Magnus Lindroos MD PhD Vitaly A. Sulimov MD PhD Gilles Montalescot MD L. Kristin Newby MD MHS Robert P. Giugliano MD SM Frans Van de Werf MD PhD Paul W. Armstrong MD 《Catheterization and cardiovascular interventions》2014,84(6):934-942