[The fox guarding the henhouse. Who decides diagnostic criteria?].

To reduce overprescribing, the consequences due to the invention of new diseases and the systematic reduction of threshold values have been studied, and projects to reduce procedures of low efficacy, the number of prescribed drugs, and procedures at risk of inappropriateness have been developed. The composition of committees establishing diagnostic criteria was never addressed. To avoid this problem (de-diagnosing) four procedures should be implemented: 1) diagnostic criteria should be assigned to a committee of general practitioners, clinical specialists, experts like epidemiologists, sociologists, philosophers, psychologists, economists, and representatives of citizens and patients; 2) experts do not have relevant conflicts of interest; 3) criteria should be set up as recommendations to facilitate discussion between a physician and a patient on the decision whether to begin a treatment and not as a recommendation functional to overprescription; 4) criteria should be periodically revised to approach the process closer to the experiences and needs of physicians and patients.

[When medicine is respectful.].

There is a relevant gap between the medicine learned on books and the clinical practice made of suffering humans facing us. Guidelines recommendations don't usually cover this aspect. The Slow Medicine movement, born in 2011, stands as a model a sober respectful and right healthcare.

[Polypharmacy and deprescribing in cardiology].

Inappropriate prescribing of diagnostic procedures and treatments should be avoided for good medical practice. Furthermore, the therapeutic plan of each patient should be regularly revised, activating deprescription procedures to reduce the dosage or to discontinue unnecessary drugs. It has widely been reported that the number of drugs taken by each patient increases over the years and adverse events caused by polypharmacy therapy are increasingly reported.

Choosing Wisely, the reasons for its success.

The philosophy and the history of the International Choosing Wisely movement, launched in the U.S. in 2012, are described.

"Hosting" an implantable cardioverter defibrillator: A phenomenological inquiry.

Implantable cardioverter defibrillators (ICDs) can reduce unexpected cardiac mortality, but they also have a dramatic impact on a patient's quality of life. We aimed to explore ICD recipients' experiences in order to foster improvements in the quality of care. Analyses were done using a descriptive phenomenological method, based on qualitative interview data from a purposive sample of 20 ICD recipients.

[Individual response to treatment: from Withering to contemporary medicine].

This is an essay dealing with the 1785 cohort study by William Withering (the "account"), in which he reported the results of the treatment with foxglove (Digitalis purpurea) in 163 patients suffering from various forms of hydropsy (water retention). Withering reported the results of all patients, and classified them into responders and non-responders. He identified the responders as suffering from heart failure.

[Patients facing with the decision to undergo percutaneous coronary intervention].

Percutaneous coronary intervention (PCI) is a common procedure to treat coronary artery stenoses. Several studies had demonstrated that PCI does not reduce the risk of death or myocardial infarction when performed to patients with stable angina. However it has been observed that most patients believe that PCI will reduce their risk for death and myocardial infarction.

[New diagnosis without new treatments].

The improvement of our investigative and diagnostic capability allows us to recognize early stage or mostly stable diseases in asymptomatic individuals and to treat those patients based on research conducted on more severe and acute conditions. Our main concern is avoiding not to treat a patient because of a missed diagnosis, so that we can avoid regrets and legal troubles. Usually, we do not take into account the opposite risk: overtreatment induced by overdiagnosis.

[Choosing wisely: the Top 5 list of the Italian Association of Hospital Cardiologists (ANMCO)].

In recent years, a progressive increase in the number of medical diagnostic and interventional procedures has been observed, namely in cardiology. A significant proportion of them appear inappropriate, i.e.

Single-center experience of a quadripolar pacing lead for cardiac resynchronization therapy.

Aim: Recent studies have shown that a quadripolar left ventricular (LV) lead can result in low rates of dislocation and phrenic nerve stimulation (PNS) acutely and on medium-term follow-up in cardiac resynchronization therapy (CRT). We evaluated the outcomes of CRT patients in whom a quadripolar LV lead was implanted in our institution.

Methods: We studied 45 consecutive heart failure patients (75 % men; age, 70.

Oxygen pulse as a predictor of cardiopulmonary events in lung resection.

Traditional algorithms suggest a stepwise approach to the functional evaluation of candidates for lung resection. A cardiopulmonary exercise test is incorporated as a supplementary test for patients with borderline pulmonary predicted values, and sometimes as a first screening test for cardiac risk evaluation. To assess the predictive weight of exercise tests in noncardiac thoracic surgery, we retrospectively analyzed 99 patients (80 males) aged 67.

Cardiotoxicity after anthracycline chemotherapy in breast carcinoma: effects on left ventricular ejection fraction, troponin I and brain natriuretic peptide.

Unlabelled: Anthracyclines are among the most active drugs in breast cancer patients. We planned to evaluate the early and 2-year modification of left ventricular ejection fraction (LVEF) and the effects of chemotherapy on troponin I and neurohormonal assessment.

Methods: Patients with early breast cancer surgically treated and eligible to adjuvant chemotherapy were enrolled.

[Management of heart failure in Piedmont Region].

Background: Congestive heart failure (CHF) represents an emerging problem in industrialized countries: it continues to be diagnosed at high rates and has an decreased survival time, raising new problems, such as the need of an adequate medical service organization and resource expenditure. Aim of this analysis was a quantitative evaluation of diagnostic and therapeutic resource use for CHF in outpatient departments in Piedmont, Italy.

Methods: We performed a cross-sectional observational study, based on a two-month data collection in 12 outpatient departments dedicated to congestive heart failure.

Reversible impairment of coronary flow reserve in takotsubo cardiomyopathy: a myocardial PET study.

Background: The precise etiology of takotsubo cardiomyopathy remains unclear. The study of myocardial blood flow (MBF) and coronary flow reserve (CFR) by use of positron emission tomography might help in understanding this syndrome.

Methods And Results: Three postmenopausal women underwent adenosine/rest perfusion with nitrogen 13 ammonia and metabolism with fluorine 18 fluorodeoxyglucose positron emission tomography, coronary angiography, cardiac magnetic resonance, and echocardiography in the acute phase of takotsubo cardiomyopathy and at 3 months' follow-up, after normalization of left ventricular function.

Cardiac resynchronization therapy modifies the neurohormonal profile, hemodynamic and functional capacity in heart failure patients.

Background: Cardiac resynchronization therapy (CRT) has been shown to improve the clinical status and survival in congestive heart failure (CHF) patients, but little is known about its influence on neurohormonal profile.

Methods: Heart failure patients treated with CRT for moderate/severe heart failure were studied with echocardiography, cardiopulmonary test, and neurohormonal profile [brain natriuretic peptide (BNP), endothelin (END), big endothelin (big-END), epinephrine (EPI), tumor necrosis factor-alpha (TNF-alpha)] at baseline and after 1 year from the pacemaker implantation.

Results: 120 NYHA II-IV patients entered this study, all with an indication to CRT; 100 agreed to be implanted (group A), whereas 20 refused, identifying a control group (group B).

Plasma brain natriuretic peptide predicts short-term clinical outcome in heart failure patients with restrictive filling pattern.

Objective: Plasma brain natriuretic peptide (BNP) is an important parameter of severity in congestive heart failure (CHF). We analyzed if BNP might stratify 6-month clinical outcome in outpatients with CHF with restrictive mitral filling pattern.

Methods: All subjects with New York Heart Association (NYHA) class II to IV and restrictive filling pattern were enrolled at hospital discharge after an acute decompensation.

Long-term follow-up of patients eligible, deferred, or ineligible for heart transplantation.

Background: When a patient is referred to a heart transplantation center, the patient and the physician should know the predicted long-term survival according to the first transplant committee decision. The aim of the study was to describe the follow-up of patients with heart failure referred to a heart transplantation center according to the initial decision to include (eligible), exclude (ineligible), or postpone (deferred) cardiac transplantation.

Methods: The study cohort consisted of 852 consecutive patients.

[Quality of life after myocardial revascularization. The Italian version of a specific questionnaire].

The growing number of research on quality of life is stimulated by the need to compare therapeutic treatments that have a similar efficacy to reduce mid- and long-term mortality, but that can warrant different levels of quality of life. The aim of this review was to describe theories and applications of different questionnaires (generic vs specific), methodology to construct a new questionnaire, and the methods of translation and cross-cultural adaptation in another language. Finally, the characteristics of the Coronary Revascularization Outcome Questionnaire, a validated instrument that measures symptoms, physical, psychosocial and cognitive function, adverse effects and satisfaction with treatment for bypass surgery and coronary angioplasty are described.