Publications by authors named "Paul Thein"
Background: Anecdotally, patients don't seem to be more unwell than they were 10 years ago, yet they still seem more 'complex'.
Aims: The aim of this study was to use an objective measure to assess the trend in complexity of general medicine patients over a 9-year period.
Methods: Complexity was pragmatically defined as a composite of comorbidity plus dependence/frailty.
Background: Pulmonary embolism (PE) is a life-threatening disease where preemptive anticoagulation is recommended by guidelines for patients with intermediate to high pretest risk of PE.
Aims: The primary objective of our study was to describe the use of preemptive anticoagulation from the emergency department (ED) or inpatient wards stratified by risk assessment score.
Methods: We performed a retrospective observational cohort study of consecutive patients undergoing computed tomography pulmonary angiography (CTPA) for investigation of PE.
Background: Poor oral health is known to be associated with frailty in geriatric populations. Recent exposure to anticholinergic medications is responsible for features of poor oral health. Anticholinergic medications pose a cumulative risk for frailty.
View Article and Find Full Text PDFAn abnormal left ventricular contractile reserve is often seen in patients undergoing stress echocardiogram and may indicate the presence of obstructive coronary artery disease. The techniques and indexes used to identify abnormal left ventricular contractile response and its prognostic value in the absence of known causes has not been well studied. To describe the characteristics and clinical outcomes associated with an abnormal left ventricular contractile response, we performed a systematic review that identified 27 eligible studies.
View Article and Find Full Text PDFBackground: Poor nutritional status is a risk factor for the development of frailty. Likewise, oral health is independently associated with nutrition. The potential association between oral health and frailty in hospitalised elderly adults has, however, not previously been investigated.
View Article and Find Full Text PDFBackground: Atrial fibrillation (AF) occurs frequently following cardiothoracic surgery and treatment decisions are informed by evidence-based clinical guidelines. Outside this setting there are few data to guide clinical management.
Aim: To describe the characteristics, management and outcomes of hospitalised adult patients with new-onset AF.
Article Synopsis
- Biodegradable-polymer (BP) and polymer-free (PF) drug-eluting stents (DES) were created to minimize delayed arterial healing compared to durable-polymer stents (DP).
- A meta-analysis reviewed five studies with nearly 2000 patients, examining the effectiveness and safety of BP-DES versus PF-DES.
- Results indicated BP-DES had significantly lower rates of target vessel and lesion revascularization, as well as reduced late lumen loss, with no notable differences in safety outcomes like death or myocardial infarction.
Article Synopsis
- Current guidelines recommend intensive lipid-lowering therapy for high-risk cardiovascular patients, and there's research suggesting that adding ezetimibe to statins may affect plaque changes, though results vary.
- A systematic review of eight studies, involving 583 subjects, showed that combining ezetimibe with statins significantly reduced total atheroma volume and LDL cholesterol levels.
- The study findings indicated a notable decrease in total atheroma volume and LDL-C, with ezetimibe proving to be an effective addition to statin therapy.
Background: Evolocumab is an expensive proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor which has been shown to significantly improve cardiovascular outcomes in high risk patients.
Methods: This is a case study describing a stepwise approach to "PCSK9 inhibitor non-response" in a patient with familial hypercholesterolaemia. There are a few described pathophysiological mechanisms for "PCSK9 inhibitor non-response" including homozygous LDL-C receptor-negative mutations and alteration in the binding site of PCSK9 inhibitors.
Background: The benefits of physical activity and cardiovascular rehabilitation on the reduction of cardiovascular risk are well documented. Despite this, significant barriers and challenges remain in optimizing patient risk factors post acute coronary syndromes (ACS) and ensuring patient compliance. Consumer wearable personal activity trackers represent a cost effective and readily available technology that may aid in this endeavour.
View Article and Find Full Text PDFBackground: Current epidemiological data suggests that postoperative atrial fibrillation or atrial flutter (POAF) causes significant morbidity and mortality after cardiac surgery. The literature for prophylactic management of POAF is limited, resulting in the lack of clear guidelines on management recommendations.
Aim: To examine the efficacy of prophylactic rate control agents in reducing the incidence of new-onset POAF in patients undergoing elective cardiac surgery.