1,943 results match your criteria: "Harefield Hospital[Affiliation]"

How to undertake a pain assessment for -patients with acute post-operative pain.

Nurs Stand

July 2024

Clinical nurse specialist in pain management, Harefield Hospital, Guy's and St Thomas' NHS Foundation trust, London, England.

Acute post-operative pain is common among patients in secondary care settings, and the alleviation of this pain is a principal responsibility for all healthcare professionals, including nurses. To achieve this, it is essential to regularly undertake comprehensive pain assessments, using validated pain assessment tools, for all patients who have undergone a surgical procedure. Inadequate pain assessment may lead to ineffective or inappropriate pain management, which can adversely affect the patient's recovery and increase their risk of developing chronic pain.

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Performance of Purpose-Built vs Off-Label Transcatheter Devices for Aortic Regurgitation: The PURPOSE Study.

JACC Cardiovasc Interv

July 2024

IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. Electronic address:

Background: Severe pure aortic regurgitation (AR) carries a high mortality and morbidity risk, and it is often undertreated because of the inherent surgical risk. Transcatheter heart valves (THVs) have been used off-label in this setting with overall suboptimal results. The dedicated "purpose-built" Jena Valve Trilogy (JVT, JenaValve Technology) showed an encouraging performance, although it has never been compared to other THVs.

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Multimodality imaging for the evaluation and management of patients with long-term (durable) left ventricular assist devices.

Eur Heart J Cardiovasc Imaging

September 2024

William Harvey Research Institute, National Institute for Health and Care Research Barts Biomedical Research Centre, Queen Mary University London, London, UK.

Left ventricular assist devices (LVADs) are gaining increasing importance as therapeutic strategy in advanced heart failure (HF), not only as bridge to recovery or to transplant but also as destination therapy. Even though long-term LVADs are considered a precious resource to expand the treatment options and improve clinical outcome of these patients, these are limited by peri-operative and post-operative complications, such as device-related infections, haemocompatibility-related events, device mis-positioning, and right ventricular failure. For this reason, a precise pre-operative, peri-operative, and post-operative evaluation of these patients is crucial for the selection of LVAD candidates and the management LVAD recipients.

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Integrated Multiorgan Ultrasound for Assessment of Congestion: A New Frontier for Heart Failure Management.

J Am Soc Echocardiogr

October 2024

Department of Anaesthetics, Critical Care and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield Hospitals, London, United Kingdom; School of Cardiovascular, Metabolic Sciences and Medicine, King's College London, London, United Kingdom. Electronic address:

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Digital Transformation in Thoracic Surgery: a survey among the European Society of Thoracic Surgeons.

Interdiscip Cardiovasc Thorac Surg

July 2024

Department of Thoracic Surgery, Harefield Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK.

Objectives: Digital transformation has drastically changed the surgical sector, but few is known about its impact on thoracic surgical practice. The aim of this paper is to report the European Society of Thoracic Surgeons (ESTS) survey results, assessing the impact of and the need for Digital Transformation in Thoracic Surgery.

Methods: A 23-item survey was designed by the ESTS Digital Transformation Working Group to assess the impact of and the need for Digital Transformation in Thoracic Surgery.

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Background: Biologic asthma therapies reduce exacerbations and long-term oral corticosteroids (LTOCS) use in randomized controlled trials (RCTs); however, there are limited data on outcomes among patients ineligible for RCTs. Hence, we investigated responsiveness to biologics in a real-world population of adults with severe asthma.

Methods: Adults in the International Severe Asthma Registry (ISAR) with ≥24 weeks of follow-up were grouped into those who did, or did not, initiate biologics (anti-IgE, anti-IL5/IL5R, anti-IL4/13).

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Systematic hand-held echocardiography in patients hospitalized with acute coronary syndrome.

Eur Heart J Cardiovasc Imaging

September 2024

British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.

Aims: Transthoracic echocardiography is recommended in all patients with acute coronary syndrome but is time-consuming and lacks an evidence base. We aimed to assess the feasibility, diagnostic accuracy, and time efficiency of hand-held echocardiography in patients with acute coronary syndrome and describe the impact of echocardiography on clinical management in this setting.

Methods And Results: Patients with acute coronary syndrome underwent both hand-held and transthoracic echocardiographies with agreement between key imaging parameters assessed using kappa statistics.

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Article Synopsis
  • Congestion in heart failure and critical illness can increase patient morbidity and mortality, and traditional evaluation methods often fall short, leading to frequent hospital readmissions.
  • Point-of-care ultrasound (POCUS), specifically the Venous Excess Ultrasound (VExUS) score, helps quantify systemic venous congestion, improving management of fluid overload situations.
  • Recent studies highlight VExUS's effectiveness in enhancing decongestion rates and its prognostic value across various ICU populations, while underscoring the importance of understanding its technical nuances to avoid clinical errors.
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Aims: Approximately 30-49% of heart failure (HF) patients are living with obesity. The recommended body mass index (BMI) for the general population is 18.5-24.

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The challenge of advanced therapies in the contemporary era: first in Europe ECPELLA long-distance transfer-a case report.

Eur Heart J Case Rep

May 2024

Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Uxbridge, UB9 6JH, UK.

Background: The use of mechanical circulatory support (MCS) has markedly increased over the last decade, so have the inter-hospital transfers, with the aim of being able to offer advanced heart failure (AHF) therapies and centralizing patients to tertiary centres.

Case Summary: In this article, we present the first in Europe long-distance air transfer of a patient supported by veno-arterial extracorporeal membrane oxygenator and Impella (ECPELLA), as a bridge to successful heart transplant. In our case report, a foreign young patient with AHF due to familiar cardiomyopathy required multiple MCS devices to achieve cardiovascular stability.

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Background: Rejection is a major cause of mortality and morbidity in heart transplant (HTx) recipients. Current methods for diagnosing rejection have limitations. Imaging methods to map the entire left ventricle and reliably identify potential sites of rejection is lacking.

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Article Synopsis
  • The study investigates how pre-biologic biomarker levels, specifically immunoglobulin E (IgE), blood eosinophil count (BEC), and fractional exhaled nitric oxide (FeNO), influence asthma treatment outcomes when patients start biologic therapy.
  • Conducted across 23 countries with over 3750 patients, the research focused on changes in exacerbation rates, symptom control, and lung function about a year after starting treatment.
  • Results showed that higher levels of BEC and FeNO were linked to significant improvements in lung function for specific biologic therapies, while IgE was not a strong predictor of treatment effectiveness.
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Background: We evaluated the potential benefits of renin-angiotensin-aldosterone system inhibitors (RAASi) in patients with left ventricular assist device support.

Methods And Results: A total of 165 consecutive patients undergoing left ventricular assist device implant and alive at 6-month on support were studied. RAASi status after 6-month visit along with clinical reasons for nonprescription/uptitration were retrospectively assessed.

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Despite evidence suggesting the benefit of prophylactic regional antibiotic delivery (RAD) to sternal edges during cardiac surgery, it is seldom performed in clinical practice. The value of topical vancomycin and gentamicin for sternal wound infections (SWI) prophylaxis was further questioned by recent studies including randomized controlled trials (RCTs). The aim of this systematic review and meta-analysis was to comprehensively assess the safety and effectiveness of RAD to reduce the risk of SWI.

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Advanced Respiratory Failure Requiring Tracheostomy-A Marker of Unfavourable Prognosis after Heart Transplantation.

Diagnostics (Basel)

April 2024

Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK.

Article Synopsis
  • Advanced respiratory failure requiring tracheostomy is prevalent in heart transplant patients, with about 28.6% needing the procedure within approximately 11.5 days post-surgery.
  • Significant risk factors for requiring a tracheostomy include a history of stroke, previous sternotomy, longer cardiopulmonary bypass time, primary graft failure, renal replacement therapy, and higher daily mean SOFA scores.
  • Patients who needed a tracheostomy had a markedly higher one-year mortality rate (50%) compared to those who did not require one (16%), suggesting that tracheostomy is an indicator of poor prognosis in heart transplant recipients.
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Non-dilated left ventricular non-compaction cardiomyopathy with systolic dysfunction is reclassified as non-dilated left ventricular cardiomyopathy with hypertrabeculation.

Int J Cardiol

July 2024

Imaging Department, Harefield Hospital, Royal Brompton and Harefield Hospitals, Harefield, United Kingdom; 'Dimitrios Belntekos' Department of Echocardiography Training, 'Tzaneio' General Hospital of Piraeus, Piraeus, Greece. Electronic address:

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Aims: The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey on radiation exposure in interventional echocardiography. The survey aimed to collect data on local practices for radioprotection in interventional echocardiography and to assess the awareness of echocardiography operators about radiation-related risks.

Methods And Results: A total of 258 interventional echocardiographers from 52 different countries (48% European) responded to the survey.

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Objectives: Thrombocytopenia following Perceval aortic valve replacement has been described previously with variable outcome. Studies have lacked a robust analysis of platelet fluctuation and factors affecting it. We aimed to statistically describe the trend in thrombocyte variability as compared with conventional aortic valve replacement, and to assess predictors as well as impact on associated outcomes.

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Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock.

N Engl J Med

April 2024

From the Department of Cardiology, Copenhagen University Hospital-Rigshospitalet (J.E.M., T.E., M.F., L.H., J.K., R.S., J.L., S.B., C.H.), and the Department of Clinical Medicine, University of Copenhagen (T.E., L.H., C.H.), Copenhagen, the Departments of Cardiology (J.E.M., L.O.J., N.L.J.U., A.J., J.F.L.), Anesthesiology and Intensive Care (H.S., H.B.R.), and Nuclear Medicine (O.G.), Odense University Hospital, and the Department of Clinical Research, University of Southern Denmark (J.E.M., L.O.J., H.B.R., J.F.L.), Odense, the Departments of Cardiology (H.E., C.J.T., E.H.C.) and Anesthesiology and Intensive Care Medicine (S.C.), Aarhus University Hospital, Aarhus, and the Department of Cardiology, Zealand University Hospital, Roskilde (P.C., M.G.L.) - all in Denmark; the Department of Internal Medicine and Cardiology, Heart Center Dresden, University Hospital, Technische Universität Dresden, Dresden (N.M., A.L., F.J.W.), the Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, and the Cardiovascular Research Institute Düsseldorf, Düsseldorf (A.P., R.W.), the Department of Internal Medicine I, Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Jena (P.C.S., S.M.-W.), the Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, and Deutsches Zentrum für Herz Kreislauf Forschung, Berlin (C.S.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology, University Heart and Vascular Center, University Clinic Hamburg-Eppendorf, Hamburg (P.C.), the Department of Cardiology, University Hospital Bonn, Bonn (S.Z.), the Department of Cardiology and Angiology, Hannover Medical School, Hannover (A.S.), and the Department of Internal Medicine III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier (N.W.) - all in Germany; the Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom (V.P.); and the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York (K.W.).

Article Synopsis
  • A study examined the impact of using a microaxial flow pump alongside standard care for patients with STEMI and cardiogenic shock, focusing on mortality and safety outcomes.
  • In a trial with 360 patients, those using the pump had a lower death rate (45.8%) compared to those receiving only standard care (58.5%).
  • However, the pump group experienced a higher rate of adverse events (24.0% vs. 6.2%) and significantly more patients required renal-replacement therapy (41.9% vs. 26.7%).
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Article Synopsis
  • An implantable left ventricular assist device (LVAD) is used in the UK mainly as a temporary solution for patients awaiting heart transplants or recovery.
  • LVADs create a unique hemodynamic state, making standard measurements like blood pressure and pulse difficult to obtain, leading to challenges in patient assessment.
  • To address these challenges, UK experts developed specific guidelines for managing emergencies in LVAD patients, aimed at healthcare providers in advanced heart failure centers, ensuring appropriate care during critical situations.
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