496 results match your criteria: "Royal Blackburn Hospital[Affiliation]"

Cardiac Implantable Electronic Devices in Cardiac Transplant Patients: A Comprehensive Review.

Cardiol Rev

November 2024

Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan.

A fraction of patients (approximately 10%) undergoing heart transplantation require permanent pacemaker (PPM) implantation due to sinus node dysfunction or atrioventricular block, occurring either shortly after surgery or later. The incidence of PPM implantation has declined to less than 5% with the introduction of bicaval anastomosis transplantation surgery. Pacing dependency during follow-up varies among recipients.

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This paper explores medical students' perceptions of failure through a qualitative approach, using semi-structured interviews to gather insights from six students across different academic years at Queen Mary University of London. The study aims to understand how students define failure, its causes, and its impact on their academic and personal lives. Key findings reveal that failure is perceived as multifaceted, influenced by internal and external expectations, and evolves throughout medical school.

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Aim  Effective documentation of critical clinical information is vital for patient safety and timely discharges. Ward rounds (WRs) are crucial for multidisciplinary assessments and care planning. Current emergency surgical WR documentation is inconsistent; therefore, this study will implement a structured WR template adapted from the Royal College of Surgeons of Edinburgh's "Surgical Assessment for Emergencies Ward Round Tool" (SAFE) to address these shortcomings.

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Background: Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for chronic coronary syndromes (CCS) improves outcomes compared with angiography-guided PCI, however cardiac events still occur during long-term follow-up of FFR-negative patients. In the PREVENT study preventive PCI reduced cardiac-events in lesions which were FFR-negative (FFR > 0.80) and had intracoronary imaging defined vulnerable plaque.

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Traditionally, coronary angiography was restricted to visual estimation of contrast-filled lumen in coronary obstructive diseases. Over the previous decades, considerable development has been made in quantitatively analyzing coronary angiography, significantly improving its accuracy and reproducibility.  Notably, the integration of artificial intelligence (AI) and machine learning into quantitative coronary angiography (QCA) holds promise for further enhancing diagnostic accuracy and predictive capabilities.

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Article Synopsis
  • The LANDMARK trial compared the balloon-expandable Myval transcatheter heart valve (THV) series to the SAPIEN and Evolut THV series in 768 patients to evaluate safety and effectiveness.
  • Results showed that Myval achieved non-inferiority to SAPIEN (24.7% vs 24.1%) and Evolut (24.7% vs 30.0%) regarding a primary composite safety endpoint.
  • Additionally, while Myval had better pressure gradient metrics compared to SAPIEN, Evolut showed slightly higher rates of prosthetic valve regurgitation compared to Myval but no significant difference between Myval and SAPIEN.
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Background: The clinical performance of left atrial appendage occlusion (LAAO) as a procedure and the long-term impact of its varied implantation configurations and anticoagulation regimens remain unclear.

Objectives: This study sought to provide data in routine practice from a prospective multicenter registry.

Methods: A total of 3,096 consecutive patients from 39 Chinese centers undergoing LAAO were enrolled between April 1, 2019, and October 31, 2020.

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Impact of Pseudomonas aeruginosa carriage on intensive care unit-acquired pneumonia: a European multicentre prospective cohort study.

Clin Microbiol Infect

November 2024

Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.

Objectives: Pseudomonas aeruginosa (PA) is a common causative pathogen of pneumonia acquired in the intensive care unit (ICU). The aim of this study was to determine the incidence of PA ICU pneumonia (PAIP) and to quantify its independent association with PA colonization at different body sites.

Methods: Adult patients on mechanical ventilation at ICU admission were prospectively enrolled across 30 European ICUs.

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Article Synopsis
  • Epilepsy is a widespread neurological disorder characterized by recurrent seizures, and this article provides a clinical overview specifically for UK medical students, covering its pathophysiology, classification, and management strategies.
  • The piece distinguishes between epilepsy and seizures and discusses risk factors, clinical features, differential diagnosis, and the importance of thorough evaluations for effective management.
  • It pulls data from UK health guidelines and studies to offer insights on incidence, treatment gaps, and strategies for acute seizure management, aiming to equip students with a solid foundation for evidence-based clinical practice.
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Objectives: Average treatment effects from randomized trials do not reflect the heterogeneity of an individual's response to treatment. This study evaluates the appropriate proportions of patients for coronary artery bypass grafting, or percutaneous intervention based on the predicted/observed ratio of 10-year all-cause mortality in the SYNTAX population.

Methods: The study included 1800 randomized patients and 1275 patients in the nested percutaneous (n = 198) or surgical (n = 1077) registries.

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Background Discharge summaries (TTOs) are essential documents in the effective communication between primary and secondary care, particularly in conveying critical post-discharge instructions to patients. Inconsistencies and omissions in TTOs can significantly undermine patient outcomes and disrupt continuity of care. This is particularly relevant to surgical patients, who often require specific follow-up care such as the removal of clips or drains shortly after discharge.

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Temporal trend and regional disparity in the investigations for stable chest pain in Europe: An insight from the PIONEER IV trial.

J Cardiovasc Comput Tomogr

October 2024

Corrib Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland; Department of Cardiology, Saolta Group, Galway University Hospital Health Service Executive and University of Galway, Galway, Ireland.

Article Synopsis
  • - The ACC/AHA Chest Pain guidelines support the use of Coronary CT Angiography (CCTA) and FFRCT for better diagnosing coronary artery disease (CAD), yet many healthcare providers are not following these recommendations.
  • - In a study involving 673 stable chest pain patients across five European countries, CCTA emerged as the most frequently used noninvasive test, but nearly 40% of patients still received immediate CAD treatment without prior testing.
  • - The study revealed a lack of progress in improving adherence to CCTA and a low usage of FFRCT, underscoring the need for better diagnostic practices and updates to reimbursement policies.
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Article Synopsis
  • This study investigates how to predict suboptimal quantitative flow ratios (QFR) after successful PCI, as current models are lacking in this area.
  • The researchers created a nomogram using data from 450 vessels to evaluate the prediction based on five key variables, including a new metric called QFR-PPG.
  • Results showed strong predictive performance with high accuracy in different validation tests, highlighting the nomogram's potential to aid clinicians in making informed decisions post-PCI.
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Article Synopsis
  • Coronary microvascular dysfunction (CMD) often occurs after ST-elevation myocardial infarction (STEMI) and can negatively impact patient outcomes; TMAO, a gut microbiota metabolite, may help diagnose CMD in these patients.
  • In a study involving 210 STEMI patients, TMAO levels were measured at various points, with a key finding being that TMAO at 3 months was a more reliable indicator for diagnosing CMD compared to baseline levels.
  • The research concluded that high TMAO levels (≥3.91) were linked to a greater risk of major adverse cardiovascular and cerebrovascular events (MACCE), highlighting TMAO's potential as a biomarker that could enhance
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Background: JenaValve's Trilogy transcatheter heart valve (THV) (JenaValve Inc, Irvine, CA) is the only -marked THV system for the treatment of aortic regurgitation (AR) or aortic stenosis (AS). However, its efficacy has not been quantitatively investigated pre- and post-implantation using video-densitometric analysis.

Methods: Using the CAAS-A-Valve 2.

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Background: The long-term impact of drug-coated balloon (DCB) angioplasty for the treatment of patients with de novo coronary artery lesions remains uncertain. We aimed to assess the non-inferiority of DCB angioplasty with rescue stenting to intended drug-eluting stent (DES) deployment for patients with de novo, non-complex coronary artery lesions.

Methods: REC-CAGEFREE I was an open-label, randomised, non-inferiority trial conducted at 43 sites in China.

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Article Synopsis
  • * Out of 112 respondents, which included both surgeons and hand therapists, the study found significant variability in surgical decision-making and imaging practices, with most centers favoring ligament reconstruction using a bone anchor.
  • * Findings suggest that there is inconsistency in the treatment approaches for UCL ruptures and a strong interest among medical professionals for future clinical trials to standardize management practices.
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Background: Dual mobility (DM) implants have received increasing interest in revision surgery due to their increased stability. The aim of this systematic review was to compare outcomes of DM versus conventional fixed-bearing (FB) implants in revision total hip arthroplasty (rTHA).

Methods: A comprehensive search was performed using the PubMed, Embase, and MEDLINE databases between January 2000 and 2023.

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Article Synopsis
  • Cardiogenic shock (CS) is a severe condition caused by heart dysfunction leading to low blood pressure and poor blood circulation, requiring urgent medical intervention like mechanical circulatory support (MCS) devices.
  • This review focuses on evaluating the effectiveness of MCS in improving survival rates, and the role of drugs and non-surgical devices in treating CS to prevent complications and improve patient outcomes.
  • While MCS devices vary in their clinical outcomes, intra-aortic balloon pump (IABP) appears to offer the best short-term results, whereas ECMO is highlighted for its long-term effectiveness in managing CS.
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Long-term outcomes following bioresorbable vascular scaffolds.

Expert Rev Cardiovasc Ther

August 2024

The College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland.

Introduction: The higher scaffold thrombosis rates observed with the first-generation bioresorbable scaffolds (BRSs) compared to conventional drug-eluting stents were likely due in part to bioresorbable polymers having insufficient radial strength, necessitating larger strut profiles. Meta-analysis of the long-term outcomes from the first-generation Absorb bioresorbable vascular scaffold (BVS) showed that this period of excess risk ended at 3 years. Therefore, current attention has been focused on improving early outcomes by increasing the scaffold's tensile strength and reducing strut thickness.

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Accurate measurements of glycaemic control and the underpinning regulatory mechanisms are vital in human physiology research. Glycaemic control is the maintenance of blood glucose concentrations within optimal levels and is governed by physiological variables including insulin sensitivity, glucose tolerance and β-cell function. These can be measured with a plethora of methods, all with their own benefits and limitations.

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Article Synopsis
  • The study examines the ratio of coronary artery lumen volume (V) to myocardial mass (M) to understand the relationship between coronary arteries and heart muscle in patients with complex coronary artery disease (CAD) prior to surgery.
  • It analyzes data from coronary computed tomography angiography (CCTA) in participants from a specific trial (FAST-TRACK CABG) and compares results with another patient cohort (ADVANCE registry).
  • Findings indicate that patients requiring coronary artery bypass grafting (CABG) had significantly lower V/M ratios than those in the ADVANCE registry, suggesting that V/M could serve as a useful non-invasive marker for assessing CAD severity, particularly alongside fractional flow reserve (FFR) measurements.
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Inferior outcomes with ACURATE neo, a self-expanding transcatheter heart valve (THV) for the treatment of severe aortic stenosis, were mainly driven by higher rates of moderate/severe paravalvular leak (PVL). To overcome this limitation, the next-generation ACURATE neo2 features a 60% larger external sealing skirt. Data on long-term performance are limited; however, clinical evidence suggests improved short-term performance which is comparable to contemporary THVs.

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