ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Cardiac transplantation improves survival in patients with advanced heart failure, especially those who are dependent on intravenous inotropic support or mechanical assistance. However, cardiac transplantation remains a treatment modality rather than a curative procedure, and thus, necessitates long-term care and indefinite immunosuppression. Although quality of life is improved for most cardiac transplant recipients, concerted effort is necessary for long-term care and follow-up of the transplanted heart. The economics of cardiac transplantation are receiving increased scrutiny, especially because of the increasing pretransplant hospital expenditures that have resulted from transplantation in more patients in the hospital who require intravenous inotropic support or mechanical devices. This shift ultimately is related to the reduced supply of donors relative to the demand. The ultimate impact of managed care on cardiac transplantation is not clear, but it probably will continue to reduce expenditures in the near term.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Cardiac transplantation is a proven, effective therapy for selected patients with end-stage congestive heart failure. Recipient selection is performed by a multidisciplinary team consisting of transplant physicians and surgeons. Clinicians responsible for patient assessment must establish the severity of cardiac dysfunction, formulate a prognosis, and stratify patients according to risk for mortality. Patients whose survival and quality of life are most limited without cardiac transplantation are candidates for therapy. The scarcity of organ donors makes careful screening of potential recipients necessary to identify those individuals most likely to obtain a long-term benefit. Recipient selection criteria and management strategies are evolving because of extended waiting times and high mortality caused by the lack of sufficient numbers of donors. Alternative therapies should be applied whenever possible.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

In the previous 2 decades, there have been many advances in the treatment of coronary and valvular heart disease. However, these treatments, remain imperfect, and more patients are surviving only to have congestive heart failure develop later in life. During the same 2 decades, advances in surgical techniques and immunosuppression made cardiac transplantation the treatment of choice for severe, end-stage heart failure. Despite concomitant legislation designed to promote organ donation, there remains a severe shortfall in the number of organ donors compared with the number of potential recipients.This article discusses identification of the potential organ donor, assessment of the heart for donation, medical management of the brain-dead organ donor from pronouncement to procurement, and finally, some of the ethical issues raised in the wake of further efforts to increase the potential donor pool.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Orthotopic heart transplantation has become an established treatment for selected patients with refractory heart failure. Long-term survival rates are superior to those resulting from other forms of therapy for that patient population. In addition, an improved quality of life has been reported by many patients. However, despite these encouraging results, the transplanted heart does not provide the recipient with normal cardiac function. Cardiac physiology after heart transplantation is unique. Resting hemodynamics differ significantly, acutely and chronically, from those seen in healthy subjects. In addition, neural mechanisms undergo changes as a result of surgical denervation. Afferent control mechanisms and efferent responses both are altered, leading to important clinical abnormalities. Examples include altered cardiovascular responses to exercise, altered cardiac electrophysiology, and altered responses to cardiac pharmacologic agents. An improved understanding of the changes in cardiac physiology, which occur after heart transplant, may allow the care of these patients to be optimized.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Cardiac transplantation has become an accepted treatment for selected patients with end-stage heart failure. Despite a successful transplant, denervated transplanted hearts respond differently to cardiac drugs than nontransplanted hearts. The treatments for bradycardia, tachycardia, and hypotension are different than for nontransplanted hearts. Despite the improvement in long-term survival, a number of complications may occur posttransplantation. These complications include, allograft rejection, infection, allograft coronary artery disease, and malignancy. Additionally, posttransplant patients may have complications from the immunosuppressive agents cyclosporine, prednisione, and azathioprine. Such complications include drug interactions with commonly prescribed medications, hypertension, hyperlipidemia, osteoporosis, and gastrointestinal complications. The purpose of this article is to discuss the management of the cardiac transplant recipient as it relates to the aforementioned complications. Management of the cardiac transplantation patient by the primary care physician will also be discussed, including indications for consultation by the primary care physician with the transplant center.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

This study assesses differences in blood pressure (BP) levels prospectively between office (manual) measurement and ambulatory blood pressure monitoring(ABPM) in 70 treated, essential, hypertensive patients. The objective was to determine whether ABPM is superior to office measurement for assessing adequacy of therapy. Twenty-four patients received monotherapy and 46 received multiple therapy. Thirty-five patients were administered medication in the morning only, whereas 33 were administered medication in the morning and evening both. Mean systolic BP by manual method was identical to that obtained by ABPM (141.98 ± 14.98 mm Hg versus 141.46 ± 16.33 mm Hg, respectively). However, mean diastolic BP by manual method was significantly higher than that obtained by ABPM (90.38 ± 9.01 mm Hg versus 86.69± 10.65 mm Hg, respectively; P < 0.001). Significant correlations (P< 0.01) were found between the BP levels measured by these two methods, although individual readings differed by 10 mm Hg or more systolic and by 5 mm or more diastolic in many subjects. No significant differences were noted in BP levels measured by either method for patients treated by monotherapy or multiple therapy, and none were noted whether they were taking medication in the morning or in both the morning and evening. In addition, no differences were noted in BP levels using either method for race. Thus, this study shows that the office measurement is grossly similar to ABPM for assessment of adequacy of therapy in treated hypertensive patients whose blood pressure is controlled adequately. However, ABPM is found to be superior to office measurement in identifying hypertensive patients whose blood pressure is not controlled adequately or is uncontrolled.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The objective of this study was to determine the need for telephone medicine curricula and to help define important content for internal medicine residencies using scales that measure program director attitudes toward telephone medicine. Data were collected by surveying all 416 program directors of accredited internal medicine residencies in the United States. We applied factor analysis to develop reliable attitudinal scales and employed regression models to identify predictors of these attitudes. Response rate was 60%. Formal training for telephone medicine was available in only 6% of programs. The factor analysis showed three attitudinal concepts; all described marked program director discomfort with aspects of resident telephone prescription. Predictors of improved program director comfort included more frequent documentation of resident telephone calls, chart availability, and clear definition of resident roles pertaining to telephone interactions with patients (P < 0.02 for all predictor variables). These results identify a need for telephone curricula and suggest components that might alleviate program director discomfort with resident telephone practices.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The objectives of this study were to examine the reported accuracy of cooximetry in determination of methemoglobin levels, to report the apparent discrepant values of "measured" methemoglobin and carboxyhemoglobin, and to discuss the effect that methemoglobinemia has on pulse oximetry readings. Secondly, relative oxygen saturations measured by pulse oximetry and calculated from arterial blood gas samples were compared. A retrospective analysis was performed in an academic medical center with two patients who were diagnosed with acute methemoglobinemia after taking sulfa-containing medications. Serial pulse oximetry, arterial blood gas, and cooximeter analysis were performed for two patients. Cooximetry was performed using an IL-482 oximeter, arterial blood gas analysis was performed using a BLE 1400 oximeter, and pulse oximetry was performed using Ohmeda Biox 3740, Hewlett Packard SPO2, or Marquette SPO2 models. Methemoglobin levels ranged from 6% to 48%, however, summation of methemoglobin and oxyhemoglobin were as high as 120%. As a result, negative values of carboxyhemoglobin were recorded by the cooximeter, generating a total sum of 100%. Comparison of pulse oximetry and arterial blood gas oxygen saturation (measured and calculated values, respectively) revealed significant discrepancies; methemoglobin was > 9%, whereas oxygen saturation uniformly was lower with pulse oximetry. Therefore, we recommend that when methemoglobin levels exceed 10%, cooximetry be used as a screen for methemoglobinemia and that serial cooximeter measurements be used to guide therapy and reliance on noninvasive pulse oximetry.

ISSN:0002-9629    

出版商:OVID    

年代:1997

数据来源: OVID