Management and Outcomes Following an Acute Coronary Event in Patients With Chronic Heart Failure 1999-2007.

Management and outcomes following an acute coronary event in patients with chronic heart failure 1999-2007.

Filed under: Rehab Centers

Eur J Heart Fail. 2012 Apr 12;
Ranasinghe I, Naoum C, Aliprandi-Costa B, Sindone AP, Steg PG, Elliott J, McGarity B, Lefkovits J, Brieger D,

AimThe outcome of patients with chronic heart failure (CHF) following an ischaemic event is poorly understood. We evaluated the management and outcomes of CHF patients presenting with an acute coronary syndrome (ACS) and explored changes in outcomes over time.Method and resultsA total of 5556 patients enrolled in the Australia-New Zealand population of the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007 were included. Patients with CHF (n = 609) were compared with those without CHF (n = 4947). Patients with CHF were on average 10 years older, were more likely to be female, had more co-morbidities and cardiac risk factors, and were more likely to have a prior history of angina, myocardial infarction, and revascularization by coronary artery bypass graft (CABG) when compared with those without CHF. CHF was associated with a substantial increase in in-hospital renal failure [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.15-2.71], readmission post-discharge (OR 1.47, 95% CI 1.17-1.90), and 6-month mortality (OR 2.25, 95% CI 1.55-3.27). Over the 9 year study period, in-hospital and 6 month mortality in those with CHF declined by absolute rates of 7.5% and 14%, respectively. This was temporally associated with an increase in prescription of thienopyridines, beta-blockers, statins, and angiotensin II receptor blockers, increased rates of coronary angiography, and 31.8% absolute increase in referral rates for cardiac rehabilitation. CONCLUSIONS: Acute coronary syndrome patients with pre-existing CHF are a very high risk group and carry a disproportionate mortality burden. Encouragingly, there was a marked temporal improvement in outcomes over a 9 year period with an increase in evidence-based treatments and secondary preventative measures.
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Intestinal rehabilitation and transplantation for intestinal failure.

Filed under: Rehab Centers

Mt Sinai J Med. 2012 Mar; 79(2): 256-66
Moon J, Iyer K

The management of intestinal failure has evolved dramatically in the last decade. This evolution has been in equal part due to continued improvements in outcomes of intestinal transplantation and to recognition of the need for multidisciplinary management of the patient with intestinal failure. This has led to establishment of intestinal rehabilitation programs, centered only in some instances at institutions with established intestinal transplant programs. Alongside this, improved management of parenteral nutrition-associated liver disease is creating a paradigm shift in both intestinal-failure management and in the evolving indications for intestinal transplantation. Unsolved challenges remain: A persistent mortality on the waiting list, especially for patients awaiting combined liver-intestine transplant; late graft loss to chronic rejection, especially in isolated intestine transplant; the role of antibody-mediated rejection; and transplantation in the highly sensitized patient continue to defy satisfactory solution. Notwithstanding these challenges, overall outcomes for patients with intestinal failure are vastly improved today and are approaching those for patients with end-stage renal and liver disease. This review will focus on a comprehensive approach to the patient with intestinal failure, including an overview of intestinal rehabilitation and transplantation. Transplantation outcomes and transplantation of the patient with liver disease are covered elsewhere. Mt Sinai J Med 79:256-266, 2012. © 2012 Mount Sinai School of Medicine.
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Intestinal transplantation outcomes.

Filed under: Rehab Centers

Mt Sinai J Med. 2012 Mar; 79(2): 246-55
Gondolesi GE, Almau HM

Intestinal transplantation has evolved from being considered an experimental procedure into a clinically accepted therapy for patients with intestinal failure and parenteral nutrition life-threatening complications. Early referral, advances in immunosuppression therapy, standardization of surgical techniques, prophylactic therapy of infections, early diagnosis of rejection, and better posttransplant patient management are some of the changes that have allowed more patients to receive transplants, thus recovering intestinal sufficiency, and at the same time allowing the procedure to spread worldwide. Over the last 2 decades, transplant centers have focused on improving short-term patient survival, which has consequently increased by >20%. It is now clear that even though isolated intestinal-transplant recipients have lower mortality risk on the waiting list, they are at higher risk for long-term graft loss. Mortality is higher on the waiting list and early posttransplant in recipients whose intestinal transplants are associated with liver grafts; however, they have better long-term patient and graft survival. Nevertheless, 3-year actuarial patient survival has not changed over the same period of time, and therefore this is our challenge for the next decade. Mt Sinai J Med 79:246-255, 2012. © 2012 Mount Sinai School of Medicine.
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Ultrasonographic assessment of longitudinal median nerve and hand flexor tendon dynamics in carpal tunnel syndrome.

Filed under: Rehab Centers

Muscle Nerve. 2012 May; 45(5): 721-9
Korstanje JW, Boer MS, Blok JH, Amadio PC, Hovius SE, Stam HJ, Selles RW

Introduction: Changes in subsynovial connective tissue (SSCT) in carpal tunnel syndrome (CTS) patients may result in altered dynamics; consequently, quantification of these dynamics might support objective diagnosis of CTS. Methods: We measured and compared longitudinal excursion of the flexor digitorum superficialis and profundus tendons, the median nerve, and the SSCT between the most and least affected hands of 51 CTS patients during extension-to-fist motion. Results: Median nerve and flexor digitorum superficialis tendon excursions in the most affected hands were smaller than in the least affected hands of the same patients, whereas the excursions of the flexor digitorum profundus were larger. Based on these excursions, logistic regression models classified between 67% and 86% of the hands correctly as having CTS. Conclusions: The altered hand dynamics in CTS patients may have implications for the pathophysiology and clinical evaluation of CTS, and ultrasound-based classification models may further support the diagnosis of CTS. Muscle Nerve, 2012.
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Youth violence, staff force spiked in 2011 at troubled juvenile detention

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Youths spend months in detention centers waiting to be placed in treatment programs, a process that should take weeks. Some facilities are at nearly twice their capacity, and sometimes the young inmates resort to violence. And the staff, stressed by …
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Independent rehab centers

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Many readers have commented about the need to set up rehabilitation centers in Kuwait. I'ma Kuwaiti who fully understand Kuwaiti culture, political and social background better than any foreign expatriate who has been residing here for a number of …
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