Renal Denervation for Refractory Hypertension – Technical Aspects, Complications and Radiation Exposure.
Renal Denervation for Refractory Hypertension – Technical Aspects, Complications and Radiation Exposure.
Rofo. 2013 Mar 7;
Scheurig-Muenkler C, Weiss W, Foert E, Toelle M, van der Giet M, Kröncke TJ, Zidek W, Powerski MJ
Purpose: To analyze procedural details, complications and radiation exposure in renal denervation (RDN) using the Medtronic Symplicity® device in the treatment of refractory hypertension.Materials and Methods: Fifty three consecutive patients underwent RDN. The number of ablations per artery, peri-procedural complications, procedure time (PT), fluoroscopy time (FT), dose-area product (DAP) and procedure-related complications were documented. Additionally, the radiation dose was compared between obese (body mass index ? 30 kg/m²) and non-obese patients.Results: Bilateral RDN was performed in 50/53 (94 %) cases and with a minimum of 4 ablations per artery in 33/50 (66 %), the mean count being 5.4 (range R: 2 – 13) on the right and 4.3 (R: 1 – 10) on the left. The FT and DAP decreased significantly over the first 12 procedures, reaching a steady state with a median FT of 11.2 min (R: 7.5 – 27) and a median DAP of 4796 cGy × cm² (R: 1076 – 21 371), resulting in an effective dose of 15.7 mSv. The median PT was 57 min (R: 40 – 70). Obese patients had a 3.3-fold higher radiation dose (p < 0.001). We observed one severe spasm and one imminent respiratory depression, both resolved without sequelae.Conclusion: For an experienced interventionalist, RDN has a short learning curve with a low risk profile. The radiation dose does not exceed that of other renal artery interventions, but is explicitly higher in obese patients, who account for a large portion of patients with refractory hypertension. HubMed – depression
Ministers’ Perceptions of Church-Based Programs to Provide Depression Care for African Americans.
J Urban Health. 2013 Mar 8;
Hankerson SH, Watson KT, Lukachko A, Fullilove MT, Weissman M
African Americans, compared with white Americans, underutilize mental health services for major depressive disorder. Church-based programs are effective in reducing racial disparities in health; however, the literature on church-based programs for depression is limited. The purpose of this study was to explore ministers’ perceptions about depression and the feasibility of utilizing the church to implement evidence-based assessments and psychotherapy for depression. From August 2011 to March 2012, data were collected from three focus groups conducted with adult ministers (n?=?21) from a black mega-church in New York City. Using consensual qualitative research to analyze data, eight main domains emerged: definition of depression, identification of depression, causal factors, perceived responsibilities, limitations, assessment, group interpersonal psychotherapy, and stigma. A major finding was that ministers described depression within a context of vast suffering due to socioeconomic inequalities (e.g., financial strain and unstable housing) in many African American communities. Implementing evidence-based assessments and psychotherapy in a church was deemed feasible if principles of community-based participatory research were utilized and safeguards to protect participants’ confidentiality were employed. In conclusion, ministers were enthusiastic about the possibility of implementing church-based programs for depression care and emphasized partnering with academic researchers throughout the implementation process. More research is needed to identify effective, multidisciplinary interventions that address social inequalities which contribute to racial disparities in depression treatment. HubMed – depression
Vision Function, Functional Vision, and Depression.
JAMA Ophthalmol. 2013 Mar 7; 1-2
Morse AR
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