Sample records for improve cardiovascular practice

  1. Improved Cardiovascular Prevention Using Best CME Practices: A Randomized Trial

    ERIC Educational Resources Information Center

    Laprise, Rejean; Thivierge, Robert; Gosselin, Gilbert; Bujas-Bobanovic, Maja; Vandal, Sylvie; Paquette, Daniel; Luneau, Micheline; Julien, Pierre; Goulet, Serge; Desaulniers, Jean; Maltais, Paule

    2009-01-01

    Introduction: It was hypothesized that after a continuing medical education (CME) event, practice enablers and reinforcers addressing main clinical barriers to preventive care would be more effective in improving general practitioners' (GPs) adherence to cardiovascular guidelines than a CME event only. Methods: A cluster-randomized trial was…

  2. Process evaluation of a multifaceted intervention to improve cardiovascular disease prevention in general practice.

    PubMed

    Lobo, Claudia M; Euser, Lya; Kamp, Jeanine; Frijling, Bernard D; Severens, Johan L; Hulscher, Marlies E J L; Grol, Richard P T M; Prins, Ad; van der Wouden, Johannes C

    2003-09-01

    To perform a process evaluation of a multifaceted intervention to improve cardiovascular and diabetes care in general practice. The feasibility of the intervention, carried out by outreach visitors in 62 practices, was addressed by evaluating whether the intervention programme was performed as planned and the extent to which it was accepted by the practice team. In addition, the costs of the programme were determined. The intervention was largely carried out as planned, although the intervention period had to be extended by three months. Of the 18 topics that could be addressed during the intervention period, 12 (mean) were addressed. The number of outreach visits per practice was 15.2 (mean), each visit lasted about one hour. Most practice members endorsed both the key recommendations for clinical decision-making and cardiovascular risk profiling. The majority of GPs (range 63-98%) agreed with the guidelines for clinical decision-making, and 29-97% had a positive opinion about the guidelines for practice organisation. According to practice staff members, the outreach visitor had sufficient knowledge and skills to support them in changing the practice organisation. GPs were less positive about the outreach visitor's knowledge and skills in optimising clinical decision-making; however 78% believed that the outreach visitor contributed to effecting change in their clinical decision-making. The total costs of the intervention per practice were Euro 4317. This process evaluation demonstrated that the intervention was usually carried out as planned and achieved a high satisfaction rating from the participating practice members.

  3. AGREEing on Canadian cardiovascular clinical practice guidelines.

    PubMed

    Stone, James A; Austford, Leslie; Parker, John H; Gledhill, Norm; Tremblay, Guy; Arthur, Heather M

    2008-10-01

    The use of clinical practice guidelines (CPGs), particularly the routine implementation of evidence-based cardiovascular health maintenance and disease management recommendations, affords both expert and nonexpert practitioners the opportunity to achieve better, and at least theoretically similar, patient outcomes. However, health care practitioners are often stymied in their efforts to follow even well-researched and well-written CPGs as a consequence of contradictory information. The purposeful integration and harmonization of Canadian cardiovascular CPGs, regardless of their specific risk factor or clinical management focus, is critical to their widespread acceptance and implementation. This level of cooperation and coordination among CPG groups and organizations would help to ensure that their clinical practice roadmaps (ie, best practice recommendations) contain clear, concise and complementary, rather than contradictory, patient care information. Similarly, the application of specific tools intended to improve the quality of CPGs, such as the Appraisal of Guidelines for Research and Evaluation (AGREE) assessment tool, may also lead to improvements in CPG quality and potentially enhance their acceptance and implementation.

  4. Physician perspectives on a tailored multifaceted primary care practice facilitation intervention for improvement of cardiovascular care.

    PubMed

    Liddy, Clare; Singh, Jatinderpreet; Guo, Merry; Hogg, William

    2016-02-01

    Practice facilitation is an effective way to help physicians implement change in their clinics, but little is known about physicians' perspectives on this service. To examine physicians' responses to a practice facilitation program, focussing on their overall satisfaction, perceived most significant clinical changes, and interactions with the facilitator. The Improved Delivery of Cardiovascular Care program investigated the impact of practice facilitation on improving the quality of cardiovascular primary care in Eastern Ontario, Canada, from 2007 to 2011. We conducted a qualitative content analysis of post-intervention surveys completed by participating physicians, using a constant comparison approach framed around the Chronic Care Model. Ninety-five physicians completed the survey. Physicians overwhelmingly viewed the program positively, though descriptions of its benefits and impact varied widely. Facilitators filled three key roles for physicians, acting as a resource centre, motivator and outside perspective. Physicians adopted a number of changes in their practices. These changes include adoption of clinical information systems (diabetes registries), decision support tools (chart audits, guideline documents, flow sheets) and delivery system design (community resources). Most physicians appreciated having access to a practice facilitator and viewed the intervention positively. Insight into physicians' perspectives on practice facilitation provides a valuable counterpoint to outcomes-based evaluations of such services. Further research should investigate potential obstacles in the group of physicians who make fewer practice changes, as well as the sustainability of this type of facilitation intervention. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Improved Delivery of Cardiovascular Care (IDOCC): Findings from Narrative Reports by Practice Facilitators.

    PubMed

    Liddy, Clare; Rowan, Margo; Valiquette-Tessier, Sophie-Claire; Drosinis, Paul; Crowe, Lois; Hogg, William

    2017-03-01

    Practice facilitation can help family physicians adopt evidence-based guidelines. However, many practices struggle to effectively implement practice changes that result in meaningful improvement. Building on our previous research, we examined the barriers to and enablers of implementation perceived by practice facilitators (PF) in helping practices to adopt the Improved Delivery of Cardiovascular Care (IDOCC) program, which took place at 84 primary care practices in Ottawa, Canada between April 2008 and March 2012. We conducted a qualitative analysis of PFs' narrative reports using a multiple case study design. We used a combined purposeful sampling approach to identify cases that 1) reflected experiences typical of the broader sample and 2) presented sufficient breadth of experience from each project step and family practice model. Sampling continued until data saturation was reached. Team members conducted a qualitative analysis of reports using an open and axial coding style and a constant comparative approach. Barriers and enablers were divided into five constructs: structural, organizational, provider, patient, and innovation. Narratives from 13 practice sites were reviewed. A total of 8 barriers and 11 enablers were consistently identified across practices. Barriers were most commonly reported at the organizational (n = 3) and structural level, (n = 2) while enablers were most common at the innovation level (n = 6). While physicians responded positively to PFs' presence and largely supported their recommendations for practice change, organizational and structural aspects such as lack of time, minimal staff engagement, and provider reimbursement remained too great for practices to successfully implement practice-level changes. Trial Registration: ClinicalTrials.gov, NCT00574808.

  6. Closing the gap-cardiovascular risk and primary prevention: results from the American College of Physicians quality improvement program.

    PubMed

    Snow, Vincenza; Reynolds, Cara Egan; Bennett, Lia; Weiss, Kevin B; Snooks, Qianna; Qaseem, Amir

    2010-01-01

    The objective was to study the impact of a practice-based quality improvement program on practice teams' care for patients who have increased risk of cardiovascular disease. A total of 54 team members from 18 internal medicine practices participated in an educational program that used a pre-post intervention study design and focused on measures related to cardiovascular risk factors. The program involved live instruction, faculty-led conference calls, practice data collection, and progress reports detailing practices' improvement strategies. Data on 817 patients were reported. Practices showed significant improvement in counseling for diet (70% to 78%), exercise (67% to 74%), and weight loss (64% to 72%). Use of aspirin (53% to 64%) and statins (83% to 89%) also showed significant improvement. Administration of flu vaccine increased significantly from 51% to 54%. Improvements in patient counseling and medication management, if sustained, should lead to fewer cardiovascular events. However, program duration did not allow the capture of outcomes measures improvement.

  7. Does Improving Patient-Practitioner Communication Improve Clinical Outcomes in Patients with Cardiovascular Diseases? A Systematic Review of the Evidence

    PubMed Central

    Schoenthaler, Antoinette; Kalet, Adina; Nicholson, Joseph; Lipkin, Mack

    2014-01-01

    Objective To conduct a systematic literature review appraising the effects of interventions to improve patient-practitioner communication on cardiovascular-related clinical outcomes. Methods Databases were searched up to March 27, 2013 to identify eligible studies that included interventions to improve patient and/or practitioner communication skills and assessment of a cardiovascular-related clinical outcome in adults ≥ 18 years of age. Results Fifteen papers were reviewed: The primary focus in seven studies was the patient; seven included a practitioner-focused intervention and one targeted both. Two patient-focused and two practitioner-focused studies demonstrated a beneficial effect of the intervention compared to a control group. Patient-focused studies were designed to improve patients’ information-seeking and question-asking skills with their practitioner. Practitioner-focused studies were designed to either improve practitioner’s general patient-centered communication or risk communication skills. Conclusions Few interventions targeting patient-practitioner communication have assessed the impact on cardiovascular-related clinical outcomes, limiting the ability to determine effectiveness. Additional rigorous research supported by theoretical frameworks and validated measurement is needed to understand the potential of patient-practitioner communication to improve cardiovascular-related clinical outcomes. Practice Implications Investments in communication skills trainings in medical education and practice are needed in order to attain the full potential of patient-centered care on cardiovascular-related clinical outcomes. Systematic Review Protocol Registration CRD42013006302 PMID:24795073

  8. Big data analytics to improve cardiovascular care: promise and challenges.

    PubMed

    Rumsfeld, John S; Joynt, Karen E; Maddox, Thomas M

    2016-06-01

    The potential for big data analytics to improve cardiovascular quality of care and patient outcomes is tremendous. However, the application of big data in health care is at a nascent stage, and the evidence to date demonstrating that big data analytics will improve care and outcomes is scant. This Review provides an overview of the data sources and methods that comprise big data analytics, and describes eight areas of application of big data analytics to improve cardiovascular care, including predictive modelling for risk and resource use, population management, drug and medical device safety surveillance, disease and treatment heterogeneity, precision medicine and clinical decision support, quality of care and performance measurement, and public health and research applications. We also delineate the important challenges for big data applications in cardiovascular care, including the need for evidence of effectiveness and safety, the methodological issues such as data quality and validation, and the critical importance of clinical integration and proof of clinical utility. If big data analytics are shown to improve quality of care and patient outcomes, and can be successfully implemented in cardiovascular practice, big data will fulfil its potential as an important component of a learning health-care system.

  9. Experiences of practice facilitators working on the Improved Delivery of Cardiovascular Care project: Retrospective case study.

    PubMed

    Liddy, Clare; Rowan, Margo; Valiquette-Tessier, Sophie-Claire; Drosinis, Paul; Crowe, Lois; Hogg, William

    2018-01-01

    To examine the barriers to and facilitators of practice facilitation experienced by participants in the Improving Delivery of Cardiovascular Care (IDOCC) project. Case studies of practice facilitators' narrative reports. Eastern Ontario. Primary care practices that participated in the IDOCC project. Cases were identified by calculating sum scores in order to determine practices' performance relative to their peers. Two case exemplars were selected that scored within ± 1 SD of the total mean score, and a qualitative analysis of practice facilitators' narrative reports was conducted using a 5-factor implementation framework to identify barriers and facilitators. Narratives were divided into 3 phases: planning, implementation, and sustainability. Barriers and facilitators fluctuated over the intervention's 3 phases. Site A reported more barriers (n = 47) than facilitators (n = 38), while site B reported a roughly equal number of barriers (n = 144) and facilitators (n = 136). In both sites, the most common barriers involved organizational and provider factors and the most common facilitators were associated with innovation and structural factors. Both practices encountered various barriers and facilitators throughout the IDOCC's 3 phases. The case studies reveal the complex interactions of these factors over time, and provide insight into the implementation of practice facilitation programs. Copyright© the College of Family Physicians of Canada.

  10. [Computer-assisted cardiovascular disease management: better implementation of care but no improvement in clinical outcomes].

    PubMed

    de Wit, Niek J

    2012-01-01

    Computer support is considered by many to be a promising strategy for improving healthcare interventions, especially in the management of chronic diseases. So far, however, evidence of the effectiveness of ICT support in healthcare is limited. Recently, computer-supported cardiovascular disease management was compared with usual care during an RCT comprised of 1100 primary care patients. This trial demonstrated that neither the clinical outcome nor the cardiovascular morbidity rate improved, even though management of the risk factors improved over 1 year of follow-up. The pragmatic design of the RCT in daily general practice may have restricted implementing the computer support, and may also have hampered the evaluation of the cardiovascular effects. The results demonstrate that although computer support may help improve the performance of disease management, its impact on disease outcomes is questionable. ICT innovations in healthcare require rigorous investigative evaluation before their implementation in daily practice can be justified.

  11. Can machine-learning improve cardiovascular risk prediction using routine clinical data?

    PubMed Central

    Kai, Joe; Garibaldi, Jonathan M.; Qureshi, Nadeem

    2017-01-01

    Background Current approaches to predict cardiovascular risk fail to identify many people who would benefit from preventive treatment, while others receive unnecessary intervention. Machine-learning offers opportunity to improve accuracy by exploiting complex interactions between risk factors. We assessed whether machine-learning can improve cardiovascular risk prediction. Methods Prospective cohort study using routine clinical data of 378,256 patients from UK family practices, free from cardiovascular disease at outset. Four machine-learning algorithms (random forest, logistic regression, gradient boosting machines, neural networks) were compared to an established algorithm (American College of Cardiology guidelines) to predict first cardiovascular event over 10-years. Predictive accuracy was assessed by area under the ‘receiver operating curve’ (AUC); and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) to predict 7.5% cardiovascular risk (threshold for initiating statins). Findings 24,970 incident cardiovascular events (6.6%) occurred. Compared to the established risk prediction algorithm (AUC 0.728, 95% CI 0.723–0.735), machine-learning algorithms improved prediction: random forest +1.7% (AUC 0.745, 95% CI 0.739–0.750), logistic regression +3.2% (AUC 0.760, 95% CI 0.755–0.766), gradient boosting +3.3% (AUC 0.761, 95% CI 0.755–0.766), neural networks +3.6% (AUC 0.764, 95% CI 0.759–0.769). The highest achieving (neural networks) algorithm predicted 4,998/7,404 cases (sensitivity 67.5%, PPV 18.4%) and 53,458/75,585 non-cases (specificity 70.7%, NPV 95.7%), correctly predicting 355 (+7.6%) more patients who developed cardiovascular disease compared to the established algorithm. Conclusions Machine-learning significantly improves accuracy of cardiovascular risk prediction, increasing the number of patients identified who could benefit from preventive treatment, while avoiding unnecessary treatment of others

  12. Can machine-learning improve cardiovascular risk prediction using routine clinical data?

    PubMed

    Weng, Stephen F; Reps, Jenna; Kai, Joe; Garibaldi, Jonathan M; Qureshi, Nadeem

    2017-01-01

    Current approaches to predict cardiovascular risk fail to identify many people who would benefit from preventive treatment, while others receive unnecessary intervention. Machine-learning offers opportunity to improve accuracy by exploiting complex interactions between risk factors. We assessed whether machine-learning can improve cardiovascular risk prediction. Prospective cohort study using routine clinical data of 378,256 patients from UK family practices, free from cardiovascular disease at outset. Four machine-learning algorithms (random forest, logistic regression, gradient boosting machines, neural networks) were compared to an established algorithm (American College of Cardiology guidelines) to predict first cardiovascular event over 10-years. Predictive accuracy was assessed by area under the 'receiver operating curve' (AUC); and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) to predict 7.5% cardiovascular risk (threshold for initiating statins). 24,970 incident cardiovascular events (6.6%) occurred. Compared to the established risk prediction algorithm (AUC 0.728, 95% CI 0.723-0.735), machine-learning algorithms improved prediction: random forest +1.7% (AUC 0.745, 95% CI 0.739-0.750), logistic regression +3.2% (AUC 0.760, 95% CI 0.755-0.766), gradient boosting +3.3% (AUC 0.761, 95% CI 0.755-0.766), neural networks +3.6% (AUC 0.764, 95% CI 0.759-0.769). The highest achieving (neural networks) algorithm predicted 4,998/7,404 cases (sensitivity 67.5%, PPV 18.4%) and 53,458/75,585 non-cases (specificity 70.7%, NPV 95.7%), correctly predicting 355 (+7.6%) more patients who developed cardiovascular disease compared to the established algorithm. Machine-learning significantly improves accuracy of cardiovascular risk prediction, increasing the number of patients identified who could benefit from preventive treatment, while avoiding unnecessary treatment of others.

  13. Practice facilitation for improving cardiovascular care: secondary evaluation of a stepped wedge cluster randomized controlled trial using population-based administrative data.

    PubMed

    Deri Armstrong, Catherine; Taljaard, Monica; Hogg, William; Mark, Amy E; Liddy, Clare

    2016-09-05

    Practice facilitation (PF), a multifaceted approach in which facilitators (external health care professionals) help family physicians to improve their adoption of best practices, has been highly successful. Improved Delivery of Cardiovascular Care (IDOCC) was an innovative PF trial designed to improve evidence-based care for people who have, or are at risk of, cardiovascular disease (CVD). The intervention was found to be ineffective as assessed by a patient-level composite score based on chart reviews from a subsample of patients (N = 5292). Here, we used population-based administrative data to examine IDOCC's effect on CVD-related hospitalizations. IDOCC used a pragmatic, stepped wedge cluster randomized controlled design involving primary care providers recruited across Eastern Ontario, Canada. IDOCC's effect on CVD-related hospitalizations was assessed in the 2 years of active intervention and post-intervention years. Marginal and mixed-effects regression analyses were used to account for the study design and to control for patient, physician, and practice characteristics. Secondary and subgroup analyses investigated robustness. Our sample included 262,996 patient/year observations representing 54,085 unique patients who had, or were at risk of, CVD, from 70 practices. There was a strong decreasing secular trend in CVD-related hospitalizations but no statistically significant effect of IDOCC. Relative to patients in the control condition, patients in the intervention condition were estimated to have 4 % lower odds of CVD-related hospitalizations (adjOR = 0.96, 99 % CI 0.83 to 1.11). The nonsignificant result persisted across robustness analyses. Clinical outcomes from administrative databases were examined to form a more complete picture of the (in)effectiveness of a large-scale quality improvement intervention. IDOCC did not have a significant effect on CVD hospitalizations, suggesting that the results from the primary composite adherence score

  14. Primary prevention of cardiovascular diseases: a cost study in family practices.

    PubMed

    de Bekker-Grob, Esther W; van Dulmen, Sandra; van den Berg, Matthijs; Verheij, Robert A; Slobbe, Laurentius C J

    2011-07-06

    Considering the scarcity of health care resources and the high costs associated with cardiovascular diseases, we investigated the spending on cardiovascular primary preventive activities and the prescribing behaviour of primary preventive cardiovascular medication (PPCM) in Dutch family practices (FPs). A mixed methods design was used, which consisted of a questionnaire (n = 80 FPs), video recordings of hypertension- or cholesterol-related general practitioner visits (n = 56), and the database of Netherlands Information Network of General Practice (n = 45 FPs; n = 157,137 patients). The questionnaire and video recordings were used to determine the average frequency and time spent on cardiovascular primary preventive activities per FP respectively. Taking into account the annual income and full time equivalents of general practitioners, health care assistants, and practice nurses as well as the practice costs, the total spending on cardiovascular primary preventive activities in Dutch FPs was calculated. The database of Netherlands Information Network of General Practice was used to determine the prescribing behaviour in Dutch FPs by conducting multilevel regression models and adjusting for patient and practice characteristics. Total expenditure on cardiovascular primary preventive activities in FPs in 2009 was €38.8 million (€2.35 per capita), of which 47% was spent on blood pressure measurements, 26% on cardiovascular risk profiling, and 11% on lifestyle counselling. Fifteen percent (€11 per capita) of all cardiovascular medication prescribed in FPs was a PPCM. FPs differed greatly on prescription of PPCM (odds ratio of 3.1). Total costs of cardiovascular primary preventive activities in FPs such as blood pressure measurements and lifestyle counselling are relatively low compared to the costs of PPCM. There is considerable heterogeneity in prescribing behaviour of PPCM between FPs. Further research is needed to determine whether such large differences in

  15. Practical identifiability analysis of a minimal cardiovascular system model.

    PubMed

    Pironet, Antoine; Docherty, Paul D; Dauby, Pierre C; Chase, J Geoffrey; Desaive, Thomas

    2017-01-17

    Parameters of mathematical models of the cardiovascular system can be used to monitor cardiovascular state, such as total stressed blood volume status, vessel elastance and resistance. To do so, the model parameters have to be estimated from data collected at the patient's bedside. This work considers a seven-parameter model of the cardiovascular system and investigates whether these parameters can be uniquely determined using indices derived from measurements of arterial and venous pressures, and stroke volume. An error vector defined the residuals between the simulated and reference values of the seven clinically available haemodynamic indices. The sensitivity of this error vector to each model parameter was analysed, as well as the collinearity between parameters. To assess practical identifiability of the model parameters, profile-likelihood curves were constructed for each parameter. Four of the seven model parameters were found to be practically identifiable from the selected data. The remaining three parameters were practically non-identifiable. Among these non-identifiable parameters, one could be decreased as much as possible. The other two non-identifiable parameters were inversely correlated, which prevented their precise estimation. This work presented the practical identifiability analysis of a seven-parameter cardiovascular system model, from limited clinical data. The analysis showed that three of the seven parameters were practically non-identifiable, thus limiting the use of the model as a monitoring tool. Slight changes in the time-varying function modeling cardiac contraction and use of larger values for the reference range of venous pressure made the model fully practically identifiable. Copyright © 2017. Published by Elsevier B.V.

  16. Improving cardiovascular disease management in Australia: NPS MedicineWise.

    PubMed

    Gadzhanova, Svetla V; Roughead, Elizabeth E; Bartlett, Mark J

    2013-08-05

    To determine the impact of four NPS MedicineWise programs targeting quality use of medicines in cardiovascular management in primary care. Interrupted time-series analysis using the Department of Veterans' Affairs (DVA) claims dataset from 1 January 2002 to 31 August 2010. We examined the use of antithrombotics in people with atrial fibrillation and in those who had had a stroke, and the use of echocardiography and spironolactone in the population with heart failure. All veterans and their dependants in Australia who had received cardiovascular medicines or health services related to the targeted intervention. NPS MedicineWise national programs to improve cardiovascular management in primary care, which included prescriber feedback, academic detailing, case studies and audits as well as printed educational materials. Changes in medication and health service use before and after the interventions. All national programs were positively associated with significant improvements in related prescribing or test request practice. The interventions to improve the use of antithrombotics resulted in a 1.27% (95% CI, 1.26%-1.28%) and 0.63% (95% CI, 0.62%-0.64%) relative increase in the use of aspirin or warfarin in the population with atrial fibrillation 6 and 12 months after the program, respectively, and in a 1.51% (95% CI, 1.49%-1.53%) relative increase in the use of aspirin as monotherapy for secondary stroke prevention 12 months after the intervention. The heart failure programs resulted in a 3.69% (95% CI, 3.67%-3.71%) relative increase in the use of low-dose spironolactone and a 4.31% (95% CI, 4.27%-4.35%) relative increase in the use of echocardiogram tests 12 months after the intervention. NPS MedicineWise programs were effective in achieving positive changes in medicine and health service use for patients with cardiovascular diseases.

  17. Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care

    PubMed Central

    Thompson, Sandra C; Haynes, Emma; Woods, John A; Bessarab, Dawn C; Dimer, Lynette A; Wood, Marianne M; Sanfilippo, Frank M; Hamilton, Sandra J; Katzenellenbogen, Judith M

    2016-01-01

    Background: The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health. Methods: The overall research utilised mixed methods and included data analysis, interviews and group processes which included Aboriginal people, service providers and policymakers. Workshop discussions to identify barriers and what works were recorded by notes and on whiteboards, then distilled and circulated to participants and other stakeholders to refine and validate information. Additional engagement occurred through circulation of draft material and further discussions. This report distils the lessons for primary care practitioners to improve outcomes through management that is attentive to the needs of Aboriginal people. Results: Aspects of primordial, primary and secondary prevention are identified, with practical strategies for intervention summarised. The premature onset and high incidence of Aboriginal cardiovascular disease make prevention imperative and require that primary care practitioners understand and work to address the social underpinnings of poor health. Doctors are well placed to reinforce the importance of healthy lifestyle at all visits to involve the family and to reduce barriers which impede early care seeking. Ensuring better information for Aboriginal patients and better integrated care for patients who frequently have complex needs and multi-morbidities will also improve care outcomes. Conclusion: Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their Aboriginal patients

  18. Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care.

    PubMed

    Thompson, Sandra C; Haynes, Emma; Woods, John A; Bessarab, Dawn C; Dimer, Lynette A; Wood, Marianne M; Sanfilippo, Frank M; Hamilton, Sandra J; Katzenellenbogen, Judith M

    2016-01-01

    The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health. The overall research utilised mixed methods and included data analysis, interviews and group processes which included Aboriginal people, service providers and policymakers. Workshop discussions to identify barriers and what works were recorded by notes and on whiteboards, then distilled and circulated to participants and other stakeholders to refine and validate information. Additional engagement occurred through circulation of draft material and further discussions. This report distils the lessons for primary care practitioners to improve outcomes through management that is attentive to the needs of Aboriginal people. Aspects of primordial, primary and secondary prevention are identified, with practical strategies for intervention summarised. The premature onset and high incidence of Aboriginal cardiovascular disease make prevention imperative and require that primary care practitioners understand and work to address the social underpinnings of poor health. Doctors are well placed to reinforce the importance of healthy lifestyle at all visits to involve the family and to reduce barriers which impede early care seeking. Ensuring better information for Aboriginal patients and better integrated care for patients who frequently have complex needs and multi-morbidities will also improve care outcomes. Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their Aboriginal patients and work at multiple levels both outside and

  19. Cardiovascular disease in the Amish: an exploratory study of knowledge, beliefs, and health care practices.

    PubMed

    Gillum, Deborah R; Staffileno, Beth A; Schwartz, Karon S; Coke, Lola; Fogg, Louis; Reiling, Denise

    2011-01-01

    The Old Order Amish population is growing, yet little is known about their cardiovascular health care practices. This ethnographic study explored their cardiovascular knowledge, beliefs, and health care practices. This study showed that the Amish have distinct beliefs and practices which affect their cardiovascular health, and that culturally appropriate education is needed. Copyright © 2011 Lippincott Williams & Wilkins.

  20. Audit on cardiovascular disease preventive care in general practice.

    PubMed

    Chan, S C; Lee, T W; Teoh, L C; Abdullah, Z C; Xavier, G; Sim, C K; Ng, A C; Ong, I C H; Begum, R; Leong, C C

    2008-04-01

    Cardiovascular disease is a major cause of morbidity and mortality. Primary care doctors as general practitioners (GPs) play a central role in prevention, as they are in contact with a large number of patients in the community through provision of first contact, comprehensive and continuing care. This study aims to assess the adequacy of cardiovascular disease preventive care in general practice through a medical audit. Nine GPs in Malaysia did a retrospective audit on the records of patients, aged 45 years and above, who attended the clinics in June 2005. The adequacy of cardiovascular disease preventive care was assessed using agreed criteria and standards. Standards achieved included blood pressure recording (92.4 percent), blood sugar screening (72.7 percent) and attaining the latest blood pressure of equal or less than 140/90 mmHg in hypertensive patients (71.3 percent). Achieved standards ranged from 11.1 percent to 66.7 percent in the maintenance of hypertension and diabetic registries, recording of smoking status, height and weight, screening of lipid profile and attaining target blood sugar levels in diabetics. In the nine general practice clinics audited, targets were achieved in three out of ten indicators of cardiovascular preventive care. There were vast differences among individual clinics.

  1. Combining risk markers improves cardiovascular risk prediction in women.

    PubMed

    Holewijn, Suzanne; den Heijer, Martin; Kiemeney, Lambertus A; Stalenhoef, Anton F H; de Graaf, Jacqueline

    2014-01-01

    Cardiovascular risk stratification could be improved by adding measures of atherosclerosis to current risk scores, especially in intermediate-risk individuals. We prospectively evaluated the additive value of different non-invasive risk markers (both individual and combined) for gender-specific cardiovascular risk stratification on top of traditional risk factors in a middle-aged population-based cohort. Carotid-plaques, IMT (intima-media thickness), ABI (ankle-brachial index), PWV (pulse-wave velocity), AIx (augmentation index), CAP (central augmented pressure) and CSP (central-systolic pressure) were measured in 1367 CVD (cardiovascular disease)-free participants aged 50-70 years old. Cardiovascular events were validated after a mean follow-up of 3.8 years. AUC (area-under-the-curve) and NRI (net reclassification improvement) analyses (total-NRI for all and clinical-NRI for intermediate-risk groups) were used to determine the additive value of individual and combined risk markers. Cardiovascular events occurred in 32 women and 39 men. Traditional cardiovascular risk factors explained 6.2% and 12.5% of the variance in CVD in women and men respectively. AUCs did not substantially increase by adding individual or combined non-invasive risk markers. Individual risk markers only improved reclassification in intermediate-risk women and more than in men; clinical-NRIs ranged between 48.0 and 173.1% in women and 8.9 and 20% in men. Combined non-invasive-risk markers improved reclassification in all women and even more in those at intermediate risk; 'IMT-presence-thickness-of-plaques' showed largest reclassification [total-NRI=33.8%, P=0.012; IDI (integrated-discrimination-improvement)=0.048, P=0.066; clinical-NRI=168.0%]. In men, combined non-invasive risk markers improved reclassification only in those at intermediate risk; 'PWV-AIx-CSP-CAP-IMT' showed the largest reclassification (total-NRI=14.5%, P=0.087; IDI=0.016, P=0.148; clinical-NRI=46.0%). In all women

  2. Rationale and methods of the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA).

    PubMed

    Rodríguez-Artalejo, Fernando; Guallar, Eliseo; Borghi, Claudio; Dallongeville, Jean; De Backer, Guy; Halcox, Julian P; Hernández-Vecino, Ramón; Jiménez, Francisco Javier; Massó-González, Elvira L; Perk, Joep; Steg, Philippe Gabriel; Banegas, José R

    2010-06-30

    The EURIKA study aims to assess the status of primary prevention of cardiovascular disease (CVD) across Europe. Specifically, it will determine the degree of control of cardiovascular risk factors in current clinical practice in relation to the European guidelines on cardiovascular prevention. It will also assess physicians' knowledge and attitudes about CVD prevention as well as the barriers impeding effective risk factor management in clinical practice. Cross-sectional study conducted simultaneously in 12 countries across Europe. The study has two components: firstly at the physician level, assessing eight hundred and nine primary care and specialist physicians with a daily practice in CVD prevention. A physician specific questionnaire captures information regarding physician demographics, practice settings, cardiovascular prevention beliefs and management. Secondly at the patient level, including 7641 patients aged 50 years or older, free of clinical CVD and with at least one classical risk factor, enrolled by the participating physicians. A patient-specific questionnaire captures information from clinical records and patient interview regarding sociodemographic data, CVD risk factors, and current medications. Finally, each patient provides a fasting blood sample, which is sent to a central laboratory for measuring serum lipids, apolipoproteins, hemoglobin-A1c, and inflammatory biomarkers. Primary prevention of CVD is an extremely important clinical issue, with preventable circulatory diseases remaining the leading cause of major disease burden. The EURIKA study will provide key information to assess effectiveness of and attitudes toward primary prevention of CVD in Europe. A transnational study creates opportunities for benchmarking good clinical practice across countries and improving outcomes. (ClinicalTrials.gov number, NCT00882336).

  3. 3D printing from cardiovascular CT: a practical guide and review

    PubMed Central

    Birbara, Nicolette S.; Hussain, Tarique; Greil, Gerald; Foley, Thomas A.; Pather, Nalini

    2017-01-01

    Current cardiovascular imaging techniques allow anatomical relationships and pathological conditions to be captured in three dimensions. Three-dimensional (3D) printing, or rapid prototyping, has also become readily available and made it possible to transform virtual reconstructions into physical 3D models. This technology has been utilised to demonstrate cardiovascular anatomy and disease in clinical, research and educational settings. In particular, 3D models have been generated from cardiovascular computed tomography (CT) imaging data for purposes such as surgical planning and teaching. This review summarises applications, limitations and practical steps required to create a 3D printed model from cardiovascular CT. PMID:29255693

  4. Which interventions are used by health care professionals to enhance medication adherence in cardiovascular patients? A survey of current clinical practice.

    PubMed

    Berben, Lut; Bogert, Laura; Leventhal, Marcia E; Fridlund, Bengt; Jaarsma, Tiny; Norekvål, Tone M; Smith, Karen; Strömberg, Anna; Thompson, David R; De Geest, Sabina

    2011-03-01

    Complex medication regimens are often required to manage cardiovascular diseases. As non-adherence, which can have severe negative outcomes, is common among cardiovascular patients, various interventions to improve adherence should be implemented in daily practice. To assess which strategies cardiovascular nurses and allied health professionals utilize to (1) assess patients' adherence to medication regimen, and (2) enhance medication adherence via educational/cognitive, counseling/behavioral, and psychological/affective interventions. A 45-item questionnaire to assess adherence assessment and interventional strategies utilized by health care professionals in daily clinical practice was distributed to a convenience sample of attendants of the 10th Annual Spring Meeting of the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions conference in Geneva (Switzerland) in March 2010. Respondents not in direct clinical practice were excluded. Descriptive statistics were used to describe practice patterns regarding adherence management. Of 276 distributed questionnaires, 171 (62%) were returned, of which 34 (20%) were excluded as respondents performed no direct patient care. Questioning patients about non-adherence during follow-up was the most frequently reported assessment strategy (56%). Educational/cognitive adherence enhancing interventions were used most frequently, followed by counseling/behavioral interventions. Psychological/affective interventions were less frequently used. The most frequent intervention used was providing reading materials (66%) followed by training patients regarding medication taking during inpatient recovery (48%). Slightly over two-thirds (69%) reported using a combination of interventions to improve patient's adherence. Educational interventions are used most in clinical practice, although evidence shows they are less effective than behavioral interventions at enhancing medication adherence. Copyright

  5. Cardiovascular Complications of Cancer Therapy: Best Practices in Diagnosis, Prevention, and Management: Part 1.

    PubMed

    Chang, Hui-Ming; Moudgil, Rohit; Scarabelli, Tiziano; Okwuosa, Tochukwu M; Yeh, Edward T H

    2017-11-14

    Modern cancer therapy has successfully cured many cancers and converted a terminal illness into a chronic disease. Because cancer patients often have coexisting heart diseases, expert advice from cardiologists will improve clinical outcome. In addition, cancer therapy can also cause myocardial damage, induce endothelial dysfunction, and alter cardiac conduction. Thus, it is important for practicing cardiologists to be knowledgeable about the diagnosis, prevention, and management of the cardiovascular complications of cancer therapy. In this first part of a 2-part review, we will review cancer therapy-induced cardiomyopathy and ischemia. This review is based on a MEDLINE search of published data, published clinical guidelines, and best practices in major cancer centers. With the number of cancer survivors expanding quickly, the time has come for cardiologists to work closely with cancer specialists to prevent and treat cancer therapy-induced cardiovascular complications. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  6. [Effectiveness of an intervention to improve quality care in reducing cardiovascular risk in hypertense patients].

    PubMed

    Gómez Marcos, Manuel A; García Ortiz, Luis; González Elena, Luis Javier; Sánchez Rodríguez, Angel

    2006-05-31

    To evaluate the effectiveness of an intervention on health workers, based on quality improvement through reduction of cardiovascular risk in patients with hypertension. Quasi-experimental study. Primary care. Two urban health centres. A thousand hypertense patients selected by stratified random sampling. One centre (500) was assigned to implement a quality improvement intervention, while at the other centre (500) "usual care" procedures were followed (control group). The quality improvement intervention consisted of a combined program designed for the medical and nursing staff that comprised audit, feedback, training sessions, and implementation of clinical practice guidelines. Coronary risk using the Framingham scale and cardiovascular mortality risk using the SCORE project. Absolute coronary risk decreased from 16.94% (95% CI, 15.92-17.66) to 13.81% (95% CI, 13.09-14.52) (P<.001) in the intervention group; whilst there was no significant change in the control group, which dropped from 17.63% (95% CI, 16.68-18.53) to 16.82% (95% CI, 15.91-17.74). The intervention led to a 2.28% point decrease (95% CI, 1.35-3.21) (P<.001) in coronary risk. Cardiovascular mortality risk decreased from 2.48% (95% CI, 2.35-2.62) to 2.19% (95% CI, 2.07-2.31) (P<.001) in the intervention group, with no significant change in the control group, which changed from 2.45% (95% CI, 2.30-2.59) to 2.52% (95% CI, 2.38-2.66). The intervention led to a 0.36% point decrease (95% CI, 0.05-0.73) (P<.001) in cardiovascular mortality risk. The quality improvement intervention was effective in decreasing coronary risk and cardiovascular mortality risk in patients with hypertension.

  7. Current practices in corrosion, surface characterization, and nickel leach testing of cardiovascular metallic implants.

    PubMed

    Nagaraja, Srinidhi; Di Prima, Matthew; Saylor, David; Takai, Erica

    2017-08-01

    In an effort to better understand current test practices and improve nonclinical testing of cardiovascular metallic implants, the Food and Drug Administration (FDA) held a public workshop on Cardiovascular Metallic Implants: corrosion, surface characterization, and nickel leaching. The following topics were discussed: (1) methods used for corrosion assessments, surface characterization techniques, and nickel leach testing of metallic cardiovascular implant devices, (2) the limitations of each of these in vitro tests in predicting in vivo performance, (3) the need, utility, and circumstances when each test should be considered, and (4) the potential testing paradigms, including acceptance criteria for each test. In addition to the above topics, best practices for these various tests were discussed, and knowledge gaps were identified. Prior to the workshop, discussants had the option to provide feedback and information on issues relating to each of the topics via a voluntary preworkshop assignment. During the workshop, the pooled responses were presented and a panel of experts discussed the results. This article summarizes the proceedings of this workshop and background information provided by workshop participants. Published 2016. This article is a U.S. Government work and is in the public domain in the USA. J Biomed Mater Res Part B: Appl Biomater, 105B: 1330-1341, 2017. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  8. Does treatment of SDB in children improve cardiovascular outcome?

    PubMed

    Vlahandonis, Anna; Walter, Lisa M; Horne, Rosemary S C

    2013-02-01

    Sleep disordered breathing (SDB) is a common disorder in both adults and children and is caused by the obstruction of the upper airway during sleep. Unlike adults, most cases of paediatric SDB are due to the presence of enlarged tonsils and adenoids, thus the main treatment option is adenotonsillectomy (T&A). It is well known that obstructive sleep apnoea in adults increases the risk for hypertension, coronary artery disease and stroke, and there is now mounting evidence that SDB also has a significant impact on the cardiovascular system in children with reports of elevated blood pressure, endothelial dysfunction and altered autonomic cardiovascular control. As there is now substantial evidence that elevated blood pressure in childhood is carried on to adulthood it is important to know if treatment of SDB improves cardiovascular outcomes. Studies in adults have shown that treatment of SDB leads to improvements in cardiovascular function, including a reduction in pulmonary artery pressure, systemic blood pressure and endothelial dysfunction. However, studies exploring the outcomes of treatment of SDB in children on the cardiovascular system are limited and varied in their methodology and outcome measures. As a number of cardiovascular disturbances are sequelae of SDB, early detection and management could result in the reduction of elevated blood pressure in children, and consequently a reduction in cardiovascular morbidity in adulthood. The aim of this review is to summarise the findings of studies to date which have investigated the cardiovascular outcomes in children treated for SDB and to make recommendations for future management of this very common disease. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  9. Consensus Statement of Standards for Interventional Cardiovascular Nursing Practice.

    PubMed

    White, Kevin; Macfarlane, Heather; Hoffmann, Bernadette; Sirvas-Brown, Helene; Hines, Kathryn; Rolley, John Xavier; Graham, Sandi

    2018-05-01

    Interventional cardiovascular nursing is a critical care nursing specialty providing complex nursing interventions to patients prone to clinical deterioration, through the combined risks of the pathophysiology of their illness and undergoing technically complex interventional cardiovascular procedures. No guidelines were identified worldwide to assist health care providers and educational institutions in workforce development and education guidelines to minimise patients' risk of adverse events. The Interventional Nurses Council (INC) developed a definition and scope of practice for interventional cardiac nursing (ICN's) in 2013. The INC executive committee established a working party of seven representatives from Australia and New Zealand. Selection was based on expertise in interventional cardiovascular nursing and experience providing education and mentoring in the clinical and postgraduate environment. A literature search of the electronic databases Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Health Source was performed, using the search terms: clinical deterioration, ST elevation myocardial infarction, vital signs, primary percutaneous coronary intervention, PCI, AMI, STEMI, acute coronary syndrome, peri-procedural care, unstable angina, PCI complications, structural heart disease, TAVI, TAVR, cardiac rhythm management, pacing, electrophysiology studies, vascular access, procedural sedation. Articles were limited to the cardiac catheterisation laboratory and relevance to nursing based outcomes. Reference lists were examined to identify relevant articles missed in the initial search. The literature was compared with national competency standards, quality and safety documents and the INC definition and scope of practice. Consensus of common themes, a taxonomy of education and seven competency domains were achieved via frequent teleconferences and two face-to-face meetings. The working party finalised the

  10. Evaluation of cardiovascular demands of game play and practice in women's ice hockey.

    PubMed

    Spiering, Barry A; Wilson, Meredith H; Judelson, Daniel A; Rundell, Kenneth W

    2003-05-01

    Preparation for the physical demands of competition often involves game simulation during practice. This paradigm is thought to promote physiological adaptations that enhance maximal performance. However, a mismatch between practice intensity and actual competition intensity may not provide adequate training to achieve optimal game-play fitness. The purpose of this study was to evaluate the effectiveness of practice in meeting the cardiovascular demands of a women's ice hockey game. Heart rate (HR) data from 11 U.S. National Women's Ice Hockey team members were collected (5-second intervals) during a game and a typical practice session. Data was normalized to individual HRmax determined during Vo(2)max testing. Working time was defined as a game shift or practice-working interval. Mean working HR was greater during the game than the practice, 90 +/- 2% and 76 +/- 3% of HRmax, respectively (p < 0.05). Mean percent session time (game or practice) >90% HRmax was also longer during the game than the practice, 10.5 +/- 4.1% and 5.6 +/- 3.5% (p < 0.05), respectively. Mean session HR, percent time >80% HRmax, and mean resting HR were not different between game and practice (68 +/- 7% vs. 69 +/- 5%, 23.2 +/- 5.3% vs. 26.1 +/- 9.2%, and 59 +/- 8% vs. 56 +/- 5%, respectively). Elite women hockey players experience significantly greater cardiovascular load during game play than during practice. This mismatch in cardiovascular demand may prevent players from achieving "game shape," thus affecting competition play.

  11. Quality of cardiovascular disease care in Ontario's primary care practices: a cross sectional study examining differences in guideline adherence by patient sex.

    PubMed

    Naicker, Kiyuri; Liddy, Clare; Singh, Jatinderpreet; Taljaard, Monica; Hogg, William

    2014-06-18

    Women are disproportionately affected by cardiovascular disease, often experiencing poorer outcomes following a cardiovascular event. Evidence points to inequities in processes of care as a potential contributing factor. This study sought to determine whether any sex differences exist in adherence to process of care guidelines for cardiovascular disease within primary care practices in Ontario, Canada. This is a secondary analysis of pooled cross-sectional baseline data collected through a larger quality improvement initiative known as the Improved Delivery of Cardiovascular Care (IDOCC). Chart abstraction was performed for 4,931 patients from 84 primary care practices in Eastern Ontario who had, or were at high risk of, cardiovascular disease. Measures examining adherence to guidelines associated with nine areas of cardiovascular care (coronary artery disease, peripheral vascular disease (PVD), stroke/transient ischemic attack, chronic kidney disease, diabetes, dyslipidemia, hypertension, smoking cessation, and weight management) were collected. Multivariable logistic regression analysis was performed to evaluate sex differences, adjusting for age, physician remuneration, and rurality. Women were significantly less likely to have their lipid profiles taken (OR=1.17, 95% CI 1.03-1.33), be prescribed lipid lowering medication for dyslipidemia (OR=1.54, 95% CI 1.20-1.97), and to be prescribed ASA following stroke (OR=1.56, 95% CI 1.39-1.75). Women with PVD were significantly less likely to be prescribed ACE inhibitors and/or angiotensin receptor blockers (OR=1.74, 95% CI 1.25-2.41) and lipid lowering medications (OR=1.95, 95% CI 1.46-2.62) or ASA (OR=1.59, 95% CI 1.43-1.78). However, women were more likely to have two blood pressure measurements taken and to be referred to a dietician or weight loss program. Male patients with diabetes were less likely to be prescribed glycemic control medication (OR=0.84, 95% CI 0.74-0.86). Sex disparities exist in the quality of

  12. Erectile dysfunction in the cardiovascular patient.

    PubMed

    Vlachopoulos, Charalambos; Jackson, Graham; Stefanadis, Christodoulos; Montorsi, Piero

    2013-07-01

    Erectile dysfunction is common in the patient with cardiovascular disease. It is an important component of the quality of life and it also confers an independent risk for future cardiovascular events. The usual 3-year time period between the onset of erectile dysfunction symptoms and a cardiovascular event offers an opportunity for risk mitigation. Thus, sexual function should be incorporated into cardiovascular disease risk assessment for all men. A comprehensive approach to cardiovascular risk reduction (comprising of both lifestyle changes and pharmacological treatment) improves overall vascular health, including sexual function. Proper sexual counselling improves the quality of life and increases adherence to medication. This review explores the critical connection between erectile dysfunction and cardiovascular disease and evaluates how this relationship may influence clinical practice. Algorithms for the management of patient with erectile dysfunction according to the risk for sexual activity and future cardiovascular events are proposed.

  13. Cardiovascular preparticipation screening practices of college team physicians.

    PubMed

    Asplund, Chad A; Asif, Irfan M

    2014-07-01

    Determine the cardiovascular screening practices of college team physicians. Cross-sectional survey. Electronic mail with a link to a 9-item survey. American Medical Society for Sports Medicine college team physicians. Screening practices survey administered to college team physicians. Cardiovascular preparticipation screening practices including noninvasive cardiac screening (NICS) such as electrocardiogram (ECG) or echocardiogram. Two hundred twenty-four of 613 AMSSM members identifying themselves as college team physicians (36.5%) responded: National Collegiate Athletic Association Division I: 146, Division II: 41, Division III: 27, National Association of Intercollegiate Athletics: 8, and Junior College: 2. The majority (78%) of schools conducted the American Heart Association (AHA) 12-element history and physical examination. Division I institutions were more likely to add an ECG and/or echocardiogram (30%) to their preparticipation examination (PPE) compared with lower divisions (P < 0.0001). Those Division I schools using NICS were more likely to do so for all athletes (P < 0.001) or revenue generating sports (P < 0.001), whereas other institutions did so only for high-risk subgroups (P < 0.01). Lower division schools would consider adding ECG if it cost less (P = 0.01) or if there were more local expertise in athlete-specific interpretation standards (P = 0.04). Many National Collegiate Athletic Association Athletes Division I programs already use NICS to screen athletes, whereas a significant portion of lower division schools add ECG for athletes deemed high risk. Increased use of these modalities suggests limitations of traditional PPE screening methods. This is the first study to assess cardiac screening practices across all collegiate divisions and broadens our understanding of cardiac screening in high-level athletes.

  14. Evidence based position paper on physical and rehabilitation medicine (PRM) professional practice for people with cardiovascular conditions. The European PRM position (UEMS PRM Section).

    PubMed

    Juocevicius, Alvydas; Oral, Aydan; Lukmann, Aet; Takáč, Peter; Tederko, Piotr; Hāznere, Ilze; Aguiar-Branco, Catarina; Lazovic, Milica; Negrini, Stefano; Varela Donoso, Enrique; Christodoulou, Nicolas

    2018-05-02

    Cardiovascular conditions are significant causes of mortality and morbidity leading to substantial disability. The aim of the paper is to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for persons with cardiovascular conditions in order to promote their functioning properties and to reduce activity limitations and/or participation restrictions. A systematic review of the literature and a Consensus procedure by means of a Delphi process has been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty recommendations resulting from the Delphi procedure. The professional role of PRM physicians having expertise in the rehabilitation of cardiovascular conditions is to lead cardiac rehabilitation programmes in multiprofessional teams, working in collaboration with other disciplines in a variety of settings to improve functioning of people with cardiovascular conditions. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in persons with cardiovascular conditions.

  15. Cardiovascular diseases in dental practice. Practical considerations.

    PubMed

    Margaix Muñoz, María; Jiménez Soriano, Yolanda; Poveda Roda, Rafael; Sarrión, Gracia

    2008-05-01

    Coronary heart disease is the principal cause of death in the industrialized world. Its most serious expression, acute myocardial infarction, causes 7.2 million deaths each year worldwide, and it is estimated that 20% of all people will suffer heart failure in the course of their lifetime. The control of risk cardiovascular factors, including arterial hypertension, obesity and diabetes mellitus is the best way to prevent such diseases. The most frequent and serious cardiovascular emergencies that can manifest during dental treatment are chest pain (as a symptom of underlying disease) and acute lung edema. Due to the high prevalence and seriousness of these problems, the dental surgeon must be aware of them and should be able to act quickly and effectively in the case of an acute cardiovascular event. In patients with a history of cardiovascular disease, attention must center on the control of pain, the reduction of stress, and the use or avoidance of a vasoconstrictor in dental anesthesia. In turn, caution is required in relation to the antiplatelet, anticoagulant and antihypertensive medication typically used by such patients.

  16. Sexual counseling and cardiovascular disease: practical approaches

    PubMed Central

    Steinke, Elaine E; Jaarsma, Tiny

    2015-01-01

    Patients with cardiovascular disease and their partners expect health care providers to provide sexual counseling to assist them in maintaining sexual quality of life. Evidence suggests however, that there is a gap in integrating evidence into practice and that relatively few cardiac patients receive sexual counseling. This can result in negative psychological, physical, and quality of life outcomes for couples who may needlessly decide sexual activity is too risky and cease all sexual activity. Two scientific statements now exist that provide ample guidance to health care providers in discussing this important topic. Using a team approach that includes physicians, nurses, physical therapists, rehabilitation staff, and others is important to ensure that sexual counseling occurs throughout recovery. In addition, several trials using interventional approaches for sexual counseling provide insight into successful approaches for sexual counseling in practice. This article provides practical strategies and evidence-based approaches for assessment and sexual counseling for all cardiac patients and their partners, and specific counseling for those with ischemic conditions, heart failure, and implanted devices. PMID:25219908

  17. Sexual counseling and cardiovascular disease: practical approaches.

    PubMed

    Steinke, Elaine E; Jaarsma, Tiny

    2015-01-01

    Patients with cardiovascular disease and their partners expect health care providers to provide sexual counseling to assist them in maintaining sexual quality of life. Evidence suggests however, that there is a gap in integrating evidence into practice and that relatively few cardiac patients receive sexual counseling. This can result in negative psychological, physical, and quality of life outcomes for couples who may needlessly decide sexual activity is too risky and cease all sexual activity. Two scientific statements now exist that provide ample guidance to health care providers in discussing this important topic. Using a team approach that includes physicians, nurses, physical therapists, rehabilitation staff, and others is important to ensure that sexual counseling occurs throughout recovery. In addition, several trials using interventional approaches for sexual counseling provide insight into successful approaches for sexual counseling in practice. This article provides practical strategies and evidence-based approaches for assessment and sexual counseling for all cardiac patients and their partners, and specific counseling for those with ischemic conditions, heart failure, and implanted devices.

  18. A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol.

    PubMed

    Cohen, Deborah J; Balasubramanian, Bijal A; Gordon, Leah; Marino, Miguel; Ono, Sarah; Solberg, Leif I; Crabtree, Benjamin F; Stange, Kurt C; Davis, Melinda; Miller, William L; Damschroder, Laura J; McConnell, K John; Creswell, John

    2016-06-29

    The Agency for Healthcare Research and Quality (AHRQ) launched the EvidenceNOW Initiative to rapidly disseminate and implement evidence-based cardiovascular disease (CVD) preventive care in smaller primary care practices. AHRQ funded eight grantees (seven regional Cooperatives and one independent national evaluation) to participate in EvidenceNOW. The national evaluation examines quality improvement efforts and outcomes for more than 1500 small primary care practices (restricted to those with fewer than ten physicians per clinic). Examples of external support include practice facilitation, expert consultation, performance feedback, and educational materials and activities. This paper describes the study protocol for the EvidenceNOW national evaluation, which is called Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES). This prospective observational study will examine the portfolio of EvidenceNOW Cooperatives using both qualitative and quantitative data. Qualitative data include: online implementation diaries, observation and interviews at Cooperatives and practices, and systematic assessment of context from the perspective of Cooperative team members. Quantitative data include: practice-level performance on clinical quality measures (aspirin prescribing, blood pressure and cholesterol control, and smoking cessation; ABCS) collected by Cooperatives from electronic health records (EHRs); practice and practice member surveys to assess practice capacity and other organizational and structural characteristics; and systematic tracking of intervention delivery. Quantitative, qualitative, and mixed methods analyses will be conducted to examine how Cooperatives organize to provide external support to practices, to compare effectiveness of the dissemination and implementation approaches they implement, and to examine how regional variations and other organization and contextual factors influence implementation and effectiveness. ESCALATES is

  19. Using human factors engineering to improve patient safety in the cardiovascular operating room.

    PubMed

    Gurses, Ayse P; Martinez, Elizabeth A; Bauer, Laura; Kim, George; Lubomski, Lisa H; Marsteller, Jill A; Pennathur, Priyadarshini R; Goeschel, Chris; Pronovost, Peter J; Thompson, David

    2012-01-01

    Despite significant medical advances, cardiac surgery remains a high risk procedure. Sub-optimal work system design characteristics can contribute to the risks associated with cardiac surgery. However, hazards due to work system characteristics have not been identified in the cardiovascular operating room (CVOR) in sufficient detail to guide improvement efforts. The purpose of this study was to identify and categorize hazards (anything that has the potential to cause a preventable adverse patient safety event) in the CVOR. An interdisciplinary research team used prospective hazard identification methods including direct observations, contextual inquiry, and photographing to collect data in 5 hospitals for a total 22 cardiac surgeries. We performed thematic analysis of the qualitative data guided by a work system model. 60 categories of hazards such as practice variations, high workload, non-compliance with evidence-based guidelines, not including clinicians' in medical device purchasing decisions were found. Results indicated that hazards are common in cardiac surgery and should be eliminated or mitigated to improve patient safety. To improve patient safety in the CVOR, efforts should focus on creating a culture of safety, increasing compliance with evidence based infection control practices, improving communication and teamwork, and designing better tools and technologies through partnership among all stakeholders.

  20. Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: the treatment of cardiovascular risk using electronic decision support cluster-randomized trial.

    PubMed

    Peiris, David; Usherwood, Tim; Panaretto, Kathryn; Harris, Mark; Hunt, Jennifer; Redfern, Julie; Zwar, Nicholas; Colagiuri, Stephen; Hayman, Noel; Lo, Serigne; Patel, Bindu; Lyford, Marilyn; MacMahon, Stephen; Neal, Bruce; Sullivan, David; Cass, Alan; Jackson, Rod; Patel, Anushka

    2015-01-01

    Despite effective treatments to reduce cardiovascular disease risk, their translation into practice is limited. Using a parallel arm cluster-randomized controlled trial in 60 Australian primary healthcare centers, we tested whether a multifaceted quality improvement intervention comprising computerized decision support, audit/feedback tools, and staff training improved (1) guideline-indicated risk factor measurements and (2) guideline-indicated medications for those at high cardiovascular disease risk. Centers had to use a compatible software system, and eligible patients were regular attendees (Aboriginal and Torres Strait Islander people aged ≥ 35 years and others aged ≥ 45 years). Patient-level analyses were conducted using generalized estimating equations to account for clustering. Median follow-up for 38,725 patients (mean age, 61.0 years; 42% men) was 17.5 months. Mean monthly staff support was <1 hour/site. For the coprimary outcomes, the intervention was associated with improved overall risk factor measurements (62.8% versus 53.4% risk ratio; 1.25; 95% confidence interval, 1.04-1.50; P=0.02), but there was no significant differences in recommended prescriptions for the high-risk cohort (n=10,308; 56.8% versus 51.2%; P=0.12). There were significant treatment escalations (new prescriptions or increased numbers of medicines) for antiplatelet (17.9% versus 2.7%; P<0.001), lipid-lowering (19.2% versus 4.8%; P<0.001), and blood pressure-lowering medications (23.3% versus 12.1%; P=0.02). In Australian primary healthcare settings, a computer-guided quality improvement intervention, requiring minimal support, improved cardiovascular disease risk measurement but did not increase prescription rates in the high-risk group. Computerized quality improvement tools offer an important, albeit partial, solution to improving primary healthcare system capacity for cardiovascular disease risk management. https

  1. Cardiovascular risk assessment: audit findings from a nurse clinic--a quality improvement initiative.

    PubMed

    Waldron, Sarah; Horsburgh, Margaret

    2009-09-01

    Evidence has shown the effectiveness of risk factor management in reducing mortality and morbidity from cardiovascular disease (CVD). An audit of a nurse CVD risk assessment programme undertaken between November 2005 and December 2008 in a Northland general practice. A retrospective audit of CVD risk assessment with data for the first entry of 621 patients collected exclusively from PREDICT-CVDTM, along with subsequent data collected from 320 of these patients who had a subsequent assessment recorded at an interval ranging from six months to three years (18 month average). Of the eligible population (71%) with an initial CVD risk assessment, 430 (69.2%) had afive-year absolute risk less than 15%, with 84 (13.5%) having a risk greater than 15% and having not had a cardiovascular event. Of the patients with a follow-up CVD risk assessment, 34 showed improvement. Medication prescribing for patients with absolute CVD risk greater than 15% increased from 71% to 86% for anti-platelet medication and for lipid lowering medication from 65% to 72% in the audit period. The recently available 'heart health' trajectory tool will help patients become more aware of risks that are modifiable, together with community support to engage more patients in the nurse CVD prevention programme. Further medication audits to monitor prescribing trends. Patients who showed an improvement in CVD risk had an improvement in one or more modifiable risk factors and became actively involved in making changes to their health.

  2. Improving HRD Practice.

    ERIC Educational Resources Information Center

    Gilley, Jerry W.

    This book provides human resource development (HRD) professionals with a practical approach for improving the way they practice their profession and presents a four-part framework for improving HRD practice. Each of the book's four parts is dedicated to one part of the framework: examining HRD strategy; improving perceptions of HRD; improving…

  3. Uniform data collection in routine clinical practice in cardiovascular patients for optimal care, quality control and research: The Utrecht Cardiovascular Cohort.

    PubMed

    Asselbergs, Folkert W; Visseren, Frank Lj; Bots, Michiel L; de Borst, Gert J; Buijsrogge, Marc P; Dieleman, Jan M; van Dinther, Baukje Gf; Doevendans, Pieter A; Hoefer, Imo E; Hollander, Monika; de Jong, Pim A; Koenen, Steven V; Pasterkamp, Gerard; Ruigrok, Ynte M; van der Schouw, Yvonne T; Verhaar, Marianne C; Grobbee, Diederick E

    2017-05-01

    Background Cardiovascular disease remains the major contributor to morbidity and mortality. In routine care for patients with an elevated cardiovascular risk or with symptomatic cardiovascular disease information is mostly collected in an unstructured manner, making the data of limited use for structural feedback, quality control, learning and scientific research. Objective The Utrecht Cardiovascular Cohort (UCC) initiative aims to create an infrastructure for uniform registration of cardiovascular information in routine clinical practice for patients referred for cardiovascular care at the University Medical Center Utrecht, the Netherlands. This infrastructure will promote optimal care according to guidelines, continuous quality control in a learning healthcare system and creation of a research database. Methods The UCC comprises three parts. UCC-1 comprises enrolment of all eligible cardiovascular patients in whom the same information will be collected, based on the Dutch cardiovascular management guideline. A sample of UCC-1 will be invited for UCC-2. UCC-2 involves an enrichment through extensive clinical measurements with emphasis on heart failure, cerebral ischaemia, arterial aneurysms, diabetes mellitus and elevated blood pressure. UCC-3 comprises on-top studies, with in-depth measurements in smaller groups of participants typically based on dedicated project grants. All participants are followed up for morbidity and mortality through linkage with national registries. Conclusion In a multidisciplinary effort with physicians, patients and researchers the UCC sets a benchmark for a learning cardiovascular healthcare system. UCC offers an invaluable resource for future high quality care as well as for first-class research for investigators.

  4. Applications of 3D printing in cardiovascular diseases.

    PubMed

    Giannopoulos, Andreas A; Mitsouras, Dimitris; Yoo, Shi-Joon; Liu, Peter P; Chatzizisis, Yiannis S; Rybicki, Frank J

    2016-12-01

    3D-printed models fabricated from CT, MRI, or echocardiography data provide the advantage of haptic feedback, direct manipulation, and enhanced understanding of cardiovascular anatomy and underlying pathologies. Reported applications of cardiovascular 3D printing span from diagnostic assistance and optimization of management algorithms in complex cardiovascular diseases, to planning and simulating surgical and interventional procedures. The technology has been used in practically the entire range of structural, valvular, and congenital heart diseases, and the added-value of 3D printing is established. Patient-specific implants and custom-made devices can be designed, produced, and tested, thus opening new horizons in personalized patient care and cardiovascular research. Physicians and trainees can better elucidate anatomical abnormalities with the use of 3D-printed models, and communication with patients is markedly improved. Cardiovascular 3D bioprinting and molecular 3D printing, although currently not translated into clinical practice, hold revolutionary potential. 3D printing is expected to have a broad influence in cardiovascular care, and will prove pivotal for the future generation of cardiovascular imagers and care providers. In this Review, we summarize the cardiovascular 3D printing workflow, from image acquisition to the generation of a hand-held model, and discuss the cardiovascular applications and the current status and future perspectives of cardiovascular 3D printing.

  5. Practitioner Gender and Quality of Care in Ambulatory Cardiology Practices: A Report From the National Cardiovascular Data Practice Innovation and Clinical Excellence (PINNACLE) Registry.

    PubMed

    Gupta, Dipti; Tang, Fengming; Masoudi, Frederick A; Jones, Philip G; Chan, Paul S; Daugherty, Stacie L

    Some studies suggest that female practitioners are more likely to provide guideline-concordant care than male practitioners; however, little is known about the role of practitioner gender in cardiology. The aim of the study was to measure the association between practitioner gender and adherence to the cardiovascular performance measures in the American College of Cardiology's ambulatory Practice Innovation and Clinical Excellence Registry. Patients with at least 1 outpatient visit with a unique practitioner were included. Among eligible patients, adherence to 7 guideline-supported performance measures for coronary artery disease, heart failure, and atrial fibrillation over 12 months after registry entry was compared by practitioner gender using hierarchical models adjusting for practitioner type (physicians vs advance practice practitioners) and number of visits. The study cohort included 1493 individual practitioners who saw 769 139 patients; 80% of practitioners were men. Male practitioners were more often physicians compared with female practitioners (98.2% vs 43.7%, P < .01). Accounting for practitioner category and visit frequency, guideline adherence rates were similar by practitioner gender for all measures with the exception of marginally higher rates for coronary artery disease performance measures for male practitioners compared with female practitioners (antiplatelet: rate ratio [RR] = 1.06; 95% confidence interval [CI], 1.03-1.09; β-blockers: RR = 1.06; 95% CI, 1.01-1.10; and lipid-lowering drug: RR = 1.07; 95% CI, 1.04-1.10) and atrial fibrillation (oral anticoagulants: RR = 1.05; 95% CI, 1.01-1.09). Male practitioners marginally outperformed their female counterparts in ambulatory practices enrolled in a voluntary cardiovascular performance improvement registry program. Overall low adherence to some performance measures suggests room for improvement among all practitioners.

  6. Practical aspects of the control of cardiovascular risk in type 2 diabetes mellitus and the metabolic syndrome

    PubMed Central

    Cerghizan, Anca; Bala, Cornelia; Nita, Cristina; Hancu, Nicolae

    2007-01-01

    Cardiovascular disease is unanimously recognized as the major burden in type 2 diabetes, in terms of both mortality and morbidity. There is an extensive evidence coming from epidemiological studies that supports this statement. The presence of the metabolic syndrome confers a higher risk of long-term death, and dysglycemia appears to be responsible for the most of the excess risk. The metabolic syndrome also has an essential role in the modern concept of cardiovascular prevention. Global cardiovascular risk represents the action and consequences of all risk factors that simultaneously or sequentially act on the body, leading to atherogenesis/atherosclerosis. In daily practice, a stepwise approach to control cardiovascular risk in people with type 2 diabetes has been proposed. This algorithm comprises three steps: identification of cardiovascular risk factors, interpretation of global cardiovascular risk, and intervention for all identified risk factors and diseases. In the past decades, the whole concept of diabetes and the metabolic syndrome care has undergone a radical change. From here the concept of modern management of those diseases emerged: early, multi-factorial and intensive control. This concept emphasized early and aggressive interventions for all cardiovascular risk factors in the long-term management. The model of multiple cardiovascular risk factor intervention ought to be implemented in daily practice as much as possible. This offers a unique opportunity to reduce the devastating cardiovascular morbidity and mortality in people with type 2 diabetes and the metabolic syndrome. PMID:18650987

  7. Practices in management of cancer treatment-related cardiovascular toxicity: A cardio-oncology survey.

    PubMed

    Jovenaux, Ludovic; Cautela, Jennifer; Resseguier, Noemie; Pibarot, Michele; Taouqi, Myriam; Orabona, Morgane; Pinto, Johan; Peyrol, Michael; Barraud, Jeremie; Laine, Marc; Bonello, Laurent; Paganelli, Franck; Barlesi, Fabrice; Thuny, Franck

    2017-08-15

    Cardiovascular toxicity has become a challenging issue during cancer therapy. Nonetheless, there is a lack of consensual guidelines for their management. We aimed to determine the current practices of oncologists regarding cardiovascular toxicity related to anthracyclines, trastuzumab and angiogenic inhibitors and to gather their opinions on the development of cardio-oncology programs. A cross-sectional declarative study was submitted to French oncologists in the form of an individual, structured questionnaire. A total of 303 oncologists responded to the survey. Ninety-nine percent of oncologists prescribed cardiotoxic therapies, including anthracyclines (83%), trastuzumab (51%) and other angiogenic inhibitors (64%). The method adopted for managing cardiovascular toxicity was based on guidelines from expert oncology societies for only 35% of oncologists. None was aware of recommendations from expert cardiology societies. Prescription of pre-, peri- and post-therapy cardiovascular assessment was inconsistent and significantly less frequent for all classes of angiogenic inhibitors than for anthracyclines and trastuzumab (P<0.0001). Relative to pre-therapy assessment, post-therapy assessment was prescribed significantly less often for all cancer therapies (P<0.0001). Attitudes regarding the onset of left ventricular dysfunction were much more inconsistent when angiogenic inhibitors were involved. Additionally, the management of hypertension and QT prolongation was also inconsistent. Finally, 88% of oncologists supported projects of cardio-oncology programs development. Practices of oncologists are disparate in the field of cardiovascular toxicity. This finding underlines the complexity of managing many different situations and the need for distribution of formal guidelines from oncology and cardiology expert societies. The development of personalized cardio-oncology programs seems essential. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Prevention of cardiovascular disease guided by total risk estimations--challenges and opportunities for practical implementation: highlights of a CardioVascular Clinical Trialists (CVCT) Workshop of the ESC Working Group on CardioVascular Pharmacology and Drug Therapy.

    PubMed

    Zannad, Faiez; Dallongeville, Jean; Macfadyen, Robert J; Ruilope, Luis M; Wilhelmsen, Lars; De Backer, Guy; Graham, Ian; Lorenz, Matthias; Mancia, Giuseppe; Morrow, David A; Reiner, Zeljko; Koenig, Wolfgang

    2012-12-01

    This paper presents a summary of the potential practical and economic barriers to implementation of primary prevention of cardiovascular disease guided by total cardiovascular risk estimations in the general population. It also reviews various possible solutions to overcome these barriers. The report is based on discussion among experts in the area at a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy that took place in September 2009. It includes a review of the evidence in favour of the "treat-to-target" paradigm, as well as potential difficulties with this approach, including the multiple pathological processes present in high-risk patients that may not be adequately addressed by this strategy. The risk-guided therapy approach requires careful definitions of cardiovascular risk and consideration of clinical endpoints as well as the differences between trial and "real-world" populations. Cost-effectiveness presents another issue in scenarios of finite healthcare resources, as does the difficulty of documenting guideline uptake and effectiveness in the primary care setting, where early modification of risk factors may be more beneficial than later attempts to manage established disease. The key to guideline implementation is to improve the quality of risk assessment and demonstrate the association between risk factors, intervention, and reduced event rates. In the future, this may be made possible by means of automated data entry and various other measures. In conclusion, opportunities exist to increase guideline implementation in the primary care setting, with potential benefits for both the general population and healthcare resources.

  9. Cardiovascular Magnetic Resonance in Cardiology Practice: A Concise Guide to Image Acquisition and Clinical Interpretation.

    PubMed

    Valbuena-López, Silvia; Hinojar, Rocío; Puntmann, Valentina O

    2016-02-01

    Cardiovascular magnetic resonance plays an increasingly important role in routine cardiology clinical practice. It is a versatile imaging modality that allows highly accurate, broad and in-depth assessment of cardiac function and structure and provides information on pertinent clinical questions in diseases such as ischemic heart disease, nonischemic cardiomyopathies, and heart failure, as well as allowing unique indications, such as the assessment and quantification of myocardial iron overload or infiltration. Increasing evidence for the role of cardiovascular magnetic resonance, together with the spread of knowledge and skill outside expert centers, has afforded greater access for patients and wider clinical experience. This review provides a snapshot of cardiovascular magnetic resonance in modern clinical practice by linking image acquisition and postprocessing with effective delivery of the clinical meaning. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  10. Improving access and equity in reducing cardiovascular risk: the Queensland Health model.

    PubMed

    Ski, Chantal F; Vale, Margarite J; Bennett, Gary R; Chalmers, Victoria L; McFarlane, Kim; Jelinek, V Michael; Scott, Ian A; Thompson, David R

    2015-02-16

    To measure changes in cardiovascular risk factors among patients with coronary heart disease (CHD) and/or type 2 diabetes enrolled in a centralised statewide coaching program delivered by telephone and mail-out in the public health sector in Queensland. A population-based audit of cardiovascular risk factor data collected prospectively as part of The COACH (Coaching Patients On Achieving Cardiovascular Health) Program (TCP) delivered through Queensland Health's Health Contact Centre. 1962 patients with CHD and 707 patients with type 2 diabetes who completed TCP from 20 February 2009 to 20 June 2013, of whom 145 were Indigenous Australians. Changes in fasting lipids, fasting glucose, glycosylated haemoglobin levels, blood pressure, body weight, body mass index, smoking, alcohol consumption and physical activity, as measured at entry to and completion of the program. Statistically significant improvements in cardiovascular risk factor status, from entry to completion of the program, were found across all biomedical and lifestyle factors in patients with CHD and/or type 2 diabetes. For both diseases, improvements in serum lipids, blood glucose, smoking habit and alcohol consumption combined with increases in physical activity were the most notable findings. Similar differences were found in mean change scores in cardiovascular risk factors between Indigenous and non-Indigenous Queenslanders. A centralised statewide coaching program delivered by telephone and mail-out overcomes obstacles of distance and limited access to health services and facilitates a guideline-concordant decrease in cardiovascular risk.

  11. Tetrahydrobiopterin Improves Endothelial Function in Cardiovascular Disease: A Systematic Review

    PubMed Central

    Wang, Qiongying; Yang, Mina; Xu, Han; Yu, Jing

    2014-01-01

    Background. Tetrahydrobiopterin (BH4) is a cofactor of nitric oxide synthase (NOS). Nitric oxide (NO) bioavailability is reduced during the early stage of vascular diseases, such as coronary artery disease, hypercholesterolemia, hypertension, and diabetic vasculopathy, and even throughout the entire progression of atherosclerosis. Methods. A literature search was performed using electronic databases (up to January 31, 2014), including MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL), using an established strategy. Results. Fourteen articles were selected with a total of 370 patients. Ten of the fourteen studies showed a significant improvement in the endothelial dysfunction of various cardiovascular disease groups with BH4 supplementation compared with the control groups or placebos. Three studies showed no positive outcome, and one study showed that low-dose BH4 had no effect but that high-dose BH4 did have a significantly different result. Conclusions. This review concludes that supplementation with BH4 and/or augmentation of the endogenous levels of BH4 will be a novel approach to improve the endothelial dysfunction observed in various cardiovascular diseases. BH4 might be considered to be a new therapeutic agent to prevent the initiation and progression of cardiovascular disease. PMID:25548592

  12. [Cardiovascular risks differences in women: how can we improve the management?].

    PubMed

    Mounier-Vehier, Claire; Delsart, Pascal; Letombe, Brigitte

    2010-02-01

    Some aspects of cardiovascular risk differ in women; on the whole, this risk is underestimated and insufficiently treated because of lack of knowledge of the problem. According to an INSERM report in 1999, one Frenchwoman in three will die from a cardiovascular disease, while only one in 25 will die of breast cancer. For new generations of women, the protective effect of the estrogen burden may be counterbalanced by the increasing prevalence during the perimenopausal period of metabolic syndrome, particularly harmful in terms of cardiovascular risk. Before oral contraceptives are prescribed, an extremely thorough history must be taken. These should in no case be prescribed for smokers older than 35 years, regardless of how little they smoke. Neither uncomplicated diabetes nor controlled dyslipidemia is a contraindication to hormonal contraception for women. It now seems clear that hormone therapy of menopause does not prevent cardiovascular disease. Nor, however, does it increase the risk if it is administered early, that is, during the first five years of menopause, and accompanied by close monitoring of cardiovascular risk factors and annual reassessment of the benefit-risk balance. The old cliché remains true: the patient at high risk of cardiovascular disease is a man older than 50 years, who smokes and is obese. But men still die more often from cancer than from cardiovascular disease, while the latter is the leading of cause in women, especially after menopause. The symptoms are often misleading and diagnosis is thus frequently delayed. Smoking, lack of exercise, overweight, and stress are all risk factors in women of all ages, and exposure to them can increase as women grow older. These factors should alert the physician and induce earlier screening for cardiovascular disease. In practice, too many women and their physicians underestimate their real risk of cardiovascular accident. It is accordingly essential to develop new campaigns of information and

  13. Oral health and cardiovascular care: Perceptions of people with cardiovascular disease

    PubMed Central

    Salamonson, Yenna; Ajwani, Shilpi; Bhole, Sameer; Bishop, Joshua; Lintern, Karen; Nolan, Samantha; Rajaratnam, Rohan; Redfern, Julie; Sheehan, Maria; Skarligos, Fiona; Spencer, Lissa; Srinivas, Ravi

    2017-01-01

    Main objective The aim of this study was to explore the perception of patients with cardiovascular disease towards oral health and the potential for cardiac care clinicians to promote oral health. Method A needs assessment was undertaken with twelve patients with cardiovascular disease attending cardiac rehabilitation between 2015 and 2016, in three metropolitan hospitals in Sydney, Australia. These patients participated in face-to-face semi-structured interviews. Data was analysed using thematic analysis. Results Results suggested that while oral health was considered relevant there was high prevalence of poor oral health among participants, especially those from socioeconomic disadvantaged background. Awareness regarding the importance of oral health care its impact on cardiovascular outcomes was poor among participants. Oral health issues were rarely discussed in the cardiac setting. Main barriers deterring participants from seeking oral health care included lack of awareness, high cost of dental care and difficulties in accessing the public dental service. Findings also revealed that participants were interested in receiving further information about oral health and suggested various mediums for information delivery. The concept of cardiac care clinicians, especially nurses providing education, assessment and referrals to ongoing dental care was well received by participants who felt the post-acute period was the most appropriate time to receive oral health care advice. The issues of oral health training for non-dental clinicians and how to address existing barriers were highlighted by participants. Relevance to clinical practice The lack of oral health education being provided to patients with cardiovascular disease offers an opportunity to improve care and potentially, outcomes. In view of the evidence linking poor oral health with cardiovascular disease, cardiac care clinicians, especially nurses, should be appropriately trained to promote oral health in

  14. Effectiveness of a tailored intervention to improve cardiovascular risk management in primary care: study protocol for a randomised controlled trial.

    PubMed

    Huntink, Elke; Heijmans, Naomi; Wensing, Michel; van Lieshout, Jan

    2013-12-17

    Cardiovascular disease (CVD) is an important worldwide cause of mortality. In The Netherlands, CVD is the leading cause of death for women and the second cause of death for men. Recommendations for diagnosis and treatment of CVD are not well implemented in primary care. In this study, we aim to examine the effectiveness of a tailored implementation program targeted at practice nurses to improve healthcare for patients with (high risk for) CVD. A two-arm cluster randomized trial is planned. We offer practice nurses a tailored program to improve adherence to six specific recommendations related to blood pressure and cholesterol target values, risk profiling and lifestyle advice. Practice nurses are offered training and feedback on their motivational interviewing technique and an e-learning program on cardiovascular risk management (CVRM). They are also advised to screen for the presence and severity of depressive symptoms in patients. We also advise practice nurses to use selected E-health options (selected websites and Twitter-consult) in patients without symptoms of depression. Patients with mild depressive symptoms are referred to a physical exercise group. We recommend referring patients with major depressive symptoms for assessment and treatment of depressive symptoms if appropriate before starting CVRM. Data from 900 patients at high risk of CVD or with established CVD will be collected in 30 general practices in several geographical areas in The Netherlands. The primary outcome measure is performance of practice nurses in CVRM and reflects application of recommendations for personalized counselling and education of CVRM patients. Patients' health-related lifestyles (physical exercise, diet and smoking status) will be measured with validated questionnaires and medical record audit will be performed to document estimated CVD risk. Additionally, we will survey and interview participating healthcare professionals for exploration of processes of change. The control

  15. Interplay between statins and PPARs in improving cardiovascular outcomes: a double-edged sword?

    PubMed Central

    Balakumar, Pitchai; Mahadevan, Nanjaian

    2012-01-01

    Statins are best-selling medications in the management of high cholesterol and associated cardiovascular complications. They inhibit 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA)-reductase in order to prevent disproportionate cholesterol synthesis. Statins slow the progression of atherosclerosis, prevent the secondary cardiovascular events and improve the cardiovascular outcomes in patients with elevated cholesterol levels. The underlying mechanisms pertaining to the cardioprotective role of statins are linked with numerous pleiotropic actions including inhibition of inflammatory events and improvement of endothelial function, besides an effective cholesterol-lowering ability. Intriguingly, recent studies suggest possible interplay between statins and nuclear transcription factors like PPARs, which should also be taken into consideration while analysing the potential of statins in the management of cardiovascular complications. It could be suggested that statins have two major roles: (i) a well-established cholesterol-lowering effect through inhibition of HMG-CoA-reductase; (ii) a newly explored PPAR-activating property, which could mediate most of cardiovascular protective pleiotropic effects of statins including anti-inflammatory, antioxidant and anti-fibrotic properties. The present review addressed the underlying principles pertaining to the modulatory role of statins on PPARs. PMID:21790534

  16. Differences in Lifestyle Improvements With the Intention to Prevent Cardiovascular Diseases by Socioeconomic Status in a Representative Japanese Population: NIPPON DATA2010.

    PubMed

    Goryoda, Sayuri; Nishi, Nobuo; Hozawa, Atsushi; Yoshita, Katsushi; Arai, Yusuke; Kondo, Keiko; Miyagawa, Naoko; Hayakawa, Takehito; Fujiyoshi, Akira; Kadota, Aya; Ohkubo, Takayoshi; Okamura, Tomonori; Okuda, Nagako; Ueshima, Hirotsugu; Okayama, Akira; Miura, Katsuyuki

    2018-01-01

    The relationships among socioeconomic status and lifestyle improvements have not yet been examined in a representative Japanese population. We analyzed data from 2,647 participants (1,087 men and 1,560 women) who participated in NIPPON DATA2010. This survey inquired about lifestyle improvements and socioeconomic status. Education was categorized as low (≤9 years), middle (10-12 years), and high (≥13 years). Marital status was categorized as married, divorced, widowed, and never married/other. A multivariable logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of lifestyle improvements with the intention of preventing cardiovascular diseases for educational attainment and marital status, with adjustments for age and awareness of cardiovascular disease risk factors. Overall, 1,507 (56.9%) participants practiced prevention and improvements in hypertension, diabetes, elevated cholesterol, and metabolic syndrome, and the OR of lifestyle improvements was significantly higher with a high education than with a low education in men (OR 2.86; 95% CI, 1.96-4.17) and women (OR 2.36; 95% CI, 1.67-3.33). The number of participants who practiced prevention and improvements in hypertension, diabetes, elevated cholesterol, and metabolic syndrome was significantly lower in divorced than in married men (OR 0.46; 95% CI, 0.22-0.95) and women (OR 0.53; 95% CI, 0.33-0.86). Specific differences caused by educational attainment and marital status may exist in lifestyle improvements.

  17. [Practical guidelines for genetic testing in cardiovascular diseases].

    PubMed

    Reinhard, W; Trenkwalder, T; Schunkert, H

    2017-08-01

    In the last decade, genetic testing for cardiovascular disorders has become more and more relevant. Progress in molecular genetics has led to new opportunities for diagnostics, improved risk prediction and could lead to novel therapeutic approaches. Genetic diagnostic testing is relevant for both confirming a diagnosis as well as deciding on therapeutic consequences, if applicable. Furthermore, predictive testing in family members for specific cardiovascular diseases is now a standard procedure in holistic patient management. The process of genetic testing as well as documentation requirements and discussion of test results with patients are subject to legal regulations. These regulations might be confusing for clinical practitioners/cardiologists. The aim of this article is to provide a clinical framework for genetic testing. First, we explain the legal and ethical background. Second, we illustrate the process of genetic testing step by step and present updates on remuneration. Finally, we discuss the significance of genetic testing and specific disease indications in cardiology.

  18. Automated electronic reminders to facilitate primary cardiovascular disease prevention: randomised controlled trial

    PubMed Central

    Holt, Tim A; Thorogood, Margaret; Griffiths, Frances; Munday, Stephen; Friede, Tim; Stables, David

    2010-01-01

    Background Primary care databases contain cardiovascular disease risk factor data, but practical tools are required to improve identification of at-risk patients. Aim To test the effects of a system of electronic reminders (the ‘e-Nudge’) on cardiovascular events and the adequacy of data for cardiovascular risk estimation. Design of study Randomised controlled trial. Setting Nineteen general practices in the West Midlands, UK. Method The e-Nudge identifies four groups of patients aged over 50 years on the basis of estimated cardiovascular risk and adequacy of risk factor data in general practice computers. Screen messages highlight individuals at raised risk and prompt users to complete risk profiles where necessary. The proportion of the study population in the four groups was measured, as well as the rate of cardiovascular events in each arm after 2 years. Results Over 38 000 patients' electronic records were randomised. The intervention led to an increase in the proportion of patients with sufficient data who were identifiably at risk, with a difference of 1.94% compared to the control group (95% confidence interval [CI] = 1.38 to 2.50, P<0.001). A corresponding reduction occurred in the proportion potentially at risk but requiring further data for a risk estimation (difference = –3.68%, 95% CI = –4.53 to –2.84, P<0.001). No significant difference was observed in the incidence of cardiovascular events (rate ratio = 0.96, 95% CI = 0.85 to 1.10, P = 0.59). Conclusion Automated electronic reminders using routinely collected primary care data can improve the adequacy of cardiovascular risk factor information during everyday practice and increase the visibility of the at-risk population. PMID:20353659

  19. “More than I Expected”: Perceived Benefits of Yoga Practice among Older Adults at Risk for Cardiovascular Disease

    PubMed Central

    Alexander, Gina K.; Innes, Kim E.; Selfe, Terry K.; Brown, Cynthia J.

    2012-01-01

    Objective This study was conducted with participants from trials examining the effects of an Iyengar yoga program on cardiovascular disease risk. The objective of the current study was to evaluate the perceived benefits of yoga in a population of older, predominantly overweight adults participating in a gentle 8-week yoga program. Design This study used a constructivist-interpretive approach to naturalistic inquiry. Setting A total of 42 participants completed the intervention and met the inclusion criteria for the current qualitative study. Intervention The 8-week Iyengar yoga program included two 90-minute yoga classes and five 30-minute home sessions per week. Participants completed weekly logs and an exit questionnaire at the end of the study. Main Outcome Measures Qualitative data from weekly logs and exit questionnaires were compiled and conventional content analysis performed with the use of ATLAS.ti to facilitate the process. Results Four broad themes emerged from content analysis: Practicing yoga improved overall physical function and capacity (for 83% of participants); practicing yoga reduced stress/anxiety and enhanced calmness (83% of participants); practicing yoga enriched the quality of sleep (21% of participants); and practicing yoga supported efforts toward dietary improvements (14% of participants). Conclusions These results suggest that yoga may have ancillary benefits in terms of improved physical function, enhanced mental/emotional state, enriched sleep quality, and improved lifestyle choices, and may be useful as a health promotion strategy in the prevention and management of chronic disease. PMID:23374201

  20. Perceived determinants of cardiovascular risk management in primary care: disconnections between patient behaviours, practice organisation and healthcare system.

    PubMed

    Huntink, E; Wensing, M; Klomp, M A; van Lieshout, J

    2015-12-15

    Although conditions for high quality cardiovascular risk management in primary care in the Netherlands are favourable, there still remains a gap between practice guideline recommendations and practice. The aim of the current study was to identify determinants of cardiovascular primary care in the Netherlands. We performed a qualitative study, using semi-structured interviews with healthcare professionals and patients with established cardiovascular diseases or at high cardiovascular risk. A framework analysis was used to cluster the determinants into seven domains: 1) guideline factors, 2) individual healthcare professional factors, 3) patient factors, 4) professional interaction, 5) incentives and recourses, 6) mandate, authority and accountability, and 7) social, political and legal factors. Twelve healthcare professionals and 16 patients were interviewed. Healthcare professionals and patients mentioned a variety of factors concerning all seven domains. Determinants of practice according to the health care professionals were related to communication between healthcare professionals, patients' lack of knowledge and self-management, time management, market mechanisms in the Dutch healthcare system and motivational interviewing skills of healthcare professionals. Patients mentioned determinants related to their knowledge of risk factors for cardiovascular diseases, medication adherence and self-management as key determinants. A key finding is the mismatch between healthcare professionals' and patients' views on patient's knowledge and self-management. Perceived determinants of cardiovascular risk management were mainly related to patient behaviors and (but only for health professionals) to the healthcare system. Though health care professionals and patients agree upon the importance of patients' knowledge and self-management, their judgment of the current state of knowledge and self-management is entirely different.

  1. Identifying individuals for primary cardiovascular disease prevention in UK general practice: priorities and resource implications

    PubMed Central

    Holt, Tim A; Thorogood, Margaret; Griffiths, Frances; Munday, Stephen; Stables, David

    2008-01-01

    Targeted cardiovascular disease prevention relies on risk-factor information held in primary care records. A risk algorithm, the ‘e-Nudge’, was applied to data from a population of ≥50-year-olds in 19 West Midlands practices, to identify those individuals at risk of cardiovascular disease. Altogether, 5.9% were identified aged 50–74 years at ≥20% 10-year risk based on existing data, and a further 26.4% were potentially at risk but had missing risk-factor information; 9.2% of patients aged over 50 years with established cardiovascular disease had at least one modifiable risk factor outside the audit target of the Quality and Outcomes Framework. Implications for resource allocation are discussed. PMID:18611316

  2. Plant-based diets and cardiovascular health.

    PubMed

    Satija, Ambika; Hu, Frank B

    2018-02-13

    Plant-based diets, defined in terms of low frequency of animal food consumption, have been increasingly recommended for their health benefits. Numerous studies have found plant-based diets, especially when rich in high quality plant foods such as whole grains, fruits, vegetables, and nuts, to be associated with lower risk of cardiovascular outcomes and intermediate risk factors. This review summarizes the current evidence base examining the associations of plant-based diets with cardiovascular endpoints, and discusses the potential biological mechanisms underlying their health effects, practical recommendations and applications of this research, and directions for future research. Healthful plant-based diets should be recommended as an environmentally sustainable dietary option for improved cardiovascular health. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Cardiovascular news 2013/2014.

    PubMed

    Cuende, J I; Lahoz, C; Armario, P; García-Alegría, J; Ena, J; García de Casasola, G; Mostaza, J M

    2015-01-01

    During 2013 and the first months of 2014, numerous studies have been published in the cardiovascular field. New guidelines have appeared for managing arterial hypertension and reducing cardiovascular risk by lowering cholesterol levels. New data have emerged on the considerable lipid-lowering efficacy of monoclonal antibodies against PCSK-9, in contrast, however, to the clinical trials directed towards raising HDL-cholesterol with nicotinic acid, which have not shown a reduction in the rate of cardiovascular complications. In the field of hypertension, neither stent placement in patients with renovascular hypertension nor sympathetic denervation in patients with resistant hypertension has been shown to be effective in reducing blood pressure. In terms of antithrombotic treatment, the pharmacogenetic tests do not seem useful for maintaining patients anticoagulated with warfarin within the therapeutic range for longer periods. Moreover, there is increasing evidence that, for patients with coronary artery disease and atrial fibrillation, antiplatelet therapy adds no benefit to anticoagulation therapy and is associated with a greater risk of bleeding. Lastly, a Mediterranean diet could prevent the onset of diabetes, while bariatric surgery could be a reasonable option for improving the disease in patients with obesity. Many of these studies have immediate practice applications in daily clinical practice. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  4. [Secondary cardiovascular prevention after acute coronary syndrome in clinical practice].

    PubMed

    Colivicchi, Furio; Di Roma, Angelo; Uguccioni, Massimo; Scotti, Emilio; Ammirati, Fabrizio; Arcas, Marcello; Avallone, Aniello; Bonaccorso, Orazio; Germanò, Giuseppe; Letizia, Claudio; Manfellotto, Dario; Minardi, Giovanni; Pristipino, Christian; D'Amore, Francesco; Di Veroli, Claudio; Fierro, Aldo; Pastorellio, Ruggero; Tozzi, Quinto; Tubaro, Marco; Santini, Massimo; Angelico, Francesco; Azzolini, Paolo; Bellasi, Antonio; Brocco, Paola; Calò, Leonardo; Cerquetani, Elena; De Biase, Luciano; Di Napoli, Mauro; Galati, Alfonso; Gallieni, Maurizio; Jesi, Anna Patrizia; Lombardo, Antonella; Loricchio, Vincenzo; Menghini, Fabio; Mezzanotte, Roberto; Minutolos, Roberto; Mocini, David; Patti, Giuseppe; Patrizi, Roberto; Pajes, Giuseppe; Pulignano, Giovanni; Ricci, Renato Pietro; Ricci, Roberto; Sardella, Gennaro; Strano, Stefano; Terracina, David; Testa, Marco; Tomai, Fabrizio; Volpes, Roberto; Volterrani, Maurizio

    2010-05-01

    Secondary prevention after acute coronary syndromes should be aimed at reducing the risk of further adverse cardiovascular events, thereby improving quality of life, and lengthening survival. Despite compelling evidence from large randomized controlled trials, secondary prevention is not fully implemented in most cases after hospitalization for acute coronary syndrome. The Lazio Region (Italy) has about 5.3 million inhabitants (9% of the entire Italian population). Every year about 11 000 patients are admitted for acute coronary syndrome in hospitals of the Lazio Region. Most of these patients receive state-of-the art acute medical and interventional care during hospitalization. However, observational data suggest that after discharge acute coronary syndrome patients are neither properly followed nor receive all evidence-based treatments. This consensus document has been developed by 11 Scientific Societies of Cardiovascular and Internal Medicine in order develop a sustainable and effective clinical approach for secondary cardiovascular prevention after acute coronary syndrome in the local scenario of the Lazio Region. An evidence-based simplified decalogue for secondary cardiovascular prevention is proposed as the cornerstone of clinical intervention, taking into account regional laws and relative shortage of resources. The following appropriate interventions should be consistently applied: smoking cessation, blood pressure control (blood pressure < 130/80 mmHg), optimal lipid management (LDL cholesterol < 80 mmHg), weight and diabetes management, promotion of physical activity and rehabilitation, correct use of antiplatelet agents, beta-blockers, renin-angiotensin-aldosterone system blockers.

  5. Improving long-term prediction of first cardiovascular event: the contribution of family history of coronary heart disease and social status.

    PubMed

    Veronesi, G; Gianfagna, F; Giampaoli, S; Chambless, L E; Mancia, G; Cesana, G; Ferrario, M M

    2014-07-01

    The aim of this study is to assess whether family history of coronary heart disease (CHD) and education as proxy of social status improve long-term cardiovascular disease risk prediction in a low-incidence European population. The 20-year risk of first coronary or ischemic stroke events was estimated using sex-specific Cox models in 3956 participants of three population-based surveys in northern Italy, aged 35-69 years and free of cardiovascular disease at enrollment. The additional contribution of education and positive family history of CHD was defined as change in discrimination and Net Reclassification Improvement (NRI) over the model including 7 traditional risk factors. Kaplan-Meier 20-year risk was 16.8% in men (254 events) and 6.4% in women (102 events). Low education (hazard ratio=1.35, 95%CI 0.98-1.85) and family history of CHD (1.55; 1.19-2.03) were associated with the endpoint in men, but not in women. In men, the addition of education and family history significantly improved discrimination by 1%; NRI was 6% (95%CI: 0.2%-15.2%), raising to 20% (0.5%-44%) in those at intermediate risk. NRI in women at intermediate risk was 7%. In low-incidence populations, family history of CHD and education, easily assessed in clinical practice, should be included in long-term cardiovascular disease risk scores, at least in men. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Selected Activities to Improve Cardiovascular Endurance and Strength and Muscular Endurance; K-3.

    ERIC Educational Resources Information Center

    Schmidt, Sharon

    Activities to help the young child improve his/her physical fitness are difficult to find because of insufficient research supporting the effectiveness of proposed activities. However, several activities are assumed to improve the fitness of various areas of the body while concurrently improving cardiovascular endurance by increasing the heart…

  7. Improving clinical trials for cardiovascular diseases: a position paper from the Cardiovascular Round Table of the European Society of Cardiology.

    PubMed

    Jackson, Neville; Atar, Dan; Borentain, Maria; Breithardt, Günter; van Eickels, Martin; Endres, Matthias; Fraass, Uwe; Friede, Tim; Hannachi, Hakima; Janmohamed, Salim; Kreuzer, Jörg; Landray, Martin; Lautsch, Dominik; Le Floch, Chantal; Mol, Peter; Naci, Huseyin; Samani, Nilesh J; Svensson, Anders; Thorstensen, Cathrine; Tijssen, Jan; Vandzhura, Victoria; Zalewski, Andrew; Kirchhof, Paulus

    2016-03-01

    Cardiovascular disease is the most common cause of mortality and morbidity in the world, but the pharmaceutical industry's willingness to invest in this field has declined because of the many challenges involved with bringing new cardiovascular drugs to market, including late-stage failures, escalating regulatory requirements, bureaucracy of the clinical trial business enterprise, and limited patient access after approval. This contrasts with the remaining burden of cardiovascular disease in Europe and in the world. Thus, clinical cardiovascular research needs to adapt to address the impact of these challenges in order to ensure development of new cardiovascular medicines. The present paper is the outcome of a two-day workshop held by the Cardiovascular Round Table of the European Society of Cardiology. We propose strategies to improve development of effective new cardiovascular therapies. These can include (i) the use of biomarkers to describe patients who will benefit from new therapies more precisely, achieving better human target validation; (ii) targeted, mechanism-based approaches to drug development for defined populations; (iii) the use of information technology to simplify data collection and follow-up in clinical trials; (iv) streamlining adverse event collection and reducing monitoring; (v) extended patent protection or limited rapid approval of new agents to motivate investment in early phase development; and (vi) collecting data needed for health technology assessment continuously throughout the drug development process (before and after approval) to minimize delays in patient access. Collaboration across industry, academia, regulators, and payers will be necessary to enact change and to unlock the existing potential for cardiovascular clinical drug development. A coordinated effort involving academia, regulators, industry, and payors will help to foster better and more effective conduct of clinical cardiovascular trials, supporting earlier

  8. Pulmonary rehabilitation improves cardiovascular response to exercise in COPD.

    PubMed

    Ramponi, Sara; Tzani, Panagiota; Aiello, Marina; Marangio, Emilio; Clini, Enrico; Chetta, Alfredo

    2013-01-01

    Pulmonary rehabilitation (PR) has emerged as a recommended standard of care in symptomatic COPD. We now studied whether PR may affect cardiovascular response to exercise in these patients. Twenty-seven patients (9 females aged 69 ± 8 years) with moderate-to-severe airflow obstruction admitted to a 9-week PR course performed a pre-to-post evaluation of lung function test and symptom-limited cardiopulmonary exercise test (CPET). Oxygen uptake (VO2), tidal volume (V(T)), dyspnea and leg fatigue scores were measured during CPET. Cardiovas-cular response was assessed by means of oxygen pulse (O2Pulse), the oxygen uptake efficiency slope and heart rate recovery at the 1st min. A significant increase in peak VO2 and in all cardiovascular parameters (p < 0.05) was found following PR when compared to baseline. Leg fatigue (p < 0.05), but not dyspnea, was significantly reduced after PR. When assessed at metabolic and ventilatory iso levels [% VCO2max and % minute ventilation (VEmax)], O2Pulse and V(T) were significantly higher (p < 0.05) at submaximal exercise (75 and 50% of VCO2max and VEmax) after PR when compared to baseline. V(T) percent changes at 75% VCO2max and 75% VEmax after PR significantly correlated with corresponding changes in O2Pulse (p < 0.01). In COPD patients, a PR training program improved the cardiovascular response during exercise at submaximal exercise independent of the external workload. This change was associated with an enhanced ventilatory function during exercise. Copyright © 2013 S. Karger AG, Basel.

  9. How can we improve our understanding of cardiovascular safety liabilities to develop safer medicines?

    PubMed Central

    Laverty, HG; Benson, C; Cartwright, EJ; Cross, MJ; Garland, C; Hammond, T; Holloway, C; McMahon, N; Milligan, J; Park, BK; Pirmohamed, M; Pollard, C; Radford, J; Roome, N; Sager, P; Singh, S; Suter, T; Suter, W; Trafford, A; Volders, PGA; Wallis, R; Weaver, R; York, M; Valentin, JP

    2011-01-01

    Given that cardiovascular safety liabilities remain a major cause of drug attrition during preclinical and clinical development, adverse drug reactions, and post-approval withdrawal of medicines, the Medical Research Council Centre for Drug Safety Science hosted a workshop to discuss current challenges in determining, understanding and addressing ‘Cardiovascular Toxicity of Medicines’. This article summarizes the key discussions from the workshop that aimed to address three major questions: (i) what are the key cardiovascular safety liabilities in drug discovery, drug development and clinical practice? (ii) how good are preclinical and clinical strategies for detecting cardiovascular liabilities? and (iii) do we have a mechanistic understanding of these liabilities? It was concluded that in order to understand, address and ultimately reduce cardiovascular safety liabilities of new therapeutic agents there is an urgent need to: Fully characterize the incidence, prevalence and impact of drug-induced cardiovascular issues at all stages of the drug development process. Ascertain the predictive value of existing non-clinical models and assays towards the clinical outcome. Understand the mechanistic basis of cardiovascular liabilities; by addressing areas where it is currently not possible to predict clinical outcome based on preclinical safety data. Provide scientists in all disciplines with additional skills to enable them to better integrate preclinical and clinical data and to better understand the biological and clinical significance of observed changes. Develop more appropriate, highly relevant and predictive tools and assays to identify and wherever feasible to eliminate cardiovascular safety liabilities from molecules and wherever appropriate to develop clinically relevant and reliable safety biomarkers. PMID:21306581

  10. Cardiovascular risk factors burden in Saudi Arabia: The Africa Middle East Cardiovascular Epidemiological (ACE) study.

    PubMed

    Ahmed, Amjad M; Hersi, Ahmad; Mashhoud, Walid; Arafah, Mohammed R; Abreu, Paula C; Al Rowaily, Mohammed Abdullah; Al-Mallah, Mouaz H

    2017-10-01

    Limited data exist on the epidemiology of cardiovascular risk factors in Saudi Arabia, particularly in relation to the differences between Saudi nationals and expatriates in Saudi Arabia. The aim of this analysis was to describe the current prevalence of cardiovascular risk factors among patients attending general practice clinics across Saudi Arabia. In this cross-sectional epidemiological analysis of the Africa Middle East Cardiovascular Epidemiological (ACE) study, the prevalence of cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity, smoking, abdominal obesity) was evaluated in adults attending primary care clinics in Saudi Arabia. Group comparisons were made between patients of Saudi ethnicity (SA nationals) and patients who were not of Saudi ethnicity (expatriates). A total of 550 participants were enrolled from different clinics across Saudi Arabia [aged (mean ± standard deviation) 43 ± 11 years; 71% male]. Nearly half of the study cohort (49.8%) had more than three cardiovascular risk factors. Dyslipidemia was the most prevalent risk factor (68.6%). The prevalence of hypertension (47.5%) and dyslipidemia (75.5%) was higher among expatriates when compared with SA nationals (31.4% vs. 55.1%, p  = 0.0003 vs. p  < 0.0001, respectively). Conversely, obesity (52.6% vs. 41.0%; p  = 0.008) and abdominal obesity (65.5% vs. 52.2%; p  = 0.0028) were higher among SA nationals vs. expatriates. Modifiable cardiovascular risk factors are highly prevalent in SA nationals and expatriates. Programmed community-based screening is needed for all cardiovascular risk factors in Saudi Arabia. Improving primary care services to focus on risk factor control may ultimately decrease the incidence of coronary artery disease and improve overall quality of life. The ACE trial is registered under NCT01243138.

  11. Impact of a Population Health Management Intervention on Disparities in Cardiovascular Disease Control.

    PubMed

    James, Aisha; Berkowitz, Seth A; Ashburner, Jeffrey M; Chang, Yuchiao; Horn, Daniel M; O'Keefe, Sandra M; Atlas, Steven J

    2018-04-01

    Healthcare systems use population health management programs to improve the quality of cardiovascular disease care. Adding a dedicated population health coordinator (PHC) who identifies and reaches out to patients not meeting cardiovascular care goals to these programs may help reduce disparities in cardiovascular care. To determine whether a program that used PHCs decreased racial/ethnic disparities in LDL cholesterol and blood pressure (BP) control. Retrospective difference-in-difference analysis. Twelve thousdand five hundred fifty-five primary care patients with cardiovascular disease (cohort for LDL analysis) and 41,183 with hypertension (cohort for BP analysis). From July 1, 2014-December 31, 2014, 18 practices used an information technology (IT) system to identify patients not meeting LDL and BP goals; 8 practices also received a PHC. We examined whether having the PHC plus IT system, compared with having the IT system alone, decreased racial/ethnic disparities, using difference-in-difference analysis of data collected before and after program implementation. Meeting guideline concordant LDL and BP goals. At baseline, there were racial/ethnic disparities in meeting LDL (p = 0.007) and BP (p = 0.0003) goals. Comparing practices with and without a PHC, and accounting for pre-intervention LDL control, non-Hispanic white patients in PHC practices had improved odds of LDL control (OR 1.20 95% CI 1.09-1.32) compared with those in non-PHC practices. Non-Hispanic black (OR 1.15 95% CI 0.80-1.65) and Hispanic (OR 1.29 95% CI 0.66-2.53) patients saw similar, but non-significant, improvements in LDL control. For BP control, non-Hispanic white patients in PHC practices (versus non-PHC) improved (OR 1.13 95% CI 1.05-1.22). Non-Hispanic black patients (OR 1.17 95% CI 0.94-1.45) saw similar, but non-statistically significant, improvements in BP control, but Hispanic (OR 0.90 95% CI 0.59-1.36) patients did not. Interaction testing confirmed that disparities did not

  12. When practice transformation impedes practice improvement.

    PubMed

    Bujold, Edward

    2015-01-01

    I lead a small practice in rural western North Carolina. We have embraced the patient-centered medical home model and other practice-improvement initiatives, and I have seen our practice transformed in many positive ways. But in the past year alone, my staff and I have spent hundreds of hours studying for and taking exams, certifying for numerous programs, and updating our electronic health records system (EHR) to meet new national requirements and then relearning our EHR. Seeing patients used to be the hardest part of my job. It is now the easiest by far. I am considering walking away from the time-intensive PCMH certification even though it would cause financial hardship. We have more important business at hand-taking excellent care of patients, improving our practice, and meaningfully engaging with our patients. © 2015 Annals of Family Medicine, Inc.

  13. Practice Guidelines for Cardiovascular Fitness and Strengthening Exercise Prescription After Burn Injury.

    PubMed

    Nedelec, Bernadette; Parry, Ingrid; Acharya, Hernish; Benavides, Lynne; Bills, Sara; Bucher, Janelle L; Cheal, Joanne; Chouinard, Annick; Crump, Donna; Duch, Sarah; Godleski, Matthew; Guenther, Jennifer; Knox, Catherine; LaBonte, Eric; Lorello, David; Lucio, J Xavier; Macdonald, Lori E; Kemp-Offenberg, Jennifer; Osborne, Candice; Pontius, Kara; Yelvington, Miranda; de Oliveira, Ana; Kloda, Lorie A

    The objective of this review was to systematically evaluate the available clinical evidence for the prescription of strength training and cardiovascular endurance exercise programs for pediatric and adult burn survivors so that practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. Summary recommendations were made after the literature was retrieved by systematic review, was critically appraised by multiple authors and the level of evidence determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Although gaps in the literature persist and should be addressed in future research projects, currently, strong research evidence supports the prescription of strength training and aerobic conditioning exercise programs for both adult and pediatric burn survivors when in the presence of strength limitations and/or decreased cardiovascular endurance after evaluation.

  14. The effect of sibutramine prescribing in routine clinical practice on cardiovascular outcomes: a cohort study in the United Kingdom.

    PubMed

    Hayes, J F; Bhaskaran, K; Batterham, R; Smeeth, L; Douglas, I

    2015-09-01

    The marketing authorization for the weight loss drug sibutramine was suspended in 2010 following a major trial that showed increased rates of non-fatal myocardial infarction and cerebrovascular events in patients with pre-existing cardiovascular disease. In routine clinical practice, sibutramine was already contraindicated in patients with cardiovascular disease and so the relevance of these influential clinical trial findings to the 'real World' population of patients receiving or eligible for the drug is questionable. We assessed rates of myocardial infarction and cerebrovascular events in a cohort of patients prescribed sibutramine or orlistat in the United Kingdom. A cohort of patients prescribed weight loss medication was identified within the Clinical Practice Research Datalink. Rates of myocardial infarction or cerebrovascular event, and all-cause mortality were compared between patients prescribed sibutramine and similar patients prescribed orlistat, using both a multivariable Cox proportional hazard model, and propensity score-adjusted model. Possible effect modification by pre-existing cardiovascular disease and cardiovascular risk factors was assessed. Patients prescribed sibutramine (N=23,927) appeared to have an elevated rate of myocardial infarction or cerebrovascular events compared with those taking orlistat (N=77,047; hazard ratio 1.69, 95% confidence interval 1.12-2.56). However, subgroup analysis showed the elevated rate was larger in those with pre-existing cardiovascular disease (hazard ratio 4.37, 95% confidence interval 2.21-8.64), compared with those with no cardiovascular disease (hazard ratio 1.52, 95% confidence interval 0.92-2.48, P-interaction=0.0076). All-cause mortality was not increased in those prescribed sibutramine (hazard ratio 0.67, 95% confidence interval 0.34-1.32). Sibutramine was associated with increased rates of acute cardiovascular events in people with pre-existing cardiovascular disease, but there was a low absolute

  15. Improving Medication Adherence in Cardiometabolic Disease: Practical and Regulatory Implications.

    PubMed

    Ferdinand, Keith C; Senatore, Fortunato Fred; Clayton-Jeter, Helene; Cryer, Dennis R; Lewin, John C; Nasser, Samar A; Fiuzat, Mona; Califf, Robert M

    2017-01-31

    Medication nonadherence, a major problem in cardiovascular disease (CVD), contributes yearly to approximately 125,000 preventable deaths, which is partly attributable to only about one-half of CVD patients consistently taking prescribed life-saving medications. Current interest has focused on how labeling and education influence adherence. This paper summarizes the scope of CVD nonadherence, describes key U.S. Food and Drug Administration initiatives, and identifies potential targets for improvement. We describe key adherence factors, methods, and technological applications for simplifying regimens and enhancing adherence, and 4 areas where additional collaborative research and implementation involving the regulatory system and clinical community could substantially reduce nonadherence: 1) identifying monitoring methods; 2) improving the evidence base to better understand adherence; 3) developing patient/health provider team-based engagement strategies; and 4) alleviating health disparities. Alignment of U.S. Food and Drug Administration approaches to dissemination of information about appropriate use with clinical practice could improve adherence, and thereby reduce CVD death and disability. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  16. Development of the Champlain primary care cardiovascular disease prevention and management guideline

    PubMed Central

    Montoya, Lorraine; Liddy, Clare; Hogg, William; Papadakis, Sophia; Dojeiji, Laurie; Russell, Grant; Akbari, Ayub; Pipe, Andrew; Higginson, Lyall

    2011-01-01

    Abstract Problem addressed A well documented gap remains between evidence and practice for clinical practice guidelines in cardiovascular disease (CVD) care. Objective of program As part of the Champlain CVD Prevention Strategy, practitioners in the Champlain District of Ontario launched a large quality-improvement initiative that focused on increasing the uptake in primary care practice settings of clinical guidelines for heart disease, stroke, diabetes, and CVD risk factors. Program description The Champlain Primary Care CVD Prevention and Management Guideline is a desktop resource for primary care clinicians working in the Champlain District. The guideline was developed by more than 45 local experts to summarize the latest evidence-based strategies for CVD prevention and management, as well as to increase awareness of local community-based programs and services. Conclusion Evidence suggests that tailored strategies are important when implementing specific practice guidelines. This article describes the process of creating an integrated clinical guideline for improvement in the delivery of cardiovascular care. PMID:21673196

  17. Improvement of Processing Speed in Executive Function Immediately following an Increase in Cardiovascular Activity.

    PubMed

    Tam, Nicoladie D

    2013-01-01

    This study aims to identify the acute effects of physical exercise on specific cognitive functions immediately following an increase in cardiovascular activity. Stair-climbing exercise is used to increase the cardiovascular output of human subjects. The color-naming Stroop Test was used to identify the cognitive improvements in executive function with respect to processing speed and error rate. The study compared the Stroop results before and immediately after exercise and before and after nonexercise, as a control. The results show that there is a significant increase in processing speed and a reduction in errors immediately after less than 30 min of aerobic exercise. The improvements are greater for the incongruent than for the congruent color tests. This suggests that physical exercise induces a better performance in a task that requires resolving conflict (or interference) than a task that does not. There is no significant improvement for the nonexercise control trials. This demonstrates that an increase in cardiovascular activity has significant acute effects on improving the executive function that requires conflict resolution (for the incongruent color tests) immediately following aerobic exercise more than similar executive functions that do not require conflict resolution or involve the attention-inhibition process (for the congruent color tests).

  18. Reducing indoor air pollution by air conditioning is associated with improvements in cardiovascular health among the general population.

    PubMed

    Lin, Lian-Yu; Chuang, Hsiao-Chi; Liu, I-Jung; Chen, Hua-Wei; Chuang, Kai-Jen

    2013-10-01

    Indoor air pollution is associated with cardiovascular effects, however, little is known about the effects of improving indoor air quality on cardiovascular health. The aim of this study was to explore whether improving indoor air quality through air conditioning can improve cardiovascular health in human subjects. We recruited a panel of 300 healthy subjects from Taipei, aged 20 and over, to participate in six home visits each, to measure a variety of cardiovascular endpoints, including high sensitivity-C-reactive protein (hs-CRP), 8-hydroxy-2'-deoxyguanosine (8-OHdG), fibrinogen in plasma and heart rate variability (HRV). Indoor particles and total volatile organic compounds (VOCs) were measured simultaneously at the participant's home during each visit. Three exposure conditions were investigated in this study: participants were requested to keep their windows open during the first two visits, close their windows during the next two visits, and close the windows and turn on their air conditioners during the last two visits. We used linear mixed-effects models to associate the cardiovascular endpoints with individual indoor air pollutants. The results showed that increases in hs-CRP, 8-OHdG and fibrinogen, and decreases in HRV indices were associated with increased levels of indoor particles and total VOCs in single-pollutant and two-pollutant models. The effects of indoor particles and total VOCs on cardiovascular endpoints were greatest during visits with the windows open. During visits with the air conditioners turned on, no significant changes in cardiovascular endpoints were observed. In conclusion, indoor air pollution is associated with inflammation, oxidative stress, blood coagulation and autonomic dysfunction. Reductions in indoor air pollution and subsequent improvements in cardiovascular health can be achieved by closing windows and turning on air conditioners at home. Copyright © 2013 Elsevier B.V. All rights reserved.

  19. Themes in the literature related to cardiovascular disease risk reduction.

    PubMed

    Cohen, Shannon Munro; Kataoka-Yahiro, Merle

    2009-01-01

    This article aimed to identify themes in the literature related to patient-healthcare provider beliefs, barriers to adherence, and interventions pertaining to cardiovascular disease risk reduction. Twenty quantitative and qualitative primary research studies including 2 meta-analyses published between 1995 and 2008 were analyzed for themes and practice implications to synthesize existing research on cardiovascular disease risk reduction. Databases searched included EBSCO, CINAHL, MEDLINE, ScienceDirect, HealthSource, and PsychLit using the search terms patient- provider adherence, adherence and shared decision making, adherence and decision support, patient- provider goal setting, and cardiovascular disease risk reduction. The emergent themes found in this literature review included (1) complex medication regimens; (2) risk perception, quality of life, and competing priorities; (3) motivation for change; (4) provider clinical inertia; and (5) goal setting, feedback, and reminders. Studies reporting the highest rates of adherence to cardiovascular disease risk reduction recommendations incorporated patient-provider goal setting and decision support, self-management techniques, and personalized printed communication. Goal setting in cardiovascular disease risk reduction is a relatively unexplored area and is an important component of shared decision making and adherence to cardiovascular disease health recommendations. The following review will address the 5 themes identified in more detail and provide a basis for improved clinical practice.

  20. Streamlining cardiovascular clinical trials to improve efficiency and generalisability.

    PubMed

    Zannad, Faiez; Pfeffer, Marc A; Bhatt, Deepak L; Bonds, Denise E; Borer, Jeffrey S; Calvo-Rojas, Gonzalo; Fiore, Louis; Lund, Lars H; Madigan, David; Maggioni, Aldo Pietro; Meyers, Catherine M; Rosenberg, Yves; Simon, Tabassome; Stough, Wendy Gattis; Zalewski, Andrew; Zariffa, Nevine; Temple, Robert

    2017-08-01

    Controlled trials provide the most valid determination of the efficacy and safety of an intervention, but large cardiovascular clinical trials have become extremely costly and complex, making it difficult to study many important clinical questions. A critical question, and the main objective of this review, is how trials might be simplified while maintaining randomisation to preserve scientific integrity and unbiased efficacy assessments. Experience with alternative approaches is accumulating, specifically with registry-based randomised controlled trials that make use of data already collected. This approach addresses bias concerns while still capitalising on the benefits and efficiencies of a registry. Several completed or ongoing trials illustrate the feasibility of using registry-based controlled trials to answer important questions relevant to daily clinical practice. Randomised trials within healthcare organisation databases may also represent streamlined solutions for some types of investigations, although data quality (endpoint assessment) is likely to be a greater concern in those settings. These approaches are not without challenges, and issues pertaining to informed consent, blinding, data quality and regulatory standards remain to be fully explored. Collaboration among stakeholders is necessary to achieve standards for data management and analysis, to validate large data sources for use in randomised trials, and to re-evaluate ethical standards to encourage research while also ensuring that patients are protected. The rapidly evolving efforts to streamline cardiovascular clinical trials have the potential to lead to major advances in promoting better care and outcomes for patients with cardiovascular disease. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Children First Study: how an educational program in cardiovascular prevention at school can improve parents' cardiovascular risk.

    PubMed

    Fornari, Luciana S; Giuliano, Isabela; Azevedo, Fernanda; Pastana, Adriana; Vieira, Carolina; Caramelli, Bruno

    2013-04-01

    To evaluate whether a multidisciplinary educational program (EP) in cardiovascular prevention (CVP) for children could improve the Framingham cardiovascular risk (FCR) of their parents after one year. This was a prospective community-based study in Brazil during 2010 that randomized students aged 6 to 10 years old to two different approaches to receiving healthy lifestyle information. The control group received written educational material (EM) for their parents about healthy lifestyle. The intervention group received the same EM for parents, and children were exposed to a weekly EP in CVP with a multidisciplinary health team. At onset and end of the study, we collected data from parents and children (weight, height, arterial blood pressure, and laboratory tests). We studied 197 children and 323 parents. Analyzing the parents' FCR we found that 9.3% of the control group and 6.8% of the intervention group had more than a 10% year risk of cardiovascular heart disease (CHD) over the next 10 years. After the children's EP for the year, the intervention group had a reduction of 91% in the intermediate/high FCR group compared with a 13% reduction in the control group, p = 0.002). In the same way, analyzing the FCR of all parents, there was a reduction of the average risk in the intervention group (3.6% to 2.8% respectively, p < 0.001) compared with the control group (4.4% to 4.4%, p = 0.98). An educational program in cardiovascular prevention directed at school-age children can reduce the FCR risk of their parents, especially in the intermediate/high risk categories.

  2. An observational study to evaluate the clinical practice of cardiovascular risk management among hypertensive patients in Turkey.

    PubMed

    Kozan, Omer

    2011-09-01

    We evaluated clinical practice in cardiovascular risk management and related patient compliance among Turkish hypertensive patients. This noninterventional, observational study included 1023 patients (620 women, 403 men; mean age 58.4 ± 10.6 years) with essential hypertension, from 50 centers across Turkey. Patients were evaluated at a cross-sectional phase and a follow-up phase of nine months. Data obtained at the cross-sectional phase included patient demographics, medical and past history, cardiovascular risk status, and current practice patterns regarding cardiovascular risk management. The mean duration of hypertension was 8.1 ± 7.1 years. The mean body mass index was 30.3 ± 5.2 kg/m2 and systolic and diastolic blood pressures (BP) were 147.8 ± 22.4 and 88.9 ± 12.5 mmHg, respectively. Ten-year coronary heart disease risk and risk level were significantly higher in males, and significantly increased in the presence of diabetes, metabolic syndrome, and renal disease and/or microalbuminuria (p<0.05). In past year history of cardiovascular risk management, 7.3% of the patients did not have BP measurements; no diet was recommended to 15.6%; 79.3% had high BP levels, and patient compliance with antihypertensive drug treatment and dietary recommendations were 87.7% and 62.5%, respectively. A similar profile was observed for dyslipidemia and diabetes mellitus. The physicians' efforts to motivate the patients to quit smoking, to lose weight, and involve in physical exercise were far below satisfactory levels, and the patients' compliance rates with these recommendations were even lower. Our study demonstrates that hypertensive patients are not adequately evaluated for cardiovascular risk, which is significantly increased in the presence of various cardiovascular risk factors such as diabetes, metabolic syndrome, and renal disease.

  3. Australian community pharmacists' awareness and practice in supporting secondary prevention of cardiovascular disease.

    PubMed

    Puspitasari, Hanni Prihhastuti; Aslani, Parisa; Krass, Ines

    2013-12-01

    Pharmacists are well placed to identify, prevent and resolve medicine related problems as well as monitor the effectiveness of treatments in cardiovascular disease (CVD). Pharmacists' interventions in CVD secondary prevention have been shown to improve outcomes for clients with established CVD. To explore the scope of pharmacists' activities in supporting CVD secondary prevention. Community pharmacies in New South Wales, Australia. Twenty-one in-depth, semi-structured interviews with a range of community pharmacists were conducted. All interviews were audio-recorded and transcribed ad verbatim. Data were analyzed using a 'grounded-theory' approach by applying methods of constant comparison. Community pharmacists' awareness and current practice in supporting secondary prevention of CVD. Four key themes identified included 'awareness', 'patient counselling', 'patient monitoring', and 'perceptions of the role of pharmacists in CVD secondary prevention'. The pharmacists demonstrated a moderate understanding of CVD secondary prevention. There was considerable variability in the scope of practice among the participants, ranging from counselling only about medicines to providing continuity of care. A minority of pharmacists who had negative beliefs about their roles in CVD secondary prevention offered limited support to their clients. The majority of pharmacists, however, believed that they have an important role to play in supporting clients with established CVD. Community pharmacists in Australia make a contribution to the care of clients with established CVD despite the gap in their knowledge and understanding of CVD secondary prevention. The scope of practice in CVD secondary prevention ranged from only counselling about medicines to offering continuity of care. The extent of pharmacists' involvement in offering disease management appears to be influenced by their beliefs regarding what is required within their scope of practice.

  4. Cardiovascular imaging and image processing: Theory and practice - 1975; Proceedings of the Conference, Stanford University, Stanford, Calif., July 10-12, 1975

    NASA Technical Reports Server (NTRS)

    Harrison, D. C.; Sandler, H.; Miller, H. A.

    1975-01-01

    The present collection of papers outlines advances in ultrasonography, scintigraphy, and commercialization of medical technology as applied to cardiovascular diagnosis in research and clinical practice. Particular attention is given to instrumentation, image processing and display. As necessary concomitants to mathematical analysis, recently improved magnetic recording methods using tape or disks and high-speed computers of large capacity are coming into use. Major topics include Doppler ultrasonic techniques, high-speed cineradiography, three-dimensional imaging of the myocardium with isotopes, sector-scanning echocardiography, and commercialization of the echocardioscope. Individual items are announced in this issue.

  5. A Narrative Review of How Sleep-Related Breathing Disorders and Cardiovascular Diseases Are Linked: An Update for Advanced Practice Registered Nurses.

    PubMed

    Moon, Chooza; Phelan, Cynthia H; Lauver, Diane R; Bratzke, Lisa C

    Sleep-related breathing disorders (SRBDs), including obstructive sleep apnea and central sleep apnea, are common among patients with cardiovascular disease (CVD), but clinicians often do not pay enough attention to SRBDs. The purpose of this narrative review is to update advanced practice registered nurses on the literature focusing on the relationship between SRBDs and CVD (eg, hypertension, heart failure, coronary artery disease, arrhythmias, and stroke) and on treatments that can improve SRBDs in patients with CVD. We conducted an electronic search of the literature published between 1980 and 2016 from PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Academic Search Premier, and related health resource Web sites to address the aims of this study. Fifty-six primary research articles (42 observational studies and 14 experimental and quasi-experimental studies) were selected based on our study aims and inclusion criteria. The studies revealed that individuals with CVD are at a greater risk for SRBDs and that SRBDs can worsen CVD. The findings from the studies also suggest that positive airway treatment could improve both SRBDs and CVD. This review found a close relationship between SRBDs and CVD. Advanced practice registered nurses are in key positions to identify and help patients manage SRBDs. In particular, advanced practice registered nurses can educate staff and establish standards of practice to improve outcomes for patients with CVD.

  6. The effect of sibutramine prescribing in routine clinical practice on cardiovascular outcomes: a cohort study in the United Kingdom

    PubMed Central

    Hayes, J F; Bhaskaran, K; Batterham, R; Smeeth, L; Douglas, I

    2015-01-01

    Background/Objectives: The marketing authorization for the weight loss drug sibutramine was suspended in 2010 following a major trial that showed increased rates of non-fatal myocardial infarction and cerebrovascular events in patients with pre-existing cardiovascular disease. In routine clinical practice, sibutramine was already contraindicated in patients with cardiovascular disease and so the relevance of these influential clinical trial findings to the ‘real World' population of patients receiving or eligible for the drug is questionable. We assessed rates of myocardial infarction and cerebrovascular events in a cohort of patients prescribed sibutramine or orlistat in the United Kingdom. Subjects/Methods: A cohort of patients prescribed weight loss medication was identified within the Clinical Practice Research Datalink. Rates of myocardial infarction or cerebrovascular event, and all-cause mortality were compared between patients prescribed sibutramine and similar patients prescribed orlistat, using both a multivariable Cox proportional hazard model, and propensity score-adjusted model. Possible effect modification by pre-existing cardiovascular disease and cardiovascular risk factors was assessed. Results: Patients prescribed sibutramine (N=23 927) appeared to have an elevated rate of myocardial infarction or cerebrovascular events compared with those taking orlistat (N=77 047; hazard ratio 1.69, 95% confidence interval 1.12–2.56). However, subgroup analysis showed the elevated rate was larger in those with pre-existing cardiovascular disease (hazard ratio 4.37, 95% confidence interval 2.21–8.64), compared with those with no cardiovascular disease (hazard ratio 1.52, 95% confidence interval 0.92–2.48, P-interaction=0.0076). All-cause mortality was not increased in those prescribed sibutramine (hazard ratio 0.67, 95% confidence interval 0.34–1.32). Conclusions: Sibutramine was associated with increased rates of acute cardiovascular events in

  7. Research on Improved Depth Belief Network-Based Prediction of Cardiovascular Diseases

    PubMed Central

    Zhang, Hongpo

    2018-01-01

    Quantitative analysis and prediction can help to reduce the risk of cardiovascular disease. Quantitative prediction based on traditional model has low accuracy. The variance of model prediction based on shallow neural network is larger. In this paper, cardiovascular disease prediction model based on improved deep belief network (DBN) is proposed. Using the reconstruction error, the network depth is determined independently, and unsupervised training and supervised optimization are combined. It ensures the accuracy of model prediction while guaranteeing stability. Thirty experiments were performed independently on the Statlog (Heart) and Heart Disease Database data sets in the UCI database. Experimental results showed that the mean of prediction accuracy was 91.26% and 89.78%, respectively. The variance of prediction accuracy was 5.78 and 4.46, respectively. PMID:29854369

  8. Factors associated with emergency medical services scope of practice for acute cardiovascular events.

    PubMed

    Williams, Ishmael; Valderrama, Amy L; Bolton, Patricia; Greek, April; Greer, Sophia; Patterson, Davis G; Zhang, Zefeng

    2012-01-01

    To examine prehospital emergency medical services (EMS) scope of practice for acute cardiovascular events and characteristics that may affect scope of practice; and to describe variations in EMS scope of practice for these events and the characteristics associated with that variability. In 2008, we conducted a telephone survey of 1,939 eligible EMS providers in nine states to measure EMS agency characteristics, medical director involvement, and 18 interventions authorized for prehospital care of acute cardiovascular events by three levels of emergency medical technician (EMT) personnel. A total of 1,292 providers responded to the survey, for a response rate of 67%. EMS scope of practice interventions varied by EMT personnel level, with the proportion of authorized interventions increasing as expected from EMT-Basic to EMT-Paramedic. Seven of eight statistically significant associations indicated that EMS agencies in urban settings were less likely to authorize interventions (odds ratios <0.7) for any level of EMS personnel. Based on the subset of six statistically significant associations, fire department-based EMS agencies were two to three times more likely to authorize interventions for EMT-Intermediate personnel. Volunteer EMS agencies were more than twice as likely as nonvolunteer agencies to authorize interventions for EMT-Basic and EMT-Intermediate personnel but were less likely to authorize any one of the 11 interventions for EMT-Paramedics. Greater medical director involvement was associated with greater likelihood of authorization of seven of the 18 interventions for EMT-Basic and EMT-Paramedic personnel but had no association with EMT-Intermediate personnel. We noted statistically significant variations in scope of practice by rural vs. urban setting, medical director involvement, and type of EMS service (fire department-based/non-fire department-based; volunteer/paid). These variations highlight local differences in the composition and capacity of EMS

  9. Intermittent hypoxia training as non-pharmacologic therapy for cardiovascular diseases: Practical analysis on methods and equipment

    PubMed Central

    Serebrovskaya, Tatiana V

    2016-01-01

    The global industrialization has brought profound lifestyle changes and environmental pollutions leading to higher risks of cardiovascular diseases. Such tremendous challenges outweigh the benefits of major advances in pharmacotherapies (such as statins, antihypertensive, antithrombotic drugs) and exacerbate the public healthcare burdens. One of the promising complementary non-pharmacologic therapies is the so-called intermittent hypoxia training (IHT) via activation of the human body's own natural defense through adaptation to intermittent hypoxia. This review article primarily focuses on the practical questions concerning the utilization of IHT as a non-pharmacologic therapy against cardiovascular diseases in humans. Evidence accumulated in the past five decades of research in healthy men and patients has suggested that short-term daily sessions consisting 3–4 bouts of 5–7 min exposures to 12–10% O2 alternating with normoxic durations for 2–3 weeks can result in remarkable beneficial effects in treatment of cardiovascular diseases such as hypertension, coronary heart disease, and heart failure. Special attentions are paid to the therapeutic effects of different IHT models, along with introduction of a variety of specialized facilities and equipment available for IHT, including hypobaric chambers, hypoxia gas mixture deliver equipment (rooms, tents, face masks), and portable rebreathing devices. Further clinical trials and thorough evaluations of the risks versus benefits of IHT are much needed to develop a series of standardized and practical guidelines for IHT. Taken together, we can envisage a bright future for IHT to play a more significant role in the preventive and complementary medicine against cardiovascular diseases. PMID:27407098

  10. Value of a facilitated quality improvement initiative on cardiovascular disease risk: findings from an evaluation of the Aggressively Treating Global Cardiometabolic Risk Factors to Reduce Cardiovascular Events (AT GOAL).

    PubMed

    Losby, Jan L; Osuji, Thearis A; House, Marnie J; Davis, Rachel; Boyce, Simone Peart; Greenberg, Michael Canter; Whitehill, John M

    2015-10-01

    In the United States, cardiovascular disease (CVD) is the leading cause of death. The US Centers for Disease Control and Prevention contracted an evaluation of the Aggressively Treating Global Cardiometabolic Risk Factors to Reduce Cardiovascular Events (AT GOAL) programme as part of its effort to identify strategies to address CVD risk factors. This study analysed patient-level data from 7527 patients in 43 primary care practices. The researchers assessed average change in control rates for CVD-related measures across practices, and then across patients between baseline and a patient's last visit during the practice's tenure in the programme (referred to as 'end line') using repeated measures analysis of variance and random effects generalized least squares, respectively. Among non-diabetic patients, there were significant increases in control rates for overall blood pressure (74.3% to 78.0%, P = 0.0002), systolic blood pressure (70.3% to 80.6%, P = 0.0099), diastolic blood pressure (90.1% to 92.7%, P = 0.0001) and low-density lipoprotein (LDL; 48.6% to 53.1%, P = 0.0001) between baseline and end line. Among diabetic patients, there was a significant increase in diastolic blood pressure control (59.8% to 61.9%, P = 0.0141). While continuous CVD-related outcomes show an overall trend between baseline and end line, patients with uncontrolled measures at baseline showed a decrease between baseline and end line relative to their counterparts who were controlled at baseline. Findings from the AT GOAL evaluation support the value of a facilitated quality improvement (QI) initiative on managing CVD risk. © 2015 John Wiley & Sons, Ltd.

  11. Serum C-reactive protein in the prediction of cardiovascular diseases: Overview of the latest clinical studies and public health practice.

    PubMed

    Avan, Amir; Tavakoly Sany, Seyedeh Belin; Ghayour-Mobarhan, Majid; Rahimi, Hamid Reza; Tajfard, Mohammad; Ferns, Gordon

    2018-06-22

    Cardiovascular disease is the most common cause of morbidity and mortality globally. Epidemiological studies using high-sensitivity assays for serum C-reactive protein have shown a consistent association between cardiovascular disease risk and serum C-reactive protein concentrations. C-reactive protein is a biomarker for inflammation, and has been established in clinical practice as an independent risk factor for cardiovascular disease events. There is evidence that serum C-reactive protein is an excellent biomarker of cardiovascular disease and is also an independent and strong predictor of adverse cardiovascular events. Further characterization of the impact and influence of lifestyle exposures and genetic variation on the C-reactive protein response to cardiovascular disease events may have implications for the therapeutic approaches to reduce cardiovascular disease events. This review summarizes the studies that have examined the association between serum C-reactive protein and the risk of cardiovascular disease. We also discuss the impact of independent factors and C-reactive protein genetic polymorphisms on baseline plasma C-reactive protein levels. © 2018 Wiley Periodicals, Inc.

  12. First results of a national initiative to enable quality improvement of cardiovascular care by transparently reporting on patient-relevant outcomes.

    PubMed

    van Veghel, Dennis; Marteijn, Marloes; de Mol, Bas

    2016-06-01

    The aims of this study were to assess patient-relevant outcomes of delivered cardiovascular care by focusing on disease management as determined by a multidisciplinary Heart Team, to establish and share best practices by comparing outcomes and to embed value-based decision-making to improve quality and efficiency in Dutch heart centres. In 2014, 12 Dutch heart centres pooled patient-relevant outcome data, which resulted in transparent publication of the outcomes, including long-term follow-up up to 5 years, of approximately 86 000 heart patients. This study presents the results of both disease- and treatment patient-relevant outcome measures for coronary artery disease and aortic valve disease. The patients included were presented to a Heart Team and underwent invasive or operative treatment. In-hospital and out-of-hospital patient-relevant outcome measures were collected as well as initial conditions. Quality of life was assessed using the Short Form (SF)-36 or SF-12 health survey. In the Netherlands, patient-relevant and risk-adjusted outcomes of cardiovascular care in participating heart centres are published annually. Data were sufficiently reliable to enable comparisons and to subtract best practices. The statistically lower risk-adjusted mortality rate after coronary artery bypass grafting resulted in a voluntary roll-out of a perioperative safety check. The in-depth analysis of outcomes after percutaneous coronary intervention resulted in process improvements in several heart centres, such as pre-hydration for patients with renal insufficiency and the need of target vessel revascularizations within a year. Annual data collection on follow-up of patient-relevant outcomes of cardiovascular care, initiated and organized by physicians, appears feasible. Transparent publication of outcomes drives the improvement of quality within heart centres. The system of using a limited set of patient-relevant outcome measures enables reliable comparisons and exposes the

  13. Which practice characteristics are associated with the quality of cardiovascular disease prevention in European primary care?

    PubMed Central

    2013-01-01

    Background Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available. In this study, we assessed the relationship between structural and organisational practice characteristics and the quality of care provided in individuals at high risk for developing CVD in European primary care. Methods An observational study was conducted in 267 general practices from 9 European countries. Previously developed quality indicators were abstracted from medical records of randomly sampled patients to create a composite quality measure. Practice characteristics were collected by a practice questionnaire and face to face interviews. Data were aggregated using factor analysis to four practice scores representing structural and organisational practice features. A hierarchical multilevel analysis was performed to examine the impact of practice characteristics on quality of CVRM. Results The final sample included 4223 individuals at high risk for developing CVD (28% female) with a mean age of 66.5 years (SD 9.1). Mean indicator achievement was 59.9% with a greater variation between practices than between countries. Predictors at the patient level (age, gender) had no influence on the outcome. At the practice level, the score ‘Preventive Services’ (13 items) was positively associated with clinical performance (r = 1.92; p = 0.0058). Sensitivity analyses resulted in a 5-item score (PrevServ_5) that was also positively associated with the outcome (r = 4.28; p < 0.0001). Conclusions There was a positive association between the quality of CVRM in individuals at high risk for developing CVD and the availability of preventive services related to risk assessment and lifestyle management supported by information technology. PMID:23510482

  14. Which practice characteristics are associated with the quality of cardiovascular disease prevention in European primary care?

    PubMed

    Ludt, Sabine; Campbell, Stephen M; Petek, Davorina; Rochon, Justine; Szecsenyi, Joachim; van Lieshout, Jan; Wensing, Michel; Ose, Dominik

    2013-03-09

    Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available. In this study, we assessed the relationship between structural and organisational practice characteristics and the quality of care provided in individuals at high risk for developing CVD in European primary care. An observational study was conducted in 267 general practices from 9 European countries. Previously developed quality indicators were abstracted from medical records of randomly sampled patients to create a composite quality measure. Practice characteristics were collected by a practice questionnaire and face to face interviews. Data were aggregated using factor analysis to four practice scores representing structural and organisational practice features. A hierarchical multilevel analysis was performed to examine the impact of practice characteristics on quality of CVRM. The final sample included 4223 individuals at high risk for developing CVD (28% female) with a mean age of 66.5 years (SD 9.1). Mean indicator achievement was 59.9% with a greater variation between practices than between countries. Predictors at the patient level (age, gender) had no influence on the outcome. At the practice level, the score 'Preventive Services' (13 items) was positively associated with clinical performance (r = 1.92; p = 0.0058). Sensitivity analyses resulted in a 5-item score (PrevServ_5) that was also positively associated with the outcome (r = 4.28; p < 0.0001). There was a positive association between the quality of CVRM in individuals at high risk for developing CVD and the availability of preventive services related to risk assessment and lifestyle management supported by information technology.

  15. The effectiveness of integrative medicine interventions on pain and anxiety in cardiovascular inpatients: a practice-based research evaluation.

    PubMed

    Johnson, Jill R; Crespin, Daniel J; Griffin, Kristen H; Finch, Michael D; Rivard, Rachael L; Baechler, Courtney J; Dusek, Jeffery A

    2014-12-13

    Pain and anxiety occurring from cardiovascular disease are associated with long-term health risks. Integrative medicine (IM) therapies reduce pain and anxiety in small samples of hospitalized cardiovascular patients within randomized controlled trials; however, practice-based effectiveness research has been limited. The goal of the study is to evaluate the effectiveness of IM interventions (i.e., bodywork, mind-body and energy therapies, and traditional Chinese medicine) on pain and anxiety measures across a cardiovascular population. Retrospective data obtained from medical records identified patients with a cardiovascular ICD-9 code admitted to a large Midwestern hospital between 7/1/2009 and 12/31/2012. Outcomes were changes in patient-reported pain and anxiety, rated before and after IM treatments based on a numeric scale (0-10). Of 57,295 hospital cardiovascular admissions, 6,589 (11.5%) included IM. After receiving IM therapy, patients averaged a 46.5% (p-value < 0.001) decrease in pain and a 54.8% (p-value < 0.001) decrease in anxiety. There was no difference between treatment modalities on pain reduction; however, mind-body and energy therapies (p-value < 0.01), traditional Chinese medicine (p-value < 0.05), and combination therapies (p-value < 0.01) were more effective at reducing anxiety than bodywork therapies. Each additional year of age reduced the odds of receiving any IM therapy by two percent (OR: 0.98, p-value < 0.01) and females had 96% (OR: 1.96, p-value < 0.01) higher odds of receiving any IM therapy compared to males. Cardiovascular inpatients reported statistically significant decreases in pain and anxiety following care with adjunctive IM interventions. This study underscores the potential for future practice-based research to investigate the best approach for incorporating these therapies into an acute care setting such that IM therapies are most appropriately provided to patient populations.

  16. The impact of health literacy on cardiovascular disease

    PubMed Central

    Safeer, Richard S; Cooke, Catherine E; Keenan, Jann

    2006-01-01

    One's ability to read, listen, and comprehend health information is a vital element of maintaining and improving health. However, 90 million people in the United States exhibit less than adequate health literacy skills. Given that more than 70 million Americans suffer from cardiovascular diseases, it is certain that every physician's practice is affected by health literacy issues. Those with language and cultural issues tend to be the most affected. Yet numerous studies find physicians do a poor job of assessing their patients’ health literacy skills. Patients are also unaware of the steps they should take, and how to take them, to improve their health and prevent complications. Numerous studies find, however, that outcomes can be improved with targeted patient education and improved physician communication skills that take into account patients’ health literacy levels. Unfortunately, the health care system is only beginning to recognize this problem and take action to overcome its negative impact. By improving the communication process with patients, physicians may be able to improve cardiovascular outcomes. PMID:17323600

  17. Knowledge of cardiovascular disease in Turkish undergraduate nursing students.

    PubMed

    Badir, Aysel; Tekkas, Kader; Topcu, Serpil

    2015-10-01

    Cardiovascular disease is the number one cause of death worldwide. However, there is not enough data exploring student nurses' understanding, knowledge, and awareness of cardiovascular disease. To investigate knowledge of cardiovascular disease and its risk factors among undergraduate nursing students, with an emphasis on understanding of cardiovascular disease as the primary cause of mortality and morbidity, both in Turkey and worldwide. This cross-sectional survey assessed 1138 nursing students enrolled in nursing schools in Istanbul, Turkey. Data were collected using the Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) scale and questions from the Individual Characteristics Form about students' gender, age, level of education, and family cardiovascular health history, as well as smoking and exercise habits. Respondents demonstrated a high level of knowledge about cardiovascular disease, with years of education (p < 0.001), gender (p < 0.001), and high school type (p < 0.05) all significantly associated with CARRF-KL scores. However, more than half of the students were not aware that cardiovascular disease is the primary cause of mortality and morbidity in Turkey and worldwide. The majority of the respondents' body mass index (87%) and waist circumference values (females: 90.3%, males: 94.7%) were in the normal range and most were non-smokers (83.7%). However, more than half of the students did not exercise regularly and had inadequate dietary habits. Although students were knowledgeable about cardiovascular disease and associated risk factors, there were significant gaps in their knowledge; these should be addressed through improved nursing curricula. While students were generally healthy, they could improve their practice of health-promoting behaviors. © The European Society of Cardiology 2014.

  18. Strategic directions for developing the Australian general practice nurse role in cardiovascular disease management.

    PubMed

    Halcomb, Elizabeth J; Davidson, Patricia M; Yallop, Julie; Griffiths, Rhonda; Daly, John

    2007-08-01

    Practice nursing is an integral component of British and New Zealand primary care, but in Australia it remains an emerging specialty. Despite an increased focus on the Australian practice nurse role, there has been limited strategic role development, particularly relating to national health priority areas. This paper reports the third stage of a Project exploring the Australian practice nurse role in the management of cardiovascular disease (CVD). This stage involved a consensus development conference, undertaken to identify strategic, priority recommendations for practice nurse role development. 1. Practice nurses have an important role in developing systems and processes for CVD management; 2. A change in the culture of general practice is necessary to promote acceptance of nurse-led CVD management; 3. Future research needs to evaluate specific models of care, incorporating outcome measures sensitive to nursing interventions; 4. Considerable challenges exist in conducting research in general practice; and 5. Changes in funding models are necessary for widespread practice nurse role development. The shifting of funding models provides evidence to support interdisciplinary practice in Australian general practice. The time is ripe, therefore, to engage in prospective and strategic planning to inform development of the practice nurse role.

  19. Scorecard cardiovascular medicine. Its impact and future directions.

    PubMed

    Topol, E J; Califf, R M

    1994-01-01

    Public release of operator-specific data for cardiovascular procedures has set a new precedent, introducing the "scorecard" era. Justification exists for public disclosure, but the mechanics of appropriate data release are complex from a clinical, statistical, and logistic standpoint. Scorecard medicine may appropriately promote regionalization of medical centers and consolidation of services, but unless the process is directed effectively, it may impair the development of new treatments because of a more restrictive clinical practice environment. We propose revamping our current system to facilitate rapid and accurate access to outcome data in the local practice environment so that improvement in practice occurs on a voluntary basis rather than in response to punitive restrictions. A rational plan needs to be developed for dealing with high-risk patients, perhaps through compensation in regression models used to calculate expected outcomes, and for the start-up of novice physicians. Special provisions are needed to promote clinical research. Before procedures are done, it would be ideal to provide a full disclosure informed consent, whereby the physician reports operator-specific data and the patient's decision-making process is facilitated. Overall, appropriate implementation of scorecards could ultimately lead to a substantial improvement in the quality of U.S. cardiovascular medicine.

  20. Practical ways to facilitate ergonomics improvements in occupational health practice.

    PubMed

    Kogi, Kazutaka

    2012-12-01

    Recent advances in participatory programs for improving workplace conditions are discussed to examine practical ways to facilitate ergonomics improvements. Participatory training programs are gaining importance, particularly in promoting occupational health and safety in small-scale workplaces. These programs have led to many improvements that can reduce work-related risks in varied situations. Recent experiences in participatory action-oriented training programs in small workplaces and agriculture are reviewed.The emphasis of the review is on training steps, types of improvements achieved, and the use of action tools by trainers and training participants. Immediate improvements in multiple technical areas are targeted, including materials handling,workstation design, physical environment, welfare facilities, and work organization. In facilitating ergonomics improvements in each local situation, it is important to focus on (a) building on local good practices; (b) applying practical, simple improvements that apply the basic principles of ergonomics; and (c) developing action-oriented toolkits for direct use by workers and managers. This facilitation process is effective when locally designed action toolkits are used by trainers, including local good examples, action checklists, and illustrated how-to guides. Intervention studies demonstrate the effectiveness of participatory steps that use these toolkits in promoting good practices and reducing work-related risks. In facilitating ergonomics improvements in small-scale workplaces, it is important to focus on practical, low-cost improvements that build on local good practices. The use of action-oriented toolkits reflecting basic ergonomics principles is helpful.The promotion of the intercountry networking of positive experiences in participatory training is suggested.

  1. Effectiveness of a quality improvement intervention targeting cardiovascular risk factors: are patients responsive to information and encouragement by mail or post?

    PubMed

    Senesael, Ellie; Borgermans, Liesbeth; Van De Vijver, Erwin; Devroey, Dirk

    2013-01-01

    There is important evidence on the beneficial effects of treatment of cardiovascular risk factors in terms of morbidity and mortality, but important challenges remain in motivating patients to adhere to their treatment regimen. This study aimed to describe the effectiveness of a quality improvement intervention that included information and regular encouragement by email or letter on cardiovascular risk factors for patients at high risk for cardiovascular disease. This randomized single-blind study included patients of both sexes aged between 45 and 80 years old who had increased cardiovascular risk. Patients were randomly allocated to either a usual care group (UCG) or advanced care group (ACG). Patients in the UCG received regular care while patients in the ACG received usual care plus regular information and encouragement on cardiovascular risk factors by email or letter. Visits for both groups were planned at 0, 3, and 6 months. The outcome measures were blood pressure, weight, body mass index (BMI), waist circumference (WC), and smoking status. Out of 178 eligible patients from one single primary care practice, 55 participated in the study, three of whom dropped out. After 6 months, there was a significant decrease in mean systolic and diastolic blood pressure in the UCG and ACG (P < 0.05). The decreases were already significant after 3 months, except for systolic blood pressure in the UCG. There was also a significant increase in the proportion of patients who met the target values for blood pressure in the UCG and ACG. There was a nonsignificant decrease of the average weight in the ACG, but significantly more patients lost weight in the UCG (P = 0.02). BMI, WC, and smoking status did not change in either group. This study found that there was a significant decrease of systolic and diastolic blood pressure in both study groups. Weight, BMI, WC, and smoking did not improve in either group. Information on cardiovascular risk factors and encouragement by means

  2. Randomized clinical trial to assess the efficacy of a comprehensive programme of secondary prevention of cardiovascular disease in general practice: the PREseAP study.

    PubMed

    Brotons, Carlos; Soriano, Núria; Moral, Irene; Rodrigo, María P; Kloppe, Pilar; Rodríguez, Ana I; González, María L; Ariño, Dolores; Orozco, Domingo; Buitrago, Francisco; Pepió, Josep M; Borrás, Isabel

    2011-01-01

    To assess the efficacy of a comprehensive program of secondary prevention of cardiovascular disease in general practice. A cluster randomized clinical trial was carried out in a regular general practice setting. Male and female patients aged under 86 years with a diagnosis of ischemic heart disease, stroke or peripheral artery disease were recruited between January 2004 and May 2005. Study participants were seen at 42 health centers throughout the whole of Spain. The primary endpoint was the combination of all-cause mortality and hospital cardiovascular readmission at 3-year follow-up. In total, 1224 patients were recruited: 624 in the intervention group and 600 in the control group. The primary endpoint was observed in 29.9% (95% confidence interval [CI], 25.5-34.8%) in the intervention group and 25.6% (22.3-29.2%) in the control group (P=.15). At the end of follow-up, 8.5% (6.3-11.3%) in the intervention group and 11% (7.4-16%) in the control group were smokers (P=.07). The mean waist circumference of patients in the intervention and control groups was 100.44 cm (95% CI, 98.97-101.91 cm) and 102.58 cm (95% CI, 100.96-104.21 cm), respectively (P=.07). Overall, 20.9% (15.6-27.7%) of patients in the intervention group and 29.6% (23.9-36.1%) in the control group suffered from anxiety (P=.05), and 29.6% (22.4-37.9%) in the intervention group and 41.4% (35.8-47.3%) in the control group had depression (P=.02). A comprehensive program of secondary prevention of cardiovascular disease in general practice was not effective in reducing cardiovascular morbidity and mortality. However, some factors associated with a healthy lifestyle were improved and anxiety and depression were reduced. Copyright © 2010 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  3. Dental considerations in cardiovascular patients: A practical perspective.

    PubMed

    Chaudhry, Swantika; Jaiswal, Ritika; Sachdeva, Surender

    2016-01-01

    Cardiovascular disease trends, complications, and associated therapeutics impact the dental health and treatment. Such patients require special consideration with regard to when and which dental treatment is appropriate and what precautions are required. Alertness to potential oral adverse drug reactions enables referral of patient's to his physician or cardiologist. Cardiovascular drugs are also known to have mild to potentially fatal drug interactions. Dental professionals may be the first line of defense in the detection and referral of a patient suspected of having cardiovascular disease, an uncontrolled disease status, or oral adverse drug reactions, and they have a key role to play in oral and systemic disease prevention and treatment, in partnership with the patient and his physician. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  4. The role of mHealth for improving medication adherence in patients with cardiovascular disease: a systematic review.

    PubMed

    Gandapur, Yousuf; Kianoush, Sina; Kelli, Heval M; Misra, Satish; Urrea, Bruno; Blaha, Michael J; Graham, Garth; Marvel, Francoise A; Martin, Seth S

    2016-10-01

    Cardiovascular disease is a leading cause of morbidity and mortality worldwide, and a key barrier to improved outcomes is medication non-adherence. The aim of this study is to review the role of mobile health (mHealth) tools for improving medication adherence in patients with cardiovascular disease. We performed a systematic search for randomized controlled trials that primarily investigated mHealth tools for improving adherence to cardiovascular disease medications in patients with hypertension, coronary artery disease, heart failure, peripheral arterial disease, and stroke. We extracted and reviewed data on the types of mHealth tools used, preferences of patients and healthcare providers, the effect of the mHealth interventions on medication adherence, and the limitations of trials. We identified 10 completed trials matching our selection criteria, mostly with <100 participants, and ranging in duration from 1 to 18 months. mHealth tools included text messages, Bluetooth-enabled electronic pill boxes, online messaging platforms, and interactive voice calls. Patients and healthcare providers generally preferred mHealth to other interventions. All 10 studies reported that mHealth interventions improved medication adherence, though the magnitude of benefit was not consistently large and in one study was not greater than a telehealth comparator. Limitations of trials included small sample sizes, short duration of follow-up, self-reported outcomes, and insufficient assessment of unintended harms and financial implications. Current evidence suggests that mHealth tools can improve medication adherence in patients with cardiovascular diseases. However, high-quality clinical trials of sufficient size and duration are needed to move the field forward and justify use in routine care.

  5. Practice Facilitator Strategies for Addressing Electronic Health Record Data Challenges for Quality Improvement: EvidenceNOW.

    PubMed

    Hemler, Jennifer R; Hall, Jennifer D; Cholan, Raja A; Crabtree, Benjamin F; Damschroder, Laura J; Solberg, Leif I; Ono, Sarah S; Cohen, Deborah J

    2018-01-01

    Practice facilitators ("facilitators") can play an important role in supporting primary care practices in performing quality improvement (QI), but they need complete and accurate clinical performance data from practices' electronic health records (EHR) to help them set improvement priorities, guide clinical change, and monitor progress. Here, we describe the strategies facilitators use to help practices perform QI when complete or accurate performance data are not available. Seven regional cooperatives enrolled approximately 1500 small-to-medium-sized primary care practices and 136 facilitators in EvidenceNOW, the Agency for Healthcare Research and Quality's initiative to improve cardiovascular preventive services. The national evaluation team analyzed qualitative data from online diaries, site visit field notes, and interviews to discover how facilitators worked with practices on EHR data challenges to obtain and use data for QI. We found facilitators faced practice-level EHR data challenges, such as a lack of clinical performance data, partial or incomplete clinical performance data, and inaccurate clinical performance data. We found that facilitators responded to these challenges, respectively, by using other data sources or tools to fill in for missing data, approximating performance reports and generating patient lists, and teaching practices how to document care and confirm performance measures. In addition, facilitators helped practices communicate with EHR vendors or health systems in requesting data they needed. Overall, facilitators tailored strategies to fit the individual practice and helped build data skills and trust. Facilitators can use a range of strategies to help practices perform data-driven QI when performance data are inaccurate, incomplete, or missing. Support is necessary to help practices, particularly those with EHR data challenges, build their capacity for conducting data-driven QI that is required of them for participating in practice

  6. Economic implications of cardiovascular disease management programs: moving beyond one-off experiments.

    PubMed

    Maru, Shoko; Byrnes, Joshua; Carrington, Melinda J; Stewart, Simon; Scuffham, Paul A

    2015-01-01

    Substantial variation in economic analyses of cardiovascular disease management programs hinders not only the proper assessment of cost-effectiveness but also the identification of heterogeneity of interest such as patient characteristics. The authors discuss the impact of reporting and methodological variation on the cost-effectiveness of cardiovascular disease management programs by introducing issues that could lead to different policy or clinical decisions, followed by the challenges associated with net intervention effects and generalizability. The authors conclude with practical suggestions to mitigate the identified issues. Improved transparency through standardized reporting practice is the first step to advance beyond one-off experiments (limited applicability outside the study itself). Transparent reporting is a prerequisite for rigorous cost-effectiveness analyses that provide unambiguous implications for practice: what type of program works for whom and how.

  7. How could we improve the increased cardiovascular mortality in patients with overt and subclinical hyperthyroidism?

    PubMed

    Biondi, Bernadette

    2012-09-01

    Over the past five years several meta-analyses have evaluated the cardiovascular mortality in patients with hyperthyroidism. They assessed various studies in which different inclusion criteria were used for the analysis of the cardiovascular mortality. More selective criteria have been used in recent meta-analyses. Only prospective cohort studies were included and only cohorts using second and third generation TSH assays were chosen. In addition, only the studies where the TSH evaluation was repeated during the follow-up were selected. The results of these recent meta-analyses provide evidence that overt and subclinical hyperthyroidism, particularly in patients with undetectable serum TSH, may increase the cardiovascular mortality. However, still today, the results remain inconclusive and not sufficient enough to recommend treatment for patients with low-detectable serum TSH. The high cardiovascular risk and mortality in presence of thyroid hormone excess suggest that this dysfunction is an important health problem and requires guidelines for the treatment of patients at high cardiovascular risk. Rigorous studies are necessary to evaluate the effects of the various causes of hyperthyroidism on the clinical outcomes. Randomized controlled clinical trials are needed to assess the benefits of treatment to improve the cardiovascular mortality and morbidity of mild and overt hyperthyroidism.

  8. The role of mHealth for improving medication adherence in patients with cardiovascular disease: a systematic review

    PubMed Central

    Gandapur, Yousuf; Kianoush, Sina; Kelli, Heval M.; Misra, Satish; Urrea, Bruno; Blaha, Michael J.; Graham, Garth; Marvel, Francoise A.; Martin, Seth S.

    2016-01-01

    Abstract Cardiovascular disease is a leading cause of morbidity and mortality worldwide, and a key barrier to improved outcomes is medication non-adherence. The aim of this study is to review the role of mobile health (mHealth) tools for improving medication adherence in patients with cardiovascular disease. We performed a systematic search for randomized controlled trials that primarily investigated mHealth tools for improving adherence to cardiovascular disease medications in patients with hypertension, coronary artery disease, heart failure, peripheral arterial disease, and stroke. We extracted and reviewed data on the types of mHealth tools used, preferences of patients and healthcare providers, the effect of the mHealth interventions on medication adherence, and the limitations of trials. We identified 10 completed trials matching our selection criteria, mostly with <100 participants, and ranging in duration from 1 to 18 months. mHealth tools included text messages, Bluetooth-enabled electronic pill boxes, online messaging platforms, and interactive voice calls. Patients and healthcare providers generally preferred mHealth to other interventions. All 10 studies reported that mHealth interventions improved medication adherence, though the magnitude of benefit was not consistently large and in one study was not greater than a telehealth comparator. Limitations of trials included small sample sizes, short duration of follow-up, self-reported outcomes, and insufficient assessment of unintended harms and financial implications. Current evidence suggests that mHealth tools can improve medication adherence in patients with cardiovascular diseases. However, high-quality clinical trials of sufficient size and duration are needed to move the field forward and justify use in routine care. PMID:29474713

  9. Practical Approaches to Quality Improvement for Radiologists.

    PubMed

    Kelly, Aine Marie; Cronin, Paul

    2015-10-01

    Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. © RSNA, 2015.

  10. Cardiovascular risks in firefighters: implications for occupational health nurse practice.

    PubMed

    Byczek, Lance; Walton, Surrey M; Conrad, Karen M; Reichelt, Paul A; Samo, Daniel G

    2004-02-01

    Limited cardiovascular risk data are available for firefighters. This cross sectional study of data collected during annual physical examinations described the prevalence of cardiovascular risk factors among firefighters (N = 200) and examined relationships between body mass index (BMI) and other cardiovascular risk factors. Evidence based guidelines were used to determine prevalence of cardiovascular risk factors and Framingham risk scoring was used to estimate probability of coronary heart disease (CHD). Firefighters ranged in age from 22 to 64 with a mean of 41. The prevalence of obesity, elevated total cholesterol, and elevated blood pressure in firefighters exceeded Healthy People 2010 targets. In addition, their prevalence of obesity, low high density lipoprotein (HDL), high low density lipoprotein (LDL), and high total cholesterol levels was higher relative to the general population. Elevated body mass index (BMI) values had positive significant (p < or = .01) associations with elevated blood pressures, triglycerides, and glucose levels, and a negative significant (p < .05) association with lower HDL cholesterol levels. Fire department worksite health and fitness policies and programs should proactively target firefighters' cardiovascular risks. Future firefighter related intervention research will benefit from considering not only the individual determinants of cardiovascular disease, but also the ecological framework that includes the influences of workplace and external environmental factors.

  11. Secondary Prevention of Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus: International Insights From the TECOS Trial (Trial Evaluating Cardiovascular Outcomes With Sitagliptin).

    PubMed

    Pagidipati, Neha J; Navar, Ann Marie; Pieper, Karen S; Green, Jennifer B; Bethel, M Angelyn; Armstrong, Paul W; Josse, Robert G; McGuire, Darren K; Lokhnygina, Yuliya; Cornel, Jan H; Halvorsen, Sigrun; Strandberg, Timo E; Delibasi, Tuncay; Holman, Rury R; Peterson, Eric D

    2017-09-26

    Intensive risk factor modification significantly improves outcomes for patients with diabetes mellitus and cardiovascular disease. However, the degree to which secondary prevention treatment goals are achieved in international clinical practice is unknown. Attainment of 5 secondary prevention parameters-aspirin use, lipid control (low-density lipoprotein cholesterol <70 mg/dL or statin therapy), blood pressure control (<140 mm Hg systolic, <90 mm Hg diastolic), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, and nonsmoking status-was evaluated among 13 616 patients from 38 countries with diabetes mellitus and known cardiovascular disease at entry into TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin). Logistic regression was used to evaluate the association between individual and regional factors and secondary prevention achievement at baseline. Cox proportional hazards regression analysis was used to determine the association between baseline secondary prevention achievement and cardiovascular death, myocardial infarction, or stroke. Overall, 29.9% of patients with diabetes mellitus and cardiovascular disease achieved all 5 secondary prevention parameters at baseline, although 71.8% achieved at least 4 parameters. North America had the highest proportion (41.2%), whereas Western Europe, Eastern Europe, and Latin America had proportions of ≈25%. Individually, blood pressure control (57.9%) had the lowest overall attainment, whereas nonsmoking status had the highest (89%). Over a median 3.0 years of follow-up, a higher baseline secondary prevention score was associated with improved outcomes in a step-wise graded relationship (adjusted hazard ratio, 0.60; 95% confidence interval, 0.47-0.77 for those patients achieving all 5 measures versus those achieving ≤2). In an international trial population, significant opportunities exist to improve the quality of cardiovascular secondary prevention care among patients

  12. Introduction: Cardiovascular physics

    NASA Astrophysics Data System (ADS)

    Wessel, Niels; Kurths, Jürgen; Ditto, William; Bauernschmitt, Robert

    2007-03-01

    The number of patients suffering from cardiovascular diseases increases unproportionally high with the increase of the human population and aging, leading to very high expenses in the public health system. Therefore, the challenge of cardiovascular physics is to develop high-sophisticated methods which are able to, on the one hand, supplement and replace expensive medical devices and, on the other hand, improve the medical diagnostics with decreasing the patient's risk. Cardiovascular physics-which interconnects medicine, physics, biology, engineering, and mathematics-is based on interdisciplinary collaboration of specialists from the above scientific fields and attempts to gain deeper insights into pathophysiology and treatment options. This paper summarizes advances in cardiovascular physics with emphasis on a workshop held in Bad Honnef, Germany, in May 2005. The meeting attracted an interdisciplinary audience and led to a number of papers covering the main research fields of cardiovascular physics, including data analysis, modeling, and medical application. The variety of problems addressed by this issue underlines the complexity of the cardiovascular system. It could be demonstrated in this Focus Issue, that data analyses and modeling methods from cardiovascular physics have the ability to lead to significant improvements in different medical fields. Consequently, this Focus Issue of Chaos is a status report that may invite all interested readers to join the community and find competent discussion and cooperation partners.

  13. A Mediterranean Diet to Improve Cardiovascular and Cognitive Health: Protocol for a Randomised Controlled Intervention Study.

    PubMed

    Wade, Alexandra T; Davis, Courtney R; Dyer, Kathryn A; Hodgson, Jonathan M; Woodman, Richard J; Keage, Hannah A D; Murphy, Karen J

    2017-02-16

    The Mediterranean diet has demonstrated efficacy for improving cardiovascular and cognitive health. However, a traditional Mediterranean diet delivers fewer serves of dairy and less dietary calcium than is currently recommended in Australia, which may limit long-term sustainability. The present study aims to evaluate whether a Mediterranean diet with adequate dairy and calcium can improve cardiovascular and cognitive function in an at-risk population, and thereby reduce risk of cardiovascular disease (CVD) and cognitive decline. A randomised, controlled, parallel, crossover design trial will compare a Mediterranean diet supplemented with dairy foods against a low-fat control diet. Forty participants with systolic blood pressure above 120 mmHg and at least two other risk factors of CVD will undertake each dietary intervention for eight weeks, with an eight-week washout period between interventions. Systolic blood pressure will be the primary measure of interest. Secondary outcomes will include measures of cardiometabolic health, dietary compliance, cognitive function, assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB), psychological well-being and dementia risk. This research will provide empirical evidence as to whether the Mediterranean diet can be modified to provide recommended dairy and calcium intakes while continuing to deliver positive effects for cardiovascular and cognitive health. The findings will hold relevance for the field of preventative healthcare and may contribute to revisions of national dietary guidelines.

  14. A Mediterranean Diet to Improve Cardiovascular and Cognitive Health: Protocol for a Randomised Controlled Intervention Study

    PubMed Central

    Wade, Alexandra T.; Davis, Courtney R.; Dyer, Kathryn A.; Hodgson, Jonathan M.; Woodman, Richard J.; Keage, Hannah A. D.; Murphy, Karen J.

    2017-01-01

    The Mediterranean diet has demonstrated efficacy for improving cardiovascular and cognitive health. However, a traditional Mediterranean diet delivers fewer serves of dairy and less dietary calcium than is currently recommended in Australia, which may limit long-term sustainability. The present study aims to evaluate whether a Mediterranean diet with adequate dairy and calcium can improve cardiovascular and cognitive function in an at-risk population, and thereby reduce risk of cardiovascular disease (CVD) and cognitive decline. A randomised, controlled, parallel, crossover design trial will compare a Mediterranean diet supplemented with dairy foods against a low-fat control diet. Forty participants with systolic blood pressure above 120 mmHg and at least two other risk factors of CVD will undertake each dietary intervention for eight weeks, with an eight-week washout period between interventions. Systolic blood pressure will be the primary measure of interest. Secondary outcomes will include measures of cardiometabolic health, dietary compliance, cognitive function, assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB), psychological well-being and dementia risk. This research will provide empirical evidence as to whether the Mediterranean diet can be modified to provide recommended dairy and calcium intakes while continuing to deliver positive effects for cardiovascular and cognitive health. The findings will hold relevance for the field of preventative healthcare and may contribute to revisions of national dietary guidelines. PMID:28212320

  15. The Effects of Exercise on Cardiovascular Biomarkers: New Insights, Recent Data, and Applications.

    PubMed

    Che, Lin; Li, Dong

    2017-01-01

    The benefit of regular exercise or physical activity with appropriate intensity on improving cardiopulmonary function and endurance has long been accepted with less controversy. The challenge remains, however, quantitatively evaluate the effect of exercise on cardiovascular health due in part to the amount and intensity of exercise varies widely plus lack of effective, robust and efficient biomarker evaluation systems. Better evaluating the overall function of biomarker and validate biomarkers utility in cardiovascular health should improve the evidence regarding the benefit or the effect of exercise or physical activity on cardiovascular health, in turn increasing the efficiency of the biomarker on individuals with mild to moderate cardiovascular risk. In this review, beyond traditional cytokines, chemokines and inflammatory factors, we systemic reviewed the latest novel biomarkers in metabolomics, genomics, proteomics, and molecular imaging mainly focus on heart health, as well as cardiovascular diseases such as atherosclerosis and ischemic heart disease. Furthermore, we highlight the state-of-the-art biomarker developing techniques and its application in the field of heart health. Finally, we discuss the clinical relevance of physical activity and exercise on key biomarkers in molecular basis and practical considerations.

  16. Sustainability of depression care improvements: success of a practice change improvement collaborative.

    PubMed

    Nease, Donald E; Nutting, Paul A; Graham, Deborah G; Dickinson, W Perry; Gallagher, Kaia M; Jeffcott-Pera, Michelle

    2010-01-01

    Long-term sustainment of improvements in care continues to challenge primary care practices. During the 2 years after of our Improving Depression Care collaborative, we examined how well practices were sustaining their depression care improvements. Our study design used a qualitative interview follow-up of a modified learning collaborative intervention. We conducted telephone interviews with practice champions from 15 of the original 16 practices. Interviews were conducted during a 3-month period in 2008, and were recorded and professionally transcribed. Data on each of the depression care improvements and the change management strategy emphasized during the learning collaborative were summarized after review of the primary data and a consensus process to resolve differing interpretations. During the period from 15 months to 3 years since our project began, depression screening or case finding was sustained in 14 of 15 practices. Thirteen practices sustained use of the 9-item Patient Health Questionnaire for depression monitoring, and one additional practice initiated it. Seven practices initiated self-management support and 2 of 3 practices sustained it. In contrast, tracking and case management proved difficult to sustain, with only 4 of 8 practices continuing this activity. Diffusion of use of the 9-item Patient Health Questionnaire to other clinicians in the practice was maintained in all but 3 practices and expanded in one practice. Six of the practices continued to use the change management strategy, including all 4 of the practices that sustained tracking. Practices demonstrated long-term sustained improvement in depression care with the exception of tracking and care management, which may be a more challenging innovation to sustain. We hypothesize that sustaining complex depression care innovations may require active management by the practice.

  17. [Spanish Adaptation of the 2016 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice].

    PubMed

    Royo-Bordonada, Miguel Angel; Armario, Pedro; Lobos Bejarano, José María; Pedro-Botet, Juan; Villar Álvarez, Fernando; Elosua, Roberto; Brotons Cuixart, Carlos; Cortés, Olga; Serrano, Benilde; Camafort Babkowski, Miguel; Gil Núñez, Antonio; Pérez, Antonio; Maiques, Antonio; de Santiago Nocito, Ana; Castro, Almudena; Alegría, Eduardo; Baeza, Ciro; Herranz, María; Sans, Susana; Campos, Pilar

    2016-11-24

    The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than 10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

  18. Acarbose: safe and effective for lowering postprandial hyperglycaemia and improving cardiovascular outcomes

    PubMed Central

    DiNicolantonio, James J; Bhutani, Jaikrit; O'Keefe, James H

    2015-01-01

    α-Glucosidase inhibitors (AGIs) are a class of oral glucose-lowering drugs used exclusively for treatment or prevention of type 2 diabetes mellitus. AGIs act by altering the intestinal absorption of carbohydrates through inhibition of their conversion into simple sugars (monosaccharides) and thus decrease the bioavailability of carbohydrates in the body, significantly lowering blood glucose levels. The three AGIs used in clinical practice are acarbose, voglibose and miglitol. This review will focus on the cardiovascular properties of acarbose. The current available data suggest that AGIs (particularly acarbose) may be safe and effective for the treatment of prediabetes and diabetes. PMID:26512331

  19. Randomised controlled trial of a 12 week yoga intervention on negative affective states, cardiovascular and cognitive function in post-cardiac rehabilitation patients.

    PubMed

    Yeung, Alan; Kiat, Hosen; Denniss, A Robert; Cheema, Birinder S; Bensoussan, Alan; Machliss, Bianca; Colagiuri, Ben; Chang, Dennis

    2014-10-24

    Negative affective states such as anxiety, depression and stress are significant risk factors for cardiovascular disease, particularly in cardiac and post-cardiac rehabilitation populations.Yoga is a balanced practice of physical exercise, breathing control and meditation that can reduce psychosocial symptoms as well as improve cardiovascular and cognitive function. It has the potential to positively affect multiple disease pathways and may prove to be a practical adjunct to cardiac rehabilitation in further reducing cardiac risk factors as well as improving self-efficacy and post-cardiac rehabilitation adherence to healthy lifestyle behaviours. This is a parallel arm, multi-centre, randomised controlled trial that will assess the outcomes of post- phase 2 cardiac rehabilitation patients assigned to a yoga intervention in comparison to a no-treatment wait-list control group. Participants randomised to the yoga group will engage in a 12 week yoga program comprising of two group based sessions and one self-administered home session each week. Group based sessions will be led by an experienced yoga instructor. This will involve teaching beginner students a hatha yoga sequence that incorporates asana (poses and postures), pranayama (breathing control) and meditation. The primary outcomes of this study are negative affective states of anxiety, depression and stress assessed using the Depression Anxiety Stress Scale. Secondary outcomes include measures of quality of life, and cardiovascular and cognitive function. The cardiovascular outcomes will include blood pressure, heart rate, heart rate variability, pulse wave velocity, carotid intima media thickness measurements, lipid/glucose profiles and C-reactive protein assays. Assessments will be conducted prior to (week 0), mid-way through (week 6) and following the intervention period (week 12) as well as at a four week follow-up (week 16). This study will determine the effect of yoga practice on negative affective states

  20. Effect of improved fitness beyond weight loss on cardiovascular risk factors in individuals with type 2 diabetes in the Look AHEAD study.

    PubMed

    Gibbs, Bethany Barone; Brancati, Frederick L; Chen, Haiying; Coday, Mace; Jakicic, John M; Lewis, Cora E; Stewart, Kerry J; Clark, Jeanne M

    2014-05-01

    Because lifestyle-induced improvements in cardiovascular risk factors vary substantially across individuals with type 2 diabetes, we investigated the extent to which increases in fitness explain cardiovascular risk factor improvements independent of weight loss in a lifestyle intervention. We studied 1-year changes in Look AHEAD, a randomized trial comparing an intensive lifestyle intervention (ILI) to a diabetes support and education (DSE) control group in adults with type 2 diabetes. Assessments included weight, fitness, blood pressure (BP), glucose, HbA1c, and lipids. We evaluated the effects of changes in weight and fitness on changes in cardiovascular risk factors by study arm, using R (2) from multiple linear regression. Analyses included participants with fitness data at baseline and 1-year (n = 4408; 41% male, 36% non-white; mean age 58.7 ± 6.8 years). Weight change alone improved R (2) for explaining changes in risk factors up to 8.2% in ILI and 1.7% in DSE. Fitness change alone improved R (2) up to 3.9% in ILI and 0.8% in DSE. After adjusting for weight change, fitness was independently associated (p < 0.05) with improvements in R (2) for glucose (+0.7%), HbA1c (+1.1%), high-density lipoprotein (HDL) cholesterol (+0.4%), and triglycerides (+0.2%) in ILI and diastolic BP (+0.3%), glucose (+0.3%), HbA1c (+0.4%), and triglycerides (+0.1%) in DSE. Taken together, weight and fitness changes explained from 0.1-9.3% of the variability in cardiovascular risk factor changes. Increased fitness explained statistically significant but small improvements in several cardiovascular risk factors beyond weight loss. Further research identifying other factors that explain cardiovascular risk factor change is needed.

  1. Racial and Ethnic Disparities in Cardiovascular Disease: An Assessment of Obstetrician-Gynecologists' Knowledge, Attitudes, and Practice Patterns.

    PubMed

    Jones, Katherine M; Carter, Michele M; Schulkin, Jay

    2015-06-01

    African American and Hispanic women are disproportionately affected by cardiovascular disease (CVD) and its many risk factors. Obstetrician-gynecologists (OB/GYNs) play an integral role in well-woman care and have a unique opportunity to provide CVD counseling and screening to these at-risk and underserved groups. To assess whether OB/GYN race/ethnicity and OB/GYN practices with increasing minority patient populations predicted differences in OB/GYNs' knowledge, attitudes, and practice patterns relevant to racial/ethnic disparities in CVD. This study also sought to determine provider and patient-related barriers to CVD care. A questionnaire on CVD was mailed to 273 members of The American College of Obstetricians and Gynecologists in March-July 2013. African American and Hispanic OB/GYNs and OB/GYN practices with increasing minority patient populations were more knowledgeable of CVD disparities. These OB/GYNs reported greater concern for minority women's CVD risk relative to White OB/GYNs. Overall, OB/GYNs appear less knowledgeable and concerned with Hispanics' increased CVD risk relative to African Americans'. The most commonly reported provider and patient-related barriers to CVD care were time constraints, patient nonadherence to treatment recommendations, and inadequate training. It is likely that minority OB/GYNs and those with practices with increasing minority patient populations have greater exposure to women at risk for CVD. Dissemination of educational information regarding Hispanic women's CVD risk profile may improve OB/GYN knowledge, counseling, and screening. Increased training in CVD and multicultural competency during medical school and residency should help OB/GYNs overcome what they report as primary barriers to CVD care.

  2. Using "get with the guidelines" to improve cardiovascular secondary prevention.

    PubMed

    LaBresh, Kenneth A; Gliklich, Richard; Liljestrand, James; Peto, Randolph; Ellrodt, A Gray

    2003-10-01

    "Get With The Guidelines (GWTG)" was developed and piloted by the American Heart Association (AHA), New England Affiliate; MassPRO, Inc.; and other organizations to reduce the gap in the application of secondary prevention guidelines in hospitalized cardiovascular disease patients. Collaborative learning programs and technology solutions were created for the project. The interactive Web-based patient management tool (PMT) was developed using quality measures derived from the AHA/American College of Cardiology secondary prevention guidelines. It provided data entry, embedded reminders and guideline summaries, and online reports of quality measure performance, including comparisons with the aggregate performance of all hospitals. Multidisciplinary teams from 24 hospitals participated in the 2000-2001 pilot. Four collaborative learning sessions and monthly conference calls supported team interaction. Best-practices sharing and the use of an Internet tool enabled hospitals to change systems and collect data on 1,738 patients. The GWTG program, a template of learning sessions with didactic presentations, best-practices sharing, and collaborative multidisciplinary team meetings supported by the Internet-based data collection and reporting system, can be extended to multiple regions without requiring additional development. Following the completion of the pilot, the AHA adopted GWTG as a national program.

  3. How Can the Evidence from Global Large-scale Clinical Trials for Cardiovascular Diseases be Improved?

    PubMed

    Sawata, Hiroshi; Tsutani, Kiichiro

    2011-06-29

    Clinical investigations are important for obtaining evidence to improve medical treatment. Large-scale clinical trials with thousands of participants are particularly important for this purpose in cardiovascular diseases. Conducting large-scale clinical trials entails high research costs. This study sought to investigate global trends in large-scale clinical trials in cardiovascular diseases. We searched for trials using clinicaltrials.gov (URL: http://www.clinicaltrials.gov/) using the key words 'cardio' and 'event' in all fields on 10 April, 2010. We then selected trials with 300 or more participants examining cardiovascular diseases. The search revealed 344 trials that met our criteria. Of 344 trials, 71% were randomized controlled trials, 15% involved more than 10,000 participants, and 59% were funded by industry. In RCTs whose results were disclosed, 55% of industry-funded trials and 25% of non-industry funded trials reported statistically significant superiority over control (p = 0.012, 2-sided Fisher's exact test). Our findings highlighted concerns regarding potential bias related to funding sources, and that researchers should be aware of the importance of trial information disclosures and conflicts of interest. We should keep considering management and training regarding information disclosures and conflicts of interest for researchers. This could lead to better clinical evidence and further improvements in the development of medical treatment worldwide.

  4. Cardiovascular health knowledge, attitude and practice/behaviour in an urbanising community of Nepal: a population-based cross-sectional study from Jhaukhel-Duwakot Health Demographic Surveillance Site

    PubMed Central

    Vaidya, Abhinav; Aryal, Umesh Raj; Krettek, Alexandra

    2013-01-01

    Objectives This study determined the knowledge, attitude and practice/behaviour of cardiovascular health in residents of a semiurban community of Nepal. Design To increase the understanding of knowledge, attitude and practice/behaviour towards cardiovascular health, we conducted in-home interviews using a questionnaire based on the WHO STEPwise approach to surveillance and other resources, scoring all responses. We also recorded blood pressure and took anthropometric measurements. Setting Our study was conducted as part of the Heart-Health-Associated Research and Dissemination in the Community project in the Jhaukhel-Duwakot Health Demographic Surveillance Site in two urbanising villages near Kathmandu. Participants The study population included 777 respondents from six randomly selected clusters in both villages. Results Seventy per cent of all participants were women and 26.9% lacked formal education. The burden of cardiovascular risk factors was high; 20.1% were current smokers, 43.3% exhibited low physical activity and 21.6% were hypertensive. Participants showed only poor knowledge of heart disease causes; 29.7% identified hypertension and 11% identified overweight and physical activity as causes, whereas only 2.2% identified high blood sugar as causative. Around 60% of respondents did not know any heart attack symptoms compared with 20% who knew 2–4 symptoms. Median percentage scores for knowledge, attitude and practice/behaviour were 79.3, 74.3 and 48, respectively. Nearly 44% of respondents had insufficient knowledge and less than 20% had highly satisfactory knowledge. Among those with highly satisfactory knowledge, only 14.7% had a highly satisfactory attitude and 19.5% and 13.9% had satisfactory and highly satisfactory practices, respectively. Conclusions Our study demonstrates a gap between cardiovascular health knowledge, attitude and practice/behaviour in a semiurban community in a low-income nation, even among those already affected by

  5. CPAP Treatment Supported by Telemedicine Does Not Improve Blood Pressure in High Cardiovascular Risk OSA Patients: A Randomized, Controlled Trial

    PubMed Central

    Mendelson, Monique; Vivodtzev, Isabelle; Tamisier, Renaud; Laplaud, David; Dias-Domingos, Sonia; Baguet, Jean-Philippe; Moreau, Laurent; Koltes, Christian; Chavez, Léonidas; De Lamberterie, Gilles; Herengt, Frédéric; Levy, Patrick; Flore, Patrice; Pépin, Jean-Louis

    2014-01-01

    Study Objectives: Obstructive sleep apnea (OSA) has been associated with hypertension, which is one of the intermediary mechanisms leading to increased cardiovascular morbidity. This study aimed at evaluating the effects of a combination of continuous positive airway pressure (CPAP) and telemedicine support on blood pressure (BP) reduction in high cardiovascular risk OSA patients. Design: A multi-center randomized controlled trial that compared standard CPAP care and CPAP care and a telemedicine intervention. Setting: Sleep clinics in France. Patients or Participants: 107 adult (18-65 years old) OSA patients (AHI > 15 events/h) with a high cardiovascular risk (cardiovascular SCORE > 5% or secondary prevention). Interventions: Patients were randomized to either standard care CPAP (n = 53) or CPAP and telemedicine (n = 54). Patients assigned to telemedicine were equipped with a smartphone for uploading BP measurements, CPAP adherence, sleepiness, and quality of life data; in return, they received pictograms containing health-related messages. Measurements: The main outcome was home self-measured BP and secondary outcomes were cardiovascular risk evolution, objective physical activity, CPAP adherence, sleepiness and quality of life. Results: Self-measured BP did not improve in either group (telemedicine or standard care). Patients in primary prevention showed greater BP reduction with CPAP treatment than those in secondary prevention. Conclusions: CPAP treatment supported by telemedicine alone did not improve blood pressure and cardiovascular risk in high cardiovascular risk OSA patients. This study emphasizes the need for diet and physical activity training programs in addition to CPAP when aiming at decreasing cardiometabolic risk factors in these patients. Clinical Trials Registration: ClinicalTrials.gov identifier: NCT01226641. Citation: Mendelson M, Vivodtzev I, Tamisier R, Laplaud D, Dias-Domingos S, Baguet JP, Moreau L, Koltes C, Chavez L, De Lamberterie G

  6. A comprehensive review of adherence to diabetes and cardiovascular medications in Iran; implications for practice and research

    PubMed Central

    2013-01-01

    Treatment of diseases such as diabetes mellitus and cardiovascular disorders are highly dependent on medications and particularly adherence to medications to achieve optimal pharmacotherapy outcomes. Several factors can affect a patient’s adherence including: knowledge and beliefs about their illness and medications, concomitant psychological disorders, type of therapeutic regimen, and lack of access to medicines. In Iran, a middle income country, essential medicines are highly available and affordable. However, adherence to medications has not been emphasized especially for patients with diabetes and cardiovascular diseases. In the present study, we reviewed the available literature on adherence to medications used to treat diabetes and cardiovascular disorders in Iran. We systematically searched Scopus, Web of Science, PubMed, CINAHL, Google Scholar, Scientific Information Database, and IranMedex using a highly sensitive protocol on July 2012. We retrieved 1003 citations; and two independent researchers screened them for relevant publications. Studies were included if they reported rate or determinants of adherence to diabetes mellitus and cardiovascular medications. Trials on improving interventions were also included. The quality of studies was assessed using appropriate guidelines. Fourteen studies were eligible for data extraction and review. The definition of adherence and the measurement tools used were unclear among studies. Methodological caveats including inappropriate sample size, sampling methods, inclusion/exclusion criteria, and high rate of loss to follow-up were also observed. Nevertheless, adherence rate was reported to be 62.8-86.3% for oral hypoglycemic medications and 38.8-60.0% for cardiovascular medicines. Forgetfulness, lack of knowledge about medical condition and prescribed medications, and concerns about medications efficacy and side effects were consistently reported as barriers to adherence. Patient education plus telephone or short

  7. Protocol for the 'e-Nudge trial': a randomised controlled trial of electronic feedback to reduce the cardiovascular risk of individuals in general practice [ISRCTN64828380

    PubMed Central

    Holt, Tim A; Thorogood, Margaret; Griffiths, Frances; Munday, Stephen

    2006-01-01

    Background Cardiovascular disease (including coronary heart disease and stroke) is a major cause of death and disability in the United Kingdom, and is to a large extent preventable, by lifestyle modification and drug therapy. The recent standardisation of electronic codes for cardiovascular risk variables through the United Kingdom's new General Practice contract provides an opportunity for the application of risk algorithms to identify high risk individuals. This randomised controlled trial will test the benefits of an automated system of alert messages and practice searches to identify those at highest risk of cardiovascular disease in primary care databases. Design Patients over 50 years old in practice databases will be randomised to the intervention group that will receive the alert messages and searches, and a control group who will continue to receive usual care. In addition to those at high estimated risk, potentially high risk patients will be identified who have insufficient data to allow a risk estimate to be made. Further groups identified will be those with possible undiagnosed diabetes, based either on elevated past recorded blood glucose measurements, or an absence of recent blood glucose measurement in those with established cardiovascular disease. Outcome measures The intervention will be applied for two years, and outcome data will be collected for a further year. The primary outcome measure will be the annual rate of cardiovascular events in the intervention and control arms of the study. Secondary measures include the proportion of patients at high estimated cardiovascular risk, the proportion of patients with missing data for a risk estimate, and the proportion with undefined diabetes status at the end of the trial. PMID:16646967

  8. A Narrative Review of How Sleep Related Breathing Disorders and Cardiovascular Diseases are Linked: An update for advanced practice registered nurses

    PubMed Central

    Phelan, Cynthia H.; Lauver, Diane R.; Bratzke, Lisa C.

    2016-01-01

    Purpose/ Objectives Sleep-related breathing disorders (SRBDs), including obstructive sleep apnea and central sleep apnea, are common among patients with cardiovascular disease (CVD), but clinicians often do not pay enough attention to SRBDs. The purpose of this narrative review is to update advanced practice registered nurses (APRNs) on the literature focusing on the relationship between SRBDs and CVD (e.g., hypertension, heart failure, coronary artery disease, arrhythmias, and stroke) and on treatments that can improve SRBDs in patients with CVD. Description of the project We conducted an electronic search of the literature published between1980 and 2016 from PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Academic Search Premier, and related health resources websites to address the aims of this study. Outcomes Fifty-six primary research articles (42 observational studies and 14 experimental and quasi-experimental studies) were selected based on our study aims and inclusion criteria. The studies revealed that individuals with CVD are at a greater risk for SRBDs and that SRBDs can worsen CVD. The findings from the studies also suggest that positive airway treatment could improve both SRBDs and CVD. Conclusions This review found a close relationship between SRBDs and CVD. APRNs are in key positions to identify and help patients manage SRBDs. In particular, APRNs can educate staff and establish standards of practice to improve outcomes for CVD patients. PMID:27753673

  9. Register-Recall Systems: Tools for Chronic Disease Management in General Practice.

    PubMed

    Georgiou, Andrew; Burns, Joan; Penn, Danielle; Infante, Fernando; Harris, Mark

    2004-09-01

    The Divisions Diabetes and Cardiovascular Disease Quality Improvement Project (DDCQIP) is a national project that aims to promote quality improvement initiatives among Divisions of General Practice. DDCQIP has investigated the growth of Division-based diabetes and cardiovascular disease register-recall systems and the role they play in promoting evidence-based structured care within general practice. In the period 2000-2002, an increase in the number of GPs using register-recall systems and the rise in the number of active registered patients have made it possible to monitor quality of care and health outcome indicators, and contributed to the growth of a Division-based population health program.

  10. Practice management companies improve practices' financial position.

    PubMed

    Dupell, T

    1997-11-01

    To maintain control over healthcare delivery and financial decisions, as well as increase access to capital markets, some group practices are forming their own physician practice management companies. These companies should be organized to balance the expectations of physicians with the values of capital markets. This organization should include retained earnings, financial reporting in accordance with generally accepted accounting principles (GAAP), predictable earnings and cash flow, physician ownership and leadership, and incentives for high-quality management. Three large, primary care and multispecialty clinics that merged to form a new physician practice management company increased their access to capital markets and improved their overall financial position, which will help them achieve long-term survival.

  11. Improvement in circulation and in cardiovascular risk factors with a proprietary isotonic bioflavonoid formula OPC-3.

    PubMed

    Cesarone, Maria R; Di Renzo, Andrea; Errichi, Silvia; Schönlau, Frank; Wilmer, James L; Blumenfeld, Julian

    2008-01-01

    This study investigated the efficacy of isotonic bioflavonoid supplementation, OPC-3 on 61 individuals presenting with risk factors meeting the criteria for metabolic syndrome. Subjects were supplemented with a proprietary isotonic bioflavonoid OPC-3 or placebo over 2 months. Plasma oxidative stress status was significantly lowered by 10.1% with OPC-3. All major cardiovascular risk factors were improved with blood pressure, total cholesterol, and fasting blood glucose lowered. OPC-3 significantly improved endothelial function as evaluated by increased vasorelaxation in reactive hyperemia and enhanced diastolic carotid artery flow. Cardiac ultrasound scanning revealed a significant increase of left ventricular ejection fraction. Skin microcirculation was enhanced, and better tissue perfusion led to significantly increased transcutaneous oxygen partial pressure and decreased pCO(2). With OPC-3 a dramatic and significant plasma C-reactive protein decrease by 52.1% occurred. Individuals may improve key cardiovascular risk factors by daily supplementation with the bioflavonoid OPC-3 as an important part of a healthier lifestyle.

  12. Effectiveness of a quality-improvement program in improving management of primary care practices.

    PubMed

    Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja

    2011-12-13

    The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. In a before-after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group's second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the Europeaen Practice Assessment.

  13. The women's heart health programme: a pilot trial of sex-specific cardiovascular management.

    PubMed

    Low, Ting Ting; Chan, Siew Pang; Wai, Shin Hnin; Ang, Zhou; Kyu, Kyu; Lee, Kim Yee; Ching, Anne; Comer, Sarah; Tan, Naomi Qiu Pin; Thong, Elizabeth Grace Hui En; Nang, Tracy; Dutta, Mohan; Lam, Carolyn S P

    2018-04-16

    There is increasing knowledge of sex-specific differences in cardiovascular disease and recognition of sex disparities in management. In our study, we investigated whether a cardiovascular programme tailored to the specific needs of women could lead to improved outcomes. We randomised 100 female patients to receive cardiology follow-up with the conventional sex-neutral cardiac programme (control), or the sex-tailored Women's Heart Health Programme (intervention). The intervention group was managed by an all-women multidisciplinary team and received culture-centred health intervention workshops, designed through in-depth interviews with the participants. The primary outcome was cardiovascular risk factor improvement at 1 year. Secondary outcomes include cardiovascular event rates, quality of life scores, and self-reported improvement in knowledge, attitudes, intentions and practices. Generalised structural equation model analysis was used to determine if the intervention group had better outcomes at alpha level 0.1. The mean age was 67.3 ± 12.7 years, with an ethnic distribution of 70% Chinese, 18% Malays, and 12% Indians. The majority of these patients had no formal or primary level of education (63%), and were mostly unemployed (78%). Patients in intervention group had better control of diabetes mellitus (lower HbA1c of 0.63% [CI 0.21-1.04], p = 0.015) and lower body-mass-index (0.74 kg/m 2 [CI 0.02-1.46], p = 0.092) at 1 year, but there was no significant difference in blood pressure or lipid control. Overall, there was a trend towards better risk factor control, 31.6% of intervention group versus 26.5% of control group achieved improvement in at least 1 CV risk factor control to target range. There was no significant difference in incidence of cardiovascular events, quality of life, or domains in knowledge, attitudes, intention and practices. This pilot study is the first of its kind evaluating a new model of care for women with heart disease

  14. [Life style advice provided by primary health care to prevent cardiovascular diseases].

    PubMed

    Meland, E; Ellekjaer, H; Gjelsvik, B; Kimsås, A; Holmen, J; Hetlevik, I

    2000-09-20

    The Working Group on Hypertension of the Norwegian College of General Practitioners reports in this paper on the documentation on behavioural advice in the prevention of cardiovascular disease. Emphasis is given to hypertension. The recommendations are mainly based on updated metaanalyses and randomised controlled trials. Hypertension is treated to prevent cardiovascular disease; that is why we put emphasis on documentation with significant end points. The validity of the documentation for general practice is assessed. We have also assessed whether certain methods or theories for behavioural change could be helpful to the general practitioner. The value of advice against smoking, dietary advice (increased intake of grain products, vegetables, fruit, poultry and fish), and advice about exercise are well documented and applicable in general practice. Respect for the patient's autonomy and interest in the patients and their health-related habits seem to be important factors for improving doctor's chances of influencing patient behaviour. The value of life-style advice is well documented and should play an important role in clinical strategies to prevent cardiovascular disease in high-risk patients.

  15. Improving cardiovascular care through outpatient cardiac rehabilitation: an analysis of payment models that would improve quality and promote use.

    PubMed

    Mead, Holly; Grantham, Sarah; Siegel, Bruce

    2014-01-01

    Much attention has been paid to improving the care of patients with cardiovascular disease by focusing attention on delivery system redesign and payment reforms that encompass the healthcare spectrum, from an acute episode to maintenance of care. However, 1 area of cardiovascular disease care that has received little attention in the advancement of quality is cardiac rehabilitation (CR), a comprehensive secondary prevention program that is significantly underused despite evidence-based guidelines that recommending its use. The purpose of this article was to analyze the applicability of 2 payment and reimbursement models-pay-for-performance and bundled payments for episodes of care--that can promote the use of CR. We conclude that a payment model combining elements of both pay-for-performance and episodes of care would increase the use of CR, which would both improve quality and increase efficiency in cardiac care. Specific elements would need to be clearly defined, however, including: (a) how an episode is defined, (b) how to hold providers accountable for the care they provider, (c) how to encourage participation among CR providers, and (d) how to determine an equitable distribution of payment. Demonstrations testing new payment models must be implemented to generate empirical evidence that a melded pay-for-performance and episode-based care payment model will improve quality and efficiency.

  16. Designing a Large-Scale Multilevel Improvement Initiative: The Improving Performance in Practice Program

    ERIC Educational Resources Information Center

    Margolis, Peter A.; DeWalt, Darren A.; Simon, Janet E.; Horowitz, Sheldon; Scoville, Richard; Kahn, Norman; Perelman, Robert; Bagley, Bruce; Miles, Paul

    2010-01-01

    Improving Performance in Practice (IPIP) is a large system intervention designed to align efforts and motivate the creation of a tiered system of improvement at the national, state, practice, and patient levels, assisting primary-care physicians and their practice teams to assess and measurably improve the quality of care for chronic illness and…

  17. Cardiovascular simulator improvement: pressure versus volume loop assessment.

    PubMed

    Fonseca, Jeison; Andrade, Aron; Nicolosi, Denys E C; Biscegli, José F; Leme, Juliana; Legendre, Daniel; Bock, Eduardo; Lucchi, Julio Cesar

    2011-05-01

    This article presents improvement on a physical cardiovascular simulator (PCS) system. Intraventricular pressure versus intraventricular volume (PxV) loop was obtained to evaluate performance of a pulsatile chamber mimicking the human left ventricle. PxV loop shows heart contractility and is normally used to evaluate heart performance. In many heart diseases, the stroke volume decreases because of low heart contractility. This pathological situation must be simulated by the PCS in order to evaluate the assistance provided by a ventricular assist device (VAD). The PCS system is automatically controlled by a computer and is an auxiliary tool for VAD control strategies development. This PCS system is according to a Windkessel model where lumped parameters are used for cardiovascular system analysis. Peripheral resistance, arteries compliance, and fluid inertance are simulated. The simulator has an actuator with a roller screw and brushless direct current motor, and the stroke volume is regulated by the actuator displacement. Internal pressure and volume measurements are monitored to obtain the PxV loop. Left chamber internal pressure is directly obtained by pressure transducer; however, internal volume has been obtained indirectly by using a linear variable differential transformer, which senses the diaphragm displacement. Correlations between the internal volume and diaphragm position are made. LabVIEW integrates these signals and shows the pressure versus internal volume loop. The results that have been obtained from the PCS system show PxV loops at different ventricle elastances, making possible the simulation of pathological situations. A preliminary test with a pulsatile VAD attached to PCS system was made. © 2011, Copyright the Authors. Artificial Organs © 2011, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  18. microRNA in Cardiovascular Aging and Age-Related Cardiovascular Diseases

    PubMed Central

    de Lucia, Claudio; Komici, Klara; Borghetti, Giulia; Femminella, Grazia Daniela; Bencivenga, Leonardo; Cannavo, Alessandro; Corbi, Graziamaria; Ferrara, Nicola; Houser, Steven R.; Koch, Walter J.; Rengo, Giuseppe

    2017-01-01

    Over the last decades, life expectancy has significantly increased although several chronic diseases persist in the population, with aging as the leading risk factor. Despite improvements in diagnosis and treatment, many elderlies suffer from cardiovascular problems that are much more frequent in an older, more fragile organism. In the long term, age-related cardiovascular diseases (CVDs) contribute to the decline of quality of life and ability to perform normal activities of daily living. microRNAs (miRNAs) are a class of small non-coding RNAs that regulate gene expression at the posttranscriptional level in both physiological and pathological conditions. In this review, we will focus on the role of miRNAs in aging and age-related CVDs as heart failure, hypertension, atherosclerosis, atrial fibrillation, and diabetes mellitus. miRNAs are key regulators of complex biological mechanisms, representing an exciting potential therapeutic target in CVDs. Moreover, one major challenge in geriatric medicine is to find reliable biomarkers for diagnosis, prognosis, and prediction of the response to specific drugs. miRNAs represent a very promising tool due to their stability in the circulation and unique signature in CVDs. However, further studies are needed to investigate their translational potential in the real clinical practice. PMID:28660188

  19. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice].

    PubMed

    Royo-Bordonada, Miguel Ángel; Armario, Pedro; Lobos Bejarano, José María; Pedro-Botet, Juan; Villar Álvarez, Fernando; Elosua, Roberto; Brotons Cuixart, Carlos; Cortés, Olga; Serrano, Benilde; Camafort Babkowski, Miguel; Gil Núñez, Antonio; Pérez, Antonio; Maiques, Antonio; de Santiago Nocito, Ana; de Castro, Almudena; Alegría, Eduardo; Baeza, Ciro; Herranz, María; Sans, Susana; Campos, Pilar

    The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  20. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice].

    PubMed

    Royo-Bordonada, M Á; Armario, P; Lobos Bejarano, J M; Pedro-Botet, J; Villar Alvarez, F; Elosua, R; Brotons Cuixart, C; Cortés, O; Serrano, B; Cammafort Babkowski, M; Gil Núñez, A; Pérez, A; Maiques, A; de Santiago Nocito, A; Castro, A; Alegría, E; Baeza, C; Herranz, M; Sans, S; Campos, P

    The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  1. Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice.

    PubMed

    Royo-Bordonada, M Á; Armario, P; Lobos Bejarano, J M; Pedro-Botet, J; Villar Alvarez, F; Elosua, R; Brotons Cuixart, C; Cortés, O; Serrano, B; Camafort Babkowski, M; Gil Núñez, A; Pérez, A; Maiques, A; de Santiago Nocito, A; Castro, A; Alegría, E; Baeza, C; Herranz, M; Sans, S; Campos, P

    The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  2. Strategies to improve adherence to medications for cardiovascular diseases in socioeconomically disadvantaged populations: a systematic review.

    PubMed

    Laba, Tracey-Lea; Bleasel, Jonathan; Brien, Jo-Anne; Cass, Alan; Howard, Kirsten; Peiris, David; Redfern, Julie; Salam, Abdul; Usherwood, Tim; Jan, Stephen

    2013-09-10

    Medication non-adherence poses a major barrier to reducing cardiovascular disease (CVD) burden globally, and is increasingly recognised as a socioeconomically determined problem. Strategies promoting CVD medication adherence appear of moderate effectiveness and cost-effectiveness. Potentially, 'one-size-fits-all' measures are ill-equipped to address heterogeneous adherence behaviour between social groups. This review aims to determine the effects of strategies to improve adherence to CVD-related medications in socioeconomically disadvantaged groups. Randomised/quasi-randomised controlled trials (1996-June 2012, English), testing strategies to increase adherence to CVD-related medications prescribed to adult patients who may experience health inequity (place of residence, occupation, education, or socioeconomic position) were reviewed. 772 abstracts were screened, 111 full-text articles retrieved, and 16 full-text articles reporting on 14 studies, involving 7739 patients (age range 41-66 years), were included. Methodological and clinical heterogeneity precluded quantitative data synthesis. Studies were thematically grouped by targeted outcomes; underlying interventions and policies were classified using Michie et al.'s Behaviour Change Wheel. Contrasting with patient or physician/practice strategies, those simultaneously directed at patients and physicians/practices resulted in statistically significant improvements in relative adherence (16-169%). Comparative cost and cost-effectiveness analyses from three studies did not find cost-saving or cost-effective strategies. Unlike much current evidence in general populations, promising evidence exists about what strategies improve adherence in disadvantaged groups. These strategies were generally complex: simultaneously targeting patients and physicians; addressing social, financial, and treatment-related adherence barriers; and supported by broader guidelines, regulatory and communication-based policies. Given their

  3. Chronic treatment with tadalafil improves endothelial function in men with increased cardiovascular risk.

    PubMed

    Rosano, Giuseppe M C; Aversa, Antonio; Vitale, Cristiana; Fabbri, Andrea; Fini, Massimo; Spera, Giovanni

    2005-02-01

    Erectile dysfunction (ED) is often associated with a cluster of risk factors for coronary artery disease and reduced endothelial function. Acute and chronic administration of oral sildenafil, a phosphodiesterase type 5 (PDE5) inhibitor, improves endothelial function in patients with ED. Tadalafil (TAD) is a new PDE5 inhibitor with a long half life that allows alternate day administration. Aim of the study was to evaluate whether chronic therapy (4 weeks) with TAD improves endothelial function in patients with increased cardiovascular risk and whether this effect is sustained after discontinuation of therapy. We randomized 32 patients with increased cardiovascular risk to receive either TAD 20 mg on alternate days or matching placebo (PLB) for 4 weeks. Patients underwent evaluation of brachial artery flow-mediated dilation (FMD), nitrite/nitrate and endothelin-1 plasma levels at baseline, at the end of treatment period and after two-weeks follow-up. At 4 weeks, FMD was significantly improved by TAD (from 4.2+/-3.2 to 9.3+/-3.7%, p<0.01 vs. baseline), but was not modified by PLB (from 4.1+/-2.8 to 4.0+/-3.4%, p=NS). At 6 weeks the benefit in FMD was sustained in patients that received TAD (9.1+/-3.9% vs. 4.2+/-3.2%, p=0.01 vs. baseline; 9.1+/-3.9% vs. 9.3+/-3.7%, vs. 4 weeks, p=NS) while no changes in FMD were observed in patients randomized to PLB. Also, compared to baseline, a net increase in nitrite/nitrate levels (38.2+/-12.3 vs. 52.6+/-11.7 and 51.1+/-3.1, p<0.05) and a decrease in endothelin-1 levels (3.3+/-0.9 vs. 2.9.+/-0.7 and 2.9+/-0.9, p<0.05) was found both at four and six-weeks after TAD; these changes were inversely correlated as shown by regression analysis (adjusted R2=0.81, p<0.0001). Chronic therapy with TAD improves endothelial function in patients with increased cardiovascular risk regardless their degree of ED. The benefit of this therapy is sustained for at least two weeks after the discontinuation of therapy. Larger studies are needed in order

  4. Practice-based learning can improve osteoporosis care.

    PubMed

    Hess, Brian J; Johnston, Mary M; Iobst, William F; Lipner, Rebecca S

    2013-10-01

    To examine physician engagement in practice-based learning using a self-evaluation module to assess and improve their care of individuals with or at risk of osteoporosis. Retrospective cohort study. Internal medicine and subspecialty clinics. Eight hundred fifty U.S. physicians with time-limited certification in general internal medicine or a subspecialty. Performance rates on 23 process measures and seven practice system domain scores were obtained from the American Board of Internal Medicine (ABIM) Osteoporosis Practice Improvement Module (PIM), an Internet-based self-assessment module that physicians use to improve performance on one targeted measure. Physicians remeasured performance on their targeted measures by conducting another medical chart review. Variability in performance on measures was found, with observed differences between general internists, geriatricians, and rheumatologists. Some practice system elements were modestly associated with measure performance; the largest association was between providing patient-centered self-care support and documentation of calcium intake and vitamin D estimation and counseling (correlation coefficients from 0.20 to 0.28, Ps < .002). For all practice types, the most commonly selected measure targeted for improvement was documentation of vitamin D level (38% of physicians). On average, physicians reported significant and large increases in performance on measures targeted for improvement. Gaps exist in the quality of osteoporosis care, and physicians can apply practice-based learning using the ABIM PIM to take action to improve the quality of care. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  5. International quality improvement initiatives.

    PubMed

    Hickey, Patricia A; Connor, Jean A; Cherian, Kotturathu M; Jenkins, Kathy; Doherty, Kaitlin; Zhang, Haibo; Gaies, Michael; Pasquali, Sara; Tabbutt, Sarah; St Louis, James D; Sarris, George E; Kurosawa, Hiromi; Jonas, Richard A; Sandoval, Nestor; Tchervenkov, Christo I; Jacobs, Jeffery P; Stellin, Giovanni; Kirklin, James K; Garg, Rajnish; Vener, David F

    2017-12-01

    Across the globe, the implementation of quality improvement science and collaborative learning has positively affected the care and outcomes for children born with CHD. These efforts have advanced the collective expertise and performance of inter-professional healthcare teams. In this review, we highlight selected quality improvement initiatives and strategies impacting the field of cardiovascular care and describe implications for future practice and research. The continued leveraging of technology, commitment to data transparency, focus on team-based practice, and recognition of cultural norms and preferences ensure the success of sustainable models of global collaboration.

  6. An encapsulated juice powder concentrate improves markers of pulmonary function and cardiovascular risk factors in heavy smokers.

    PubMed

    Bamonti, Fabrizia; Pellegatta, Marco; Novembrino, Cristina; Vigna, Luisella; De Giuseppe, Rachele; de Liso, Federica; Gregori, Dario; Noce, Cinzia Della; Patrini, Lorenzo; Schiraldi, Gianfranco; Bonara, Paola; Calvelli, Laura; Maiavacca, Rita; Cighetti, Giuliana

    2013-01-01

    Cigarette smoking is associated with reduced pulmonary function and increased risk factors for cardiovascular disease. This randomized placebo-controlled double-blind study evaluated the effects of two different combinations of mixed fruit and vegetable juice powder concentrate (Juice Plus+, NSA, Collierville, TN) on heavy smokers. At baseline (T 0) and after 3 months' supplementation (T 1), pulmonary function parameters and cardiovascular risk factors-that is, plasma total homocysteine (tHcy) with related B vitamins and cysteine (tCys) concentrations-were assessed in 75 apparently healthy smokers (aged 49.2 ± 10.6 years, >20 cigarettes/d, duration ≥10 years) randomized into 3 groups: placebo (P), fruit/vegetable (FV) and fruit/vegetable/berry (FVB). T 0: most smokers showed abnormalities in tHcy and tCys concentrations. T 1: respiratory function was unchanged in P and slightly, but not significantly, improved in FV, whereas FVB showed a significant improvement in forced expiratory flow at 25% (FEF25; p < 0.0001 vs P and FV) and significant improvement in CO diffusion lung/alveolar volume (DLCO/VA). FV and FVB (50%) showed significant reduction in tHcy and tCys compared to T 0 ( p < 0.0001) and P ( p < 0.0001). At T 1, both supplemented groups, but to a greater extent the FVB group, showed improvements in some pulmonary parameters, cardiovascular risk factors, and folate status. The beneficial effects of Juice Plus+ supplementation could potentially help smokers, even if smoking cessation is advisable.

  7. CPAP treatment supported by telemedicine does not improve blood pressure in high cardiovascular risk OSA patients: a randomized, controlled trial.

    PubMed

    Mendelson, Monique; Vivodtzev, Isabelle; Tamisier, Renaud; Laplaud, David; Dias-Domingos, Sonia; Baguet, Jean-Philippe; Moreau, Laurent; Koltes, Christian; Chavez, Léonidas; De Lamberterie, Gilles; Herengt, Frédéric; Levy, Patrick; Flore, Patrice; Pépin, Jean-Louis

    2014-11-01

    Obstructive sleep apnea (OSA) has been associated with hypertension, which is one of the intermediary mechanisms leading to increased cardiovascular morbidity. This study aimed at evaluating the effects of a combination of continuous positive airway pressure (CPAP) and telemedicine support on blood pressure (BP) reduction in high cardiovascular risk OSA patients. A multi-center randomized controlled trial that compared standard CPAP care and CPAP care and a telemedicine intervention. Sleep clinics in France. 107 adult (18-65 years old) OSA patients (AHI > 15 events/h) with a high cardiovascular risk (cardiovascular SCORE > 5% or secondary prevention). Patients were randomized to either standard care CPAP (n = 53) or CPAP and telemedicine (n = 54). Patients assigned to telemedicine were equipped with a smartphone for uploading BP measurements, CPAP adherence, sleepiness, and quality of life data; in return, they received pictograms containing health-related messages. The main outcome was home self-measured BP and secondary outcomes were cardiovascular risk evolution, objective physical activity, CPAP adherence, sleepiness and quality of life. Self-measured BP did not improve in either group (telemedicine or standard care). Patients in primary prevention showed greater BP reduction with CPAP treatment than those in secondary prevention. CPAP treatment supported by telemedicine alone did not improve blood pressure and cardiovascular risk in high cardiovascular risk OSA patients. This study emphasizes the need for diet and physical activity training programs in addition to CPAP when aiming at decreasing cardiometabolic risk factors in these patients. ClinicalTrials.gov identifier: NCT01226641.

  8. Does fitness improve the cardiovascular risk profile in obese subjects?

    PubMed

    Halland, H; Lønnebakken, M T; Saeed, S; Midtbø, H; Cramariuc, D; Gerdts, E

    2017-06-01

    Good cardiorespiratory fitness has been suggested to reduce the risk of cardiovascular disease in obesity. We explored the association of fitness with the prevalences of major cardiovascular risk factor like hypertension (HT), diabetes and metabolic syndrome (MetS) in overweight and obese subjects. Clinical data from 491 participants in the FAT associated CardiOvasculaR dysfunction (FATCOR) study were analyzed. Physical fitness was assessed by ergospirometry, and subjects with at least good level of performance for age and sex were classified as fit. HT subtypes were identified from clinic and 24-h ambulatory blood pressure in combination. Diabetes was diagnosed by oral glucose tolerance test. MetS was defined by the American Heart Association and National Heart, Lung and Blood Institute criteria. The participants were on average 48 years old (60% women), and mean body mass index (BMI) was 32 kg/m 2 . 28% of study participants were classified as fit. Fitness was not associated with lower prevalences of HT or HT subtypes, diabetes, MetS or individual MetS components (all p > 0.05). In multivariable regression analysis, being fit was characterized by lower waist circumference, BMI < 30 kg/m 2 , non-smoking and a higher muscle mass (all p < 0.05). In the FATCOR population, fitness was not associated with a lower prevalence of major cardiovascular risk factors like HT, diabetes or MetS. Given the strong association of cardiovascular risk factor burden with risk of clinical cardiovascular disease, these findings challenge the notion that fitness alone is associated with lower risk of cardiovascular disease in obesity. Copyright © 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

  9. Opinions of community pharmacists on the value of a cardiovascular polypill as a means of improving medication compliance.

    PubMed

    Burns, Kharis; Turnbull, Fiona; Patel, Anushka; Peiris, David

    2012-06-01

    Cardiovascular disease is a major public health problem despite established treatment guidelines and significant healthcare expenditure worldwide. Poor medication compliance accounts in part for some of the observed evidence/practice gaps. Trials of fixed-dose combination pills are currently underway, but the attitudes of relevant health professionals to the routine use of a cardiovascular polypill are generally unknown. Pharmacists are a group of providers who play an important role in patient compliance with long-term medications. The objective was to identify the main perceived barriers to compliance and to investigate pharmacists' opinions regarding the routine use of a cardiovascular polypill. The setting was community pharmacies in the metropolitan and greater areas of New South Wales, Australia. Structured questionnaires were administered to a random sample of community pharmacists and peer-to-peer, semi-structured interviews were conducted with a sub-sample. Quantitative data were analysed using SPSS V16.0 and interviews were analysed thematically. Questionnaires were completed by 72 of the 250 pharmacists invited to participate. The major barrier to cardiovascular medication compliance identified by respondents was polypharmacy. Other barriers included patient disinterest, time constraints and costs. Most pharmacists agreed that a cardiovascular polypill could be one potential solution to poor compliance by simplifying the treatment regimen (73.6% agreed) and reducing patient costs (79.2% agreed). Inability to tailor treatment and to ascribe side effects was among some of the identified concerns. The use of a cardiovascular polypill as a means of increasing patient compliance with long-term cardiovascular preventive therapies is seen as potentially valuable by community pharmacists. © 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society.

  10. A randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes.

    PubMed

    Rothman, Russell L; Malone, Robb; Bryant, Betsy; Shintani, Ayumi K; Crigler, Britton; Dewalt, Darren A; Dittus, Robert S; Weinberger, Morris; Pignone, Michael P

    2005-03-01

    To assess the efficacy of a pharmacist-led, primary care-based, disease management program to improve cardiovascular risk factors and glycated hemoglobin (A(1C)) levels in vulnerable patients with poorly controlled diabetes. A randomized controlled trial of 217 patients with type 2 diabetes and poor glycemic control (A(1C) level >or=8.0%) was conducted at an academic general medicine practice from February 2001 to April 2003. Intervention patients received intensive management from clinical pharmacists, as well as from a diabetes care coordinator who provided diabetes education, applied algorithms for managing glucose control and decreasing cardiovascular risk factors, and addressed barriers to care. Control patients received a one-time management session from a pharmacist followed by usual care from their primary care provider. Outcomes were recorded at baseline and at 6 and 12 months. Primary outcomes included blood pressure, A(1C) level, cholesterol level, and aspirin use. Secondary outcomes included diabetes knowledge, satisfaction, use of clinical services, and adverse events. For the 194 patients (89%) with 12-month data, the intervention group had significantly greater improvement than did the control group for systolic blood pressure (-9 mm Hg; 95% confidence interval [CI]: -16 to -3 mm Hg) and A(1C) level (-0.8%; 95% CI: -1.7% to 0%). Change in total cholesterol level was not significant. At 12 months, aspirin use was 91% in the intervention group versus 58% among controls (P <0.0001). Intervention patients had greater improvements in diabetes knowledge and satisfaction than did control patients. There were no significant differences in use of clinical services or adverse events. Our comprehensive disease management program reduced cardiovascular risk factors and A(1C) levels among vulnerable patients with type 2 diabetes and poor glycemic control.

  11. Effectiveness of a quality-improvement program in improving management of primary care practices

    PubMed Central

    Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja

    2011-01-01

    Background: The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. Methods: In a before–after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group’s second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. Results: We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Interpretation: Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the

  12. Plasma Lipidomic Profiles Improve on Traditional Risk Factors for the Prediction of Cardiovascular Events in Type 2 Diabetes Mellitus.

    PubMed

    Alshehry, Zahir H; Mundra, Piyushkumar A; Barlow, Christopher K; Mellett, Natalie A; Wong, Gerard; McConville, Malcolm J; Simes, John; Tonkin, Andrew M; Sullivan, David R; Barnes, Elizabeth H; Nestel, Paul J; Kingwell, Bronwyn A; Marre, Michel; Neal, Bruce; Poulter, Neil R; Rodgers, Anthony; Williams, Bryan; Zoungas, Sophia; Hillis, Graham S; Chalmers, John; Woodward, Mark; Meikle, Peter J

    2016-11-22

    Clinical lipid measurements do not show the full complexity of the altered lipid metabolism associated with diabetes mellitus or cardiovascular disease. Lipidomics enables the assessment of hundreds of lipid species as potential markers for disease risk. Plasma lipid species (310) were measured by a targeted lipidomic analysis with liquid chromatography electrospray ionization-tandem mass spectrometry on a case-cohort (n=3779) subset from the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation). The case-cohort was 61% male with a mean age of 67 years. All participants had type 2 diabetes mellitus with ≥1 additional cardiovascular risk factors, and 35% had a history of macrovascular disease. Weighted Cox regression was used to identify lipid species associated with future cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) and cardiovascular death during a 5-year follow-up period. Multivariable models combining traditional risk factors with lipid species were optimized with the Akaike information criteria. C statistics and NRIs were calculated within a 5-fold cross-validation framework. Sphingolipids, phospholipids (including lyso- and ether- species), cholesteryl esters, and glycerolipids were associated with future cardiovascular events and cardiovascular death. The addition of 7 lipid species to a base model (14 traditional risk factors and medications) to predict cardiovascular events increased the C statistic from 0.680 (95% confidence interval [CI], 0.678-0.682) to 0.700 (95% CI, 0.698-0.702; P<0.0001) with a corresponding continuous NRI of 0.227 (95% CI, 0.219-0.235). The prediction of cardiovascular death was improved with the incorporation of 4 lipid species into the base model, showing an increase in the C statistic from 0.740 (95% CI, 0.738-0.742) to 0.760 (95% CI, 0.757-0.762; P<0.0001) and a continuous net reclassification index of 0.328 (95% CI, 0

  13. Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models.

    PubMed

    Maluf, Miguel Angel; Gomes, Walter José; Bras, Ademir Massarico; Araújo, Thiago Cavalcante Vila Nova de; Mota, André Lupp; Cardoso, Caio Cesar; Coutinho, Rafael Viana dos S

    2015-01-01

    Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art.

  14. Optimizing healthcare at the population level: results of the improving cardiovascular outcomes in Nova Scotia partnership.

    PubMed

    Cox, Jafna; Johnstone, David; Nemis-White, Joanna; Montague, Terrence

    2008-01-01

    Disease management is increasingly considered a valid strategy in the chronic care of our aging patient populations with multiple diseases. The Improving Cardiovascular Outcomes in Nova Scotia (ICONS) project examined whether a community-oriented health management partnership would lead to enhanced care and improved outcomes across an entire healthcare system. ICONS was a prospective cohort study, with baseline and repeated measurements of care and outcomes fed back to all project partners, along with other interventions aimed at optimizing care; preceding interval cohorts served as controls to post-intervention cohorts. The setting was the province of Nova Scotia, whose population is approximately 950,000. All 34,060 consecutive adult patients hospitalized in Nova Scotia with acute myocardial infarction (AMI), unstable angina (UA) or congestive heart failure (CHF) October 1997-March 2002 were included. Interventions were a combination of serial audits and feedbacks of practices and outcomes, web-based publication of findings, newsletter-based education and reminders, physician small-group workshops, pharmacy monitoring and compliance programs, care maps, algorithms, discharge forms and patient information cards. Rates of use of evidence-based marker therapies were the primary outcome measure. Secondary measures included one-year, all-cause mortality and re-hospitalization. Evidence-based prescription practices, for all target diseases, continuously and markedly improved over time. At the population level, there were no changes in one-year mortality for any disease state, although use of proven therapies predicted survival at the individual level throughout the five-year period for all disease states. Rates of re-hospitalization decreased significantly for all disease states over the course of ICONS; but most traditional positive and negative predictors of this outcome, like advanced age and use of proven therapies, respectively, were not predictive. ICONS

  15. Integrated Practice Improvement Solutions-Practical Steps to Operating Room Management.

    PubMed

    Chernov, Mikhail; Pullockaran, Janet; Vick, Angela; Leyvi, Galina; Delphin, Ellise

    2016-10-01

    Perioperative productivity is a vital concern for surgeons, anesthesiologists, and administrators as the OR is a major source of hospital elective admissions and revenue. Based on elements of existing Practice Improvement Methodologies (PIMs), "Integrated Practice Improvement Solutions" (IPIS) is a practical and simple solution incorporating aspects of multiple management approaches into a single open source framework to increase OR efficiency and productivity by better utilization of existing resources. OR efficiency was measured both before and after IPIS implementation using the total number of cases versus room utilization, OR/anesthesia revenue and staff overtime (OT) costs. Other parameters of efficiency, such as the first case on-time start and the turnover time (TOT) were measured in parallel. IPIS implementation resulted in increased numbers of surgical procedures performed by an average of 10.7%, and OR and anesthesia revenue increases of 18.5% and 6.9%, respectively, with a simultaneous decrease in TOT (15%) and OT for anesthesia staff (26%). The number of perioperative adverse events was stable during the two-year study period which involved a total of 20,378 patients. IPIS, an effective and flexible practice improvement model, was designed to quickly, significantly, and sustainably improve OR efficiency by better utilization of existing resources. Success of its implementation directly correlates with the involvement of and acceptance by the entire OR team and hospital administration.

  16. Aortic pulse wave velocity and HeartSCORE: improving cardiovascular risk stratification. a sub-analysis of the EDIVA (Estudo de DIstensibilidade VAscular) project.

    PubMed

    Pereira, T; Maldonado, J; Polónia, J; Silva, J A; Morais, J; Rodrigues, T; Marques, M

    2014-04-01

    HeartSCORE is a tool for assessing cardiovascular risk, basing its estimates on the relative weight of conventional cardiovascular risk factors. However, new markers of cardiovascular risk have been identified, such as aortic pulse wave velocity (PWV). The purpose of this study was to evaluate to what extent the incorporation of PWV in HeartSCORE increases its discriminative power of major cardiovascular events (MACE). This study is a sub-analysis of the EDIVA project, which is a prospective cohort, multicenter and observational study involving 2200 individuals of Portuguese nationality (1290 men and 910 women) aged between 18 and 91 years (mean 46.33 ± 13.76 years), with annual measurements of PWV (Complior). Only participants above 35 years old were included in the present re-analysis, resulting in a population of 1709 participants. All MACE - death, cerebrovascular accident, coronary accidents (coronary heart disease), peripheral arterial disease and renal failure - were recorded. During a mean follow-up period of 21.42 ± 10.76 months, there were 47 non-fatal MACE (2.1% of the sample). Cardiovascular risk was estimated in all patients based on the HeartSCORE risk factors. For the analysis, the refitted HeartSCORE and PWV were divided into three risk categories. The event-free survival at 2 years was 98.6%, 98.0% and 96.1%, respectively in the low-, intermediate- and high-risk categories of HeartSCORE (log-rank p < 0.001). The multi-adjusted hazard ratio (HR) per 1 - standard deviation (SD) of MACE was 1.86 (95% CI 1.37-2.53, p < 0.001) for PWV. The risk of MACE by tertiles of PWV and risk categories of the HeartSCORE increased linearly, and the risk was particularly more pronounced in the highest tertile of PWV for any category of the HeartSCORE, demonstrating an improvement in the prediction of cardiovascular risk. It was clearly depicted a high discriminative capacity of PWV even in groups of apparent intermediate cardiovascular risk. Measures of model fit

  17. Implementation of cardiovascular disease prevention in primary health care: enhancing understanding using normalisation process theory.

    PubMed

    Volker, Nerida; Williams, Lauren T; Davey, Rachel C; Cochrane, Thomas; Clancy, Tanya

    2017-02-24

    The reorientation of primary health care towards prevention is fundamental to addressing the rising burden of chronic disease. However, in Australia, cardiovascular disease prevention practice in primary health care is not generally consistent with existing guidelines. The Model for Prevention study was a whole-of-system cardiovascular disease prevention intervention, with one component being enhanced lifestyle modification support and addition of a health coaching service in the general practice setting. To determine the feasibility of translating intervention outcomes into real world practice, implementation work done by stakeholders was examined using Normalisation Process Theory as a framework. Data was collected through interviews with 40 intervention participants and included general practitioners, practice nurses, practice managers, lifestyle advisors and participants. Data analysis was informed by normalisation process theory constructs. Stakeholders were in agreement that, while prevention is a key function of general practice, it was not their usual work. There were varying levels of engagement with the intervention by practice staff due to staff interest, capacity and turnover, but most staff reconfigured their work for required activities. The Lifestyle Advisors believed staff had varied levels of interest in and understanding of, their service, but most staff felt their role was useful. Patients expanded their existing relationships with their general practice, and most achieved their lifestyle modification goals. While the study highlighted the complex nature of the change required, many of the new or enhanced processes implemented as part of the intervention could be scaled up to improve the systems approach to prevention. Overcoming the barriers to change, such as the perception of CVD prevention as a 'hard sell', is going to rely on improving the value proposition for all stakeholders. The study provided a detailed understanding of the work

  18. Pharmacogenomic Challenges in Cardiovascular Diseases: Examples of Drugs and Considerations for Future Integration in Clinical Practice.

    PubMed

    Chatelin, Jerome; Stathopoulou, Maria G; Arguinano, Alex-Ander A; Xie, Ting; Visvikis-Siest, Sophie

    2017-01-01

    Even if cardiovascular disease (CVD) drugs are supported by high level proofs, the results of CVD treatment present great disparities: there are still patients dying with supposed optimal treatment, patients facing adverse events and CVD remains the primary cause of death in the world. Pharmacogenomics is the basis of personalisation of the treatment able to allow higher medication success rates. In this review, we will present detailed examples of CVD drugs to highlight the complexity of this challenging field and we will discuss novel concepts that should be considered for a fastest integration of pharmacogenomics in clinical practice of CVD. Areas Covered: The complexity of pharmacogenetics and pharmacogenomics of CVD drugs are presented though examples of medications such as statins, with a focus on their effectiveness and adverse effects. Expert Opinion: The application of personalised medicine in the CVD medical practice requires the study of human genome with regard to drugs pharmacokinetics, pharmacodynamics, interactions and tolerance profile. The existing state -of-the-art of CVD drugs gives hopes for a future revolution in the drug development that will maximise cardiovascular patients benefit while decreasing their risks for adverse effects. Article Highlights Box: • Coronary heart disease (CHD) remains the first cause of death worldwide. • Cardiovascular treatment has a significant percentage of insufficient efficacy, poor tolerance and compliance. • Predicting the response to therapy while diminishing the side effects is the basis of personalised medicine; pharmacogenomics is leading towards this direction. • The response to CVD therapy and side effects are in the heart of CVD pharmacogenomics and significant progress has been noted. • The application of pharmacogenomics in the CVD medical practice is facing many methodological, technical, ethical, behavioral and financial issues, while cost-effectiveness is the main prerequisite. • The

  19. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI).

    PubMed

    Abbara, Suhny; Blanke, Philipp; Maroules, Christopher D; Cheezum, Michael; Choi, Andrew D; Han, B Kelly; Marwan, Mohamed; Naoum, Chris; Norgaard, Bjarne L; Rubinshtein, Ronen; Schoenhagen, Paul; Villines, Todd; Leipsic, Jonathon

    In response to recent technological advancements in acquisition techniques as well as a growing body of evidence regarding the optimal performance of coronary computed tomography angiography (coronary CTA), the Society of Cardiovascular Computed Tomography Guidelines Committee has produced this update to its previously established 2009 "Guidelines for the Performance of Coronary CTA" (1). The purpose of this document is to provide standards meant to ensure reliable practice methods and quality outcomes based on the best available data in order to improve the diagnostic care of patients. Society of Cardiovascular Computed Tomography Guidelines for the Interpretation is published separately (2). The Society of Cardiovascular Computed Tomography Guidelines Committee ensures compliance with all existing standards for the declaration of conflict of interest by all authors and reviewers for the purpose ofclarity and transparency. Copyright © 2016 Society of Cardiovascular Computed Tomography. All rights reserved.

  20. [Possibilities for cardiovascular gene therapy].

    PubMed

    Szelid, Zsolt László; Pokreisz, Peter; Janssens, Stefan; Polák, Gyula

    2005-05-29

    Despite recent advances in the management of cardiovascular disease, atherosclerotic coronary artery disease has remained a prevalent cause of mortality and morbidity among industrialized nations. Although very effective in retarding the progression of ischemic heart disease, pharmacotherapies fail to provide long-term cardio-protection and to effectively recruit contractile function of the damaged left ventricle. Moreover, in many patients the lack of compliance to the daily drug administration further reduces the potential benefit of these strategies. The recent advent of gene-based approaches, however, may represent a potential alternative to target ischemic cardiovascular diseases. During the last decade, gene transfer protocols have shown significant improvement in experimental and clinical applications, including vascular restenosis, chronic peripheral arterial insufficiency, chronic myocardial ischemia, myocardial ischemia-reperfusion injury, and congestive heart failure. Gene-based therapy using potentially beneficial gene sequences represents a promising strategy for site-specific cardiovascular treatment. Transduction of host cells may lead to prolonged bioavailability of the transgene product and may overcome the need for continuous or repetitive drug administrations. Although potential benefits are obvious, they need to be carefully balanced against untoward (inflammatory) side effects. In this review, we discuss the significance of this novel therapeutic strategy, the lessons we have learned from animal studies and how we can envision future use of gene-based strategies in clinical practice.

  1. Lipoprotein metabolism indicators improve cardiovascular risk prediction

    USDA-ARS?s Scientific Manuscript database

    Background: Cardiovascular disease risk increases when lipoprotein metabolism is dysfunctional. We have developed a computational model able to derive indicators of lipoprotein production, lipolysis, and uptake processes from a single lipoprotein profile measurement. This is the first study to inves...

  2. Barriers to promote cardiovascular health in community pharmacies: a systematic review.

    PubMed

    Alonso-Perales, María Del Mar; Lasheras, Berta; Beitia, Guadalupe; Beltrán, Idoia; Marcos, Beatriz; Núñez-Córdoba, Jorge M

    2017-06-01

    Community pharmacists play an important role in the provision of health promotion services, and community pharmacies are considered as a potentially ideal site for cardiovascular health promotion. Information based on a systematic review of barriers to promoting cardiovascular health in community pharmacy is currently lacking. We have sought to identify the most important barriers to cardiovascular health promotion in the community pharmacy. We have systematically searched PubMed and International Pharmaceutical Abstracts for a period of 15 years from 1 April 1998 to 1 April 2013, contacted subject experts and hand-searched bibliographies. We have included peer-reviewed articles, with English abstracts in the analysis, if they reported community pharmacists' perceptions of the barriers to cardiovascular health promotion activities in a community pharmacy setting. Two reviewers have independently extracted study characteristics and data. We identified 24 studies that satisfy the eligibility criteria. The main barriers to cardiovascular health promotion in the community pharmacy included pharmacist-related factors; practice site factors; financial factors; legal factors; and patient-related factors. This review will help to provide reliable evidence for health promotion practitioners of the barriers to promoting cardiovascular health in the community pharmacy setting. This knowledge is valuable for the improvement of cardiovascular health promotion in this setting and guiding future research. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  3. Diabetes Drugs and Cardiovascular Safety

    PubMed Central

    2016-01-01

    Diabetes is a well-known risk factor of cardiovascular morbidity and mortality, and the beneficial effect of improved glycemic control on cardiovascular complications has been well established. However, the rosiglitazone experience aroused awareness of potential cardiovascular risk associated with diabetes drugs and prompted the U.S. Food and Drug Administration to issue new guidelines about cardiovascular risk. Through postmarketing cardiovascular safety trials, some drugs demonstrated cardiovascular benefits, while some antidiabetic drugs raised concern about a possible increased cardiovascular risk associated with drug use. With the development of new classes of drugs, treatment options became wider and the complexity of glycemic management in type 2 diabetes has increased. When choosing the appropriate treatment strategy for patients with type 2 diabetes at high cardiovascular risk, not only the glucose-lowering effects, but also overall benefits and risks for cardiovascular disease should be taken into consideration. PMID:27302713

  4. The Supply and Demand of the Cardiovascular Workforce

    PubMed Central

    Narang, Akhil; Sinha, Shashank S.; Rajagopalan, Bharath; Ijioma, Nkechinyere N.; Jayaram, Natalie; Kithcart, Aaron P.; Tanguturi, Varsha K.; Cullen, Michael W.

    2017-01-01

    As the burden of cardiovascular disease in the United States continues to increase, uncertainty remains on how well-equipped the cardiovascular workforce is to meet the challenges that lie ahead. In a time when health care is rapidly shifting, numerous factors affect the supply and demand of the cardiovascular workforce. This Council Commentary critically examines several factors that influence the cardiovascular workforce. These include current workforce demographics and projections, evolving health care and practice environments, and the increasing burden of cardiovascular disease. Finally, we propose 3 strategies to optimize the workforce. These focus on cardiovascular disease prevention, the effective utilization of the cardiovascular care team, and alterations to the training pathway for cardiologists. PMID:27712782

  5. Cardiovascular risk

    PubMed Central

    Payne, Rupert A

    2012-01-01

    Cardiovascular disease is a major, growing, worldwide problem. It is important that individuals at risk of developing cardiovascular disease can be effectively identified and appropriately stratified according to risk. This review examines what we understand by the term risk, traditional and novel risk factors, clinical scoring systems, and the use of risk for informing prescribing decisions. Many different cardiovascular risk factors have been identified. Established, traditional factors such as ageing are powerful predictors of adverse outcome, and in the case of hypertension and dyslipidaemia are the major targets for therapeutic intervention. Numerous novel biomarkers have also been described, such as inflammatory and genetic markers. These have yet to be shown to be of value in improving risk prediction, but may represent potential therapeutic targets and facilitate more targeted use of existing therapies. Risk factors have been incorporated into several cardiovascular disease prediction algorithms, such as the Framingham equation, SCORE and QRISK. These have relatively poor predictive power, and uncertainties remain with regards to aspects such as choice of equation, different risk thresholds and the roles of relative risk, lifetime risk and reversible factors in identifying and treating at-risk individuals. Nonetheless, such scores provide objective and transparent means of quantifying risk and their integration into therapeutic guidelines enables equitable and cost-effective distribution of health service resources and improves the consistency and quality of clinical decision making. PMID:22348281

  6. Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: a randomized, controlled trial.

    PubMed

    Macko, Richard F; Ivey, Frederick M; Forrester, Larry W; Hanley, Daniel; Sorkin, John D; Katzel, Leslie I; Silver, Kenneth H; Goldberg, Andrew P

    2005-10-01

    Physical inactivity propagates disability after stroke through physical deconditioning and learned nonuse. We investigated whether treadmill aerobic training (T-AEX) is more effective than conventional rehabilitation to improve ambulatory function and cardiovascular fitness in patients with chronic stroke. Sixty-one adults with chronic hemiparetic gait after ischemic stroke (>6 months) were randomized to 6 months (3x/week) progressive T-AEX or a reference rehabilitation program of stretching plus low-intensity walking (R-CONTROL). Peak exercise capacity (Vo2 peak), o2 consumption during submaximal effort walking (economy of gait), timed walks, Walking Impairment Questionnaire (WIQ), and Rivermead Mobility Index (RMI) were measured before and after 3 and 6 months of training. Twenty-five patients completed T-AEX and 20 completed R-CONTROL. Only T-AEX increased cardiovascular fitness (17% versus 3%, delta% T-AEX versus R-CONTROL, P<0.005). Group-by-time analyses revealed T-AEX improved ambulatory performance on 6-minute walks (30% versus 11%, P<0.02) and mobility function indexed by WIQ distance scores (56% versus 12%, P<0.05). In the T-AEX group, increasing training velocity predicted improved Vo2 peak (r=0.43, P<0.05), but not walking function. In contrast, increasing training session duration predicted improved 6-minute walk (r=0.41, P<0.05), but not fitness gains. T-AEX improves both functional mobility and cardiovascular fitness in patients with chronic stroke and is more effective than reference rehabilitation common to conventional care. Specific characteristics of training may determine the nature of exercise-mediated adaptations.

  7. High-Intensity Interval Training After Stroke: An Opportunity to Promote Functional Recovery, Cardiovascular Health, and Neuroplasticity.

    PubMed

    Crozier, Jennifer; Roig, Marc; Eng, Janice J; MacKay-Lyons, Marilyn; Fung, Joyce; Ploughman, Michelle; Bailey, Damian M; Sweet, Shane N; Giacomantonio, Nicholas; Thiel, Alexander; Trivino, Michael; Tang, Ada

    2018-04-01

    Stroke is the leading cause of adult disability. Individuals poststroke possess less than half of the cardiorespiratory fitness (CRF) as their nonstroke counterparts, leading to inactivity, deconditioning, and an increased risk of cardiovascular events. Preserving cardiovascular health is critical to lower stroke risk; however, stroke rehabilitation typically provides limited opportunity for cardiovascular exercise. Optimal cardiovascular training parameters to maximize recovery in stroke survivors also remains unknown. While stroke rehabilitation recommendations suggest the use of moderate-intensity continuous exercise (MICE) to improve CRF, neither is it routinely implemented in clinical practice, nor is the intensity always sufficient to elicit a training effect. High-intensity interval training (HIIT) has emerged as a potentially effective alternative that encompasses brief high-intensity bursts of exercise interspersed with bouts of recovery, aiming to maximize cardiovascular exercise intensity in a time-efficient manner. HIIT may provide an alternative exercise intervention and invoke more pronounced benefits poststroke. To provide an updated review of HIIT poststroke through ( a) synthesizing current evidence; ( b) proposing preliminary considerations of HIIT parameters to optimize benefit; ( c) discussing potential mechanisms underlying changes in function, cardiovascular health, and neuroplasticity following HIIT; and ( d) discussing clinical implications and directions for future research. Preliminary evidence from 10 studies report HIIT-associated improvements in functional, cardiovascular, and neuroplastic outcomes poststroke; however, optimal HIIT parameters remain unknown. Larger randomized controlled trials are necessary to establish ( a) effectiveness, safety, and optimal training parameters within more heterogeneous poststroke populations; (b) potential mechanisms of HIIT-associated improvements; and ( c) adherence and psychosocial outcomes.

  8. Improving hemodynamics of cardiovascular system under a novel intraventricular assist device support via modeling and simulations.

    PubMed

    Zhu, Shidong; Luo, Lin; Yang, Bibo; Li, Xinghui; Wang, Xiaohao

    2017-12-01

    Ventricular assist devices (LVADs) are increasingly recognized for supporting blood circulation in heart failure patients who are non-transplant eligible. Because of its volume, the traditional pulsatile device is not easy to implant intracorporeally. Continuous flow LVADs (CF-LVADs) reduce arterial pulsatility and only offer continuous flow, which is different from physiological flow, and may cause long-term complications in the cardiovascular system. The aim of this study was to design a new pulsatile assist device that overcomes this disadvantage, and to test this device in the cardiovascular system. Firstly, the input and output characteristics of the new device were tested in a simple cardiovascular mock system. A detailed mathematical model was established by fitting the experimental data. Secondly, the model was tested in four pathological cases, and was simulated and coupled with a fifth-order cardiovascular system and a new device model using Matlab software. Using assistance of the new device, we demonstrated that the left ventricle pressure, aortic pressure, and aortic flow of heart failure patients improved to the levels of a healthy individual. Especially, in state IV level heart failure patients, the systolic blood pressure increased from 81.34 mmHg to 132.1 mmHg, whereas the diastolic blood pressure increased from 54.28 mmHg to 78.7 mmHg. Cardiac output increased from 3.21 L/min to 5.16 L/min. The newly-developed assist device not only provided a physiological flow that was similar to healthy individuals, but also effectively improved the ability of the pathological ventricular volume. Finally, the effects of the new device on other hemodynamic parameters are discussed.

  9. GLP-1 Receptor Agonists and Cardiovascular Disease in Patients with Type 2 Diabetes

    PubMed Central

    Merino-Torres, Juan Francisco

    2018-01-01

    Diabetes mellitus is a chronic disease prevalence of which is high and continually growing. Cardiovascular disease continues to be the leading cause of death in patients with T2DM. The prevention of cardiovascular complications and the cardiovascular safety of treatments should be a primary objective when selecting treatment. Among all the drugs available, the compounds known as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) appear to be not just innocuous in terms of CVD but indeed to be beneficial. GLP-1 RA actions not only translate on an improvement of well-known cardiovascular risk factors such as glycaemic control, dyslipidaemia, weight, or arterial hypertension but also might show benefits on endothelial function, coronary ischaemia, and heart failure. On the other hand, recent clinical trials aimed at studying cardiovascular episodes have been conducted with GLP-1 RAs. Only liraglutide and semaglutide have shown superiority in cardiovascular benefit compared with placebo. Although many of the mechanisms by which liraglutide and semaglutide produce a cardiovascular benefit are still unknown it would be desirable for these benefits to be incorporated into the therapeutic algorithms routinely used in clinical practice. The purpose of this review is to explore GLP-1 RA actions not only in cardiovascular risk factors (glucose, weight, and hypertension) but also the possible effects on established cardiovascular disease.

  10. The rise of cardiovascular medicine†

    PubMed Central

    Braunwald, Eugene

    2012-01-01

    Modern cardiology was born at the turn of the nineteenth to twentieth centuries with three great discoveries: the X ray, the sphygmomanometer, and the electrocardiograph. This was followed by cardiac catheterization, which led to coronary angiography and to percutaneous coronary intervention. The coronary care units and early reperfusion reduced the early mortality owing to acute myocardial infarction, and the discovery of coronary risk factors led to the development of Preventive Cardiology. Other major advances include several cardiac imaging techniques, the birth and development of cardiac surgery, and the control of cardiac arrhythmias. The treatment of heart failure, although greatly improved, remains a challenge. Current cardiology practice is evidence-based and global in scope. Research and practice are increasingly conducted in cardiovascular centres and institutes. It is likely that in the future, a greater emphasis will be placed on prevention, which will be enhanced by genetic information. PMID:22416074

  11. Cardiovascular program to improve physical fitness in those over 60 years old – pilot study

    PubMed Central

    Castillo-Rodríguez, Alfonso; Chinchilla-Minguet, José Luis

    2014-01-01

    Background In Spain, more than 50% of 60-year-olds are obese. Obesity is a disease with serious cardiovascular risks. The mortality rate for cardiovascular disease in Spain is 31.1%. Objectives To improve aerobic fitness, strength, flexibility and balance, and body composition (BC) in persons over 60 years old. Materials and methods A clinical intervention study of 24 participants was carried out over a period of 3 months. Aerobic fitness was assessed using the Rockport 1-Mile Walk Test. Upper-body strength was evaluated with an ad hoc test. Flexibility and balance were evaluated using the Sit and Reach Test and the Stork Balance Stand Test, respectively. Anthropometric measurements were taken by bioelectrical impedance. Results After 3 months of training, aerobic fitness was improved, as demonstrated by improved test times (pretest 13.04 minutes, posttest 12.13 minutes; P<0.05). Body composition was also improved, but the results were not statistically significant (fat mass pretest 31.58%±5.65%, posttest 30.65%±6.31%; skeletal muscle mass pretest 43.99±9.53 kg, posttest 46.63±10.90 kg). Conclusion Our data show that in subjects over 60 years old, aerobic fitness was improved due to program intervention. However, these results should be treated with caution, because of the limited sample size and the brief time period of this pilot study. A more rigorous study would include a sample of at least 100 participants. PMID:25143714

  12. Community-based cardiovascular health interventions in vulnerable populations: a systematic review.

    PubMed

    Walton-Moss, Benita; Samuel, Laura; Nguyen, Tam H; Commodore-Mensah, Yvonne; Hayat, Matthew J; Szanton, Sarah L

    2014-07-01

    Although cardiovascular health has been improving for many Americans, this is not true of those in "vulnerable populations." To address this growing disparity, communities and researchers have worked for decades, and as a result of their work, a growing body of literature supports the use of community engagement as a component of successful interventions. However, little literature synthesizes community-based interventions that address this disparity among a wide range of vulnerable populations. This article provides a critical review of community-based cardiovascular disease interventions to improve cardiovascular health behaviors and factors among vulnerable populations based on the American Heart Association's 7 metrics of ideal cardiovascular health. In February 2011, 4 databases (PubMed, PsychInfo, CINAHL, and Scopus) were searched using the following keywords: vulnerable populations OR healthcare disparities AND cardiovascular disease AND clinical trials OR public health practice AND English. This search strategy resulted in the retrieval of 7120 abstracts. Each abstract was reviewed by at least 2 authors, and eligibility for the systematic review was confirmed after reading the full article. Thirty-two studies met eligibility criteria. Education was the most common intervention (41%), followed by counseling or support (38%) and exercise classes (28%). Half of the interventions were multicomponent. Healthcare providers were the most frequent interventionists. Interventions aimed at decreasing blood pressure were the most promising, whereas behavior change interventions were the most challenging. Almost all of the interventions were at the individual level and were proof-of-concept or efficacy trials. This analysis provides a step toward understanding the current literature on cardiovascular interventions for vulnerable population. The next step should be integrating the identified successful interventions into larger health systems and/or social policies.

  13. EMERGING APPLICATIONS OF NANOMEDICINE FOR THERAPY AND DIAGNOSIS OF CARDIOVASCULAR DISEASES

    PubMed Central

    Godin, Biana; Sakamoto, Jason H.; Serda, Rita E.; Grattoni, Alessandro; Bouamrani, Ali; Ferrari, Mauro

    2010-01-01

    Nanomedicine is an emerging field of medicine which utilizes nanotechnology concepts for advanced therapy and diagnostics. This convergent discipline, which merges research areas such as chemistry, biology, physics, mathematics and engineering thus bridging the gap between molecular and cellular interactions, has a potential to revolutionize current medical practice. This review presents recent developments in nanomedicine research, which are poised to have an important impact on cardiovascular disease and treatment by improving therapy and diagnosis of such cardiovascular disorders as atherosclerosis, restenosis and myocardial infarction. Specifically, we discuss the use of nanoparticles for molecular imaging and advanced therapeutics, specially designed drug eluting stents and in vivo/ex vivo early detection techniques. PMID:20172613

  14. Can cardiovascular magnetic resonance prompt early cardiovascular/rheumatic treatment in autoimmune rheumatic diseases? Current practice and future perspectives.

    PubMed

    Mavrogeni, Sophie I; Sfikakis, Petros P; Dimitroulas, Theodoros; Koutsogeorgopoulou, Loukia; Katsifis, Gikas; Markousis-Mavrogenis, George; Kolovou, Genovefa; Kitas, George D

    2018-06-01

    Life expectancy in autoimmune rheumatic diseases (ARDs) remains lower compared to the general population, due to various comoborbidities. Cardiovascular disease (CVD) represents the main contributor to premature mortality. Conventional and biologic disease-modifying antirheumatic drugs (DMARDs) have considerably improved long-term outcomes in ARDs not only by suppressing systemic inflammation but also by lowering CVD burden. Regarding atherosclerotic disease prevention, EULAR has recommended tight disease control accompanied by regular assessment of traditional CVD risk factors and lifestyle changes. However, this approach, although rational and evidence-based, does not account for important issues such as myocardial inflammation and the long asymptomatic period that usually proceeds clinical manifestations of CVD disease in ARDs before or after the diagnosis of systemic disease. Cardiovascular magnetic resonance (CMR) can offer reliable, reproducible and operator independent information regarding myocardial inflammation, ischemia and fibrosis. Some studies suggest a role for CMR in the risk stratification of ARDs and demonstrate that oedema/fibrosis visualisation with CMR may have the potential to inform cardiac and rheumatic treatment modification in ARDs with or without abnormal routine cardiac evaluation. In this review, we discuss how CMR findings could influence anti-rheumatic treatment decisions targeting optimal control of both systemic and myocardial inflammation irrespective of clinical manifestations of cardiac disease. CMR can provide a different approach that is very promising for risk stratification and treatment modification; however, further studies are needed before the inclusion of CMR in the routine evaluation and treatment of patients with ARDs.

  15. Effects of bench step exercise intervention on work ability in terms of cardiovascular risk factors and oxidative stress: a randomized controlled study.

    PubMed

    Ohta, Masanori; Eguchi, Yasumasa; Inoue, Tomohiro; Honda, Toru; Morita, Yusaku; Konno, Yoshimasa; Yamato, Hiroshi; Kumashiro, Masaharu

    2015-01-01

    Work ability is partly determined by physical and mental fitness. Bench step exercise can be practiced anywhere at any time. The aim of this study was to determine the effects of a bench step exercise on work ability by examining cardiovascular risk factors and oxidative stress. Thirteen volunteers working in a warehousing industry comprised the bench step exercise group (n=7) and the control group (n=6). The participants in the step exercise group were encouraged to practice the step exercise at home for 16 weeks. The step exercise improved glucose metabolism and antioxidative capacity and increased work ability by reducing absences from work and improving the prognosis of work ability. The improvement in work ability was related to a reduction in oxidative stress. These results suggest that a bench step exercise may improve work ability by reducing cardiovascular risk factors and oxidative stress.

  16. Naringin Improves Diet-Induced Cardiovascular Dysfunction and Obesity in High Carbohydrate, High Fat Diet-Fed Rats

    PubMed Central

    Alam, Md. Ashraful; Kauter, Kathleen; Brown, Lindsay

    2013-01-01

    Obesity, insulin resistance, hypertension and fatty liver, together termed metabolic syndrome, are key risk factors for cardiovascular disease. Chronic feeding of a diet high in saturated fats and simple sugars, such as fructose and glucose, induces these changes in rats. Naturally occurring compounds could be a cost-effective intervention to reverse these changes. Flavonoids are ubiquitous secondary plant metabolites; naringin gives the bitter taste to grapefruit. This study has evaluated the effect of naringin on diet-induced obesity and cardiovascular dysfunction in high carbohydrate, high fat-fed rats. These rats developed increased body weight, glucose intolerance, increased plasma lipid concentrations, hypertension, left ventricular hypertrophy and fibrosis, liver inflammation and steatosis with compromised mitochondrial respiratory chain activity. Dietary supplementation with naringin (approximately 100 mg/kg/day) improved glucose intolerance and liver mitochondrial dysfunction, lowered plasma lipid concentrations and improved the structure and function of the heart and liver without decreasing total body weight. Naringin normalised systolic blood pressure and improved vascular dysfunction and ventricular diastolic dysfunction in high carbohydrate, high fat-fed rats. These beneficial effects of naringin may be mediated by reduced inflammatory cell infiltration, reduced oxidative stress, lowered plasma lipid concentrations and improved liver mitochondrial function in rats. PMID:23446977

  17. High-intensity intermittent swimming improves cardiovascular health status for women with mild hypertension.

    PubMed

    Mohr, Magni; Nordsborg, Nikolai Baastrup; Lindenskov, Annika; Steinholm, Hildigunn; Nielsen, Hans Petur; Mortensen, Jann; Weihe, Pal; Krustrup, Peter

    2014-01-01

    To test the hypothesis that high-intensity swim training improves cardiovascular health status in sedentary premenopausal women with mild hypertension, sixty-two women were randomized into high-intensity (n = 21; HIT), moderate-intensity (n = 21; MOD), and control groups (n = 20; CON). HIT performed 6-10 × 30 s all-out swimming interspersed by 2 min recovery and MOD swam continuously for 1 h at moderate intensity for a 15-week period completing in total 44 ± 1 and 43 ± 1 sessions, respectively. In CON, all measured variables were similar before and after the intervention period. Systolic BP decreased (P < 0.05) by 6 ± 1 and 4 ± 1 mmHg in HIT and MOD; respectively. Resting heart rate declined (P < 0.05) by 5 ± 1 bpm both in HIT and MOD, fat mass decreased (P < 0.05) by 1.1 ± 0.2 and 2.2 ± 0.3 kg, respectively, while the blood lipid profile was unaltered. In HIT and MOD, performance improved (P < 0.05) for a maximal 10 min swim (13 ± 3% and 22 ± 3%), interval swimming (23 ± 3% and 8 ± 3%), and Yo-Yo IE1 running performance (58 ± 5% and 45 ± 4%). In conclusion, high-intensity intermittent swimming is an effective training strategy to improve cardiovascular health and physical performance in sedentary women with mild hypertension. Adaptations are similar with high- and moderate-intensity training, despite markedly less total time spent and distance covered in the high-intensity group.

  18. High-Intensity Intermittent Swimming Improves Cardiovascular Health Status for Women with Mild Hypertension

    PubMed Central

    Mohr, Magni; Nordsborg, Nikolai Baastrup; Lindenskov, Annika; Steinholm, Hildigunn; Nielsen, Hans Petur; Mortensen, Jann; Weihe, Pal; Krustrup, Peter

    2014-01-01

    To test the hypothesis that high-intensity swim training improves cardiovascular health status in sedentary premenopausal women with mild hypertension, sixty-two women were randomized into high-intensity (n = 21; HIT), moderate-intensity (n = 21; MOD), and control groups (n = 20; CON). HIT performed 6–10 × 30 s all-out swimming interspersed by 2 min recovery and MOD swam continuously for 1 h at moderate intensity for a 15-week period completing in total 44 ± 1 and 43 ± 1 sessions, respectively. In CON, all measured variables were similar before and after the intervention period. Systolic BP decreased (P < 0.05) by 6 ± 1 and 4 ± 1 mmHg in HIT and MOD; respectively. Resting heart rate declined (P < 0.05) by 5 ± 1 bpm both in HIT and MOD, fat mass decreased (P < 0.05) by 1.1 ± 0.2 and 2.2 ± 0.3 kg, respectively, while the blood lipid profile was unaltered. In HIT and MOD, performance improved (P < 0.05) for a maximal 10 min swim (13 ± 3% and 22 ± 3%), interval swimming (23 ± 3% and 8 ± 3%), and Yo-Yo IE1 running performance (58 ± 5% and 45 ± 4%). In conclusion, high-intensity intermittent swimming is an effective training strategy to improve cardiovascular health and physical performance in sedentary women with mild hypertension. Adaptations are similar with high- and moderate-intensity training, despite markedly less total time spent and distance covered in the high-intensity group. PMID:24812628

  19. Dietary intake practices associated with cardiovascular risk in urban and rural Ecuadorian adolescents: a cross-sectional study.

    PubMed

    Ochoa-Avilés, Angélica; Verstraeten, Roosmarijn; Lachat, Carl; Andrade, Susana; Van Camp, John; Donoso, Silvana; Kolsteren, Patrick

    2014-09-09

    Cardiovascular diseases (CVD) are amongst the leading causes of death worldwide. Risk factors of CVD develop during childhood and adolescence, and dietary quality has been linked to the development of CVD itself. This study examines the association between dietary patterns and cardiovascular risk in a group of urban and rural Ecuadorian adolescents from different socioeconomic backgrounds. A cross-sectional study was conducted from January 2008 to April 2009 among 606 adolescents from the 8th, 9th and 10th grade in an urban area (Cuenca), and 173 adolescents from a rural area (Nabón) in Ecuador. Data collection involved measuring anthropometric data (weight, height and waist circumference), blood pressure, dietary intake (2-day 24 h recall) and socio-demographic characteristics. Fasting blood lipids and glucose were measured in a subsample of 334 adolescents. Factor analysis was used to identify dietary patterns and linear regression models were used to (i) identify differences in food intake practices according to socioeconomic status and place of residence and (ii) establish relationships between dietary patterns and cardiovascular risk factors. Median energy intake was 1851 kcal/day. Overall, fiber, fish and fruit and vegetables were scarcely consumed, while added sugar, refined cereals and processed food were important constituents of the diet. Two dietary patterns emerged, one labelled as "rice-rich non-animal fat pattern" and the other one as "wheat-dense animal-fat pattern". The first pattern was correlated with a moderate increase in glucose in urban participants, while the second pattern was associated with higher LDL and cholesterol blood levels in rural participants. This group of adolescents presented various dietary practices conducive to CVD development. Effective strategies are needed to prevent CVD in the Ecuadorian population by encouraging a balanced diet, which contains less refined cereals, added sugar, and processed food, but has more fruits

  20. As good as it gets? Managing risks of cardiovascular disease in California's top-performing physician organizations.

    PubMed

    Rodriguez, Hector P; Ivey, Susan L; Raffetto, Brian J; Vaughn, Jennifer; Knox, Margae; Hanley, Hattie Rees; Mangione, Carol M; Shortell, Stephen M

    2014-04-01

    The California Right Care Initiative (RCI) accelerates the adoption of evidence-based guidelines and improved care management practices for conditions for which the gap between science and practice is significant, resulting in preventable disability and death. Medical directors and quality improvement leaders from 11 of the 12 physician organizations that met the 2010 national 90th percentile performance benchmarks for control of hyperlipidemia and glycated hemoglobin in 2011 were interviewed in 2012. Interviews, as well as surveys, assessed performance reporting and feedback to individual physicians; medication management protocols; team-based care management; primary care team huddles; coordination of care between primary care clinicians and specialists; implementation of shared medical appointments; and telephone visits for high-risk patients. All but 1 of 11 organizations implemented electronic health records. Electronic information exchange between primary care physicians and specialists, however, was uncommon. Few organizations routinely used interdisciplinary team approaches, shared medical appointments, or telephonic strategies for managing cardiovascular risks among patients. Implementation barriers included physicians' resistance to change, limited resources and reimbursement for team approaches, and limited organizational capacity for change. Implementation facilitators included routine use of reliable data to guide improvement, leadership facilitation of change, physician buy-in, health information technology use, and financial incentives. To accelerate improvements in managing cardiovascular risks, physician organizations may need to implement strategies involving extensive practice reorganization and work flow redesign.

  1. Behavioral interventions to improve infection control practices.

    PubMed

    Kretzer, E K; Larson, E L

    1998-06-01

    No single intervention has been successful in improving and sustaining such infection control practices as universal precautions and handwashing by health care professionals. This paper examines several behavioral theories (Health Belief Model, Theory of Reasoned Action and Theory of Planned Behavior, self-efficacy, and the Transtheoretic Model) and relates them to individual factors, also considering interpersonal and organizational factors. Further, this article includes recommendations of individual and organizational components to be addressed when planning a theoretically based intervention for improving infection control practices. A hypothetic framework to enhance handwashing practice is proposed.

  2. Intravenous Iron Supplementation Practices and Short-Term Risk of Cardiovascular Events in Hemodialysis Patients

    PubMed Central

    Kshirsagar, Abhijit V.; Freburger, Janet K.; Ellis, Alan R.; Wang, Lily; Winkelmayer, Wolfgang C.; Brookhart, M. Alan

    2013-01-01

    Background & Objectives Intravenous iron supplementation is widespread in the hemodialysis population, but there is uncertainty about the safest dosing strategy. We compared the safety of different intravenous iron dosing practices on the risk of adverse cardiovascular outcomes in a large population of hemodialysis patients. Design settings, participants, & measurements A retrospective cohort was created from the clinical database of a large dialysis provider (years 2004-2008) merged with administrative data from the United States Renal Data System. Dosing comparisons were (1) bolus (consecutive doses ≥ 100 mg exceeding 600 mg during one month) versus maintenance (all other iron doses during the month); and (2) high (> 200 mg over 1 month) versus low dose (≤ 200 mg over 1 month). We established a 6-month baseline period (to identify potential confounders and effect modifiers), a one-month iron exposure period, and a three-month follow-up period. Outcomes were myocardial infarction, stroke, and death from cardiovascular disease. Results 117,050 patients contributed 776,203 unique iron exposure/follow-up periods. After adjustment, we found no significant associations of bolus dose versus maintenance, hazards ratio for composite outcome, 1.03 (95% C.I. 0.99, 1.07), or high dose versus low dose intravenous iron, hazards ratio for composite outcome, 0.99 (95% C.I. 0.96, 1.03). There were no consistent associations of either high or bolus dose versus low or maintenance respectively among pre-specified subgroups. Conclusions Strategies favoring large doses of intravenous iron were not associated with increased short-term cardiovascular morbidity and mortality. Investigation of the long-term safety of the various intravenous iron supplementation strategies may still be warranted. PMID:24223866

  3. The Cardiovascular Intervention Improvement Telemedicine Study (CITIES): Rationale for a Tailored Behavioral and Educational Pharmacist-Administered Intervention for Achieving Cardiovascular Disease Risk Reduction

    PubMed Central

    Zullig, Leah L.; Melnyk, S. Dee; Stechuchak, Karen M.; McCant, Felicia; Danus, Susanne; Oddone, Eugene; Bastian, Lori; Olsen, Maren; Edelman, David; Rakley, Susan; Morey, Miriam

    2014-01-01

    Abstract Background: Hypertension, hyperlipidemia, and diabetes are significant, but often preventable, contributors to cardiovascular disease (CVD) risk. Medication and behavioral nonadherence are significant barriers to successful hypertension, hyperlidemia, and diabetes management. Our objective was to describe the theoretical framework underlying a tailored behavioral and educational pharmacist-administered intervention for achieving CVD risk reduction. Materials and Methods: Adults with poorly controlled hypertension and/or hyperlipidemia were enrolled from three outpatient primary care clinics associated with the Durham Veterans Affairs Medical Center (Durham, NC). Participants were randomly assigned to receive a pharmacist-administered, tailored, 1-year telephone-based intervention or usual care. The goal of the study was to reduce the risk for CVD through a theory-driven intervention to increase medication adherence and improve health behaviors. Results: Enrollment began in November 2011 and is ongoing. The target sample size is 500 patients. Conclusions: The Cardiovascular Intervention Improvement Telemedicine Study (CITIES) intervention has been designed with a strong theoretical underpinning. The theoretical foundation and intervention are designed to encourage patients with multiple comorbidities and poorly controlled CVD risk factors to engage in home-based monitoring and tailored telephone-based interventions. Evidence suggests that clinical pharmacist-administered telephone-based interventions may be efficiently integrated into primary care for patients with poorly controlled CVD risk factors. PMID:24303930

  4. Main messages for primary care from the 2016 European Guidelines on cardiovascular disease prevention in clinical practice

    PubMed Central

    Piepoli, Massimo F.; Hoes, Arno W.; Brotons, Carlos; Hobbs, Richard F.D.; Corra, Ugo

    2018-01-01

    Abstract In 2016, a new version of the European Guidelines on Cardiovascular Prevention was released, representing a partnership between the European Association for Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology (ESC) and nine European societies, including Wonca-Europe. The ESC guidelines underscore the importance of a lifetime approach to cardiovascular (CV) risk since both CV risk and prevention are dynamic and continuous as patients’ age and/or accumulate co-morbidities. Healthy people of all ages should be encouraged to adopt a healthy lifestyle, as well as improved lifestyle and reduced risk factor levels are paramount in patients at increased risk of developing cardiovascular disease (CVD) and in those with established CVD. Healthcare professionals, and especially general practitioners, play an important role in helping patients achieve this and should set a personal example of healthy lifestyle behaviour. The ESC guidelines are based on ‘to do’ and ‘not to do’ messages. Of note, what remains uncertain is stated at the end of each dedicated chapter, confirming that guidelines are not absolute rules, and should be interpreted in the light of the healthcare worker’s knowledge and experience, patient preferences and the local social, cultural and economic situation. PMID:29168408

  5. Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models

    PubMed Central

    Maluf, Miguel Angel; Gomes, Walter José; Bras, Ademir Massarico; de Araújo, Thiago Cavalcante Vila Nova; Mota, André Lupp; Cardoso, Caio Cesar; Coutinho, Rafael Viana dos S.

    2015-01-01

    OBJECTIVE Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. METHODS First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. RESULTS The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. CONCLUSION 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art. PMID:26735604

  6. Reductions in Cardiovascular Risk After Bariatric Surgery

    PubMed Central

    Benraoune, Fethi; Litwin, Sheldon E.

    2012-01-01

    Purpose of review Obesity is commonly associated with multiple conditions imparting adverse cardiovascular risk including, hypertension, dyslipidemia and insulin resistance or diabetes. In addition, sleep disordered breathing, inflammation, left ventricular hypertrophy, left atrial enlargement and subclinical left ventricular systolic and diastolic dysfunction may collectively contribute to increased cardiovascular morbidity and mortality. This review will describe improvements in cardiovascular risk factors after bariatric surgery. Recent findings All of the cardiovascular risk factors listed above are improved or even resolved after bariatric surgery. Cardiac structure and function also have shown consistent improvement after surgically-induced weight loss. The amount of improvement in cardiac risk factors is generally proportional to the amount of weight lost. The degree of weight loss varies with different bariatric procedures. Based on the improvement in risk profiles, it has been predicted that progression of atherosclerosis could be slowed and the 10 year risk of cardiac events would decline by ~ 50% in patients undergoing weight loss surgery. In keeping with these predictions, 2 studies have demonstrated reductions in 10-year total and cardiovascular mortality of approximately 50% in patients who had bariatric surgery. Summary These encouraging data support the continued, and perhaps expanded use of surgical procedures to induce weight loss in severely obese patients. PMID:21934498

  7. Teaching cardiovascular physiology with equivalent electronic circuits in a practically oriented teaching module.

    PubMed

    Ribaric, Samo; Kordas, Marjan

    2011-06-01

    Here, we report on a new tool for teaching cardiovascular physiology and pathophysiology that promotes qualitative as well as quantitative thinking about time-dependent physiological phenomena. Quantification of steady and presteady-state (transient) cardiovascular phenomena is traditionally done by differential equations, but this is time consuming and unsuitable for most undergraduate medical students. As a result, quantitative thinking about time-dependent physiological phenomena is often not extensively dealt with in an undergraduate physiological course. However, basic concepts of steady and presteady state can be explained with relative simplicity, without the introduction of differential equation, with equivalent electronic circuits (EECs). We introduced undergraduate medical students to the concept of simulating cardiovascular phenomena with EECs. EEC simulations facilitate the understanding of simple or complex time-dependent cardiovascular physiological phenomena by stressing the analogies between EECs and physiological processes. Student perceptions on using EEC to simulate, study, and understand cardiovascular phenomena were documented over a 9-yr period, and the impact of the course on the students' knowledge of selected basic facts and concepts in cardiovascular physiology was evaluated over a 3-yr period. We conclude that EECs are a valuable tool for teaching cardiovascular physiology concepts and that EECs promote active learning.

  8. Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

    PubMed Central

    2011-01-01

    Background Primary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models. Methods This is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC) through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models. Results The percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69%) than in fee-for-service (45%) practices (Adjusted Odds Ratio (AOR) = 2.4 [95% CI 1.4-4.2], p = 0.001). Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006), and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007). Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices had the greatest gaps

  9. Community Based Cardiovascular Health Interventions in Vulnerable Populations: A Systematic Review

    PubMed Central

    Walton-Moss, Benita; Samuel, Laura; Nguyen, Tam H; Commodore-Mensah, Yvonne; Hayat, Matthew J.; Szanton, Sarah L.

    2013-01-01

    Background Although cardiovascular health has been improving for many Americans, this is not true of those in “vulnerable populations.” To address this growing disparity communities and researchers have worked for decades, and as a result of their work a growing body of literature supports the use of community engagement as a component of successful interventions. However, little literature synthesizes community-based interventions that address this disparity among a wide range of vulnerable populations. Objective This paper provides a critical review of community-based cardiovascular disease (CVD) interventions to improve cardiovascular health behaviors and factors among vulnerable populations based on the American Heart Association’s 7 metrics of ideal cardiovascular health. Methods In February 2011, four databases (PubMed, PsychInfo, CINAHL, and Scopus) were searched using the following keywords: vulnerable populations OR healthcare disparities AND cardiovascular disease AND clinical trials OR public health practice AND English. Results This search strategy resulted in the retrieval of 7,120 abstracts. Each abstract was reviewed by at least two authors and eligibility for the systematic review was confirmed after reading the full article. Thirty two studies met eligibility criteria. Education was the most common intervention (41%), followed by counseling or support (38%), and exercise classes (28%). Half of the interventions were multi-component. Health care providers were the most frequent interventionists. Interventions aimed at decreasing blood pressure were the most promising while behavior change interventions were the most challenging. Almost all of the interventions were at the individual level, and were proof of concept or efficacy trials. Conclusions This analysis provides a step towards understanding the current literature on cardiovascular interventions for vulnerable population. The next step should be integrating the identified successful

  10. Precision Cardiovascular Medicine: State of Genetic Testing.

    PubMed

    Giudicessi, John R; Kullo, Iftikhar J; Ackerman, Michael J

    2017-04-01

    In the 15 years following the release of the first complete human genome sequences, our understanding of rare and common genetic variation as determinants of cardiovascular disease susceptibility, prognosis, and therapeutic response has grown exponentially. As such, the use of genomics to enhance the care of patients with cardiovascular diseases has garnered increased attention from clinicians, researchers, and regulatory agencies eager to realize the promise of precision genomic medicine. However, owing to a large burden of "complex" common diseases, emphasis on evidence-based practice, and a degree of unfamiliarity/discomfort with the language of genomic medicine, the development and implementation of genomics-guided approaches designed to further individualize the clinical management of a variety of cardiovascular disorders remains a challenge. In this review, we detail a practical approach to genetic testing initiation and interpretation as well as review the current state of cardiovascular genetic and pharmacogenomic testing in the context of relevant society and regulatory agency recommendations/guidelines. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  11. Primary prevention of stroke and cardiovascular disease in the community (PREVENTS): Methodology of a health wellness coaching intervention to reduce stroke and cardiovascular disease risk, a randomized clinical trial.

    PubMed

    Mahon, Susan; Krishnamurthi, Rita; Vandal, Alain; Witt, Emma; Barker-Collo, Suzanne; Parmar, Priya; Theadom, Alice; Barber, Alan; Arroll, Bruce; Rush, Elaine; Elder, Hinemoa; Dyer, Jesse; Feigin, Valery

    2018-02-01

    Rationale Stroke is a major cause of death and disability worldwide, yet 80% of strokes can be prevented through modifications of risk factors and lifestyle and by medication. While management strategies for primary stroke prevention in high cardiovascular disease risk individuals are well established, they are underutilized and existing practice of primary stroke prevention are inadequate. Behavioral interventions are emerging as highly promising strategies to improve cardiovascular disease risk factor management. Health Wellness Coaching is an innovative, patient-focused and cost-effective, multidimensional psychological intervention designed to motivate participants to adhere to recommended medication and lifestyle changes and has been shown to improve health and enhance well-being. Aims and/or hypothesis To determine the effectiveness of Health Wellness Coaching for primary stroke prevention in an ethnically diverse sample including Māori, Pacific Island, New Zealand European and Asian participants. Design A parallel, prospective, randomized, open-treatment, single-blinded end-point trial. Participants include 320 adults with absolute five-year cardiovascular disease risk ≥ 10%, calculated using the PREDICT web-based clinical tool. Randomization will be to Health Wellness Coaching or usual care groups. Participants randomized to Health Wellness Coaching will receive 15 coaching sessions over nine months. Study outcomes A substantial relative risk reduction of five-year cardiovascular disease risk at nine months post-randomization, which is defined as 10% relative risk reduction among those at moderate five-year cardiovascular disease risk (10-15%) and 25% among those at high risk (>15%). Discussion This clinical trial will determine whether Health Wellness Coaching is an effective intervention for reducing modifiable risk factors, and hence decrease the risk of stroke and cardiovascular disease.

  12. Independent practice associations and physician-hospital organizations can improve care management for smaller practices.

    PubMed

    Casalino, Lawrence P; Wu, Frances M; Ryan, Andrew M; Copeland, Kennon; Rittenhouse, Diane R; Ramsay, Patricia P; Shortell, Stephen M

    2013-08-01

    Pay-for-performance, public reporting, and accountable care organization programs place pressures on physicians to use health information technology and organized care management processes to improve the care they provide. But physician practices that are not large may lack the resources and size to implement such processes. We used data from a unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which independent practice associations (IPAs) and physician-hospital organizations (PHOs) might make it possible for these smaller practices to share resources to improve care. Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients. On average, practices participating in these organizations provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did (10.4 versus 3.8). Half of these processes were provided only by IPAs or PHOs. These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations.

  13. The link between chronic kidney disease and cardiovascular disease.

    PubMed

    Said, Sarmad; Hernandez, German T

    2014-07-01

    It is well known that patients with chronic kidney disease (CKD) have a strong risk of cardiovascular disease (CVD). However, the excess risk of cardiovascular disease in patients with CKD is only partially explained by the presence of traditional risk factors, such as hypertension and diabetes mellitus. Directory of Open Access Journals (DOAJ), Google Scholar, PubMed, EBSCO and Web of Science has been searched. Chronic kidney disease even in its early stages can cause hypertension and potentiate the risk for cardiovascular disease. However, the practice of intensive blood pressure lowering was criticized in recent systematic reviews. Available evidence is inconclusive but does not prove that a blood pressure target of less than 130/80 mmHg as recommended in the guidelines improves clinical outcomes more than a target of less than 140/90 mmHg in adults with CKD. The association between CKD and CVD has been extensively documented in the literature. Both CKD and CVD share common traditional risk factors, such as smoking, obesity, hypertension, diabetes mellitus, and dyslipidemia. However, cardiovascular disease remains often underdiagnosed und undertreated in patients with CKD. It is imperative that as clinicians, we recognize that patients with CKD are a group at high risk for developing CVD and cardiovascular events. Additional studies devoted to further understand the risk factors for CVD in patients with CKD are necessary to develop and institute preventative and treatment strategies to reduce the high morbidity and mortality in patients with CKD.

  14. A randomised controlled trial of a consumer-focused e-health strategy for cardiovascular risk management in primary care: the Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) study protocol.

    PubMed

    Redfern, Julie; Usherwood, T; Harris, M F; Rodgers, A; Hayman, N; Panaretto, K; Chow, C; Lau, A Y S; Neubeck, L; Coorey, G; Hersch, F; Heeley, E; Patel, A; Jan, S; Zwar, N; Peiris, D

    2014-01-31

    Fewer than half of all people at highest risk of a cardiovascular event are receiving and adhering to best practice recommendations to lower their risk. In this project, we examine the role of an e-health-assisted consumer-focused strategy as a means of overcoming these gaps between evidence and practice. Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) aims to test whether a consumer-focused e-health strategy provided to Aboriginal and Torres Strait Islander and non-indigenous adults, recruited through primary care, at moderate-to-high risk of a cardiovascular disease event will improve risk factor control when compared with usual care. Randomised controlled trial of 2000 participants with an average of 18 months of follow-up to evaluate the effectiveness of an integrated consumer-directed e-health portal on cardiovascular risk compared with usual care in patients with cardiovascular disease or who are at moderate-to-high cardiovascular disease risk. The trial will be augmented by formal economic and process evaluations to assess acceptability, equity and cost-effectiveness of the intervention. The intervention group will participate in a consumer-directed e-health strategy for cardiovascular risk management. The programme is electronically integrated with the primary care provider's software and will include interactive smart phone and Internet platforms. The primary outcome is a composite endpoint of the proportion of people meeting the Australian guideline-recommended blood pressure (BP) and cholesterol targets. Secondary outcomes include change in mean BP and fasting cholesterol levels, proportion meeting BP and cholesterol targets separately, self-efficacy, health literacy, self-reported point prevalence abstinence in smoking, body mass index and waist circumference, self-reported physical activity and self-reported medication adherence. Primary ethics approval was received from the University of Sydney Human Research Ethics Committee and the

  15. Practical Applications for Single Pill Combinations in the Cardiovascular Continuum

    PubMed Central

    Iellamo, Ferdinando; Werdan, Karl; Narkiewicz, Krzysztof; Rosano, Giuseppe

    2017-01-01

    Despite the availability of new drugs and devices, the treatment of cardiovascular disease remains suboptimal. Single-pill combination therapy offers a number of potential advantages. It can combine different classes of drugs to increase efficacy while mitigating the risks of treatment-related adverse events, reduce pill burden, lower medical cost, and improve patient adherence. Furthermore, in hypertension, single pill combinations include standard to lower doses of each drug than would be necessary to achieve goals with monotherapy, which may explain their better tolerability compared with higher dose monotherapy. Combination therapy is now established in the treatment of hypertension. In ischaemic heart disease, the concept of a preventative polypill has been studied, but its benefits have not been established conclusively. However, the combination of ivabradine and beta-blockers has proven efficacy in patients with stable angina pectoris. This combination has also demonstrated benefits in patients with chronic heart failure. PMID:28785474

  16. Ethnic disparities in cardiovascular health.

    PubMed

    Ofili, E

    2001-01-01

    Disparities in the cardiovascular outcomes of African-American patients is evident from national, regional, and local statistical data, as well as from the daily practice of medicine. This discussion highlights the complexity of ethnic disparities using a case-based approach with two typical cases from a cardiology practice. These cases underscore the complex interplay of the following factors in ethnic disparities. 1. Excess burden of cardiovascular risk factors in African Americans, with particular emphasis on high blood pressure, diabetes, obesity, physical inactivity, and psychosocial stress. 2. Inadequate knowledge of how personal risk factors are directly linked to atherosclerosis and heart disease. 3. Cultural factors in symptom recognition and health-care seeking behavior. 4. Economic factors influencing access to health care including prevention, diagnosis, and treatment. 5. A combination of psychosocial stress, racism, and frustration leading to sub-optimal interactions with the health care system. 6. Genetics of disease and predisposition to vascular disease and atherosclerosis. We must come to terms with these fundamental factors in the causation and, therefore, the resolution of ethnic disparities in cardiovascular health. Successful strategies must include: 1) partnerships for long-term, sustainable, population-wide strategies on risk factor modification; 2) models of culturally competent health care delivery; and 3) research on the gene-environment interactions, which cause the susceptibility of ethnic minorities to cardiovascular disease.

  17. Defining Quality in Cardiovascular Imaging: A Scientific Statement From the American Heart Association.

    PubMed

    Shaw, Leslee J; Blankstein, Ron; Jacobs, Jill E; Leipsic, Jonathon A; Kwong, Raymond Y; Taqueti, Viviany R; Beanlands, Rob S B; Mieres, Jennifer H; Flamm, Scott D; Gerber, Thomas C; Spertus, John; Di Carli, Marcelo F

    2017-12-01

    The aims of the current statement are to refine the definition of quality in cardiovascular imaging and to propose novel methodological approaches to inform the demonstration of quality in imaging in future clinical trials and registries. We propose defining quality in cardiovascular imaging using an analytical framework put forth by the Institute of Medicine whereby quality was defined as testing being safe, effective, patient-centered, timely, equitable, and efficient. The implications of each of these components of quality health care are as essential for cardiovascular imaging as they are for other areas within health care. Our proposed statement may serve as the foundation for integrating these quality indicators into establishing designations of quality laboratory practices and developing standards for value-based payment reform for imaging services. We also include recommendations for future clinical research to fulfill quality aims within cardiovascular imaging, including clinical hypotheses of improving patient outcomes, the importance of health status as an end point, and deferred testing options. Future research should evolve to define novel methods optimized for the role of cardiovascular imaging for detecting disease and guiding treatment and to demonstrate the role of cardiovascular imaging in facilitating healthcare quality. © 2017 American Heart Association, Inc.

  18. Physiological Changes to the Cardiovascular System at High Altitude and Its Effects on Cardiovascular Disease.

    PubMed

    Riley, Callum James; Gavin, Matthew

    2017-06-01

    Riley, Callum James, and Matthew Gavin. Physiological changes to the cardiovascular system at high altitude and its effects on cardiovascular disease. High Alt Med Biol. 18:102-113, 2017.-The physiological changes to the cardiovascular system in response to the high altitude environment are well understood. More recently, we have begun to understand how these changes may affect and cause detriment to cardiovascular disease. In addition to this, the increasing availability of altitude simulation has dramatically improved our understanding of the physiology of high altitude. This has allowed further study on the effect of altitude in those with cardiovascular disease in a safe and controlled environment as well as in healthy individuals. Using a thorough PubMed search, this review aims to integrate recent advances in cardiovascular physiology at altitude with previous understanding, as well as its potential implications on cardiovascular disease. Altogether, it was found that the changes at altitude to cardiovascular physiology are profound enough to have a noteworthy effect on many forms of cardiovascular disease. While often asymptomatic, there is some risk in high altitude exposure for individuals with certain cardiovascular diseases. Although controlled research in patients with cardiovascular disease was largely lacking, meaning firm conclusions cannot be drawn, these risks should be a consideration to both the individual and their physician.

  19. How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

    PubMed

    OʼRourke, Hannah M; Fraser, Kimberly D

    2016-01-01

    Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base.

  20. Cardiovascular Health Issues in Inner City Populations.

    PubMed

    Nayyar, Dhruv; Hwang, Stephen W

    2015-09-01

    Inner city populations in high-income countries carry a disproportionately high burden of cardiovascular disease. Although low individual socioeconomic status has long been associated with higher morbidity and mortality from cardiovascular disease, there is a growing body of evidence that area-level socioeconomic status may also have a major effect on cardiovascular outcomes. A lack of supermarkets, limited green space, and high rates of violent crime in inner city neighbourhoods result in poor dietary intake and low rates of physical activity among residents. The physical and social environments of inner city neighbourhoods may also contribute to high rates of comorbid mental illness in disadvantaged urban populations. Mental illness may lead to the clustering of cardiovascular risk factors through its impact on health behaviours, effects of psychiatric medications, and sequelae of substance abuse. Individuals residing in disadvantaged neighbourhoods experience reduced access to both primary preventive and acute in-hospital cardiovascular care. This may be driven by financial disincentives for caring for patients with low socioeconomic status, as well as system capacity issues in the inner city, and patient-level differences in health-seeking behaviours. Small-scale studies of interventions to improve individual-level health behaviours and access to care in the inner city have demonstrated some success in improving cardiovascular outcomes through the use of mobile clinics, health coaching, and case management approaches. There is a need for further research into community-wide interventions to improve the cardiovascular health of inner city populations. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  1. Measure accurately, Act rapidly, and Partner with patients: An intuitive and practical three-part framework to guide efforts to improve hypertension control.

    PubMed

    Boonyasai, Romsai T; Rakotz, Michael K; Lubomski, Lisa H; Daniel, Donna M; Marsteller, Jill A; Taylor, Kathryn S; Cooper, Lisa A; Hasan, Omar; Wynia, Matthew K

    2017-07-01

    Hypertension is the leading cause of cardiovascular disease in the United States and worldwide. It also provides a useful model for team-based chronic disease management. This article describes the M.A.P. checklists: a framework to help practice teams summarize best practices for providing coordinated, evidence-based care to patients with hypertension. Consisting of three domains-Measure Accurately; Act Rapidly; and Partner With Patients, Families, and Communities-the checklists were developed by a team of clinicians, hypertension experts, and quality improvement experts through a multistep process that combined literature review, iterative feedback from a panel of internationally recognized experts, and pilot testing among a convenience sample of primary care practices in two states. In contrast to many guidelines, the M.A.P. checklists specifically target practice teams, instead of individual clinicians, and are designed to be brief, cognitively easy to consume and recall, and accessible to healthcare workers from a range of professional backgrounds. ©2017 Wiley Periodicals, Inc.

  2. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines for Cardiopulmonary Bypass--Temperature Management during Cardiopulmonary Bypass.

    PubMed

    Engelman, Richard; Baker, Robert A; Likosky, Donald S; Grigore, Alina; Dickinson, Timothy A; Shore-Lesserson, Linda; Hammon, John W

    2015-09-01

    To improve our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical practice guidelines, and arrived at the following recommendation.

  3. Navigating change: how outreach facilitators can help clinicians improve patient outcomes.

    PubMed

    Laferriere, Dianne; Liddy, Clare; Nash, Kate; Hogg, William

    2012-01-01

    The objective of this study was to describe outreach facilitation as an effective method of assisting and supporting primary care practices to improve processes and delivery of care. We spent 4 years working with 83 practices in Eastern Ontario, Canada, on the Improved Delivery of Cardiovascular Care through the Outreach Facilitation program. Primary care practices, even if highly motivated, face multiple challenges when providing quality patient care. Outreach facilitation can be an effective method of assisting and supporting practices to make the changes necessary to improve processes and delivery of care. Multiple jurisdictions use outreach facilitation for system redesign, improved efficiencies, and advanced access. The development and implementation of quality improvement programs using practice facilitation can be challenging. Our research team has learned valuable lessons in developing tools, finding resources, and assisting practices to reach their quality improvement goals. These lessons can lead to improved experiences for the practices and overall improved outcomes for the patients they serve.

  4. How improving practice relationships among clinicians and nonclinicians can improve quality in primary care.

    PubMed

    Lanham, Holly J; McDaniel, Reuben R; Crabtree, Benjamin F; Miller, William L; Stange, Kurt C; Tallia, Alfred F; Nutting, Paula

    2009-09-01

    Understanding the role of relationships health care organizations (HCOs) offers opportunities for shaping health care delivery. When quality is treated as a property arising from the relationships within HCOs, then different contributors of quality can be investigated and more effective strategies for improvement can be developed. Data were drawn from four large National Institutes of Health (NIH)-funded studies, and an iterative analytic strategy and a grounded theory approach were used to understand the characteristics of relationships within primary care practices. This multimethod approach amassed rich and comparable data sets in all four studies, which were all aimed at primary care practice improvement. The broad range of data included direct observation of practices during work activities and of patient-clinician interactions, in-depth interviews with physicians and other key staff members, surveys, structured checklists of office environments, and chart reviews. Analyses focused on characteristics of relationships in practices that exhibited a range of success in achieving practice improvement. Complex adaptive systems theory informed these analyses. Trust, mindfulness, heedfulness, respectful interaction, diversity, social/task relatedness, and rich/lean communication were identified as important in practice improvement. A model of practice relationships was developed to describe how these characteristics work together and interact with reflection, sensemaking, and learning to influence practice-level quality outcomes. Although this model of practice relationships was developed from data collected in primary care practices, which differ from other HCOs in some important ways, the ideas that quality is emergent and that relationships influence quality of care are universally important for all HCOs and all medical specialties.

  5. Improvement of cardiovascular risk prediction: time to review current knowledge, debates, and fundamentals on how to assess test characteristics.

    PubMed

    Romanens, Michel; Ackermann, Franz; Spence, John David; Darioli, Roger; Rodondi, Nicolas; Corti, Roberto; Noll, Georg; Schwenkglenks, Matthias; Pencina, Michael

    2010-02-01

    Cardiovascular risk assessment might be improved with the addition of emerging, new tests derived from atherosclerosis imaging, laboratory tests or functional tests. This article reviews relative risk, odds ratios, receiver-operating curves, posttest risk calculations based on likelihood ratios, the net reclassification improvement and integrated discrimination. This serves to determine whether a new test has an added clinical value on top of conventional risk testing and how this can be verified statistically. Two clinically meaningful examples serve to illustrate novel approaches. This work serves as a review and basic work for the development of new guidelines on cardiovascular risk prediction, taking into account emerging tests, to be proposed by members of the 'Taskforce on Vascular Risk Prediction' under the auspices of the Working Group 'Swiss Atherosclerosis' of the Swiss Society of Cardiology in the future.

  6. Dietary nitrate as modulator of physical performance and cardiovascular health.

    PubMed

    Kerley, Conor P

    2017-11-01

    Early interventional trials reported improvements in cardiac and exercise outcomes with inorganic nitrate ingestion. The current review aims to provide a brief update of recent evidence regarding ergogenic and cardiovascular effects of dietary nitrate and practical recommendations. Recent evidence has been inconsistent and questions remain regarding effective dose, duration, and source of nitrate and cohorts likely to benefit. Dietary nitrate may be most relevant to those with vascular/metabolic impairments, those engaging in short-term, intense exercise, deconditioned individuals, and those with a low dietary nitrate intake. The evidence for cardiovascular/exercise benefit is plausible but inconsistent. However, dietary nitrate, in contrast to pharmacological nitrate, has a high benefit-risk ratio. Although nitrate supplementation has grown in popularity, it is suggested that increased green vegetables consumption may provide similar/superior benefits to nitrate supplementation in a cheaper, safer, and potentially tastier context.

  7. Day-by-Day Variability of Home Blood Pressure and Incident Cardiovascular Disease in Clinical Practice: The J-HOP Study (Japan Morning Surge-Home Blood Pressure).

    PubMed

    Hoshide, Satoshi; Yano, Yuichiro; Mizuno, Hiroyuki; Kanegae, Hiroshi; Kario, Kazuomi

    2018-01-01

    We assessed the relationship between day-by-day home blood pressure (BP) variability and incident cardiovascular disease (CVD) in clinical practice. J-HOP study (Japan Morning Surge-Home Blood Pressure) participants underwent home BP monitoring in the morning and evening for a 14-day period, and their BP levels and BP variability independent of the mean (VIM) were assessed. Incident CVD events included coronary heart disease and stroke. Cox models were fitted to assess the home BP variability-CVD risk association. Among 4231 participants (mean±SD age, 64.9±10.9 years; 53.3% women; 79.1% taking antihypertensive medication), mean (SD) home systolic BP (SBP) levels over time and VIM SBP were 134.2 (14.3) and 6.8 (2.5) mm Hg, respectively. During a 4-year follow-up period (16 750.3 person-years), 148 CVD events occurred. VIM SBP was associated with CVD risk (hazard ratio per 1-SD increase, 1.32; 95% confidence interval [CI], 1.15-1.52), independently of mean home SBP levels over time and circulating B-type natriuretic peptide levels or urine albumin-to-creatinine ratio. Adding VIM SBP to the CVD prediction model improved the discrimination (C statistic, 0.785 versus 0.770; C statistic difference, 0.015; 95% CI, 0.003-0.028). Changes in continuous net reclassification improvement (0.259; 95% CI, 0.052-0.537), absolute integrated discrimination improvement (0.010; 95% CI, 0.003-0.016), and relative integrated discrimination improvement (0.104; 95% CI, 0.037-0.166) were also observed with the addition of VIM SBP to the CVD prediction models. In addition to the assessments of mean home SBP levels and cardiovascular end-organ damage, home BP variability measurements may provide a clinically useful distinction between high- and low-risk groups among Japanese outpatients. © 2017 American Heart Association, Inc.

  8. Improving the quality of care for women with cardiovascular disease: report of a DCRI Think Tank, March 8 to 9, 2007.

    PubMed

    Berger, Jeffrey S; Bairey-Merz, C Noel; Redberg, Rita F; Douglas, Pamela S

    2008-11-01

    Differences in pathophysiology, diagnosis, and treatment of women with cardiovascular disease compared with men has become a major focus during the past decade. Nevertheless, little attention has focused on improving the quality of healthcare in women compared with other areas of cardiovascular medicine. To address this deficit, Duke University Medical Center convened a national Duke Clinical Research Institute (DCRI) Think Tank meeting, including basic science and clinical researchers, payers, legislators, clinical experts, government regulators, and members of the pharmaceutical and device industries. This report provides an overview of the discussions and proposed solutions. Discussion concentrated on the development of strategies to improve the quality of health care for women with heart disease. Key components to improve quality care include: (1) enhance the quantity and quality of evidence-based medicine to guide care in women through improvements in trial design, enrollment and retention of women subjects, results analysis and reporting, and better incentives to perform research in women; (2) provide incentives to develop better data in women through mandating changes in the drug and device development and approval processes; (3) incorporate specific recommendations for women into guidelines when data are sufficient; and (4) apply proven sex-based differences in risk stratification, diagnostic testing, and drug usage and dosing in clinical care. Examples of possible strategies are included. The above approach represents a necessary, but not sufficient, platform to improve the overall quality of healthcare in women with cardiovascular disease.

  9. The link between chronic kidney disease and cardiovascular disease

    PubMed Central

    Said, Sarmad; Hernandez, German T.

    2014-01-01

    Context: It is well known that patients with chronic kidney disease (CKD) have a strong risk of cardiovascular disease (CVD). However, the excess risk of cardiovascular disease in patients with CKD is only partially explained by the presence of traditional risk factors, such as hypertension and diabetes mellitus. Evidence Acquisitions: Directory of Open Access Journals (DOAJ), Google Scholar, PubMed, EBSCO and Web of Science has been searched. Results: Chronic kidney disease even in its early stages can cause hypertension and potentiate the risk for cardiovascular disease. However, the practice of intensive blood pressure lowering was criticized in recent systematic reviews. Available evidence is inconclusive but does not prove that a blood pressure target of less than 130/80 mmHg as recommended in the guidelines improves clinical outcomes more than a target of less than 140/90 mmHg in adults with CKD. Conclusions: The association between CKD and CVD has been extensively documented in the literature. Both CKD and CVD share common traditional risk factors, such as smoking, obesity, hypertension, diabetes mellitus, and dyslipidemia. However, cardiovascular disease remains often underdiagnosed und undertreated in patients with CKD. It is imperative that as clinicians, we recognize that patients with CKD are a group at high risk for developing CVD and cardiovascular events. Additional studies devoted to further understand the risk factors for CVD in patients with CKD are necessary to develop and institute preventative and treatment strategies to reduce the high morbidity and mortality in patients with CKD. PMID:25093157

  10. Do Clinical Practice Guidelines Improve Quality?

    PubMed

    Baldassari, Cristina M

    2017-07-01

    Controversy exists surrounding how to best define and assess quality in the health care setting. Clinical practice guidelines (CPGs) have been developed to improve the quality of medical care by highlighting key clinical recommendations based on recent evidence. However, data linking CPGs to improvements in outcomes in otolaryngology are lacking. Numerous barriers contribute to difficulties in translating CPGs to improvements in quality. Future initiatives are needed to improve CPG adherence and define the impact of CPG recommendations on the quality of otolaryngologic care provided to our patients.

  11. How Improving Practice Relationships Among Clinicians and Nonclinicians Can Improve Quality in Primary Care

    PubMed Central

    Lanham, Holly J.; McDaniel, Reuben R.; Crabtree, Benjamin F.; Miller, William L.; Stange, Kurt C.; Tallia, Alfred F.; Nutting, Paul A.

    2010-01-01

    Background Understanding the role of relationships in health care organizations (HCOs) offers opportunities for shaping health care delivery. When quality is treated as a property arising from the relationships within HCOs, then different contributors of quality can be investigated and more effective strategies for improvement can be developed. Methods Data were drawn from four large National Institutes of Health (NIH)–funded studies, and an iterative analytic strategy and a grounded theory approach were used to understand the characteristics of relationships within primary care practices. This multimethod approach amassed rich and comparable data sets in all four studies, which were all aimed at primary care practice improvement. The broad range of data included direct observation of practices during work activities and of patient-clinician interactions, in-depth interviews with physicians and other key staff members, surveys, structured checklists of office environments, and chart reviews. Analyses focused on characteristics of relationships in practices that exhibited a range of success in achieving practice improvement. Complex adaptive systems theory informed these analyses. Findings Trust, mindfulness, heedfulness, respectful interaction, diversity, social/task relatedness, and rich/lean communication were identified as important in practice improvement. A model of practice relationships was developed to describe how these characteristics work together and interact with reflection, sensemaking, and learning to influence practice-level quality outcomes. Discussion Although this model of practice relationships was developed from data collected in primary care practices, which differ from other HCOs in some important ways, the ideas that quality is emergent and that relationships influence quality of care are universally important for all HCOs and all medical specialties. PMID:19769206

  12. Boosted classification trees result in minor to modest improvement in the accuracy in classifying cardiovascular outcomes compared to conventional classification trees

    PubMed Central

    Austin, Peter C; Lee, Douglas S

    2011-01-01

    Purpose: Classification trees are increasingly being used to classifying patients according to the presence or absence of a disease or health outcome. A limitation of classification trees is their limited predictive accuracy. In the data-mining and machine learning literature, boosting has been developed to improve classification. Boosting with classification trees iteratively grows classification trees in a sequence of reweighted datasets. In a given iteration, subjects that were misclassified in the previous iteration are weighted more highly than subjects that were correctly classified. Classifications from each of the classification trees in the sequence are combined through a weighted majority vote to produce a final classification. The authors' objective was to examine whether boosting improved the accuracy of classification trees for predicting outcomes in cardiovascular patients. Methods: We examined the utility of boosting classification trees for classifying 30-day mortality outcomes in patients hospitalized with either acute myocardial infarction or congestive heart failure. Results: Improvements in the misclassification rate using boosted classification trees were at best minor compared to when conventional classification trees were used. Minor to modest improvements to sensitivity were observed, with only a negligible reduction in specificity. For predicting cardiovascular mortality, boosted classification trees had high specificity, but low sensitivity. Conclusions: Gains in predictive accuracy for predicting cardiovascular outcomes were less impressive than gains in performance observed in the data mining literature. PMID:22254181

  13. Improving Mental Health Reporting Practices in Between Personnel Security Investigations

    DTIC Science & Technology

    2017-06-01

    Improving Mental Health Reporting Practices in Between Personnel Security Investigations Stephanie L. Jaros Donna L. Tadle David Ciani Keith B...2017 Improving Mental Health Reporting Practices in Between Personnel Security Investigations Stephanie L. Jaros, Donna L. Tadle, David Ciani, Keith...COVERED: 4. Improving Mental Health Reporting Practices in Between Personnel Security Investigations 5a. CONTRACT NUMBER: 5b. GRANT NUMBER: 5c

  14. Educating fellows in practice-based learning and improvement and systems-based practice: The value of quality improvement in clinical practice.

    PubMed

    Carey, William A; Colby, Christopher E

    2013-02-01

    In 1999, the Accreditation Council for Graduate Medical Education identified 6 general competencies in which all residents must receive training. In the decade since these requirements went into effect, practice-based learning and improvement (PBLI) and systems-based practice (SBP) have proven to be the most challenging competencies to teach and assess. Because PBLI and SBP both are related to quality improvement (QI) principles and processes, we developed a QI-based curriculum to teach these competencies to our fellows. This experiential curriculum engaged our fellows in our neonatal intensive care unit's (NICU's) structured QI process. After identifying specific patient outcomes in need of improvement, our fellows applied validated QI methods to develop evidence-based treatment protocols for our neonatal intensive care unit. These projects led to immediate and meaningful improvements in patient care and also afforded our fellows various means by which to demonstrate their competence in PBLI and SBP. Our use of portfolios enabled us to document our fellows' performance in these competencies quite easily and comprehensively. Given the clinical and educational structures common to most intensive care unit-based training programs, we believe that a QI-based curriculum such as ours could be adapted by others to teach and assess PBLI and SBP. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Room for improvement? Leadership, innovation culture and uptake of quality improvement methods in general practice.

    PubMed

    Apekey, Tanefa A; McSorley, Gerry; Tilling, Michelle; Siriwardena, A Niroshan

    2011-04-01

    Leadership and innovation are currently seen as essential elements for the development and maintenance of high-quality care. Little is known about the relationship between leadership and culture of innovation and the extent to which quality improvement methods are used in general practice. This study aimed to assess the relationship between leadership behaviour, culture of innovation and adoption of quality improvement methods in general practice. Self-administered postal questionnaires were sent to general practitioner quality improvement leads in one county in the UK between June and December 2007. The questionnaire consisted of background information, a 12-item scale to assess leadership behaviour, a seven-dimension self-rating scale for culture of innovation and questions on current use of quality improvement tools and techniques. Sixty-three completed questionnaires (62%) were returned. Leadership behaviours were not commonly reported. Most practices reported a positive culture of innovation, featuring relationship most strongly, followed by targets and information but rated lower on other dimensions of rewards, risk and resources. There was a significant positive correlation between leadership behaviour and the culture of innovation (r = 0.57; P < 0.001). Apart from clinical audit and significant event analysis, quality improvement methods were not adopted by most participating practices. Leadership behaviours were infrequently reported and this was associated with a limited culture of innovation in participating general practices. There was little use of quality improvement methods beyond clinical and significant event audit. Practices need support to enhance leadership skills, encourage innovation and develop quality improvement skills if improvements in health care are to accelerate. © 2010 Blackwell Publishing Ltd.

  16. Can experiential-didactic training improve clinical STD practices?

    PubMed

    Dreisbach, Susan; Devine, Sharon; Fitch, John; Anderson, Teri; Lee, Terry; Rietmeijer, Cornelis; Corbett, Kitty K

    2011-06-01

    High rates of sexually transmitted diseases (STDs) present an ongoing costly public health challenge. One approach to reduce STD transmission is to increase the number of clinicians adopting the Centers for Disease Control and Prevention's STD Treatment Guidelines. This evaluation assesses the effectiveness of a 3-day experiential and didactic training to translate recommendations into practice by increasing clinician knowledge and skills and helping participants anticipate and overcome barriers to implementation. Between 2001 and 2004, 110 direct care clinicians from 10 states participated in one of 27 standardized 3-day interactive trainings offered by the Denver STD/human immunodeficiency virus (HIV) Prevention Training Center. STD/HIV knowledge and clinical skills were measured before, immediately after, and 6 months after training. Practice patterns were assessed before training and after 6 months. Structural barriers to implementation were identified 6 months post-training. Trainees demonstrated significant post-training gains in mean knowledge scores immediately post-training (P < 0.001) and 6 months post-training (P = 0.002). After 6 months, self-reported mean skill levels remained significantly improved compared to precourse (P < 0.05) for each of 27 skills including STD risk assessment, clinical examination, diagnosis, and treatment. Self-reported improvement in practice patterns was significant for 23 of 35 practices (P < 0.05) 6 months post-training. Participants indicated that inadequate time (52.9%), facilities/equipment (51.5%), and staffing (47.1%) interfered with implementation of recommended practices. Experiential-didactic STD/HIV training can modestly improve knowledge, clinical skills, and implementation of STD recommended practices 6 months after training. Further research is needed to identify the impact of improved clinical practices on STD/HIV transmission.

  17. Clinical indicators for recurrent cardiovascular events in acute coronary syndrome patients treated with statins under routine practice in Thailand: an observational study.

    PubMed

    Chinwong, Dujrudee; Patumanond, Jayanton; Chinwong, Surarong; Siriwattana, Khanchai; Gunaparn, Siriluck; Hall, John Joseph; Phrommintikul, Arintaya

    2015-06-16

    Acute coronary syndrome (ACS) patients are at very high cardiovascular risk and tend to have recurrent cardiovascular events. The clinical indicators for subsequent cardiovascular events are limited and need further investigation. This study aimed to explore clinical indicators that were associated with recurrent cardiovascular events following index hospitalization. The data of patients hospitalized with ACS at a tertiary care hospital in northern Thailand between January 2009 and December 2012 were retrospectively reviewed from medical charts and the electronic hospital database. The patients were classified into three groups based on the frequency of recurrent cardiovascular events (nonfatal ACS, nonfatal stroke, or all-cause death) they suffered: no recurrent events (0), single recurrent event (1), and multiple recurrent events (≥2). Ordinal logistic regression was performed to explore the clinical indicators for recurrent cardiovascular events. A total of 405 patients were included; 60 % were male; the average age was 64.9 ± 11.5 years; 40 % underwent coronary revascularization during admission. Overall, 359 (88.6 %) had no recurrent events, 36 (8.9 %) had a single recurrent event, and 10 (2.5 %) had multiple recurrent events. The significant clinical indicators associated with recurrent cardiovascular events were achieving an LDL-C goal of < 70 mg/dL (Adjusted OR = 0.43; 95 % CI = 0.27-0.69, p-value < 0.001), undergoing revascularization during admission (Adjusted OR = 0.44; 95 % CI = 0.24-0.81, p-value = 0.009), being male (Adjusted OR = 1.85; 95 % CI = 1.29-2.66, p-value = 0.001), and decrease estimated glomerular filtration rate (Adjusted OR = 2.46; 95 % CI = 2.21-2.75, p-value < 0.001). The routine clinical practice indicators assessed in ACS patients that were associated with recurrent cardiovascular events were that achieving the LDL-C goal and revascularization are protective factors

  18. The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology.

    PubMed

    Hansen, Dominique; Dendale, Paul; Coninx, Karin; Vanhees, Luc; Piepoli, Massimo F; Niebauer, Josef; Cornelissen, Veronique; Pedretti, Roberto; Geurts, Eva; Ruiz, Gustavo R; Corrà, Ugo; Schmid, Jean-Paul; Greco, Eugenio; Davos, Constantinos H; Edelmann, Frank; Abreu, Ana; Rauch, Bernhard; Ambrosetti, Marco; Braga, Simona S; Barna, Olga; Beckers, Paul; Bussotti, Maurizio; Fagard, Robert; Faggiano, Pompilio; Garcia-Porrero, Esteban; Kouidi, Evangelia; Lamotte, Michel; Neunhäuserer, Daniel; Reibis, Rona; Spruit, Martijn A; Stettler, Christoph; Takken, Tim; Tonoli, Cajsa; Vigorito, Carlo; Völler, Heinz; Doherty, Patrick

    2017-07-01

    Background Exercise rehabilitation is highly recommended by current guidelines on prevention of cardiovascular disease, but its implementation is still poor. Many clinicians experience difficulties in prescribing exercise in the presence of different concomitant cardiovascular diseases and risk factors within the same patient. It was aimed to develop a digital training and decision support system for exercise prescription in cardiovascular disease patients in clinical practice: the European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool. Methods EXPERT working group members were requested to define (a) diagnostic criteria for specific cardiovascular diseases, cardiovascular disease risk factors, and other chronic non-cardiovascular conditions, (b) primary goals of exercise intervention, (c) disease-specific prescription of exercise training (intensity, frequency, volume, type, session and programme duration), and (d) exercise training safety advices. The impact of exercise tolerance, common cardiovascular medications and adverse events during exercise testing were further taken into account for optimized exercise prescription. Results Exercise training recommendations and safety advices were formulated for 10 cardiovascular diseases, five cardiovascular disease risk factors (type 1 and 2 diabetes, obesity, hypertension, hypercholesterolaemia), and three common chronic non-cardiovascular conditions (lung and renal failure and sarcopaenia), but also accounted for baseline exercise tolerance, common cardiovascular medications and occurrence of adverse events during exercise testing. An algorithm, supported by an interactive tool, was constructed based on these data. This training and decision support system automatically provides an exercise prescription according to the variables provided. Conclusion This digital training and decision support system may contribute in overcoming barriers in

  19. School-based exercise program improves fitness, body composition and cardiovascular risk profile in overweight/obese children.

    PubMed

    Kovács, Viktória Anna; Fajcsák, Zs; Gábor, A; Martos, E

    2009-09-01

    We determined the effect of a school-based exercise training (ET) without dietary intervention, on body composition, fitness and cardiovascular risk in overweight/obese children. Subjects were 51 overweight/obese 6.5- to 12.5-year-old children (23 boys, 28 girls; BMI 25.6+/-4.3 kg/m 2 ), of whom 48 completed the program. Participants were enrolled in a 15-week aerobic training (three 60-minute sessions/week). Working heart rate was between 120-185 beats/minute. Participation rate was 87%. BMI, waist circumference, body composition (bioimpedance), aerobic capacity (treadmill), blood pressure, lipids and insulin sensitivity (HOMA) were assessed. Waist circumference (85.9+/-12.4 vs. 80.9+/-10.2 cm), muscle mass (32.4+/-6.2 vs. 33.7+/-6.1 kg), maximal oxygen consumption (37.0+/-3.9 vs. 42.6+/-11.2 ml/kg per minute), systolic blood pressure (113.3+/-11.2 vs. 106.7+/-11.6 mmHg) and LDL cholesterol (2.4+/-0.6 vs. 1.9+/-0.6 mM/l) improved significantly. Number of children with abdominal obesity (29 vs. 20), hypertension (10 vs. 5) and elevated triglyceride (18 vs. 14) also declined significantly over time. We concluded that as a result of high attendance and appropriate training program, cardiovascular fitness and abdominal obesity improved in overweight/obese children along with the improvement in metabolic risk factor profile.

  20. Recommendations from the EGAPP Working Group: genomic profiling to assess cardiovascular risk to improve cardiovascular health.

    PubMed

    2010-12-01

    The Evaluation of Genomic Applications in Practice and Prevention Working Group (EWG) found insufficient evidence to recommend testing for the 9p21 genetic variant or 57 other variants in 28 genes (listed in ) to assess risk for cardiovascular disease (CVD) in the general population, specifically heart disease and stroke. The EWG found that the magnitude of net health benefit from use of any of these tests alone or in combination is negligible. The EWG discourages clinical use unless further evidence supports improved clinical outcomes. Based on the available evidence, the overall certainty of net health benefit is deemed "Low." It has been suggested that an improvement in CVD risk classification (adjusting intermediate risk of CVD into high- or low-risk categories) might lead to management changes (e.g., earlier initiation or higher rates of medical interventions, or targeted recommendations for behavioral change) that improve CVD outcomes. In the absence of direct evidence to support this possibility, this review sought indirect evidence aimed at documenting the extent to which genomic profiling alters CVD risk estimation, alone and in combination with traditional risk factors, and the extent to which risk reclassification improves health outcomes. Assay-related evidence on available genomic profiling tests was deemed inadequate. However, based on existing technologies that have been or may be used and on data from two of the companies performing such testing, the analytic sensitivity and specificity of tests for individual gene variants might be at least satisfactory. Twenty-nine gene candidates were evaluated, with 58 different gene variant/disease associations. Evidence on clinical validity was rated inadequate for 34 of these associations (59%) and adequate for 23 (40%). Inadequate grades were based on limited evidence, poor replication, existence of possible biases, or combinations of these factors. For heart disease (25 combined associations) and stroke (13

  1. Multifaceted prospects of nanocomposites for cardiovascular grafts and stents

    PubMed Central

    Vellayappan, Muthu Vignesh; Balaji, Arunpandian; Subramanian, Aruna Priyadarshini; John, Agnes Aruna; Jaganathan, Saravana Kumar; Murugesan, Selvakumar; Supriyanto, Eko; Yusof, Mustafa

    2015-01-01

    Cardiovascular disease is the leading cause of death across the globe. The use of synthetic materials is indispensable in the treatment of cardiovascular disease. Major drawbacks related to the use of biomaterials are their mechanical properties and biocompatibility, and these have to be circumvented before promoting the material to the market or clinical setting. Revolutionary advancements in nanotechnology have introduced a novel class of materials called nanocomposites which have superior properties for biomedical applications. Recently, there has been a widespread recognition of the nanocomposites utilizing polyhedral oligomeric silsesquioxane, bacterial cellulose, silk fibroin, iron oxide magnetic nanoparticles, and carbon nanotubes in cardiovascular grafts and stents. The unique characteristics of these nanocomposites have led to the development of a wide range of nanostructured copolymers with appreciably enhanced properties, such as improved mechanical, chemical, and physical characteristics suitable for cardiovascular implants. The incorporation of advanced nanocomposite materials in cardiovascular grafts and stents improves hemocompatibility, enhances antithrombogenicity, improves mechanical and surface properties, and decreases the microbial response to the cardiovascular implants. A thorough attempt is made to summarize the various applications of nanocomposites for cardiovascular graft and stent applications. This review will highlight the recent advances in nanocomposites and also address the need of future research in promoting nanocomposites as plausible candidates in a campaign against cardiovascular disease. PMID:25897223

  2. Improved Blood Pressure Control to Reduce Cardiovascular Disease Morbidity and Mortality: The Standardized Hypertension Treatment and Prevention Project

    PubMed Central

    Patel, Pragna; Ordunez, Pedro; DiPette, Donald; Escobar, Maria Cristina; Hassell, Trevor; Wyss, Fernando; Hennis, Anselm; Asma, Samira; Angell, Sonia

    2017-01-01

    Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems–strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality. PMID:27378199

  3. [Improved Blood Pressure Control to Reduce Cardiovascular Disease Morbidity and Mortality: The Standardized Hypertension Treatment and Prevention Project].

    PubMed

    Patel, Pragna; Ordunez, Pedro; DiPette, Donald; Escobar, María Cristina; Hassell, Trevor; Wyss, Fernando; Hennis, Anselm; Asma, Samira; Angell, Sonia

    2017-06-08

    Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems-strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality.

  4. What If? Promising Practices for Improving Schools

    ERIC Educational Resources Information Center

    Dunn, Rita, Ed.; Griggs, Shirley A., Ed.

    2007-01-01

    Today, there is little deviation from the standard, business-as-usual practices in the world of education. This book challenges these stale practices and asks the important questions that can improve schools beyond the current state of mediocrity. Written for administrators, supervisors, teachers, parents--even politicians and corporate…

  5. The Middle Ages Contributions to Cardiovascular Medicine

    PubMed Central

    Ranhel, André Silva; Mesquita, Evandro Tinoco

    2016-01-01

    The historical period called the Middle Ages, a long interval between the 5th and the 15th centuries, is still commonly known as the Dark Ages, especially in the area of health sciences. In the last decades, this "classic" view of the Middle Ages has been gradually modified with advances in historiographical studies and the history of science. During that period in Western Europe, knowledge about the human body suffered a regression in terms of anatomy and physiology, with the predominance of religious conceptions mainly about diseases and their treatments. Knowledge on the cardiovascular system and heart diseases has been classically described as a repetition of the concepts developed by Galen from the dissection of animals and his keen sense of observation. However, the Middle East, especially Persia, was the birth place of a lot of intellectuals who preserved the ancient knowledge of the Greeks while building new knowledge and practices, especially from the 8th to the 13th century. The invasion of the Arabs in North of Africa and the Iberian Peninsula and the eclosion of the Crusades resulted in a greater contact between the East and the West, which in turn brought on the arrival of the Arab medical knowledge, among others, to 12th century Europe. Such fact contributed to an extremely important change in the scientific medical knowledge in the West, leading to the incorporation of different concepts and practices in the field of cardiovascular Medicine. The new way of teaching and practicing Medicine of the great Arab doctors, together with the teaching hospitals and foundations in the Koran, transformed the Medicine practiced in Europe definitely. The objective of this paper is to describe the knowledge drawn up from the Middle Ages about the cardiovascular system, its understanding and therapeutic approach to cardiologists and cardiovascular surgeons. PMID:27556317

  6. PCSK9 Inhibitors: Treating the Right Patients in Daily Practice.

    PubMed

    King, Peta; Nicholls, Stephen J

    2017-08-01

    Monoclonal antibodies that inhibit proprotein convertase subtilisin/kexin type 9 (PCSK9) have emerged as a novel approach to low-density lipoprotein cholesterol (LDL-C) lowering. The potential role of PCSK9 inhibitors in clinical practice will be reviewed. Clinical trials have demonstrated that PCSK9 inhibitors produce robust LDL-C lowering when administered either as monotherapy or in combination with statins. This provides the opportunity to achieve effective lipid lowering in familial hypercholesterolemia, patients with either established atherosclerotic cardiovascular disease or high risk primary prevention and an important opportunity to treat patients with statin intolerance. The findings from plaque imaging and patients with established atherosclerotic cardiovascular disease suggest that PCSK9 inhibition has favorable outcomes beyond improving lipid profiles, which has the opportunity to expand their use. PCSK9 inhibitors represent a new approach to achieving effective cardiovascular risk reduction in a broader number of patients. How these agents will be taken up in clinical practice remains to be determined.

  7. An Improvement of Cardiovascular Risk Factors by Omega-3 Polyunsaturated Fatty Acids.

    PubMed

    Yanai, Hidekatsu; Masui, Yoshinori; Katsuyama, Hisayuki; Adachi, Hiroki; Kawaguchi, Akiko; Hakoshima, Mariko; Waragai, Yoko; Harigae, Tadanao; Sako, Akahito

    2018-04-01

    An epidemiological survey in the Northwest Greenland reported that the Greenlanders have a lower frequency of acute myocardial infarction and diabetes mellitus. The very low incidence of ischemic heart disease in the Greenlanders was explained by consumption of a diet rich in omega-3 polyunsaturated fatty acids (PUFAs). Possible anti-atherothrombotic effects of omega-3 PUFA include an improvement of lipid metabolism such as a reduction of triglyceride and an increase of high-density lipoprotein-cholesterol (HDL-C), and glucose metabolism, anti-platelet activity, anti-inflammatory effects, an improvement of endothelial function and stabilization of atherosclerotic plaque. The present study reviews an improvement of cardiovascular risk factors such as dyslipidemia and diabetes due to consumption of omega-3 PUFA. A sufficient number of studies suggest that omega-3 PUFA supplementation reduces serum triglyceride and increases HDL-cholesterol. The mechanisms for omega-3 PUFA-mediated improvements of lipid metabolism have been partially elucidated. The studies using experimental animals, part of trials in humans, have shown the beneficial effects of omega-3 PUFA on glucose metabolism and insulin sensitivity. The meta-analysis showed that omega-3 PUFA might prevent development of diabetes in part of population. Further studies should be performed to elucidate the association of omega-3 PUFA supplementation with diabetes, in the future.

  8. Cardiovascular health in Brazilian state capitals 1.

    PubMed

    Matozinhos, Fernanda Penido; Felisbino-Mendes, Mariana Santos; Gomes, Crizian Saar; Jansen, Ann Kristine; Machado, Ísis Eloah; Lana, Francisco Carlos Félix; Malta, Deborah Carvalho; Velaquez-Melendez, Gustavo

    2017-10-19

    to estimate the prevalence of ideal cardiovascular health indicators in the Brazilian population, according to gender, age, education and region of residence. cross-sectional study that used data from 41,134 participants of the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel). The ideal cardiovascular health assessment considers four behavioral factors: not smoking; body mass index less than 25 kg/m2; practicing physical activity, eating fruits and vegetables five or more times per day; and two clinical factors (no diagnosis of diabetes or hypertension). The sum of factors at ideal levels results in a score ranging from zero (worse cardiovascular health) to six (ideal cardiovascular health). considering the six factors, only 3.4% of the studied population presented ideal levels of cardiovascular health, with the majority of participants (57.6%) presenting three or four ideal factors. Women had higher prevalence of ideal cardiovascular health (3.8% versus 2.9% for men) (p < 0.0001). the findings of this study are consistent with the elevated risk of mortality from cardiovascular disease, observed in the Brazilian population. This may contribute to a better understanding of the scenario of cardiovascular health in the urban population of the country.

  9. Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?

    PubMed

    Fagnan, Lyle J; Walunas, Theresa L; Parchman, Michael L; Dickinson, Caitlin L; Murphy, Katrina M; Howell, Ross; Jackson, Kathryn L; Madden, Margaret B; Ciesla, James R; Mazurek, Kathryn D; Kho, Abel N; Solberg, Leif I

    2018-04-01

    The methods and costs to enroll small primary care practices in large, regional quality improvement initiatives are unknown. We describe the recruitment approach, cost, and resources required to recruit and enroll 500 practices in the Northwest and Midwest regional cooperatives participating in the Agency for Healthcare Research and Quality (AHRQ)-funded initiative, EvidenceNOW: Advancing Heart Health in Primary Care. The project management team of each cooperative tracked data on recruitment methods used for identifying and connecting with practices. We developed a cost-of-recruitment template and used it to record personnel time and associated costs of travel and communication materials. A total of 3,669 practices were contacted during the 14- to 18-month recruitment period, resulting in 484 enrolled practices across the 6 states served by the 2 cooperatives. The average number of interactions per enrolled practice was 7, with a total of 29,100 hours and a total cost of $2.675 million, or $5,529 per enrolled practice. Prior partnerships predicted recruiting almost 1 in 3 of these practices as contrasted to 1 in 20 practices without a previous relationship or warm hand-off. Recruitment of practices for large-scale practice quality improvement transformation initiatives is difficult and costly. The cost of recruiting practices without existing partnerships is expensive, costing 7 times more than reaching out to familiar practices. Investigators initiating and studying practice quality improvement initiatives should budget adequate funds to support high-touch recruitment strategies, including building trusted relationships over a long time frame, for a year or more. © 2018 Annals of Family Medicine, Inc.

  10. [Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

    PubMed

    Godény, Sándor

    2012-02-05

    The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

  11. Improving patient outcomes by pooling resources (the Texas Heart Care Partnership experience).

    PubMed

    Hillert, B; Remonte, S; Rodgers, G; Yancy, C W; Kaul, A F

    2000-02-10

    The morbidity and mortality associated with cardiovascular disease presents an enormous humanistic and economic burden in the United States. In Texas, cardiovascular disease has been the leading cause of death since 1950. Risk-factor modification has been targeted in the secondary prevention of cardiovascular disease, including lipid management, smoking cessation, improved control of blood pressure, physical activity, weight management, the use of antiplatelet agents/anticoagulants, angiotensin-converting enzyme (ACE) inhibitors in congestive heart failure, beta blockers after myocardial infarction, and estrogen replacement therapy. The Heart Care Partnership (HCP) is a multifaceted interactive program designed to improve risk-factor management in the secondary prevention of cardiovascular disease through physician education, participation, and consensus development in addition to practice improvement processes and patient education. Development and implementation of the Texas HCP was a joint effort of the Texas Medical Association, the Texas Affiliate of the American Heart Association, and Merck & Co. This program helps hospitals improve the quality of care and outcomes for patients with heart disease. Program resources include educational workshops, quality improvement processes, and patient educational materials. HCP workshops address the treatment gap, define optimal care, and help define institution-specific plans for treating heart disease. Quality-improvement processes provide hospitals with baseline data and tools to improve and measure outcomes over time. The HCP workshops are provided as a combination of lectures, interactive discussions, and small group planning sessions designed to encourage audience participation. Upon completing the HCP program, participants are able to (1) describe the evidence-based medicine supporting secondary prevention of cardiovascular disease; (2) identify and prioritize cardiovascular disease risk factors for secondary

  12. Teaching Cardiovascular Physiology with Equivalent Electronic Circuits in a Practically Oriented Teaching Module

    ERIC Educational Resources Information Center

    Ribaric, Samo; Kordas, Marjan

    2011-01-01

    Here, we report on a new tool for teaching cardiovascular physiology and pathophysiology that promotes qualitative as well as quantitative thinking about time-dependent physiological phenomena. Quantification of steady and presteady-state (transient) cardiovascular phenomena is traditionally done by differential equations, but this is time…

  13. Cardiovascular risk management in patients with coronary heart disease in primary care: variation across countries and practices. An observational study based on quality indicators.

    PubMed

    van Lieshout, Jan; Grol, Richard; Campbell, Stephen; Falcoff, Hector; Capell, Eva Frigola; Glehr, Mathias; Goldfracht, Margalit; Kumpusalo, Esko; Künzi, Beat; Ludt, Sabine; Petek, Davorina; Vanderstighelen, Veerle; Wensing, Michel

    2012-10-05

    Primary care has an important role in cardiovascular risk management (CVRM) and a minimum size of scale of primary care practices may be needed for efficient delivery of CVRM . We examined CVRM in patients with coronary heart disease (CHD) in primary care and explored the impact of practice size. In an observational study in 8 countries we sampled CHD patients in primary care practices and collected data from electronic patient records. Practice samples were stratified according to practice size and urbanisation; patients were selected using coded diagnoses when available. CVRM was measured on the basis of internationally validated quality indicators. In the analyses practice size was defined in terms of number of patients registered of visiting the practice. We performed multilevel regression analyses controlling for patient age and sex. We included 181 practices (63% of the number targeted). Two countries included a convenience sample of practices. Data from 2960 CHD patients were available. Some countries used methods supplemental to coded diagnoses or other inclusion methods introducing potential inclusion bias. We found substantial variation on all CVRM indicators across practices and countries. We computed aggregated practice scores as percentage of patients with a positive outcome. Rates of risk factor recording varied from 55% for physical activity as the mean practice score across all practices (sd 32%) to 94% (sd 10%) for blood pressure. Rates for reaching treatment targets for systolic blood pressure, diastolic blood pressure and LDL cholesterol were 46% (sd 21%), 86% (sd 12%) and 48% (sd 22%) respectively. Rates for providing recommended cholesterol lowering and antiplatelet drugs were around 80%, and 70% received influenza vaccination. Practice size was not associated to indicator scores with one exception: in Slovenia larger practices performed better. Variation was more related to differences between practices than between countries. CVRM measured by

  14. The impact of the `Getting Practical: Improving Practical Work in Science' continuing professional development programme on teachers' ideas and practice in science practical work

    NASA Astrophysics Data System (ADS)

    Abrahams, Ian; Reiss, Michael J.; Sharpe, Rachael

    2014-09-01

    Background:Despite the widespread use of practical work in school it has been recognised that more needs to be done to improve its effectiveness in developing conceptual understanding. The 'Getting Practical' CPD (Continuing Professional Development) programme was designed to contribute towards an improvement in the effectiveness of practical work through initiating changes in teachers' predominantly 'hands-on' approach to practical work to one which manifests a more equitable balance between 'hands-on' and 'minds-on'. Purpose:To evaluate the impact of the Getting Practical: Improving Practical Work in Science CPD programme on teachers' ideas and practice in science practical work in primary and secondary schools in England. Programme description:The CPD programme was designed to improve the effectiveness of science practical work in developing conceptual understanding in primary and secondary schools in England. Sample:Ten teachers of primary science and 20 secondary science teachers. Design and methods:The study employed a condensed fieldwork strategy with data collected using interviews, observational field notes and pre- and post-CPD training observations in practical lessons within 30 schools. Results:Whilst the CPD programme was effective in getting teachers to reflect on the ideas associated with the Getting Practical programme, it was much less effective in bringing about changes in actual teaching practice. Conclusion:The findings suggest that if change, rather than only an enhanced awareness of the issues, is to be brought about in established teaching <span class="hlt">practice</span> then there is a need for ongoing support over an extended period of time. Furthermore, the impact of such CPD is more likely to be effective if it is undertaken by a senior member of a department or school with the full support of the SMT.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=%22evidence+based+medicine%22&pg=6&id=EJ772886','ERIC'); return false;" href="https://eric.ed.gov/?q=%22evidence+based+medicine%22&pg=6&id=EJ772886"><span>Physician Leadership: Influence on <span class="hlt">Practice</span>-Based Learning and <span class="hlt">Improvement</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Prather, Stephen E.; Jones, David N.</p> <p>2003-01-01</p> <p>In response to the technology and information explosion, <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span> is emerging within the medical field to deliver systematic <span class="hlt">practice</span>-linked <span class="hlt">improvements</span>. However, its emergence has been inhibited by the slow acceptance of evidence-based medicine among physicians, who are reluctant to embrace proven high-performance…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3716622','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3716622"><span>Evaluating an implementation strategy in <span class="hlt">cardiovascular</span> prevention to <span class="hlt">improve</span> prescribing of statins in Germany: an intention to treat analysis</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2013-01-01</p> <p>Background The prescription of statins is an evidence-based treatment to reduce the risk of <span class="hlt">cardiovascular</span> events in patients with elevated <span class="hlt">cardiovascular</span> risk or with a <span class="hlt">cardiovascular</span> disorder (CVD). In spite of this, many of these patients do not receive statins. Methods We evaluated the impact of a brief educational intervention in <span class="hlt">cardiovascular</span> prevention in primary care physicians’ prescribing behaviour regarding statins beyond their participation in a randomised controlled trial (RCT). For this, prescribing data of all patients > 35 years who were counselled before and after the study period were analysed (each n > 75000). Outcome measure was prescription of Hydroxymethylglutaryl-CoA Reductase Inhibitors (statins) corresponding to patients’ overall risk for CVD. Appropriateness of prescribing was examined according to different risk groups based on the Anatomical Therapeutic Chemical Classification System (ATC codes). Results There was no consistent association between group allocation and statin prescription controlling for risk status in each risk group before and after study participation. However, we found a change to more significant drug configurations predicting the prescription of statins in the intervention group, which can be regarded as a small intervention effect. Conclusion Our results suggest that an active implementation of a brief evidence-based educational intervention does not lead to prescription modifications in everyday <span class="hlt">practice</span>. Physician’s prescribing behaviour is affected by an established health care system, which is not easy to change. Trial registration ISRCTN71348772 PMID:23819600</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.gpo.gov/fdsys/pkg/FR-2011-10-06/pdf/2011-25780.pdf','FEDREG'); return false;" href="https://www.gpo.gov/fdsys/pkg/FR-2011-10-06/pdf/2011-25780.pdf"><span>76 FR 62164 - VASRD <span class="hlt">Improvement</span> Forum-Updating Disability Criteria for the Respiratory System, <span class="hlt">Cardiovascular</span>...</span></a></p> <p><a target="_blank" href="http://www.gpo.gov/fdsys/browse/collection.action?collectionCode=FR">Federal Register 2010, 2011, 2012, 2013, 2014</a></p> <p></p> <p>2011-10-06</p> <p>... Respiratory System, <span class="hlt">Cardiovascular</span> System, Hearing Impairment, and Ear, Nose and Throat Diseases AGENCY... System, <span class="hlt">Cardiovascular</span> System, Hearing Impairment, and Ear, Nose and Throat Diseases. The purpose of this...) the <span class="hlt">Cardiovascular</span> System (38 CFR 4.100-4.104), (3) the Impairment of Auditory Acuity (38 CFR 4.85 and...</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.osti.gov/servlets/purl/841312','SCIGOV-STC'); return false;" href="https://www.osti.gov/servlets/purl/841312"><span>Weight-loss changes PPAR expression, reduces atherosclerosis and <span class="hlt">improves</span> <span class="hlt">cardiovascular</span> function in obese insulin-resistant mice</span></a></p> <p><a target="_blank" href="http://www.osti.gov/search">DOE Office of Scientific and Technical Information (OSTI.GOV)</a></p> <p>Verreth, Wim; Verhamme, Peter; Pelat, Michael</p> <p>2003-09-01</p> <p>Weight-loss in obese insulin-resistant, but not in insulin-sensitive, persons reduces CHD risk. It is not known to what extent changes in the adipose gene expression profile are important for reducing CHD risk. We studied the effect of diet restriction-induced weight-loss on gene expression in adipose tissue, atherosclerosis and <span class="hlt">cardiovascular</span> function in mice with combined leptin and LDL-receptor deficiency. Obesity, hypertriglyceridemia and insulin-resistance are associated with hypertension, impaired left ventricle function and accelerated atherosclerosis in those mice. Diet restriction during 12 weeks caused a 45% weight-loss and changes in the gene expression in adipose tissue of PPARa and PPAR? and ofmore » key genes regulating glucose transport and insulin sensitivity, lipid metabolism, oxidative stress and inflammation, most of which are under the transcriptional control of PPARs. These changes were associated with increased insulin-sensitivity, decreased hypertriglyceridemia, reduced mean 24-hour blood pressure and heart rate, restored circadian variations of blood pressure and heart rate, increased ejection fraction, and reduced atherosclerosis. Thus, induction of PPARa and PPAR? in adipose tissue is a key mechanism for reducing atherosclerosis and <span class="hlt">improving</span> <span class="hlt">cardiovascular</span> function resulting from weight-loss. Our observations point to the critical role of PPARs in the pathogenesis of <span class="hlt">cardiovascular</span> features of the metabolic syndrome.« less</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25719216','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25719216"><span>Community <span class="hlt">cardiovascular</span> disease risk from cross-sectional general <span class="hlt">practice</span> clinical data: a spatial analysis.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Bagheri, Nasser; Gilmour, Bridget; McRae, Ian; Konings, Paul; Dawda, Paresh; Del Fante, Peter; van Weel, Chris</p> <p>2015-02-26</p> <p><span class="hlt">Cardiovascular</span> disease (CVD) continues to be a leading cause of illness and death among adults worldwide. The objective of this study was to calculate a CVD risk score from general <span class="hlt">practice</span> (GP) clinical records and assess spatial variations of CVD risk in communities. We used GP clinical data for 4,740 men and women aged 30 to 74 years with no history of CVD. A 10-year absolute CVD risk score was calculated based on the Framingham risk equation. The individual risk scores were aggregated within each Statistical Area Level One (SA1) to predict the level of CVD risk in that area. Finally, the pattern of CVD risk was visualized to highlight communities with high and low risk of CVD. The overall 10-year risk of CVD in our sample population was 14.6% (95% confidence interval [CI], 14.3%-14.9%). Of the 4,740 patients in our study, 26.7% were at high risk, 29.8% were at moderate risk, and 43.5% were at low risk for CVD over 10 years. The proportion of patients at high risk for CVD was significantly higher in the communities of low socioeconomic status. This study illustrates methods to further explore prevalence, location, and correlates of CVD to identify communities of high levels of unmet need for <span class="hlt">cardiovascular</span> care and to enable geographic targeting of effective interventions for enhancing early and timely detection and management of CVD in those communities.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/18199330','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/18199330"><span>Implementing change in primary care <span class="hlt">practices</span> using electronic medical records: a conceptual framework.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Nemeth, Lynne S; Feifer, Chris; Stuart, Gail W; Ornstein, Steven M</p> <p>2008-01-16</p> <p>Implementing change in primary care is difficult, and little <span class="hlt">practical</span> guidance is available to assist small primary care <span class="hlt">practices</span>. Methods to structure care and develop new roles are often needed to implement an evidence-based <span class="hlt">practice</span> that <span class="hlt">improves</span> care. This study explored the process of change used to implement clinical guidelines for primary and secondary prevention of <span class="hlt">cardiovascular</span> disease in primary care <span class="hlt">practices</span> that used a common electronic medical record (EMR). Multiple conceptual frameworks informed the design of this study designed to explain the complex phenomena of implementing change in primary care <span class="hlt">practice</span>. Qualitative methods were used to examine the processes of change that <span class="hlt">practice</span> members used to implement the guidelines. Purposive sampling in eight primary care <span class="hlt">practices</span> within the <span class="hlt">Practice</span> Partner Research Network-Translating Researching into <span class="hlt">Practice</span> (PPRNet-TRIP II) clinical trial yielded 28 staff members and clinicians who were interviewed regarding how change in <span class="hlt">practice</span> occurred while implementing clinical guidelines for primary and secondary prevention of <span class="hlt">cardiovascular</span> disease and strokes. A conceptual framework for implementing clinical guidelines into primary care <span class="hlt">practice</span> was developed through this research. Seven concepts and their relationships were modelled within this framework: leaders setting a vision with clear goals for staff to embrace; involving the team to enable the goals and vision for the <span class="hlt">practice</span> to be achieved; enhancing communication systems to reinforce goals for patient care; developing the team to enable the staff to contribute toward <span class="hlt">practice</span> <span class="hlt">improvement</span>; taking small steps, encouraging <span class="hlt">practices</span>' tests of small changes in <span class="hlt">practice</span>; assimilating the electronic medical record to maximize clinical effectiveness, enhancing <span class="hlt">practices</span>' use of the electronic tool they have invested in for patient care <span class="hlt">improvement</span>; and providing feedback within a culture of <span class="hlt">improvement</span>, leading to an iterative cycle of goal setting</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_10");'>10</a></li> <li><a href="#" onclick='return showDiv("page_11");'>11</a></li> <li class="active"><span>12</span></li> <li><a href="#" onclick='return showDiv("page_13");'>13</a></li> <li><a href="#" onclick='return showDiv("page_14");'>14</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_12 --> <div id="page_13" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_11");'>11</a></li> <li><a href="#" onclick='return showDiv("page_12");'>12</a></li> <li class="active"><span>13</span></li> <li><a href="#" onclick='return showDiv("page_14");'>14</a></li> <li><a href="#" onclick='return showDiv("page_15");'>15</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="241"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21287948','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21287948"><span>Trends in <span class="hlt">cardiovascular</span> diseases in Bosnia and Herzegovina and perspectives with heartscore programme.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Masic, Izet; Dilic, Mirza; Raljevic, Enver; Vulic, Dusko; Mott, Dario</p> <p>2010-01-01</p> <p><span class="hlt">Cardiovascular</span> diseases are still the major cause of death, morbidity, mortality and loss of quality of life in European countries and worldwide. In Bosnia and Herzegovina we have burden of <span class="hlt">cardiovascular</span> diseases with higher rate of morbidity and mortality than in the countries of EU zone or broader Europe. The cause of mortality is in close relation to multiple risk factors but also with specific conditions in our country; post war situation, transition and overall economic position. The main mission of European Society of Cardiology is to <span class="hlt">improve</span> quality of life in the European population by reducing the impact of <span class="hlt">cardiovascular</span> diseases. HeartScore web based program and PS Standalone program are introduce to assesses the overall risk of <span class="hlt">cardiovascular</span> death for a period of 10 years, based on variables such as age, sex, smoking, systolic blood pressure and cholesterol levels in the blood, or total cholesterol/HDL ratio. Standalone PS HeartScore is <span class="hlt">practical</span> to use, requires no permanent internet connection, the system offers its own database for each patient and the print version of the guidelines to reduce risk factors, based on evidence based medicine Program is tailored to patients, the system provides a graphical representation of the absolute risk of CVD, a version for our country is developed on the principle of high-risk populations and is available in the languages of the peoples of Bosnia and Herzegovina. Program is available for all types of medical <span class="hlt">practice</span> which is equipped with computers, the laptop, and suitable for community nursing service as well.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4615587','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4615587"><span>National Institutes of Health Career Development Awards for <span class="hlt">Cardiovascular</span> Physician-Scientists: Recent Trends and Strategies for Success</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Carlson, Drew E.; Balke, C. William; Jackson, Elizabeth A.; Madhur, Meena S.; Barac, Ana; Abdalla, Marwah; Brittain, Evan L.; Desai, Nihar; Kates, Andrew M.; Freeman, Andrew M.; Mann, Douglas L.</p> <p>2015-01-01</p> <p>Nurturing the development of <span class="hlt">cardiovascular</span> physician-scientist investigators is critical for sustained progress in <span class="hlt">cardiovascular</span> science and <span class="hlt">improving</span> human health. The transition from an inexperienced trainee to an independent physician-scientist is a multifaceted process requiring a sustained commitment from the trainee, mentors, and institution. A cornerstone of this training process is a career development (K) award from the National Institutes of Health (NIH). These awards generally require 75% of the awardee’s professional effort devoted to research aims and diverse career development activities carried out in a mentored environment over a 5-year period. We report on recent success rates for obtaining NIH K awards, provide strategies for preparing a successful application and navigating the early career period for aspiring <span class="hlt">cardiovascular</span> investigators, and offer <span class="hlt">cardiovascular</span> division leadership perspectives regarding K awards in the current era. Our objective is to offer <span class="hlt">practical</span> advice that will equip trainees considering an investigator path for success. PMID:26483107</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26483107','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26483107"><span>National Institutes of Health Career Development Awards for <span class="hlt">Cardiovascular</span> Physician-Scientists: Recent Trends and Strategies for Success.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lindman, Brian R; Tong, Carl W; Carlson, Drew E; Balke, C William; Jackson, Elizabeth A; Madhur, Meena S; Barac, Ana; Abdalla, Marwah; Brittain, Evan L; Desai, Nihar; Kates, Andrew M; Freeman, Andrew M; Mann, Douglas L</p> <p>2015-10-20</p> <p>Nurturing the development of <span class="hlt">cardiovascular</span> physician-scientist investigators is critical for sustained progress in <span class="hlt">cardiovascular</span> science and <span class="hlt">improving</span> human health. The transition from an inexperienced trainee to an independent physician-scientist is a multifaceted process requiring a sustained commitment from the trainee, mentors, and institution. A cornerstone of this training process is a career development (K) award from the National Institutes of Health (NIH). These awards generally require 75% of the awardee's professional effort devoted to research aims and diverse career development activities carried out in a mentored environment over a 5-year period. We report on recent success rates for obtaining NIH K awards, provide strategies for preparing a successful application and navigating the early career period for aspiring <span class="hlt">cardiovascular</span> investigators, and offer <span class="hlt">cardiovascular</span> division leadership perspectives regarding K awards in the current era. Our objective is to offer <span class="hlt">practical</span> advice that will equip trainees considering an investigator path for success. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/15482416','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/15482416"><span>Gender bias in <span class="hlt">cardiovascular</span> advertisements.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Ahmed, Sofia B; Grace, Sherry L; Stelfox, Henry Thomas; Tomlinson, George; Cheung, Angela M</p> <p>2004-11-01</p> <p>Women with <span class="hlt">cardiovascular</span> disease are treated less aggressively than men. The reasons for this disparity are unclear. Pharmaceutical advertisements may influence physician <span class="hlt">practices</span> and patient care. To determine if female and male patients are equally likely to be featured in <span class="hlt">cardiovascular</span> advertisements. We examined all <span class="hlt">cardiovascular</span> advertisements from US editions of general medical and <span class="hlt">cardiovascular</span> journals published between 1 January 1996 and 30 June 1998. For each unique advertisement, we recorded the total number of journal appearances and the number of appearances in journals' premium positions. We noted the gender, age, race and role of both the primary figure and the majority of people featured in the advertisement. Nine hundred and nineteen unique <span class="hlt">cardiovascular</span> advertisements were identified of which 254 depicted a patient as the primary figure. A total of 20%[95% confidence interval (CI) 15.3-25.5%] of these advertisements portrayed a female patient, while 80% (95% CI 74.5-84.7%) depicted a male patient, P <0.0001. Female patient advertisements appeared 249 times (13.3%; 95% CI 8.6-18.9%) while male patient advertisements appeared 1618 times (86.7%; 95% CI 81.1-91.4%), P <0.0001. Female patient advertisements also had significantly fewer mean appearances than male patient advertisements in journals' premium positions (0.82 vs. 1.99, P=0.02). Similar results were seen when the advertisements were analysed according to predominant gender. Despite increasing emphasis on <span class="hlt">cardiovascular</span> disease in women, significant under-representation of female patients exists in <span class="hlt">cardiovascular</span> advertisements. Physicians should be cognizant of this gender bias.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=cholesterol&pg=6&id=EJ789693','ERIC'); return false;" href="https://eric.ed.gov/?q=cholesterol&pg=6&id=EJ789693"><span>Self-Assessment of <span class="hlt">Practice</span> Performance: Development of the ABIM <span class="hlt">Practice</span> <span class="hlt">Improvement</span> Module (PIM[superscript SM])</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Duffy, F. Daniel; Lynn, Lorna A.; Didura, Halyna; Hess, Brian; Caverzagie, Kelly; Grosso, Louis; Lipner, Rebecca A.; Holmboe, Eric S.</p> <p>2008-01-01</p> <p>Background: Quality measurement and <span class="hlt">improvement</span> in <span class="hlt">practice</span> are requirements for Maintenance of Certification by the American Board of Medical Specialties boards and a component of many pay for performance programs. Objective: To describe the development of the American Board of Internal Medicine (ABIM) <span class="hlt">Practice</span> <span class="hlt">Improvement</span> Module (PIM[superscript…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27467177','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27467177"><span>Sleep: important considerations for the prevention of <span class="hlt">cardiovascular</span> disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Grandner, Michael A; Alfonso-Miller, Pamela; Fernandez-Mendoza, Julio; Shetty, Safal; Shenoy, Sundeep; Combs, Daniel</p> <p>2016-09-01</p> <p>Sleep plays many roles in maintenance of <span class="hlt">cardiovascular</span> health. This review summarizes the literature across several areas of sleep and sleep disorders in relation to cardiometabolic disease risk factors. Insufficient sleep duration is prevalent in the population and is associated with weight gain and obesity, inflammation, <span class="hlt">cardiovascular</span> disease, diabetes, and mortality. Insomnia is also highly present and represents an important risk factor for <span class="hlt">cardiovascular</span> disease, especially when accompanied by short sleep duration. Sleep apnea is a well-characterized risk factor for cardiometabolic disease and <span class="hlt">cardiovascular</span> mortality. Other issues are relevant as well. For example, sleep disorders in pediatric populations may convey <span class="hlt">cardiovascular</span> risks. Also, sleep may play an important role in <span class="hlt">cardiovascular</span> health disparities. Sleep and sleep disorders are implicated in cardiometabolic disease risk. This review addresses these and other issues, concluding with recommendations for research and clinical <span class="hlt">practice</span>.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29632228','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29632228"><span><span class="hlt">Practice</span> Facilitators' and Leaders' Perspectives on a Facilitated Quality <span class="hlt">Improvement</span> Program.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>McHugh, Megan; Brown, Tiffany; Liss, David T; Walunas, Theresa L; Persell, Stephen D</p> <p>2018-04-01</p> <p><span class="hlt">Practice</span> facilitation is a promising approach to helping <span class="hlt">practices</span> implement quality <span class="hlt">improvements</span>. Our purpose was to describe <span class="hlt">practice</span> facilitators' and <span class="hlt">practice</span> leaders' perspectives on implementation of a <span class="hlt">practice</span> facilitator-supported quality <span class="hlt">improvement</span> program and describe where their perspectives aligned and diverged. We conducted interviews with <span class="hlt">practice</span> leaders and <span class="hlt">practice</span> facilitators who participated in a program that included 35 <span class="hlt">improvement</span> strategies aimed at the ABCS of heart health (aspirin use in high-risk individuals, blood pressure control, cholesterol management, and smoking cessation). Rapid qualitative analysis was used to collect, organize, and analyze the data. We interviewed 17 of the 33 eligible <span class="hlt">practice</span> leaders, and the 10 <span class="hlt">practice</span> facilitators assigned to those <span class="hlt">practices</span>. <span class="hlt">Practice</span> leaders and <span class="hlt">practice</span> facilitators both reported value in the program's ability to bring needed, high-quality resources to <span class="hlt">practices</span>. <span class="hlt">Practice</span> leaders appreciated being able to set the schedule for facilitation and select among the 35 interventions. According to <span class="hlt">practice</span> facilitators, however, relying on <span class="hlt">practice</span> leaders to set the pace of the intervention resulted in a lower level of program intensity than intended. <span class="hlt">Practice</span> leaders preferred targeted assistance, particularly electronic health record documentation guidance and linkages to state smoking cessation programs. <span class="hlt">Practice</span> facilitators reported that the easiest interventions were those that did not alter care <span class="hlt">practices</span>. The dual perspectives of <span class="hlt">practice</span> leaders and <span class="hlt">practice</span> facilitators provide a more holistic picture of enablers and barriers to program implementation. There may be greater opportunities to assist small <span class="hlt">practices</span> through simple, targeted <span class="hlt">practice</span> facilitator-supported efforts rather than larger, comprehensive quality <span class="hlt">improvement</span> projects. © 2018 Annals of Family Medicine, Inc.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=triple+AND+point&id=EJ935875','ERIC'); return false;" href="https://eric.ed.gov/?q=triple+AND+point&id=EJ935875"><span>Embedding "Getting <span class="hlt">Practical</span>" and ASE <span class="hlt">Improving</span> <span class="hlt">Practical</span> Work in Triple Science LSN Network</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Stephenson, Kay; Chapman, Georgina</p> <p>2011-01-01</p> <p>With the two-year pilot of "Getting <span class="hlt">Practical</span>" drawing to a close, new ways to embed the key messages into existing CPD programmes are being sought. In "Embedding Getting <span class="hlt">Practical</span>," the first author describes how she has been able to do this with the courses she is involved with. In "ASE <span class="hlt">Improving</span> <span class="hlt">Practical</span> Work in Triple Science LSN Network,"…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27091540','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27091540"><span>Inspiratory Muscle Training <span class="hlt">Improves</span> Sleep and Mitigates <span class="hlt">Cardiovascular</span> Dysfunction in Obstructive Sleep Apnea.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Vranish, Jennifer R; Bailey, E Fiona</p> <p>2016-06-01</p> <p>New and effective strategies are needed to manage the autonomic and <span class="hlt">cardiovascular</span> sequelae of obstructive sleep apnea (OSA). We assessed the effect of daily inspiratory muscle strength training (IMT) on sleep and <span class="hlt">cardiovascular</span> function in adults unable to use continuous positive airway pressure (CPAP) therapy. This is a placebo-controlled, single-blind study conducted in twenty four adults with mild, moderate, and severe OSA. Subjects were randomly assigned to placebo or inspiratory muscle strength training. Subjects in each group performed 5 min of training each day for 6 w. All subjects underwent overnight polysomnography at intake and again at study close. We evaluated the effects of placebo training or IMT on sleep, blood pressure, and plasma catecholamines. Relative to placebo-trained subjects with OSA, subjects with OSA who performed IMT manifested reductions in systolic and diastolic blood pressures (-12.3 ± 1.6 SBP and -5.0 ± 1.3 DBP mmHg; P < 0.01); plasma norepinephrine levels (536.3 ± 56.6 versus 380.6 ± 41.2 pg/mL; P = 0.01); and registered fewer nighttime arousals and reported <span class="hlt">improved</span> sleep (Pittsburgh Sleep Quality Index scores: 9.1 ± 0.9 versus 5.1 ± 0.7; P = 0.001). These favorable outcomes were achieved without affecting apneahypopnea index. The results are consistent with our previously published findings in normotensive adults but further indicate that IMT can modulate blood pressure and plasma catecholamines in subjects with ongoing nighttime apnea and hypoxemia. Accordingly, we suggest IMT offers a low cost, nonpharmacologic means of <span class="hlt">improving</span> sleep and blood pressure in patients who are intolerant of CPAP. © 2016 Associated Professional Sleep Societies, LLC.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27595685','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27595685"><span>Rationale and design of the <span class="hlt">Improving</span> Care for <span class="hlt">Cardiovascular</span> Disease in China (CCC) project: A national effort to prompt quality enhancement for acute coronary syndrome.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Hao, Yongchen; Liu, Jing; Liu, Jun; Smith, Sidney C; Huo, Yong; Fonarow, Gregg C; Ma, Changsheng; Ge, Junbo; Taubert, Kathryn A; Morgan, Louise; Guo, Yang; Zhang, Qian; Wang, Wei; Zhao, Dong</p> <p>2016-09-01</p> <p>A sizeable gap exists between guideline recommendations for treatment of acute coronary syndrome (ACS) and application of these recommendations in clinical <span class="hlt">practice</span>. The CCC-ACS project is a novel national quality enhancement registry designed to help medical care providers bridge this gap, thereby <span class="hlt">improving</span> clinical outcomes for ACS patients in China. The CCC-ACS project uses data collection, analysis, feedback, rapid-cycle <span class="hlt">improvement</span>, and performance recognition to extend the use of evidence-based guidelines throughout the health care system and <span class="hlt">improve</span> <span class="hlt">cardiovascular</span> health. The project was launched in 2014, with 150 centers recruited representing the diversity of care for ACS patients in tertiary hospitals across China. Clinical information for patients with ACS is collected via a Web-based data collecting platform, including patients' demographics, medical history, symptoms on arrival, in-hospital treatment and procedures, in-hospital outcomes, and discharge medications for secondary prevention. <span class="hlt">Improvement</span> in adherence to guideline recommendations is facilitated through monthly benchmarked hospital quality reports, recognition of hospital quality achievement, and regular webinars. As of April 16, 2016, a total of 35,616 ACS cases have been enrolled. The CCC-ACS is a national hospital-based quality <span class="hlt">improvement</span> program, aiming to increase adherence to ACS guidelines in China and <span class="hlt">improve</span> patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23205383','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23205383"><span>Can formal collaborative methodologies <span class="hlt">improve</span> quality in primary health care in New Zealand? Insights from the EQUIPPED Auckland Collaborative.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Palmer, Celia; Bycroft, Janine; Healey, Kate; Field, Adrian; Ghafel, Mazin</p> <p>2012-12-01</p> <p>Auckland District Health Board was one of four District Health Boards to trial the Breakthrough Series (BTS) methodology to <span class="hlt">improve</span> the management of long-term conditions in New Zealand, with support from the Ministry of Health. To <span class="hlt">improve</span> clinical outcomes, facilitate planned care and promote quality <span class="hlt">improvement</span> within participating <span class="hlt">practices</span> in Auckland. Implementation of the Collaborative followed the <span class="hlt">improvement</span> model / Institute for Healthcare <span class="hlt">Improvement</span> methodology. Three topic areas were selected: system redesign, <span class="hlt">cardio-vascular</span> disease/diabetes, and self-management support. An expert advisory group and the <span class="hlt">Improvement</span> Foundation Australia helped guide project development and implementation. Primary Health Organisation facilitators were trained in the methodology and 15 <span class="hlt">practice</span> teams participated in the three learning workshops and action periods over 12 months. An independent evaluation study using both quantitative and qualitative methods was conducted. <span class="hlt">Improvements</span> were recorded in <span class="hlt">cardiovascular</span> disease risk assessment, <span class="hlt">practice</span>-level systems of care, self-management systems and follow-up and coordination for patients. Qualitative research found <span class="hlt">improvements</span> in coordination and teamwork, knowledge of <span class="hlt">practice</span> populations and understanding of managing long-term conditions. The Collaborative process delivered some real <span class="hlt">improvements</span> in the systems of care for people with long-term conditions and a change in culture among participating <span class="hlt">practices</span>. The findings suggest that by strengthening facilitation processes, <span class="hlt">improving</span> access to comprehensive population audit tools and lengthening the time frame, the process has the potential to make significant <span class="hlt">improvements</span> in <span class="hlt">practice</span>. Other organisations should consider this approach when investigating quality <span class="hlt">improvement</span> programmes.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3599652','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3599652"><span>Effectiveness of late gadolinium enhancement to <span class="hlt">improve</span> outcomes prediction in patients referred for <span class="hlt">cardiovascular</span> magnetic resonance after echocardiography</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2013-01-01</p> <p>Background Echocardiography (echo) is a first line test to assess cardiac structure and function. It is not known if <span class="hlt">cardiovascular</span> magnetic resonance (CMR) with late gadolinium enhancement (LGE) ordered during routine clinical <span class="hlt">practice</span> in selected patients can add additional prognostic information after routine echo. We assessed whether CMR <span class="hlt">improves</span> outcomes prediction after contemporaneous echo, which may have implications for efforts to optimize processes of care, assess effectiveness, and allocate limited health care resources. Methods and results We prospectively enrolled 1044 consecutive patients referred for CMR. There were 38 deaths and 3 cardiac transplants over a median follow-up of 1.0 years (IQR 0.4-1.5). We first reproduced previous survival curve strata (presence of LGE and ejection fraction (EF) < 50%) for transplant free survival, to support generalizability of any findings. Then, in a subset (n = 444) with contemporaneous echo (median 3 days apart, IQR 1–9), EF by echo (assessed visually) or CMR were modestly correlated (R2 = 0.66, p < 0.001), and 30 deaths and 3 transplants occurred over a median follow-up of 0.83 years (IQR 0.29-1.40). CMR EF predicted mortality better than echo EF in univariable Cox models (Integrated Discrimination <span class="hlt">Improvement</span> (IDI) 0.018, 95% CI 0.008-0.034; Net Reclassification <span class="hlt">Improvement</span> (NRI) 0.51, 95% CI 0.11-0.85). Finally, LGE further <span class="hlt">improved</span> prediction beyond EF as determined by hazard ratios, NRI, and IDI in all Cox models predicting mortality or transplant free survival, adjusting for age, gender, wall motion, and EF. Conclusions Among those referred for CMR after echocardiography, CMR with LGE further <span class="hlt">improves</span> risk stratification of individuals at risk for death or death/cardiac transplant. PMID:23324403</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5466021','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5466021"><span>Methodological Rigor in Preclinical <span class="hlt">Cardiovascular</span> Studies</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Ramirez, F. Daniel; Motazedian, Pouya; Jung, Richard G.; Di Santo, Pietro; MacDonald, Zachary D.; Moreland, Robert; Simard, Trevor; Clancy, Aisling A.; Russo, Juan J.; Welch, Vivian A.; Wells, George A.</p> <p>2017-01-01</p> <p>Rationale: Methodological sources of bias and suboptimal reporting contribute to irreproducibility in preclinical science and may negatively affect research translation. Randomization, blinding, sample size estimation, and considering sex as a biological variable are deemed crucial study design elements to maximize the quality and predictive value of preclinical experiments. Objective: To examine the prevalence and temporal patterns of recommended study design element implementation in preclinical <span class="hlt">cardiovascular</span> research. Methods and Results: All articles published over a 10-year period in 5 leading <span class="hlt">cardiovascular</span> journals were reviewed. Reports of in vivo experiments in nonhuman mammals describing pathophysiology, genetics, or therapeutic interventions relevant to specific <span class="hlt">cardiovascular</span> disorders were identified. Data on study design and animal model use were collected. Citations at 60 months were additionally examined as a surrogate measure of research impact in a prespecified subset of studies, stratified by individual and cumulative study design elements. Of 28 636 articles screened, 3396 met inclusion criteria. Randomization was reported in 21.8%, blinding in 32.7%, and sample size estimation in 2.3%. Temporal and disease-specific analyses show that the implementation of these study design elements has overall not appreciably increased over the past decade, except in preclinical stroke research, which has uniquely demonstrated significant <span class="hlt">improvements</span> in methodological rigor. In a subset of 1681 preclinical studies, randomization, blinding, sample size estimation, and inclusion of both sexes were not associated with increased citations at 60 months. Conclusions: Methodological shortcomings are prevalent in preclinical <span class="hlt">cardiovascular</span> research, have not substantially <span class="hlt">improved</span> over the past 10 years, and may be overlooked when basing subsequent studies. Resultant risks of bias and threats to study validity have the potential to hinder progress in</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://files.eric.ed.gov/fulltext/ED427470.pdf','ERIC'); return false;" href="http://files.eric.ed.gov/fulltext/ED427470.pdf"><span>Reflective <span class="hlt">Practice</span>: Creating Capacities for School <span class="hlt">Improvement</span>.</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Montie, Jo; York-Barr, Jennifer; Kronberg, Robi; Stevenson, Jane; Vallejo, Barb; Lunders, Cheri</p> <p></p> <p>This monograph addresses the importance of and strategies for <span class="hlt">improving</span> education through reflective <span class="hlt">practice</span>, defined as cognitive processes and an open perspective that involve conscious self-examination in order to gain understandings and <span class="hlt">improve</span> the lives of students. Chapter 1 provides an overview and explains origins of reflective practice…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28182814','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28182814"><span>Gender Differences in Knowledge, Attitudes and <span class="hlt">Practices</span> towards <span class="hlt">Cardiovascular</span> Disease and its Treatment among Asian Patients.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Shen, Tong; Teo, Tse Yean; Yap, Jonathan Jl; Yeo, Khung Keong</p> <p>2017-01-01</p> <p>Introduction : Knowledge, attitudes and <span class="hlt">practices</span> (KAP) impact on cardiac disease outcomes, with noted cultural and gender differences. In this Asian cohort, we aimed to analyse the KAP of patients towards cardiac diseases and pertinent factors that influence such behaviour, focusing on gender differences. Materials and Methods : A cross-sectional survey was performed among consecutive outpatients from a cardiac clinic over 2 months in 2014. Results : Of 1406 patients approached, 1000 (71.1%) responded (mean age 57.0 ± 12.7 years, 713 [71.3%] males). There was significant correlation between knowledge and attitude scores (r = 0.224, P <0.001), and knowledge and <span class="hlt">practice</span> scores (r = 0.114, P <0.001). There was no correlation between attitude and <span class="hlt">practice</span> scores. Multivariate predictors of higher knowledge scores included female sex, higher education, higher attitude and <span class="hlt">practice</span> scores and prior coronary artery disease. Multivariate predictors of higher attitude scores included higher education, higher knowledge scores and non-Indian ethnicity. Multivariate predictors of higher <span class="hlt">practice</span> scores included male sex, Indian ethnicity, older age, higher knowledge score and hypertension. Males had lower knowledge scores (85.8 ± 8.0% vs 88.0 ± 8.2%, P <0.001), lower attitude scores (91.4 ± 9.4% vs 93.2 ± 8.3%, P = 0.005) and higher <span class="hlt">practice</span> scores (58.4 ± 18.7% vs 55.1 ± 19.3%, P = 0.013) than females. Conclusion : In our Asian cohort, knowledge of <span class="hlt">cardiovascular</span> health plays a significant role in influencing attitudes and <span class="hlt">practices</span>. There exists significant gender differences in KAP. Adopting gender-specific strategies for future public health campaigns could address the above gender differences.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27539179','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27539179"><span>Positive <span class="hlt">Cardiovascular</span> Health: A Timely Convergence.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Labarthe, Darwin R; Kubzansky, Laura D; Boehm, Julia K; Lloyd-Jones, Donald M; Berry, Jarett D; Seligman, Martin E P</p> <p>2016-08-23</p> <p>Two concepts, positive health and <span class="hlt">cardiovascular</span> health, have emerged recently from the respective fields of positive psychology and preventive cardiology. These parallel constructs are converging to foster positive <span class="hlt">cardiovascular</span> health and a growing collaboration between psychologists and <span class="hlt">cardiovascular</span> scientists to achieve significant <span class="hlt">improvements</span> in both individual and population <span class="hlt">cardiovascular</span> health. We explore these 2 concepts and note close similarities in the measures that define them, the health states that they aim to produce, and their intended long-term clinical and public health outcomes. We especially examine subjective health assets, such as optimism, that are a core focus of positive psychology, but have largely been neglected in preventive cardiology. We identify research to date on positive <span class="hlt">cardiovascular</span> health, discuss its strengths and limitations thus far, and outline directions for further engagement of <span class="hlt">cardiovascular</span> scientists with colleagues in positive psychology to advance this new field. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/20875948','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/20875948"><span>Implementation of <span class="hlt">cardiovascular</span> secondary prevention guidelines in clinical <span class="hlt">practice</span>: a nationwide survey in Italy.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Perrone-Filardi, P; Poli, A; Ambrosio, G; Proto, C; Chimini, C; Chiariello, M</p> <p>2012-02-01</p> <p>To report the implementation of <span class="hlt">cardiovascular</span> secondary prevention guidelines following a <span class="hlt">cardiovascular</span> event in Italy. Data were collected from 878 consecutive patients, who had suffered a <span class="hlt">cardiovascular</span> event requiring hospitalisation in the preceding 12-24 months and who presented at 49 outpatient clinics across Italy. <span class="hlt">Cardiovascular</span> risk markers were assessed through clinical examination, interview and reviewing of patients' charts; in addition, we collected information on changes in prevalence of selected risk factors that occurred since the time of index event. At the time of evaluation, increased body mass index (BMI) was observed in 35% of patients, with 20% being obese; 26% had diabetes and 21% uncontrolled hypertension. Although 91% of patients were on statins, no measurement of low-density lipoprotein (LDL)-cholesterol was available in the previous 6 months in 27% of patients and 16% had no knowledge of any lipid parameter in the same period. In the remaining patients, LDL was <100 mg dl(-1) in 57% and <70 mg dl(-1) in 20% of them. From the time of index event to interview, prevalence of uncontrolled hypertension remained stable, from 24% to 21% of patients; according to the patients' self-reporting, smoking had declined from 32% to 13% of patients and physical inactivity from 43% to 33% of patients. This survey shows, in a large national cohort, a suboptimal implementation of lifestyle changes and inadequate lipid control in patients at high <span class="hlt">cardiovascular</span> risk after a <span class="hlt">cardiovascular</span> event. Reinforcement of patients and physicians, implementation and adherence to guidelines is needed to reduce the burden of <span class="hlt">cardiovascular</span> disease. Copyright © 2010 Elsevier B.V. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25447261','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25447261"><span>Impact of the 2014 expert panel recommendations for management of high blood pressure on contemporary <span class="hlt">cardiovascular</span> <span class="hlt">practice</span>: insights from the NCDR PINNACLE registry.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Borden, William B; Maddox, Thomas M; Tang, Fengming; Rumsfeld, John S; Oetgen, William J; Mullen, J Brendan; Spinler, Sarah A; Peterson, Eric D; Masoudi, Frederick A</p> <p>2014-12-02</p> <p>Since 2003, the Seventh Report of the Joint National Committee (JNC-7) has been the predominant guideline for blood pressure management. A 2014 expert panel recommended increasing the blood pressure targets for patients age 60 years and older, as well as those with diabetes or chronic kidney disease. The purpose of this study was to examine the effect of the 2014 expert panel blood pressure management recommendations on patients managed in U.S. ambulatory <span class="hlt">cardiovascular</span> <span class="hlt">practices</span>. Using the National <span class="hlt">Cardiovascular</span> Data Registry PINNACLE Registry, we assessed the proportion of patients who met the 2003 and 2014 panel recommendations, highlighting the populations of patients for whom the blood pressure goals changed. Of 1,185,253 patients in the study cohort, 706,859 (59.6%) achieved the 2003 JNC-7 goals. Using the 2014 recommendations, 880,378 (74.3%) patients were at goal. Among the 173,519 (14.6%) for whom goal achievement changed, 40,323 (23.2%) had a prior stroke or transient ischemic attack, and 112,174 (64.6%) had coronary artery disease. In addition, the average Framingham risk score in this group was 8.5 ± 3.2%, and the 10-year ASCVD risk score was 28.0 ± 19.5%. Among U.S. ambulatory cardiology patients with hypertension, nearly 1 in 7 who did not meet JNC-7 recommendations would now meet the 2014 treatment goals. If the new recommendations are implemented in clinical <span class="hlt">practice</span>, blood pressure target achievement and <span class="hlt">cardiovascular</span> events will need careful monitoring, because many patients for whom the target blood pressure is now more permissive are at high <span class="hlt">cardiovascular</span> risk. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2838248','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2838248"><span>Highly accelerated <span class="hlt">cardiovascular</span> MR imaging using many channel technology: concepts and clinical applications</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Sodickson, Daniel K.</p> <p>2010-01-01</p> <p><span class="hlt">Cardiovascular</span> magnetic resonance imaging (CVMRI) is of proven clinical value in the non-invasive imaging of <span class="hlt">cardiovascular</span> diseases. CVMRI requires rapid image acquisition, but acquisition speed is fundamentally limited in conventional MRI. Parallel imaging provides a means for increasing acquisition speed and efficiency. However, signal-to-noise (SNR) limitations and the limited number of receiver channels available on most MR systems have in the past imposed <span class="hlt">practical</span> constraints, which dictated the use of moderate accelerations in CVMRI. High levels of acceleration, which were unattainable previously, have become possible with many-receiver MR systems and many-element, cardiac-optimized RF-coil arrays. The resulting imaging speed <span class="hlt">improvements</span> can be exploited in a number of ways, ranging from enhancement of spatial and temporal resolution to efficient whole heart coverage to streamlining of CVMRI work flow. In this review, examples of these strategies are provided, following an outline of the fundamentals of the highly accelerated imaging approaches employed in CVMRI. Topics discussed include basic principles of parallel imaging; key requirements for MR systems and RF-coil design; <span class="hlt">practical</span> considerations of SNR management, supported by multi-dimensional accelerations, 3D noise averaging and high field imaging; highly accelerated clinical state-of-the art <span class="hlt">cardiovascular</span> imaging applications spanning the range from SNR-rich to SNR-limited; and current trends and future directions. PMID:17562047</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29453595','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29453595"><span>Cardio-oncology: conflicting priorities of anticancer treatment and <span class="hlt">cardiovascular</span> outcome.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Tilemann, Lisa M; Heckmann, Markus B; Katus, Hugo A; Lehmann, Lorenz H; Müller, Oliver J</p> <p>2018-04-01</p> <p>This article about the emerging field of cardio-oncology highlights typical side effects of oncological therapies in the <span class="hlt">cardiovascular</span> system, <span class="hlt">cardiovascular</span> complications of malignancies itself, and potential preventive or therapeutic modalities. We performed a selective literature search in PubMed until September 2016. <span class="hlt">Cardiovascular</span> events in cancer patients can be frequently attributed to oncological therapies or to the underlying malignancy itself. Furthermore, many patients with cancer have pre-existing <span class="hlt">cardiovascular</span> diseases that can be aggravated by the malignancy or its therapy. <span class="hlt">Cardiovascular</span> abnormalities in oncological patients comprise a broad spectrum from alterations in electrophysiological, laboratory or imaging tests to the occurrence of thromboembolic, ischemic or rhythmological events and the impairment of left ventricular function or manifest heart failure. A close interdisciplinary collaboration between oncologists and cardiologists/angiologists as well as an increased awareness of potential <span class="hlt">cardiovascular</span> complications could <span class="hlt">improve</span> clinical care of cancer patients and provides a basis for an <span class="hlt">improved</span> understanding of underlying mechanisms of <span class="hlt">cardiovascular</span> morbidity.</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_11");'>11</a></li> <li><a href="#" onclick='return showDiv("page_12");'>12</a></li> <li class="active"><span>13</span></li> <li><a href="#" onclick='return showDiv("page_14");'>14</a></li> <li><a href="#" onclick='return showDiv("page_15");'>15</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_13 --> <div id="page_14" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_12");'>12</a></li> <li><a href="#" onclick='return showDiv("page_13");'>13</a></li> <li class="active"><span>14</span></li> <li><a href="#" onclick='return showDiv("page_15");'>15</a></li> <li><a href="#" onclick='return showDiv("page_16");'>16</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="261"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25837207','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25837207"><span>Switching to a 10-day Mediterranean-style diet <span class="hlt">improves</span> mood and <span class="hlt">cardiovascular</span> function in a controlled crossover study.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lee, Jaime; Pase, Matthew; Pipingas, Andrew; Raubenheimer, Jessica; Thurgood, Madeline; Villalon, Lorena; Macpherson, Helen; Gibbs, Amy; Scholey, Andrew</p> <p>2015-05-01</p> <p>Even short-term adherence to a Mediterranean-style diet may benefit aspects of psychological functioning. The aim of the present study was to assess the effects of switching to a 10-d Mediterranean-style diet on mood, cognition, and <span class="hlt">cardiovascular</span> measures. Using a crossover design, 24 women were randomly assigned to either the diet change (where they switched to a Mediterranean-style diet) or no diet change (normal diet) condition for 10 days before switching to the other condition for the same duration. Mood, cognition, and <span class="hlt">cardiovascular</span> measures of blood pressure, blood flow velocity, and arterial stiffness were assessed at baseline and at the completion of the two diets (days 11 and 22). Independent of whether the Mediterranean-style diet was undertaken before or after the crossover, it was associated with significantly elevated contentment and alertness, and significantly reduced confusion. Additionally, aspects of cognition, such as memory recall, <span class="hlt">improved</span> significantly as a result of switching to the Mediterranean-style diet. Regarding <span class="hlt">cardiovascular</span> measures, there was a significant reduction in augmentation pressure associated with the Mediterranean-style diet intervention, but blood flow velocity through the common carotid artery did not change. This Mediterranean-style diet has the potential to enhance aspects of mood, cognition, and <span class="hlt">cardiovascular</span> function in a young, healthy adult sample. Copyright © 2015 Elsevier Inc. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25403616','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25403616"><span><span class="hlt">Improving</span> nutritional care: innovation and good <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Chapman, Carol; Barker, Mary; Lawrence, Wendy</p> <p>2015-04-01</p> <p>This paper presents examples of good <span class="hlt">practice</span> in nutritional screening and care and identifies methods used to overcome contextual constraints and discusses the implications for nursing <span class="hlt">practice</span> in hospitals. Nutritional screening is an important step in identifying those at risk of malnutrition, but does not produce <span class="hlt">improved</span> nutritional care unless it results in a care plan that is acted on. The importance of nutrition and implications for clinical care make it imperative to <span class="hlt">improve</span> <span class="hlt">practice</span>. Qualitative investigation. Between January 2011-February 2012, focus groups were held using a semi-structured discussion guide with nine groups of health professionals (n = 80) from one hospital: four with nurses, three with doctors and two with dietitians. Discussions were audio-recorded, transcribed and coded into themes and sub-themes, which were then depicted in a thematic map and illustrated with verbatim quotes. Three strategies for sustaining effective nutritional <span class="hlt">practice</span> emerged: establishing routines to ensure screening was undertaken; re-organizing aspects of care to promote good <span class="hlt">practice</span>; developing innovative approaches. Issues to be addressed were the perceived disconnection between mandatory screening and the delivery of effective care, a requirement for nutrition education, organizational constraints of a large university hospital and the complexities of multidisciplinary working. Professionals seeking to <span class="hlt">improve</span> nutritional care in hospitals need to understand the interaction of system and person to facilitate change. Nursing staff need to be able to exercise autonomy and the hospital system must offer enough flexibility to allow wards to organize nutritional screening and care in a way that meets the needs of individual patients. © 2014 John Wiley & Sons Ltd.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28853126','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28853126"><span><span class="hlt">Improving</span> coding accuracy in an academic <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Nguyen, Dana; O'Mara, Heather; Powell, Robert</p> <p>2017-01-01</p> <p><span class="hlt">Practice</span> management has become an increasingly important component of graduate medical education. This applies to every <span class="hlt">practice</span> environment; private, academic, and military. One of the most critical aspects of <span class="hlt">practice</span> management is documentation and coding for physician services, as they directly affect the financial success of any <span class="hlt">practice</span>. Our quality <span class="hlt">improvement</span> project aimed to implement a new and innovative method for teaching billing and coding in a longitudinal fashion in a family medicine residency. We hypothesized that implementation of a new teaching strategy would increase coding accuracy rates among residents and faculty. Design: single group, pretest-posttest. military family medicine residency clinic. Study populations: 7 faculty physicians and 18 resident physicians participated as learners in the project. Educational intervention: monthly structured coding learning sessions in the academic curriculum that involved learner-presented cases, small group case review, and large group discussion. overall coding accuracy (compliance) percentage and coding accuracy per year group for the subjects that were able to participate longitudinally. Statistical tests used: average coding accuracy for population; paired t test to assess <span class="hlt">improvement</span> between 2 intervention periods, both aggregate and by year group. Overall coding accuracy rates remained stable over the course of time regardless of the modality of the educational intervention. A paired t test was conducted to compare coding accuracy rates at baseline (mean (M)=26.4%, SD=10%) to accuracy rates after all educational interventions were complete (M=26.8%, SD=12%); t24=-0.127, P=.90. Didactic teaching and small group discussion sessions did not <span class="hlt">improve</span> overall coding accuracy in a residency <span class="hlt">practice</span>. Future interventions could focus on educating providers at the individual level.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26228782','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26228782"><span>ISPD <span class="hlt">Cardiovascular</span> and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part I - Assessment and Management of Various <span class="hlt">Cardiovascular</span> Risk Factors.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Wang, Angela Yee Moon; Brimble, K Scott; Brunier, Gillian; Holt, Stephen G; Jha, Vivekanand; Johnson, David W; Kang, Shin-Wook; Kooman, Jeroen P; Lambie, Mark; McIntyre, Chris; Mehrotra, Rajnish; Pecoits-Filho, Roberto</p> <p>2015-01-01</p> <p><span class="hlt">Cardiovascular</span> disease contributes significantly to the adverse clinical outcomes of peritoneal dialysis (PD) patients. Numerous <span class="hlt">cardiovascular</span> risk factors play important roles in the development of various <span class="hlt">cardiovascular</span> complications. Of these, loss of residual renal function is regarded as one of the key <span class="hlt">cardiovascular</span> risk factors and is associated with an increased mortality and <span class="hlt">cardiovascular</span> death. It is also recognized that PD solutions may incur significant adverse metabolic effects in PD patients. The International Society for Peritoneal Dialysis (ISPD) commissioned a global workgroup in 2012 to formulate a series of recommendations regarding lifestyle modification, assessment and management of various <span class="hlt">cardiovascular</span> risk factors, as well as management of the various <span class="hlt">cardiovascular</span> complications including coronary artery disease, heart failure, arrhythmia (specifically atrial fibrillation), cerebrovascular disease, peripheral arterial disease and sudden cardiac death, to be published in 2 guideline documents. This publication forms the first part of the guideline documents and includes recommendations on assessment and management of various <span class="hlt">cardiovascular</span> risk factors. The documents are intended to serve as a global clinical <span class="hlt">practice</span> guideline for clinicians who look after PD patients. The ISPD workgroup also identifies areas where evidence is lacking and further research is needed. Copyright © 2015 International Society for Peritoneal Dialysis.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=improve+AND+effectiveness+AND+teaching+AND+science&pg=2&id=EJ1041694','ERIC'); return false;" href="https://eric.ed.gov/?q=improve+AND+effectiveness+AND+teaching+AND+science&pg=2&id=EJ1041694"><span>The Impact of the "Getting <span class="hlt">Practical</span>: <span class="hlt">Improving</span> <span class="hlt">Practical</span> Work in Science" Continuing Professional Development Programme on Teachers' Ideas and <span class="hlt">Practice</span> in Science <span class="hlt">Practical</span> Work</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Abrahams, Ian; Reiss, Michael J.; Sharpe, Rachael</p> <p>2014-01-01</p> <p>Background: Despite the widespread use of <span class="hlt">practical</span> work in school it has been recognised that more needs to be done to <span class="hlt">improve</span> its effectiveness in developing conceptual understanding. The "Getting <span class="hlt">Practical</span>" CPD (Continuing Professional Development) programme was designed to contribute towards an <span class="hlt">improvement</span> in the effectiveness of…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25546953','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25546953"><span>[Main ways of <span class="hlt">improvements</span> of the systems of medical rehabilitation of military servicemen after <span class="hlt">cardiovascular</span> surgery].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Iudin, V E; Klimko, V V; Shkarupa, O F; Guzenko, I E</p> <p>2014-08-01</p> <p>For better <span class="hlt">improvement</span> of medical rehabilitation referred to effective restoration of functional status of servicemen after <span class="hlt">cardiovascular</span> surgery it is necessary to introduce standards of medical rehabilitation at all stages of rehabilitation, syndrome-pathologic principle of grouping patients, multidisciplinary organisation of medical activity: cardiologist-physician, specialist of functional diagnostics, specialist of physical therapy, psychotherapist, physical therapeutic, surgeon and specialist of professional rehabilitation. Basic ways of <span class="hlt">improvement</span> of the system of rehabilitation were organisational technologies of interaction during early and late stages of rehabilitation and persistent control of quality and effectiveness of rehabilitation. Optimization of organisation of late stage of hospitalisation allowed to reduce the average time of rehabilitation to 33,3% and at the same time to <span class="hlt">improve</span> effectiveness of rehabilitation.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21902085','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21902085"><span>Sleep apnoea syndromes and the <span class="hlt">cardiovascular</span> system.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Pepperell, Justin C</p> <p>2011-06-01</p> <p>Management of SAS and <span class="hlt">cardiovascular</span> disease risk should be closely linked. It is important to screen for <span class="hlt">cardiovascular</span> disease risk in patients with SAS and vice versa. CSA/CSR may be <span class="hlt">improved</span> by ventilation strategies in heart failure, but benefit remains to be proven. For OSA, although CPAP may reduce <span class="hlt">cardiovascular</span> disease risk, its main benefit is symptom control. In the longer-term, CPAP should be used alongside standard <span class="hlt">cardiovascular</span> risk reduction strategies including robust weight management programmes, with referral for bariatric surgery in appropriate cases. CPAP and NIV should be considered for acute admissions with decompensated cardiac failure.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5056590','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5056590"><span>Sleep: Important Considerations for the Prevention of <span class="hlt">Cardiovascular</span> Disease</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Grandner, Michael A.; Alfonso-Miller, Pamela; Fernandez-Mendoza, Julio; Shetty, Safal; Shenoy, Sundeep; Combs, Daniel</p> <p>2016-01-01</p> <p>Purpose of Review Sleep plays many roles in maintenance of <span class="hlt">cardiovascular</span> health. This review summarizes the literature across several areas of sleep and sleep disorders in relation to cardiometabolic disease risk factors. Current Findings Insufficient sleep duration is prevalent in the population and is associated with weight gain and obesity, inflammation, <span class="hlt">cardiovascular</span> disease, diabetes, and mortality. Insomnia is also highly present and represents an important risk factor for <span class="hlt">cardiovascular</span> disease, especially when accompanied by short sleep duration. Sleep apnea is a well-characterized risk factor for cardiometabolic disease and <span class="hlt">cardiovascular</span> mortality. Other issues are relevant as well. For example, sleep disorders in pediatric populations may convey <span class="hlt">cardiovascular</span> risks. Also, sleep may play an important role in <span class="hlt">cardiovascular</span> health disparities. Summary Sleep and sleep disorders are implicated in cardiometabolic disease risk. This review addresses these and other issues, concluding with recommendations for research and clinical <span class="hlt">practice</span>. PMID:27467177</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28821509','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28821509"><span>Does Tai Chi <span class="hlt">improve</span> psychological well-being and quality of life in patients with <span class="hlt">cardiovascular</span> disease and/or <span class="hlt">cardiovascular</span> risk factors? A systematic review protocol.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Yang, Guoyan; Li, Wenyuan; Cao, Huijuan; Klupp, Nerida; Liu, Jianping; Bensoussan, Alan; Kiat, Hosen; Chang, Dennis</p> <p>2017-08-18</p> <p><span class="hlt">Cardiovascular</span> disease (CVD) is a leading cause of morbidity and mortality worldwide. Psychological risk factors such as stress, anxiety and depression are known to play a significant and independent role in the development and progression of CVD and its risk factors. Tai Chi has been reported to be potentially effective for health and well-being. It is of value to assess the effectiveness and safety of Tai Chi on psychological well-being and quality of life in people with CVD and/or <span class="hlt">cardiovascular</span> risk factors. We will include all relevant randomised controlled trials on Tai Chi for stress, anxiety, depression, psychological well-being and quality of life in people with CVD and <span class="hlt">cardiovascular</span> risk factors. Literature searching will be conducted until 31 December 2016 from major English and Chinese databases. Two authors will conduct data selection and extraction independently. Quality assessment will be conducted using the risk of bias tool recommended by the Cochrane Collaboration. We will conduct data analysis using Cochrane's RevMan software. Forest plots and summary of findings tables will illustrate the results from a meta-analysis if sufficient studies are identified. Ethics approval is not required as this study will not involve patients. The results of this study will be submitted to a peer-reviewed journal for publication, to inform both clinical <span class="hlt">practice</span> and further research on Tai Chi and CVDs. This review will summarise the evidence on Tai Chi for psychological well-being and quality of life in people with CVD and their risk factors. We anticipate that the results of this review would be useful for healthcare professionals and researchers on Tai Chi and CVDs. International Prospective Register for Systematic Reviews (PROSPERO) number CRD42016042905. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27652999','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27652999"><span>FGF-23 and <span class="hlt">cardiovascular</span> disease: review of literature.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Batra, Jasveen; Buttar, Rupinder Singh; Kaur, Pardeep; Kreimerman, Jacqueline; Melamed, Michal L</p> <p>2016-12-01</p> <p>This review examines associations between fibroblast growth factor 23 (FGF-23) and <span class="hlt">cardiovascular</span> disease. FGF-23 is a hormone produced by osteocytes and osteoblasts that aids with phosphate excretion by the kidney and acts as a negative feedback regulator for activated vitamin D synthesis. Recent studies have found associations between elevated FGF-23 levels and a number of <span class="hlt">cardiovascular</span> diseases, including hypertension, left ventricular hypertrophy, endothelial dysfunction, <span class="hlt">cardiovascular</span> events and mortality. Recent studies have explored the possible effects of FGF-23 on the <span class="hlt">cardiovascular</span> system. In animal and observational human studies, there is a link between elevated FGF-23 levels and multiple <span class="hlt">cardiovascular</span> outcomes, including hypertension, left ventricular hypertrophy and <span class="hlt">cardiovascular</span> events and mortality. Further studies are required to evaluate whether decreasing FGF-23 levels <span class="hlt">improves</span> <span class="hlt">cardiovascular</span> outcomes.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21631823','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21631823"><span><span class="hlt">Improving</span> and ensuring best <span class="hlt">practice</span> continence management in residential aged care.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Heckenberg, Gayle</p> <p>2008-06-01</p> <p>Background  Continence Management within residential aged care is an every day component of care that requires assessment, implementation of strategies, resource allocation and evaluation. At times the management of incontinence of aged residents can be challenging and unsuccessful. The project chosen through the Clinical Fellowship program was Continence Management with the aim of raising awareness of best <span class="hlt">practice</span> to assist in <span class="hlt">improving</span> and providing person-centred resident care. Aims/objectives •  Review the literature on best <span class="hlt">practice</span> management of incontinence •  Evaluate current <span class="hlt">practice</span> in continence management for elderly residents within residential aged care services •  <span class="hlt">Improve</span> adherence to best <span class="hlt">practice</span> strategies of care for incontinence •  Raise awareness within the nursing home of the best <span class="hlt">practice</span> management of incontinence •  Promote appropriate and effective use of resources for continence management •  Deliver individualised person-centred care to residents. •  Ensure best <span class="hlt">practice</span> in continence management Methods  The Joanna Briggs Institute (JBI) <span class="hlt">Practical</span> Application of Clinical Evidence System clinical audit tool was utilised to measure current <span class="hlt">practice</span> against best <span class="hlt">practice</span>. The results identify gaps that require <span class="hlt">improvement</span>. The Getting Research into <span class="hlt">Practice</span> process then allowed analysis of the level of compliance with each of the audit criteria, which would identify any barriers in implementing a selected course of action and aim to <span class="hlt">improve</span> compliance. The project team was consulted with additional stakeholder consultation to form an action plan and implement strategies to <span class="hlt">improve</span> <span class="hlt">practice</span>. Results  Although 100% compliance with all audit criteria in audit 1 and 2 was not achieved, there was <span class="hlt">improvement</span> in the criteria concerning the documented fluid intake for residents. Further strategies have been identified and implemented and this continues to be a 'work in progress'. Staff now have an acute awareness</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24943303','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24943303"><span>Ghrelin and the <span class="hlt">cardiovascular</span> system.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Tokudome, Takeshi; Kishimoto, Ichiro; Miyazato, Mikiya; Kangawa, Kenj</p> <p>2014-01-01</p> <p>Ghrelin is a peptide that was originally isolated from the stomach. It exerts potent growth hormone (GH)-releasing and orexigenic activities. Several studies have highlighted the therapeutic benefits of ghrelin for the treatment of <span class="hlt">cardiovascular</span> disease. In animal models of chronic heart failure, the administration of ghrelin <span class="hlt">improved</span> cardiac function and remodeling; these findings were replicated in human patients with heart failure. Moreover, in an animal study, ghrelin administration effectively reduced pulmonary hypertension induced by chronic hypoxia. In addition, repeated administration of ghrelin to cachectic patients with chronic obstructive pulmonary disease had positive effects on overall body function, including muscle wasting, functional capacity and sympathetic activity. The administration of ghrelin early after myocardial infarction (MI) reduced fatal arrhythmia and related mortality. In ghrelin-deficient mice, both exogenous and endogenous ghrelin were protective against fatal arrhythmia and promoted remodeling after MI. Although the mechanisms underlying the effects of ghrelin on the <span class="hlt">cardiovascular</span> system remain unclear, there are indications that its beneficial effects are mediated through both direct physiological actions, including increased GH levels, <span class="hlt">improved</span> energy balance and direct actions on <span class="hlt">cardiovascular</span> cells, and regulation of autonomic nervous system activity. Therefore, ghrelin is a promising novel therapeutic agent for <span class="hlt">cardiovascular</span> disease. © 2014 S. Karger AG, Basel.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24799539','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24799539"><span><span class="hlt">Practice</span>-tailored facilitation to <span class="hlt">improve</span> pediatric preventive care delivery: a randomized trial.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Meropol, Sharon B; Schiltz, Nicholas K; Sattar, Abdus; Stange, Kurt C; Nevar, Ann H; Davey, Christina; Ferretti, Gerald A; Howell, Diana E; Strosaker, Robyn; Vavrek, Pamela; Bader, Samantha; Ruhe, Mary C; Cuttler, Leona</p> <p>2014-06-01</p> <p>Evolving primary care models require methods to help <span class="hlt">practices</span> achieve quality standards. This study assessed the effectiveness of a <span class="hlt">Practice</span>-Tailored Facilitation Intervention for <span class="hlt">improving</span> delivery of 3 pediatric preventive services. In this cluster-randomized trial, a <span class="hlt">practice</span> facilitator implemented <span class="hlt">practice</span>-tailored rapid-cycle feedback/change strategies for <span class="hlt">improving</span> obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty <span class="hlt">practices</span> were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods. Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late <span class="hlt">practices</span>, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: <0.1% success for all <span class="hlt">practices</span>. Four months after randomization, performance rose in Early <span class="hlt">practices</span>, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for <span class="hlt">improvement</span> compared with Late <span class="hlt">practices</span>' control time. During the full 6-month intervention, care <span class="hlt">improved</span> versus baseline in all <span class="hlt">practices</span>, for Obesity for Early <span class="hlt">practices</span> to 86.5%, and for Late <span class="hlt">practices</span> 88.9%; for Lead for Early <span class="hlt">practices</span> to 87.5% and Late <span class="hlt">practices</span> 94.5%; and for Fluoride, for Early <span class="hlt">practices</span> to 78.9% and Late <span class="hlt">practices</span> 81.9%, all P < .001 compared with baseline. <span class="hlt">Improvements</span> were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of <span class="hlt">practice</span> need. <span class="hlt">Practice</span>-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained <span class="hlt">improvements</span> in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care. Copyright © 2014 by the American Academy of Pediatrics.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29172687','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29172687"><span>European <span class="hlt">cardiovascular</span> nurses' and allied professionals' knowledge and <span class="hlt">practical</span> skills regarding cardiopulmonary resuscitation.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Pettersen, Trond R; Mårtensson, Jan; Axelsson, Åsa; Jørgensen, Marianne; Strömberg, Anna; Thompson, David R; Norekvål, Tone M</p> <p>2018-04-01</p> <p>Cardiopulmonary resuscitation (CPR) remains a cornerstone in the treatment of cardiac arrest, and is directly linked to survival rates. Nurses are often first responders and need to be skilled in the performance of cardiopulmonary resuscitation. As cardiopulmonary resuscitation skills deteriorate rapidly, the purpose of this study was to investigate whether there was an association between participants' cardiopulmonary resuscitation training and their <span class="hlt">practical</span> cardiopulmonary resuscitation test results. This comparative study was conducted at the 2014 EuroHeartCare meeting in Stavanger ( n=133) and the 2008 Spring Meeting on <span class="hlt">Cardiovascular</span> Nursing in Malmö ( n=85). Participants performed cardiopulmonary resuscitation for three consecutive minutes CPR training manikins from Laerdal Medical®. Data were collected with a questionnaire on demographics and participants' level of cardiopulmonary resuscitation training. Most participants were female (78%) nurses (91%) from Nordic countries (77%), whose main role was in nursing <span class="hlt">practice</span> (63%), and 71% had more than 11 years' experience ( n=218). Participants who conducted cardiopulmonary resuscitation training once a year or more ( n=154) performed better regarding ventilation volume than those who trained less (859 ml vs. 1111 ml, p=0.002). Those who had cardiopulmonary resuscitation training offered at their workplace ( n=161) also performed better regarding ventilation volume (889 ml vs. 1081 ml, p=0.003) and compression rate per minute (100 vs. 91, p=0.04) than those who had not. Our study indicates a positive association between participants' performance on the <span class="hlt">practical</span> cardiopulmonary resuscitation test and the frequency of cardiopulmonary resuscitation training and whether cardiopulmonary resuscitation training was offered in the workplace. Large ventilation volumes were the most common error at both measuring points.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/17229595','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/17229595"><span>Vascular endothelium summary statement II: <span class="hlt">Cardiovascular</span> disease prevention and control.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Mensah, George A; Ryan, Una S; Hooper, W Craig; Engelgau, Michael M; Callow, Allan D; Kapuku, Gaston K; Mantovani, Alberto</p> <p>2007-05-01</p> <p>The prevention and control of <span class="hlt">cardiovascular</span> disease (CVD), principally ischemic heart disease and stroke, are a major clinical and public health challenge. Worldwide, CVD accounts for substantial morbidity and mortality. The major modifiable CVD risk factors are known and all of them cause endothelial activation and dysfunction. Preventing and controlling the established risk factors are associated with preserved endothelial function and reduced risk of CVD. Research advances that <span class="hlt">improve</span> our understanding of strategies to preserve endothelial function or make the endothelial cells resilient to environmental insults may help <span class="hlt">improve</span> our preventive interventions. This summary statement addresses the current state of the science with respect to endothelial dysfunction and CVD pathogenesis, diagnostic evaluation, and suggested strategies for public health <span class="hlt">practice</span> and research.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/14987181','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/14987181"><span>Assessing <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lynch, Deirdre C; Swing, Susan R; Horowitz, Sheldon D; Holt, Kathleen; Messer, Joseph V</p> <p>2004-01-01</p> <p><span class="hlt">Practice</span>-based learning and <span class="hlt">improvement</span> (PBLI) is 1 of 6 general competencies expected of physicians who graduate from an accredited residency education program in the United States and is an anticipated requirement for those who wish to maintain certification by the member boards of the American Board of Medical Specialties. This article describes methods used to assess PBLI. Six electronic databases were searched using several search terms pertaining to PBLI. The review indicated that 4 assessment methods have been used to assess some or all steps of PBLI: portfolios, projects, patient record and chart review, and performance ratings. Each method is described, examples of application are provided, and validity, reliability, and feasibility characteristics are discussed. Portfolios may be the most useful approach to assess residents' PBLI abilities. Active participation in peer-driven performance <span class="hlt">improvement</span> initiatives may be a valuable approach to confirm <span class="hlt">practicing</span> physician involvement in PBLI.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21192206','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21192206"><span>Appreciative Inquiry for quality <span class="hlt">improvement</span> in primary care <span class="hlt">practices</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Ruhe, Mary C; Bobiak, Sarah N; Litaker, David; Carter, Caroline A; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen J; Weyer, Sharon M; Werner, James J; Fry, Ronald E; Stange, Kurt C</p> <p>2011-01-01</p> <p>To test the effect of an Appreciative Inquiry (AI) quality <span class="hlt">improvement</span> strategy on clinical quality management and <span class="hlt">practice</span> development outcomes. Appreciative inquiry enables the discovery of shared motivations, envisioning a transformed future, and learning around the implementation of a change process. Thirty diverse primary care <span class="hlt">practices</span> were randomly assigned to receive an AI-based intervention focused on a <span class="hlt">practice</span>-chosen topic and on <span class="hlt">improving</span> preventive service delivery (PSD) rates. Medical-record review assessed change in PSD rates. Ethnographic field notes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and <span class="hlt">practice</span> development outcomes. The PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives, and fostered respectful interactions. <span class="hlt">Practices</span> most likely to implement the intervention or develop new <span class="hlt">practice</span> capacities exhibited 1 or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and <span class="hlt">practice</span> flexibility, and a history of constructive <span class="hlt">practice</span> change. An AI approach and enabling <span class="hlt">practice</span> conditions can lead to intervention implementation and <span class="hlt">practice</span> development by connecting individual and <span class="hlt">practice</span> strengths and motivations to the change objective.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4222905','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4222905"><span>Appreciative Inquiry for Quality <span class="hlt">Improvement</span> in Primary Care <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Ruhe, Mary C.; Bobiak, Sarah N.; Litaker, David; Carter, Caroline A.; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen; Weyer, Sharon M.; Werner, James J.; Fry, Ronald E.; Stange, Kurt C.</p> <p>2014-01-01</p> <p>Purpose To test the effect of an Appreciative Inquiry (AI) quality <span class="hlt">improvement</span> strategy, on clinical quality management and <span class="hlt">practice</span> development outcomes. AI enables discovery of shared motivations, envisioning a transformed future, and learning around implementation of a change process. Methods Thirty diverse primary care <span class="hlt">practices</span> were randomly assigned to receive an AI-based intervention focused on a <span class="hlt">practice</span>-chosen topic and on <span class="hlt">improving</span> preventive service delivery (PSD) rates. Medical record review assessed change in PSD rates. Ethnographic fieldnotes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and <span class="hlt">practice</span> development outcomes. Results PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives and fostered respectful interactions. <span class="hlt">Practices</span> most likely to implement the intervention or develop new <span class="hlt">practice</span> capacities exhibited one or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and <span class="hlt">practice</span> flexibility, and a history of constructive <span class="hlt">practice</span> change. Conclusions An AI approach and enabling <span class="hlt">practice</span> conditions can lead to intervention implementation and <span class="hlt">practice</span> development by connecting individual and <span class="hlt">practice</span> strengths and motivations to the change objective. PMID:21192206</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23750574','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23750574"><span>Assessment of <span class="hlt">cardiovascular</span> risk and target organ damage among adult patients with primary hypertension in Thika Level 5 Hospital, Kenya: a criteria-based clinical audit.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Mwita, Clifford Chacha; Akello, Walter; Sisenda, Gloria; Ogoti, Evans; Tivey, David; Munn, Zachary; Mbogo, David</p> <p>2013-06-01</p> <p>Appropriate management of hypertension reduces the risk of death from stroke and cardiac disease and includes routine assessment for target organ damage and estimation of <span class="hlt">cardiovascular</span> risk. However, implementation of evidence-based hypertension management guidelines is unsatisfactory. We explore the use of audit and feedback as a quality <span class="hlt">improvement</span> (QI) strategy for reducing the knowledge <span class="hlt">practice</span> gap in hypertension care in a resource poor setting. The aim of this study is to determine the level of compliance to evidence-based guidelines on assessment of <span class="hlt">cardiovascular</span> risk and target organ damage among patients with hypertension in Thika Level 5 Hospital in central Kenya and to implement best <span class="hlt">practice</span> with regard to evidence utilisation among clinicians in the hospital. A retrospective clinical audit done in three phases spread over 5 months. Phase one involved identifying five audit criteria on assessment of <span class="hlt">cardiovascular</span> risk and target organ damage in patients with hypertension and conducting a baseline audit in which compliance to audit criteria, blood pressure control and drug prescription <span class="hlt">practices</span> were assessed. Phase two involved identifying barriers to compliance to audit criteria and strategies to overcoming these barriers. The third phase was a follow-up audit. There was no use of a <span class="hlt">cardiovascular</span> risk assessment tool in both audits (0% vs. 0%; P = 1.00). Testing urine for haematuria and proteinuria reduced from 13% to 8% (P = 0.230) while taking a blood sample for measuring blood glucose, electrolytes and creatinine levels <span class="hlt">improved</span> from 11% to 17% (P = 0.401). Performance of fundoscopy and electrocardiography remained unchanged at 2% and 8%, respectively (P = 0.886 and P = 0.898). High patient load was identified as the biggest barrier to implementation of best <span class="hlt">practice</span>. Blood pressure control <span class="hlt">improved</span> from 33% to 70% (P ≤ 0.001), whereas the proportion of patients on two or more recommended antihypertensive drugs rose</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/17301805','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/17301805"><span>Ethnicity and <span class="hlt">cardiovascular</span> disease prevention in the United Kingdom: a <span class="hlt">practical</span> approach to management.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lip, G Y H; Barnett, A H; Bradbury, A; Cappuccio, F P; Gill, P S; Hughes, E; Imray, C; Jolly, K; Patel, K</p> <p>2007-03-01</p> <p>The United Kingdom is a diverse society with 7.9% of the population from black and minority ethnic groups (BMEGs). The causes of the excess <span class="hlt">cardiovascular</span> disease (CVD) and stroke morbidity and mortality in BMEGs are incompletely understood though socio-economic factors are important. However, the role of classical <span class="hlt">cardiovascular</span> (CV) risk factors is clearly important despite the patterns of these risk factors varying significantly by ethnic group. Despite the major burden of CVD and stroke among BMEGs in the UK, the majority of the evidence on the management of such conditions has been based on predominantly white European populations. Moreover, the CV epidemiology of African Americans does not represent well the morbidity and mortality experience seen in black Africans and black Caribbeans, both in Britain and in their native African countries. In particular, atherosclerotic disease and coronary heart disease are still relatively rare in the latter groups. This is unlike the South Asian diaspora, who have prevalence rates of CVD in epidemic proportions both in the diaspora and on the subcontinent. As the BMEGs have been under-represented in research, a multitude of guidelines exists for the 'general population.' However, specific reference and recommendation on primary and secondary prevention guidelines in relation to ethnic groups is extremely limited. This document provides an overview of ethnicity and CVD in the United Kingdom, with management recommendations based on a roundtable discussion of a multidisciplinary ethnicity and CVD consensus group, all of whom have an academic interest and clinical <span class="hlt">practice</span> in a multiethnic community.</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_12");'>12</a></li> <li><a href="#" onclick='return showDiv("page_13");'>13</a></li> <li class="active"><span>14</span></li> <li><a href="#" onclick='return showDiv("page_15");'>15</a></li> <li><a href="#" onclick='return showDiv("page_16");'>16</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_14 --> <div id="page_15" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_13");'>13</a></li> <li><a href="#" onclick='return showDiv("page_14");'>14</a></li> <li class="active"><span>15</span></li> <li><a href="#" onclick='return showDiv("page_16");'>16</a></li> <li><a href="#" onclick='return showDiv("page_17");'>17</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="281"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4035588','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4035588"><span><span class="hlt">Practice</span>-Tailored Facilitation to <span class="hlt">Improve</span> Pediatric Preventive Care Delivery: A Randomized Trial</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Schiltz, Nicholas K.; Sattar, Abdus; Stange, Kurt C.; Nevar, Ann H.; Davey, Christina; Ferretti, Gerald A.; Howell, Diana E.; Strosaker, Robyn; Vavrek, Pamela; Bader, Samantha; Ruhe, Mary C.; Cuttler, Leona</p> <p>2014-01-01</p> <p>OBJECTIVE: Evolving primary care models require methods to help <span class="hlt">practices</span> achieve quality standards. This study assessed the effectiveness of a <span class="hlt">Practice</span>-Tailored Facilitation Intervention for <span class="hlt">improving</span> delivery of 3 pediatric preventive services. METHODS: In this cluster-randomized trial, a <span class="hlt">practice</span> facilitator implemented <span class="hlt">practice</span>-tailored rapid-cycle feedback/change strategies for <span class="hlt">improving</span> obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty <span class="hlt">practices</span> were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods. RESULTS: Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late <span class="hlt">practices</span>, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: <0.1% success for all <span class="hlt">practices</span>. Four months after randomization, performance rose in Early <span class="hlt">practices</span>, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for <span class="hlt">improvement</span> compared with Late practices’ control time. During the full 6-month intervention, care <span class="hlt">improved</span> versus baseline in all <span class="hlt">practices</span>, for Obesity for Early <span class="hlt">practices</span> to 86.5%, and for Late <span class="hlt">practices</span> 88.9%; for Lead for Early <span class="hlt">practices</span> to 87.5% and Late <span class="hlt">practices</span> 94.5%; and for Fluoride, for Early <span class="hlt">practices</span> to 78.9% and Late <span class="hlt">practices</span> 81.9%, all P < .001 compared with baseline. <span class="hlt">Improvements</span> were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of <span class="hlt">practice</span> need. CONCLUSIONS: <span class="hlt">Practice</span>-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained <span class="hlt">improvements</span> in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care. PMID:24799539</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/17252092','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/17252092"><span>Quality <span class="hlt">improvement</span> activities associated with organisational capacity in general <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Amoroso, Cheryl; Proudfoot, Judy; Bubner, Tanya; Swan, Edward; Espinel, Paola; Barton, Christopher; Beilby, Justin; Harris, Mark</p> <p>2007-01-01</p> <p>Clinical audit is recognised worldwide as a useful tool for quality <span class="hlt">improvement</span>. A feedback report profiling capacity for chronic disease care was sent to 97 general <span class="hlt">practices</span>. These <span class="hlt">practices</span> were invited to complete a clinical audit activity based on that feedback. Data were analysed quantitatively and case studies were developed based on the free text responses. Eighty-two (33%) of 247 general practitioners participated in the clinical audit process, representing 57 (59%) of 97 general <span class="hlt">practices</span>. From the data in their feedback report, 37 (65%) of the 57 <span class="hlt">practices</span> recognised the area most in need of <span class="hlt">improvement</span>. This was most likely where the need related to clinical <span class="hlt">practice</span> or teamwork, and least likely where the need related to linkages with other services, and business and finance. Only 25 <span class="hlt">practices</span> (46%) developed an action plan related to their recognised area for <span class="hlt">improvement</span>, and 22 (39%) <span class="hlt">practices</span> implemented their chosen activity. Participating GPs judged that change activity focused on teamwork was most successful. The clinical audit process offered participating GPs and <span class="hlt">practices</span> an opportunity to reflect on their performance across a number of key areas and to implement change to enhance the <span class="hlt">practice</span>'s capacity for quality chronic disease care. The relationship between need and action was weak, suggesting a need for greater support to overcome barriers.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3819592','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3819592"><span><span class="hlt">Cardiovascular</span> reactivity, stress, and physical activity</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Huang, Chun-Jung; Webb, Heather E.; Zourdos, Michael C.; Acevedo, Edmund O.</p> <p>2013-01-01</p> <p>Psychological stress has been proposed as a major contributor to the progression of <span class="hlt">cardiovascular</span> disease (CVD). Acute mental stress can activate the sympathetic-adrenal-medullary (SAM) axis, eliciting the release of catecholamines (NE and EPI) resulting in the elevation of heart rate (HR) and blood pressure (BP). Combined stress (psychological and physical) can exacerbate these <span class="hlt">cardiovascular</span> responses, which may partially contribute to the elevated risk of CVD and increased proportionate mortality risks experienced by some occupations (e.g., firefighting and law enforcement). Studies have supported the benefits of physical activity on physiological and psychological health, including the <span class="hlt">cardiovascular</span> response to acute stress. Aerobically trained individuals exhibit lower sympathetic nervous system (e.g., HR) reactivity and enhanced <span class="hlt">cardiovascular</span> efficiency (e.g., lower vascular reactivity and decreased recovery time) in response to physical and/or psychological stress. In addition, resistance training has been demonstrated to attenuate <span class="hlt">cardiovascular</span> responses and <span class="hlt">improve</span> mental health. This review will examine stress-induced <span class="hlt">cardiovascular</span> reactivity and plausible explanations for how exercise training and physical fitness (aerobic and resistance exercise) can attenuate <span class="hlt">cardiovascular</span> responses to stress. This enhanced functionality may facilitate a reduction in the incidence of stroke and myocardial infarction. Finally, this review will also address the interaction of obesity and physical activity on <span class="hlt">cardiovascular</span> reactivity and CVD. PMID:24223557</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28446446','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28446446"><span>The <span class="hlt">Cardiovascular</span> Health in Ambulatory Care Research Team performance indicators for the primary prevention of <span class="hlt">cardiovascular</span> disease: a modified Delphi panel study.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Tu, Jack V; Maclagan, Laura C; Ko, Dennis T; Atzema, Clare L; Booth, Gillian L; Johnston, Sharon; Tu, Karen; Lee, Douglas S; Bierman, Arlene; Hall, Ruth; Bhatia, R Sacha; Gershon, Andrea S; Tobe, Sheldon W; Sanmartin, Claudia; Liu, Peter; Chu, Anna</p> <p>2017-04-25</p> <p>High-quality ambulatory care can reduce <span class="hlt">cardiovascular</span> disease risk, but important gaps exist in the provision of <span class="hlt">cardiovascular</span> preventive care. We sought to develop a set of key performance indicators that can be used to measure and <span class="hlt">improve</span> <span class="hlt">cardiovascular</span> care in the primary care setting. As part of the <span class="hlt">Cardiovascular</span> Health in Ambulatory Care Research Team initiative, we established a 14-member multidisciplinary expert panel to develop a set of indicators for measuring primary prevention performance in ambulatory <span class="hlt">cardiovascular</span> care. We used a 2-stage modified Delphi panel process to rate potential indicators, which were identified from the literature and national <span class="hlt">cardiovascular</span> organizations. The top-rated indicators were pilot tested to determine their measurement feasibility with the use of data routinely collected in the Canadian health care system. A set of 28 indicators of primary prevention performance were identified, which were grouped into 5 domains: risk factor prevalence, screening, management, intermediate outcomes and long-term outcomes. The indicators reflect the major <span class="hlt">cardiovascular</span> risk factors including smoking, obesity, hypertension, diabetes, dyslipidemia and atrial fibrillation. All indicators were determined to be amenable to measurement with the use of population-based administrative (physician claims, hospital admission, laboratory, medication), survey or electronic medical record databases. The <span class="hlt">Cardiovascular</span> Health in Ambulatory Care Research Team indicators of primary prevention performance provide a framework for the measurement of <span class="hlt">cardiovascular</span> primary prevention efforts in Canada. The indicators may be used by clinicians, researchers and policy-makers interested in measuring and <span class="hlt">improving</span> the prevention of <span class="hlt">cardiovascular</span> disease in ambulatory care settings. Copyright 2017, Joule Inc. or its licensors.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28506979','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28506979"><span>Impact of Ezetimibe on the Rate of <span class="hlt">Cardiovascular</span>-Related Hospitalizations and Associated Costs Among Patients With a Recent Acute Coronary Syndrome: Results From the <span class="hlt">IMPROVE</span>-IT Trial (<span class="hlt">Improved</span> Reduction of Outcomes: Vytorin Efficacy International Trial).</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Pokharel, Yashashwi; Chinnakondepalli, Khaja; Vilain, Katherine; Wang, Kaijun; Mark, Daniel B; Davies, Glenn; Blazing, Michael A; Giugliano, Robert P; Braunwald, Eugene; Cannon, Christopher P; Cohen, David J; Magnuson, Elizabeth A</p> <p>2017-05-01</p> <p>Ezetimibe, when added to simvastatin therapy, reduces <span class="hlt">cardiovascular</span> events after recent acute coronary syndrome. However, the impact of ezetimibe on <span class="hlt">cardiovascular</span>-related hospitalizations and associated costs is unknown. We used patient-level data from the <span class="hlt">IMPROVE</span>-IT (<span class="hlt">Improved</span> Reduction of Outcomes: Vytorin Efficacy International Trial) to examine the impact of simvastatin-ezetimibe versus simvastatin-placebo on <span class="hlt">cardiovascular</span>-related hospitalizations and related costs (excluding drug costs) over 7 years follow-up. Medicare Severity-Diagnosis Related Groups were assigned to all <span class="hlt">cardiovascular</span> hospitalizations. Hospital costs were estimated using Medicare reimbursement rates for 2013. Associated physician costs were estimated as a percentage of hospital costs. The impact of treatment assignment on hospitalization rates and costs was estimated using Poisson and linear regression, respectively. There was a significantly lower <span class="hlt">cardiovascular</span> hospitalization rate with ezetimibe compared with placebo (risk ratio, 0.95; 95% confidence interval, 0.90-0.99; P =0.031), mainly attributable to fewer hospitalizations for percutaneous coronary intervention, angina, and stroke. Consequently, <span class="hlt">cardiovascular</span>-related hospitalization costs over 7 years were $453 per patient lower with ezetimibe (95% confidence interval, -$38 to -$869; P =0.030). Although all prespecified subgroups had lower cost with ezetimibe therapy, patients with diabetes mellitus, patients aged ≥75 years, and patients at higher predicted risk for recurrent ischemic events had even greater cost offsets. Addition of ezetimibe to statin therapy in patients with a recent acute coronary syndrome leads to reductions in <span class="hlt">cardiovascular</span>-related hospitalizations and associated costs, with the greatest cost offsets in high-risk patients. These cost reductions may completely offset the cost of the drug once ezetimibe becomes generic, and may lead to cost savings from the perspective of the healthcare system, if treatment</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/18221692','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/18221692"><span>[Cooperative <span class="hlt">Cardiovascular</span> Disease Research Network (RECAVA)].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>García-Dorado, David; Castro-Beiras, Alfonso; Díez, Javier; Gabriel, Rafael; Gimeno-Blanes, Juan R; Ortiz de Landázuri, Manuel; Sánchez, Pedro L; Fernández-Avilés, Francisco</p> <p>2008-01-01</p> <p>Today, <span class="hlt">cardiovascular</span> disease is the principal cause of death and hospitalization in Spain, and accounts for an annual healthcare budget of more than 4000 million euros. Consequently, early diagnosis, effective prevention, and the optimum treatment of <span class="hlt">cardiovascular</span> disease present a significant social and healthcare challenge for the country. In this context, combining all available resources to increase the efficacy and healthcare benefits of scientific research is a priority. This rationale prompted the establishment of the Spanish Cooperative <span class="hlt">Cardiovascular</span> Disease Research Network, or RECAVA (Red Temática de Investigación Cooperativa en Enfermedades <span class="hlt">Cardiovasculares</span>), 5 years ago. Since its foundation, RECAVA's activities have focused on achieving four objectives: a) to facilitate contacts between basic, clinical and epidemiological researchers; b) to promote the shared use of advanced technological facilities; c) to apply research results to clinical <span class="hlt">practice</span>, and d) to train a new generation of translational <span class="hlt">cardiovascular</span> researchers in Spain. At present, RECAVA consists of 41 research groups and seven shared technological facilities. RECAVA's research strategy is based on a scientific design matrix centered on the most important <span class="hlt">cardiovascular</span> processes. The level of RECAVA's research activity is reflected in the fact that 28 co-authored articles were published in international journals during the first six months of 2007, with each involving contributions from at least two groups in the network. Finally, RECAVA also participates in the work of the Spanish National Center for <span class="hlt">Cardiovascular</span> Research, or CNIC (Centro Nacional de Investigación <span class="hlt">Cardiovascular</span>), and some established Biomedical Research Network Centers, or CIBER (Centros de Investigación Biomédica en RED), with the aim of consolidating the development of a dynamic multidisciplinary research framework that is capable of meeting the growing challenge that <span class="hlt">cardiovascular</span> disease will present</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2953358','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2953358"><span><span class="hlt">Cardiovascular</span> Prevention in a High Risk Sport, Ice Hockey: Applications in Wider Sports Physical Therapy <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2006-01-01</p> <p>Although acute myocardial infarction and sudden cardiac death are relatively rare occurrences in athletics, <span class="hlt">cardiovascular</span> accidents do occur. This manuscript presents information on the <span class="hlt">cardiovascular</span> risks in athletics. In addition, information is provided on screening for <span class="hlt">cardiovascular</span> risk – including history taking, chart review, physical examination – and the appropriate guidelines on the treatment of athletes found to be at risk. For the purpose of this article, the sport of ice hockey is used to illustrate the subject matter and highlight the behaviors in sport that carry <span class="hlt">cardiovascular</span> risk. Physical therapists have ethical and legal responsibility to undertake the necessary screening procedures to recognize and respond to any signs of <span class="hlt">cardiovascular</span> risk in their clients. PMID:21522221</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21522221','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21522221"><span><span class="hlt">Cardiovascular</span> prevention in a high risk sport, ice hockey: applications in wider sports physical therapy <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Hopkins-Rosseel, Diana H</p> <p>2006-11-01</p> <p>Although acute myocardial infarction and sudden cardiac death are relatively rare occurrences in athletics, <span class="hlt">cardiovascular</span> accidents do occur. This manuscript presents information on the <span class="hlt">cardiovascular</span> risks in athletics. In addition, information is provided on screening for <span class="hlt">cardiovascular</span> risk - including history taking, chart review, physical examination - and the appropriate guidelines on the treatment of athletes found to be at risk. For the purpose of this article, the sport of ice hockey is used to illustrate the subject matter and highlight the behaviors in sport that carry <span class="hlt">cardiovascular</span> risk. Physical therapists have ethical and legal responsibility to undertake the necessary screening procedures to recognize and respond to any signs of <span class="hlt">cardiovascular</span> risk in their clients.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3873841','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3873841"><span>Pregnancy Characteristics and Women's Future <span class="hlt">Cardiovascular</span> Health: An Underused Opportunity to <span class="hlt">Improve</span> Women's Health?</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Rich-Edwards, Janet W.; Fraser, Abigail; Lawlor, Deborah A.; Catov, Janet M.</p> <p>2014-01-01</p> <p>Growing evidence indicates that women with a history of common pregnancy complications, including fetal growth restriction and preterm delivery (often combined as low birth weight), hypertensive disorders of pregnancy, and gestational diabetes, are at increased risk for <span class="hlt">cardiovascular</span> disease later in life. The purpose of this paper was to review the associations of parity and these 4 pregnancy complications with <span class="hlt">cardiovascular</span> morbidity and mortality; to review the role of <span class="hlt">cardiovascular</span> risk factors before, during, and after pregnancy complications in explaining these associations; and to explore the implications of this emerging science for new research and policy. We systematically searched for relevant cohort and case-control studies in Medline through December 2012 and used citation searches for already published reviews to identify new studies. The findings of this review suggest consistent and often strong associations of pregnancy complications with latent and future <span class="hlt">cardiovascular</span> disease. Many pregnancy complications appear to be preceded by subclinical vascular and metabolic dysfunction, suggesting that the complications may be useful markers of latent high-risk <span class="hlt">cardiovascular</span> trajectories. With further replication research, these findings would support the utility of these prevalent pregnancy complications in identifying high-risk women for screening, prevention, and treatment of <span class="hlt">cardiovascular</span> disease, the leading cause of morbidity and mortality among women. PMID:24025350</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24025350','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24025350"><span>Pregnancy characteristics and women's future <span class="hlt">cardiovascular</span> health: an underused opportunity to <span class="hlt">improve</span> women's health?</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Rich-Edwards, Janet W; Fraser, Abigail; Lawlor, Deborah A; Catov, Janet M</p> <p>2014-01-01</p> <p>Growing evidence indicates that women with a history of common pregnancy complications, including fetal growth restriction and preterm delivery (often combined as low birth weight), hypertensive disorders of pregnancy, and gestational diabetes, are at increased risk for <span class="hlt">cardiovascular</span> disease later in life. The purpose of this paper was to review the associations of parity and these 4 pregnancy complications with <span class="hlt">cardiovascular</span> morbidity and mortality; to review the role of <span class="hlt">cardiovascular</span> risk factors before, during, and after pregnancy complications in explaining these associations; and to explore the implications of this emerging science for new research and policy. We systematically searched for relevant cohort and case-control studies in Medline through December 2012 and used citation searches for already published reviews to identify new studies. The findings of this review suggest consistent and often strong associations of pregnancy complications with latent and future <span class="hlt">cardiovascular</span> disease. Many pregnancy complications appear to be preceded by subclinical vascular and metabolic dysfunction, suggesting that the complications may be useful markers of latent high-risk <span class="hlt">cardiovascular</span> trajectories. With further replication research, these findings would support the utility of these prevalent pregnancy complications in identifying high-risk women for screening, prevention, and treatment of <span class="hlt">cardiovascular</span> disease, the leading cause of morbidity and mortality among women.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3416944','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3416944"><span>Future Directions for <span class="hlt">Cardiovascular</span> Disease Comparative Effectiveness Research</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Hlatky, Mark A; Douglas, Pamela S; Cook, Nakela L; Wells, Barbara; Benjamin, Emelia J; Dickersin, Kay; Goff, David C; Hirsch, Alan T; Hylek, Elaine M; Peterson, Eric; Roger, Véronique L; Selby, Joseph V; Udelson, James E; Lauer, Michael S</p> <p>2012-01-01</p> <p>Comparative effectiveness research (CER) aims to provide decision-makers the evidence needed to evaluate the benefits and harms of alternative clinical management strategies. CER has become a national priority, with considerable new research funding allocated. <span class="hlt">Cardiovascular</span> disease is a priority area for CER. This workshop report provides an overview of CER methods, with an emphasis on <span class="hlt">practical</span> clinical trials and observational treatment comparisons. The report also details recommendations to the National Heart Lung and Blood Institute for a new framework for evidence development to foster <span class="hlt">cardiovascular</span> CER, and specific studies to address eight clinical issues identified by the Institute of Medicine as high priorities for <span class="hlt">cardiovascular</span> CER. PMID:22796257</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24480180','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24480180"><span>The Asia-Pacific Evaluation of <span class="hlt">Cardiovascular</span> Therapies (ASPECT) collaboration --<span class="hlt">improving</span> the quality of <span class="hlt">cardiovascular</span> care in the Asia Pacific region.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Reid, Christopher M; Yan, Bryan; Wan Ahmad, Wan Azman; Bang, Liew Houng; Hian, Sim Kui; Chua, Terrance; Chan, Mark; Beltrame, John; Duffy, Stephen J; Brennan, Angela; Ajani, Andrew</p> <p>2014-03-01</p> <p>Clinicians and other stakeholders recognize the need for clinical registries to monitor data in order to <span class="hlt">improve</span> the outcome and quality of care in the delivery of medical interventions. The establishment of a collaboration across the Asia Pacific Region to inform on variations in patient and procedural characteristics and associated clinical outcomes would enable regional benchmarking of quality. The aims of the collaboration are a) to identify the characteristics of patients undergoing PCI across the Asia Pacific region, b) to report on outcomes of patients undergoing PCI, c) to develop an appropriate ethnic and region specific risk adjustment model for patients undergoing PCI and d) to establish a registry framework for research, education and training in the area of <span class="hlt">cardiovascular</span> interventions across the Asia Pacific Region. Descriptive characteristics of patient undergoing PCI over a 12 month period were collated and reported. Representatives from 27 hospitals attended the inaugural meeting with interested parties from Australia, Singapore, Malaysia and Hong Kong. In every country, males predominated PCI activity. Subjects were older and had higher rates of family history of <span class="hlt">cardiovascular</span> disease in Australia, while Asian subjects had higher rates of diabetes, dyslipidemia and renal failure. STEMI presentation was higher in Australia than in Asia and drug eluting stent use was higher in Asia. Procedural success rates were similar across the region (>95%). Procedural success was similar across the region despite differing patient characteristics across countries in terms of pre-procedural risk factors and clinical presentation. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/19520103','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/19520103"><span>Making perceptual learning <span class="hlt">practical</span> to <span class="hlt">improve</span> visual functions.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Polat, Uri</p> <p>2009-10-01</p> <p>Task-specific <span class="hlt">improvement</span> in performance after training is well established. The finding that learning is stimulus-specific and does not transfer well between different stimuli, between stimulus locations in the visual field, or between the two eyes has been used to support the notion that neurons or assemblies of neurons are modified at the earliest stage of cortical processing. However, a debate regarding the proposed mechanism underlying perceptual learning is an ongoing issue. Nevertheless, generalization of a trained task to other functions is an important key, for both understanding the neural mechanisms and the <span class="hlt">practical</span> value of the training. This manuscript describes a structured perceptual learning method that previously used (amblyopia, myopia) and a novel technique and results that were applied for presbyopia. In general, subjects were trained for contrast detection of Gabor targets under lateral masking conditions. Training <span class="hlt">improved</span> contrast sensitivity and diminished the lateral suppression when it existed (amblyopia). The <span class="hlt">improvement</span> was transferred to unrelated functions such as visual acuity. The new results of presbyopia show substantial <span class="hlt">improvement</span> of the spatial and temporal contrast sensitivity, leading to <span class="hlt">improved</span> processing speed of target detection as well as reaction time. Consequently, the subjects, who were able to eliminate the need for reading glasses, benefited. Thus, here we show that the transfer of functions indicates that the specificity of <span class="hlt">improvement</span> in the trained task can be generalized by repetitive <span class="hlt">practice</span> of target detection, covering a sufficient range of spatial frequencies and orientations, leading to an <span class="hlt">improvement</span> in unrelated visual functions. Thus, perceptual learning can be a <span class="hlt">practical</span> method to <span class="hlt">improve</span> visual functions in people with impaired or blurred vision.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28826540','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28826540"><span>Cannabinoids in the <span class="hlt">Cardiovascular</span> System.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Ho, Wing S V; Kelly, Melanie E M</p> <p>2017-01-01</p> <p>Cannabinoids are known to modulate <span class="hlt">cardiovascular</span> functions including heart rate, vascular tone, and blood pressure in humans and animal models. Essential components of the endocannabinoid system, namely, the production, degradation, and signaling pathways of endocannabinoids have been described not only in the central and peripheral nervous system but also in myocardium, vasculature, platelets, and immune cells. The mechanisms of <span class="hlt">cardiovascular</span> responses to endocannabinoids are often complex and may involve cannabinoid CB 1 and CB 2 receptors or non-CB 1/2 receptor targets. Preclinical and some clinical studies have suggested that targeting the endocannabinoid system can <span class="hlt">improve</span> <span class="hlt">cardiovascular</span> functions in a number of pathophysiological conditions, including hypertension, metabolic syndrome, sepsis, and atherosclerosis. In this chapter, we summarize the local and systemic <span class="hlt">cardiovascular</span> effects of cannabinoids and highlight our current knowledge regarding the therapeutic potential of endocannabinoid signaling and modulation. © 2017 Elsevier Inc. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28864808','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28864808"><span>Oral Health Care in the Future: Expansion of the Scope of Dental <span class="hlt">Practice</span> to <span class="hlt">Improve</span> Health.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lamster, Ira B; Myers-Wright, Noreen</p> <p>2017-09-01</p> <p>The health care environment in the U.S. is changing. The population is aging, the prevalence of non-communicable diseases (NCDs) is increasing, edentulism is decreasing, and periodontal infection/inflammation has been identified as a risk factor for NCDs. These trends offer an opportunity for oral health care providers to broaden the scope of traditional dental <span class="hlt">practice</span>, specifically becoming more involved in the management of the general health of patients. This new <span class="hlt">practice</span> paradigm will promote a closer integration with the larger health care system. This change is based on the realization that a healthy mouth is essential for a healthy life, including proper mastication, communication, esthetics, and comfort. Two types of primary care are proposed: screenings for medical conditions that are directly affected by oral disease (and may modify the provision of dental care), and a broader emphasis on prevention that focuses on lifestyle behaviors. Included in the former category are screenings for NCDs (e.g., the risk of <span class="hlt">cardiovascular</span> disease and identification of patients with undiagnosed dysglycemia or poorly managed diabetes mellitus), as well as identification of infectious diseases, such as HIV or hepatitis C. Reducing the risk of disease can be accomplished by an emphasis on smoking cessation and dietary intake and the prevention of obesity. These activities will promote interprofessional health care education and <span class="hlt">practice</span>. While change is always challenging, this new <span class="hlt">practice</span> paradigm could <span class="hlt">improve</span> both oral health and health outcomes of patients seen in the dental office. This article was written as part of the project "Advancing Dental Education in the 21 st Century."</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28630370','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28630370"><span>Evidence for Therapeutic Patient Education Interventions to Promote <span class="hlt">Cardiovascular</span> Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Barnason, Susan; White-Williams, Connie; Rossi, Laura P; Centeno, Mae; Crabbe, Deborah L; Lee, Kyoung Suk; McCabe, Nancy; Nauser, Julie; Schulz, Paula; Stamp, Kelly; Wood, Kathryn</p> <p>2017-06-01</p> <p>The burden of <span class="hlt">cardiovascular</span> disease as a chronic illness increasingly requires patients to assume more responsibility for their self-management. Patient education is believed to be an essential component of <span class="hlt">cardiovascular</span> care; however, there is limited evidence about specific therapeutic patient education approaches used and the impact on patient self-management outcomes. An integrative review of the literature was conducted to critically analyze published research studies of therapeutic patient education for self-management in selected <span class="hlt">cardiovascular</span> conditions. There was variability in methodological approaches across settings and disease conditions. The most effective interventions were tailored to individual patient needs, used multiple components to <span class="hlt">improve</span> self-management outcomes, and often used multidisciplinary approaches. This synthesis of evidence expands the base of knowledge related to the development of patient self-management skills and provides direction for more rigorous research. Recommendations are provided to guide the implementation of therapeutic patient education in clinical <span class="hlt">practice</span> and the design of comprehensive self-management interventions to <span class="hlt">improve</span> outcomes for <span class="hlt">cardiovascular</span> patients. © 2017 American Heart Association, Inc.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/11143207','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/11143207"><span>Using data to <span class="hlt">improve</span> medical <span class="hlt">practice</span> by measuring processes and outcomes of care.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Nelson, E C; Splaine, M E; Godfrey, M M; Kahn, V; Hess, A; Batalden, P; Plume, S K</p> <p>2000-12-01</p> <p>The purpose of this article is to help clinicians expand their use of data to <span class="hlt">improve</span> medical <span class="hlt">practice</span> performance and to do <span class="hlt">improvement</span> research. Clinical <span class="hlt">practices</span> can be viewed as small, complex organizations (microsystems) that produce services for specific patient populations. These services can be greatly <span class="hlt">improved</span> by embedding measurement into the flow of daily work in the <span class="hlt">practice</span>. WHY DO IT?: Four good reasons to build measures into daily medical <span class="hlt">practice</span> are to (1) diagnose strengths and weaknesses in <span class="hlt">practice</span> performance; (2) <span class="hlt">improve</span> and innovate in providing care and services using <span class="hlt">improvement</span> research; (3) manage patients and the <span class="hlt">practice</span>; and (4) evaluate changes in results over time. It is helpful to have a "physiological" model of a medical <span class="hlt">practice</span> to analyze the <span class="hlt">practice</span>, to manage it, and to <span class="hlt">improve</span> it. One model views clinical <span class="hlt">practices</span> as microsystems that are designed to generate desired health outcomes for specific subsets of patients and to use resources efficiently. This article provides case study examples to show what an office-based <span class="hlt">practice</span> might look like if it were using front-line measurement to <span class="hlt">improve</span> care and services most of the time and to conduct clinical <span class="hlt">improvement</span> research some of the time. WHAT ARE THE PRINCIPLES FOR USING DATA TO <span class="hlt">IMPROVE</span> PROCESSES AND OUTCOMES OF CARE?: Principles reflected in the case study examples--such as "Keep Measurement Simple. Think Big and Start Small" and "More Data Is Not Necessarily Better Data. Seek Usefulness, Not Perfection, in Your Measures"--may help guide the development of data to study and <span class="hlt">improve</span> <span class="hlt">practice</span>. HOW CAN A <span class="hlt">PRACTICE</span> START TO USE DATA TO <span class="hlt">IMPROVE</span> CARE AND CONDUCT <span class="hlt">IMPROVEMENT</span> RESEARCH?: <span class="hlt">Practical</span> challenges are involved in starting to use data for enhancing care and <span class="hlt">improvement</span> research. To increase the odds for success, it would be wise to use a change management strategy to launch the startup plan. Other recommendations include "Establish a Sense of Urgency. (Survival Is Not</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=muscle+AND+improvement&pg=3&id=EJ409600','ERIC'); return false;" href="https://eric.ed.gov/?q=muscle+AND+improvement&pg=3&id=EJ409600"><span><span class="hlt">Cardiovascular</span> Aspects of Aging (Part 1 of 2).</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Van Camp, Steven P.; Boyer, John L.</p> <p>1989-01-01</p> <p>Reviews <span class="hlt">cardiovascular</span> changes occurring during the aging process and the trainability of older persons. Although <span class="hlt">cardiovascular</span> changes are part of life, activity levels need not decrease. Beneficial aspects of exercise include <span class="hlt">improvements</span> in muscle strength, joint mobility, flexibility, coordination, and weight control. (SM)</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29801678','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29801678"><span>Rationale and Methodology of the SARAH Trial: Long-Term <span class="hlt">Cardiovascular</span> Outcomes in Patients With Resistant Hypertension and Obstructive Sleep Apnea.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Sapiña-Beltrán, Esther; Torres, Gerard; Martínez-Alonso, Montserrat; Sánchez-de-la-Torre, Manuel; Franch, Maria; Bravo, Carmen; Masa, Juan F; Felez, Miquel; Fortuna-Gutierrez, Ana Maria; Abad, Jorge; García-Río, Francisco; Drager, Luciano F; Lee Chi-Hang, Ronald; Martínez-García, Miguel Ángel; Barbé, Ferran; Dalmases, Mireia</p> <p>2018-05-22</p> <p>Patients with resistant hypertension (RH) have a high risk of developing <span class="hlt">cardiovascular</span> events; therefore, new therapeutic approaches to better control blood pressure may be useful in <span class="hlt">improving</span> <span class="hlt">cardiovascular</span> outcomes. The prevalence of obstructive sleep apnea (OSA) is very high among patients with RH. Continuous positive airway pressure (CPAP) has been shown to be an effective treatment for reducing blood pressure in patients with RH. Nevertheless, the long-term effect of CPAP treatment on <span class="hlt">cardiovascular</span> outcomes has not been explored. The main objective of the SARAH study is to assess the impact of OSA and its treatment on <span class="hlt">cardiovascular</span> outcomes (morbidity and mortality) in patients with RH. This study is a multi-center, prospective, observational cohort study. A total of 1371 patients with RH will be enrolled in the study and followed once a year for five years. At inclusion, ambulatory blood pressure monitoring (ABPM) and a sleep study will be performed in all subjects. Socio-demographic, clinical and <span class="hlt">cardiovascular</span> variables will be collected at baseline and follow-up. Subsequently, subjects with OSA will be managed according to local standard <span class="hlt">practice</span>. Based on the OSA diagnosis and its treatment, three cohorts of subjects with RH will be defined: non-OSA, treated OSA and non-treated OSA. This study will contribute to elucidating the long-term impact of OSA treatments on blood pressure control and <span class="hlt">cardiovascular</span> outcomes in patients with RH. These results will contribute to <span class="hlt">improve</span> the <span class="hlt">cardiovascular</span> prognosis of patients with RH. Copyright © 2018 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4655736','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4655736"><span><span class="hlt">Improving</span> patient safety culture in general <span class="hlt">practice</span>: an interview study</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Verbakel, Natasha J; de Bont, Antoinette A; Verheij, Theo JM; Wagner, Cordula; Zwart, Dorien LM</p> <p>2015-01-01</p> <p>Background When <span class="hlt">improving</span> patient safety a positive safety culture is key. As little is known about <span class="hlt">improving</span> patient safety culture in primary care, this study examined whether administering a culture questionnaire with or without a complementary workshop could be used as an intervention for <span class="hlt">improving</span> safety culture. Aim To gain insight into how two interventions affected patient safety culture in everyday <span class="hlt">practice</span>. Design and setting After conducting a randomised control trial of two interventions, this was a qualitative study conducted in 30 general <span class="hlt">practices</span> to aid interpretation of the previous quantitative findings. Method Interviews were conducted at <span class="hlt">practice</span> locations (n = 27) with 24 GPs and 24 <span class="hlt">practice</span> nurses. The theory of communities of <span class="hlt">practice</span> — in particular, its concepts of a domain, a community, and a <span class="hlt">practice</span> — was used to interpret the findings by examining which elements were or were not present in the participating <span class="hlt">practices</span>. Results Communal awareness of the problem was only raised after getting together and discussing patient safety. The combination of a questionnaire and workshop enhanced the interaction of team members and nourished team feelings. This shared experience also helped them to understand and develop tools and language for daily <span class="hlt">practice</span>. Conclusion In order for patient safety culture to <span class="hlt">improve</span>, the safety culture questionnaire was more successful when accompanied by a <span class="hlt">practice</span> workshop. Initial discussion and negotiation of shared goals during the workshop fuelled feelings of coherence and belonging to a community wishing to learn about enhancing patient safety. Team meetings and day-to-day interactions enhanced further liaison and sharing, making patient safety a common and conscious goal. PMID:26622035</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_13");'>13</a></li> <li><a href="#" onclick='return showDiv("page_14");'>14</a></li> <li class="active"><span>15</span></li> <li><a href="#" onclick='return showDiv("page_16");'>16</a></li> <li><a href="#" onclick='return showDiv("page_17");'>17</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_15 --> <div id="page_16" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_14");'>14</a></li> <li><a href="#" onclick='return showDiv("page_15");'>15</a></li> <li class="active"><span>16</span></li> <li><a href="#" onclick='return showDiv("page_17");'>17</a></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="301"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/14666835','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/14666835"><span><span class="hlt">Practice</span>-based learning and <span class="hlt">improvement</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Moore, Donald E; Pennington, Floyd C</p> <p>2003-01-01</p> <p>Workplace learning is becoming increasingly important in all fields. While workplace learning in medicine, also called <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span> (PBLI) is not new, understanding how it works and how it fits with an individual physician's continuing professional development is new. In this article, we describe seven issues associated with PBLI and then pose questions for reflections, as continuing medical education (CME) planners consider working with PBLI.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/12606226','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/12606226"><span>The benefits of ribose in <span class="hlt">cardiovascular</span> disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Pauly, D F; Johnson, C; St Cyr, J A</p> <p>2003-02-01</p> <p><span class="hlt">Cardiovascular</span> disease still ranks as the leading cause of death in men and women. Adults have tried to lower their risk of <span class="hlt">cardiovascular</span> disease by <span class="hlt">improving</span> their diet, quitting smoking, controlling blood pressure and exercising regularly. Additionally, many adults have turned to nutriceutical or natural products. Myocardial ischemia, produces a depression in myocardial tissue levels of high energy compounds, along with a compromise in myocardial function. Ribose, a naturally occurring sugar, has been extensively investigated, both in animal and clinical studies, as an agent to enhance the recovery of these depressed energy compounds. Results of these studies have been promising in enhancing the recovery of these energy molecules along with an <span class="hlt">improvement</span> in myocardial function. Therefore, ribose should be considered as a potential agent in the treatment of ischemic <span class="hlt">cardiovascular</span> disease.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://ntrs.nasa.gov/search.jsp?R=20040088740&hterms=cognitive+Neuroscience&qs=Ntx%3Dmode%2Bmatchall%26Ntk%3DAll%26N%3D0%26No%3D80%26Ntt%3Dcognitive%2BNeuroscience','NASA-TRS'); return false;" href="https://ntrs.nasa.gov/search.jsp?R=20040088740&hterms=cognitive+Neuroscience&qs=Ntx%3Dmode%2Bmatchall%26Ntk%3DAll%26N%3D0%26No%3D80%26Ntt%3Dcognitive%2BNeuroscience"><span>Variable <span class="hlt">practice</span> with lenses <span class="hlt">improves</span> visuo-motor plasticity</span></a></p> <p><a target="_blank" href="http://ntrs.nasa.gov/search.jsp">NASA Technical Reports Server (NTRS)</a></p> <p>Roller, C. A.; Cohen, H. S.; Kimball, K. T.; Bloomberg, J. J.</p> <p>2001-01-01</p> <p>Novel sensorimotor situations present a unique challenge to an individual's adaptive ability. Using the simple and easily measured paradigm of visual-motor rearrangement created by the use of visual displacement lenses, we sought to determine whether an individual's ability to adapt to visuo-motor discordance could be <span class="hlt">improved</span> through training. Subjects threw small balls at a stationary target during a 3-week <span class="hlt">practice</span> regimen involving repeated exposure to one set of lenses in block <span class="hlt">practice</span> (x 2.0 magnifying lenses), multiple sets of lenses in variable <span class="hlt">practice</span> (x 2.0 magnifying, x 0.5 minifying and up-down reversing lenses) or sham lenses. At the end of training, adaptation to a novel visuo-motor situation (20-degree right shift lenses) was tested. We found that (1) training with variable <span class="hlt">practice</span> can increase adaptability to a novel visuo-motor situation, (2) increased adaptability is retained for at least 1 month and is transferable to further novel visuo-motor permutations and (3) variable <span class="hlt">practice</span> <span class="hlt">improves</span> performance of a simple motor task even in the undisturbed state. These results have implications for the design of clinical rehabilitation programs and countermeasures to enhance astronaut adaptability, facilitating adaptive transitions between gravitational environments.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26248610','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26248610"><span>Role of nurse practitioners in reducing <span class="hlt">cardiovascular</span> risk factors: a retrospective cohort study.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Klemenc-Ketis, Zalika; Terbovc, Alenka; Gomiscek, Bostjan; Kersnik, Janko</p> <p>2015-11-01</p> <p>To determine the impact of nurse practitioners' counselling on reducing <span class="hlt">cardiovascular</span> risk factors in patients participating in routine preventive check-ups. A new model of 'renewed' family <span class="hlt">practice</span> was introduced in Slovenia as a pilot project in 2011, in which nurse practitioners are included in a team carrying out preventive activities and managing patients with stable chronic diseases. A retrospective cohort study. This study was conducted in 16 family medicine <span class="hlt">practices</span> (eight renewed and eight regular family <span class="hlt">practices</span>). In each family <span class="hlt">practice</span>, a systematic sample was selected of registered patients participating in a <span class="hlt">cardiovascular</span> preventive check-up. Data on sex, age, blood pressure, cholesterol, blood sugar, smoking, level of physical activity and <span class="hlt">cardiovascular</span> risk were collected. Patients attending renewed family <span class="hlt">practices</span> received counselling on risk factors from nurse practitioners (test group), and patients attending regular family <span class="hlt">practices</span> received counselling from family physicians (control group). Data were collected again at least one and no more than five years after the baseline consultation. There were 128 patients in the test group and 129 patients in the control group. At the control visit, the patients counselled by nurse practitioners had significantly lower levels of systolic blood pressure and cholesterol and <span class="hlt">practiced</span> regular physical activity significantly more often than patients counselled by family physicians. Nurse practitioners can be at least as successful as physicians when counselling patients on <span class="hlt">cardiovascular</span> risk factors during their preventive check-ups. This study showed that nurse practitioners have an important role in managing patients at the primary care level. © 2015 John Wiley & Sons Ltd.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=epr&pg=2&id=EJ436966','ERIC'); return false;" href="https://eric.ed.gov/?q=epr&pg=2&id=EJ436966"><span><span class="hlt">Improving</span> Service through Effective <span class="hlt">Practice</span> Reviews.</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Mangano, Michael</p> <p>1991-01-01</p> <p>Effective <span class="hlt">practice</span> reviews (EPRs) are described as used in evaluation studies for the Office of Evaluation and Inspections, a component of the U.S. Department of Health and Human Services. Examples are given of EPRs in addressing new problems, structuring and <span class="hlt">improving</span> federal programs, and decreasing costs. (SLD)</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/14666834','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/14666834"><span>Physician leadership: influence on <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Prather, Stephen E; Jones, David N</p> <p>2003-01-01</p> <p>In response to the technology and information explosion, <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span> is emerging within the medical field to deliver systematic <span class="hlt">practice</span>-linked <span class="hlt">improvements</span>. However, its emergence has been inhibited by the slow acceptance of evidence-based medicine among physicians, who are reluctant to embrace proven high-performance leadership principles long established in other high-risk fields. This reluctance may be attributable to traditional medical training, which encourages controlling leadership styles that magnify the resistance common to all change efforts. To overcome this resistance, physicians must develop the same leadership skills that have proven to be critical to success in other service and high-performance industries. Skills such as self-awareness, shared authority, conflict resolution, and nonpunitive critique can emerge in <span class="hlt">practice</span> only if they are taught. A dramatic shift away from control and blame has become a requirement for achieving success in other industries based on complex group process. This approach is so mainstream that the burden of proof that cooperative leadership is not a requirement for medical <span class="hlt">improvement</span> falls to those institutions perpetuating the outmoded paradigm of the past. Cooperative leadership skills that have proven central to implementing change in the information era are suggested as a core cultural support for <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>. Complex adaptive systems theory, long used as a way to understand evolutionary biology, and more recently computer science and economics, predicts that behavior emerging among some groups of providers will be selected for duplication by the competitive environment. A curriculum framework needed to teach leadership skills to expand the influence of <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span> is offered as a guide to accelerate change.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29531376','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29531376"><span>[Consensus document and recommendations for the prevention of <span class="hlt">cardiovascular</span> disease in Italy - 2018].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Volpe, Massimo; Tocci, Giuliano; Accettura, Domenico; Battistoni, Allegra; Bellone, Simonetta; Bellotti, Paolo; Bertolotti, Marco; Borghi, Claudio; Casasco, Maurizio; Consoli, Agostino; Coppini, Raffaele; Corsini, Alberto; Costanzo, Gianfranco; Desideri, Giovambattista; Ferri, Claudio; Galanti, Giorgio; Giada, Franco; Icardi, Giancarlo; Lombardi, Niccolò; Modena, Maria Grazia; Modesti, Pietro Amedeo; Monti, Giorgio; Mugelli, Alessandro; Orsi, Andrea; Parati, Gianfranco; Pedretti, Roberto F.E.; Perseghin, Gianluca; Pirro, Matteo; Ricotti, Roberta; Rizzoni, Damiano; Rotella, Carlo; Rubattu, Speranza; Salvetti, Guido; Sarto, Patrizio; Tassinari, Federico; Trimarco, Bruno; de Kreutzenberg, Saula Vigili; Volpe, Roberto</p> <p>2018-02-01</p> <p><span class="hlt">Cardiovascular</span> prevention represents a cornerstone of modern strategies to reduce the burden of <span class="hlt">cardiovascular</span> disease. It is of key importance to prevent <span class="hlt">cardiovascular</span> diseases and associated events, not only to reduce morbidity and mortality, but also to increase the years of wellness in the aging population and to make the growing socio-economic burden imposed by <span class="hlt">cardiovascular</span> events more sustainable.The current approach to prevention is based on an integrated use of effective lifestyle measures and, whenever appropriate, of antihypertensive and antidiabetic drugs, lipid-lowering agents and antiplatelet drugs.Given that population characteristics, in terms of ethnicity, demography and lifestyle habits, and healthcare system organizations differ among countries, international guidelines are not always applicable to specific countries and, often, are difficult to translate into daily clinical <span class="hlt">practice</span>.In order to afford the specific features of Italy, 10 Scientific Societies and Research Institutions, mostly involved in preventive strategies, contributed to the present Italian consensus document, which includes brief, <span class="hlt">practical</span> recommendations to support the preventive actions within the physician community and the general <span class="hlt">practice</span> setting.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4139197','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4139197"><span>Simulating the Impact of <span class="hlt">Improved</span> <span class="hlt">Cardiovascular</span> Risk Interventions on Clinical and Economic Outcomes in Russia</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Shum, Kenny; Alperin, Peter; Shalnova, Svetlana; Boytsov, Sergey; Kontsevaya, Anna; Vigdorchik, Alexey; Guetz, Adam; Eriksson, Jennifer; Hughes, David</p> <p>2014-01-01</p> <p>Objectives Russia faces a high burden of <span class="hlt">cardiovascular</span> disease. Prevalence of all <span class="hlt">cardiovascular</span> risk factors, especially hypertension, is high. Elevated blood pressure is generally poorly controlled and medication usage is suboptimal. With a disease-model simulation, we forecast how various treatment programs aimed at increasing blood pressure control would affect <span class="hlt">cardiovascular</span> outcomes. In addition, we investigated what additional benefit adding lipid control and smoking cessation to blood pressure control would generate in terms of reduced <span class="hlt">cardiovascular</span> events. Finally, we estimated the direct health care costs saved by treating fewer <span class="hlt">cardiovascular</span> events. Methods The Archimedes Model, a detailed computer model of human physiology, disease progression, and health care delivery was adapted to the Russian setting. Intervention scenarios of achieving systolic blood pressure control rates (defined as systolic blood pressure <140 mmHg) of 40% and 60% were simulated by modifying adherence rates of an antihypertensive medication combination and compared with current care (23.9% blood pressure control rate). Outcomes of major adverse <span class="hlt">cardiovascular</span> events; cerebrovascular event (stroke), myocardial infarction, and <span class="hlt">cardiovascular</span> death over a 10-year time horizon were reported. Direct health care costs of strokes and myocardial infarctions were derived from official Russian statistics and tariff lists. Results To achieve systolic blood pressure control rates of 40% and 60%, adherence rates to the antihypertensive treatment program were 29.4% and 65.9%. <span class="hlt">Cardiovascular</span> death relative risk reductions were 13.2%, and 29.6%, respectively. For the current estimated 43,855,000-person Russian hypertensive population, each control-rate scenario resulted in an absolute reduction of 1.0 million and 2.4 million <span class="hlt">cardiovascular</span> deaths, and a reduction of 1.2 million and 2.7 million stroke/myocardial infarction diagnoses, respectively. Averted direct costs from current care levels</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28545640','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28545640"><span>Artificial Intelligence in Precision <span class="hlt">Cardiovascular</span> Medicine.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Krittanawong, Chayakrit; Zhang, HongJu; Wang, Zhen; Aydar, Mehmet; Kitai, Takeshi</p> <p>2017-05-30</p> <p>Artificial intelligence (AI) is a field of computer science that aims to mimic human thought processes, learning capacity, and knowledge storage. AI techniques have been applied in <span class="hlt">cardiovascular</span> medicine to explore novel genotypes and phenotypes in existing diseases, <span class="hlt">improve</span> the quality of patient care, enable cost-effectiveness, and reduce readmission and mortality rates. Over the past decade, several machine-learning techniques have been used for <span class="hlt">cardiovascular</span> disease diagnosis and prediction. Each problem requires some degree of understanding of the problem, in terms of <span class="hlt">cardiovascular</span> medicine and statistics, to apply the optimal machine-learning algorithm. In the near future, AI will result in a paradigm shift toward precision <span class="hlt">cardiovascular</span> medicine. The potential of AI in <span class="hlt">cardiovascular</span> medicine is tremendous; however, ignorance of the challenges may overshadow its potential clinical impact. This paper gives a glimpse of AI's application in <span class="hlt">cardiovascular</span> clinical care and discusses its potential role in facilitating precision <span class="hlt">cardiovascular</span> medicine. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28149651','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28149651"><span>Hepatitis C virus and <span class="hlt">cardiovascular</span>: A review.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Petta, Salvatore</p> <p>2017-03-01</p> <p>Chronic hepatitis C virus (HCV) infection is a systemic disease that leads to increased risks of cirrhosis and its complications, as well as extrahepatic disturbances, including immune-related disorders and metabolic alterations such as insulin resistance and steatosis. Recent accumulating evidence suggests that HCV infection can increase <span class="hlt">cardiovascular</span> risk, and that viral eradication can <span class="hlt">improve</span> <span class="hlt">cardiovascular</span> outcomes in the clinical setting. These data are strengthened by evidence identifying potential mechanisms (in)directly linking HCV infection to vascular damage. However, the high prevalence of both HCV infection and <span class="hlt">cardiovascular</span> alterations, as well as the presence of contrasting results not identifying any association between HCV infection and <span class="hlt">cardiovascular</span> dysfunction, provides uncertainty about a direct association of HCV infection with <span class="hlt">cardiovascular</span> risk. Further studies are needed to clarify definitively the role of HCV infection in <span class="hlt">cardiovascular</span> alterations, as well as the impact of viral eradication on <span class="hlt">cardiovascular</span> outcomes. These features are now more attractive, considering the availability of new, safe, and very effective interferon-free antiviral agents for the treatment of HCV infection. This review aims to discuss carefully available data on the relationship between HCV infection and <span class="hlt">cardiovascular</span> risk.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24044686','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24044686"><span>Instituting systems-based <span class="hlt">practice</span> and <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>: a curriculum of inquiry.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Wilper, Andrew P; Smith, Curtis Scott; Weppner, William</p> <p>2013-09-16</p> <p>The Accreditation Council for Graduate Medical Education (ACGME) requires that training programs integrate system-based <span class="hlt">practice</span> (SBP) and <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span> (PBLI) into internal medicine residency curricula. CONTEXT AND SETTING: We instituted a seminar series and year-long-mentored curriculum designed to engage internal medicine residents in these competencies. Residents participate in a seminar series that includes assigned reading and structured discussion with faculty who assist in the development of quality <span class="hlt">improvement</span> or research projects. Residents pursue projects over the remainder of the year. Monthly works in progress meetings, protected time for inquiry, and continued faculty mentorship guide the residents in their project development. Trainees present their work at hospital-wide grand rounds at the end of the academic year. We performed a survey of residents to assess their self-reported knowledge, attitudes and skills in SBP and PBLI. In addition, blinded faculty scored projects for appropriateness, impact, and feasibility. We measured resident self-reported knowledge, attitudes, and skills at the end of the academic year. We found evidence that participants <span class="hlt">improved</span> their understanding of the context in which they were <span class="hlt">practicing</span>, and that their ability to engage in quality <span class="hlt">improvement</span> projects increased. Blinded faculty reviewers favorably ranked the projects' feasibility, impact, and appropriateness. The 'Curriculum of Inquiry' generated 11 quality <span class="hlt">improvement</span> and research projects during the study period. Barriers to the ongoing work include a limited supply of mentors and delays due to Institutional Review Board approval. Hospital leadership recognizes the importance of the curriculum, and our accreditation manager now cites our ongoing work. A structured residency-based curriculum facilitates resident demonstration of SBP and <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>. Residents gain knowledge and skills though this enterprise</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3776321','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3776321"><span>Instituting systems-based <span class="hlt">practice</span> and <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>: a curriculum of inquiry</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Wilper, Andrew P.; Smith, Curtis Scott; Weppner, William</p> <p>2013-01-01</p> <p>Background The Accreditation Council for Graduate Medical Education (ACGME) requires that training programs integrate system-based <span class="hlt">practice</span> (SBP) and <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span> (PBLI) into internal medicine residency curricula. Context and setting We instituted a seminar series and year-long-mentored curriculum designed to engage internal medicine residents in these competencies. Methods Residents participate in a seminar series that includes assigned reading and structured discussion with faculty who assist in the development of quality <span class="hlt">improvement</span> or research projects. Residents pursue projects over the remainder of the year. Monthly works in progress meetings, protected time for inquiry, and continued faculty mentorship guide the residents in their project development. Trainees present their work at hospital-wide grand rounds at the end of the academic year. We performed a survey of residents to assess their self-reported knowledge, attitudes and skills in SBP and PBLI. In addition, blinded faculty scored projects for appropriateness, impact, and feasibility. Outcomes We measured resident self-reported knowledge, attitudes, and skills at the end of the academic year. We found evidence that participants <span class="hlt">improved</span> their understanding of the context in which they were <span class="hlt">practicing</span>, and that their ability to engage in quality <span class="hlt">improvement</span> projects increased. Blinded faculty reviewers favorably ranked the projects’ feasibility, impact, and appropriateness. The ‘Curriculum of Inquiry’ generated 11 quality <span class="hlt">improvement</span> and research projects during the study period. Barriers to the ongoing work include a limited supply of mentors and delays due to Institutional Review Board approval. Hospital leadership recognizes the importance of the curriculum, and our accreditation manager now cites our ongoing work. Conclusions A structured residency-based curriculum facilitates resident demonstration of SBP and <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>. Residents gain</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28166020','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28166020"><span>Instituting systems-based <span class="hlt">practice</span> and <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>: a curriculum of inquiry.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Wilper, Andrew P; Smith, Curtis Scott; Weppner, William</p> <p>2013-01-01</p> <p>Background The Accreditation Council for Graduate Medical Education (ACGME) requires that training programs integrate system-based <span class="hlt">practice</span> (SBP) and <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span> (PBLI) into internal medicine residency curricula. Context and setting We instituted a seminar series and year-long-mentored curriculum designed to engage internal medicine residents in these competencies. Methods Residents participate in a seminar series that includes assigned reading and structured discussion with faculty who assist in the development of quality <span class="hlt">improvement</span> or research projects. Residents pursue projects over the remainder of the year. Monthly works in progress meetings, protected time for inquiry, and continued faculty mentorship guide the residents in their project development. Trainees present their work at hospital-wide grand rounds at the end of the academic year. We performed a survey of residents to assess their self-reported knowledge, attitudes and skills in SBP and PBLI. In addition, blinded faculty scored projects for appropriateness, impact, and feasibility. Outcomes We measured resident self-reported knowledge, attitudes, and skills at the end of the academic year. We found evidence that participants <span class="hlt">improved</span> their understanding of the context in which they were <span class="hlt">practicing</span>, and that their ability to engage in quality <span class="hlt">improvement</span> projects increased. Blinded faculty reviewers favorably ranked the projects' feasibility, impact, and appropriateness. The 'Curriculum of Inquiry' generated 11 quality <span class="hlt">improvement</span> and research projects during the study period. Barriers to the ongoing work include a limited supply of mentors and delays due to Institutional Review Board approval. Hospital leadership recognizes the importance of the curriculum, and our accreditation manager now cites our ongoing work. Conclusions A structured residency-based curriculum facilitates resident demonstration of SBP and <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>. Residents gain</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/20947296','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/20947296"><span><span class="hlt">Cardiovascular</span> disease and musculoskeletal disorder labels in family <span class="hlt">practice</span> acted as markers of physical health severity.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Prior, James A; Kadam, Umesh T</p> <p>2011-05-01</p> <p>Family practitioner diagnostic labels applied in consultation provide a signpost for treatment and management. Yet, it is unknown whether each label reflects the health of the respective patient group. Consultation records of 7,799 patients aged 50 years and older from six family <span class="hlt">practices</span> were linked to a cross-sectional baseline health survey. Associations between six mutually exclusive <span class="hlt">cardiovascular</span> disease and nine mutually exclusive musculoskeletal disorder categories, and physical health severity as measured by the Short Form-12 questionnaire were examined. There were 2,447 (31.4%) <span class="hlt">cardiovascular</span> disease and 3,321 (42.6%) musculoskeletal disorder consulters. The mean physical health scores ranged from 38.38 (95% confidence interval [CI]: 37.8-39.0) for hypertension to the poorest score of health 28.98 (95% CI: 27.5-30.5) for consulters with heart failure, whereas in the musculoskeletal disorder group, scores ranged from 44.85 (95% CI: 42.2-47.5) for soft tissue disorder to 28.79 (95% CI: 26.8-30.8) for consulters with inflammatory polyarthropathy (trend P<0.001). This trend in the association between diagnostic categories and physical health severity within both spectrums remained after adjustment for confounders. Specific diagnostic labels for selected chronic illness indicate the severity of physical health for the corresponding consulting population. Copyright © 2011 Elsevier Inc. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24321852','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24321852"><span>Collaborative <span class="hlt">practice</span> model between cardiologists and clinical pharmacists for management of patients with <span class="hlt">cardiovascular</span> disease in an outpatient clinic.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Ripley, Toni L; Adamson, Philip B; Hennebry, Thomas A; Van Tuyl, Joseph S; Harrison, Donald L; Rathbun, R Chris</p> <p>2014-03-01</p> <p>The increasing prevalence of <span class="hlt">cardiovascular</span> disease (CVD) has prompted leading <span class="hlt">cardiovascular</span> organizations to advocate utilization of a team approach to patient care that includes nonphysician providers. In spite of that, the American College of Cardiology reported that nonphysician providers are underutilized in the management of patients with CVD. A survey of cardiologists revealed that the underutilization is a result of lack of understanding of how best to involve nonphysician providers in the health care team. Clinical pharmacists are one category of nonphysician providers that have recognized effectiveness in managing patients with CVD. No example of a comprehensive model of collaboration between cardiologists and clinical pharmacists is described in the literature that could serve to close this gap in understanding. The objective of this report is to describe a model of cardiologist-clinical pharmacist collaboration in the longitudinal management of patients with CVD that has been successfully implemented in 2 diverse settings. The implementation, evolution, scope of <span class="hlt">practice</span>, required pharmacist training, logistical elements needed for success, and implementation barriers are reviewed. A summary of the patients referred to the clinic are examined as well.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2516922','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2516922"><span>Getting the Word Out: Teaching Middle-School Children about <span class="hlt">Cardiovascular</span> Disease</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Toepperwein, Mary Anne; Pruski, Linda A.; Blalock, Cheryl L.; Lemelle, Olivia R.; Lichtenstein, Michael J.</p> <p>2008-01-01</p> <p><span class="hlt">Cardiovascular</span> disease (CVD) has roots in childhood; since CVD begins early, a clear strong case for early education focused on CVD primary prevention exists. Scientists are not traditionally involved in disseminating health knowledge into public education. Similarly, public school teachers typically do not have access to biomedical research that may increase their students’ health science literacy. One way to bridge the ‘cultural’ gap between researchers and school teachers is to form science education partnerships. In order for such partnerships to be successful, teams of scientists and teachers must ‘translate’ biomedical research into plain language appropriate for students. In this article, we briefly review the need for <span class="hlt">improving</span> health literacy, especially through school-based programs, and describe work with one model scientist/teacher partnership, the Teacher Enrichment Initiatives. Examples of <span class="hlt">cardiovascular</span> research ‘translated’ into plain language lessons for middle school students are provided and <span class="hlt">practical</span> considerations for researchers pursuing a science education partnership are delineated. PMID:19122871</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29458515','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29458515"><span>A Pilot Feasibility Study to <span class="hlt">Improve</span> Food Parenting <span class="hlt">Practices</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Moore, Amy M; Clair-Michaud, Mary; Melanson, Kathleen J; Tovar, Alison</p> <p>2018-03-01</p> <p>We examined the feasibility and acceptability of a novel home-based intervention to <span class="hlt">improve</span> the food parenting <span class="hlt">practices</span> of low-income mothers with preschool-aged children. Mother-child dyads (N = 15) were recruited from WIC in southern Rhode Island. A non-experimental, pretest-posttest design was used to assess changes in maternal food parenting <span class="hlt">practices</span>. Dyads participated in 3 home-based sessions that included baseline measures and an evening meal video recording at session 1, a motivational interviewing (MI) intervention that included feedback on the evening meal video recording at session 2, and a satisfaction ques- tionnaire at session 3. Pretest-posttest measures included 5 subscales of the Comprehensive Feeding <span class="hlt">Practices</span> Questionnaire. Fifteen mother-child dyads (mothers: 32.3, SD = 4.6 years, 86.7% white; children: 3.2, SD = 0.9 years, male = 73.3%, 66.7% white) completed the study. Mothers reported <span class="hlt">improvements</span> in food parenting <span class="hlt">practices</span> following the home-based MI intervention. Overall, 93% of mothers 'strongly agreed' that it was worth their effort to participate in the study. A home-based MI intervention may be an effective strategy for <span class="hlt">improving</span> maternal food parenting <span class="hlt">practices</span> in low-income populations. Most mothers found that watching themselves was informative and applicable to their own lives.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29525828','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29525828"><span>Exercise Training and <span class="hlt">Cardiovascular</span> Health in Cancer Patients.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Squires, Ray W; Shultz, Adam M; Herrmann, Joerg</p> <p>2018-03-10</p> <p>Cancer patients nearly universally experience a decline in quality of life, with fatigue and reduced exercise tolerance as cardinal reflections. A routine exercise program can <span class="hlt">improve</span> these signs and symptoms as well as overall outcomes. The review provides an updated overview of the field and its translation to clinical <span class="hlt">practice</span>. A wealth of clinical studies have documented the safety and benefits of exercise after and during cancer therapy, and pilot and larger-scale studies are currently ongoing to integrate exercise into the treatment program for cancer patients undergoing active therapy (EXACT pilot, OptiTrain, and TITAN study). More recently, efforts have emerged to commence exercise programs before the start of cancer therapy, so-called pre-habilitation. The concept of increasing the <span class="hlt">cardiovascular</span> reserve beforehand is intuitively attractive. In agreement, preclinical studies support exercise as an effective preventive means before and during cardiotoxic drug exposure. Assuming that a pronounced drop in exercise tolerance will occur during cancer therapy, pre-habilitation can potentially curtail or raise the nadir level of exercise tolerance. Furthermore, such efforts might serve as pre-conditioning efforts in reducing not only the nadir, but even the magnitude of drop in <span class="hlt">cardiovascular</span> reserve. Initiated beforehand, cancer patients are also more likely to continue these efforts during cancer therapy. Finally, an active exercise routine (≥ 150 min/week moderate intensity or ≥ 75 min/week vigorous intensity or combination) in conjunction with the other six American Heart Association's <span class="hlt">cardiovascular</span> health metrics (BMI < 25 kg/m 2 , blood pressure < 120/80 mmHg, fasting plasma glucose < 100 mg/dL, total cholesterol < 200 mg/dL, 4-5 component healthy diet, no smoking) reduces not only the <span class="hlt">cardiovascular</span> but also the cancer disease risk. Exercise can reduce the risks of developing cancer, the detrimental effects of its treatment on the</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28291729','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28291729"><span>Association Between <span class="hlt">Improvement</span> in <span class="hlt">Cardiovascular</span> Risk Profile and Changes in Sickness Absence: Results of the ICARIA Study.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Calvo-Bonacho, Eva; Catalina-Romero, Carlos; Cabrera, Martha; Fernández-Labandera, Carlos; Sánchez Chaparro, Miguel Ángel; Brotons, Carlos; Ruilope, Luis Miguel</p> <p>2017-11-01</p> <p>The purpose of this study was to investigate whether changes in <span class="hlt">cardiovascular</span> risk (CVR) are associated with the length and cost of sickness absence. A prospective cohort of 179 186 participants was evaluated. Each participant's CVR (SCORE) was assessed on 2 consecutive medical examinations, approximately 1 year apart (365 ± 90 days). <span class="hlt">Cardiovascular</span> risk was categorized as < 4% or ≥ 4%, and participants were divided into 4 groups according to changes in their risk between the 2 assessments. After the second CVR estimate, a 1-year follow-up was carried out to assess sickness absence. Differences between the 4 groups in terms of the total count of sickness absence days during the follow-up period were tested using Poisson regression models. After adjustment for covariates, participants who showed an <span class="hlt">improvement</span> in CVR had a lower count of sickness absence days compared with both those who showed a worsening in risk and those who remained stable at ≥ 4% (RR, 0.91; 95%CI, 0.84-0.98). In comparison with participants whose CVR did not <span class="hlt">improve</span>, more of the participants whose risk did <span class="hlt">improve</span> had quit smoking (+17.2%; P < .001), and had controlled their blood pressure (+26.0%, P < .001), total cholesterol (+9.3%; P < .001), low-density lipoprotein cholesterol (+14.9%; P < .001), and triglyceride levels (+14.6%; P < .001). Our results suggest that an <span class="hlt">improvement</span> in CVR profile is accompanied by a decrease in sickness absence during a 1-year follow-up. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26446095','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26446095"><span>Anti-inflammatory γ- and δ-tocotrienols <span class="hlt">improve</span> <span class="hlt">cardiovascular</span>, liver and metabolic function in diet-induced obese rats.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Wong, Weng-Yew; Ward, Leigh C; Fong, Chee Wai; Yap, Wei Ney; Brown, Lindsay</p> <p>2017-02-01</p> <p>This study tested the hypothesis that γ- and δ-tocotrienols are more effective than α-tocotrienol and α-tocopherol in attenuating the signs of diet-induced metabolic syndrome in rats. Five groups of rats were fed a corn starch-rich (C) diet containing 68 % carbohydrates as polysaccharides, while the other five groups were fed a diet (H) high in simple carbohydrates (fructose and sucrose in food, 25 % fructose in drinking water, total 68 %) and fats (beef tallow, total 24 %) for 16 weeks. Separate groups from each diet were supplemented with either α-, γ-, δ-tocotrienol or α-tocopherol (85 mg/kg/day) for the final 8 of the 16 weeks. H rats developed visceral obesity, hypertension, insulin resistance, <span class="hlt">cardiovascular</span> remodelling and fatty liver. α-Tocopherol, α-, γ- and δ-tocotrienols reduced collagen deposition and inflammatory cell infiltration in the heart. Only γ- and δ-tocotrienols <span class="hlt">improved</span> <span class="hlt">cardiovascular</span> function and normalised systolic blood pressure compared to H rats. Further, δ-tocotrienol <span class="hlt">improved</span> glucose tolerance, insulin sensitivity, lipid profile and abdominal adiposity. In the liver, these interventions reduced lipid accumulation, inflammatory infiltrates and plasma liver enzyme activities. Tocotrienols were measured in heart, liver and adipose tissue showing that chronic oral dosage delivered tocotrienols to these organs despite low or no detection of tocotrienols in plasma. In rats, δ-tocotrienol <span class="hlt">improved</span> inflammation, heart structure and function, and liver structure and function, while γ-tocotrienol produced more modest <span class="hlt">improvements</span>, with minimal changes with α-tocotrienol and α-tocopherol. The most important mechanism of action is likely to be reduction in organ inflammation.</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_14");'>14</a></li> <li><a href="#" onclick='return showDiv("page_15");'>15</a></li> <li class="active"><span>16</span></li> <li><a href="#" onclick='return showDiv("page_17");'>17</a></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_16 --> <div id="page_17" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_15");'>15</a></li> <li><a href="#" onclick='return showDiv("page_16");'>16</a></li> <li class="active"><span>17</span></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="321"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28153943','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28153943"><span>The <span class="hlt">cardiovascular</span> system after exercise.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Romero, Steven A; Minson, Christopher T; Halliwill, John R</p> <p>2017-04-01</p> <p>Recovery from exercise refers to the time period between the end of a bout of exercise and the subsequent return to a resting or recovered state. It also refers to specific physiological processes or states occurring after exercise that are distinct from the physiology of either the exercising or the resting states. In this context, recovery of the <span class="hlt">cardiovascular</span> system after exercise occurs across a period of minutes to hours, during which many characteristics of the system, even how it is controlled, change over time. Some of these changes may be necessary for long-term adaptation to exercise training, yet some can lead to <span class="hlt">cardiovascular</span> instability during recovery. Furthermore, some of these changes may provide insight into when the <span class="hlt">cardiovascular</span> system has recovered from prior training and is physiologically ready for additional training stress. This review focuses on the most consistently observed hemodynamic adjustments and the underlying causes that drive <span class="hlt">cardiovascular</span> recovery and will highlight how they differ following resistance and aerobic exercise. Primary emphasis will be placed on the hypotensive effect of aerobic and resistance exercise and associated mechanisms that have clinical relevance, but if left unchecked, can progress to symptomatic hypotension and syncope. Finally, we focus on the <span class="hlt">practical</span> application of this information to strategies to maximize the benefits of <span class="hlt">cardiovascular</span> recovery, or minimize the vulnerabilities of this state. We will explore appropriate field measures, and discuss to what extent these can guide an athlete's training. Copyright © 2017 the American Physiological Society.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5407206','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5407206"><span>The <span class="hlt">cardiovascular</span> system after exercise</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Romero, Steven A.; Minson, Christopher T.</p> <p>2017-01-01</p> <p>Recovery from exercise refers to the time period between the end of a bout of exercise and the subsequent return to a resting or recovered state. It also refers to specific physiological processes or states occurring after exercise that are distinct from the physiology of either the exercising or the resting states. In this context, recovery of the <span class="hlt">cardiovascular</span> system after exercise occurs across a period of minutes to hours, during which many characteristics of the system, even how it is controlled, change over time. Some of these changes may be necessary for long-term adaptation to exercise training, yet some can lead to <span class="hlt">cardiovascular</span> instability during recovery. Furthermore, some of these changes may provide insight into when the <span class="hlt">cardiovascular</span> system has recovered from prior training and is physiologically ready for additional training stress. This review focuses on the most consistently observed hemodynamic adjustments and the underlying causes that drive <span class="hlt">cardiovascular</span> recovery and will highlight how they differ following resistance and aerobic exercise. Primary emphasis will be placed on the hypotensive effect of aerobic and resistance exercise and associated mechanisms that have clinical relevance, but if left unchecked, can progress to symptomatic hypotension and syncope. Finally, we focus on the <span class="hlt">practical</span> application of this information to strategies to maximize the benefits of <span class="hlt">cardiovascular</span> recovery, or minimize the vulnerabilities of this state. We will explore appropriate field measures, and discuss to what extent these can guide an athlete’s training. PMID:28153943</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25661547','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25661547"><span><span class="hlt">Cardiovascular</span> consequences of childhood obesity.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>McCrindle, Brian W</p> <p>2015-02-01</p> <p>Childhood and adolescent overweight and obesity is an important and increasingly prevalent public health problem in Canada and worldwide. High adiposity in youth is indicated in clinical <span class="hlt">practice</span> by plotting body mass index on appropriate percentile charts normed for age and sex, although waist measures might be a further tool. High adiposity can lead to adiposopathy in youth, with associated increases in inflammation and oxidative stress, changes in adipokines, and endocrinopathy. This is manifest as cardiometabolic risk factors in similar patterns to those in noted in obese adults. Obesity and cardiometabolic risk factors have been shown to be associated with vascular changes indicative of early atherosclerosis, and ventricular hypertrophy, dilation, and dysfunction. These <span class="hlt">cardiovascular</span> consequences are evident in youth, but childhood obesity is also predictive of similar consequences in adulthood. Childhood obesity and risk factors have been shown to track into adulthood and worsen in most individuals. The result is an exponential acceleration of atherosclerosis, which can be predicted to translate into an epidemic of premature <span class="hlt">cardiovascular</span> disease and events. A change in paradigm is needed toward preventing and curing atherosclerosis and not just preventing <span class="hlt">cardiovascular</span> disease. This would necessarily create an imperative for preventing and treating childhood obesity. Urgent attention, policy, and action are needed to avoid the enormous future social and health care costs associated with the <span class="hlt">cardiovascular</span> consequences of obesity in youth. Copyright © 2015 Canadian <span class="hlt">Cardiovascular</span> Society. Published by Elsevier Inc. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23642297','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23642297"><span>[<span class="hlt">Cardiovascular</span> clearance for competitive sport in aging people].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Carré, François</p> <p>2013-06-01</p> <p>The regular sport <span class="hlt">practice</span> slows the physiological deleterious effects of aging. However, during intense exercise, the hazard of acute <span class="hlt">cardiovascular</span> event is significantly increased. Whatever their <span class="hlt">cardiovascular</span> risk factors are, aging people are more prone to coronary acute event during intense exertion than a young one. <span class="hlt">Cardiovascular</span> exam, with resting ECG and maximal exercise test, is needed to give clearance for competitive sport in aging people (>65 y.o.). The limited value to evaluate the individual risk of acute cardiac event during intense exercise must be clearly explained to Master athletes. They must be aware to the necessity to consult their physician in case of abnormal symptom during exercise. Copyright © 2013 Elsevier Masson SAS. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27692117','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27692117"><span>Impact of Cardiac Rehabilitation and Exercise Training on Psychological Risk Factors and Subsequent Prognosis in Patients With <span class="hlt">Cardiovascular</span> Disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lavie, Carl J; Menezes, Arthur R; De Schutter, Alban; Milani, Richard V; Blumenthal, James A</p> <p>2016-10-01</p> <p>The role of psychological risk factors has been under-recognized in most subspecialties of medicine, as well as in general medicine <span class="hlt">practices</span>. However, considerable evidence indicates that psychosocial factors are involved in the pathogenesis and progression of <span class="hlt">cardiovascular</span> disease (CVD). Emerging data from cardiac rehabilitation (CR) settings and CR exercise training (CRET) programs have demonstrated the value of comprehensive CRET to <span class="hlt">improve</span> psychological functioning and reduce all-cause mortality. Recent evidence also supports the role of CRET and the added value of stress management training in the secondary prevention of CVD. Copyright © 2016 Canadian <span class="hlt">Cardiovascular</span> Society. Published by Elsevier Inc. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4834856','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4834856"><span><span class="hlt">Cardiovascular</span> Disease in Women: Clinical Perspectives</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Garcia, Mariana; Mulvagh, Sharon L.; Merz, C. Noel Bairey; Buring, Julie E.; Manson, JoAnn E.</p> <p>2016-01-01</p> <p><span class="hlt">Cardiovascular</span> disease (CVD) continues to be the leading cause of death among women in the United States, accounting for approximately one of every three female deaths. Sex-specific data focused on CVD has been increasing steadily, yet is not routinely collected nor translated into <span class="hlt">practice</span>. This comprehensive review focuses on novel and unique aspects of <span class="hlt">cardiovascular</span> health in women and sex-differences as they relate to clinical <span class="hlt">practice</span> in the prevention, diagnosis, and treatment of CVD. This review also provides current approaches to the evaluation and treatment of acute coronary syndromes that are more prevalent in women, including: myocardial infarction associated with non-obstructive coronary arteries, spontaneous coronary artery dissection, and stress-induced cardiomyopathy (Takotsubo Syndrome). Other CVD entities with higher prevalence or unique considerations in women, such as heart failure with preserved ejection fraction, peripheral arterial disease and abdominal aortic aneurysms, are also briefly reviewed. Lastly, recommendations for cardiac rehabilitation are addressed. PMID:27081110</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24071661','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24071661"><span>A European Renal Best <span class="hlt">Practice</span> (ERBP) position statement on the Kidney Disease: <span class="hlt">Improving</span> Global Outcomes (KDIGO) clinical <span class="hlt">practice</span> guideline for the management of blood pressure in non-dialysis-dependent chronic kidney disease: an endorsement with some caveats for real-life application.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Verbeke, Francis; Lindley, Elisabeth; Van Bortel, Luc; Vanholder, Raymond; London, Gérard; Cochat, Pierre; Wiecek, Andrzej; Fouque, Denis; Van Biesen, Wim</p> <p>2014-03-01</p> <p>Developing guidelines on a subject as broad as hypertension is difficult, especially when the guidance relates to hypertension in the chronic kidney disease (CKD) population. The Kidney Disease: <span class="hlt">Improving</span> Global Outcomes Guideline Development Group has applied a rigorous methodology in reviewing all available evidence, and their recommendations are consistent with the evidence-based approach. As a result, the European Renal Best <span class="hlt">Practice</span> endorses most of its recommendations. However, the Work Group feels that some additional advice could help clinicians in daily <span class="hlt">practice</span>: (i) individualization of treatment should be taken into account, especially (<span class="hlt">cardiovascular</span>) co-morbidities, age, gender and race; (ii) side-effects, such as postural dizziness should be monitored closely, particularly in elderly, diabetics and patients with arterial stiffness; (iii) the importance of salt restriction should not be neglected; (iv) although angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blocker (ARBs) remain a cornerstone in the management of hypertension, and especially <span class="hlt">cardiovascular</span> protection, in some particular situations such as in advanced CKD and in patients without proteinuria, their role is less well defined; (v) as most CKD patients need more than one antihypertensive drug to achieve blood pressure control, the specific (renal) (dis)advantages of other classes than ACE-I or ARB should be taken into account.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28691508','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28691508"><span>Substantial <span class="hlt">improvement</span> of primary <span class="hlt">cardiovascular</span> prevention by a systematic score-based multimodal approach: A randomized trial: The PreFord-Study.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Gysan, Detlef Bernd; Millentrup, Stefanie; Albus, Christian; Bjarnason-Wehrens, Birna; Latsch, Joachim; Gohlke, Helmut; Herold, Gerd; Wegscheider, Karl; Heming, Christian; Seyfarth, Melchior; Predel, Hans-Georg</p> <p>2017-09-01</p> <p>Trial design Prospective randomized multicentre interventional study. Methods Individual <span class="hlt">cardiovascular</span> risk assessment in Ford Company, Germany employees ( n = 4.196), using the European Society of Cardiology-Systematic Coronary Risk Evaluation (ESC-SCORE) for classification into three risk groups. Subjects assigned to ESC high-risk group (ESC-SCORE ≥ 5%), without a history of <span class="hlt">cardiovascular</span> disease were eligible for randomization to a multimodal 15-week intervention programme (INT) or to usual care and followed up for 36 months. Objectives Evaluation of the long-term effects of a risk-adjusted multimodal intervention in high-risk subjects. Primary endpoint: reduction of ESC-SCORE in INT versus usual care. Secondary endpoints: composite of fatal and non-fatal <span class="hlt">cardiovascular</span> events and time to first <span class="hlt">cardiovascular</span> event. intention-to-treat and per-protocol analysis. Results Four hundred and forty-seven subjects were randomized to INT ( n = 224) or to usual care ( n = 223). After 36 months ESC-SCORE development favouring INT was observed (INT: 8.70% to 10.03% vs. usual care: 8.49% to 12.09%; p = 0.005; net difference: 18.50%). Moreover, a significant reduction in the composite <span class="hlt">cardiovascular</span> events was observed: (INT: n = 11 vs. usual care: n = 27). Hazard ratio of intervention versus control was 0.51 (95% confidence interval 0.25-1.03; p = 0.062) in the intention-to-treat analysis and 0.41 (95% confidence interval 0.18-0.90; p = 0.026) in the per-protocol analysis, respectively. No intervention-related adverse events or side-effects were observed. Conclusions Our results demonstrate the efficiency of identifying <span class="hlt">cardiovascular</span> high-risk subjects by the ESC-SCORE in order to enrol them to a risk adjusted primary prevention programme. This strategy resulted in a significant <span class="hlt">improvement</span> of ESC-SCORE, as well as a reduction in predefined <span class="hlt">cardiovascular</span> endpoints in the INT within 36 months. (ISRCTN 23536103.).</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29909161','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29909161"><span>[Host-microbiota crosstalk and <span class="hlt">cardiovascular</span> diseases].</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Amar, Jacques</p> <p>2018-06-13</p> <p>When analyzing the microbiota-host crosstalk, we have to consider three participants in this dialogue: the gut microbiota, the intestinal barrier and bacterial translocation. Experimental data demonstrate that host microbiota crosstalk plays a causal on the regulation of blood pressure, glucose metabolism and the development of atherosclerosis. Host microbiota crosstalk is associated in humans with main <span class="hlt">cardiovascular</span> risk factors notably hypertension and type 2 diabetes. Host microbiota crosstalk is associated in humans with the onset of <span class="hlt">cardiovascular</span> diseases. The Mediterranean diet has proven as proven to be an effective strategy in <span class="hlt">improving</span> <span class="hlt">cardiovascular</span> prognosis and in changing gut microbiota. Copyright © 2018. Published by Elsevier Masson SAS.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24199747','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24199747"><span>A lifestyle intervention supported by mobile health technologies to <span class="hlt">improve</span> the cardiometabolic risk profile of individuals at risk for <span class="hlt">cardiovascular</span> disease and type 2 diabetes: study rationale and protocol.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Stuckey, Melanie I; Shapiro, Sheree; Gill, Dawn P; Petrella, Robert J</p> <p>2013-11-07</p> <p>Metabolic syndrome is a cluster of <span class="hlt">cardiovascular</span> risk factors that greatly increase the risk of developing <span class="hlt">cardiovascular</span> disease and type 2 diabetes. Regular exercise <span class="hlt">improves</span> the risk profile, but most people do not successfully change their exercise habits to beneficially reduce risk. Tailored exercise prescribed by a family physician has shown promise as a means to increase fitness and reduce cardiometabolic risk, but optimal implementation <span class="hlt">practices</span> remain unknown. Mobile health technologies have proved to be a beneficial tool to achieve blood pressure and blood glucose control in patients with diabetes. These technologies may address the limited access to health interventions in rural and remote regions. However, the potential as a tool to support exercise-based prevention activities is not well understood. This study was undertaken to investigate the effects of a tailored exercise prescription alone or supported by mobile health technologies to <span class="hlt">improve</span> metabolic syndrome and related cardiometabolic risk factors in rural community-dwelling adults at risk for <span class="hlt">cardiovascular</span> disease and type 2 diabetes. Adults (n = 149) with at least two metabolic syndrome risk factors were recruited from rural communities and randomized to either: 1) an intervention group receiving an exercise prescription and devices for monitoring of risk factors with a smartphone data portal equipped with a mobile health application; or 2) an active control group receiving only an exercise prescription. All participants reported to the research centre at baseline, and at 12-, 24- and 52-week follow-up visits for measurement of anthropometrics and blood pressure and for a blood draw to test blood-borne markers of cardiometabolic health. Vascular and autonomic function were examined. Fitness was assessed and exercise prescribed according to the Step Test and Exercise Prescription protocol. This study tested the effects of a prescriptive exercise intervention alone, versus one supported</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27450696','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27450696"><span>THERAPY OF ENDOCRINE DISEASE: <span class="hlt">Improvement</span> of <span class="hlt">cardiovascular</span> risk factors after adrenalectomy in patients with adrenal tumors and subclinical Cushing's syndrome: a systematic review and meta-analysis.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Bancos, Irina; Alahdab, Fares; Crowley, Rachel K; Chortis, Vasileios; Delivanis, Danae A; Erickson, Dana; Natt, Neena; Terzolo, Massimo; Arlt, Wiebke; Young, William F; Murad, M Hassan</p> <p>2016-12-01</p> <p>Beneficial effects of adrenalectomy on <span class="hlt">cardiovascular</span> risk factors in patients with subclinical Cushing's syndrome (SCS) are uncertain. We sought to conduct a systematic review and meta-analysis with the following objectives: (i) determine the effect of adrenalectomy compared with conservative management on <span class="hlt">cardiovascular</span> risk factors in patients with SCS and (ii) compare the effect of adrenalectomy on <span class="hlt">cardiovascular</span> risk factors in patients with SCS vs those with a nonfunctioning (NF) adrenal tumor. MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE and Cochrane Central Register of Controlled Trial were searched on 17 November 2015. Reviewers extracted data and assessed methodological quality in duplicate. We included 26 studies reporting on 584 patients with SCS and 457 patients with NF adrenal tumors. Studies used different definitions of SCS. Patients with SCS undergoing adrenalectomy demonstrated an overall <span class="hlt">improvement</span> in <span class="hlt">cardiovascular</span> risk factors (61% for hypertension, 52% for diabetes mellitus, 45% for obesity and 24% for dyslipidemia). When compared with conservative management, patients with SCS undergoing adrenalectomy experienced <span class="hlt">improvement</span> in hypertension (RR 11, 95% CI: 4.3-27.8) and diabetes mellitus (RR 3.9, 95% CI: 1.5-9.9), but not dyslipidemia (RR 2.6, 95% CI: 0.97-7.2) or obesity (RR 3.4, 95% CI: 0.95-12). Patients with NF adrenal tumors experienced <span class="hlt">improvement</span> in hypertension (21/54 patients); however, insufficient data exist for comparison to patients with SCS. Available low-to-moderate-quality evidence from heterogeneous studies suggests a beneficial effect of adrenalectomy on <span class="hlt">cardiovascular</span> risk factors in patients with SCS overall and compared with conservative management. © 2016 European Society of Endocrinology.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/10159233','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/10159233"><span>Using scientific evidence to <span class="hlt">improve</span> information <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Bradley, J; Marshall, J G</p> <p>1995-09-01</p> <p>The recent policy statement of the Medical Library Association (MLA) takes the position that scientific evidence is the basis for <span class="hlt">improving</span> the quality of library and information sciences now and in the future. Research activity is seen as the foundation of an evolving knowledge base for the profession--a knowledge base that will set health sciences librarians apart from others in an increasingly competitive world of information service providers. The statement represents the culmination of many years of activity by association members, during which the role of research in health information <span class="hlt">practice</span> has been debated. Over a similar time period, the quality movement, with its increasing demand for the collection and use of data, has been growing. Developments such as total quality management (TQM) and continuous quality <span class="hlt">improvement</span> (CQI) reinforce the centrality of research with its increasing demand for the collection and use of data, has been growing. Developments such as total quality management (TQM) and continuous quality <span class="hlt">improvement</span> (CQI) reinforce the centrality of research and its relationship to efficient and effective information <span class="hlt">practice</span> as envisioned in the MLA policy statement.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5316356','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5316356"><span><span class="hlt">Cardiovascular</span> Impact in Patients Undergoing Maintenance Hemodialysis: Clinical Management Considerations</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Chirakarnjanakorn, Srisakul; Navaneethan, Sankar D.; Francis, Gary S.; Tang, W.H. Wilson</p> <p>2017-01-01</p> <p>Patients undergoing maintenance hemodialysis develop both structural and functional <span class="hlt">cardiovascular</span> abnormalities. Despite <span class="hlt">improvement</span> of dialysis technology, <span class="hlt">cardiovascular</span> mortality of this population remains high. The pathophysiological mechanisms of these changes are complex and not well understood. It has been postulated that several non-traditional, uremic-related risk factors, especially the long-term uremic state, which may affect the <span class="hlt">cardiovascular</span> system. There are many <span class="hlt">cardiovascular</span> changes that occur in chronic kidney disease including left ventricular hypertrophy, myocardial fibrosis, microvascular disease, accelerated atherosclerosis and arteriosclerosis. These structural and functional changes in patients receiving chronic dialysis make them more susceptible to myocardial ischemia. Hemodialysis itself may adversely affect the <span class="hlt">cardiovascular</span> system due to non-physiologic fluid removal, leading to hemodynamic instability and initiation of systemic inflammation. In the past decade there has been growing awareness that pathophysiological mechanisms cause <span class="hlt">cardiovascular</span> dysfunction in patients on chronic dialysis, and there are now pharmacological and non-pharmacological therapies that may <span class="hlt">improve</span> the poor quality of life and high mortality rate that these patients experience. PMID:28108129</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28108129','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28108129"><span><span class="hlt">Cardiovascular</span> impact in patients undergoing maintenance hemodialysis: Clinical management considerations.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Chirakarnjanakorn, Srisakul; Navaneethan, Sankar D; Francis, Gary S; Tang, W H Wilson</p> <p>2017-04-01</p> <p>Patients undergoing maintenance hemodialysis develop both structural and functional <span class="hlt">cardiovascular</span> abnormalities. Despite <span class="hlt">improvement</span> of dialysis technology, <span class="hlt">cardiovascular</span> mortality of this population remains high. The pathophysiological mechanisms of these changes are complex and not well understood. It has been postulated that several non-traditional, uremic-related risk factors, especially the long-term uremic state, which may affect the <span class="hlt">cardiovascular</span> system. There are many <span class="hlt">cardiovascular</span> changes that occur in chronic kidney disease including left ventricular hypertrophy, myocardial fibrosis, microvascular disease, accelerated atherosclerosis and arteriosclerosis. These structural and functional changes in patients receiving chronic dialysis make them more susceptible to myocardial ischemia. Hemodialysis itself may adversely affect the <span class="hlt">cardiovascular</span> system due to non-physiologic fluid removal, leading to hemodynamic instability and initiation of systemic inflammation. In the past decade there has been growing awareness that pathophysiological mechanisms cause <span class="hlt">cardiovascular</span> dysfunction in patients on chronic dialysis, and there are now pharmacological and non-pharmacological therapies that may <span class="hlt">improve</span> the poor quality of life and high mortality rate that these patients experience. Copyright © 2017 Elsevier B.V. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27469997','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27469997"><span>Reach of Individuals at Risk for <span class="hlt">Cardiovascular</span> Disease by Proactive Recruitment Strategies in General <span class="hlt">Practices</span>, Job Centers, and Health Insurance.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Guertler, Diana; Meyer, Christian; Dörr, Marcus; Braatz, Janina; Weymar, Franziska; John, Ulrich; Freyer-Adam, Jennis; Ulbricht, Sabina</p> <p>2017-02-01</p> <p>Reach of individuals at risk for <span class="hlt">cardiovascular</span> disease (CVD) constitutes a major determinant of the population impact of preventive effort. This study compares three proactive recruitment strategies regarding their reach of individuals with CVD risk factors. Individuals aged 40-65 years were invited to a two-stage cardio-preventive program including an on-site health screening and a <span class="hlt">cardiovascular</span> examination program (CEP) using face-to-face recruitment in general <span class="hlt">practices</span> (n = 671), job centers (n = 1049), and mail invitations from health insurance (n = 894). The recruitment strategies were compared regarding the following: (1) participation rate; (2) participants' characteristics, i.e., socio-demographics, self-reported health, and CVD risk factors (smoking, physical activity, fruit/vegetable consumption, body mass index, blood pressure, high-density lipoprotein, triglycerides, and glycated hemoglobin); and (3) participation factors, i.e., differences between participants and non-participants. Screening participation rates were 56.0, 32.8, and 23.5 % for the general <span class="hlt">practices</span>, the job centers, and the health insurance, respectively. Among eligible individuals for the CEP, respectively, 80.3, 65.5, and 96.1 % participated in the CEP. Job center clients showed the lowest socio-economic status and the most adverse CVD risk pattern. Being female predicted screening participation across all strategies (OR = 1.45, 95 % CI 1.07-1.98; OR = 1.34, 95 % CI 1.04-1.74; OR = 1.62, 95 % CI 1.16-2.27). Age predicted screening participation only within health insurance (OR = 1.04, 95 % CI 1.01-1.06). Within the general <span class="hlt">practices</span> and the job centers, CEP participants were less likely to be smokers than non-participants (OR = 0.49, 95 % CI 0.26-0.94; OR = 0.42, 95 % CI 0.20-0.89). The recruitment in general <span class="hlt">practices</span> yielded the highest reach. However, job centers may be useful to reduce health inequalities induced by social gradient.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29726808','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29726808"><span>Perioperative hair removal: A review of best <span class="hlt">practice</span> and a <span class="hlt">practice</span> <span class="hlt">improvement</span> opportunity.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Spencer, Maureen; Barnden, Marsha; Johnson, Helen Boehm; Fauerbach, Loretta Litz; Graham, Denise; Edmiston, Charles E</p> <p>2018-06-01</p> <p>The current <span class="hlt">practice</span> of perioperative hair removal reflects research-driven changes designed to minimize the risk of surgical wound infection. An aspect of the <span class="hlt">practice</span> which has received less scrutiny is the clean-up of the clipped hair. This process is critical. The loose fibers represent a potential infection risk because of the micro-organisms they can carry, but their clean-up can pose a logistical problem because of the time required to remove them. Research has demonstrated that the most commonly employed means of clean-up, the use of adhesive tape or sticky mitts, can be both ineffective and time-consuming in addition to posing an infection risk from cross-contamination. Recently published research evaluating surgical clippers fitted with a vacuum-assisted hair collection device highlights the potential for significant <span class="hlt">practice</span> <span class="hlt">improvement</span> in the perioperative hair removal clean-up process. These <span class="hlt">improvements</span> include not only further mitigation of potential infection risk but also substantial OR time and cost savings.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24358808','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24358808"><span><span class="hlt">Improving</span> educational environment in medical colleges through transactional analysis <span class="hlt">practice</span> of teachers.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Rajan, Marina; Chacko, Thomas</p> <p>2012-01-01</p> <p> A FAIMER (Foundation for Advancement in International Medical Education and Research) fellow organized a comprehensive faculty development program to <span class="hlt">improve</span> faculty awareness resulting in changed teaching <span class="hlt">practices</span> and better teacher student relationships using Transactional Analysis (TA). <span class="hlt">Practicing</span> TA tools help development of 'awareness' about intrapersonal and interpersonal processes. To <span class="hlt">improve</span> self-awareness among medical educators.To bring about self-directed change in <span class="hlt">practices</span> among medical educators.To assess usefulness of TA tools for the same.  An experienced trainer conducted a basic course (12 hours) in TA for faculty members. The PAC model of personality structure, functional fluency model of personal functioning, stroke theory on motivation, passivity and script theories of adult functional styles were taught experientially with examples from the Medical Education Scenario. Self-reported <span class="hlt">improvement</span> in awareness and changes in <span class="hlt">practices</span> were assessed immediately after, at three months, and one year after training.  The mean <span class="hlt">improvement</span> in self-'awareness' is 13.3% (95% C.I 9.3-17.2) among nineteen participants. This persists one year after training. Changes in <span class="hlt">practices</span> within a year include, collecting feedback, new teaching styles and better relationship with students.  These findings demonstrate sustainable and measurable <span class="hlt">improvement</span> in self-awareness by <span class="hlt">practice</span> of TA tools. <span class="hlt">Improvement</span> in self-'awareness' of faculty resulted in self-directed changes in teaching <span class="hlt">practices</span>. Medical faculty has judged the TA tools effective for <span class="hlt">improving</span> self-awareness leading to self-directed changes.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3751144','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3751144"><span><span class="hlt">Improving</span> educational environment in medical colleges through transactional analysis <span class="hlt">practice</span> of teachers</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Rajan, Marina</p> <p>2012-01-01</p> <p>Context: A FAIMER (Foundation for Advancement in International Medical Education and Research) fellow organized a comprehensive faculty development program to <span class="hlt">improve</span> faculty awareness resulting in changed teaching <span class="hlt">practices</span> and better teacher student relationships using Transactional Analysis (TA). <span class="hlt">Practicing</span> TA tools help development of ‘awareness’ about intrapersonal and interpersonal processes. Objectives: To <span class="hlt">improve</span> self-awareness among medical educators.To bring about self-directed change in <span class="hlt">practices</span> among medical educators.To assess usefulness of TA tools for the same. Methods: An experienced trainer conducted a basic course (12 hours) in TA for faculty members. The PAC model of personality structure, functional fluency model of personal functioning, stroke theory on motivation, passivity and script theories of adult functional styles were taught experientially with examples from the Medical Education Scenario. Self-reported <span class="hlt">improvement</span> in awareness and changes in <span class="hlt">practices</span> were assessed immediately after, at three months, and one year after training. Findings: The mean <span class="hlt">improvement</span> in self-'awareness' is 13.3% (95% C.I 9.3-17.2) among nineteen participants. This persists one year after training. Changes in <span class="hlt">practices</span> within a year include, collecting feedback, new teaching styles and better relationship with students. Discussion and Conclusions: These findings demonstrate sustainable and measurable <span class="hlt">improvement</span> in self-awareness by <span class="hlt">practice</span> of TA tools. <span class="hlt">Improvement</span> in self-'awareness' of faculty resulted in self-directed changes in teaching <span class="hlt">practices</span>. Medical faculty has judged the TA tools effective for <span class="hlt">improving</span> self-awareness leading to self-directed changes. PMID:24358808</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23596158','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23596158"><span>Higher protein diets consumed ad libitum <span class="hlt">improve</span> <span class="hlt">cardiovascular</span> risk markers in children of overweight parents from eight European countries.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Damsgaard, Camilla T; Papadaki, Angeliki; Jensen, Signe M; Ritz, Christian; Dalskov, Stine-Mathilde; Hlavaty, Petr; Saris, Wim H M; Martinez, J Alfredo; Handjieva-Darlenska, Teodora; Andersen, Malene R; Stender, Steen; Larsen, Thomas M; Astrup, Arne; Mølgaard, Christian; Michaelsen, Kim F</p> <p>2013-06-01</p> <p>Dietary strategies to <span class="hlt">improve</span> early <span class="hlt">cardiovascular</span> markers in overweight children are needed. We investigated the effect of dietary protein and glycemic index (GI) on <span class="hlt">cardiovascular</span> markers and metabolic syndrome (MetS) scores in 5- to 18-y-old children of overweight/obese parents from 8 European centers. Families were randomized to 1 of 5 diets consumed ad libitum: high protein (HP) or low protein (LP) combined with high GI (HGI) or low GI (LGI), or a control diet. At 6 centers, families received dietary instruction (instruction centers); at 2 centers, free foods were also provided (supermarket centers). Diet, anthropometry, blood pressure, and serum <span class="hlt">cardiovascular</span> markers (lipid profile, glucose regulation, and inflammation) were measured in 253 children at baseline, 1 mo, and/or 6 mo. Protein intake was higher in the HP groups (19.9 ± 1.3% energy) than in the LP groups at 6 mo (16.8 ± 1.2% energy) (P = 0.001). The GI was 4.0 points lower (95% CI: 2.1, 6.1) in the LGI compared with the HGI groups (P < 0.001). In the supermarket centers, the HP and LP groups differed more in protein intake than did the groups in the instruction centers (P = 0.009), indicating better compliance. The HP diets evoked a 2.7-cm (95% CI: 0.9, 5.1) smaller waist circumference and a 0.25-mmol/L (95% CI: 0.09, 0.41) lower serum LDL cholesterol compared with the LP diets at 6 mo (P < 0.007). In a separate supermarket center analysis, the HP compared with LP diets reduced waist circumference (P = 0.004), blood pressure (P < 0.01), serum insulin (P = 0.013), and homeostasis model of assessment-insulin resistance (P = 0.016). In the instruction centers, the HP compared with the LP diets reduced LDL cholesterol (P = 0.004). No consistent effect of GI was seen and the MetS scores were not affected. In conclusion, increased protein intake <span class="hlt">improved</span> <span class="hlt">cardiovascular</span> markers in high-risk children, particularly in those undergoing most intensive intervention.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4331396','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4331396"><span>Mechanisms Linking Red Blood Cell Disorders and <span class="hlt">Cardiovascular</span> Diseases</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2015-01-01</p> <p>The present paper aims to review the main pathophysiological links between red blood cell disorders and <span class="hlt">cardiovascular</span> diseases, provides a brief description of the latest studies in this area, and considers implications for clinical <span class="hlt">practice</span> and therapy. Anemia is associated with a special risk in proatherosclerotic conditions and heart disease and became a new therapeutic target. Guidelines must be updated for the management of patients with red blood cell disorders and <span class="hlt">cardiovascular</span> diseases, and targets for hemoglobin level should be established. Risk scores in several <span class="hlt">cardiovascular</span> diseases should include red blood cell count and RDW. Complete blood count and hemorheological parameters represent useful, inexpensive, widely available tools for the management and prognosis of patients with coronary heart disease, heart failure, hypertension, arrhythmias, and stroke. Hypoxia and iron accumulation cause the most important <span class="hlt">cardiovascular</span> effects of sickle cell disease and thalassemia. Patients with congenital chronic hemolytic anemia undergoing splenectomy should be monitored, considering thromboembolic and <span class="hlt">cardiovascular</span> risk. PMID:25710019</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_15");'>15</a></li> <li><a href="#" onclick='return showDiv("page_16");'>16</a></li> <li class="active"><span>17</span></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_17 --> <div id="page_18" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_16");'>16</a></li> <li><a href="#" onclick='return showDiv("page_17");'>17</a></li> <li class="active"><span>18</span></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="341"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/1521852','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/1521852"><span>The application of motivational theory to <span class="hlt">cardiovascular</span> risk reduction.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Fleury, J</p> <p>1992-01-01</p> <p>The level of motivation sustained by an individual has been identified as a primary predictor of success in sustained <span class="hlt">cardiovascular</span> risk factor modification efforts. This article reviews the primary motivational theories that have been used to explain and predict <span class="hlt">cardiovascular</span> risk reduction. Specifically, the application of the Health Belief Model, Health Promotion Model, Theory of Reasoned Action, Theory of Planned Behavior and Self-efficacy Theory to the initiation and maintenance of <span class="hlt">cardiovascular</span> health behavior is addressed. The implication of these theories for the development of nursing interventions as well as new directions for nursing research and <span class="hlt">practice</span> in the study of individual motivation in health behavior change are discussed.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28757291','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28757291"><span>Protein aggregation, <span class="hlt">cardiovascular</span> diseases, and exercise training: Where do we stand?</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Gouveia, Marisol; Xia, Ke; Colón, Wilfredo; Vieira, Sandra I; Ribeiro, Fernando</p> <p>2017-11-01</p> <p>Cells ensure their protein quality control through the proteostasis network. Aging and age-related diseases, such as neurodegenerative and <span class="hlt">cardiovascular</span> diseases, have been associated to the reduction of proteostasis network efficiency and, consequently, to the accumulation of protein misfolded aggregates. The decline in protein homeostasis has been associated with the development and progression of atherosclerotic <span class="hlt">cardiovascular</span> disease, cardiac hypertrophy, cardiomyopathies, and heart failure. Exercise training is a key component of the management of patients with <span class="hlt">cardiovascular</span> disease, consistently <span class="hlt">improving</span> quality of life and prognosis. In this review, we give an overview on age-related protein aggregation, the role of the increase of misfolded protein aggregates on <span class="hlt">cardiovascular</span> pathophysiology, and describe the beneficial or deleterious effects of the proteostasis network on the development of <span class="hlt">cardiovascular</span> disease. We subsequently discuss how exercise training, a key lifestyle intervention in those with <span class="hlt">cardiovascular</span> disease, could restore proteostasis and <span class="hlt">improve</span> disease status. Copyright © 2017 Elsevier B.V. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/12440181','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/12440181"><span>The Blue Cross Blue Shield of Michigan <span class="hlt">Cardiovascular</span> Consortium (BMC2) collaborative quality <span class="hlt">improvement</span> initiative in percutaneous coronary interventions.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Moscucci, Mauro; Share, David; Kline-Rogers, Eva; O'Donnell, Michael; Maxwell-Eward, Ann; Meengs, William L; Clark, Vivian L; Kraft, Phillip; De Franco, Anthony C; Chambers, James L; Patel, Kirit; McGinnity, John G; Eagle, Kim A</p> <p>2002-10-01</p> <p>The past decade has been characterized by increased scrutiny of outcomes of surgical and percutaneous coronary interventions (PCIs). This increased scrutiny has led to the development of regional, state, and national databases for outcome assessment and for public reporting. This report describes the initial development of a regional, collaborative, <span class="hlt">cardiovascular</span> consortium and the progress made so far by this collaborative group. In 1997, a group of hospitals in the state Michigan agreed to create a regional collaborative consortium for the development of a quality <span class="hlt">improvement</span> program in interventional cardiology. The project included the creation of a comprehensive database of PCIs to be used for risk assessment, feedback on absolute and risk-adjusted outcomes, and sharing of information. To date, information from nearly 20,000 PCIs have been collected. A risk prediction tool for death in the hospital and additional risk prediction tools for other outcomes have been developed from the data collected, and are currently used by the participating centers for risk assessment and for quality <span class="hlt">improvement</span>. As the project enters into year 5, the participating centers are deeply engaged in the quality <span class="hlt">improvement</span> phase, and expansion to a total of 17 hospitals with active PCI programs is in process. In conclusion, the Blue Cross Blue Shield of Michigan <span class="hlt">Cardiovascular</span> Consortium is an example of a regional collaborative effort to assess and <span class="hlt">improve</span> quality of care and outcomes that overcome the barriers of traditional market and academic competition.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4006665','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4006665"><span>Guideline harmonization and implementation plan for the BETTER trial: Building on Existing Tools to <span class="hlt">Improve</span> Chronic Disease Prevention and Screening in Family <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Rogers, Jess; Manca, Donna; Lang-Robertson, Kelly; Bell, Stephanie; Salvalaggio, Ginetta; Greiver, Michelle; Korownyk, Christina; Klein, Doug; Carroll, June C.; Kahan, Mel; Meuser, Jamie; Buchman, Sandy; Barrett, Rebekah M.; Grunfeld, Eva</p> <p>2014-01-01</p> <p>Background The aim of the Building on Existing Tools to <span class="hlt">Improve</span> Chronic Disease Prevention and Screening in Family <span class="hlt">Practice</span> (BETTER) randomized controlled trial is to <span class="hlt">improve</span> the primary prevention of and screening for multiple conditions (diabetes, <span class="hlt">cardiovascular</span> disease, cancer) and some of the associated lifestyle factors (tobacco use, alcohol overuse, poor nutrition, physical inactivity). In this article, we describe how we harmonized the evidence-based clinical <span class="hlt">practice</span> guideline recommendations and patient tools to determine the content for the BETTER trial. Methods We identified clinical <span class="hlt">practice</span> guidelines and tools through a structured literature search; we included both indexed and grey literature. From these guidelines, recommendations were extracted and integrated into knowledge products and outcome measures for use in the BETTER trial. End-users (family physicians, nurse practitioners, nurses and dieticians) were engaged in reviewing the recommendations and tools, as well as tailoring the content to the needs of the BETTER trial and family <span class="hlt">practice</span>. Results In total, 3–5 high-quality guidelines were identified for each condition; from these, we identified high-grade recommendations for the prevention of and screening for chronic disease. The guideline recommendations were limited by conflicting recommendations, vague wording and different taxonomies for strength of recommendation. There was a lack of quality evidence for manoeuvres to <span class="hlt">improve</span> the uptake of guidelines among patients with depression. We developed the BETTER clinical algorithms for the implementation plan. Although it was difficult to identify high-quality tools, 180 tools of interest were identified. Interpretation The intervention for the BETTER trial was built by integrating existing guidelines and tools, and working with end-users throughout the process to increase the intervention’s utility for <span class="hlt">practice</span>. Trial registration: ISRCTN07170460 PMID:25077119</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/22570431','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/22570431"><span>Assessing the potential adverse consequences of supplemental calcium on <span class="hlt">cardiovascular</span> outcomes: should we change our approach to bone health?</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Rojas-Fernandez, Carlos H; Maclaughlin, Eric J; Dore, Naomi L; Ebsary, Sally</p> <p>2012-05-01</p> <p>To assess <span class="hlt">cardiovascular</span> risks associated with supplemental calcium use to assist clinicians with evidence-based recommendations for patients who have, or who are at risk for, osteoporosis or osteopenia. Literature was accessed through December 2011 using MEDLINE, Cochrane Library, and International Pharmaceutical Abstracts using the terms calcium compounds and <span class="hlt">cardiovascular</span> disease. In addition, reference citations from the publications identified were reviewed. All English-language articles were evaluated. Randomized controlled trials, observational studies, and meta-analyses were included. While supplemental calcium and vitamin D have been demonstrated to <span class="hlt">improve</span> bone mineral density and decrease the risk of fractures, there have been recent reports that calcium supplements may increase the risk for <span class="hlt">cardiovascular</span> events. Nine clinical trials and/or meta-analyses were reviewed; 3 documented increases in <span class="hlt">cardiovascular</span> risk associated with calcium supplements, and 6 did not. No studies were designed to assess <span class="hlt">cardiovascular</span> outcomes as primary end points. Balancing the evidence from these analyses with the results of randomized controlled trials assessing the effect of calcium on fracture prevention suggests that the benefits of calcium outweigh the <span class="hlt">cardiovascular</span> risk. At this time, there is no cause to change routine <span class="hlt">practice</span> surrounding supplemental calcium use in patients who have, or are at risk for, osteoporosis or osteopenia.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23332146','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23332146"><span>Acute pneumonia and the <span class="hlt">cardiovascular</span> system.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Corrales-Medina, Vicente F; Musher, Daniel M; Shachkina, Svetlana; Chirinos, Julio A</p> <p>2013-02-09</p> <p>Although traditionally regarded as a disease confined to the lungs, acute pneumonia has important effects on the <span class="hlt">cardiovascular</span> system at all severities of infection. Pneumonia tends to affect individuals who are also at high <span class="hlt">cardiovascular</span> risk. Results of recent studies show that about a quarter of adults admitted to hospital with pneumonia develop a major acute cardiac complication during their hospital stay, which is associated with a 60% increase in short-term mortality. These findings suggest that outcomes of patients with pneumonia can be <span class="hlt">improved</span> by prevention of the development and progression of associated cardiac complications. Before this hypothesis can be tested, however, an adequate mechanistic understanding of the <span class="hlt">cardiovascular</span> changes that occur during pneumonia, and their role in the trigger of various cardiac complications, is needed. In this Review, we summarise knowledge about the burden of cardiac complications in adults with acute pneumonia, the <span class="hlt">cardiovascular</span> response to this infection, the potential effects of commonly used <span class="hlt">cardiovascular</span> and anti-infective drugs on these associations, and possible directions for future research. Copyright © 2013 Elsevier Ltd. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23143695','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23143695"><span>The <span class="hlt">cardiovascular</span> system in growth hormone excess and growth hormone deficiency.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lombardi, G; Di Somma, C; Grasso, L F S; Savanelli, M C; Colao, A; Pivonello, R</p> <p>2012-12-01</p> <p>The clinical conditions associated with GH excess and GH deficiency (GHD) are known to be associated with an increased risk for the <span class="hlt">cardiovascular</span> morbidity and mortality, suggesting that either an excess or a deficiency in GH and/or IGF-I is deleterious for <span class="hlt">cardiovascular</span> system. In patients with acromegaly, chronic GH and IGF-I excess commonly causes a specific cardiomyopathy characterized by a concentric cardiac hypertrophy associated with diastolic dysfunction and, in later stages, with systolic dysfunction ending in heart failure if GH/IGF-I excess is not controlled. Abnormalities of cardiac rhythm and anomalies of cardiac valves can also occur. Moreover, the increased prevalence of <span class="hlt">cardiovascular</span> risk factors, such as hypertension, diabetes mellitus, and insulin resistance, as well as dyslipidemia, confer an increased risk for vascular atherosclerosis. Successful control of the disease is accompanied by a decrease of the cardiac mass and <span class="hlt">improvement</span> of cardiac function and an <span class="hlt">improvement</span> in <span class="hlt">cardiovascular</span> risk factors. In patients with hypopituitarism, GHD has been considered the under- lying factor of the increased mortality when appropriate standard replacement of the pituitary hormones deficiencies is given. Either childhood-onset or adulthood-onset GHD are characterized by a cluster of abnormalities associated with an increased <span class="hlt">cardiovascular</span> risk, including altered body composition, unfavorable lipid profile, insulin resistance, endothelial dysfunction and vascular atherosclerosis, a decrease in cardiac mass together with an impairment of systolic function mainly after exercise. Treatment with recombinant GH in patients with GHD is followed by an <span class="hlt">improvement</span> of the <span class="hlt">cardiovascular</span> risk factors and an increase in cardiac mass together with an <span class="hlt">improvement</span> in cardiac performance. In conclusion, acromegaly and GHD are associated with an increased risk for <span class="hlt">cardiovascular</span> morbidity and mortality, but the control of GH/IGF-I secretion reverses <span class="hlt">cardiovascular</span></p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23428613','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23428613"><span>Fifteen years of GH replacement <span class="hlt">improves</span> body composition and <span class="hlt">cardiovascular</span> risk factors.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Elbornsson, Mariam; Götherström, Galina; Bosæus, Ingvar; Bengtsson, Bengt-Åke; Johannsson, Gudmundur; Svensson, Johan</p> <p>2013-05-01</p> <p>Few studies have determined the effects of more than 5-10 years of GH replacement in adults on body composition and <span class="hlt">cardiovascular</span> risk factors. In this prospective, single-center, open-label study, the effects of 15 years of GH replacement on body composition and <span class="hlt">cardiovascular</span> risk factors were determined in 156 hypopituitary adults (93 men) with adult-onset GH deficiency (GHD). Mean age was 50.5 (range 22-74) years at study start. Body composition was measured using dual-energy X-ray absorptiometry. The mean initial GH dose of 0.55 (S.E.M. 0.03) mg/day was gradually lowered to 0.40 (0.01) mg/day after 15 years. The mean serum IGF1 SDS increased from -1.53 (0.10) at baseline to 0.74 (0.13) at study end (P<0.001 vs baseline). Lean soft tissue (LST) increased to 3% above the baseline level at study end (P<0.001). After a 9% decrease during the first year of treatment (P<0.001 vs baseline), body fat (BF) started to increase and had returned to the baseline level after 15 years. Serum levels of total cholesterol and LDL-cholesterol decreased and serum HDL-cholesterol level increased. Fasting plasma glucose increased from 4.4 (0.1) at baseline to 4.8 (0.1) mmol/l at study end (P<0.001). However, blood HbA1c decreased from 5.0 (0.1) to 4.6 (0.1) % (P<0.001). Fifteen-year GH replacement in GHD adults induced a transient decrease in BF and sustained <span class="hlt">improvements</span> of LST and serum lipid profile. Fasting plasma glucose increased whereas blood HbA1c was reduced.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=receivable+AND+management&id=EJ499667','ERIC'); return false;" href="https://eric.ed.gov/?q=receivable+AND+management&id=EJ499667"><span>Student Receivables Management: Opportunities for <span class="hlt">Improved</span> <span class="hlt">Practices</span>.</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Jacquin, Jules C.; Goyal, Anil K.</p> <p>1995-01-01</p> <p>The college or university's business office can help reduce problems with student receivables through procedural review of the tuition revenue process, application of analytical methods, and <span class="hlt">improved</span> operating <span class="hlt">practices</span>. Admissions, financial aid, and billing offices must all be involved. (MSE)</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/20860415','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/20860415"><span><span class="hlt">Cardiovascular</span> risk-benefit profile of sibutramine.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Scheen, A J</p> <p>2010-01-01</p> <p>Sibutramine is a combined norepinephrine and serotonin reuptake inhibitor used as an antiobesity agent to reduce appetite and promote weight loss in combination with diet and exercise. At a daily dose of 10-20 mg, it was initially considered to have a good safety profile, as it does not induce primary pulmonary hypertension or adverse effects on cardiac valves, in contrast to previous reports relating to some other antiobesity agents. However, it exerts disparate effects on <span class="hlt">cardiovascular</span> risk factors. On the one hand, sibutramine may have antiatherogenic activities, as it <span class="hlt">improves</span> insulin resistance, glucose metabolism, dyslipidemia, and inflammatory markers, with most of these effects resulting from weight loss rather than from an intrinsic effect of the drug. On the other hand, because of its specific mode of action, sibutramine exerts a peripheral sympathomimetic effect, which induces a moderate increase in heart rate and attenuates the reduction in BP attributable to weight loss or even slightly increases BP. It may also prolong the QT interval, an effect that could induce arrhythmias. Because of these complex effects, it is difficult to conclude what the final impact of sibutramine on <span class="hlt">cardiovascular</span> outcomes might be. Sibutramine has been shown to exert favorable effects on some surrogate <span class="hlt">cardiovascular</span> endpoints such as reduction of left ventricular hypertrophy and <span class="hlt">improvement</span> of endothelial dysfunction. A good <span class="hlt">cardiovascular</span> safety profile was demonstrated in numerous 1- to 2-year controlled trials, in both diabetic and nondiabetic well selected patients, as well as in several observational studies. However, since 2002, several <span class="hlt">cardiovascular</span> adverse events (hypertension, tachycardia, arrhythmias, and myocardial infarction) have been reported in sibutramine-treated patients. This led to a contraindication of the use of this antiobesity agent in patients with established coronary heart disease, previous stroke, heart failure, or cardiac arrhythmias. SCOUT</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5587512','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5587512"><span>Knowledge Translation for <span class="hlt">Cardiovascular</span> Disease Research and Management in Japan</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Shommu, Nusrat S</p> <p>2017-01-01</p> <p>Knowledge translation is an essential and emerging arena in healthcare research. It is the process of aiding the application of research knowledge into clinical <span class="hlt">practice</span> or policymaking. Individuals at all levels of the health care system, including patients, healthcare professionals, and policymakers, are affected by the gaps that exist between research evidence and <span class="hlt">practice</span>; the process of knowledge translation plays a role in bridging these gaps and incorporating high-quality clinical research into decision-making. <span class="hlt">Cardiovascular</span> disease (CVD) management is a crucial area of healthcare where information gaps are known to exist. Although Japan has one of the lowest risks and mortality rates from CVDs, an increasing trend of <span class="hlt">cardiovascular</span> incidence and changes in the risk factor conditions have been observed in recent years. This article provides an overview of knowledge translation and its importance in the <span class="hlt">cardiovascular</span> health of the Japanese population, and describes the key steps of a typical knowledge translation strategy. PMID:28757537</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28757537','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28757537"><span>Knowledge Translation for <span class="hlt">Cardiovascular</span> Disease Research and Management in Japan.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Shommu, Nusrat S; Turin, Tanvir C</p> <p>2017-09-01</p> <p>Knowledge translation is an essential and emerging arena in healthcare research. It is the process of aiding the application of research knowledge into clinical <span class="hlt">practice</span> or policymaking. Individuals at all levels of the health care system, including patients, healthcare professionals, and policymakers, are affected by the gaps that exist between research evidence and <span class="hlt">practice</span>; the process of knowledge translation plays a role in bridging these gaps and incorporating high-quality clinical research into decision-making. <span class="hlt">Cardiovascular</span> disease (CVD) management is a crucial area of healthcare where information gaps are known to exist. Although Japan has one of the lowest risks and mortality rates from CVDs, an increasing trend of <span class="hlt">cardiovascular</span> incidence and changes in the risk factor conditions have been observed in recent years. This article provides an overview of knowledge translation and its importance in the <span class="hlt">cardiovascular</span> health of the Japanese population, and describes the key steps of a typical knowledge translation strategy.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28435234','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28435234"><span>Strengthening care teams to <span class="hlt">improve</span> adherence in cystic fibrosis: a qualitative <span class="hlt">practice</span> assessment and quality <span class="hlt">improvement</span> initiative.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Gardner, Allison J; Gray, Alice L; Self, Staci; Wagener, Jeffrey S</p> <p>2017-01-01</p> <p>Treatment regimens for patients with cystic fibrosis (CF) are complex, time consuming, and burdensome, and adherence to CF treatment is suboptimal. CF care teams play a critical role in supporting patients' chronic self-management skills, but there is no uniform method for assessing patients' adherence to treatment or standard interventions to help patients <span class="hlt">improve</span> when necessary. Between May 2015 and March 2016, care team members from 10 CF centers in the USA participated in a <span class="hlt">practice</span> assessment and quality <span class="hlt">improvement</span> (QI) initiative. The intervention included a baseline <span class="hlt">practice</span> assessment survey, personalized continuing medical education (CME)-certified Webconferences with expert study faculty, targeted reinforcement of key <span class="hlt">practice</span> points, and follow-up online survey and telephone interviews to evaluate the benefits and limitations of the intervention. Responses to the baseline <span class="hlt">practice</span> assessment survey were received from 50 multidisciplinary care team members representing 10 CF centers. Primary barriers to adherence-related aspects of care in their clinics were motivating patients and caregivers to <span class="hlt">improve</span> adherence and obtaining accurate information about adherence from patients. At the conclusion of the initiative, participants reported <span class="hlt">improvements</span> in communication within their care team, implementation of new approaches to asking about adherence, and a renewed commitment to asking patients and caregivers about adherence at each clinic visit. Structured QI interventions that bring multidisciplinary care teams together to reflect on clinic processes and elicit objective insights from outside faculty have the potential to <span class="hlt">improve</span> <span class="hlt">practice</span> patterns related to the assessment and <span class="hlt">improvement</span> of patient adherence in CF.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3867977','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3867977"><span>Mitochondria and <span class="hlt">Cardiovascular</span> Aging</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Dai, Dao-Fu; Ungvari, Zoltan</p> <p>2013-01-01</p> <p>Old age is a major risk factor for <span class="hlt">cardiovascular</span> diseases. Several lines of evidence in experimental animal models have indicated the central role of mitochondria both in lifespan determination and <span class="hlt">cardiovascular</span> aging. In this article we review the evidence supporting the role of mitochondrial oxidative stress, mitochondrial damage and biogenesis as well as the crosstalk between mitochondria and cellular signaling in cardiac and vascular aging. Intrinsic cardiac aging in the murine model closely recapitulates age-related cardiac changes in humans (left ventricular hypertrophy, fibrosis and diastolic dysfunction), while the phenotype of vascular aging include endothelial dysfunction, reduced vascular elasticity and chronic vascular inflammation. Both cardiac and vascular aging involve neurohormonal signaling (e.g. renin-angiotensin, adrenergic, insulin-IGF1 signaling) and cell-autonomous mechanisms. The potential therapeutic strategies to <span class="hlt">improve</span> mitochondrial function in aging and <span class="hlt">cardiovascular</span> diseases are also discussed, with a focus on mitochondrial-targeted antioxidants, calorie restriction, calorie restriction mimetics and exercise training. PMID:22499901</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/11880594','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/11880594"><span>Soy, soy phytoestrogens and <span class="hlt">cardiovascular</span> disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Clarkson, Thomas B</p> <p>2002-03-01</p> <p>Dietary soy protein has been shown to have several beneficial effects on <span class="hlt">cardiovascular</span> health. The best-documented effect is on plasma lipid and lipoprotein concentrations, with reductions of approximately 10% in LDL cholesterol concentrations (somewhat greater for individuals with high pretreatment LDL cholesterol concentrations) and small increases in HDL cholesterol concentrations. Dietary soy protein <span class="hlt">improves</span> flow-mediated arterial dilation of postmenopausal women but worsens that of men. Soy isoflavone extracts <span class="hlt">improve</span> systemic arterial compliance, an indicator of atherosclerosis extent. Complete soy protein but not alcohol-washed soy protein reduces atherosclerosis of postmenopausal monkeys. No definite experimental evidence exists currently to establish that the <span class="hlt">cardiovascular</span> benefits of soy protein are accounted for by its isoflavones.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29189213','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29189213"><span>Blood pressure monitoring: theory and <span class="hlt">practice</span>. European Society of Hypertension Working Group on Blood Pressure Monitoring and <span class="hlt">Cardiovascular</span> Variability Teaching Course Proceedings.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Stergiou, George S; Palatini, Paolo; Asmar, Roland; Bilo, Grzegorz; de la Sierra, Alejandro; Head, Geoff; Kario, Kazuomi; Mihailidou, Anastasia; Wang, Jiguang; Mancia, Giuseppe; O'Brien, Eoin; Parati, Gianfranco</p> <p>2018-02-01</p> <p>The European Society of Hypertension (ESH) Working Group on Blood Pressure (BP) Monitoring and <span class="hlt">Cardiovascular</span> Variability organized a Teaching Course on 'Blood Pressure Monitoring: Theory and <span class="hlt">Practice</span>' during the 2017 ESH Meeting in Milan, Italy. This course performed by 11 international BP monitoring experts covered key topics of BP monitoring, including office BP measurement, ambulatory BP monitoring, home BP monitoring, ambulatory versus home BP, white-coat and masked hypertension, cuff use, and BP variability. This article presents a summary of the proceedings of the ESH BP Monitoring Teaching Course, including essential information, <span class="hlt">practical</span> issues, and recommendations on the clinical application of BP monitoring methods, aiming to the optimal management of patients with suspected or diagnosed hypertension.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2737093','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2737093"><span>PPARs and the <span class="hlt">Cardiovascular</span> System</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Hamblin, Milton; Chang, Lin; Fan, Yanbo; Zhang, Jifeng</p> <p>2009-01-01</p> <p>Abstract Peroxisome proliferator-activated receptors (PPARs) belong to the nuclear hormone-receptor superfamily. Originally cloned in 1990, PPARs were found to be mediators of pharmacologic agents that induce hepatocyte peroxisome proliferation. PPARs also are expressed in cells of the <span class="hlt">cardiovascular</span> system. PPARγ appears to be highly expressed during atherosclerotic lesion formation, suggesting that increased PPARγ expression may be a vascular compensatory response. Also, ligand-activated PPARγ decreases the inflammatory response in <span class="hlt">cardiovascular</span> cells, particularly in endothelial cells. PPARα, similar to PPARγ, also has pleiotropic effects in the <span class="hlt">cardiovascular</span> system, including antiinflammatory and antiatherosclerotic properties. PPARα activation inhibits vascular smooth muscle proinflammatory responses, attenuating the development of atherosclerosis. However, PPARδ overexpression may lead to elevated macrophage inflammation and atherosclerosis. Conversely, PPARδ ligands are shown to attenuate the pathogenesis of atherosclerosis by <span class="hlt">improving</span> endothelial cell proliferation and survival while decreasing endothelial cell inflammation and vascular smooth muscle cell proliferation. Furthermore, the administration of PPAR ligands in the form of TZDs and fibrates has been disappointing in terms of markedly reducing <span class="hlt">cardiovascular</span> events in the clinical setting. Therefore, a better understanding of PPAR-dependent and -independent signaling will provide the foundation for future research on the role of PPARs in human <span class="hlt">cardiovascular</span> biology. Antioxid. Redox Signal. 11, 1415–1452. PMID:19061437</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26159941','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26159941"><span>Prevention and management of work-related <span class="hlt">cardiovascular</span> disorders.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Tsutsumi, Akizumi</p> <p>2015-01-01</p> <p><span class="hlt">Cardiovascular</span> disorders (CVDs) constitute a major burden for health of working populations throughout the world with as much as 50% of all causes of death and at least 25% of work disability. There are some changes in CVD risk factors among occupational classes. This is mainly due to the new types of work-related causes of morbidity associated with the recent developments in global work life, particularly in the industrialized countries. Meanwhile, in the developing countries or those in transition (e.g., in Eastern Europe), CVD mortality is increasing due to major socioeconomic changes, the demographic transition and rapid industrialisation and urbanisation, all leading to growing challenges to <span class="hlt">cardiovascular</span> health. Better control of known risk factors (i.e., smoking, obesity, physical inactivity, high cholesterol, high blood pressure, and high blood glucose) is effective to prevent CVD incidence. But the expected <span class="hlt">improvement</span> has not been achieved. The obstacles of achieving such impact are due to lack of awareness, lack of policies and their implementation into <span class="hlt">practice</span> and shortage of infrastructures and human resources. These are needed for wide-scale and long-term programme implementation. Considering the WHO Global Strategy on Occupational Health for All, the WHO Global Action Plan on Workers' Health, the WHO Programme on Prevention of Non-communicable Diseases and the ILO Decent Work agenda, the 6th ICOH International Conference on Work Environment and <span class="hlt">Cardiovascular</span> Diseases adopted the Tokyo Declaration. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29464893','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29464893"><span><span class="hlt">Improvements</span> in fitness are not obligatory for exercise training-induced <span class="hlt">improvements</span> in CV risk factors.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Hartman, Yvonne A W; Hopman, Maria T E; Schreuder, Tim H; Verheggen, Rebecca J H M; Scholten, Ralph R; Oudegeest-Sander, Madelijn H; Poelkens, Fleur; Maiorana, Andrew J; Naylor, Louise H; Willems, Peter H; Tack, Cees J; Thijssen, Dick H J; Green, Daniel J</p> <p>2018-02-01</p> <p>The purpose of this study was to assess whether changes in physical fitness relate to changes in <span class="hlt">cardiovascular</span> risk factors following standardized, center-based and supervised exercise training programs in subjects with increased <span class="hlt">cardiovascular</span> risk. We pooled data from exercise training studies of subjects with increased <span class="hlt">cardiovascular</span> risk (n = 166) who underwent 8-52 weeks endurance training. We determined fitness (i.e., peak oxygen uptake) and traditional <span class="hlt">cardiovascular</span> risk factors (body mass index, blood pressure, total cholesterol, high-density lipoprotein cholesterol), before and after training. We divided subjects into quartiles based on <span class="hlt">improvement</span> in fitness, and examined whether these groups differed in terms of risk factors. Associations between changes in fitness and in <span class="hlt">cardiovascular</span> risk factors were further tested using Pearson correlations. Significant heterogeneity was apparent in the <span class="hlt">improvement</span> of fitness and individual risk factors, with nonresponder rates of 17% for fitness, 44% for body mass index, 33% for mean arterial pressure, 49% for total cholesterol, and 49% for high-density lipoprotein cholesterol. Neither the number, nor the magnitude, of change in <span class="hlt">cardiovascular</span> risk factors differed significantly between quartiles of fitness change. Changes in fitness were not correlated with changes in <span class="hlt">cardiovascular</span> risk factors (all P > 0.05). Our data suggest that significant heterogeneity exists in changes in peak oxygen uptake after training, while <span class="hlt">improvement</span> in fitness did not relate to <span class="hlt">improvement</span> in <span class="hlt">cardiovascular</span> risk factors. In subjects with increased <span class="hlt">cardiovascular</span> risk, <span class="hlt">improvements</span> in fitness are not obligatory for training-induced <span class="hlt">improvements</span> in <span class="hlt">cardiovascular</span> risk factors. © 2018 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=activities+AND+improve+AND+motivation+AND+teaching&pg=3&id=EJ930568','ERIC'); return false;" href="https://eric.ed.gov/?q=activities+AND+improve+AND+motivation+AND+teaching&pg=3&id=EJ930568"><span>How to <span class="hlt">Improve</span> Teaching <span class="hlt">Practices</span>: The Role of Teacher Motivation, Organizational Factors, and Leadership <span class="hlt">Practices</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Thoonen, Erik E. J.; Sleegers, Peter J. C.; Oort, Frans J.; Peetsma, Thea T. D.; Geijsel, Femke P.</p> <p>2011-01-01</p> <p>Purpose: Although it is expected that building schoolwide capacity for teacher learning will <span class="hlt">improve</span> teaching <span class="hlt">practices</span>, there is little systematic evidence to support this claim. This study aimed to examine the relative impact of transformational leadership <span class="hlt">practices</span>, school organizational conditions, teacher motivational factors, and teacher…</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_16");'>16</a></li> <li><a href="#" onclick='return showDiv("page_17");'>17</a></li> <li class="active"><span>18</span></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_18 --> <div id="page_19" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_17");'>17</a></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li class="active"><span>19</span></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="361"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3470596','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3470596"><span>Regression trees for predicting mortality in patients with <span class="hlt">cardiovascular</span> disease: What <span class="hlt">improvement</span> is achieved by using ensemble-based methods?</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Austin, Peter C; Lee, Douglas S; Steyerberg, Ewout W; Tu, Jack V</p> <p>2012-01-01</p> <p>In biomedical research, the logistic regression model is the most commonly used method for predicting the probability of a binary outcome. While many clinical researchers have expressed an enthusiasm for regression trees, this method may have limited accuracy for predicting health outcomes. We aimed to evaluate the <span class="hlt">improvement</span> that is achieved by using ensemble-based methods, including bootstrap aggregation (bagging) of regression trees, random forests, and boosted regression trees. We analyzed 30-day mortality in two large cohorts of patients hospitalized with either acute myocardial infarction (N = 16,230) or congestive heart failure (N = 15,848) in two distinct eras (1999–2001 and 2004–2005). We found that both the in-sample and out-of-sample prediction of ensemble methods offered substantial <span class="hlt">improvement</span> in predicting <span class="hlt">cardiovascular</span> mortality compared to conventional regression trees. However, conventional logistic regression models that incorporated restricted cubic smoothing splines had even better performance. We conclude that ensemble methods from the data mining and machine learning literature increase the predictive performance of regression trees, but may not lead to clear advantages over conventional logistic regression models for predicting short-term mortality in population-based samples of subjects with <span class="hlt">cardiovascular</span> disease. PMID:22777999</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26995380','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26995380"><span><span class="hlt">Cardiovascular</span> outcomes after pharmacologic stress myocardial perfusion imaging.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lee, Douglas S; Husain, Mansoor; Wang, Xuesong; Austin, Peter C; Iwanochko, Robert M</p> <p>2016-04-01</p> <p>While pharmacologic stress single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) is used for noninvasive evaluation of patients who are unable to perform treadmill exercise, its impact on net reclassification <span class="hlt">improvement</span> (NRI) of prognosis is unknown. We evaluated the prognostic value of pharmacologic stress MPI for prediction of <span class="hlt">cardiovascular</span> death or non-fatal myocardial infarction (MI) within 1 year at a single-center, university-based laboratory. We examined continuous and categorical NRI of pharmacologic SPECT-MPI for prediction of outcomes beyond clinical factors alone. Six thousand two hundred forty patients (median age 66 years [IQR 56-74], 3466 men) were studied and followed for 5963 person-years. SPECT-MPI variables associated with increased risk of <span class="hlt">cardiovascular</span> death or non-fatal MI included summed stress score, stress ST-shift, and post-stress resting left ventricular ejection fraction ≤50%. Compared to a clinical model which included age, sex, <span class="hlt">cardiovascular</span> disease, risk factors, and medications, model χ(2) (210.5 vs. 281.9, P < .001) and c-statistic (0.74 vs. 0.78, P < .001) were significantly increased by addition of SPECT-MPI predictors (summed stress score, stress ST-shift and stress resting left ventricular ejection fraction). SPECT-MPI predictors increased continuous NRI by 49.4% (P < .001), reclassifying 66.5% of patients as lower risk and 32.8% as higher risk of <span class="hlt">cardiovascular</span> death or non-fatal MI. Addition of MPI predictors to clinical factors using risk categories, defined as <1%, 1% to 3%, and >3% annualized risk of <span class="hlt">cardiovascular</span> death or non-fatal MI, yielded a 15.0% <span class="hlt">improvement</span> in NRI (95% CI 7.6%-27.6%, P < .001). Pharmacologic stress MPI substantially <span class="hlt">improved</span> net reclassification of <span class="hlt">cardiovascular</span> death or MI risk beyond that afforded by clinical factors. Copyright © 2016 Elsevier Inc. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/22688205','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/22688205"><span>Implementing <span class="hlt">practice</span> management strategies to <span class="hlt">improve</span> patient care: the EPIC project.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Attwell, David; Rogers-Warnock, Leslie; Nemis-White, Joanna</p> <p>2012-01-01</p> <p>Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their <span class="hlt">practice</span> environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of <span class="hlt">practice</span> patterns and outcomes have been shown to narrow care gaps. <span class="hlt">Practice</span> management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their <span class="hlt">practice</span>. The Enhancing <span class="hlt">Practice</span> to <span class="hlt">Improve</span> Care project was initiated to determine the impact of a patient-centred health and disease management partnership using <span class="hlt">practice</span> management strategies to <span class="hlt">improve</span> patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general <span class="hlt">practices</span> from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be <span class="hlt">improved</span> via the implementation of <span class="hlt">practice</span> management strategies in a patient-centred partnership measurement model of health and disease management.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3326380','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3326380"><span>Genetic Predictors for <span class="hlt">Cardiovascular</span> Disease in Hispanics</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Qi, Lu; Campos, Hannia</p> <p>2012-01-01</p> <p>A less favorable <span class="hlt">cardiovascular</span> risk factor profile, but paradoxically lower <span class="hlt">cardiovascular</span> morbidity and mortality have been observed in Hispanics, a pattern often referred to as the Hispanic Paradox. It was proposed the specific genetic susceptibility of this admixed population and gene-environment interactions may partly explain the paradox. The past few years have seen great advances in discovering genetic risk factors using genome-wide association studies (GWAS) for <span class="hlt">cardiovascular</span> disease especially in Caucasians. However, there is no GWAS of <span class="hlt">cardiovascular</span> disease that have been reported in Hispanics. In the Costa Rican Heart Study we reported both the consistency and disparity of genetic effects on risk of coronary heart disease (CHD) between Hispanics and other ethnic groups. We demonstrated the <span class="hlt">improvement</span> in the identified genetic markers on discrimination of CHD in Hispanics was modest. Future genetic research in Hispanics would consider the diversities in genetic structure, lifestyle and socioeconomics among various sub-populations, and comprehensively evaluate potential gene-environment interactions in relation to <span class="hlt">cardiovascular</span> risk. PMID:22498015</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26558401','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26558401"><span>Brachial-Ankle PWV: Current Status and Future Directions as a Useful Marker in the Management of <span class="hlt">Cardiovascular</span> Disease and/or <span class="hlt">Cardiovascular</span> Risk Factors.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Tomiyama, Hirofumi; Matsumoto, Chisa; Shiina, Kazuki; Yamashina, Akira</p> <p>2016-01-01</p> <p>Since 2001, brachial-ankle pulse wave velocity (brachial-ankle PWV) measurement has been applied for risk stratification of patients with atherosclerotic <span class="hlt">cardiovascular</span> disease and/or its risk factors in Japan. Measurement of the brachial-ankle PWV is simple and well standardized, and its reproducibility and accuracy are acceptable. Several cross-sectional studies have demonstrated a significant correlation between the brachial-ankle PWV and known risk factors for <span class="hlt">cardiovascular</span> disease; the correlation is stronger in subjects with <span class="hlt">cardiovascular</span> disease than in those without <span class="hlt">cardiovascular</span> disease. We conducted a meta-analysis, which demonstrated that the brachial-ankle PWV is an independent predictor of future <span class="hlt">cardiovascular</span> events. Furthermore, the treatment of <span class="hlt">cardiovascular</span> risk factors and lifestyle modifications have been shown to <span class="hlt">improve</span> the brachial-ankle PWV. Thus, at present, brachial-ankle PWV is close to being considered as a useful marker in the management of atherosclerotic <span class="hlt">cardiovascular</span> disease and/or its risk factors.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29550903','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29550903"><span>Functional Nitric Oxide Nutrition to Combat <span class="hlt">Cardiovascular</span> Disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Bryan, Nathan S</p> <p>2018-03-17</p> <p>To reveal the mechanisms of nitric oxide (NO) production in humans and how lifestyle, drug therapy, and hygienic <span class="hlt">practices</span> can decrease NO production. Furthermore, to show how functional nitric oxide nutrition can overcome these limitations to restore endogenous NO production and combat <span class="hlt">cardiovascular</span> disease. Research over the past decade has revealed that inorganic nitrate and nitrite found naturally in green leafy vegetables and other vegetables such as beets can provide the human body with a source of bioactive nitric oxide. NO is one of the most important molecules produced within the <span class="hlt">cardiovascular</span> system that maintains normal blood pressure and prevents inflammation, immune dysfunction, and oxidative stress, hallmarks of <span class="hlt">cardiovascular</span> disease. This pathway is dependent upon the amount of inorganic nitrate and nitrite in the foods we eat, the presence of oral nitrate-reducing bacteria, and sufficient stomach acid production. The concept of food being medicine and medicine being food has lost its place in the <span class="hlt">practice</span> and implementation of modern medicine over the past century. Certain dietary patterns and specific foods are known to confer very significant protective effects for many human diseases, including <span class="hlt">cardiovascular</span> disease, the number one killer of men and women in the developed world. However, identification of single or multiple bioactive molecules that are responsible for these effects has escaped scientists and nutritionists for many years. This review will highlight the biochemical, physiological, and epidemiological basis for functional nitric oxide nutrition that can be safely and effectively utilized in patients.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26552205','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26552205"><span>Heart health in Lebanon and considerations for addressing the burden of <span class="hlt">cardiovascular</span> disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Deek, Hiba; Newton, Phillip; Inglis, Sally; Kabbani, Samer; Noureddine, Samar; Macdonald, Peter S; Davidson, Patricia M</p> <p>2015-01-01</p> <p>Lebanon is a small country located at the western boundary of the Middle East. Approximately 40% of health care in Lebanon is financed by the public sector. <span class="hlt">Cardiovascular</span> diseases in Lebanon are scarcely addressed in the literature raising the need for baseline data on these health condition to be better treated. To (1) aggregate and define the burden of <span class="hlt">cardiovascular</span> disease in Lebanon and (2) describe implications for policy, <span class="hlt">practice</span> and research to <span class="hlt">improve</span> health outcomes in Lebanon. An integrative review was conducted of both peer-reviewed papers and unpublished reports. CINAHL, Medline, Google Scholar and Academic Search Complete were searched along with the websites of The World Health Organization, Ministry of Public Health Lebanon and Central Intelligence Agency of Lebanon. No year limit was applied to our search. The search yielded 28 peer-reviewed articles and 15 reports. <span class="hlt">Cardiovascular</span> diseases are the leading cause of morbidity and mortality in Lebanon and is also the primary cause of hospital admission. A range of social, political, economic and cultural factors explain the burden of <span class="hlt">cardiovascular</span> diseases, some of these risks are culture specific such as the arghile smoking and the high rates of familial hypercholesterolemia. Workforce shortage produced by high rates of migrating nurses also has an implication on the patients' outcomes. Conclusion: Much of the presented data are sourced from the gray literature; more research, using systematic and prospective data collection methods, are needed to inform health services planning, delivery and evaluation. Primary care needs to be enhanced to produce better outcomes for a population with high profile of <span class="hlt">cardiovascular</span> risk factors.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5372571','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5372571"><span>Effects and Mechanisms of Fruit and Vegetable Juices on <span class="hlt">Cardiovascular</span> Diseases</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Zheng, Jie; Zhou, Yue; Li, Sha; Zhang, Pei; Zhou, Tong; Xu, Dong-Ping; Li, Hua-Bin</p> <p>2017-01-01</p> <p>Many studies have indicated that consumption of vegetables and fruits are positively related to lower incidence of several chronic noncommunicable diseases. Although composition of fruit and vegetable juices is different from that of the edible portion of fruits and vegetables, they contain polyphenols and vitamins from fruits and vegetables. Drinking vegetable and fruit juices is very popular in many countries, and also an efficient way to <span class="hlt">improve</span> consumption of fruits and vegetables. The studies showed that fruit and vegetable juices affect <span class="hlt">cardiovascular</span> risk factors, such as lowering blood pressure and <span class="hlt">improving</span> blood lipid profiles. The main mechanisms of action included antioxidant effects, <span class="hlt">improvement</span> of the aspects of the <span class="hlt">cardiovascular</span> system, inhibition of platelet aggregation, anti-inflammatory effects, and prevention of hyperhomocysteinemia. Drinking juices might be a potential way to <span class="hlt">improve</span> <span class="hlt">cardiovascular</span> health, especially mixtures of juices because they contain a variety of polyphenols, vitamins, and minerals from different fruits and vegetables. This review summarizes recent studies on the effects of fruit and vegetable juices on indicators of <span class="hlt">cardiovascular</span> disease, and special attention is paid to the mechanisms of action. PMID:28273863</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23091501','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23091501"><span>Personalized medicine in <span class="hlt">cardiovascular</span> diseases.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lee, Moo-Sik; Flammer, Andreas J; Lerman, Lilach O; Lerman, Amir</p> <p>2012-09-01</p> <p>Personalized medicine is a novel medical model with all decisions and <span class="hlt">practices</span> being tailored to individual patients in whatever ways possible. In the era of genomics, personalized medicine combines the genetic information for additional benefit in preventive and therapeutic strategies. Personalized medicine may allow the physician to provide a better therapy for patients in terms of efficiency, safety and treatment length to reduce the associated costs. There was a remarkable growth in scientific publication on personalized medicine within the past few years in the <span class="hlt">cardiovascular</span> field. However, so far, only very few cardiologists in the USA are incorporating personalized medicine into clinical treatment. We review the concepts, strengths, limitations and challenges of personalized medicine with a particular focus on <span class="hlt">cardiovascular</span> diseases (CVDs). There are many challenges from both scientific and policy perspectives to personalized medicine, which can overcome them by comprehensive concept and understanding, clinical application, and evidence based <span class="hlt">practices</span>. Individualized medicine serves a pivotal role in the evolution of national and global healthcare reform, especially, in the CVDs fields. Ultimately, personalized medicine will affect the entire landscape of health care system in the near future.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3467440','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3467440"><span>Personalized Medicine in <span class="hlt">Cardiovascular</span> Diseases</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Lee, Moo-Sik; Flammer, Andreas J.; Lerman, Lilach O.</p> <p>2012-01-01</p> <p>Personalized medicine is a novel medical model with all decisions and <span class="hlt">practices</span> being tailored to individual patients in whatever ways possible. In the era of genomics, personalized medicine combines the genetic information for additional benefit in preventive and therapeutic strategies. Personalized medicine may allow the physician to provide a better therapy for patients in terms of efficiency, safety and treatment length to reduce the associated costs. There was a remarkable growth in scientific publication on personalized medicine within the past few years in the <span class="hlt">cardiovascular</span> field. However, so far, only very few cardiologists in the USA are incorporating personalized medicine into clinical treatment. We review the concepts, strengths, limitations and challenges of personalized medicine with a particular focus on <span class="hlt">cardiovascular</span> diseases (CVDs). There are many challenges from both scientific and policy perspectives to personalized medicine, which can overcome them by comprehensive concept and understanding, clinical application, and evidence based <span class="hlt">practices</span>. Individualized medicine serves a pivotal role in the evolution of national and global healthcare reform, especially, in the CVDs fields. Ultimately, personalized medicine will affect the entire landscape of health care system in the near future. PMID:23091501</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26478474','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26478474"><span>A call for the better utilization of physical activity and exercise training in the defense against <span class="hlt">cardiovascular</span> disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Murlasits, Zsolt</p> <p>2015-11-01</p> <p>Statins, also known as 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, effectively reduce elevated levels of serum LDL-C concentration and in turn lower <span class="hlt">cardiovascular</span> morbidity and mortality. Regular exercise and physical activity also have significant preventive effects against <span class="hlt">cardiovascular</span> diseases by simultaneously reducing multiple risk factors. However, statins also produce a number of adverse events, including muscle pain, which increases dramatically in statin users who also exercise, likely limiting the <span class="hlt">cardiovascular</span> benefits. Most importantly, reduced physical activity participation due to statin-related side effects can cancel out the benefits of the pharmacological treatment. Although exercise training offers more modest benefits compared to pharmacological therapy against traditional risk factors, considering the total impact of exercise on <span class="hlt">cardiovascular</span> health, it is now evident that this intervention may offer a greater reduction of risks compared to statin therapy alone. However, primary recommendations regarding <span class="hlt">cardiovascular</span> therapy still center around pharmacological approaches. Thus a new outlook is called for in clinical <span class="hlt">practice</span> that provides room for physical activity and exercise training, thus lipid targets can be reached by a combined intervention along with <span class="hlt">improvements</span> in other <span class="hlt">cardiovascular</span> parameters, such as endothelial function and low-grade inflammation. Databases such as Pubmed and Google Scholar as well as the reference list of the relevant articles were searched to collect information for this opinion article.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28237404','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28237404"><span>Pharmacogenetics in <span class="hlt">cardiovascular</span> diseases: State of the art and implementation-recommendations of the French National Network of Pharmacogenetics (RNPGx).</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lamoureux, Fabien; Duflot, Thomas</p> <p>2017-04-01</p> <p>The use of genomic markers to predict drug response and effectiveness has the potential to <span class="hlt">improve</span> healthcare by increasing drug efficacy and minimizing adverse effects. Polymorphisms associated with inter-individual variability in drug metabolism, transport, or pharmacodynamics of major <span class="hlt">cardiovascular</span> drugs have been identified. These include single nucleotide polymorphisms (SNP) affecting clinical outcomes in patients receiving antiplatelet agents, oral anticoagulants and statins. Based on clinical evidence supporting genetic testing in the management of <span class="hlt">cardiovascular</span> diseases using these drug classes, this short review presents clinical guidance regarding current pharmacogenetics implementation in routine medical <span class="hlt">practice</span>. Copyright © 2017 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29401016','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29401016"><span>Taking Innovation To Scale In Primary Care <span class="hlt">Practices</span>: The Functions Of Health Care Extension.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Ono, Sarah S; Crabtree, Benjamin F; Hemler, Jennifer R; Balasubramanian, Bijal A; Edwards, Samuel T; Green, Larry A; Kaufman, Arthur; Solberg, Leif I; Miller, William L; Woodson, Tanisha Tate; Sweeney, Shannon M; Cohen, Deborah J</p> <p>2018-02-01</p> <p>Health care extension is an approach to providing external support to primary care <span class="hlt">practices</span> with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for <span class="hlt">cardiovascular</span> preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension-technological and quality <span class="hlt">improvement</span> support, <span class="hlt">practice</span> capacity building, and linking with community resources-to more than two hundred primary care <span class="hlt">practices</span> in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality <span class="hlt">improvement</span> support to primary care <span class="hlt">practices</span>. With investment, health care extension may be an effective platform for federal and state quality <span class="hlt">improvement</span> efforts to create economies of scale and provide <span class="hlt">practices</span> with more robust and coordinated support services.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5805471','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5805471"><span>Taking Innovation To Scale In Primary Care <span class="hlt">Practices</span>: The Functions Of Health Care Extension</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Ono, Sarah S.; Crabtree, Benjamin F.; Hemler, Jennifer R.; Balasubramanian, Bijal A.; Edwards, Samuel T.; Green, Larry A.; Kaufman, Arthur; Solberg, Leif I.; Miller, William L.; Woodson, Tanisha Tate; Sweeney, Shannon M.; Cohen, Deborah J.</p> <p>2018-01-01</p> <p>Health care extension is an approach to providing external support to primary care <span class="hlt">practices</span> with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for <span class="hlt">cardiovascular</span> preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension—technological and quality <span class="hlt">improvement</span> support, <span class="hlt">practice</span> capacity building, and linking with community resources—to more than two hundred primary care <span class="hlt">practices</span> in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality <span class="hlt">improvement</span> support to primary care <span class="hlt">practices</span>. With investment, health care extension may be an effective platform for federal and state quality <span class="hlt">improvement</span> efforts to create economies of scale and provide <span class="hlt">practices</span> with more robust and coordinated support services. PMID:29401016</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29483085','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29483085"><span>Low-Calorie Vegetarian Versus Mediterranean Diets for Reducing Body Weight and <span class="hlt">Improving</span> <span class="hlt">Cardiovascular</span> Risk Profile: CARDIVEG Study (<span class="hlt">Cardiovascular</span> Prevention With Vegetarian Diet).</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Sofi, Francesco; Dinu, Monica; Pagliai, Giuditta; Cesari, Francesca; Gori, Anna Maria; Sereni, Alice; Becatti, Matteo; Fiorillo, Claudia; Marcucci, Rossella; Casini, Alessandro</p> <p>2018-03-13</p> <p>Only a few randomized dietary intervention studies that investigated the effects of lacto-ovo vegetarian diet (Vd) in clinically healthy omnivorous subjects are available. We randomly assigned to overweight omnivores with a low-to-moderate <span class="hlt">cardiovascular</span> risk profile a low-calorie Vd compared with a low-calorie Mediterranean diet (MD), each lasting 3 months, with a crossover design. The primary outcome was the difference in body weight, body mass index, and fat mass changes between the 2 groups. Secondary outcomes were differences in circulating <span class="hlt">cardiovascular</span> disease risk parameters changes between the 2 groups. One hundred eighteen subjects (mean age: 51.1 years, females: 78%) were enrolled. The total participation rate at the end of the study was 84.7%. No differences between the 2 diets in body weight were observed, as reported by similar and significant reductions obtained by both Vd (-1.88 kg) and MD (-1.77 kg). Similar results were observed for body mass index and fat mass. In contrast, significant differences between the 2 interventions were obtained for low-density lipoprotein cholesterol, triglycerides, and vitamin B 12 levels. The difference between the Vd and MD groups, in terms of end-of-diet values, was recorded at 9.10 mg/dL for low-density lipoprotein cholesterol ( P =0.01), 12.70 mg/dL for triglycerides ( P <0.01), and 32.32 pg/mL for vitamin B 12 ( P <0.01). Finally, no significant difference was found between Vd and MD interventions in oxidative stress markers and inflammatory cytokines, except for interleukin-17, which <span class="hlt">improved</span> only in the MD group. Forty-six participants during the Vd period and 35 during the MD period reached the target values for ≥1 <span class="hlt">cardiovascular</span> risk factor. Both Vd and MD were effective in reducing body weight, body mass index, and fat mass, with no significant differences between them. However, Vd was more effective in reducing low-density lipoprotein cholesterol levels, whereas MD led to a greater reduction in</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23652394','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23652394"><span>Ghrelin and the <span class="hlt">cardiovascular</span> system.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Isgaard, Jörgen</p> <p>2013-01-01</p> <p>Although ghrelin was initially associated with regulation of appetite, the <span class="hlt">cardiovascular</span> system has also been recognized as a potentially important target for its effects. Moreover, experimental and a limited number of clinical studies suggest a potential role for ghrelin in the treatment of congestive heart failure. So far, reported <span class="hlt">cardiovascular</span> effects of growth hormone secretagogues and/or ghrelin include lowering of peripheral resistance, either direct at the vascular level and/or by modulating sympathetic nervous activity. Other observed effects indicate possible <span class="hlt">improvement</span> of contractility and cardioprotective and anti-inflammatory effects both in vivo and in vitro. Taken together, these results offer an interesting perspective on the future where further studies aiming at evaluating a role of growth hormone secretagogues and ghrelin in the treatment of <span class="hlt">cardiovascular</span> disease are warranted. Copyright © 2013 S. Karger AG, Basel.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28421481','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28421481"><span>Cancer as a Risk Factor for <span class="hlt">Cardiovascular</span> Disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Giza, Dana Elena; Iliescu, Gloria; Hassan, Saamir; Marmagkiolis, Konstantinos; Iliescu, Cezar</p> <p>2017-06-01</p> <p><span class="hlt">Improvements</span> in early diagnosis and cancer treatments have contributed to high survival rates for many cancer patients. However, these patients often die of <span class="hlt">cardiovascular</span> disease rather than recurrence of their cancer. Heart disease manifesting after cancer may be due to several mechanisms: shared <span class="hlt">cardiovascular</span> risks between cancer and <span class="hlt">cardiovascular</span> disease, inflammatory states associated with malignancies, and/or cardiotoxic effects of cancer therapy. Cancer treatment increases the risk of <span class="hlt">cardiovascular</span> diseases directly by damaging critical structures of the heart or indirectly by promoting accelerated atherosclerosis. Estimating <span class="hlt">cardiovascular</span> risk by using advanced imaging and monitoring of the cardiac biomarkers can be used for early detection and treatment of subclinical cardiac injury. Better knowledge of these early and late cardiac effects in cancer patients will enable adoption of both primary and secondary prevention measures of long-term treatment complications in cancer survivors.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29615155','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29615155"><span>The History and State of Neonatal Nursing Quality <span class="hlt">Improvement</span> <span class="hlt">Practice</span> and Education.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Kukla, Aniko; Dowling, Donna A; Dolansky, Mary A</p> <p>2018-03-01</p> <p>Quality <span class="hlt">improvement</span> has evolved rapidly in neonatal nursing. This review outlines the history and current state of quality <span class="hlt">improvement</span> <span class="hlt">practice</span> and education in neonatal nursing. The future of neonatal nursing includes a stronger emphasis on quality <span class="hlt">improvement</span> in advanced <span class="hlt">practice</span> education that promotes doctoral projects that result in clinical <span class="hlt">improvements</span>. A collective focus will ensure that neonatal nurses not only deliver evidence-based care, but also continually <span class="hlt">improve</span> the care they deliver.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26455858','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26455858"><span>Discharge planning for acute coronary syndrome patients in a tertiary hospital: a best <span class="hlt">practice</span> implementation project.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lu, Minmin; Tang, Jun; Wu, Jianjin; Yang, Jie; Yu, Jiangyue</p> <p>2015-08-14</p> <p>Acute coronary syndromes threaten the lives of patients, and pose a high risk for morbidity and mortality despite advances in treatment. Evidence highlights that effective discharge planning is associated with long-term prognosis of patients. The aim of this project was to <span class="hlt">improve</span> local <span class="hlt">practice</span> in discharge planning for acute coronary syndrome patients in Huadong Hospital, Shanghai. Five criteria identified by the Joanna Briggs Institute were used to conduct an audit in the <span class="hlt">Cardiovascular</span> Ward and Coronary Care Unit of Huadong Hospital, Shanghai. Forty-two nurses and 65 patients were involved. The Joanna Briggs Institute <span class="hlt">Practical</span> Application of Clinical Evidence System and Getting Research into <span class="hlt">Practice</span> audit tools for promoting change in health <span class="hlt">practice</span> were used to ascertain compliance with the criteria before and after the implementation of best <span class="hlt">practice</span>. The program included three phases and was conducted over five months. The project showed that the compliance rates of in-house education, advice on lifestyle changes, education on discharge medication and left ventricular assessment reached 100%. Psychological screening also attained 97% compliance. There were <span class="hlt">improvements</span> in the compliance rates of four criteria from 38% to 100%, excluding in-house education which was already 100% compliant. The project achieved significant <span class="hlt">improvements</span> in establishing evidence-based <span class="hlt">practice</span> of discharge planning for acute coronary syndrome patients in the <span class="hlt">Cardiovascular</span> Ward and Coronary Care Unit. Strategies for sustaining best <span class="hlt">practice</span> will continue to be developed in the future. The Joanna Briggs Institute.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26234862','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26234862"><span>The Society of Thoracic Surgeons, The Society of <span class="hlt">Cardiovascular</span> Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical <span class="hlt">Practice</span> Guidelines for Cardiopulmonary Bypass--Temperature Management During Cardiopulmonary Bypass.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Engelman, Richard; Baker, Robert A; Likosky, Donald S; Grigore, Alina; Dickinson, Timothy A; Shore-Lesserson, Linda; Hammon, John W</p> <p>2015-08-01</p> <p>In order to <span class="hlt">improve</span> our understanding of the evidence-based literature supporting temperature management during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of <span class="hlt">Cardiovascular</span> Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including: 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical <span class="hlt">practice</span> guidelines, and arrived at the following recommendations: No Recommendation No recommendation for a guideline is provided concerning optimal temperature for weaning from CPB due to insufficient published evidence. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_17");'>17</a></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li class="active"><span>19</span></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_19 --> <div id="page_20" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li class="active"><span>20</span></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="381"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29952159','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29952159"><span><span class="hlt">Improvement</span> of arterial wall phenotype in subjects at moderate <span class="hlt">cardiovascular</span> risk induced by very low-dose fluvastatin/valsartan combination: a pilot study.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Turk Veselič, Martina; Žorž, Neža; Eržen, Barbara; Škerl, Petra; Novaković, Srdjan; Janić, Miodrag; Šabovič, Mišo</p> <p>2018-06-27</p> <p>The largest population that suffers from <span class="hlt">cardiovascular</span> events are subjects at moderate <span class="hlt">cardiovascular</span> risk. However, no effective and safe preventive treatment is available for this population. We investigated whether their arterial wall phenotype could be turned to a lower risk direction by low-dose fluvastatin/valsartan combination (low-flu/val). Twenty males at moderate <span class="hlt">cardiovascular</span> risk (as classified by SCORE) were blindly randomised into the intervention group (n=10, low-flu/val: 10 mg/20mg) or control group (n=10, placebo). At inclusion and after 30 days of treatment, brachial flow-mediated dilatation (FMD), β-stiffness coefficient, carotid pulse wave velocity (c-PWV), carotid- femoral PWV, reactive hyperaemia index, high-sensitivity C-reactive protein (hs-CRP), interleukin 6, vascular cell adhesion molecule 1, total antioxidant status and expression of several protective genes (SIRT1, mTOR, NF-κB1, NFE2L2, PRKAA1) were followed. Treatment resulted in <span class="hlt">improved</span> FMD (from 3% to 4.2%, p=0.008), c-PWV (from 6.7 to 6.2 m/s, p=0.006), hs-CRP (from 5.39 to 3.35 mg/L, p=0.041) and SIRT1 expression (3.34-fold difference, p=0.047). No other vascular, inflammation and genetic parameters changed. The hs-CRP values after intervention correlated significantly with SIRT1 expression. The <span class="hlt">improved</span> FMD persisted even 10 weeks after treatment discontinuation. The obtained changes were not followed by changes of lipids or blood pressure. Overall, the results revealed <span class="hlt">improvement</span> in three different, although interrelated preventive arterial wall characteristics. This pilot study revealed that intervention with low-flu/val importantly shifts the arterial wall phenotype in a lower risk direction. This <span class="hlt">improvement</span> could be interpolated into clinical benefits that remain to be further studied.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4278729','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4278729"><span>Overview of saxagliptin efficacy and safety in patients with type 2 diabetes and <span class="hlt">cardiovascular</span> disease or risk factors for <span class="hlt">cardiovascular</span> disease</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Toth, Peter P</p> <p>2015-01-01</p> <p>Most individuals with type 2 diabetes mellitus have or will develop multiple independent risk factors for <span class="hlt">cardiovascular</span> disease, particularly coronary artery disease (CAD). CAD is the leading cause of morbidity and mortality among individuals with type 2 diabetes mellitus, and treating these patients is challenging. The risk of hypoglycemia, weight gain, or fluid retention with some diabetes medications should be considered when developing a treatment plan for individuals with a history of CAD or at risk for CAD. Dipeptidyl peptidase-4 inhibitors are oral antihyperglycemic agents that inhibit the breakdown of the incretin hormones glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide, resulting in increased glucose-dependent insulin secretion and suppression of glucagon secretion. Saxagliptin is a potent and selective dipeptidyl peptidase-4 inhibitor that <span class="hlt">improves</span> glycemic control and is generally well tolerated when used as monotherapy and as add-on therapy to other antihyperglycemic medications. This review summarizes findings from recently published post hoc analyses of saxagliptin clinical trials that have been conducted in patients with and without a history of <span class="hlt">cardiovascular</span> disease and in patients with and without various risk factors for <span class="hlt">cardiovascular</span> disease. The results show that saxagliptin was generally well tolerated and consistently <span class="hlt">improved</span> glycemic control, as assessed by reductions from baseline in glycated hemoglobin, fasting plasma glucose concentration, and postprandial glucose concentration, regardless of the presence or absence of baseline <span class="hlt">cardiovascular</span> disease, hypertension, statin use, number of <span class="hlt">cardiovascular</span> risk factors, or high Framingham 10-year <span class="hlt">cardiovascular</span> risk score. PMID:25565858</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/17976439','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/17976439"><span>Propensity-score matching in the <span class="hlt">cardiovascular</span> surgery literature from 2004 to 2006: a systematic review and suggestions for <span class="hlt">improvement</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Austin, Peter C</p> <p>2007-11-01</p> <p>I conducted a systematic review of the use of propensity score matching in the <span class="hlt">cardiovascular</span> surgery literature. I examined the adequacy of reporting and whether appropriate statistical methods were used. I examined 60 articles published in the Annals of Thoracic Surgery, European Journal of Cardio-thoracic Surgery, Journal of <span class="hlt">Cardiovascular</span> Surgery, and the Journal of Thoracic and <span class="hlt">Cardiovascular</span> Surgery between January 1, 2004, and December 31, 2006. Thirty-one of the 60 studies did not provide adequate information on how the propensity score-matched pairs were formed. Eleven (18%) of studies did not report on whether matching on the propensity score balanced baseline characteristics between treated and untreated subjects in the matched sample. No studies used appropriate methods to compare baseline characteristics between treated and untreated subjects in the propensity score-matched sample. Eight (13%) of the 60 studies explicitly used statistical methods appropriate for the analysis of matched data when estimating the effect of treatment on the outcomes. Two studies used appropriate methods for some outcomes, but not for all outcomes. Thirty-nine (65%) studies explicitly used statistical methods that were inappropriate for matched-pairs data when estimating the effect of treatment on outcomes. Eleven studies did not report the statistical tests that were used to assess the statistical significance of the treatment effect. Analysis of propensity score-matched samples tended to be poor in the <span class="hlt">cardiovascular</span> surgery literature. Most statistical analyses ignored the matched nature of the sample. I provide suggestions for <span class="hlt">improving</span> the reporting and analysis of studies that use propensity score matching.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/12775655','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/12775655"><span>Tissue engineering therapy for <span class="hlt">cardiovascular</span> disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Nugent, Helen M; Edelman, Elazer R</p> <p>2003-05-30</p> <p>The present treatments for the loss or failure of <span class="hlt">cardiovascular</span> function include organ transplantation, surgical reconstruction, mechanical or synthetic devices, or the administration of metabolic products. Although routinely used, these treatments are not without constraints and complications. The emerging and interdisciplinary field of tissue engineering has evolved to provide solutions to tissue creation and repair. Tissue engineering applies the principles of engineering, material science, and biology toward the development of biological substitutes that restore, maintain, or <span class="hlt">improve</span> tissue function. Progress has been made in engineering the various components of the <span class="hlt">cardiovascular</span> system, including blood vessels, heart valves, and cardiac muscle. Many pivotal studies have been performed in recent years that may support the move toward the widespread application of tissue-engineered therapy for <span class="hlt">cardiovascular</span> diseases. The studies discussed include endothelial cell seeding of vascular grafts, tissue-engineered vascular conduits, generation of heart valve leaflets, cardiomyoplasty, genetic manipulation, and in vitro conditions for optimizing tissue-engineered <span class="hlt">cardiovascular</span> constructs.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3528785','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3528785"><span><span class="hlt">Cardiovascular</span> Biology of the Incretin System</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Ussher, John R.; Drucker, Daniel J.</p> <p>2012-01-01</p> <p>Glucagon-like peptide-1 (GLP-1) is an incretin hormone that enhances glucose-stimulated insulin secretion and exerts direct and indirect actions on the <span class="hlt">cardiovascular</span> system. GLP-1 and its related incretin hormone, glucose-dependent insulinotropic polypeptide (GIP), are rapidly inactivated by the enzyme dipeptidyl peptidase 4 (DPP-4), a key determinant of incretin bioactivity. Two classes of medications that enhance incretin action, GLP-1R agonists and DPP-4 inhibitors, are used for the treatment of type 2 diabetes mellitus (T2DM). We review herein the <span class="hlt">cardiovascular</span> biology of GLP-1R agonists and DPP-4 inhibitors, including direct and indirect effects on cardiomyocytes, blood vessels, adipocytes, the control of blood pressure and postprandial lipoprotein secretion. Both GLP-1R activation and DPP-4 inhibition exert multiple cardioprotective actions in preclinical models of <span class="hlt">cardiovascular</span> dysfunction, and short term studies in human subjects appear to demonstrate modest yet beneficial actions on cardiac function in subjects with ischemic heart disease. Incretin-based agents control body weight, <span class="hlt">improve</span> glycemic control with a low risk of hypoglycemia, decrease blood pressure, inhibit the secretion of intestinal chylomicrons, and reduce inflammation in preclinical studies. Nevertheless, there is limited information on the <span class="hlt">cardiovascular</span> actions of these agents in patients with diabetes and established <span class="hlt">cardiovascular</span> disease. Hence, a more complete understanding of the <span class="hlt">cardiovascular</span> risk:benefit ratio of incretin-based therapies will require completion of long term <span class="hlt">cardiovascular</span> outcome studies currently underway in patients with T2DM. PMID:22323472</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4317158','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4317158"><span>The Role of Aspirin in the Prevention of <span class="hlt">Cardiovascular</span> Disease</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Ittaman, Sunitha V.; VanWormer, Jeffrey J.; Rezkalla, Shereif H.</p> <p>2014-01-01</p> <p>Aspirin therapy is well-accepted as an agent for the secondary prevention of <span class="hlt">cardiovascular</span> events and current guidelines also define a role for aspirin in primary prevention. In this review, we describe the seminal trials of aspirin use in the context of current guidelines, discuss factors that may influence the effectiveness of aspirin therapy for <span class="hlt">cardiovascular</span> disease prevention, and briefly examine patterns of use. The body of evidence supports a role for aspirin in both secondary and primary prevention of <span class="hlt">cardiovascular</span> events in selected population groups, but <span class="hlt">practice</span> patterns may be suboptimal. As a simple and inexpensive prophylactic measure for <span class="hlt">cardiovascular</span> disease, aspirin use should be carefully considered in all at-risk adult patients, and further measures, including patient education, are necessary to ensure its proper use. PMID:24573704</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23467955','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23467955"><span>The Combined therapy myo-inositol plus D-Chiro-inositol, in a physiological ratio, reduces the <span class="hlt">cardiovascular</span> risk by <span class="hlt">improving</span> the lipid profile in PCOS patients.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Minozzi, M; Nordio, M; Pajalich, R</p> <p>2013-02-01</p> <p>Women with Polycystic Ovarian Syndrome (PCOS) present several factors that increase the <span class="hlt">cardiovascular</span> risk, such as insulin resistance and dyslipidemia. Myo-inositol and D-chiro-inositol have been shown to <span class="hlt">improve</span> insulin resistance, hyperandrogenism and to induce ovulation in PCOS women. However, their effects on dyslipidemia are less clear. The aim of the present study was to evaluate whether the combined therapy myo-inositol plus D-chiro-inositol (in a in a physiological ratio of 40:1) <span class="hlt">improve</span> the metabolic profile, therefore, reducing <span class="hlt">cardiovascular</span> risk in PCOS patients. Twenty obese PCOS patients [BMI 33.7 ± 6 kg/m2 (mean ± SD)] were recruited. The lipid profile was assessed by measuring total cholesterol, LDL, HDL and triglycerides before and after 6 months treatment with the combined therapy. Secondary end points included changes in BMI, waist-hip ratio, percentage of body fat, HOMA-IR and blood pressure. The combined therapy myo-inositol and D-chiro-inositol <span class="hlt">improved</span> LDL levels (3.50 ± 0.8 mmol/L versus, 3 ± 1.2 mmol/L p < 0.05), HDL (1.1 mmol/L ± 0.3 versus 1.6 mmol/L ± 0.4 p < 0.05) and triglycerides (2.3 ± 1.5 mmol/L versus 1.75 ± 1.9 mmol/L p < 0.05). Furthermore, significant <span class="hlt">improvements</span> in HOMA-IR were also observed. The combined therapy myo-inositol plus D-chiro-inositol is able to <span class="hlt">improve</span> the metabolic profile of PCOS women, therefore, reducing the <span class="hlt">cardiovascular</span> risk.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/18613897','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/18613897"><span><span class="hlt">Cardiovascular</span> testing in Fabry disease: exercise capacity reduction, chronotropic incompetence and <span class="hlt">improved</span> anaerobic threshold after enzyme replacement.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lobo, T; Morgan, J; Bjorksten, A; Nicholls, K; Grigg, L; Centra, E; Becker, G</p> <p>2008-06-01</p> <p>The aim of this study was to document exercise capacity and serial electrocardiogram and echocardiograph findings in a cohort of Australian patients with Fabry disease, in relation to their history of enzyme replacement therapy (ERT). Fabry disease has multifactorial effects on the <span class="hlt">cardiovascular</span> system. Most previous studies have focused on electrocardiographic and echocardiographic parameters. Exercise capacity can be used as an integrated measure of <span class="hlt">cardiovascular</span> function and allows the effects of treatment to be monitored. A total of 38 patients (30 men and 8 women) with Fabry disease were monitored by 12-lead electrocardiograms every 6-12 months, and by annual standardized-protocol echocardiograms. Bicycle stress tests with VO(2) max measurement and once-only 6 minutes' walk tests were also carried out in subsets of patients whose general health status allowed testing. Seventy per cent of patients met electrocardiogram criteria for left ventricular hypertrophy. Left ventricular hypertrophy on echocardiograph was present in 64% of patients (80% of men). Exercise capacity was reduced in patients with Fabry disease compared with that predicted from normative population data. Mild <span class="hlt">improvement</span> in anaerobic threshold was seen in the first year of ERT (14.1 +/- 3.0 to 15.8 +/- 3.0, P = 0.02), but no consistent further increase was seen beyond the first year. Most patients had resting bradycardia, with impaired ability to increase heart rate during exercise. Serial testing on ERT showed an <span class="hlt">improvement</span> in anaerobic threshold but no significant change in VO(2) max. Male patients with Fabry disease were unable to attain predicted maximal heart rate on exercise or to achieve normal exercise levels. ERT was associated with a small <span class="hlt">improvement</span> in anaerobic threshold over the first year.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3971190','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3971190"><span>Mindfulness may both moderate and mediate the effect of physical fitness on <span class="hlt">cardiovascular</span> responses to stress: a speculative hypothesis</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Demarzo, Marcelo M. P.; Montero-Marin, Jesús; Stein, Phyllis K.; Cebolla, Ausiàs; Provinciale, Jaime G.; García-Campayo, Javier</p> <p>2014-01-01</p> <p>The psychological construct of mindfulness refers to an awareness that emerges by intentionally paying attention to the present experience in a non-judgmental or evaluative way. This particular quality of awareness has been associated to several indicators of physical and psychological health, and can be developed using mindfulness-based interventions (MBIs), and therefore MBIs have been successfully applied as preventive and complementary interventions and therapies in medicine and psychology. Together with quiet sitting and lying meditation <span class="hlt">practices</span>, mindful physical exercises such as “mindful walking” and “mindful movement” are key elements in MBIs and couple muscular activity with an internally directed focus, <span class="hlt">improving</span> interoceptive attention to bodily sensations. In addition, MBIs seem to share similar mechanisms with physical fitness (PF) by which they may influence <span class="hlt">cardiovascular</span> responses to stress. Based on these facts, it is feasible to raise the question of whether physical training itself may induce the development of that particular quality of awareness associated with mindfulness, or if one's dispositional mindfulness (DM) (the tendency to be more mindful in daily life) could moderate the effects of exercise on <span class="hlt">cardiovascular</span> response to stress. The role of mindfulness as a mediator or moderator of the effect of exercise training on <span class="hlt">cardiovascular</span> responses to stress has barely been studied. In this study, we have hypothesized pathways (moderation and mediation) by which mindfulness could significantly influence the effects of PF on <span class="hlt">cardiovascular</span> responses to stress and discussed potential <span class="hlt">practical</span> ways to test these hypotheses. PMID:24723891</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24723891','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24723891"><span>Mindfulness may both moderate and mediate the effect of physical fitness on <span class="hlt">cardiovascular</span> responses to stress: a speculative hypothesis.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Demarzo, Marcelo M P; Montero-Marin, Jesús; Stein, Phyllis K; Cebolla, Ausiàs; Provinciale, Jaime G; García-Campayo, Javier</p> <p>2014-01-01</p> <p>The psychological construct of mindfulness refers to an awareness that emerges by intentionally paying attention to the present experience in a non-judgmental or evaluative way. This particular quality of awareness has been associated to several indicators of physical and psychological health, and can be developed using mindfulness-based interventions (MBIs), and therefore MBIs have been successfully applied as preventive and complementary interventions and therapies in medicine and psychology. Together with quiet sitting and lying meditation <span class="hlt">practices</span>, mindful physical exercises such as "mindful walking" and "mindful movement" are key elements in MBIs and couple muscular activity with an internally directed focus, <span class="hlt">improving</span> interoceptive attention to bodily sensations. In addition, MBIs seem to share similar mechanisms with physical fitness (PF) by which they may influence <span class="hlt">cardiovascular</span> responses to stress. Based on these facts, it is feasible to raise the question of whether physical training itself may induce the development of that particular quality of awareness associated with mindfulness, or if one's dispositional mindfulness (DM) (the tendency to be more mindful in daily life) could moderate the effects of exercise on <span class="hlt">cardiovascular</span> response to stress. The role of mindfulness as a mediator or moderator of the effect of exercise training on <span class="hlt">cardiovascular</span> responses to stress has barely been studied. In this study, we have hypothesized pathways (moderation and mediation) by which mindfulness could significantly influence the effects of PF on <span class="hlt">cardiovascular</span> responses to stress and discussed potential <span class="hlt">practical</span> ways to test these hypotheses.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21155703','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21155703"><span>Social networks in <span class="hlt">cardiovascular</span> disease management.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Shaya, Fadia T; Yan, Xia; Farshid, Maryam; Barakat, Samer; Jung, Miah; Low, Sara; Fedder, Donald</p> <p>2010-12-01</p> <p><span class="hlt">Cardiovascular</span> disease remains the leading cause of death in the USA. Social networks have a positive association with obesity, smoking cessation and weight loss. This article summarizes studies evaluating the impact of social networks on the management of <span class="hlt">cardiovascular</span> disease. The 35 studies included in the article describe the impact of social networks on a decreased incidence of <span class="hlt">cardiovascular</span> disease, depression and mortality. In addition, having a large-sized social network is also associated with better outcomes and <span class="hlt">improved</span> health. The role of pharmacists is beginning to play an important role in the patient-centered medical home, which needs to be incorporated into social networks. The patient-centered medical home can serve as an adaptive source for social network evolvement.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4594193','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4594193"><span>Kidney measures beyond traditional risk factors for <span class="hlt">cardiovascular</span> prediction: A collaborative meta-analysis</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Matsushita, Kunihiro; Coresh, Josef; Sang, Yingying; Chalmers, John; Fox, Caroline; Guallar, Eliseo; Jafar, Tazeen; Jassal, Simerjot K.; Landman, Gijs W.D.; Muntner, Paul; Roderick, Paul; Sairenchi, Toshimi; Schöttker, Ben; Shankar, Anoop; Shlipak, Michael; Tonelli, Marcello; Townend, Jonathan; van Zuilen, Arjan; Yamagishi, Kazumasa; Yamashita, Kentaro; Gansevoort, Ron; Sarnak, Mark; Warnock, David G.; Woodward, Mark; Ärnlöv, Johan</p> <p>2015-01-01</p> <p>Background The utility of estimated glomerular filtration rate (eGFR) and albuminuria for <span class="hlt">cardiovascular</span> prediction is controversial. Methods We meta-analyzed individual-level data from 24 cohorts (with a median follow-up time longer than 4 years, varying from 4.2 to 19.0 years) in the Chronic Kidney Disease Prognosis Consortium (637,315 participants without a history of <span class="hlt">cardiovascular</span> disease) and assessed C-statistic difference and reclassification <span class="hlt">improvement</span> for <span class="hlt">cardiovascular</span> mortality and fatal and non-fatal cases of coronary heart disease, stroke, and heart failure in 5-year timeframe, contrasting prediction models consisting of traditional risk factors with and without creatinine-based eGFR and/or albuminuria (either albumin-to-creatinine ratio [ACR] or semi-quantitative dipstick proteinuria). Findings The addition of eGFR and ACR significantly <span class="hlt">improved</span> the discrimination of <span class="hlt">cardiovascular</span> outcomes beyond traditional risk factors in general populations, but the <span class="hlt">improvement</span> was greater with ACR than with eGFR and more evident for <span class="hlt">cardiovascular</span> mortality (c-statistic difference 0.0139 [95%CI 0.0105–0.0174] and 0.0065 [0.0042–0.0088], respectively) and heart failure (0.0196 [0.0108–0.0284] and 0.0109 [0.0059–0.0159]) than for coronary disease (0.0048 [0.0029–0.0067] and 0.0036 [0.0019–0.0054]) and stroke (0.0105 [0.0058–0.0151] and 0.0036 [0.0004–0.0069]). Dipstick proteinuria demonstrated smaller <span class="hlt">improvement</span> than ACR. The discrimination <span class="hlt">improvement</span> with kidney measures was especially evident in individuals with diabetes or hypertension but remained significant with ACR for <span class="hlt">cardiovascular</span> mortality and heart failure in those without either of these conditions. In participants with chronic kidney disease (CKD), the combination of eGFR and ACR for risk discrimination outperformed most single traditional predictors; the c-statistic for <span class="hlt">cardiovascular</span> mortality declined by 0.023 [0.016–0.030] vs. <0.007 when omitting eGFR and ACR vs. any single</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/10162427','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/10162427"><span>Centers of excellence: an assessment tool for <span class="hlt">cardiovascular</span> and orthopedic programs.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Ronning, P L; Meyer, J W</p> <p>1996-10-01</p> <p>As payers place more weight on contracting with hospital/health system programs that can differentiate themselves in the market as a "true" center of excellence (COE), it becomes imperative that hospitals/health systems understand the payer perspective about those programmatic attributes that can truly differentiate them from other programs. This report describes an evaluation and rating methodology for hospital/health system subspecialty programs, particularly <span class="hlt">cardiovascular</span> and orthopedic programs, that can be used as a self-assessment tool. Using as its core a Rating Scale and Ranking Taxonomy, the evaluation and rating methodology presented here allow <span class="hlt">cardiovascular</span> and orthopedic programs to do the following: Understand the differentiating characteristic of COE. Rate itself against detailed criteria that are being used by payers. Compare aspects of its program to premier or benchmark programs. Interpret the results to assist with strategic and operational direction. Allocate scarce resources to implement a subspecialty program that will attract payers. The Rating Scale and Ranking Taxonomy has 20 criteria for assessing <span class="hlt">cardiovascular</span> programs and 18 criteria for orthopedic programs. The assessment process is designed to produce two important results: dialogue and action. The underpinnings of any action is a solid business plan that clarifies the program's vision, values, and mission. They are important because most programs will ultimately pursue very similar strategies and tactics; however, the most successful subspecialty programs and <span class="hlt">practices</span> will be the ones that can execute the strategies and tactics quickly and effectively. In addition, the changes that are engendered by this targeted yet comprehensive assessment process can lead to <span class="hlt">improved</span> clinical and functional outcomes for patients, as well as systemic <span class="hlt">improvements</span> in the delivery of care.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28956772','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28956772"><span>Machine Learning Approaches in <span class="hlt">Cardiovascular</span> Imaging.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Henglin, Mir; Stein, Gillian; Hushcha, Pavel V; Snoek, Jasper; Wiltschko, Alexander B; Cheng, Susan</p> <p>2017-10-01</p> <p><span class="hlt">Cardiovascular</span> imaging technologies continue to increase in their capacity to capture and store large quantities of data. Modern computational methods, developed in the field of machine learning, offer new approaches to leveraging the growing volume of imaging data available for analyses. Machine learning methods can now address data-related problems ranging from simple analytic queries of existing measurement data to the more complex challenges involved in analyzing raw images. To date, machine learning has been used in 2 broad and highly interconnected areas: automation of tasks that might otherwise be performed by a human and generation of clinically important new knowledge. Most <span class="hlt">cardiovascular</span> imaging studies have focused on task-oriented problems, but more studies involving algorithms aimed at generating new clinical insights are emerging. Continued expansion in the size and dimensionality of <span class="hlt">cardiovascular</span> imaging databases is driving strong interest in applying powerful deep learning methods, in particular, to analyze these data. Overall, the most effective approaches will require an investment in the resources needed to appropriately prepare such large data sets for analyses. Notwithstanding current technical and logistical challenges, machine learning and especially deep learning methods have much to offer and will substantially impact the future <span class="hlt">practice</span> and science of <span class="hlt">cardiovascular</span> imaging. © 2017 American Heart Association, Inc.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28218596','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28218596"><span>Forced Aerobic Exercise Preceding Task <span class="hlt">Practice</span> <span class="hlt">Improves</span> Motor Recovery Poststroke.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Linder, Susan M; Rosenfeldt, Anson B; Dey, Tanujit; Alberts, Jay L</p> <p></p> <p>To understand how two types of aerobic exercise affect upper-extremity motor recovery post-stroke. Our aims were to (1) evaluate the feasibility of having people who had a stroke complete an aerobic exercise intervention and (2) determine whether forced or voluntary exercise differentially facilitates upper-extremity recovery when paired with task <span class="hlt">practice</span>. Seventeen participants with chronic stroke completed twenty-four 90-min sessions over 8 wk. Aerobic exercise was immediately followed by task <span class="hlt">practice</span>. Participants were randomized to forced or voluntary aerobic exercise groups or to task <span class="hlt">practice</span> only. <span class="hlt">Improvement</span> on the Fugl-Meyer Assessment exceeded the minimal clinically important difference: 12.3, 4.8, and 4.4 for the forced exercise, voluntary exercise, and repetitive task <span class="hlt">practice</span>-only groups, respectively. Only the forced exercise group exhibited a statistically significant <span class="hlt">improvement</span>. People with chronic stroke can safely complete intensive aerobic exercise. Forced aerobic exercise may be optimal in facilitating motor recovery associated with task <span class="hlt">practice</span>. Copyright © 2017 by the American Occupational Therapy Association, Inc.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23292717','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23292717"><span>Magnetic resonance imaging and spectroscopy of the murine <span class="hlt">cardiovascular</span> system.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Akki, Ashwin; Gupta, Ashish; Weiss, Robert G</p> <p>2013-03-01</p> <p>Magnetic resonance imaging (MRI) has emerged as a powerful and reliable tool to noninvasively study the <span class="hlt">cardiovascular</span> system in clinical <span class="hlt">practice</span>. Because transgenic mouse models have assumed a critical role in <span class="hlt">cardiovascular</span> research, technological advances in MRI have been extended to mice over the last decade. These have provided critical insights into cardiac and vascular morphology, function, and physiology/pathophysiology in many murine models of heart disease. Furthermore, magnetic resonance spectroscopy (MRS) has allowed the nondestructive study of myocardial metabolism in both isolated hearts and in intact mice. This article reviews the current techniques and important pathophysiological insights from the application of MRI/MRS technology to murine models of <span class="hlt">cardiovascular</span> disease.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/abs/2015SPIE.9448E..1FG','NASAADS'); return false;" href="http://adsabs.harvard.edu/abs/2015SPIE.9448E..1FG"><span>Patient-specific system for prognosis of surgical treatment outcomes of human <span class="hlt">cardiovascular</span> system</span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Golyadkina, Anastasiya A.; Kalinin, Aleksey A.; Kirillova, Irina V.; Kossovich, Elena L.; Kossovich, Leonid Y.; Menishova, Liyana R.; Polienko, Asel V.</p> <p>2015-03-01</p> <p>Object of study: <span class="hlt">Improvement</span> of life quality of patients with high stroke risk ia the main goal for development of system for patient-specific modeling of <span class="hlt">cardiovascular</span> system. This work is dedicated at increase of safety outcomes for surgical treatment of brain blood supply alterations. The objects of study are common carotid artery, internal and external carotid arteries and bulb. Methods: We estimated mechanical properties of carotid arteries tissues and patching materials utilized at angioplasty. We studied angioarchitecture features of arteries. We developed and clinically adapted computer biomechanical models, which are characterized by geometrical, physical and mechanical similarity with carotid artery in norm and with pathology (atherosclerosis, pathological tortuosity, and their combination). Results: Collaboration of <span class="hlt">practicing</span> <span class="hlt">cardiovascular</span> surgeons and specialists in the area of Mathematics and Mechanics allowed to successfully conduct finite-element modeling of surgical treatment taking into account various features of operation techniques and patching materials for a specific patient. Numerical experiment allowed to reveal factors leading to brain blood supply decrease and atherosclerosis development. Modeling of carotid artery reconstruction surgery for a specific patient on the basis of the constructed biomechanical model demonstrated the possibility of its application in clinical <span class="hlt">practice</span> at approximation of numerical experiment to the real conditions.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26950206','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26950206"><span>Continuous patient engagement in <span class="hlt">cardiovascular</span> disease clinical comparative effectiveness research.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Vandigo, Joseph; Oloyede, Ebenezer; Aly, Abdalla; Laird, Aurelia L; Cooke, Catherine E; Mullins, C Daniel</p> <p>2016-01-01</p> <p>Researchers have produced evidence that identifies interventions that reduce <span class="hlt">cardiovascular</span> disease (CVD) risk; however, despite a significant investment in research CVD remains the leading cause of death. Engaging patients in the research process has the potential to ensure that evidence-based treatments are adopted in real-world <span class="hlt">practice</span> to <span class="hlt">improve</span> patient outcomes. The Patient-Centered Outcomes Research Institute has created an Engagement Rubric to guide meaningful engagement in the research process. A 10-step systematic framework to enhance patient engagement throughout the comparative effectiveness research process also has been proposed. This special report identifies the relationship between these two approaches to patient engagement and describes examples of how patients could be engaged in a hypothetical CVD study.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/abs/2016AGUFMGC11C1156B','NASAADS'); return false;" href="http://adsabs.harvard.edu/abs/2016AGUFMGC11C1156B"><span>Ranking agricultural <span class="hlt">practices</span> on soil water <span class="hlt">improvements</span>: a meta-analysis</span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Basche, A.; DeLonge, M. S.; Gonzalez, J.</p> <p>2016-12-01</p> <p>Increased rainfall variability is well documented in the historic record and predicted to intensify with future climate change. Managing excess water in periods of heavy rain and a lack of water in periods of inadequate precipitation will continue to be a challenge. <span class="hlt">Improving</span> soil resiliency through increased water storage is a promising strategy to combat effects of both rainfall extremes. The goal of this research is to quantify to what extent various conservation and ecological <span class="hlt">practices</span> can <span class="hlt">improve</span> soil hydrology. We are conducting a global meta-analysis focused on studies where conservation and ecological <span class="hlt">practices</span> are compared to more conventional management. To date we have analyzed 100 studies with more than 450 paired comparisons to understand the effect of management on water infiltration rates, a critical process that ensures water enters the soil profile for crop use, water storage and runoff prevention. The database will be expanded to include studies measuring soil porosity and the water retained at field capacity. Statistical analysis has been done both with both a bootstrap method and a mixed model that weights studies based on precision while accounting for between-study variation. We find that conservation and ecological <span class="hlt">practices</span>, ranging from no-till, cover crops, crop rotation, perennial crops and agroforestry, on average significantly increased water infiltration rates relative to more conventional <span class="hlt">practice</span> controls (mean of 75%, standard error 25%). There were significant differences between <span class="hlt">practices</span>, where perennial and agroforestry systems show the greatest potential for <span class="hlt">improving</span> water infiltration rates (> 100% increase). Cover crops also lead to a significant increase in water infiltration rates (> 60%) while crop rotations and no-till systems did not consistently demonstrate increases. We also found that studies needed to include alternative management for more than two years to detect a significant increase. Overall this global meta</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=lecture&pg=6&id=ED568022','ERIC'); return false;" href="https://eric.ed.gov/?q=lecture&pg=6&id=ED568022"><span>Effective Online Lectures: <span class="hlt">Improving</span> <span class="hlt">Practice</span> through Design and Pedagogy</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Bese, Terry Lane</p> <p>2016-01-01</p> <p>The purpose of this research project was to <span class="hlt">improve</span> the <span class="hlt">practice</span> of using online lectures at a small private university. Using action research methodology, the researcher worked with a group of five university instructors to refine the use of online lectures through design and pedagogical <span class="hlt">practice</span>. Beginning with a template or guide based on the…</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_18");'>18</a></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li class="active"><span>20</span></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_20 --> <div id="page_21" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li class="active"><span>21</span></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li><a href="#" onclick='return showDiv("page_23");'>23</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="401"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4755414','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4755414"><span><span class="hlt">Improved</span> <span class="hlt">Cardiovascular</span> Disease Outcomes in Older Adults</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Forman, Daniel E.; Alexander, Karen; Brindis, Ralph G.; Curtis, Anne B.; Maurer, Mathew; Rich, Michael W.; Sperling, Laurence; Wenger, Nanette K.</p> <p>2016-01-01</p> <p>Longevity is increasing and the population of older adults is growing. The biology of aging is conducive to <span class="hlt">cardiovascular</span> disease (CVD), such that prevalence of coronary artery disease, heart failure, valvular heart disease, arrhythmia and other disorders are increasing as more adults survive into old age.  Furthermore, CVD in older adults is distinctive, with management issues predictably complicated by multimorbidity, polypharmacy, frailty and other complexities of care that increase management risks (e.g., bleeding, falls, and rehospitalization) and uncertainty of outcomes.  In this review, state-of-the-art advances in heart failure, acute coronary syndromes, transcatheter aortic valve replacement, atrial fibrillation, amyloidosis, and CVD prevention are discussed.  Conceptual benefits of treatments are considered in relation to the challenges and ambiguities inherent in their application to older patients. PMID:26918183</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3328790','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3328790"><span>Transforming growth factor beta signaling in adult <span class="hlt">cardiovascular</span> diseases and repair</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Doetschman, Thomas; Barnett, Joey V.; Runyan, Raymond B.; Camenisch, Todd D.; Heimark, Ronald L.; Granzier, Henk L.; Conway, Simon J.; Azhar, Mohamad</p> <p>2011-01-01</p> <p>The majority of children with congenital heart disease now live into adulthood due to the remarkable surgical and medical advances that have taken place over the past half century. Because of this, the adults now represent the largest age group with adult <span class="hlt">cardiovascular</span> diseases. They include patients with heart diseases that were not detected or not treated during childhood, those whose defects were surgically corrected but now need revision due to maladaptive responses to the procedure, those with exercise problems, and those with age-related degenerative diseases. Because adult <span class="hlt">cardiovascular</span> diseases in this population are relatively new, they are not well understood. It is therefore necessary to understand the molecular and physiological pathways involved if we are to <span class="hlt">improve</span> treatments. Since there is a developmental basis to adult <span class="hlt">cardiovascular</span> disease, transforming growth factor beta (TGFβ) signaling pathways that are essential for proper <span class="hlt">cardiovascular</span> development may also play critical roles in the homeostatic, repair and stress response processes involved in adult <span class="hlt">cardiovascular</span> diseases. Consequently, we have chosen to summarize the current information on a subset of TGFβ ligand and receptor genes and related effector genes that when dysregulated are known to lead to <span class="hlt">cardiovascular</span> diseases and adult <span class="hlt">cardiovascular</span> deficiencies and/or pathologies. A better understanding of the TGFβ signaling network in <span class="hlt">cardiovascular</span> disease and repair will impact genetic and physiologic investigations of <span class="hlt">cardiovascular</span> diseases in elderly patients and lead to an <span class="hlt">improvement</span> in clinical interventions. PMID:21953136</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29571235','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29571235"><span>Do not fear the Framingham: <span class="hlt">Practical</span> application to properly evaluate and modify <span class="hlt">cardiovascular</span> risk in commercial divers.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Suresh, Rahul; Pavela, James; Kus, Marcus S; Alleman, Tony; Sanders, Robert</p> <p>2018-01-01</p> <p>In April 2016 the Association of Diving Contractors International (ADCI) consensus guidelines began recommending annual <span class="hlt">cardiovascular</span> risk stratification of commercial divers using the Framingham Risk Score (FRS). For those at elevated risk, further testing is recommended. This approach has raised concerns about potential operational and financial impacts. However, the prevalence of elevated <span class="hlt">cardiovascular</span> risk and need for additional testing among commercial divers is not known. Clinical data required to calculate the FRS was abstracted for 190 commercial divers in two cohorts. Population demographics, FRS distribution, contributions of risk factors and effect of interventions on reducing risk-factor burden were assessed. Mean FRS score was 1.68 ± 6.35 points, with 13 divers (6.8%) at intermediate risk and none at high 10-year risk. In these 13 divers, the mean contributions to the FRS were from age (6.5 points), cholesterol (3.1 pts.), smoking (1.3 pts.), highdensity lipoprotein (1 pt.), and systolic blood pressure (0.8 pts). The youngest age group had a significantly higher modifiable risk core than the oldest age group (5.87 vs. 1.2 points, P ⟨ 0.001). All 13 intermediate risk divers could have been reclassified as low-risk with successful treatment of modifiable risk factors. The prevalence of elevated <span class="hlt">cardiovascular</span> risk among commercial divers is low, and treatment of modifiable risk factors could reclassify those at intermediate risk to low risk. Therefore, FRS implementation coupled with intensive risk-reduction strategies for at risk-divers may help <span class="hlt">improve</span> diver health and prolong the careers of divers while limiting the need for additional testing and adverse operational impact. Copyright© Undersea and Hyperbaric Medical Society.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23279247','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23279247"><span>Assessing <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Salzman, David H; Franzen, Douglas S; Leone, Katrina A; Kessler, Chad S</p> <p>2012-12-01</p> <p>Assessment of <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span> (PBLI) is a core concept identified in several competency frameworks. This paper summarizes the current state of PBLI assessment as presented at the 2012 Academic Emergency Medicine consensus conference on education research in emergency medicine. Based on these findings and consensus achieved at the conference, seven recommendations have been identified for future research. © 2012 by the Society for Academic Emergency Medicine.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/17701262','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/17701262"><span>Surgical education to <span class="hlt">improve</span> the quality of patient care: the role of <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Sachdeva, Ajit K</p> <p>2007-11-01</p> <p>Health care is going through immense change, and concerns regarding the quality of patient care and patient safety continue to be expressed in many national forums. A variety of stakeholders are demanding greater accountability from the health care profession. Education is key to supporting surgeons' efforts to provide high-quality patient care during these challenging times. Educational programs for surgeons should be founded on principles of continuous professional development (CPD) and <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span> (PBLI). CPD focuses on the specific needs of individual surgeons and involves lifelong learning throughout a surgeon's career. It needs to form the basis of PBLI efforts. PBLI involves a cycle of four steps--identifying areas for <span class="hlt">improvement</span>, engaging in learning, applying new knowledge and skills to <span class="hlt">practice</span>, and checking for <span class="hlt">improvement</span>. Ongoing involvement in PBLI activities to address specific learning needs should positively impact a surgeon's <span class="hlt">practice</span> and <span class="hlt">improve</span> outcomes of surgical care.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/17824261','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/17824261"><span>Business intelligence: using insight to <span class="hlt">improve</span> the value and performance of your <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Coan, Tim</p> <p>2007-01-01</p> <p>Using information to <span class="hlt">improve</span> the value of your <span class="hlt">practice</span> can be a great way to create leverage and <span class="hlt">improve</span> the performance of your <span class="hlt">practice</span>. Business intelligence (BI) is the result of a complete system that produces meaningful insights by providing the information necessary to make business decisions. Changes made from these insights <span class="hlt">improve</span> both the performance and value of your <span class="hlt">practice</span>. It is important to identify the key elements required of a good BI system and the areas within a <span class="hlt">practice</span> that can directly benefit from an effective BI system.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/22718797','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/22718797"><span>Secondary prevention in the clinical management of patients with <span class="hlt">cardiovascular</span> diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European Association for <span class="hlt">Cardiovascular</span> Prevention & Rehabilitation. Endorsed by the Committee for <span class="hlt">Practice</span> Guidelines of the European Society of Cardiology.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Piepoli, Massimo F; Corrà, Ugo; Adamopoulos, Stamatis; Benzer, Werner; Bjarnason-Wehrens, Birna; Cupples, Margaret; Dendale, Paul; Doherty, Patrick; Gaita, Dan; Höfer, Stefan; McGee, Hannah; Mendes, Miguel; Niebauer, Josef; Pogosova, Nana; Garcia-Porrero, Esteban; Rauch, Bernhard; Schmid, Jean Paul; Giannuzzi, Pantaleo</p> <p>2014-06-01</p> <p>Despite major <span class="hlt">improvements</span> in diagnostics and interventional therapies, <span class="hlt">cardiovascular</span> diseases remain a major health care and socio-economic burden both in western and developing countries, in which this burden is increasing in close correlation to economic growth. Health authorities and the general population have started to recognize that the fight against these diseases can only be won if their burden is faced by increasing our investment on interventions in lifestyle changes and prevention. There is an overwhelming evidence of the efficacy of secondary prevention initiatives including cardiac rehabilitation in terms of reduction in morbidity and mortality. However, secondary prevention is still too poorly implemented in clinical <span class="hlt">practice</span>, often only on selected populations and over a limited period of time. The development of systematic and full comprehensive preventive programmes is warranted, integrated in the organization of national health systems. Furthermore, systematic monitoring of the process of delivery and outcomes is a necessity. Cardiology and secondary prevention, including cardiac rehabilitation, have evolved almost independently of each other and although each makes a unique contribution it is now time to join forces under the banner of preventive cardiology and create a comprehensive model that optimizes long term outcomes for patients and reduces the future burden on health care services. These are the aims that the Cardiac Rehabilitation Section of the European Association for <span class="hlt">Cardiovascular</span> Prevention & Rehabilitation has foreseen to promote secondary preventive cardiology in clinical <span class="hlt">practice</span>. © The European Society of Cardiology 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4141811','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4141811"><span>Unmet Needs for <span class="hlt">Cardiovascular</span> Care in Indonesia</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Maharani, Asri; Tampubolon, Gindo</p> <p>2014-01-01</p> <p>Background In the past twenty years the heaviest burden of <span class="hlt">cardiovascular</span> diseases has begun to shift from developed to developing countries. However, little is known about the real needs for <span class="hlt">cardiovascular</span> care in these countries and how well those needs are being met. This study aims to investigate the prevalence and determinants of unmet needs for <span class="hlt">cardiovascular</span> care based on objective assessment. Methods and Findings Multilevel analysis is used to analyse the determinants of met needs and multilevel multiple imputation is applied to manage missing data. The 2008 Indonesian Family Life Survey (IFLS4) survey is the source of the household data used in this study, while district data is sourced from the Ministry of Health and Ministry of Finance. The data shows that nearly 70% of respondents with moderate to high <span class="hlt">cardiovascular</span> risk failed to receive <span class="hlt">cardiovascular</span> care. Higher income, possession of health insurance and residence in urban areas are significantly associated with met needs for <span class="hlt">cardiovascular</span> care, while health facility density and physician density show no association with them. Conclusions The prevalence of unmet needs for <span class="hlt">cardiovascular</span> care is considerable in Indonesia. Inequality persists as a factor in meeting needs for <span class="hlt">cardiovascular</span> care as the needs of people with higher incomes and those living in urban areas are more likely to be met. Alleviation of poverty, provision of health care insurance for the poor, and <span class="hlt">improvement</span> in the quality of healthcare providers are recommended in order to meet this ever-increasing need. PMID:25148389</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29098624','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29098624"><span>NO Signaling in the <span class="hlt">Cardiovascular</span> System and Exercise.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Fernandes, Tiago; Gomes-Gatto, Camila V; Pereira, Noemy P; Alayafi, Yahya R; das Neves, Vander J; Oliveira, Edilamar M</p> <p>2017-01-01</p> <p>Nitric oxide (NO) is a small molecule implicated in multiple signal transduction pathways thus contributing to the regulation of many cellular functions. The identification of NO synthase (NOS) isoforms and the subsequent characterization of the mechanisms of cell activation of the enzymes permitted the partial understanding of both the physiological and pathological processes. NO bioavailability plays an important role in the pathophysiology of <span class="hlt">cardiovascular</span> disease and its reduction in endothelial cells is strictly associated to endothelial dysfunction which, in turn, correlates with <span class="hlt">cardiovascular</span> mortality. Indeed, endothelial NO synthase (eNOS) has a key role in limiting cardiac dysfunction and remodeling in heart diseases, in part by decreasing myocyte hypertrophy. Conversely, exercise training is recommended to prevent and treat <span class="hlt">cardiovascular</span> diseases-associated disorders at least by enhanced NO synthase activity and expression, and increased production of antioxidants, which prevents premature breakdown of NO. Exercise training may cause an <span class="hlt">improvement</span> in endothelial function for both experimental animals and humans; Studies in both healthy subjects and patients with impaired NO-related vasorelaxation remarked exercise training ability to <span class="hlt">improve</span> vascular structure and function and endothelial homeostasis. This chapter will briefly consider the importance of NO signaling in the maintenance of <span class="hlt">cardiovascular</span> physiology, and discuss recent insights into the effect of exercise training on the signaling pathways that modulate NO synthesis and degradation in health and <span class="hlt">cardiovascular</span> disease. In addition, we will highlight the molecular mechanisms via which microRNAs (miRs) target NO signaling in the <span class="hlt">cardiovascular</span> system, and NO as a candidate molecule for development of new therapies.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=project+AND+waves&pg=7&id=EJ895852','ERIC'); return false;" href="https://eric.ed.gov/?q=project+AND+waves&pg=7&id=EJ895852"><span>Infrastructure for Large-Scale Quality-<span class="hlt">Improvement</span> Projects: Early Lessons from North Carolina <span class="hlt">Improving</span> Performance in <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Newton, Warren P.; Lefebvre, Ann; Donahue, Katrina E.; Bacon, Thomas; Dobson, Allen</p> <p>2010-01-01</p> <p>Introduction: Little is known regarding how to accomplish large-scale health care <span class="hlt">improvement</span>. Our goal is to <span class="hlt">improve</span> the quality of chronic disease care in all primary care <span class="hlt">practices</span> throughout North Carolina. Methods: Methods for <span class="hlt">improvement</span> include (1) common quality measures and shared data system; (2) rapid cycle <span class="hlt">improvement</span> principles; (3)…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3010953','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3010953"><span>Evaluating <span class="hlt">Practice</span>-Based Learning and <span class="hlt">Improvement</span>: Efforts to <span class="hlt">Improve</span> Acceptance of Portfolios</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Fragneto, Regina Y.; DiLorenzo, Amy Noel; Schell, Randall M.; Bowe, Edwin A.</p> <p>2010-01-01</p> <p>Introduction The Accreditation Council for Graduate Medical Education (ACGME) recommends resident portfolios as 1 method for assessing competence in <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>. In July 2005, when anesthesiology residents in our department were required to start a portfolio, the residents and their faculty advisors did not readily accept this new requirement. Intensive education efforts addressing the goals and importance of portfolios were undertaken. We hypothesized that these educational efforts <span class="hlt">improved</span> acceptance of the portfolio and retrospectively audited the portfolio evaluation forms completed by faculty advisors. Methods Intensive education about the goals and importance of portfolios began in January 2006, including presentations at departmental conferences and one-on-one education sessions. Faculty advisors were instructed to evaluate each resident's portfolio and complete a review form. We retrospectively collected data to determine the percentage of review forms completed by faculty. The portfolio reviews also assessed the percentage of 10 required portfolio components residents had completed. Results Portfolio review forms were completed by faculty advisors for 13% (5/38) of residents during the first advisor-advisee meeting in December 2005. Initiation of intensive education efforts significantly <span class="hlt">improved</span> compliance, with review forms completed for 68% (26/38) of residents in May 2006 (P < .0001) and 95% (36/38) in December 2006 (P < .0001). Residents also significantly <span class="hlt">improved</span> the completeness of portfolios between May and December of 2006. Discussion Portfolios are considered a best methods technique by the ACGME for evaluation of <span class="hlt">practice</span>-based learning and <span class="hlt">improvment</span>. We have found that intensive education about the goals and importance of portfolios can enhance acceptance of this evaluation tool, resulting in <span class="hlt">improved</span> compliance in completion and evaluation of portfolios. PMID:22132291</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/22132291','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/22132291"><span>Evaluating <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>: efforts to <span class="hlt">improve</span> acceptance of portfolios.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Fragneto, Regina Y; Dilorenzo, Amy Noel; Schell, Randall M; Bowe, Edwin A</p> <p>2010-12-01</p> <p>The Accreditation Council for Graduate Medical Education (ACGME) recommends resident portfolios as 1 method for assessing competence in <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>. In July 2005, when anesthesiology residents in our department were required to start a portfolio, the residents and their faculty advisors did not readily accept this new requirement. Intensive education efforts addressing the goals and importance of portfolios were undertaken. We hypothesized that these educational efforts <span class="hlt">improved</span> acceptance of the portfolio and retrospectively audited the portfolio evaluation forms completed by faculty advisors. Intensive education about the goals and importance of portfolios began in January 2006, including presentations at departmental conferences and one-on-one education sessions. Faculty advisors were instructed to evaluate each resident's portfolio and complete a review form. We retrospectively collected data to determine the percentage of review forms completed by faculty. The portfolio reviews also assessed the percentage of 10 required portfolio components residents had completed. Portfolio review forms were completed by faculty advisors for 13% (5/38) of residents during the first advisor-advisee meeting in December 2005. Initiation of intensive education efforts significantly <span class="hlt">improved</span> compliance, with review forms completed for 68% (26/38) of residents in May 2006 (P < .0001) and 95% (36/38) in December 2006 (P < .0001). Residents also significantly <span class="hlt">improved</span> the completeness of portfolios between May and December of 2006. Portfolios are considered a best methods technique by the ACGME for evaluation of <span class="hlt">practice</span>-based learning and <span class="hlt">improvment</span>. We have found that intensive education about the goals and importance of portfolios can enhance acceptance of this evaluation tool, resulting in <span class="hlt">improved</span> compliance in completion and evaluation of portfolios.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26031632','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26031632"><span><span class="hlt">Cardiovascular</span> genetics: technological advancements and applicability for dilated cardiomyopathy.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Kummeling, G J M; Baas, A F; Harakalova, M; van der Smagt, J J; Asselbergs, F W</p> <p>2015-07-01</p> <p>Genetics plays an important role in the pathophysiology of <span class="hlt">cardiovascular</span> diseases, and is increasingly being integrated into clinical <span class="hlt">practice</span>. Since 2008, both capacity and cost-efficiency of mutation screening of DNA have been increased magnificently due to the technological advancement obtained by next-generation sequencing. Hence, the discovery rate of genetic defects in <span class="hlt">cardiovascular</span> genetics has grown rapidly and the financial threshold for gene diagnostics has been lowered, making large-scale DNA sequencing broadly accessible. In this review, the genetic variants, mutations and inheritance models are briefly introduced, after which an overview is provided of current clinical and technological applications in gene diagnostics and research for <span class="hlt">cardiovascular</span> disease and in particular, dilated cardiomyopathy. Finally, a reflection on the future perspectives in cardiogenetics is given.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25583139','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25583139"><span>Cumulative effect of psychosocial factors in youth on ideal <span class="hlt">cardiovascular</span> health in adulthood: the <span class="hlt">Cardiovascular</span> Risk in Young Finns Study.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Pulkki-Råback, Laura; Elovainio, Marko; Hakulinen, Christian; Lipsanen, Jari; Hintsanen, Mirka; Jokela, Markus; Kubzansky, Laura D; Hintsa, Taina; Serlachius, Anna; Laitinen, Tomi T; Laitinen, Tomi; Pahkala, Katja; Mikkilä, Vera; Nevalainen, Jaakko; Hutri-Kähönen, Nina; Juonala, Markus; Viikari, Jorma; Raitakari, Olli T; Keltikangas-Järvinen, Liisa</p> <p>2015-01-20</p> <p>The American Heart Association has defined a new metric of ideal <span class="hlt">cardiovascular</span> health as part of its 2020 Impact Goals. We examined whether psychosocial factors in youth predict ideal <span class="hlt">cardiovascular</span> health in adulthood. Participants were 477 men and 612 women from the nationwide <span class="hlt">Cardiovascular</span> Risk in Young Finns Study. Psychosocial factors were measured from cohorts 3 to 18 years of age at the baseline of the study, and ideal <span class="hlt">cardiovascular</span> health was examined 27 years later in adulthood. The summary measure of psychosocial factors in youth comprised socioeconomic factors, emotional factors, parental health behaviors, stressful events, self-regulation of the child, and social adjustment of the child. There was a positive association between a higher number of favorable psychosocial factors in youth and greater ideal <span class="hlt">cardiovascular</span> health index in adulthood (β=0.16; P<0.001) that persisted after adjustment for age, sex, medication use, and <span class="hlt">cardiovascular</span> risk factors in childhood (β=0.15; P<0.001). The association was monotonic, suggesting that each increment in favorable psychosocial factors was associated with <span class="hlt">improvement</span> in <span class="hlt">cardiovascular</span> health. Of the specific psychosocial factors, a favorable socioeconomic environment (β=0.12; P<0.001) and participants' self-regulatory behavior (β=0.07; P=0.004) were the strongest predictors of ideal <span class="hlt">cardiovascular</span> health in adulthood. The findings suggest a dose-response association between favorable psychosocial factors in youth and <span class="hlt">cardiovascular</span> health in adulthood, as defined by the American Heart Association metrics. The effect seems to persist throughout the range of <span class="hlt">cardiovascular</span> health, potentially shifting the population distribution of <span class="hlt">cardiovascular</span> health rather than simply having effects in a high-risk population. © 2015 American Heart Association, Inc.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/22846415','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/22846415"><span>Risk of <span class="hlt">cardiovascular</span> events in people prescribed glucocorticoids with iatrogenic Cushing's syndrome: cohort study.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Fardet, Laurence; Petersen, Irene; Nazareth, Irwin</p> <p>2012-07-30</p> <p>To investigate whether there is an increased risk of <span class="hlt">cardiovascular</span> events in people who exhibit iatrogenic Cushing's syndrome during treatment with glucocorticoids. Cohort study. 424 UK general <span class="hlt">practices</span> contributing to The Health <span class="hlt">Improvement</span> Network database. People prescribed systemic glucocorticoids and with a diagnosis of iatrogenic Cushing's syndrome (n = 547) and two comparison groups: those prescribed glucocorticoids and with no diagnosis of iatrogenic Cushing's syndrome (n = 3231) and those not prescribed systemic glucocorticoids (n = 3282). Incidence of <span class="hlt">cardiovascular</span> events within a year after diagnosis of iatrogenic Cushing's syndrome or after a randomly selected date, and association between iatrogenic Cushing's syndrome and risk of <span class="hlt">cardiovascular</span> events. 417 <span class="hlt">cardiovascular</span> events occurred in 341 patients. Taking into account only the first event by patient (coronary heart disease n = 177, heart failure n = 101, ischaemic stroke n = 63), the incidence rates of <span class="hlt">cardiovascular</span> events per 100 person years at risk were 15.1 (95% confidence interval 11.8 to 18.4) in those prescribed glucocorticoids and with a diagnosis of iatrogenic Cushing's syndrome, 6.4 (5.5 to 7.3) in those prescribed glucocorticoids without a diagnosis of iatrogenic Cushing's syndrome, and 4.1 (3.4 to 4.8) in those not prescribed glucocorticoids. In multivariate analyses adjusted for sex, age, intensity of glucocorticoid use, underlying disease, smoking status, and use of aspirin, diabetes drugs, antihypertensive drugs, lipid lowering drugs, or oral anticoagulant drugs, the relation between iatrogenic Cushing's syndrome and <span class="hlt">cardiovascular</span> events was strong (adjusted hazard ratios 2.27 (95% confidence interval 1.48 to 3.47) for coronary heart disease, 3.77 (2.41 to 5.90) for heart failure, and 2.23 (0.96 to 5.17) for ischaemic cerebrovascular events). The adjusted hazard ratio for any <span class="hlt">cardiovascular</span> event was 4.16 (2.98 to 5.82) when the group prescribed glucocorticoids and with</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/15630832','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/15630832"><span>Optimal healing environments for chronic <span class="hlt">cardiovascular</span> disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Marshall, Debra A; Walizer, Elaine; Vernalis, Marina N</p> <p>2004-01-01</p> <p>A substantial increase in chronic <span class="hlt">cardiovascular</span> disease is projected for the next several decades. This is attributable to an aging population and accelerated rates of obesity and diabetes. Despite technological advances that have <span class="hlt">improved</span> survival for acute events, there is suboptimal translation of research knowledge for prevention and treatment of chronic <span class="hlt">cardiovascular</span> illness. Beginning with a brief review of the demographics and pathogenesis of atherosclerotic <span class="hlt">cardiovascular</span> disease, this paper discusses the obstacles and approaches to optimal care of patients with chronic <span class="hlt">cardiovascular</span> disease. The novel concept of an optimal healing environment (OHE) is defined and explored as a model for integrative cardiac health care. Aspects generally underexamined in cardiac care such as intrapersonal/interpersonal characteristics of the health care provider and patient, mind/body/spirit wholeness and healing versus curing are discussed, as is the impact psychosocial factors may have on atherosclerosis and <span class="hlt">cardiovascular</span> health. Information from research on the impact of an OHE might renew the healing mission in medicine, reveal new approaches for healing the heart and establish the importance of a heart-mind-body connection.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23735635','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23735635"><span>Physician <span class="hlt">cardiovascular</span> disease risk factor management: <span class="hlt">practice</span> analysis in Japan versus the USA.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Schuster, Richard J; Zhu, Ye; Ogunmoroti, Oluseye; Terwoord, Nancy; Ellison, Sylvia; Fujiyoshi, Akira; Ueshima, Hirotsugu; Muira, Katsuyuki</p> <p>2013-01-01</p> <p>There is a 42% lower <span class="hlt">cardiovascular</span> disease (CVD) death rate in Japan compared with the USA. Do physicians report differences in <span class="hlt">practice</span> management of CVD risk factors in the two countries that might contribute to this difference? CVD risk factor management reported by Japanese versus US primary care physicians was studied. We undertook a descriptive study. An internet-based survey was conducted with physicians from each country. A convenience sample from the Shiga Prefecture in Japan and the state of Ohio in the USA resulted in 48 Japanese and 53 US physicians completing the survey. The survey group may not be representative of a larger sample. The survey demonstrated that 98% of responding Japanese physicians spend <10 minutes performing a patient visit, while 76% of US physicians spend 10 to 20 minutes (P < 0.0001) managing CVD risk factors. Eighty-seven percent of Japanese physicians (vs. 32% of US physicians) see patients in within three months for follow-up (P < 0.0001). Sixty-one percent of Japanese physicians allocate < 30% of visit time to patient education, whereas 60% of US physicians spend > 30% of visit time on patient education (P < 0.0001). Prescriptions are renewed very frequently by Japanese physicians (83% renewing less than monthly) compared with 75% of US physicians who renew medications every one to six months (P < 0.0001). Only 20% of Japanese physicians use <span class="hlt">practice</span> guidelines routinely compared with 50% of US physicians (P = 0.0413). US physicians report disparities in care more frequently (P < 0.0001). Forty-three percent of Japanese (vs. 10% of US) physicians believe that they have relative freedom to practise medicine (P < 0.0001). Many factors undoubtedly affect CVD in different countries. The dominant ones include social determinants of health, genetics, public health and overall culture (which in turn determine diet, exercise and other factors). Yet the medical care system is an expensive component of society and its role in managing</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28980137','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28980137"><span>Lifestyle Medicine and the Management of <span class="hlt">Cardiovascular</span> Disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Doughty, Kimberly N; Del Pilar, Nelson X; Audette, Amanda; Katz, David L</p> <p>2017-10-04</p> <p>Evidence has clearly demonstrated the importance of lifestyle factors (e.g., diet, physical activity, smoking) in the development of <span class="hlt">cardiovascular</span> disease (CVD). Interventions targeting these behaviors may <span class="hlt">improve</span> outcomes for CVD patients. The aim of this review is to summarize the effects of lifestyle interventions in individuals with established CVD. Most recent trials focused on diet, physical activity, stress reduction, or a combination of these. Findings were mixed, but most interventions <span class="hlt">improved</span> at least some markers of <span class="hlt">cardiovascular</span> risk. Few studies measured long-term clinical outcomes, but some suggested a possible benefit of stress reduction and multifaceted interventions on <span class="hlt">cardiovascular</span> events. The benefits of lifestyle change for CVD patients have been established by decades of evidence. However, further research is needed to determine the optimal intensity, duration, and mode of delivery for interventions. Additional studies with long-term follow-up and measurement of clinical outcomes are also needed.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27708350','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27708350"><span>Beatquency domain and machine learning <span class="hlt">improve</span> prediction of <span class="hlt">cardiovascular</span> death after acute coronary syndrome.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Liu, Yun; Scirica, Benjamin M; Stultz, Collin M; Guttag, John V</p> <p>2016-10-06</p> <p>Frequency domain measures of heart rate variability (HRV) are associated with adverse events after a myocardial infarction. However, patterns in the traditional frequency domain (measured in Hz, or cycles per second) may capture different cardiac phenomena at different heart rates. An alternative is to consider frequency with respect to heartbeats, or beatquency. We compared the use of frequency and beatquency domains to predict patient risk after an acute coronary syndrome. We then determined whether machine learning could further <span class="hlt">improve</span> the predictive performance. We first evaluated the use of pre-defined frequency and beatquency bands in a clinical trial dataset (N = 2302) for the HRV risk measure LF/HF (the ratio of low frequency to high frequency power). Relative to frequency, beatquency <span class="hlt">improved</span> the ability of LF/HF to predict <span class="hlt">cardiovascular</span> death within one year (Area Under the Curve, or AUC, of 0.730 vs. 0.704, p < 0.001). Next, we used machine learning to learn frequency and beatquency bands with optimal predictive power, which further <span class="hlt">improved</span> the AUC for beatquency to 0.753 (p < 0.001), but not for frequency. Results in additional validation datasets (N = 2255 and N = 765) were similar. Our results suggest that beatquency and machine learning provide valuable tools in physiological studies of HRV.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28038717','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28038717"><span>American College of Cardiology (ACC)'s PINNACLE India Quality <span class="hlt">Improvement</span> Program (PIQIP)-Inception, progress and future direction: A report from the PIQIP Investigators.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Kalra, Ankur; Glusenkamp, Nathan; Anderson, Karen; Kalra, Ram N; Kerkar, Prafulla G; Kumar, Ganesh; Maddox, Thomas M; Oetgen, William J; Virani, Salim S</p> <p>2016-12-01</p> <p><span class="hlt">Cardiovascular</span> diseases have surpassed infectious disorders to become the leading cause of morbidity and mortality in India. 1 A national-level registry comprehensively documenting the current-day prevalence of <span class="hlt">cardiovascular</span> risk factors and disease burden among patients seeking care in the outpatient setting in India is currently non-existent. With a burgeoning urban population, the <span class="hlt">cardiovascular</span> disease burden in India is set to skyrocket, with an estimated 18 million productive years of life lost by 2030. 2 While there are limited quality <span class="hlt">improvement</span> registries in India, for example, the Kerala acute coronary syndrome and Trivandrum heart failure registries, their focus is on in-patient care quality <span class="hlt">improvement</span>, while the vast majority of patients with <span class="hlt">cardiovascular</span> diseases worldwide, including India, interact with the health care system in the outpatient setting. 3,4 Recognizing this unmet need, the American College of Cardiology partnered with local stakeholders in India to establish India's first outpatient <span class="hlt">cardiovascular</span> disease performance measurement initiative in 2011, the PINNACLE (<span class="hlt">Practice</span> Innovation and Clinical Excellence) India Quality <span class="hlt">Improvement</span> Program (PIQIP). 5 This manuscript discusses the inception of the PIQIP registry, the progress it has made and challenges thus far, and its future direction and the promise it holds for <span class="hlt">cardiovascular</span> care quality <span class="hlt">improvement</span> in India. Copyright © 2016. Published by Elsevier B.V.</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_19");'>19</a></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li class="active"><span>21</span></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li><a href="#" onclick='return showDiv("page_23");'>23</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_21 --> <div id="page_22" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li class="active"><span>22</span></li> <li><a href="#" onclick='return showDiv("page_23");'>23</a></li> <li><a href="#" onclick='return showDiv("page_24");'>24</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="421"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/22780945','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/22780945"><span><span class="hlt">Improving</span> blood transfusion <span class="hlt">practice</span> by regular education in the United Arab Emirates.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Sajwani, F H</p> <p>2012-07-01</p> <p>A cross-match to transfused unit ratio of less than 2.0 is frequently used to assess performance in many hospital blood banks. This brief report was initiated to evaluate the <span class="hlt">practice</span> at a local hospital and to emphasize the importance of regular educational sessions to <span class="hlt">improve</span> blood transfusion <span class="hlt">practice</span>. Retrospective data on cross-match : transfused (C : T) ratio of all departments was collected and educational sessions were given to <span class="hlt">improve</span> <span class="hlt">practice</span>. Thereafter, a new set of data was collected and change in <span class="hlt">practice</span> was assessed. Initial data showed total (C : T) ratio of 1.95. After medical staff education, analysis showed clinically significant <span class="hlt">improvement</span> in blood utilization <span class="hlt">practice</span> with a (C : T) ratio of 1.60. This brief report indicates the importance of regular physician education, the potential role of blood transfusion committee, and the need to implement clear guidelines for blood transfusion. © 2012 American Association of Blood Banks.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4902280','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4902280"><span>Exercise Dose in Clinical <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Wasfy, Meagan; Baggish, Aaron L.</p> <p>2016-01-01</p> <p>There is wide variability in the physical activity patterns of the patients in contemporary clinical <span class="hlt">cardiovascular</span> <span class="hlt">practice</span>. This review is designed to address the impact of exercise dose on key <span class="hlt">cardiovascular</span> risk factors and on mortality. We begin by examining the body of literature that supports a dose-response relationship between exercise and <span class="hlt">cardiovascular</span> disease risk factors including plasma lipids, hypertension, diabetes mellitus, and obesity. We next explore the relationship between exercise dose and mortality by reviewing the relevant epidemiological literature underlying current physical activity guideline recommendations. We then expand this discussion to critically examine recent data pertaining to the impact of exercise dose at the lowest and highest ends of the spectrum. Finally, we provide a framework for how the key concepts of exercise dose can be integrated into clinical <span class="hlt">practice</span>. PMID:27267537</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3489477','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3489477"><span>Dietary nitrite and nitrate: a review of potential mechanisms of <span class="hlt">cardiovascular</span> benefits</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Machha, Ajay</p> <p>2012-01-01</p> <p>Purpose In the last decade, a growing scientific and medical interest has emerged toward <span class="hlt">cardiovascular</span> effects of dietary nitrite and nitrate; however, many questions concerning their mode of action(s) remain unanswered. In this review, we focus on multiple mechanisms that might account for potential <span class="hlt">cardiovascular</span> beneficial effects of dietary nitrite and nitrate. Results Beneficial changes to <span class="hlt">cardiovascular</span> health from dietary nitrite and nitrate might result from several mechanism(s) including their reduction into nitric oxide, <span class="hlt">improvement</span> in endothelial function, vascular relaxation, and/or inhibition of the platelet aggregation. From recently obtained evidence, it appears that the longstanding concerns about the toxicity of oral nitrite or nitrate are overstated. Conclusion Dietary nitrite and nitrate may have <span class="hlt">cardiovascular</span> protective effects in both healthy individuals and also those with <span class="hlt">cardiovascular</span> disease conditions. A role for nitrite and nitrate in nitric oxide biosynthesis and/or in <span class="hlt">improving</span> nitric oxide bioavailability may eventually provide a rationale for using dietary nitrite and nitrate supplementation in the treatment and prevention of <span class="hlt">cardiovascular</span> diseases. PMID:21626413</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3602757','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3602757"><span>Magnetic resonance imaging and spectroscopy of the murine <span class="hlt">cardiovascular</span> system</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Akki, Ashwin; Gupta, Ashish</p> <p>2013-01-01</p> <p>Magnetic resonance imaging (MRI) has emerged as a powerful and reliable tool to noninvasively study the <span class="hlt">cardiovascular</span> system in clinical <span class="hlt">practice</span>. Because transgenic mouse models have assumed a critical role in <span class="hlt">cardiovascular</span> research, technological advances in MRI have been extended to mice over the last decade. These have provided critical insights into cardiac and vascular morphology, function, and physiology/pathophysiology in many murine models of heart disease. Furthermore, magnetic resonance spectroscopy (MRS) has allowed the nondestructive study of myocardial metabolism in both isolated hearts and in intact mice. This article reviews the current techniques and important pathophysiological insights from the application of MRI/MRS technology to murine models of <span class="hlt">cardiovascular</span> disease. PMID:23292717</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/11070736','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/11070736"><span><span class="hlt">Practice</span>-based learning for <span class="hlt">improvement</span>: the pursuit of clinical excellence.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Staker, L V</p> <p>2000-10-01</p> <p>Physicians often seem to be paralyzed waiting for a health plan, a health maintenance organization, or an integrated health care system to bring about change or <span class="hlt">improvement</span> in health care. But small changes in individual <span class="hlt">practices</span> (microsystems) can have a profound impact on outcomes in an organization (microsystem). With simple graphical measurement tools, physicians can teach patients to measure and empower themselves to learn to <span class="hlt">improve</span> both their health and their health care. At the same time, physicians can learn a great deal from their patient population data. When these measurement tools and a well-known and widely accepted method for clinical <span class="hlt">practice</span> <span class="hlt">improvement</span> called rapid cycle testing were used in a population of patients with diabetes, the average fasting blood sugar changed from 187 to 110 and the average hemoglobin A1c from 10.5 to 7.2. This article shows that measurement using specification charts and control charts in patient care can have a profound impact on patients, physicians, and organizations. Understanding these principles and using time-sequence measurement with graphical data feedback, physicians can engage in <span class="hlt">practice</span>-based learning and can participate in <span class="hlt">improvement</span> in the microsystems over which they have control.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25447615','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25447615"><span>The Mediterranean diet, its components, and <span class="hlt">cardiovascular</span> disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Widmer, R Jay; Flammer, Andreas J; Lerman, Lilach O; Lerman, Amir</p> <p>2015-03-01</p> <p>One of the best-studied diets for <span class="hlt">cardiovascular</span> health is the Mediterranean diet. This consists of fish, monounsaturated fats from olive oil, fruits, vegetables, whole grains, legumes/nuts, and moderate alcohol consumption. The Mediterranean diet has been shown to reduce the burden, or even prevent the development, of <span class="hlt">cardiovascular</span> disease, breast cancer, depression, colorectal cancer, diabetes, obesity, asthma, erectile dysfunction, and cognitive decline. This diet is also known to <span class="hlt">improve</span> surrogates of <span class="hlt">cardiovascular</span> disease, such as waist-to-hip ratio, lipids, and markers of inflammation, as well as primary <span class="hlt">cardiovascular</span> disease outcomes such as death and events in both observational and randomized controlled trial data. These enhancements easily rival those seen with more established tools used to fight <span class="hlt">cardiovascular</span> disease such as aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and exercise. However, it is unclear if the Mediterranean diet offers <span class="hlt">cardiovascular</span> disease benefit from its individual constituents or in aggregate. Furthermore, the potential benefit of the Mediterranean diet or its components is not yet validated by concrete <span class="hlt">cardiovascular</span> disease endpoints in randomized trials or observational studies. This review will focus on the effects of the whole and parts of the Mediterranean diet with regard to both population-based and experimental data highlighting <span class="hlt">cardiovascular</span> disease morbidity or mortality and <span class="hlt">cardiovascular</span> disease surrogates when hard outcomes are not available. Our synthesis will highlight the potential for the Mediterranean diet to act as a key player in <span class="hlt">cardiovascular</span> disease prevention, and attempt to identify certain aspects of the diet that are particularly beneficial for cardioprotection. Copyright © 2015 Elsevier Inc. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24084492','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24084492"><span>Sleep apnea and <span class="hlt">cardiovascular</span> risk.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Floras, John S</p> <p>2014-01-01</p> <p>Sleep apnea is evident in approximately 10% of adults in the general population, but in certain <span class="hlt">cardiovascular</span> diseases, and in particular those characterized by sodium and water retention, its prevalence can exceed 50%. Although sleep apnea is not as yet integrated into formal <span class="hlt">cardiovascular</span> risk assessment algorithms, there is increasing awareness of its importance in the causation or promotion of hypertension, coronary artery disease, heart failure, atrial arrhythmias, and stroke, and thus, not surprisingly, as a predictor of premature <span class="hlt">cardiovascular</span> death. Sleep apnea manifests as two principal phenotypes, both characterized by respiratory instability: obstructive (OSA), which arises when sleep-related withdrawal of respiratory drive to the upper airway dilator muscles is superimposed upon a narrow and highly compliant airway predisposed to collapse, and central (CSA), which occurs when the partial pressure of arterial carbon dioxide falls below the apnea threshold, resulting in withdrawal of central drive to respiratory muscles. The present objectives are to: (1) review the epidemiology and patho-physiology of OSA and CSA, with particular emphasis on the role of renal sodium retention in initiating and promoting these processes, and on population studies that reveal the long-term consequences of untreated OSA and CSA; (2) illustrate mechanical, autonomic, chemical, and inflammatory mechanisms by which OSA and CSA can increase <span class="hlt">cardiovascular</span> risk and event rates by initiating or promoting hypertension, atherosclerosis, coronary artery disease, heart failure, arrhythmias, and stroke; (3) highlight insights from randomized trials in which treating sleep apnea was the specific target of therapy; (4) emphasize the present lack of evidence that treating sleep apnea reduces <span class="hlt">cardiovascular</span> risk and the current clinical equipoise concerning treatment of asymptomatic patients with sleep apnea; and (5) consider clinical implications and future directions of clinical</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28847593','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28847593"><span>Evidence of Dietary <span class="hlt">Improvement</span> and Preventable Costs of <span class="hlt">Cardiovascular</span> Disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Zhang, Donglan; Cogswell, Mary E; Wang, Guijing; Bowman, Barbara A</p> <p>2017-11-01</p> <p>We conducted a review to summarize preventable medical costs of <span class="hlt">cardiovascular</span> disease (CVD) associated with <span class="hlt">improved</span> diet, as defined by the 2020 Strategic Impact Goal of the American Heart Association. We searched databases of PubMed, Embase, CINAHL and ABI/INFORM to identify population-based studies published from January 1995 to December 2015 on CVD medical costs related to excess intake of salt/sodium or sugar-sweetened beverages, and inadequate intake of fruits and vegetables, fish/fish oils/omega-3 fatty acids, or whole grains/fiber/dietary fiber. Based on the American Heart Association's secondary dietary metrics, we also searched the literature on inadequate intake of nuts and excess intake of processed meat and saturated fat. For each component, we evaluated the CVD cost savings if consumption levels were changed. The cost savings were adjusted into 2013 US dollars. Among 330 studies focusing on diet and economic consequences, 16 studies evaluated CVD costs associated with 1 or more dietary components: salt/sodium (n = 13), fruits and vegetables (n = 1), meat (n = 1), and saturated fat (n = 3). In the United States, reducing individual sodium intake to 2,300 mg/day from the current level could potentially save $1,990.9/person per year for hypertension treatment, based on a simulation study. Increasing consumption of fruits and vegetables from <0.5 cup/day to >1.5 cups/day could save $1,568.0/person per year in treatment costs for CVD, based on a cohort study. Potential CVD cost savings associated with diet <span class="hlt">improvement</span> are substantial. Interventions for reducing sodium intake and increasing fruit and vegetable consumption could be viable means to alleviate the increasing national medical expenditures. Published by Elsevier Inc.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/12414478','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/12414478"><span>Definitions and competencies for <span class="hlt">practice</span>-based learning and <span class="hlt">improvement</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Hayden, Stephen R; Dufel, Susan; Shih, Richard</p> <p>2002-11-01</p> <p>The Outcome Project is a long-term initiative by which the Accreditation Council for Graduate Medical Education (ACGME) is increasing emphasis on educational outcomes in the evaluation of residency programs. The ACGME initiated the Outcome Project to "ensure and <span class="hlt">improve</span> the quality of graduate medical education." In order to assist program directors in emergency medicine (EM) to begin complying with components of the ACGME Outcome Project, the Council of Residency Directors in Emergency Medicine (CORD-EM) convened a consensus conference in March 2002 in conjunction with several other EM organizations. The working group for the competency of <span class="hlt">Practice</span>-based Learning and <span class="hlt">Improvement</span> (PBL) defined the components of PBL as: 1) analyze and assess <span class="hlt">practice</span> experience and perform <span class="hlt">practice</span>-based <span class="hlt">improvement</span>; 2) locate, appraise, and utilize scientific evidence related to the patient's health problems and the larger population from which they are drawn; 3) apply knowledge of study design and statistical methods to critically appraise the medical literature; 4) utilize information technology to enhance personal education and <span class="hlt">improve</span> patient care; and 5) facilitate the learning of students, colleagues, and other health care professionals in EM principles and <span class="hlt">practice</span>. Establishing resident portfolios is a preferred method to chronicle resident competence in PBL. Traditional global evaluation of resident performance is de-emphasized. Checklist evaluation is appropriate for assessing any competency that can be broken down into specific behaviors or actions. 360-degree evaluation may be used to assess teamwork, communication skills, management skills, and clinical decision making. Chart-stimulated recall and record review are additional evaluation methods that can be used to assess resident competency in PBL. Simulations and models, such as computer-based scenarios, may be ideal for low-frequency but critical procedures.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5378509','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5378509"><span>Regional variations in ambulatory care and incidence of <span class="hlt">cardiovascular</span> events</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Tu, Jack V.; Chu, Anna; Maclagan, Laura; Austin, Peter C.; Johnston, Sharon; Ko, Dennis T.; Cheung, Ingrid; Atzema, Clare L.; Booth, Gillian L.; Bhatia, R. Sacha; Lee, Douglas S.; Jackevicius, Cynthia A.; Kapral, Moira K.; Tu, Karen; Wijeysundera, Harindra C.; Alter, David A.; Udell, Jacob A.; Manuel, Douglas G.; Mondal, Prosanta; Hogg, William</p> <p>2017-01-01</p> <p>BACKGROUND: Variations in the prevalence of traditional cardiac risk factors only partially account for geographic variations in the incidence of <span class="hlt">cardiovascular</span> disease. We examined the extent to which preventive ambulatory health care services contribute to geographic variations in <span class="hlt">cardiovascular</span> event rates. METHODS: We conducted a cohort study involving 5.5 million patients aged 40 to 79 years in Ontario, Canada, with no hospital stays for <span class="hlt">cardiovascular</span> disease as of January 2008, through linkage of multiple population-based health databases. The primary outcome was the occurrence of a major <span class="hlt">cardiovascular</span> event (myocardial infarction, stroke or <span class="hlt">cardiovascular</span>-related death) over the following 5 years. We compared patient demographics, cardiac risk factors and ambulatory health care services across the province’s 14 health service regions, known as Local Health Integration Networks (LHINs), and evaluated the contribution of these variables to regional variations in <span class="hlt">cardiovascular</span> event rates. RESULTS: <span class="hlt">Cardiovascular</span> event rates across LHINs varied from 3.2 to 5.7 events per 1000 person-years. Compared with residents of high-rate LHINs, those of low-rate health regions received physician services more often (e.g., 4.2 v. 3.5 mean annual family physician visits, p value for LHIN-level trend = 0.01) and were screened for risk factors more often. Low-rate LHINs were also more likely to achieve treatment targets for hypercholes-terolemia (51.8% v. 49.6% of patients, p = 0.03) and controlled hypertension (67.4% v. 53.3%, p = 0.04). Differences in patient and health system factors accounted for 74.5% of the variation in events between LHINs, of which 15.5% was attributable to health system factors alone. INTERPRETATION: Preventive ambulatory health care services were provided more frequently in health regions with lower <span class="hlt">cardiovascular</span> event rates. Health system interventions to <span class="hlt">improve</span> equitable access to preventive care might <span class="hlt">improve</span> <span class="hlt">cardiovascular</span> outcomes. PMID</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/22083220','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/22083220"><span><span class="hlt">Cardiovascular</span> safety of biologic therapies for the treatment of RA.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Greenberg, Jeffrey D; Furer, Victoria; Farkouh, Michael E</p> <p>2011-11-15</p> <p><span class="hlt">Cardiovascular</span> disease represents a major source of extra-articular comorbidity in patients with rheumatoid arthritis (RA). A combination of traditional <span class="hlt">cardiovascular</span> risk factors and RA-related factors accounts for the excess risk in RA. Among RA-related factors, chronic systemic inflammation has been implicated in the pathogenesis and progression of atherosclerosis. A growing body of evidence--mainly derived from observational databases and registries--suggests that specific RA therapies, including methotrexate and anti-TNF biologic agents, can reduce the risk of future <span class="hlt">cardiovascular</span> events in patients with RA. The <span class="hlt">cardiovascular</span> profile of other biologic therapies for the treatment of RA has not been adequately studied, including of investigational drugs that <span class="hlt">improve</span> systemic inflammation but alter traditional <span class="hlt">cardiovascular</span> risk factors. In the absence of large clinical trials adequately powered to detect differences in <span class="hlt">cardiovascular</span> events between biologic drugs in RA, deriving firm conclusions on <span class="hlt">cardiovascular</span> safety is challenging. Nevertheless, observational research using large registries has emerged as a promising approach to study the <span class="hlt">cardiovascular</span> risk of emerging RA biologic therapies.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4747916','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4747916"><span>Fibroblast growth factors in <span class="hlt">cardiovascular</span> disease: The emerging role of FGF21</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Domouzoglou, Eleni M.; Naka, Katerina K.; Vlahos, Antonios P.; Papafaklis, Michail I.; Michalis, Lampros K.; Tsatsoulis, Agathoklis</p> <p>2015-01-01</p> <p>Early detection of risk factors for enhanced primary prevention and novel therapies for treating the chronic consequences of <span class="hlt">cardiovascular</span> disease are of the utmost importance for reducing morbidity. Recently, fibroblast growth factors (FGFs) have been intensively studied as potential new molecules in the prevention and treatment of <span class="hlt">cardiovascular</span> disease mainly attributable to metabolic effects and angiogenic actions. Members of the endocrine FGF family have been shown to increase metabolic rate, decrease adiposity, and restore glucose homeostasis, suggesting a multiple metabolic role. Serum levels of FGFs have been associated with established <span class="hlt">cardiovascular</span> risk factors as well as with the severity and extent of coronary artery disease and could be useful for prediction of <span class="hlt">cardiovascular</span> death. Furthermore, preclinical investigations and clinical trials have tested FGF administration for therapeutic angiogenesis in ischemic vascular disease, demonstrating a potential role in <span class="hlt">improving</span> angina and limb function. FGF21 has lately emerged as a potent metabolic regulator with multiple effects that ultimately <span class="hlt">improve</span> the lipoprotein profile. Early studies show that FGF21 is associated with the presence of atherosclerosis and may play a protective role against plaque formation by <span class="hlt">improving</span> endothelial function. The present review highlights recent investigations suggesting that FGFs, in particular FGF21, may be useful as markers of <span class="hlt">cardiovascular</span> risk and may also serve as protective/therapeutic agents in <span class="hlt">cardiovascular</span> disease. PMID:26232236</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26232236','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26232236"><span>Fibroblast growth factors in <span class="hlt">cardiovascular</span> disease: The emerging role of FGF21.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Domouzoglou, Eleni M; Naka, Katerina K; Vlahos, Antonios P; Papafaklis, Michail I; Michalis, Lampros K; Tsatsoulis, Agathoklis; Maratos-Flier, Eleftheria</p> <p>2015-09-15</p> <p>Early detection of risk factors for enhanced primary prevention and novel therapies for treating the chronic consequences of <span class="hlt">cardiovascular</span> disease are of the utmost importance for reducing morbidity. Recently, fibroblast growth factors (FGFs) have been intensively studied as potential new molecules in the prevention and treatment of <span class="hlt">cardiovascular</span> disease mainly attributable to metabolic effects and angiogenic actions. Members of the endocrine FGF family have been shown to increase metabolic rate, decrease adiposity, and restore glucose homeostasis, suggesting a multiple metabolic role. Serum levels of FGFs have been associated with established <span class="hlt">cardiovascular</span> risk factors as well as with the severity and extent of coronary artery disease and could be useful for prediction of <span class="hlt">cardiovascular</span> death. Furthermore, preclinical investigations and clinical trials have tested FGF administration for therapeutic angiogenesis in ischemic vascular disease, demonstrating a potential role in <span class="hlt">improving</span> angina and limb function. FGF21 has lately emerged as a potent metabolic regulator with multiple effects that ultimately <span class="hlt">improve</span> the lipoprotein profile. Early studies show that FGF21 is associated with the presence of atherosclerosis and may play a protective role against plaque formation by <span class="hlt">improving</span> endothelial function. The present review highlights recent investigations suggesting that FGFs, in particular FGF21, may be useful as markers of <span class="hlt">cardiovascular</span> risk and may also serve as protective/therapeutic agents in <span class="hlt">cardiovascular</span> disease. Copyright © 2015 the American Physiological Society.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3765342','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3765342"><span>Management of diabetes mellitus and associated <span class="hlt">cardiovascular</span> risk factors in Brazil – the Brazilian study on the <span class="hlt">practice</span> of diabetes care</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2013-01-01</p> <p>Background The Brazilian Study on the <span class="hlt">Practice</span> of Diabetes Care main objective was to provide an epidemiological profile of individuals with type 1 and 2 diabetes mellitus (DM) in Brazil, concerning therapy and adherence to international guidelines in the medical <span class="hlt">practice</span>. Methods This observational, cross-sectional, multicenter study collected and analyzed data from individuals with type 1 and 2 DM attending public or private clinics in Brazil. Each investigator included the first 10 patients with type 2 DM who visited his/her office, and the first 5 patients with type 1 DM. Results A total of 1,358 patients were analyzed; 375 (27.6%) had type 1 and 983 (72.4%) had type 2 DM. Most individuals were women, Caucasian, and private health care users. High prevalence rates of hypertension, dyslipidemia and central obesity were observed, particularly in type 2 DM. Only 7.3% and 5.1% of the individuals with types 1 and 2 DM, respectively, had optimal control of blood pressure, plasma glucose and lipids. The absence of hypertension and female sex were associated with better control of type 1 DM and other <span class="hlt">cardiovascular</span> risk factors. In type 2 DM, older age was also associated with better control. Conclusions Female sex, older age, and absence of hypertension were associated with better metabolic control. An optimal control of plasma glucose and other <span class="hlt">cardiovascular</span> risk factors are obtained only in a minority of individuals with diabetes. Local numbers, compared to those from other countries are worse. PMID:23972112</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29699206','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29699206"><span><span class="hlt">Cardiovascular</span> consequences of hormone therapy in postmenopausal women: Messages to clinicians.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Ylikorkala, O; Mikkola, T</p> <p>2005-03-01</p> <p>Results from the recent randomized clinical trials indicating that hormone therapy (HT) does not provide <span class="hlt">cardiovascular</span> protection, but potentially harm are in profound disagreement with the sound evidence from numerous observational and experimental studies. While the observational studies have mainly assessed symptomatic recently menopausal women, the randomized trials have studied symptomless elderly postmenopausal women with established coronary heart disease or various risk factors for <span class="hlt">cardiovascular</span> disease. Therefore, the recent trials have only revealed that HT does not provide secondary <span class="hlt">cardiovascular</span> benefits. Since primary <span class="hlt">cardiovascular</span> benefits of HT are rational but not yet proven in clinical trials, new studies are in demand. Until more data from recently menopausal symptomatic women are available, we need to base our decisions on existing evidence and good clinical <span class="hlt">practice</span>. Although the potential of HT to provide <span class="hlt">cardiovascular</span> benefits is decreased by advancing age and time since menopause, this should not preclude the use of individualized HT in younger postmenopausal women. (Reprod Med Biol 2005; 4 : 1- 6).</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3807633','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3807633"><span>The management of <span class="hlt">cardiovascular</span> disease in the Netherlands: analysis of different programmes</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Cramm, Jane M.; Tsiachristas, Apostolos; Walters, Bethany H.; Adams, Samantha A.; Bal, Roland; Huijsman, Robbert; Rutten-Van Mölken, Maureen P.M.H.; Nieboer, Anna P.</p> <p>2013-01-01</p> <p>Background Disease management programmes are increasingly used to <span class="hlt">improve</span> the efficacy and effectiveness of chronic care delivery. But, disease management programme development and implementation is a complex undertaking that requires effective decision-making. Choices made in the earliest phases of programme development are crucial, as they ultimately impact costs, outcomes and sustainability. Methods To increase our understanding of the choices that primary healthcare <span class="hlt">practices</span> face when implementing such programmes and to stimulate successful implementation and sustainability, we compared the early implementation of eight <span class="hlt">cardiovascular</span> disease management programmes initiated and managed by healthcare <span class="hlt">practices</span> in various regions of the Netherlands. Using a mixed-methods design, we identified differences in and challenges to programme implementation in terms of context, patient characteristics, disease management level, healthcare utilisation costs, development costs and health-related quality of life. Results Shifting to a multidisciplinary, patient-centred care pathway approach to disease management is demanding for organisations, professionals and patients, and is especially vulnerable when sustainable change is the goal. Funding is an important barrier to sustainable implementation of <span class="hlt">cardiovascular</span> disease management programmes, although development costs of the individual programmes varied considerably in relation to the length of the development period. The large number of professionals involved in combination with duration of programme development was the largest cost drivers. While Information and Communication Technology systems to support the new care pathways did not directly contribute to higher costs, delays in implementation indirectly did. Conclusions Developing and implementing <span class="hlt">cardiovascular</span> disease management programmes is time-consuming and challenging. Multidisciplinary, patient-centred care demands multifaceted changes in routine care. As</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24167456','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24167456"><span>The management of <span class="hlt">cardiovascular</span> disease in the Netherlands: analysis of different programmes.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Cramm, Jane M; Tsiachristas, Apostolos; Walters, Bethany H; Adams, Samantha A; Bal, Roland; Huijsman, Robbert; Rutten-Van Mölken, Maureen P M H; Nieboer, Anna P</p> <p>2013-01-01</p> <p>Disease management programmes are increasingly used to <span class="hlt">improve</span> the efficacy and effectiveness of chronic care delivery. But, disease management programme development and implementation is a complex undertaking that requires effective decision-making. Choices made in the earliest phases of programme development are crucial, as they ultimately impact costs, outcomes and sustainability. To increase our understanding of the choices that primary healthcare <span class="hlt">practices</span> face when implementing such programmes and to stimulate successful implementation and sustainability, we compared the early implementation of eight <span class="hlt">cardiovascular</span> disease management programmes initiated and managed by healthcare <span class="hlt">practices</span> in various regions of the Netherlands. Using a mixed-methods design, we identified differences in and challenges to programme implementation in terms of context, patient characteristics, disease management level, healthcare utilisation costs, development costs and health-related quality of life. Shifting to a multidisciplinary, patient-centred care pathway approach to disease management is demanding for organisations, professionals and patients, and is especially vulnerable when sustainable change is the goal. Funding is an important barrier to sustainable implementation of <span class="hlt">cardiovascular</span> disease management programmes, although development costs of the individual programmes varied considerably in relation to the length of the development period. The large number of professionals involved in combination with duration of programme development was the largest cost drivers. While Information and Communication Technology systems to support the new care pathways did not directly contribute to higher costs, delays in implementation indirectly did. Developing and implementing <span class="hlt">cardiovascular</span> disease management programmes is time-consuming and challenging. Multidisciplinary, patient-centred care demands multifaceted changes in routine care. As care pathways become more complex, they</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21442376','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21442376"><span><span class="hlt">Improvement</span> of insulin resistance and reduction of <span class="hlt">cardiovascular</span> risk among obese patients with type 2 diabetes with the duodenojejunal bypass liner.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>de Moura, Eduardo Guimarães Hourneaux; Orso, Ivan Roberto Bonotto; Martins, Bruno da Costa; Lopes, Guilherme Sauniti; de Oliveira, Suzana Lopes; Galvão-Neto, Manoel dos Passos; Mancini, Marcio Correa; Santo, Marco Aurélio; Sakai, Paulo; Ramos, Almino Cardoso; Garrido-Júnior, Arthur Belarmino; Halpern, Alfredo; Cecconello, Ivan</p> <p>2011-07-01</p> <p>This study aims to evaluate the effectiveness of the duodenojejunal bypass liner (DJBL) in the <span class="hlt">improvement</span> of insulin resistance and reduction of <span class="hlt">cardiovascular</span> risk among morbidly obese patients with type 2 diabetes mellitus, using the triglyceride/high-density lipoprotein (HDL) cholesterol ratio, percentage of weight loss, and glycemic control. We used the TG/HDL ratio with a cutoff value of 3.5 to identify patients with insulin resistance. The value of the initial ratio was compared with the ratio obtained 6 months after implantation to evaluate whether an <span class="hlt">improvement</span> in insulin resistance occurred. We also evaluated the <span class="hlt">improvement</span> of glycated hemoglobin levels and the weight loss resulted from the use of the device and correlated that with the <span class="hlt">improvement</span> of the TG/HDL ratio. All patients implanted with the device presented a statistically significant reduction of the HbA1c levels, with most patients (70.3%) obtaining diabetes control with HbA1c levels lower than 7% at the end of the study. All patients also presented a significant weight reduction, with an average loss of 12.6% of their initial weight. We observed an important <span class="hlt">improvement</span> in insulin resistance and metabolic syndrome, with a significant reduction of the TG/HDL ratio from 5.75 to 4.36 (p < 0.001) and 42.6% of the patients presenting a TG/HDL ratio lower than 3.5 at the end of the study. The DJBL, when used for a period of 6 months, is effective in the control of diabetes, weight loss, <span class="hlt">improvement</span> of insulin resistance, and decrease of <span class="hlt">cardiovascular</span> risk among morbidly obese patients with type 2 diabetes mellitus.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24668104','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24668104"><span>Glycated hemoglobin measurement and prediction of <span class="hlt">cardiovascular</span> disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Di Angelantonio, Emanuele; Gao, Pei; Khan, Hassan; Butterworth, Adam S; Wormser, David; Kaptoge, Stephen; Kondapally Seshasai, Sreenivasa Rao; Thompson, Alex; Sarwar, Nadeem; Willeit, Peter; Ridker, Paul M; Barr, Elizabeth L M; Khaw, Kay-Tee; Psaty, Bruce M; Brenner, Hermann; Balkau, Beverley; Dekker, Jacqueline M; Lawlor, Debbie A; Daimon, Makoto; Willeit, Johann; Njølstad, Inger; Nissinen, Aulikki; Brunner, Eric J; Kuller, Lewis H; Price, Jackie F; Sundström, Johan; Knuiman, Matthew W; Feskens, Edith J M; Verschuren, W M M; Wald, Nicholas; Bakker, Stephan J L; Whincup, Peter H; Ford, Ian; Goldbourt, Uri; Gómez-de-la-Cámara, Agustín; Gallacher, John; Simons, Leon A; Rosengren, Annika; Sutherland, Susan E; Björkelund, Cecilia; Blazer, Dan G; Wassertheil-Smoller, Sylvia; Onat, Altan; Marín Ibañez, Alejandro; Casiglia, Edoardo; Jukema, J Wouter; Simpson, Lara M; Giampaoli, Simona; Nordestgaard, Børge G; Selmer, Randi; Wennberg, Patrik; Kauhanen, Jussi; Salonen, Jukka T; Dankner, Rachel; Barrett-Connor, Elizabeth; Kavousi, Maryam; Gudnason, Vilmundur; Evans, Denis; Wallace, Robert B; Cushman, Mary; D'Agostino, Ralph B; Umans, Jason G; Kiyohara, Yutaka; Nakagawa, Hidaeki; Sato, Shinichi; Gillum, Richard F; Folsom, Aaron R; van der Schouw, Yvonne T; Moons, Karel G; Griffin, Simon J; Sattar, Naveed; Wareham, Nicholas J; Selvin, Elizabeth; Thompson, Simon G; Danesh, John</p> <p>2014-03-26</p> <p>The value of measuring levels of glycated hemoglobin (HbA1c) for the prediction of first <span class="hlt">cardiovascular</span> events is uncertain. To determine whether adding information on HbA1c values to conventional <span class="hlt">cardiovascular</span> risk factors is associated with <span class="hlt">improvement</span> in prediction of <span class="hlt">cardiovascular</span> disease (CVD) risk. Analysis of individual-participant data available from 73 prospective studies involving 294,998 participants without a known history of diabetes mellitus or CVD at the baseline assessment. Measures of risk discrimination for CVD outcomes (eg, C-index) and reclassification (eg, net reclassification <span class="hlt">improvement</span>) of participants across predicted 10-year risk categories of low (<5%), intermediate (5% to <7.5%), and high (≥ 7.5%) risk. During a median follow-up of 9.9 (interquartile range, 7.6-13.2) years, 20,840 incident fatal and nonfatal CVD outcomes (13,237 coronary heart disease and 7603 stroke outcomes) were recorded. In analyses adjusted for several conventional <span class="hlt">cardiovascular</span> risk factors, there was an approximately J-shaped association between HbA1c values and CVD risk. The association between HbA1c values and CVD risk changed only slightly after adjustment for total cholesterol and triglyceride concentrations or estimated glomerular filtration rate, but this association attenuated somewhat after adjustment for concentrations of high-density lipoprotein cholesterol and C-reactive protein. The C-index for a CVD risk prediction model containing conventional <span class="hlt">cardiovascular</span> risk factors alone was 0.7434 (95% CI, 0.7350 to 0.7517). The addition of information on HbA1c was associated with a C-index change of 0.0018 (0.0003 to 0.0033) and a net reclassification <span class="hlt">improvement</span> of 0.42 (-0.63 to 1.48) for the categories of predicted 10-year CVD risk. The <span class="hlt">improvement</span> provided by HbA1c assessment in prediction of CVD risk was equal to or better than estimated <span class="hlt">improvements</span> for measurement of fasting, random, or postload plasma glucose levels. In a study of individuals</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4386007','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4386007"><span>Glycated Hemoglobin Measurement and Prediction of <span class="hlt">Cardiovascular</span> Disease</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Angelantonio, Emanuele Di; Gao, Pei; Khan, Hassan; Butterworth, Adam S.; Wormser, David; Kaptoge, Stephen; Kondapally Seshasai, Sreenivasa Rao; Thompson, Alex; Sarwar, Nadeem; Willeit, Peter; Ridker, Paul M; Barr, Elizabeth L.M.; Khaw, Kay-Tee; Psaty, Bruce M.; Brenner, Hermann; Balkau, Beverley; Dekker, Jacqueline M.; Lawlor, Debbie A.; Daimon, Makoto; Willeit, Johann; Njølstad, Inger; Nissinen, Aulikki; Brunner, Eric J.; Kuller, Lewis H.; Price, Jackie F.; Sundström, Johan; Knuiman, Matthew W.; Feskens, Edith J. M.; Verschuren, W. M. M.; Wald, Nicholas; Bakker, Stephan J. L.; Whincup, Peter H.; Ford, Ian; Goldbourt, Uri; Gómez-de-la-Cámara, Agustín; Gallacher, John; Simons, Leon A.; Rosengren, Annika; Sutherland, Susan E.; Björkelund, Cecilia; Blazer, Dan G.; Wassertheil-Smoller, Sylvia; Onat, Altan; Marín Ibañez, Alejandro; Casiglia, Edoardo; Jukema, J. Wouter; Simpson, Lara M.; Giampaoli, Simona; Nordestgaard, Børge G.; Selmer, Randi; Wennberg, Patrik; Kauhanen, Jussi; Salonen, Jukka T.; Dankner, Rachel; Barrett-Connor, Elizabeth; Kavousi, Maryam; Gudnason, Vilmundur; Evans, Denis; Wallace, Robert B.; Cushman, Mary; D’Agostino, Ralph B.; Umans, Jason G.; Kiyohara, Yutaka; Nakagawa, Hidaeki; Sato, Shinichi; Gillum, Richard F.; Folsom, Aaron R.; van der Schouw, Yvonne T.; Moons, Karel G.; Griffin, Simon J.; Sattar, Naveed; Wareham, Nicholas J.; Selvin, Elizabeth; Thompson, Simon G.; Danesh, John</p> <p>2015-01-01</p> <p>IMPORTANCE The value of measuring levels of glycated hemoglobin (HbA1c) for the prediction of first <span class="hlt">cardiovascular</span> events is uncertain. OBJECTIVE To determine whether adding information on HbA1c values to conventional <span class="hlt">cardiovascular</span> risk factors is associated with <span class="hlt">improvement</span> in prediction of <span class="hlt">cardiovascular</span> disease (CVD) risk. DESIGN, SETTING, AND PARTICIPANTS Analysis of individual-participant data available from 73 prospective studies involving 294 998 participants without a known history of diabetes mellitus or CVD at the baseline assessment. MAIN OUTCOMES AND MEASURES Measures of risk discrimination for CVD outcomes (eg, C-index) and reclassification (eg, net reclassification <span class="hlt">improvement</span>) of participants across predicted 10-year risk categories of low (<5%), intermediate (5%to <7.5%), and high (≥7.5%) risk. RESULTS During a median follow-up of 9.9 (interquartile range, 7.6-13.2) years, 20 840 incident fatal and nonfatal CVD outcomes (13 237 coronary heart disease and 7603 stroke outcomes) were recorded. In analyses adjusted for several conventional <span class="hlt">cardiovascular</span> risk factors, there was an approximately J-shaped association between HbA1c values and CVD risk. The association between HbA1c values and CVD risk changed only slightly after adjustment for total cholesterol and triglyceride concentrations or estimated glomerular filtration rate, but this association attenuated somewhat after adjustment for concentrations of high-density lipoprotein cholesterol and C-reactive protein. The C-index for a CVD risk prediction model containing conventional <span class="hlt">cardiovascular</span> risk factors alone was 0.7434 (95% CI, 0.7350 to 0.7517). The addition of information on HbA1c was associated with a C-index change of 0.0018 (0.0003 to 0.0033) and a net reclassification <span class="hlt">improvement</span> of 0.42 (−0.63 to 1.48) for the categories of predicted 10-year CVD risk. The <span class="hlt">improvement</span> provided by HbA1c assessment in prediction of CVD risk was equal to or better than estimated <span class="hlt">improvements</span> for</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_20");'>20</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li class="active"><span>22</span></li> <li><a href="#" onclick='return showDiv("page_23");'>23</a></li> <li><a href="#" onclick='return showDiv("page_24");'>24</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_22 --> <div id="page_23" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li class="active"><span>23</span></li> <li><a href="#" onclick='return showDiv("page_24");'>24</a></li> <li><a href="#" onclick='return showDiv("page_25");'>25</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="441"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/18295445','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/18295445"><span><span class="hlt">Cardiovascular</span> exercise intervention <span class="hlt">improves</span> the primary antibody response to keyhole limpet hemocyanin (KLH) in previously sedentary older adults.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Grant, R W; Mariani, R A; Vieira, V J; Fleshner, M; Smith, T P; Keylock, K T; Lowder, T W; McAuley, E; Hu, L; Chapman-Novakofski, K; Woods, J A</p> <p>2008-08-01</p> <p>Based upon a prior cross-sectional study, we hypothesized that an aerobic exercise intervention in sedentary older adults would <span class="hlt">improve</span> a primary T cell-dependent immune response. Participants were a subset of older subjects from a large, ongoing exercise intervention study who were randomly assigned to either an aerobic exercise (Cardio, n=30, 68.9+0.8 years) or flexibility/balance (Flex, n=20, 69.9+1.2 years) intervention. The intervention consisted of either three aerobic sessions for 30-60 min at 55-70% VO(2 max) or two 60 min flexibility/balance sessions weekly for 10 months. Eight months into the intervention, samples were collected before intramuscular administration of KLH (125 microg), followed by sampling at 2, 3, and 6 weeks post-KLH. Serum anti-KLH IgM, IgG1, and IgG2 was measured by ELISA. Physiological and psychosocial measures were also assessed pre- and post-intervention. While there was no difference in the anti-KLH IgG2 response between groups, Cardio displayed significantly (p<0.05) higher anti-KLH IgG1 (at weeks 2, 3, and 6 post) and IgM responses when compared to Flex. Despite <span class="hlt">cardiovascular</span> intervention-induced <span class="hlt">improvement</span> in physical fitness (approximately 11% vs. 1% change in VO(2 peak) in Cardio vs. Flex, respectively), we found no relationship between <span class="hlt">improved</span> fitness and enhanced anti-KLH antibody responses. Optimism, perceived stress, and affect were all associated with enhanced immune response. We have shown for the first time that <span class="hlt">cardiovascular</span> training in previously sedentary elderly results in significantly higher primary IgG1 and IgM antibody responses, while having no effect on IgG2 production.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28167710','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28167710"><span>Workplace Programs, Policies, And Environmental Supports To Prevent <span class="hlt">Cardiovascular</span> Disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Goetzel, Ron Z; Henke, Rachel Mosher; Head, Michael A; Benevent, Richele; Calitz, Chris</p> <p>2017-02-01</p> <p>Using a novel approach, we provide a preliminary "snapshot" of how the comprehensiveness of workplace <span class="hlt">cardiovascular</span> health initiatives is related to measures of employees' health risks, disease prevalence, and medical expenditures. We linked scores for the twenty large organizations that voluntarily completed the American Heart Association's newly launched Worksite Health Achievement Index (WHAI) for 2015 to individual-level MarketScan® data for 373,478 of their workers with employer benefits that year. Higher aggregate WHAI scores were associated with lower values for four of seven modifiable indicators of <span class="hlt">cardiovascular</span> risk and a higher value for one. Although also associated with lower prevalence of <span class="hlt">cardiovascular</span> disease, higher aggregate scores were associated with higher spending on the condition. These and other findings provide useful benchmarks and norms for employer <span class="hlt">practices</span> related to <span class="hlt">cardiovascular</span> disease prevention. As employers continue to complete the annual WHAI, we expect to gain further insights into the policies, programs, and environmental supports employers can implement to positively influence <span class="hlt">cardiovascular</span> health and related spending. Project HOPE—The People-to-People Health Foundation, Inc.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29581366','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29581366"><span><span class="hlt">Cardiovascular</span> and Metabolic Heterogeneity of Obesity: Clinical Challenges and Implications for Management.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Neeland, Ian J; Poirier, Paul; Després, Jean-Pierre</p> <p>2018-03-27</p> <p>The prevalence of obesity has increased globally over the last 2 decades. Although the body mass index has been a convenient and simple index of obesity at the population level, studies have shown that obesity defined by body mass index alone is a remarkably heterogeneous condition with varying <span class="hlt">cardiovascular</span> and metabolic manifestations across individuals. Adipose tissue is an exquisitely active metabolic organ engaged in cross-talk between various systems; perturbation of adipose tissue results in a pathological response to positive caloric balance in susceptible individuals that directly and indirectly contributes to <span class="hlt">cardiovascular</span> and metabolic disease. Inadequate subcutaneous adipose tissue expansion in the face of dietary triglycerides leads to visceral and ectopic fat deposition, inflammatory/adipokine dysregulation, and insulin resistance. Conversely, preferential fat storage in the lower body depot may act as a metabolic buffer and protect other tissues from lipotoxicity caused by lipid overflow and ectopic fat. Translational, epidemiological, and clinical studies over the past 30 years have clearly demonstrated a strong link between visceral and ectopic fat and the development of a clinical syndrome characterized by atherogenic dyslipidemia, hyperinsulinemia/glucose intolerance, hypertension, atherosclerosis, and adverse cardiac remodeling/heart failure. This relationship is even more nuanced when clinical entities such as metabolically healthy obesity phenotype and the obesity paradox are considered. Although it is clear that the accumulation of visceral/ectopic fat is a major contributor to <span class="hlt">cardiovascular</span> and metabolic risk above and beyond the body mass index, implementation of fat distribution assessment into clinical <span class="hlt">practice</span> remains a challenge. Anthropometric indexes of obesity are easily implemented, but newer imaging-based methods offer <span class="hlt">improved</span> sensitivity and specificity for measuring specific depots. Lifestyle, pharmacological, and surgical</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3042924','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3042924"><span>Management of <span class="hlt">cardiovascular</span> risk factors with pioglitazone combination therapies in type 2 diabetes: an observational cohort study</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2011-01-01</p> <p>Background Type 2 diabetes (T2D) is strongly associated with <span class="hlt">cardiovascular</span> risk and requires medications that <span class="hlt">improve</span> glycemic control and other <span class="hlt">cardiovascular</span> risk factors. The authors aimed to assess the relative effectiveness of pioglitazone (Pio), metformin (Met) and any sulfonylurea (SU) combinations in non-insulin-treated T2D patients who were failing previous hypoglycemic therapy. Methods Over a 1-year period, two multicenter, open-labeled, controlled, 1-year, prospective, observational studies evaluated patients with T2D (n = 4585) from routine clinical <span class="hlt">practice</span> in Spain and Greece with the same protocol. Patients were eligible if they had been prescribed Pio + SU, Pio + Met or SU + Met serving as a control cohort, once they had failed with previous therapy. Anthropometric measurements, lipid and glycemic profiles, blood pressure, and the proportions of patients at microvascular and macrovascular risk were assessed. Results All study treatment combinations rendered progressive 6-month and 12-month lipid, glycemic, and blood pressure <span class="hlt">improvements</span>. Pio combinations, especially Pio + Met, were associated with increases in HDL-cholesterol and decreases in triglycerides and in the atherogenic index of plasma. The proportion of patients at high risk decreased after 12 months in all study cohorts. Minor weight changes (gain or loss) and no treatment-related fractures occurred during the study. The safety profile was good and proved similar among treatments, except for more hypoglycemic episodes in patients receiving SU and for the occurrence of edema in patients using Pio combinations. Serious <span class="hlt">cardiovascular</span> events were rarely reported. Conclusions In patients with T2D failing prior hypoglycemic therapies, Pio combinations with SU or Met (especially Pio + Met) <span class="hlt">improved</span> blood lipid and glycemic profiles, decreasing the proportion of patients with a high microvascular or macrovascular risk. The combination of Pio with SU or Met may therefore be recommended for T2D</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2980765','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2980765"><span><span class="hlt">Improvement</span> of Aging-Associated <span class="hlt">Cardiovascular</span> Dysfunction by the Orally Administered Copper(II)-Aspirinate Complex</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Gerö, Domokos; Lin, Li-ni; Loganathan, Sivakkanan; Hoppe-Tichy, Torsten; Szabó, Csaba; Karck, Matthias; Sakurai, Hiromu; Szabó, Gábor</p> <p>2008-01-01</p> <p>Abstract Background Aging-associated nitro-oxidative stress causes tissue injury and activates proinflammatory pathways that play an important role in the pathogenesis of aging-associated <span class="hlt">cardiovascular</span> dysfunction. It has been recently reported, that the copper(II)–aspirinate complex (CuAsp) exerts not only the well-known anti-inflammatory and platelet antiaggregating effects of aspirin, but, due to its superoxide dismutase mimetic activity, it acts as a potent antioxidant as well. In this study we investigated the effects of CuAsp on aging-associated myocardial and endothelial dysfunction. Methods and Results Aging and young rats were treated for 3 weeks with vehicle, or with CuAsp (200 mg/kg per day per os). Left ventricular pressure–volume relations were measured by using a microtip pressure–volume conductance catheter, and indexes of contractility (e.g., slope of end-systolic pressure–volume relationships [ESPVR] [Ees], and dP/dtmax – end-diastolic volume [EDV]) were calculated. In organ bath experiments for isometric tension with isolated aortic rings, endothelium-dependent and -independent vasorelaxation were investigated by using acetylcholine and sodium nitroprusside. When compared to the young controls, aging rats showed impaired left ventricular contractility (Ees, 0.51 ± 0.04 vs. 2.16 ± 0.28 mmHg/μL; dP/dtmax – EDV, 10.71 ± 2.02 vs. 37.23 ± 4.18 mmHg/sec per μL; p < 0.05) and a marked endothelial dysfunction (maximal relaxation to acetylcholine: 66.66 ± 1.30 vs. 87.09 ± 1.35%; p < 0.05). Treatment with CuAsp resulted in reduced nitro-oxidative stress, <span class="hlt">improved</span> cardiac function (Ees, 1.21 ± 0.17 vs. 0.51 ± 0.04 mmHg/μL; dP/dtmax – EDV, 23.40 ± 3.34 vs. 10.71 ± 2.02 mmHg/sec per μL; p < 0.05) and higher vasorelaxation to acetylcholine in aging animals (94.83 ± 0.73 vs. 66.66 ± 1.30%; p < 0.05). The treatment did not influence the <span class="hlt">cardiovascular</span> functions of young rats. Conclusions Our results demonstrate that oxidative stress</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26140291','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26140291"><span>Relationships between evidence-based <span class="hlt">practice</span>, quality <span class="hlt">improvement</span> and clinical error experience of nurses in Korean hospitals.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Hwang, Jee-In; Park, Hyeoun-Ae</p> <p>2015-07-01</p> <p>This study investigated individual and work-related factors associated with nurses' perceptions of evidence-based <span class="hlt">practice</span> (EBP) and quality <span class="hlt">improvement</span> (QI), and the relationships between evidence-based <span class="hlt">practice</span>, quality <span class="hlt">improvement</span> and clinical errors. Understanding the factors affecting evidence-based <span class="hlt">practice</span> and quality <span class="hlt">improvement</span> activities and their relationships with clinical errors is important for designing strategies to promote evidence-based <span class="hlt">practice</span>, quality <span class="hlt">improvement</span> and patient safety. A cross-sectional survey was conducted with 594 nurses in two Korean teaching hospitals using the evidence-based <span class="hlt">practice</span> Questionnaire and quality <span class="hlt">improvement</span> scale developed in this study. Four hundred and forty-three nurses (74.6%) returned the completed survey. Nurses' ages and educational levels were significantly associated with evidence-based <span class="hlt">practice</span> scores whereas age and job position were associated with quality <span class="hlt">improvement</span> scores. There were positive, moderate correlations between evidence-based <span class="hlt">practice</span> and quality <span class="hlt">improvement</span> scores. Nurses who had not made any clinical errors during the past 12 months had significantly higher quality <span class="hlt">improvement</span> skills scores than those who had. The findings indicated the necessity of educational support regarding evidence-based <span class="hlt">practice</span> and quality <span class="hlt">improvement</span> for younger staff nurses who have no master degrees. Enhancing quality <span class="hlt">improvement</span> skills may reduce clinical errors. Nurse managers should consider the characteristics of their staff when implementing educational and clinical strategies for evidence-based <span class="hlt">practice</span> and quality <span class="hlt">improvement</span>. © 2013 John Wiley & Sons Ltd.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27886780','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27886780"><span>Global Shifts in <span class="hlt">Cardiovascular</span> Disease, the Epidemiologic Transition, and Other Contributing Factors: Toward a New <span class="hlt">Practice</span> of Global Health Cardiology.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Mendoza, Walter; Miranda, J Jaime</p> <p>2017-02-01</p> <p>One of the major drivers of change in the <span class="hlt">practice</span> of cardiology is population change. This article discusses the current debate about epidemiologic transition paired with other ongoing transitions with direct relevance to <span class="hlt">cardiovascular</span> conditions. Challenges specific to patterns of risk factors over time; readiness for disease surveillance and meeting global targets; health system, prevention, and treatment efforts; and physiologic traits and human-environment interactions are identified. This article concludes that a focus on the most populated regions of the world will contribute substantially to protecting the large gains in global survival and life expectancy accrued over the last decades. Copyright © 2016 Elsevier Inc. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5584050','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5584050"><span>Maintenance of Certification: How Performance in <span class="hlt">Practice</span> Changes <span class="hlt">Improve</span> Tobacco Cessation in Addiction Psychiatrists’ <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Ford, James H.; Oliver, Karen A.; Giles, Miriam; Cates-Wessel, Kathryn; Krahn, Dean; Levin, Frances R.</p> <p>2017-01-01</p> <p>Background and Objectives In 2000, the American Board of Medical Specialties implemented the Maintenance of Certification (MOC), a structured process to help physicians identify and implement a quality <span class="hlt">improvement</span> project to <span class="hlt">improve</span> patient care. This study reports on findings from an MOC Performance in <span class="hlt">Practice</span> (PIP) module designed and evaluated by addiction psychiatrists who are members of the American Academy of Addiction Psychiatry (AAAP). Method A 3-phase process was utilized to recruit AAAP members to participate in the study. The current study utilized data from 154 self-selected AAAP members who evaluated the effectiveness of the MOC Tobacco Cessation PIP. Results Of the physicians participating, 76% (n 120) completed the Tobacco PIP. A paired t-test analysis revealed that reported changes in clinical measure documentation were significant across all six measures. Targeted <span class="hlt">improvement</span> efforts focused on a single clinical measure. Results found that simple change projects designed to <span class="hlt">improve</span> clinical <span class="hlt">practice</span> led to substantial changes in self-reported chart documentation for the selected measure. Conclusions The current findings suggest that addiction psychiatrists can leverage the MOC process to <span class="hlt">improve</span> clinical care. PMID:27973746</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28040402','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28040402"><span>Subclinical hypothyroidism, lipid metabolism and <span class="hlt">cardiovascular</span> disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Delitala, Alessandro P; Fanciulli, Giuseppe; Maioli, Margherita; Delitala, Giuseppe</p> <p>2017-03-01</p> <p>Subclinical hypothyroidism is defined by elevated serum thyrotropin in presence of normal free thyroid hormones. Lipid metabolism is influenced by thyroid hormone and many reports showed that lipids status worsen along with TSH level. Subclinical hypothyroidism has been also linked to other <span class="hlt">cardiovascular</span> risk factors such as alteration in blood pressure and increased atherosclerosis. Further evidences suggested that mild dysfunction of thyroid gland is associated with metabolic syndrome and heart failure. Thyrotropin level seems the best predictor of <span class="hlt">cardiovascular</span> disease, in particular when its levels are above 10mU/L. However, despite these observations, there is no clear evidence that levothyroxine therapy in subjects with milder form of subclinical hypothyroidism could <span class="hlt">improve</span> lipid status and the other <span class="hlt">cardiovascular</span> risk factors. In this review, we address the effect of thyroid hormone and <span class="hlt">cardiovascular</span> risk, with a focus on lipid metabolism. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24439610','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24439610"><span>Operationalizing quality <span class="hlt">improvement</span> in a pediatric surgical <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Arca, Marjorie J; Enters, Jessica; Christensen, Melissa; Jeziorczak, Paul; Sato, Thomas T; Thielke, Robert; Oldham, Keith T</p> <p>2014-01-01</p> <p>Quality <span class="hlt">improvement</span> (QI) is critical to enhancing patient care. It is necessary to prioritize which QI initiatives are relevant to one's institution and <span class="hlt">practice</span>, as implementation is resource-intensive. We have developed and implemented a streamlined process to identify QI opportunities in our <span class="hlt">practice</span>. We designed a web-based Pediatric and Infant Case Log and Outcomes (PICaLO) instrument using Research Electronic Data Capture (REDCap™) to record all surgical procedures for our <span class="hlt">practice</span>. At the time of operation, a surgeon completes a case report form. An administrative assistant enters the data in PICaLO within 5-7days. Outcomes such as complications, deaths, and "occurrences" (readmissions, reoperations, transfers to ICU, ER visit, additional clinic visits) are recorded at the time of encounter, during M & M Conferences, and during follow-up clinic visits. Variables were chosen and defined based on national standards from the American College of Surgeons (ACS) National Surgical Quality <span class="hlt">Improvement</span> Program (NSQIP), and Patient Based Learning Log. Occurrences are queried for potential QI initiatives. In 2012, 3597 patients were entered, totaling 5177 procedures. There were 220 complications, 278 occurrences, and 16 deaths. Specific QI opportunities were identified and put into place. Data on procedures and outcomes can be collected effectively in a pediatric surgery <span class="hlt">practice</span> to delineate pertinent QI initiatives. PICaLO is recognized by the American Board of Surgery as a mechanism to meet Maintenance of Certification 4 criteria. © 2014.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5456324','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5456324"><span>The <span class="hlt">Cardiovascular</span> Effects of Cocoa Polyphenols—An Overview</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Aprotosoaie, Ana Clara; Miron, Anca; Trifan, Adriana; Luca, Vlad Simon; Costache, Irina-Iuliana</p> <p>2016-01-01</p> <p>Cocoa is a rich source of high-quality antioxidant polyphenols. They comprise mainly catechins (29%–38% of total polyphenols), anthocyanins (4% of total polyphenols) and proanthocyanidins (58%–65% of total polyphenols). A growing body of experimental and epidemiological evidence highlights that the intake of cocoa polyphenols may reduce the risk of <span class="hlt">cardiovascular</span> events. Beyond antioxidant properties, cocoa polyphenols exert blood pressure lowering activity, antiplatelet, anti-inflammatory, metabolic and anti-atherosclerotic effects, and also <span class="hlt">improve</span> endothelial function. This paper reviews the role of cocoa polyphenols in <span class="hlt">cardiovascular</span> protection, with a special focus on mechanisms of action, clinical relevance and correlation between antioxidant activity and <span class="hlt">cardiovascular</span> health. PMID:28933419</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21119574','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21119574"><span>Combined short-arm centrifuge and aerobic exercise training <span class="hlt">improves</span> <span class="hlt">cardiovascular</span> function and physical working capacity in humans.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Yang, Chang-Bin; Zhang, Shu; Zhang, Yu; Wang, Bing; Yao, Yong-Jie; Wang, Yong-Chun; Wu, Yan-Hong; Liang, Wen-Bin; Sun, Xi-Qing</p> <p>2010-12-01</p> <p>Musculoskeletal and <span class="hlt">cardiovascular</span> deconditioning occurring in long-term spaceflight gives rise to the needs to develop new strategies to counteract these adverse effects. Short-arm centrifuge combined with ergometer has been proposed as a strategy to counteract adverse effects of microgravity. This study sought to investigate whether the combination of short-arm centrifuge and aerobic exercise training have advantages over short-arm centrifuge or aerobic exercise training alone. One week training was conducted by 24 healthy men. They were randomly divided into 3 groups: (1) short-arm centrifuge training, (2) aerobic exercise training, 40 W, and (3) combined short-arm centrifuge and aerobic exercise training. Before and after training, the cardiac pump function represented by stroke volume, cardiac output, left ventricular ejection time, and total peripheral resistance was evaluated. Variability of heart rate and systolic blood pressure were determined by spectral analysis. Physical working capacity was surveyed by near maximal physical working capacity test. The 1-week combined short-arm centrifuge and aerobic exercise training remarkably ameliorated the cardiac pump function and enhanced vasomotor sympathetic nerve modulation and <span class="hlt">improved</span> physical working capacity by 10.9% (P<.05, n=8). In contrast, neither the short-arm centrifuge nor the aerobic exercise group showed <span class="hlt">improvements</span> in these functions. These results demonstrate that combined short-arm centrifuge and aerobic exercise training has advantages over short-arm centrifuge or aerobic exercise training alone in influencing several physiologically important <span class="hlt">cardiovascular</span> functions in humans. The combination of short-arm centrifuge and aerobic exercise offers a promising countermeasure to microgravity.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26973130','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26973130"><span>Obesity and <span class="hlt">Cardiovascular</span> Disease: a Risk Factor or a Risk Marker?</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Mandviwala, Taher; Khalid, Umair; Deswal, Anita</p> <p>2016-05-01</p> <p>In the USA, 69 % of adults are either overweight or obese and 35 % are obese. Obesity is associated with an increased incidence of various <span class="hlt">cardiovascular</span> disorders. Obesity is a risk marker for <span class="hlt">cardiovascular</span> disease, in that it is associated with a much higher prevalence of comorbidities such as diabetes, hypertension, and metabolic syndrome, which then increase the risk for <span class="hlt">cardiovascular</span> disease. However, in addition, obesity may also be an independent risk factor for the development of <span class="hlt">cardiovascular</span> disease. Furthermore, although obesity has been shown to be an independent risk factor for several <span class="hlt">cardiovascular</span> diseases, it is often associated with <span class="hlt">improved</span> survival once the diagnosis of the <span class="hlt">cardiovascular</span> disease has been made, leading to the term "obesity paradox." Several pathways linking obesity and <span class="hlt">cardiovascular</span> disease have been described. In this review, we attempt to summarize the complex relationship between obesity and <span class="hlt">cardiovascular</span> disorders, in particular coronary atherosclerosis, heart failure, and atrial fibrillation.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://hdl.handle.net/2060/20040201532','NASA-TRS'); return false;" href="http://hdl.handle.net/2060/20040201532"><span><span class="hlt">Cardiovascular</span> Deconditioning</span></a></p> <p><a target="_blank" href="http://ntrs.nasa.gov/search.jsp">NASA Technical Reports Server (NTRS)</a></p> <p>Charles, John B.; Fritsch-Yelle, Janice M.; Whitson, Peggy A.; Wood, Margie L.; Brown, Troy E.; Fortner, G. William</p> <p>1999-01-01</p> <p>Spaceflight causes adaptive changes in <span class="hlt">cardiovascular</span> function that may deleteriously affect crew health and safety. Over the last three decades, symptoms of <span class="hlt">cardiovascular</span> changes have ranged from postflight orthostatic tachycardia and decreased exercise capacity to serious cardiac rhythm disturbances during extravehicular activities (EVA). The most documented symptom of <span class="hlt">cardiovascular</span> dysfunction, postflight orthostatic intolerance, has affected a significant percentage of U.S. Space Shuttle astronauts. Problems of <span class="hlt">cardiovascular</span> dysfunction associated with spaceflight are a concern to NASA. This has been particularly true during Shuttle flights where the primary concern is the crew's physical health, including the pilot's ability to land the Orbiter, and the crew's ability to quickly egress and move to safety should a dangerous condition arise. The study of astronauts during Shuttle activities is inherently more difficult than most human research. Consequently, sample sizes have been small and results have lacked consistency. Before the Extended Duration Orbiter Medical Project (EDOMP), there was a lack of normative data on changes in <span class="hlt">cardiovascular</span> parameters during and after spaceflight. The EDOMP for the first time allowed studies on a large enough number of subjects to overcome some of these problems. There were three primary goals of the <span class="hlt">Cardiovascular</span> EDOMP studies. The first was to establish, through descriptive studies, a normative data base of <span class="hlt">cardiovascular</span> changes attributable to spaceflight. The second goal was to determine mechanisms of <span class="hlt">cardiovascular</span> changes resulting from spaceflight (particularly orthostatic hypotension and cardiac rhythm disturbances). The third was to evaluate possible countermeasures. The <span class="hlt">Cardiovascular</span> EDOMP studies involved parallel descriptive, mechanistic, and countermeasure evaluations.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/22345672','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/22345672"><span>Benchmarking progress in the implementation of the Fourth Joint Societies' Task Force Guidelines on the Prevention of <span class="hlt">Cardiovascular</span> Disease in Clinical <span class="hlt">Practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Morgan, Karen; Burke, Helen; McGee, Hannah</p> <p>2013-02-01</p> <p>The Fourth Joint Societies' Task Force (4th JTF) Guidelines on <span class="hlt">Cardiovascular</span> Disease Prevention in Clinical <span class="hlt">Practice</span> are agreed, evidence-based standards of care across European countries and professions. In advance of the publication of the 5th JTF Guidelines in 2012, this work assesses the extent to which the 4th JTF guidelines have been implemented. Qualitative study of guideline implementation in 13 European countries, focusing on the themes of guideline implementation structures, processes, and outcomes. Key personnel in 13 selected countries completed interviews or comparable questionnaires: they were national coordinators for CVD prevention (n = 14) and representatives of the national cardiac society (n = 9), heart foundations (n = 11), health ministry (n = 8), and service providers (n = 3). Interview and service-related data from each country were compiled to provide a detailed overview. Ten of the 13 countries used European Society of Cardiology (ESC) guidelines on prevention at a national level, where three broad approaches to implementation were identified. In all 10 countries, multidisciplinary alliances oversaw implementation, but ongoing promotion of the guidelines was not evident, with just two of the 10 countries conducting evaluation of implementation. Barriers to implementation included weak health authority support, the unwieldy nature of the guidelines, guideline fatigue, and the lesser role of prevention in national healthcare systems. Substantial progress had been made in implementing the guidelines, but countries struggled with the task. Some rebalancing of the ESC focus may be warranted so that part of the effort dedicated to <span class="hlt">improving</span> guidelines might be redirected at translating them into <span class="hlt">practice</span>.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26938637','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26938637"><span>Ginseng and Ginkgo Biloba Effects on Cognition as Modulated by <span class="hlt">Cardiovascular</span> Reactivity: A Randomised Trial.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Ong Lai Teik, Derek; Lee, Xiao Shiang; Lim, Chu Jian; Low, Chia Mei; Muslima, Mariyam; Aquili, Luca</p> <p>2016-01-01</p> <p>There is some evidence to suggest that ginseng and Ginkgo biloba can <span class="hlt">improve</span> cognitive performance, however, very little is known about the mechanisms associated with such <span class="hlt">improvement</span>. Here, we tested whether <span class="hlt">cardiovascular</span> reactivity to a task is associated with cognitive <span class="hlt">improvement</span>. Using a double-blind, placebo controlled, crossover design, participants (N = 24) received two doses of Panax Ginseng (500, 1000 mg) or Ginkgo Biloba (120, 240 mg) (N = 24), and underwent a series of cognitive tests while systolic, diastolic, and heart rate readings were taken. Ginkgo Biloba <span class="hlt">improved</span> aspects of executive functioning (Stroop and Berg tasks) in females but not in males. Ginseng had no effect on cognition. Ginkgo biloba in females reversed the initial (i.e. placebo) increase in <span class="hlt">cardiovascular</span> reactivity (systolic and diastolic readings increased compared to baseline) to cognitive tasks. This effect (reversal) was most notable after those tasks (Stroop and Iowa) that elicited the greatest <span class="hlt">cardiovascular</span> reactivity during placebo. In males, although ginkgo also decreased <span class="hlt">cardiovascular</span> readings, it did so from an initial (placebo) blunted response (i.e. decrease or no change from baseline) to cognitive tasks. Ginseng, on the contrary, increased <span class="hlt">cardiovascular</span> readings compared to placebo. These results suggest that <span class="hlt">cardiovascular</span> reactivity may be a mechanism by which ginkgo but not ginseng, in females is associated with certain forms of cognitive <span class="hlt">improvement</span>. ClinicalTrials.gov NCT02386852.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27267537','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27267537"><span>Exercise Dose in Clinical <span class="hlt">Practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Wasfy, Meagan M; Baggish, Aaron L</p> <p>2016-06-07</p> <p>There is wide variability in the physical activity patterns of the patients in contemporary clinical <span class="hlt">cardiovascular</span> <span class="hlt">practice</span>. This review is designed to address the impact of exercise dose on key <span class="hlt">cardiovascular</span> risk factors and on mortality. We begin by examining the body of literature that supports a dose-response relationship between exercise and <span class="hlt">cardiovascular</span> disease risk factors, including plasma lipids, hypertension, diabetes mellitus, and obesity. We next explore the relationship between exercise dose and mortality by reviewing the relevant epidemiological literature underlying current physical activity guideline recommendations. We then expand this discussion to critically examine recent data pertaining to the impact of exercise dose at the lowest and highest ends of the spectrum. Finally, we provide a framework for how the key concepts of exercise dose can be integrated into clinical <span class="hlt">practice</span>. © 2016 American Heart Association, Inc.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/22731956','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/22731956"><span>Psoriasis and <span class="hlt">cardiovascular</span> risk. Assessment by different <span class="hlt">cardiovascular</span> risk scores.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Fernández-Torres, R; Pita-Fernández, S; Fonseca, E</p> <p>2013-12-01</p> <p>Psoriasis is an inflammatory disease associated with an increased risk of <span class="hlt">cardiovascular</span> morbidity and mortality. However, very few studies determine <span class="hlt">cardiovascular</span> risk by means of Framingham risk score or other indices more appropriate for countries with lower prevalence of <span class="hlt">cardiovascular</span> risk factors. To determine multiple <span class="hlt">cardiovascular</span> risk scores in psoriasis patients, the relation between <span class="hlt">cardiovascular</span> risk and psoriasis features and to compare our results with those in the literature. We assessed demographic data, smoking status, psoriasis features, blood pressure and analytical data. <span class="hlt">Cardiovascular</span> risk was determined by means of Framingham, SCORE, DORICA and REGICOR scores. A total of 395 patients (59.7% men and 40.3% women) aged 18-86 years were included. The proportion of patients at intermediate and high risk of suffering a major <span class="hlt">cardiovascular</span> event in the next 10 years was 30.5% and 11.4%, respectively, based on Framingham risk score; 26.9% and 2.2% according to DORICA and 6.8% and 0% using REGICOR score. According to the SCORE index, 22.1% of patients had a high risk of death due to a <span class="hlt">cardiovascular</span> event over the next 10 years. <span class="hlt">Cardiovascular</span> risk was not related to psoriasis characteristics, except for the Framingham index, with higher risk in patients with more severe psoriasis (P = 0.032). A considerable proportion of patients had intermediate or high <span class="hlt">cardiovascular</span> risk, without relevant relationship with psoriasis characteristics and treatment schedules. Therefore, systematic evaluation of <span class="hlt">cardiovascular</span> risk scores in all psoriasis patients could be useful to identify those with increased <span class="hlt">cardiovascular</span> risk, subsidiary of lifestyle changes or therapeutic interventions. © 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/17604260','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/17604260"><span>Review: nanoparticles in delivery of <span class="hlt">cardiovascular</span> drugs.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Arayne, M Saeed; Sultana, Najma; Qureshi, Faiza</p> <p>2007-10-01</p> <p>Everything in nature is built upward from the atomic level to define limits and structures to everything. Nanomedicines marked the field of medicine from nanobiotechnology, biological micro-electromechanical systems, microfluidics, biosensors, drug delivery, microarrays to tissue microengineering. Since then nanoparticles has overcome many challenges from blood brain barrier to targeting tumors. Where solid biodegradable nanoparticles were a step up liposome, targeting nanoparticles opened a whole new field for drug delivery. In this article, we attempt to discuss how the pioneered technique is serving in the drug delivery to <span class="hlt">cardiovascular</span> system and how with the manipulation of their properties, nanoparticles can be made to fulfill desired function. Also how nanocarriers are <span class="hlt">improving</span> molecular imaging to help <span class="hlt">improve</span> diagnosis and treatment of <span class="hlt">cardiovascular</span> disease is focused in this article.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26865199','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26865199"><span>Allopurinol and <span class="hlt">Cardiovascular</span> Outcomes in Adults With Hypertension.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>MacIsaac, Rachael L; Salatzki, Janek; Higgins, Peter; Walters, Matthew R; Padmanabhan, Sandosh; Dominiczak, Anna F; Touyz, Rhian M; Dawson, Jesse</p> <p>2016-03-01</p> <p>Allopurinol lowers blood pressure in adolescents and has other vasoprotective effects. Whether similar benefits occur in older individuals remains unclear. We hypothesized that allopurinol is associated with <span class="hlt">improved</span> <span class="hlt">cardiovascular</span> outcomes in older adults with hypertension. Data from the United Kingdom Clinical Research <span class="hlt">Practice</span> Datalink were used. Multivariate Cox-proportional hazard models were applied to estimate hazard ratios for stroke and cardiac events (defined as myocardial infarction or acute coronary syndrome) associated with allopurinol use over a 10-year period in adults aged >65 years with hypertension. A propensity-matched design was used to reduce potential for confounding. Allopurinol exposure was a time-dependent variable and was defined as any exposure and then as high (≥300 mg daily) or low-dose exposure. A total of 2032 allopurinol-exposed patients and 2032 matched nonexposed patients were studied. Allopurinol use was associated with a significantly lower risk of both stroke (hazard ratio, 0.50; 95% confidence interval, 0.32-0.80) and cardiac events (hazard ratio, 0.61; 95% confidence interval, 0.43-0.87) than nonexposed control patients. In exposed patients, high-dose treatment with allopurinol (n=1052) was associated with a significantly lower risk of both stroke (hazard ratio, 0.58; 95% confidence interval, 0.36-0.94) and cardiac events (hazard ratio, 0.65; 95% confidence interval, 0.46-0.93) than low-dose treatment (n=980). Allopurinol use is associated with lower rates of stroke and cardiac events in older adults with hypertension, particularly at higher doses. Prospective clinical trials are needed to evaluate whether allopurinol <span class="hlt">improves</span> <span class="hlt">cardiovascular</span> outcomes in adults with hypertension. © 2016 American Heart Association, Inc.</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li class="active"><span>23</span></li> <li><a href="#" onclick='return showDiv("page_24");'>24</a></li> <li><a href="#" onclick='return showDiv("page_25");'>25</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_23 --> <div id="page_24" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li><a href="#" onclick='return showDiv("page_23");'>23</a></li> <li class="active"><span>24</span></li> <li><a href="#" onclick='return showDiv("page_25");'>25</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="461"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5279938','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5279938"><span>Primary Prevention of Atherosclerotic <span class="hlt">Cardiovascular</span> Disease in Women</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>McKibben, Rebeccah A.; Al Rifai, Mahmoud; Mathews, Lena M.; Michos, Erin D.</p> <p>2016-01-01</p> <p>Atherosclerotic <span class="hlt">cardiovascular</span> disease (ASCVD) is the leading cause of morbidity and mortality among women. Despite <span class="hlt">improvements</span> in <span class="hlt">cardiovascular</span> disease prevention efforts, there remain gaps in <span class="hlt">cardiovascular</span> disease awareness among women, as well as age and racial disparities in ASCVD outcomes for women. Disparity also exists in the impact the traditional risk factors confer on ASCVD risk between women and men, with smoking and diabetes both resulting in stronger relative risks in women compared to men. Additionally there are risk factors that are unique to women (such as pregnancy-related factors) or that disproportionally affect women (such as auto-immune disease) where preventive efforts should be targeted. Risk assessment and management must also be sex-specific to effectively reduce <span class="hlt">cardiovascular</span> disease and <span class="hlt">improve</span> outcomes among women. Evidence supports the use of statin therapy for primary prevention in women at higher ASCVD risk. However, some pause should be given to prescribing aspirin therapy in women without known ASCVD, with most evidence supporting the use of aspirin for women≥65 years not at increased risk for bleeding. This review article will summarize (1) traditional and non-traditional assessments of ASCVD risk and (2) lifestyle and pharmacologic therapies for the primary prevention of ASCVD in women. PMID:28149430</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26149486','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26149486"><span><span class="hlt">Cardiovascular</span> biomarkers and sex: the case for women.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Daniels, Lori B; Maisel, Alan S</p> <p>2015-10-01</p> <p>Measurement of biomarkers is a critical component of <span class="hlt">cardiovascular</span> care. Women and men differ in their cardiac physiology and manifestations of <span class="hlt">cardiovascular</span> disease. Although most <span class="hlt">cardiovascular</span> biomarkers are used by clinicians without taking sex into account, sex-specific differences in biomarkers clearly exist. Baseline concentrations of many biomarkers (including cardiac troponin, natriuretic peptides, galectin-3, and soluble ST2) differ in men versus women, but these sex-specific differences do not generally translate into a need for differential sex-based cut-off points. Furthermore, most biomarkers are similarly diagnostic and prognostic, regardless of sex. Two potential exceptions are cardiac troponins measured by high-sensitivity assay, and proneurotensin. Troponin levels are lower in women than in men and, with the use of high-sensitivity assays, sex-specific cut-off points might <span class="hlt">improve</span> the diagnosis of myocardial infarction. Proneurotensin is a novel biomarker that was found to be predictive of incident <span class="hlt">cardiovascular</span> disease in women, but not men, and was also predictive of incident breast cancer. If confirmed, proneurotensin might be a unique biomarker of disease risk in women. With any biomarker, an understanding of sex-specific differences might <span class="hlt">improve</span> its use and might also lead to an enhanced understanding of the physiological differences between the hearts of men and women.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21659815','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21659815"><span>Preparing nurses for leadership roles in <span class="hlt">cardiovascular</span> disease prevention.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lanuza, Dorothy M; Davidson, Patricia M; Dunbar, Sandra B; Hughes, Suzanne; De Geest, Sabina</p> <p>2011-01-01</p> <p><span class="hlt">Cardiovascular</span> disease (CVD) is a critical global health issue, and <span class="hlt">cardiovascular</span> nurses play a vital role in decreasing the global burden and contributing to <span class="hlt">improving</span> outcomes in individuals and communities. <span class="hlt">Cardiovascular</span> nurses require the knowledge, skills, and resources that will enable them to function as leaders in CVD. This article addresses the education, training, and strategies that are needed to prepare nurses for leadership roles in preventing and managing CVD. Building on the World Health Organization core competencies for 21st-century health care workers, the specific competencies of <span class="hlt">cardiovascular</span> nurses working in prevention are outlined. These can be further strengthened by investing in the development of cultural, system change and leadership competencies. Mentorship is proposed as a powerful strategy for promoting the <span class="hlt">cardiovascular</span> nursing role and equipping individual nurses to contribute meaningfully to health system reform and community engagement in CVD risk reduction.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4615750','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4615750"><span>Deaf Adolescents’ Learning of <span class="hlt">Cardiovascular</span> Health Information: Sources and Access Challenges</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Smith, Scott R.; Kushalnagar, Poorna; Hauser, Peter C.</p> <p>2015-01-01</p> <p>Deaf individuals have more <span class="hlt">cardiovascular</span> risks than the general population that are believed to be related to their <span class="hlt">cardiovascular</span> health knowledge disparities. This phenomenological study describes where 20 deaf sign language-using adolescents from Rochester, New York, many who possess many positive characteristics to support their health literacy, learn <span class="hlt">cardiovascular</span> health information and their lived experiences accessing health information. The goal is to ultimately use this information to <span class="hlt">improve</span> the delivery of <span class="hlt">cardiovascular</span> health education to this population and other deaf adolescents at a higher risk for weak health literacy. Deaf bilingual researchers interviewed deaf adolescents, transcribed and coded the data, and described the findings. Five major sources of <span class="hlt">cardiovascular</span> health information were identified including family, health education teachers, healthcare providers, printed materials, and informal sources. Despite possessing advantageous characteristics contributing to stronger health literacy, study participants described significant challenges with accessing health information from each source. They also demonstrated inconsistencies in their <span class="hlt">cardiovascular</span> health knowledge, especially regarding heart attack, stroke, and cholesterol. These findings suggest a great need for additional public funding to research deaf adolescents’ informal health-related learning, develop accessible and culturally appropriate health surveys and health education programming, <span class="hlt">improve</span> interpreter education, and disseminate information through social media. PMID:26048900</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/25940444','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/25940444"><span>Influenza vaccines for preventing <span class="hlt">cardiovascular</span> disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Clar, Christine; Oseni, Zainab; Flowers, Nadine; Keshtkar-Jahromi, Maryam; Rees, Karen</p> <p>2015-05-05</p> <p>This is an update of the original review published in 2008. The risk of adverse <span class="hlt">cardiovascular</span> outcomes is increased with influenza-like infection, and vaccination against influenza may <span class="hlt">improve</span> <span class="hlt">cardiovascular</span> outcomes. To assess the potential benefits of influenza vaccination for primary and secondary prevention of <span class="hlt">cardiovascular</span> disease. We searched the following electronic databases on 18 October 2013: The Cochrane Library (including Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Economic Evaluation Database (EED) and Health Technology Assessment database (HTA)), MEDLINE, EMBASE, Science Citation Index Expanded, Conference Proceedings Citation Index - Science and ongoing trials registers (www.controlled-trials.com/ and www.clinicaltrials.gov). We examined reference lists of relevant primary studies and systematic reviews. We performed a limited PubMed search on 20 February 2015, just before publication. Randomised controlled trials (RCTs) of influenza vaccination compared with placebo or no treatment in participants with or without <span class="hlt">cardiovascular</span> disease, assessing <span class="hlt">cardiovascular</span> death or non-fatal <span class="hlt">cardiovascular</span> events. We used standard methodological procedures as expected by The Cochrane Collaboration. We carried out meta-analyses only for <span class="hlt">cardiovascular</span> death, as other outcomes were reported too infrequently. We expressed effect sizes as risk ratios (RRs), and we used random-effects models. We included eight trials of influenza vaccination compared with placebo or no vaccination, with 12,029 participants receiving at least one vaccination or control treatment. We included six new studies (n = 11,251), in addition to the two included in the previous version of the review. Four of these trials (n = 10,347) focused on prevention of influenza in the general or elderly population and reported <span class="hlt">cardiovascular</span> outcomes among their safety analyses; four trials (n = 1682) focused on prevention of</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3635575','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3635575"><span>Depressive disorder in the last phase of life in patients with <span class="hlt">cardiovascular</span> disease, cancer, and COPD: data from a 20-year follow-up period in general <span class="hlt">practice</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Warmenhoven, Franca; Bor, Hans; Lucassen, Peter; Vissers, Kris; van Weel, Chris; Prins, Judith; Schers, Henk</p> <p>2013-01-01</p> <p>Background Depression is assumed to be common in chronically ill patients during their last phase of life and is associated with poorer outcomes. The prevalence of depression is widely varying in previous studies due to the use of different terminology, classification, and assessment methods. Aim To explore the reported incidence of depressive disorder, as registered in the last phase of life of patients who died from <span class="hlt">cardiovascular</span> disease, cancer or COPD, in a sample of primary care patients. Design and setting A historic cohort study, using a 20-year period registration database of medical records in four Dutch general <span class="hlt">practices</span> (a dynamic population based on the Continuous Morbidity Registration database). Method Medical history of the sample cohort was analysed for the diagnosis of a new episode of depressive disorder and descriptive statistics were used. Results In total 982 patients were included, and 19 patients (1.9%) were diagnosed with a new depressive disorder in the last year of their life. The lifetime prevalence of depressive disorder in this sample was 8.2%. Conclusion The incidence of depressive disorder in the last phase of life is remarkably low in this study. These data were derived from actual patient care in general <span class="hlt">practice</span>. Psychiatric diagnoses were made by GPs in the context of both patient needs and delivered care. A broader concept of depression in general <span class="hlt">practice</span> is recommended to <span class="hlt">improve</span> the diagnosis and treatment of mood disorders in patients in the last phase of life. PMID:23643227</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23643227','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23643227"><span>Depressive disorder in the last phase of life in patients with <span class="hlt">cardiovascular</span> disease, cancer, and COPD: data from a 20-year follow-up period in general <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Warmenhoven, Franca; Bor, Hans; Lucassen, Peter; Vissers, Kris; van Weel, Chris; Prins, Judith; Schers, Henk</p> <p>2013-05-01</p> <p>Depression is assumed to be common in chronically ill patients during their last phase of life and is associated with poorer outcomes. The prevalence of depression is widely varying in previous studies due to the use of different terminology, classification, and assessment methods. To explore the reported incidence of depressive disorder, as registered in the last phase of life of patients who died from <span class="hlt">cardiovascular</span> disease, cancer or COPD, in a sample of primary care patients. A historic cohort study, using a 20-year period registration database of medical records in four Dutch general <span class="hlt">practices</span> (a dynamic population based on the Continuous Morbidity Registration database). Medical history of the sample cohort was analysed for the diagnosis of a new episode of depressive disorder and descriptive statistics were used. In total 982 patients were included, and 19 patients (1.9%) were diagnosed with a new depressive disorder in the last year of their life. The lifetime prevalence of depressive disorder in this sample was 8.2%. The incidence of depressive disorder in the last phase of life is remarkably low in this study. These data were derived from actual patient care in general <span class="hlt">practice</span>. Psychiatric diagnoses were made by GPs in the context of both patient needs and delivered care. A broader concept of depression in general <span class="hlt">practice</span> is recommended to <span class="hlt">improve</span> the diagnosis and treatment of mood disorders in patients in the last phase of life.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3376835','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3376835"><span>MicroRNA therapeutics in <span class="hlt">cardiovascular</span> medicine</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Thum, Thomas</p> <p>2012-01-01</p> <p><span class="hlt">Cardiovascular</span> diseases are the most common causes of human morbidity and mortality despite significant therapeutic <span class="hlt">improvements</span> by surgical, interventional and pharmacological approaches in the last decade. MicroRNAs (miRNAs) are important and powerful mediators in a wide range of diseases and thus emerged as interesting new drug targets. An array of animal and even human miRNA-based therapeutic studies has been performed, which validate miRNAs as being successfully targetable to treat a wide range of diseases. Here, the current knowledge about miRNAs therapeutics in <span class="hlt">cardiovascular</span> diseases on their way to clinical use are reviewed and discussed. PMID:22162462</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/20083680','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/20083680"><span>Arterial stiffness and <span class="hlt">cardiovascular</span> events: the Framingham Heart Study.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Mitchell, Gary F; Hwang, Shih-Jen; Vasan, Ramachandran S; Larson, Martin G; Pencina, Michael J; Hamburg, Naomi M; Vita, Joseph A; Levy, Daniel; Benjamin, Emelia J</p> <p>2010-02-02</p> <p>Various measures of arterial stiffness and wave reflection have been proposed as <span class="hlt">cardiovascular</span> risk markers. Prior studies have not assessed relations of a comprehensive panel of stiffness measures to prognosis in the community. We used proportional hazards models to analyze first-onset major <span class="hlt">cardiovascular</span> disease events (myocardial infarction, unstable angina, heart failure, or stroke) in relation to arterial stiffness (pulse wave velocity [PWV]), wave reflection (augmentation index, carotid-brachial pressure amplification), and central pulse pressure in 2232 participants (mean age, 63 years; 58% women) in the Framingham Heart Study. During median follow-up of 7.8 (range, 0.2 to 8.9) years, 151 of 2232 participants (6.8%) experienced an event. In multivariable models adjusted for age, sex, systolic blood pressure, use of antihypertensive therapy, total and high-density lipoprotein cholesterol concentrations, smoking, and presence of diabetes mellitus, higher aortic PWV was associated with a 48% increase in <span class="hlt">cardiovascular</span> disease risk (95% confidence interval, 1.16 to 1.91 per SD; P=0.002). After PWV was added to a standard risk factor model, integrated discrimination <span class="hlt">improvement</span> was 0.7% (95% confidence interval, 0.05% to 1.3%; P<0.05). In contrast, augmentation index, central pulse pressure, and pulse pressure amplification were not related to <span class="hlt">cardiovascular</span> disease outcomes in multivariable models. Higher aortic stiffness assessed by PWV is associated with increased risk for a first <span class="hlt">cardiovascular</span> event. Aortic PWV <span class="hlt">improves</span> risk prediction when added to standard risk factors and may represent a valuable biomarker of <span class="hlt">cardiovascular</span> disease risk in the community.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29475873','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29475873"><span>Twenty-Four-Hour Central Pulse Pressure for <span class="hlt">Cardiovascular</span> Events Prediction in a Low-<span class="hlt">Cardiovascular</span>-Risk Population: Results From the Bordeaux Cohort.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Cremer, Antoine; Boulestreau, Romain; Gaillard, Prune; Lainé, Marion; Papaioannou, Georgios; Gosse, Philippe</p> <p>2018-02-23</p> <p>Central blood pressure (BP) is a promising marker to identify subjects with higher <span class="hlt">cardiovascular</span> risk than expected by traditional risk factors. Significant results have been obtained in populations with high <span class="hlt">cardiovascular</span> risk, but little is known about low-<span class="hlt">cardiovascular</span>-risk patients, although the differences between central and peripheral BP (amplification) are usually greater in this population. The study aim was to evaluate central BP over 24 hours for <span class="hlt">cardiovascular</span> event prediction in hypertensive subjects with low <span class="hlt">cardiovascular</span> risk. Peripheral and central BPs were recorded during clinical visits and over 24 hours in hypertensive patients with low <span class="hlt">cardiovascular</span> risk (Systematic Coronary Risk Evaluation ≤5%). Our primary end point is the occurrence of a <span class="hlt">cardiovascular</span> event during follow-up. To assess the potential interest in central pulse pressure over 24 hours, we performed Cox proportional hazard models analysis and comparison of area under the curves using the contrast test for peripheral and central BP. A cohort of 703 hypertensive subjects from Bordeaux were included. After the first 24 hours of BP measurement, the subjects were then followed up for an average of 112.5±70 months. We recorded 65 <span class="hlt">cardiovascular</span> events during follow-up. Amplification was found to be significantly associated with <span class="hlt">cardiovascular</span> events when added to peripheral 24-hour pulse pressure ( P =0.0259). The area under the curve of 24-hour central pulse pressure is significantly more important than area under the curve of office BP ( P =0.0296), and there is a trend of superiority with the area under the curve of peripheral 24-hour pulse pressure. Central pulse pressure over 24 hours <span class="hlt">improves</span> the prediction of <span class="hlt">cardiovascular</span> events for hypertensive patients with low <span class="hlt">cardiovascular</span> risk compared to peripheral pulse pressure. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/27913628','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/27913628"><span>Kinect system in home-based <span class="hlt">cardiovascular</span> rehabilitation.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Vieira, Ágata; Gabriel, Joaquim; Melo, Cristina; Machado, Jorge</p> <p>2017-01-01</p> <p><span class="hlt">Cardiovascular</span> diseases lead to a high consumption of financial resources. An important part of the recovery process is the <span class="hlt">cardiovascular</span> rehabilitation. This study aimed to present a new <span class="hlt">cardiovascular</span> rehabilitation system to 11 outpatients with coronary artery disease from a Hospital in Porto, Portugal, later collecting their opinions. This system is based on a virtual reality game system, using the Kinect sensor while performing an exercise protocol which is integrated in a home-based <span class="hlt">cardiovascular</span> rehabilitation programme, with a duration of 6 months and at the maintenance phase. The participants responded to a questionnaire asking for their opinion about the system. The results demonstrated that 91% of the participants (n = 10) enjoyed the artwork, while 100% (n = 11) agreed on the importance and usefulness of the automatic counting of the number of repetitions, moreover 64% (n = 7) reported motivation to continue performing the programme after the end of the study, and 100% (n = 11) recognized Kinect as an instrument with potential to be an asset in <span class="hlt">cardiovascular</span> rehabilitation. Criticisms included limitations in motion capture and gesture recognition, 91% (n = 10), and the lack of home space, 27% (n = 3). According to the participants' opinions, the Kinect has the potential to be used in <span class="hlt">cardiovascular</span> rehabilitation; however, several technical details require <span class="hlt">improvement</span>, particularly regarding the motion capture and gesture recognition.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4351995','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4351995"><span>The low-carbohydrate diet and <span class="hlt">cardiovascular</span> risk factors: Evidence from epidemiologic studies</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Hu, T.; Bazzano, L. A.</p> <p>2015-01-01</p> <p>Aims Obesity is an important public health issue because of its high prevalence and concomitant increase in risk of <span class="hlt">cardiovascular</span> diseases. Low carbohydrate diets are popular for weight loss and weight management but are not recommended in leading guidelines due to the perception that increases in dietary fat intake may lead to an adverse <span class="hlt">cardiovascular</span> risk profile. To clarify the effects of a low-carbohydrate diet for weight loss on <span class="hlt">cardiovascular</span> disease risk factors as compared to a low fat diet for weight loss, we systematically reviewed data from randomized controlled clinical trials and large observational studies. Data synthesis We searched the MEDLINE database (Jan 1966–Nov 2013) to identify studies that examined a low-carbohydrate diet as compared to a low-fat diet for weight loss or the <span class="hlt">improvement</span> of <span class="hlt">cardiovascular</span> disease risk factors. Conclusions Recent randomized controlled trials document that low-carbohydrate diets not only decrease body weight but also <span class="hlt">improve</span> <span class="hlt">cardiovascular</span> risk factors. In light of this evidence from randomized controlled trials, dietary guidelines should be re-visited advocating a healthy low carbohydrate dietary pattern as an alternative dietary strategy for the prevention of obesity and <span class="hlt">cardiovascular</span> disease risk factors. PMID:24613757</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29058131','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29058131"><span>Insulin and Its <span class="hlt">Cardiovascular</span> Effects: What Is the Current Evidence?</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Dongerkery, Sahana Pai; Schroeder, Pamela R; Shomali, Mansur E</p> <p>2017-10-23</p> <p>In this article, we examine the nature of the complex relationship between insulin and <span class="hlt">cardiovascular</span> disease. With metabolic abnormalities comes increased risk for <span class="hlt">cardiovascular</span> complications. We discuss the key factors implicated in development and progression of <span class="hlt">cardiovascular</span> disease, its relationship to insulin therapy, and what can be learned from large, recent <span class="hlt">cardiovascular</span> outcome studies. Preclinical studies suggest that insulin has positive effects of facilitating glucose entry into cells and maintaining euglycemia and negative effects of favoring obesity and atherogenesis under certain conditions. Confounding this relationship is that <span class="hlt">cardiovascular</span> morbidity is linked closely to duration and control of diabetes, and insulin is often used in patients with diabetes of longer duration. However, more recent clinical studies examining the <span class="hlt">cardiovascular</span> safety of insulin therapy have been reassuring. Diabetes and <span class="hlt">cardiovascular</span> outcomes are closely linked. Many studies have implicated insulin resistance and hyperinsulinemia as a major factor for poor <span class="hlt">cardiovascular</span> outcomes. Additional studies link the anabolic effects of therapeutic insulin to weight gain, along with hypoglycemia, which may further aggravate <span class="hlt">cardiovascular</span> risk in this population. Though good glycemic control has been shown to <span class="hlt">improve</span> microvascular risks in type 1 and type 2 diabetes, what are the known <span class="hlt">cardiovascular</span> effects of insulin therapy? The ORIGIN trial suggests at least a neutral effect of the basal insulin glargine on <span class="hlt">cardiovascular</span> outcomes. Recent studies have demonstrated that ultra-long-acting insulin analogs like insulin degludec are non-inferior to insulin glargine with regard to <span class="hlt">cardiovascular</span> outcomes.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28652015','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28652015"><span>Landscape of Innovation for <span class="hlt">Cardiovascular</span> Pharmaceuticals: From Basic Science to New Molecular Entities.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Beierlein, Jennifer M; McNamee, Laura M; Walsh, Michael J; Kaitin, Kenneth I; DiMasi, Joseph A; Ledley, Fred D</p> <p>2017-07-01</p> <p>This study examines the complete timelines of translational science for new <span class="hlt">cardiovascular</span> therapeutics from the initiation of basic research leading to identification of new drug targets through clinical development and US Food and Drug Administration (FDA) approval of new molecular entities (NMEs) based on this research. This work extends previous studies by examining the association between the growth of research on drug targets and approval of NMEs associated with these targets. Drawing on research on innovation in other technology sectors, where technological maturity is an important determinant in the success or failure of new product development, an analytical model was used to characterize the growth of research related to the known targets for all 168 approved <span class="hlt">cardiovascular</span> therapeutics. Categorizing and mapping the technological maturity of <span class="hlt">cardiovascular</span> therapeutics reveal that (1) there has been a distinct transition from phenotypic to targeted methods for drug discovery, (2) the durations of clinical and regulatory processes were significantly influenced by changes in FDA <span class="hlt">practice</span>, and (3) the longest phase of the translational process was the time required for technology to advance from initiation of research to a statistically defined established point of technology maturation (mean, 30.8 years). This work reveals a normative association between metrics of research maturation and approval of new <span class="hlt">cardiovascular</span> therapeutics and suggests strategies for advancing translational science by accelerating basic and applied research and <span class="hlt">improving</span> the synchrony between the maturation of this research and drug development initiatives. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28623159','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28623159"><span>Epigenetic Biomarkers and <span class="hlt">Cardiovascular</span> Disease: Circulating MicroRNAs.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>de Gonzalo-Calvo, David; Iglesias-Gutiérrez, Eduardo; Llorente-Cortés, Vicenta</p> <p>2017-09-01</p> <p>MicroRNAs (miRNAs) are a class of small noncoding RNA (20-25 nucleotides) involved in gene regulation. In recent years, miRNAs have emerged as a key epigenetic mechanism in the development and physiology of the <span class="hlt">cardiovascular</span> system. These molecular species regulate basic functions in virtually all cell types, and are therefore directly associated with the pathophysiology of a large number of <span class="hlt">cardiovascular</span> diseases. Since their relatively recent discovery in extracellular fluids, miRNAs have been studied as potential biomarkers of disease. A wide array of studies have proposed miRNAs as circulating biomarkers of different <span class="hlt">cardiovascular</span> pathologies (eg, myocardial infarction, coronary heart disease, and heart failure, among others), which may have superior physicochemical and biochemical properties than the conventional protein indicators currently used in clinical <span class="hlt">practice</span>. In the present review, we provide a brief introduction to the field of miRNAs, paying special attention to their potential clinical application. This includes their possible role as new diagnostic or prognostic biomarkers in <span class="hlt">cardiovascular</span> disease. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3943377','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3943377"><span><span class="hlt">Improving</span> the Nurse–Family Partnership in Community <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Donelan-McCall, Nancy; O’Brien, Ruth; MacMillan, Harriet; Jack, Susan; Jenkins, Thomas; Dunlap, Wallace P.; O’Fallon, Molly; Yost, Elly; Thorland, Bill; Pinto, Francesca; Gasbarro, Mariarosa; Baca, Pilar; Melnick, Alan; Beeber, Linda</p> <p>2013-01-01</p> <p>BACKGROUND: Evidence-based preventive interventions are rarely final products. They have reached a stage of development that warrant public investment but require additional research and development to strengthen their effects. The Nurse-Family Partnership (NFP), a program of nurse home visiting, is grounded in findings from replicated randomized controlled trials. OBJECTIVE: Evidence-based programs require replication in accordance with the models tested in the original randomized controlled trials in order to achieve impacts comparable to those found in those trials, and yet they must be changed in order to <span class="hlt">improve</span> their impacts, given that interventions require continuous <span class="hlt">improvement</span>. This article provides a framework and illustrations of work our team members have developed to address this tension. METHODS: Because the NFP is delivered in communities outside of research contexts, we used quantitative and qualitative research to identify challenges with the NFP program model and its implementation, as well as promising approaches for addressing them. RESULTS: We describe a framework used to address these issues and illustrate its use in <span class="hlt">improving</span> nurses’ skills in retaining participants, reducing closely spaced subsequent pregnancies, responding to intimate partner violence, observing and promoting caregivers’ care of their children, addressing parents’ mental health problems, classifying families’ risks and strengths as a guide for program implementation, and collaborating with indigenous health organizations to adapt and evaluate the program for their populations. We identify common challenges encountered in conducting research in <span class="hlt">practice</span> settings and translating findings from these studies into ongoing program implementation. CONCLUSIONS: The conduct of research focused on quality <span class="hlt">improvement</span>, model <span class="hlt">improvement</span>, and implementation in NFP <span class="hlt">practice</span> settings is challenging, but feasible, and holds promise for <span class="hlt">improving</span> the impact of the NFP. PMID</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26935162','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26935162"><span><span class="hlt">Cardiovascular</span> Nursing: From Florence to Melbourne.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Thompson, David R</p> <p>2016-08-01</p> <p>This paper, based on the 2015 CSANZ <span class="hlt">Cardiovascular</span> Nursing Lecture, takes its title from the invitation to give this lecture in Melbourne being received when the author was visiting Florence, after whom Florence Nightingale, the founder of modern nursing, is named. Her work has indirectly shaped and influenced <span class="hlt">cardiovascular</span> nursing, which has developed over the past 50 years. Despite its relatively short history, <span class="hlt">cardiovascular</span> nursing has made a major contribution to <span class="hlt">improving</span> the <span class="hlt">cardiovascular</span> health and well-being of patients and families through health promotion, risk reduction and disease prevention. Examples include cardiac rehabilitation and secondary prevention and chronic heart failure disease management. Challenges, however, remain, including nurses practising to the full extent of their education and training, working as full partners with physicians and other health professionals in redesigning healthcare, ensuring better data collection and being more active in advocacy and policy initiatives. <span class="hlt">Cardiovascular</span> nursing has a strong record of innovation but should always remember that it is there to serve the public and, bearing in mind the risk of potential harm versus benefit, be mindful of Florence Nightingale's wise counsel, "First, do no harm". Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28551971','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28551971"><span>Recommended Nordic diet and risk markers for <span class="hlt">cardiovascular</span> disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Berild, Astrid; Holven, Kirsten B; Ulven, Stine M</p> <p>2017-05-01</p> <p><span class="hlt">Cardiovascular</span> diseases are among the main causes of morbidity and mortality in Norway. The objective of this article is to provide an overview of literature that describes the effect of a Nordic diet in line with the authorities’ dietary advice on risk factors for <span class="hlt">cardiovascular</span> disease. Electronic literature searches were undertaken in the PubMed, Cochrane and Embase databases. Randomised, controlled studies that described the Nordic diet and <span class="hlt">cardiovascular</span> disease were included. A total of 15 articles were included. These are based on four dietary intervention studies conducted in the Nordic countries. All of the dietary intervention studies indicated effects on blood lipids. In one of the studies, a Nordic diet caused a 21 % reduction in LDL cholesterol levels. Three of the studies showed that a Nordic diet reduces blood pressure. Results from two of the studies showed that it also <span class="hlt">improved</span> glucose and insulin sensitivity, but after adjustment for weight loss, this effect disappeared. Three of the studies showed that a Nordic diet may positively affect inflammation. A diet based on the authorities’ dietary recommendation and consisting of Nordic ingredients <span class="hlt">improves</span> the risk profile in those who are predisposed to developing <span class="hlt">cardiovascular</span> disease.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/28780647','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/28780647"><span><span class="hlt">Cardiovascular</span> Responses to Skeletal Muscle Stretching: "Stretching" the Truth or a New Exercise Paradigm for <span class="hlt">Cardiovascular</span> Medicine?</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Kruse, Nicholas T; Scheuermann, Barry W</p> <p>2017-12-01</p> <p>Stretching is commonly prescribed with the intended purpose of increasing range of motion, enhancing muscular coordination, and preventing prolonged immobilization induced by aging or a sedentary lifestyle. Emerging evidence suggests that acute or long-term stretching exercise may modulate a variety of <span class="hlt">cardiovascular</span> responses. Specifically, at the onset of stretch, the mechanical deformation of the vascular bed coupled with stimulation of group III muscle afferent fibers initiates a cascade of events resulting in both peripheral vasodilation and a heart rate-driven increase in cardiac output, blood pressure, and muscle blood flow. This potential to increase shear stress and blood flow without the use of excessive muscle energy expenditure may hold important implications for future therapeutic vascular medicine and cardiac health. However, the idea that a <span class="hlt">cardiovascular</span> component may be involved in human skeletal muscle stretching is relatively new. Therefore, the primary intent of this review is to highlight topics related to skeletal muscle stretching and <span class="hlt">cardiovascular</span> regulation and function. The current evidence suggests that acute stretching causes a significant macro- and microcirculatory event that alters blood flow and the relationship between oxygen availability and oxygen utilization. These acute vascular changes if performed chronically may result in <span class="hlt">improved</span> endothelial function, <span class="hlt">improved</span> arterial blood vessel stiffness, and/or reduced blood pressure. Although several mechanisms have been postulated, an increased nitric oxide bioavailability has been highlighted as one promising candidate for the <span class="hlt">improvement</span> in vessel function with stretching. Collectively, the evidence provided in this review suggests that stretching acutely or long term may serve as a novel and alternative low intensity therapeutic intervention capable of <span class="hlt">improving</span> several parameters of vascular function.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4030272','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4030272"><span>Diabetes and <span class="hlt">cardiovascular</span> disease: from evidence to clinical <span class="hlt">practice</span> – position statement 2014 of Brazilian Diabetes Society</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2014-01-01</p> <p>There is a very well known correlation between diabetes and <span class="hlt">cardiovascular</span> disease but many health care professionals are just concerned with glycemic control, ignoring the paramount importance of controlling other risk factors involved in the pathogenesis of serious <span class="hlt">cardiovascular</span> diseases. This Position Statement from the Brazilian Diabetes Society was developed to promote increased awareness in relation to six crucial topics dealing with diabetes and <span class="hlt">cardiovascular</span> disease: Glicemic Control, <span class="hlt">Cardiovascular</span> Risk Stratification and Screening Coronary Artery Disease, Treatment of Dyslipidemia, Hypertension, Antiplatelet Therapy and Myocardial Revascularization. The issue of what would be the best algorithm for the use of statins in diabetic patients received a special attention and a new Brazilian algorithm was developed by our editorial committee. This document contains 38 recommendations which were classified by their levels of evidence (A, B, C and D). The Editorial Committee included 22 specialists with recognized expertise in diabetes and cardiology. PMID:24855495</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li><a href="#" onclick='return showDiv("page_23");'>23</a></li> <li class="active"><span>24</span></li> <li><a href="#" onclick='return showDiv("page_25");'>25</a></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_24 --> <div id="page_25" class="hiddenDiv"> <div class="row"> <div class="col-sm-12"> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li><a href="#" onclick='return showDiv("page_23");'>23</a></li> <li><a href="#" onclick='return showDiv("page_24");'>24</a></li> <li class="active"><span>25</span></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div> </div> <div class="row"> <div class="col-sm-12"> <ol class="result-class" start="481"> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4315664','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4315664"><span>Long-term insulin glargine therapy in type 2 diabetes mellitus: a focus on <span class="hlt">cardiovascular</span> outcomes</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Joseph, Joshua J; Donner, Thomas W</p> <p>2015-01-01</p> <p><span class="hlt">Cardiovascular</span> disease is the leading cause of mortality in type 2 diabetes mellitus. Hyperinsulinemia is associated with increased <span class="hlt">cardiovascular</span> risk, but the effects of exogenous insulin on <span class="hlt">cardiovascular</span> disease progression have been less well studied. Insulin has been shown to have both cardioprotective and atherosclerosis-promoting effects in laboratory animal studies. Long-term clinical trials using insulin to attain <span class="hlt">improved</span> diabetes control in younger type 1 and type 2 diabetes patients have shown <span class="hlt">improved</span> <span class="hlt">cardiovascular</span> outcomes. Shorter trials of intensive diabetes control with high insulin use in higher risk patients with type 2 diabetes have shown either no <span class="hlt">cardiovascular</span> benefit or increased all cause and <span class="hlt">cardiovascular</span> mortality. Glargine insulin is a basal insulin analog widely used to treat patients with type 1 and type 2 diabetes. This review focuses on the effects of glargine on <span class="hlt">cardiovascular</span> outcomes. Glargine lowers triglycerides, leads to a modest weight gain, causes less hypoglycemia when compared with intermediate-acting insulin, and has a neutral effect on blood pressure. The Outcome Reduction With Initial Glargine Intervention (ORIGIN trial), a 6.2 year dedicated <span class="hlt">cardiovascular</span> outcomes trial of glargine demonstrated no increased <span class="hlt">cardiovascular</span> risk. PMID:25657589</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=transformation+AND+leadership&pg=2&id=ED507458','ERIC'); return false;" href="https://eric.ed.gov/?q=transformation+AND+leadership&pg=2&id=ED507458"><span><span class="hlt">Improving</span> Your Daily <span class="hlt">Practice</span>: A Guide for Effective School Leadership</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Berkey, Timothy B.</p> <p>2009-01-01</p> <p>This book will show principals how they can change daily <span class="hlt">practices</span> to invest more time in the <span class="hlt">improvement</span> of teaching and learning. It redirects leadership to effective <span class="hlt">practices</span> in instructional leadership. Contents include an Introduction and the following chapters: (1) Why Change the Way I Lead?; (2) The Path to Effective School Leadership; (3)…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/24662444','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/24662444"><span>Updated standards and processes for accreditation of echocardiographic laboratories from The European Association of <span class="hlt">Cardiovascular</span> Imaging.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Popescu, Bogdan A; Stefanidis, Alexandros; Nihoyannopoulos, Petros; Fox, Kevin F; Ray, Simon; Cardim, Nuno; Rigo, Fausto; Badano, Luigi P; Fraser, Alan G; Pinto, Fausto; Zamorano, Jose Luis; Habib, Gilbert; Maurer, Gerald; Lancellotti, Patrizio; Andrade, Maria Joao; Donal, Erwan; Edvardsen, Thor; Varga, Albert</p> <p>2014-07-01</p> <p>Standards for echocardiographic laboratories were proposed by the European Association of Echocardiography (now the European Association of <span class="hlt">Cardiovascular</span> Imaging) 7 years ago in order to raise standards of <span class="hlt">practice</span> and <span class="hlt">improve</span> the quality of care. Criteria and requirements were published at that time for transthoracic, transoesophageal, and stress echocardiography. This paper reassesses and updates the quality standards to take account of experience and the technical developments of modern echocardiographic <span class="hlt">practice</span>. It also discusses quality control, the incentives for laboratories to apply for accreditation, the reaccreditation criteria, and the current status and future prospects of the laboratory accreditation process. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/17117036','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/17117036"><span>Impact of augmenting dialysis frequency and duration on <span class="hlt">cardiovascular</span> function.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Ly, Joseph; Chan, Christopher T</p> <p>2006-01-01</p> <p>Conventional hemodialysis (CHD) only delivers 10% to 15% of renal function in a nonphysiological intermittent mode. Because it occurs nightly and is sustained over a longer dialysis time, the uremic clearance provided by nocturnal hemodialysis (NHD) far exceeds that of CHD. Increasing the dose and frequency of dialysis by NHD has been demonstrated, in both short- and long-term studies, to reverse several important risk factors for adverse <span class="hlt">cardiovascular</span> events in patients with end-stage renal disease such as hypertension, left ventricular hypertrophy, systolic dysfunction, conduit artery stiffness, attenuated baroreflex regulation of heart rate, disturbed heart rate variability, sleep apnea, and endothelium-dependent vasodilation. In addition, the Toronto NHD experience has reported an emerging body of evidence demonstrating the benefits of NHD on anemia management, inflammation, and endothelial progenitor cell biology. The mechanism(s) by which nocturnal hemodialysis <span class="hlt">improves</span> <span class="hlt">cardiovascular</span> outcomes are under active investigation by our group. It is tempting to speculate that NHD has the potential to decrease endothelial/myocardial injury and restore simultaneously endothelial repair, thereby <span class="hlt">improving</span> <span class="hlt">cardiovascular</span> function in patients with end-stage renal disease. The objectives of the present document are (1) to review the mechanisms underlying dialysis-associated <span class="hlt">cardiovascular</span> morbidity and (2) to describe the restorative potential of NHD on the <span class="hlt">cardiovascular</span> system.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/20601202','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/20601202"><span>Vitamin D and musculoskeletal health, <span class="hlt">cardiovascular</span> disease, autoimmunity and cancer: Recommendations for clinical <span class="hlt">practice</span>.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Souberbielle, Jean-Claude; Body, Jean-Jacques; Lappe, Joan M; Plebani, Mario; Shoenfeld, Yehuda; Wang, Thomas J; Bischoff-Ferrari, Heike A; Cavalier, Etienne; Ebeling, Peter R; Fardellone, Patrice; Gandini, Sara; Gruson, Damien; Guérin, Alain P; Heickendorff, Lene; Hollis, Bruce W; Ish-Shalom, Sofia; Jean, Guillaume; von Landenberg, Philipp; Largura, Alvaro; Olsson, Tomas; Pierrot-Deseilligny, Charles; Pilz, Stefan; Tincani, Angela; Valcour, Andre; Zittermann, Armin</p> <p>2010-09-01</p> <p>There is increasing evidence that, in addition to the well-known effects on musculoskeletal health, vitamin D status may be related to a number of non-skeletal diseases. An international expert panel formulated recommendations on vitamin D for clinical <span class="hlt">practice</span>, taking into consideration the best evidence available based on published literature today. In addition, where data were limited to smaller clinical trials or epidemiologic studies, the panel made expert-opinion based recommendations. Twenty-five experts from various disciplines (classical clinical applications, cardiology, autoimmunity, and cancer) established draft recommendations during a 2-day meeting. Thereafter, representatives of all disciplines refined the recommendations and related texts, subsequently reviewed by all panelists. For all recommendations, panelists expressed the extent of agreement using a 5-point scale. Recommendations were restricted to clinical <span class="hlt">practice</span> and concern adult patients with or at risk for fractures, falls, <span class="hlt">cardiovascular</span> or autoimmune diseases, and cancer. The panel reached substantial agreement about the need for vitamin D supplementation in specific groups of patients in these clinical areas and the need for assessing their 25-hydroxyvitamin D (25(OH)D) serum levels for optimal clinical care. A target range of at least 30 to 40 ng/mL was recommended. As response to treatment varies by environmental factors and starting levels of 25(OH)D, testing may be warranted after at least 3 months of supplementation. An assay measuring both 25(OH)D(2) and 25(OH)D(3) is recommended. Dark-skinned or veiled individuals not exposed much to the sun, elderly and institutionalized individuals may be supplemented (800 IU/day) without baseline testing. Copyright 2010 Elsevier B.V. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/23638684','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/23638684"><span>A study of the knowledge, attitudes, and <span class="hlt">practices</span> (KAP) of the women referred to health centers for <span class="hlt">cardiovascular</span> disease (CVDs) and their risk factors.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Mazloomy, Seyed Said; Baghianimoghadam, Mohammad Hosein; Ehrampoush, Mohammad Hasan; Baghianimoghadam, Behnam; Mazidi, Maysam; Mozayan, Mohammad Reza</p> <p>2014-01-01</p> <p>Hypertension, dyslipidemia, and diabetes are established risk factors for <span class="hlt">cardiovascular</span> disease (CVD) morbidity and mortality. In the past decade a general increase in CVD risk factors in the population aged 65 and older, along with suboptimal control rates, have occurred. In this descriptive, cross-sectional study, the authors describe the knowledge, attitudes, and <span class="hlt">practices</span> (KAP) of Iranian females regarding risk factors for CVD, in an attempt to help with the development of strategies to control risk factors and CVD. Participants were 200 women ages 15-49 referred to health centers in Yazd, selected from four different centers. Data were gathered through a questionnaire consisting of demographics and questions related to KAP. The validity of the questionnaire was determined by a health education specialist, with its reliability determined by piloting and measuring the related Cronbach's alpha (Alpha = 0.720). Measuring knowledge of CVD on a scale of 0-20, the mean knowledge score was 10.203.91. More than 76% of the participants knew that CVD is preventable. Ninety-one percent liked exercising and believed that exercising would make them feel better. The average mean scores for attitudes of participants toward CVD were 30.31 ± 3.21 out of 36. The authors conclude that there is a need for enhancing mothers' general knowledge about the disease, because of the increasing rates of CVD in females. This will lead to <span class="hlt">improvements</span> in attitude and <span class="hlt">practice</span>. Furthermore, learning in groups of 12 can be a beneficial educational method.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3830984','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3830984"><span><span class="hlt">Improvement</span> in the management of gout is vital and overdue: an audit from a UK primary care medical <span class="hlt">practice</span></span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p></p> <p>2013-01-01</p> <p>Background Gout is estimated to affect 1.4% of adults in the UK. Appropriate and timely management is essential to reduce the risk of further flares, complications, and to reduce <span class="hlt">cardiovascular</span> disease risk. The British Society for Rheumatology and British Health Professionals in Rheumatology (BSR/BHPR) and the European League Against Rheumatism (EULAR) have published guidance regarding the management of gout, thereby providing standards against which performance can be measured. This audit was designed to assess the extent to which patients diagnosed with gout in one primary care medical <span class="hlt">practice</span> in North Staffordshire, UK, are managed in accordance with current best <span class="hlt">practice</span> guidelines, and to identify strategies for <span class="hlt">improvement</span> where appropriate. Methods Audit criteria were derived from the EULAR and BSR/BHPR guidelines; standards were set arbitrarily, but with consideration of patient comorbidity and other factors which may influence concordance. An electronic search of the <span class="hlt">practice</span> records was performed to identify adults with a diagnosis of gout. Medical record review with a descriptive analysis was undertaken to assess the extent to which medical management adhered to the predefined standards. Results Of the total ≥18 year-old <span class="hlt">practice</span> population (n = 8686), 305 (3%) patient records included a diagnosis of gout. Of these, 74% (n = 226) had an electronic record of serum uric acid (SUA), and 11% (n = 34) and 53% (n = 162) a measure of estimated glomerular filtration rate (eGFR) ever and serum glucose since diagnosis respectively. 34% (n = 105) of patients had ever taken urate-lowering therapy with 25% (n = 77) currently prescribed this at the time of data extraction. Dose adjustment and monitoring of treatment according to SUA was found to be inadequate. Provision of lifestyle advice and consideration of comorbidities was also lacking. Conclusions The primary care management of gout in this <span class="hlt">practice</span> was not concordant with national</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4787294','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4787294"><span>Point-of-Care Technologies for Precision <span class="hlt">Cardiovascular</span> Care and Clinical Research</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>King, Kevin; Grazette, Luanda P.; Paltoo, Dina N.; McDevitt, John T.; Sia, Samuel K.; Barrett, Paddy M.; Apple, Fred S.; Gurbel, Paul A.; Weissleder, Ralph; Leeds, Hilary; Iturriaga, Erin J.; Rao, Anupama; Adhikari, Bishow; Desvigne-Nickens, Patrice; Galis, Zorina S.; Libby, Peter</p> <p>2016-01-01</p> <p>Point-of-care technologies (POC or POCT) are enabling innovative <span class="hlt">cardiovascular</span> diagnostics that promise to <span class="hlt">improve</span> patient care across diverse clinical settings. The National Heart, Lung, and Blood Institute convened a working group to discuss POCT in <span class="hlt">cardiovascular</span> medicine. The multidisciplinary working group, which included clinicians, scientists, engineers, device manufacturers, regulatory officials, and program staff, reviewed the state of the POCT field; discussed opportunities for POCT to <span class="hlt">improve</span> <span class="hlt">cardiovascular</span> care, realize the promise of precision medicine, and advance the clinical research enterprise; and identified barriers facing translation and integration of POCT with existing clinical systems. A POCT development roadmap emerged to guide multidisciplinary teams of biomarker scientists, technologists, health care providers, and clinical trialists as they: 1) formulate needs assessments; 2) define device design specifications; 3) develop component technologies and integrated systems; 4) perform iterative pilot testing; and 5) conduct rigorous prospective clinical testing to ensure that POCT solutions have substantial effects on <span class="hlt">cardiovascular</span> care. PMID:26977455</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://eric.ed.gov/?q=quantitative+AND+pretest+AND+posttest+AND+research&pg=5&id=EJ1111041','ERIC'); return false;" href="https://eric.ed.gov/?q=quantitative+AND+pretest+AND+posttest+AND+research&pg=5&id=EJ1111041"><span><span class="hlt">Improving</span> Kindergarten Teachers' Differentiation <span class="hlt">Practices</span> to Better Anticipate Student Differences</span></a></p> <p><a target="_blank" href="http://www.eric.ed.gov/ERICWebPortal/search/extended.jsp?_pageLabel=advanced">ERIC Educational Resources Information Center</a></p> <p>Dijkstra, Elma M.; Walraven, Amber; Mooij, Ton; Kirschner, Paul A.</p> <p>2016-01-01</p> <p>This article presents the findings from a teacher intervention in Dutch kindergartens aimed at <span class="hlt">improving</span> teachers' differentiation <span class="hlt">practices</span> (DP) to better anticipate student differences. The intervention was designed to <span class="hlt">improve</span> the match between student levels and curricular activities, in particular for high-ability students and consists of…</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/16387571','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/16387571"><span><span class="hlt">Cardiovascular</span> issues in hypogonadism and testosterone therapy.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Shabsigh, Ridwan; Katz, Mark; Yan, Grace; Makhsida, Nawras</p> <p>2005-12-26</p> <p>A systematic literature search was conducted to investigate the <span class="hlt">cardiovascular</span> issues related to hypogonadism and testosterone therapy. Vascular cells contain sex steroid hormone receptors. Testosterone can exert effects on the vascular wall, either by itself or through aromatization as estrogen. Hypogonadism is associated with central obesity; insulin resistance; low levels of high-density lipoprotein (HDL); high cholesterol levels; and high levels of low-density lipoprotein (LDL), triglycerides, fibrinogen, and plasminogen activator-1. Some observational studies show a correlation between low testosterone and <span class="hlt">cardiovascular</span> disease (CVD), and others show no correlation. Interventional studies do not reveal a direct long-term relation between testosterone therapy and CVD. Short-term data suggest <span class="hlt">cardiovascular</span> benefits of testosterone. Testosterone therapy has beneficial and deleterious effects on <span class="hlt">cardiovascular</span> risk factors. It <span class="hlt">improves</span> insulin sensitivity, central obesity, and lowers total cholesterol and LDL. In some studies, testosterone therapy has an HDL-lowering effect, and in other studies this effect is insignificant. This should not be assumed to be atherogenic because it might be related to reverse cholesterol transport and effects on the HDL(3) subfraction. The <span class="hlt">cardiovascular</span> effects of testosterone therapy may be neutral to beneficial. There is no contraindication for testosterone therapy in men with CVD and diagnosed hypogonadism with or without erectile dysfunction. Caution should be exercised regarding occasional increases in hematocrit levels, especially in patients with congestive heart failure. Conversely, evidence does not support testosterone therapy in aging men for the purpose of <span class="hlt">cardiovascular</span> benefit, despite claims to this effect. Further research on the <span class="hlt">cardiovascular</span> benefits and risks of testosterone is strongly recommended.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4936733','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4936733"><span>A <span class="hlt">Practical</span> Guide for <span class="hlt">Improving</span> Transparency and Reproducibility in Neuroimaging Research</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Poldrack, Russell A.</p> <p>2016-01-01</p> <p>Recent years have seen an increase in alarming signals regarding the lack of replicability in neuroscience, psychology, and other related fields. To avoid a widespread crisis in neuroimaging research and consequent loss of credibility in the public eye, we need to <span class="hlt">improve</span> how we do science. This article aims to be a <span class="hlt">practical</span> guide for researchers at any stage of their careers that will help them make their research more reproducible and transparent while minimizing the additional effort that this might require. The guide covers three major topics in open science (data, code, and publications) and offers <span class="hlt">practical</span> advice as well as highlighting advantages of adopting more open research <span class="hlt">practices</span> that go beyond <span class="hlt">improved</span> transparency and reproducibility. PMID:27389358</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/20121985','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/20121985"><span><span class="hlt">Cardiovascular</span> exercise training extends influenza vaccine seroprotection in sedentary older adults: the immune function intervention trial.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Woods, Jeffrey A; Keylock, K Todd; Lowder, Thomas; Vieira, Victoria J; Zelkovich, William; Dumich, Sara; Colantuano, Kim; Lyons, Kristin; Leifheit, Kurt; Cook, Marc; Chapman-Novakofski, Karen; McAuley, Edward</p> <p>2009-12-01</p> <p>To determine whether <span class="hlt">cardiovascular</span> exercise training resulted in <span class="hlt">improved</span> antibody responses to influenza vaccination in sedentary elderly people who exhibited poor vaccine responses. Single-site randomized parallel-arm 10-month controlled trial. University of Illinois at Urbana-Champaign. One hundred forty-four sedentary, healthy older (69.9 +/- 0.4) adults. Moderate (60-70% maximal oxygen uptake) <span class="hlt">cardiovascular</span> exercise was compared with flexibility and balance training. The primary outcome was influenza vaccine response, as measured according to hemagglutination inhibition (HI) anti-influenza antibody titer and seroprotective responses (HI titer > or =40). Secondary measures included <span class="hlt">cardiovascular</span> fitness and body composition. Of the 160 participants enrolled, 144 (90%) completed the 10-month intervention with excellent compliance ( approximately 83%). <span class="hlt">Cardiovascular</span>, but not flexibility, exercise intervention resulted in <span class="hlt">improvements</span> in indices of <span class="hlt">cardiovascular</span> fitness, including maximal oxygen uptake. Although not affecting peak (e.g., 3 and 6 weeks) postvaccine anti-influenza HI titers, <span class="hlt">cardiovascular</span> exercise resulted in a significant increase in seroprotection 24 weeks after vaccination (30-100% dependent on vaccine variant), whereas flexibility training did not. Participants randomized to <span class="hlt">cardiovascular</span> exercise experienced <span class="hlt">improvements</span> in influenza seroprotection throughout the entire influenza season, whereas those in the balance and flexibility intervention did not. Although there were no differences in reported respiratory tract infections, the exercise group exhibited reduced overall illness severity and sleep disturbance. These data support the hypothesis that regular endurance exercise <span class="hlt">improves</span> influenza vaccine responses.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1921048','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1921048"><span><span class="hlt">Cardiovascular</span> Sound and the Stethoscope, 1816 to 2016</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Segall, Harold N.</p> <p>1963-01-01</p> <p><span class="hlt">Cardiovascular</span> sound escaped attention until Laennec invented and demonstrated the usefulness of the stethoscope. Accuracy of diagnosis using <span class="hlt">cardiovascular</span> sounds as clues increased with <span class="hlt">improvement</span> in knowledge of the physiology of circulation. Nearly all currently acceptable clinicopathological correlations were established by physicians who used the simplest of stethoscopes or listened with the bare ear. Certain refinements followed the use of modern methods which afford greater precision in timing <span class="hlt">cardiovascular</span> sounds. These methods contribute to educating the human ear, so that those advantages may be applied which accrue from auscultation, plus the method of writing quantitative symbols to describe what is heard, by focusing the sense of hearing on each segment of the cardiac cycle in turn. By the year 2016, electronic systems of collecting and analyzing data about the <span class="hlt">cardiovascular</span> system may render the stethoscope obsolete. ImagesFig. 1Fig. 2Fig. 3Fig. 5Fig. 8 PMID:13987676</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/21762853','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/21762853"><span>Preparing nurses for leadership roles in <span class="hlt">cardiovascular</span> disease prevention.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Lanuza, Dorothy M; Davidson, Patricia M; Dunbar, Sandra B; Hughes, Suzanne; De Geest, Sabina</p> <p>2011-07-01</p> <p><span class="hlt">Cardiovascular</span> disease (CVD) is a critical global health issue, and <span class="hlt">cardiovascular</span> nurses play a vital role in decreasing the global burden and contributing to <span class="hlt">improving</span> outcomes in individuals and communities. <span class="hlt">Cardiovascular</span> nurses require the knowledge, skills, and resources that will enable them to function as leaders in CVD. This article addresses the education, training, and strategies that are needed to prepare nurses for leadership roles in preventing and managing CVD. Building on the World Health Organization core competencies for 21st-century health care workers, the specific competencies of <span class="hlt">cardiovascular</span> nurses working in prevention are outlined. These can be further strengthened by investing in the development of cultural, system change and leadership competencies. Mentorship is proposed as a powerful strategy for promoting the <span class="hlt">cardiovascular</span> nursing role and equipping individual nurses to contribute meaningfully to health system reform and community engagement in CVD risk reduction. Copyright © 2011 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/17172882','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/17172882"><span>Native American medicine and <span class="hlt">cardiovascular</span> disease.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Nauman, Eileen</p> <p>2007-01-01</p> <p>Native American medicine provides an approach to the treatment of <span class="hlt">cardiovascular</span> disease that is unique and that can complement modern medicine treatments. Although specific <span class="hlt">practices</span> among the various Native American tribes (Nations) can vary, there is a strong emphasis on the power of shamanism that can be supplemented by the use of herbal remedies, sweat lodges, and special ceremonies. Most of the <span class="hlt">practices</span> are passed down by oral tradition, and there is specific training regarding the Native American healer. Native American medicine has strong testimonial experiences to suggest benefit in cardiac patients; however, critical scientific scrutiny is necessary to confirm the validity of the benefits shown to date.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4777384','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4777384"><span>Ginseng and Ginkgo Biloba Effects on Cognition as Modulated by <span class="hlt">Cardiovascular</span> Reactivity: A Randomised Trial</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Ong Lai Teik, Derek; Lee, Xiao Shiang; Lim, Chu Jian; Low, Chia Mei; Muslima, Mariyam; Aquili, Luca</p> <p>2016-01-01</p> <p>Background There is some evidence to suggest that ginseng and Ginkgo biloba can <span class="hlt">improve</span> cognitive performance, however, very little is known about the mechanisms associated with such <span class="hlt">improvement</span>. Here, we tested whether <span class="hlt">cardiovascular</span> reactivity to a task is associated with cognitive <span class="hlt">improvement</span>. Methodology/Principal findings Using a double-blind, placebo controlled, crossover design, participants (N = 24) received two doses of Panax Ginseng (500, 1000 mg) or Ginkgo Biloba (120, 240 mg) (N = 24), and underwent a series of cognitive tests while systolic, diastolic, and heart rate readings were taken. Ginkgo Biloba <span class="hlt">improved</span> aspects of executive functioning (Stroop and Berg tasks) in females but not in males. Ginseng had no effect on cognition. Ginkgo biloba in females reversed the initial (i.e. placebo) increase in <span class="hlt">cardiovascular</span> reactivity (systolic and diastolic readings increased compared to baseline) to cognitive tasks. This effect (reversal) was most notable after those tasks (Stroop and Iowa) that elicited the greatest <span class="hlt">cardiovascular</span> reactivity during placebo. In males, although ginkgo also decreased <span class="hlt">cardiovascular</span> readings, it did so from an initial (placebo) blunted response (i.e. decrease or no change from baseline) to cognitive tasks. Ginseng, on the contrary, increased <span class="hlt">cardiovascular</span> readings compared to placebo. Conclusions/Significance These results suggest that <span class="hlt">cardiovascular</span> reactivity may be a mechanism by which ginkgo but not ginseng, in females is associated with certain forms of cognitive <span class="hlt">improvement</span>. Trial Registration ClinicalTrials.gov NCT02386852 PMID:26938637</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3313551','PMC'); return false;" href="https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3313551"><span>Implementing Quality <span class="hlt">Improvement</span> in Small, Autonomous Primary Care <span class="hlt">Practices</span>: Implications for the Patient Centered Medical Home</span></a></p> <p><a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pmc">PubMed Central</a></p> <p>Arar, Nedal H.; Noel, Polly H.; Leykum, Luci; Zeber, John E.; Romero, Raquel; Parchman, Michael L.</p> <p>2012-01-01</p> <p>Background Implementing <span class="hlt">improvement</span> programs to enhance quality of care within primary care clinics is complex, with limited <span class="hlt">practical</span> guidance available to help <span class="hlt">practices</span> during the process. Understanding how <span class="hlt">improvement</span> strategies can be implemented in primary care is timely given the recent national movement towards transforming primary care into patient-centered medical homes (PCMH). This study examined <span class="hlt">practice</span> members’ perceptions of the opportunities and challenges associated with implementing changes in their <span class="hlt">practice</span>. Methods Semi-structured interviews were conducted with a purposive sample of 56 individuals working in 16 small, community-based primary care <span class="hlt">practices</span>. The interview consisted of open-ended questions focused on participants’ perceptions of: (1) <span class="hlt">practice</span> vision, (2) perceived need for <span class="hlt">practice</span> <span class="hlt">improvement</span>, and (3) barriers that hinder <span class="hlt">practice</span> <span class="hlt">improvement</span>. The interviews were conducted at the participating clinics and were tape-recorded, transcribed, and content analyzed. Results Content analysis identified two main domains for <span class="hlt">practice</span> <span class="hlt">improvement</span> related to: (1) the process of care, and (2) patients’ involvement in their disease management. Examples of desired process of care changes included <span class="hlt">improvement</span> in patient tracking/follow-up system, standardization of processes of care, and overall clinic documentations. Changes related to the patients’ involvement in their care included <span class="hlt">improving</span> (a) health education, and (b) self care management. Among the internal barriers were: staff readiness for change, poor communication, and relationship difficulties among team members. External barriers were: insurance regulations, finances and patient health literacy. <span class="hlt">Practice</span> Implications Transforming their <span class="hlt">practices</span> to more patient-centered models of care will be a priority for primary care providers. Identifying opportunities and challenges associated with implementing change is critical for successful <span class="hlt">improvement</span> programs. Successful strategy</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/26689218','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/26689218"><span>Systematic Review of Yoga Interventions to Promote <span class="hlt">Cardiovascular</span> Health in Older Adults.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Barrows, Jennifer L; Fleury, Julie</p> <p>2016-06-01</p> <p>The benefits of physical activity are well established, yet few older adults engage in adequate physical activity to optimize health. While yoga may reduce the risk of <span class="hlt">cardiovascular</span> disease, few studies have focused on the efficacy of yoga-based physical activity to promote <span class="hlt">cardiovascular</span> health in older adults. The objective of this review is to provide an evaluation of yoga interventions to reduce <span class="hlt">cardiovascular</span> risk in older adults. Four databases were searched for randomized controlled trials of yoga interventions in older adults. Studies with <span class="hlt">cardiovascular</span> outcomes were included. Literature searches identified nine articles eligible for review. Significant health benefits were reported, including favorable changes in blood pressure, body composition, glucose, and lipids. Yoga <span class="hlt">practices</span>, participant characteristics, and outcome measures were variable. There was limited use of theory. Yoga is safe and feasible in older adults; additional research is warranted to examine the specific components of yoga interventions essential to reducing <span class="hlt">cardiovascular</span> risk. © The Author(s) 2015.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('https://www.ncbi.nlm.nih.gov/pubmed/29605893','PUBMED'); return false;" href="https://www.ncbi.nlm.nih.gov/pubmed/29605893"><span>Does Real World Use of Liraglutide Match its Use in the LEADER <span class="hlt">Cardiovascular</span> Outcome Trial? Study Protocol.</span></a></p> <p><a target="_blank" href="https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed">PubMed</a></p> <p>Hinton, William; Feher, Michael; Munro, Neil; de Lusignan, Simon</p> <p>2018-06-01</p> <p>Liraglutide is an injectable therapy to treat type 2 diabetes (T2DM), belonging to the glucagon-like peptide-1 receptor agonist class of drugs. The Liraglutide Effect and Action in Diabetes: Evaluation of <span class="hlt">Cardiovascular</span> Outcome Results (LEADER) trial established that liraglutide demonstrated glucose-lowering benefits and <span class="hlt">improved</span> <span class="hlt">cardiovascular</span> outcomes in those individuals with T2DM at high <span class="hlt">cardiovascular</span> risk. The aim of this study is to report the prevalence and characteristics of people treated with liraglutide compared with the LEADER trial. In addition, the remaining portion of the T2DM population will be examined to determine the prevalence of those who meet the inclusion criteria for the LEADER trial but who are not treated with this medication. This is a cross-sectional analysis of routinely collected primary care data on all people with T2DM included in the Royal College of General Practitioners (RCGP) Research and Surveillance Center (RSC) network database. People with T2DM will be identified from the dataset using a well-established ontological process. Read and other clinical codes will be used to identify people prescribed liraglutide and those at high <span class="hlt">cardiovascular</span> risk. We will use descriptive statistics to report the characteristics of people with T2DM prescribed liraglutide compared with those of the LEADER trial and the proportion of the wider T2DM cohort that matches the LEADER inclusion criteria. In terms of ethical considerations, this study used pseudonymized data, and was classed as an "Audit of current <span class="hlt">practice</span>". The results of the study will be submitted for publication in a peer-reviewed journal to report the applicability of the results of the LEADER trial to real-world clinical <span class="hlt">practice</span>. Novo Nordisk Limited.</p> </li> <li> <p><a target="_blank" onclick="trackOutboundLink('http://adsabs.harvard.edu/abs/2017RScEd..47..913L','NASAADS'); return false;" href="http://adsabs.harvard.edu/abs/2017RScEd..47..913L"><span><span class="hlt">Improving</span> Inquiry Teaching through Reflection on <span class="hlt">Practice</span></span></a></p> <p><a target="_blank" href="http://adsabs.harvard.edu/abstract_service.html">NASA Astrophysics Data System (ADS)</a></p> <p>Lotter, Christine R.; Miller, Cory</p> <p>2017-08-01</p> <p>In this paper, we explore middle school science teachers' learning of inquiry-based instructional strategies through reflection on <span class="hlt">practice</span> teaching sessions during a summer enrichment program with middle level students. The reflection sessions were part of a larger year-long inquiry professional development program in which teachers learned science content and inquiry pedagogy. The program included a 2-week summer institute in which teachers participated in science content sessions, <span class="hlt">practice</span> teaching to middle level students, and small group-facilitated reflection sessions on their teaching. For this study, data collection focused on teachers' recorded dialogue during the facilitator - run reflection sessions, the teachers' daily written reflections, a final written reflection, and a written reflection on a videotaped teaching session. We investigated the teachers' reflection levels and the themes teachers focused on during their reflection sessions. Teachers were found to reflect at various reflection levels, from simple description to a more sophisticated focus on how to <span class="hlt">improve</span> student learning. Recurrent themes point to the importance of providing situated learning environments, such as the <span class="hlt">practice</span> teaching with immediate reflection for teachers to have time to <span class="hlt">practice</span> new instructional strategies and gain insight from peers and science educators on how to handle student learning issues.</p> </li> </ol> <div class="pull-right"> <ul class="pagination"> <li><a href="#" onclick='return showDiv("page_1");'>«</a></li> <li><a href="#" onclick='return showDiv("page_21");'>21</a></li> <li><a href="#" onclick='return showDiv("page_22");'>22</a></li> <li><a href="#" onclick='return showDiv("page_23");'>23</a></li> <li><a href="#" onclick='return showDiv("page_24");'>24</a></li> <li class="active"><span>25</span></li> <li><a href="#" onclick='return showDiv("page_25");'>»</a></li> </ul> </div> </div><!-- col-sm-12 --> </div><!-- row --> </div><!-- page_25 --> <div class="footer-extlink text-muted" style="margin-bottom:1rem; text-align:center;">Some links on this page may take you to non-federal websites. 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