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Sample records for nuclear cardiology procedures

  1. American Society of Nuclear Cardiology

    MedlinePlus

    ... of Nuclear Cardiology Official publication of the American Society of Nuclear Cardiology Clinical Guidelines Procedures, Appropriate Use Criteria, Information Statements and Joint Society Statements Member Login Enter Forgot your password? Meetings & ...

  2. Diagnostic procedures in cardiology: A clinician's guide

    SciTech Connect

    Warren, J.V.; Lewis, R.P.

    1985-01-01

    This book contains 31 papers. Some of the titles are: Cardiovascular radiology; Nuclear cardiology; echocardiography; The use and conduct of exercise tests; Lipid studies in cardiology; and The practice of cardiology in an era of high technology.

  3. Recent Advances in Nuclear Cardiology.

    PubMed

    Lee, Won Woo

    2016-09-01

    Nuclear cardiology is one of the major fields of nuclear medicine practice. Myocardial perfusion studies using single-photon emission computed tomography (SPECT) have played a crucial role in the management of coronary artery diseases. Positron emission tomography (PET) has also been considered an important tool for the assessment of myocardial viability and perfusion. However, the recent development of computed tomography (CT)/magnetic resonance imaging (MRI) technologies and growing concerns about the radiation exposure of patients remain serious challenges for nuclear cardiology. In response to these challenges, remarkable achievements and improvements are currently in progress in the field of myocardial perfusion imaging regarding the applicable software and hardware. Additionally, myocardial perfusion positron emission tomography (PET) is receiving increasing attention owing to its unique capability of absolute myocardial blood flow estimation. An F-18-labeled perfusion agent for PET is under clinical trial with promising interim results. The applications of F-18 fluorodeoxyglucose (FDG) and F-18 sodium fluoride (NaF) to cardiovascular diseases have revealed details on the basic pathophysiology of ischemic heart diseases. PET/MRI seems to be particularly promising for nuclear cardiology in the future. Restrictive diseases, such as cardiac sarcoidosis and amyloidosis, are effectively evaluated using a variety of nuclear imaging tools. Considering these advances, the current challenges of nuclear cardiology will become opportunities if more collaborative efforts are devoted to this exciting field of nuclear medicine. PMID:27540423

  4. Patient Radiation Doses in Interventional Cardiology Procedures

    PubMed Central

    Pantos, Ioannis; Patatoukas, Georgios; Katritsis, Demosthenes G; Efstathopoulos, Efstathios

    2009-01-01

    Interventional cardiology procedures result in substantial patient radiation doses due to prolonged fluoroscopy time and radiographic exposure. The procedures that are most frequently performed are coronary angiography, percutaneous coronary interventions, diagnostic electrophysiology studies and radiofrequency catheter ablation. Patient radiation dose in these procedures can be assessed either by measurements on a series of patients in real clinical practice or measurements using patient-equivalent phantoms. In this article we review the derived doses at non-pediatric patients from 72 relevant studies published during the last 22 years in international scientific literature. Published results indicate that patient radiation doses vary widely among the different interventional cardiology procedures but also among equivalent studies. Discrepancies of the derived results are patient-, procedure-, physician-, and fluoroscopic equipmentrelated. Nevertheless, interventional cardiology procedures can subject patients to considerable radiation doses. Efforts to minimize patient exposure should always be undertaken. PMID:20066141

  5. Privileging and credentialing for interventional cardiology procedures.

    PubMed

    Blankenship, James C; Rosenfield, Kenneth; Jennings, Henry S

    2015-10-01

    Local institutional-specific credentialing and privileging for procedures is an important process for ensuring the quality of care provided by interventional cardiologists. Recently revised standards for coronary intervention and the blossoming of structural heart disease programs have generated controversy over these processes. How standards are set for credentialing and privileging is poorly understood by most interventional cardiologists, including those responsible for credentialing and privileging. Requirements from The Joint Commission dictate how credentialing and privileging is performed at hospitals they accredit. Physicians must be recredentialed every 2 years at each hospital, with privileges renewed at that time. Hospitals must review quality of physicians even more frequently using Ongoing Professional Practice Evaluations. Hospitals must also evaluate the performance of physicians when they join a hospital staff or when they begin performing new procedures using Focused Professional Practice Evaluations. Cardiology department directors and catheterization laboratory directors are responsible for recredentialing and reprivileging members of their departments. Individual physicians are responsible for cooperating with these processes, and for periodic recertification with specialty boards and governmental agencies. We provide specific guidance to help physicians navigate these processes. PMID:25534235

  6. Recent Trends in Nuclear Cardiology Practice

    PubMed Central

    Song, Bong-Il

    2013-01-01

    Over the past three decades, radionuclide myocardial perfusion scintigraphy (MPS) has become established as the main functional cardiac imaging technique for ischemic heart disease. It is currently appropriate for all aspects of detecting and managing ischemic heart disease, including diagnosis, risk assessment and stratification, assessment of myocardial viability, and evaluation of left ventricular function. The purpose of this article was to review recent trends in nuclear cardiology practice, excluding positron emission tomography. The past few years have brought several rapid developments that have increased photon sensitivity in nuclear cardiology scanner hardware. Additionally, software applying new methods of single photon emission tomography (SPECT) reconstruction on conventional and dedicated systems has preserved or even improved SPECT image quality with lower count statistics. On the other hand, much interest has been shown in lowering the radiation dose by the stakeholders of MPS. PMID:24010067

  7. Nuclear cardiology: 2014 innovations and developments.

    PubMed

    Mahmarian, John J; Chang, SuMin; Nabi, Faisal

    2014-01-01

    Nuclear cardiac imaging is acknowledged as a robust technique for clinically assessing patients with a wide spectrum of cardiac illnesses. Recent technical, radiotracer, and stressor advancements continue to expand the role of nuclear cardiology for the accurate diagnosis and prognostication of patients with known or suspected coronary artery disease. The introduction of I-123 MIBG represents another advance for assessing risk in patients with congestive heart failure and depressed left ventricular (LV) function. Software and hardware innovations and recent shifts in acquisition protocols have greatly improved image quality, reduced cost and radiation exposure, and continue to promote patient and physician satisfaction. The following article will highlight recent achievements in the field that continue to foster a patient-centered imaging approach. PMID:25574344

  8. Nuclear Cardiology: 2014 Innovations and Developments

    PubMed Central

    Mahmarian, John J.; Chang, SuMin; Nabi, Faisal

    2014-01-01

    Nuclear cardiac imaging is acknowledged as a robust technique for clinically assessing patients with a wide spectrum of cardiac illnesses. Recent technical, radiotracer, and stressor advancements continue to expand the role of nuclear cardiology for the accurate diagnosis and prognostication of patients with known or suspected coronary artery disease. The introduction of I-123 MIBG represents another advance for assessing risk in patients with congestive heart failure and depressed left ventricular (LV) function. Software and hardware innovations and recent shifts in acquisition protocols have greatly improved image quality, reduced cost and radiation exposure, and continue to promote patient and physician satisfaction. The following article will highlight recent achievements in the field that continue to foster a patient-centered imaging approach. PMID:25574344

  9. Role of nuclear cardiology in advancing cardiac surgery.

    PubMed

    Abidov, Aiden; Hachamovitch, Rory; Berman, Daniel S

    2004-01-01

    Cardiac surgeons are commonly faced with issues regarding the balance between the potential risk and the potential benefit of a surgical procedure. Nuclear cardiology procedures [myocardial perfusion SPECT (MPS) and positron emission tomography (PET)] provide the surgeon with objective information that augments standard clinical and angiographic assessments with respect to diagnosis, prognosis, and potential benefit from intervention. Development of the technology and methodology of gated MPS acquisition and interpretation allows assessment of the extent and severity of hypoperfused but viable myocardium, as well as global LVEF and LV volume measurements, diastolic function, and LV geometry. With PET, myocardial metabolism and blood flow reserve can also be measured. This chapter provides insight into the current evidence regarding settings in which nuclear cardiology procedures are helpful to the surgeon in assessment of patients having or being considered for cardiac surgery in the setting of coronary artery disease (CAD). Overall, a risk-benefit approach to MPS results is proposed, with principal focus on identifying patients at risk for major cardiac events who may benefit from a surgical procedure. PMID:15619195

  10. Radiation-Induced Noncancer Risks in Interventional Cardiology: Optimisation of Procedures and Staff and Patient Dose Reduction

    PubMed Central

    Khairuddin Md Yusof, Ahmad

    2013-01-01

    Concerns about ionizing radiation during interventional cardiology have been increased in recent years as a result of rapid growth in interventional procedure volumes and the high radiation doses associated with some procedures. Noncancer radiation risks to cardiologists and medical staff in terms of radiation-induced cataracts and skin injuries for patients appear clear potential consequences of interventional cardiology procedures, while radiation-induced potential risk of developing cardiovascular effects remains less clear. This paper provides an overview of the evidence-based reviews of concerns about noncancer risks of radiation exposure in interventional cardiology. Strategies commonly undertaken to reduce radiation doses to both medical staff and patients during interventional cardiology procedures are discussed; optimisation of interventional cardiology procedures is highlighted. PMID:24027768

  11. Robotic surgery in Cardiology: a safe and effective procedure

    PubMed Central

    Poffo, Robinson; Toschi, Alisson Parrilha; Pope, Renato Bastos; Celullare, Alex Luiz; Benício, Anderson; Fischer, Claudio Henrique; Vieira, Marcelo Luiz Campos; Teruya, Alexandre; Hatanaka, Dina Mie; Rusca, Gabriel Franzin; Makdisse, Marcia

    2013-01-01

    ABSTRACT Objective: To evaluate the short and medium-term outcomes of patients undergoing robotic-assisted minimally invasive cardiac surgery. Methods: From March 2010 to March 2013, 21 patients underwent robotic-assisted cardiac surgery. The procedures performed were: mitral valve repair, mitral valve replacement, surgical correction of atrial fibrillation, surgical correction of atrial septal defect, intracardiac tumor resection, totally endoscopic coronary artery bypass surgery and pericardiectomy. Results: The mean age was 48.39±18.05 years. The mean cardiopulmonary bypass time was 151.7±99.97 minutes, and the mean aortic cross-clamp time was 109.94±81.34 minutes. The mean duration of intubation was 7.52±15.2 hours, and 16 (76.2%) patients were extubated in the operating room immediately after the procedure. The mean length of intensive care unit stay was 1.67±1.46 days. There were no conversions to sternotomy. There was no in-hospital death or deaths during the medium-term follow-up. Patients mean follow up time was 684±346 days, ranging from 28 to 1096 days. Conclusion: Robotic-assisted cardiac surgery proved to be feasible, safe and effective and can be applied in the correction of various intra and extracardiac pathologies. PMID:24136755

  12. Status of radiation protection in various interventional cardiology procedures in the Asia Pacific region

    PubMed Central

    Tsapaki, Virginia; Faruque Ghulam, Mohammed; Lim, Soo Teik; Ngo Minh, Hung; Nwe, Nwe; Sharma, Anil; Sim, Kui-Hian; Srimahachota, Suphot; Rehani, Madan Mohan

    2011-01-01

    Objective Increasing use of interventional procedures in cardiology with unknown levels of radiation protection in many countries of Asia-Pacific region necessitates the need for status assessment. The study was part of an International Atomic Energy Agency (IAEA) project for achieving improved radiation protection in interventional cardiology (IC) in developing countries. Design The survey covers 18 cardiac catheterisation laboratories in seven countries (Bangladesh, India, Malaysia, Myanmar, Singapore, Thailand and Vietnam). An important step was the creation of the ‘Asian network of Cardiologists in Radiation Protection’ and a newsletter. Data were collected on: radiation protection tools, number of IC laboratories, and annual number of various IC paediatric and adult procedures in the hospital and in the country. Patient radiation dose data were collected in terms of Kerma Area Product (KAP) and cumulative dose (CD). Results It is encouraging that protection devices for staff are largely used in the routine practice. Only 39% of the angiographic machines were equipped with a KAP meter. Operators' initial lack of awareness on radiation-protection optimisation improved significantly after participation in IAEA radiation-protection training. Only two out of five countries reporting patient percutaneous coronary intervention radiation-dose data were fully within the international guidance levels. Data from 51 patients who underwent multiple therapeutic procedures (median 2–3) indicated a total KAP reaching 995 Gy.cm2 (range 10.1–995) and CD 15.1 Gy (range 0.4–15.1), stressing the importance of dose monitoring and optimisation. Conclusions There is a need for interventional cardiology societies to play an active role in training actions and implementation of radiation protection. PMID:27325974

  13. Assessment of the occupational exposure in real time during interventional cardiology procedures.

    PubMed

    Baptista, M; Figueira, C; Teles, P; Cardoso, G; Zankl, M; Vaz, P

    2015-07-01

    Interventional cardiology (IC) procedures can be complex, requiring the operators to work near the patient, during long exposure times. Owing to scattered radiation in the patient and the fluoroscopic equipment, the medical staff are exposed to a non-uniform radiation field and can receive high radiation doses. In this study, it is proposed to analyse staff doses obtained in real time, during IC procedures. A system for occupational dosimetry in real time was used. In order to identify some parameters that may affect the staff doses, Monte Carlo (MC) calculations, using MCNPX v.2.7.0 code and voxel phantoms, were performed. The data obtained from measurements, together with MC simulations, allowed the identification of actions and behaviours of the medical staff that could be considered a risk under routine working conditions. The implementation of this monitoring system for exposure of personnel may have a positive effect on optimisation of radiological protection in fluoroscopically guided cardiac procedures. PMID:25848113

  14. Reporting nuclear cardiology: a joint position paper by the European Association of Nuclear Medicine (EANM) and the European Association of Cardiovascular Imaging (EACVI).

    PubMed

    Trägårdh, Elin; Hesse, Birger; Knuuti, Juhani; Flotats, Albert; Kaufmann, Philipp A; Kitsiou, Anastasia; Hacker, Marcus; Verberne, Hein J; Edenbrandt, Lars; Delgado, Victoria; Donal, Erwan; Edvardsen, Thor; Galderisi, Maurizio; Habib, Gilbert; Lancellotti, Patrizio; Nieman, Koen; Rosenhek, Raphael; Agostini, Denis; Gimelli, Alessia; Lindner, Oliver; Slart, Riemert; Ubleis, Christopher

    2015-03-01

    The report of an imaging procedure is a critical component of an examination, being the final and often the only communication from the interpreting physician to the referring or treating physician. Very limited evidence and few recommendations or guidelines on reporting imaging studies are available; therefore, an European position statement on how to report nuclear cardiology might be useful. The current paper combines the limited existing evidence with expert consensus, previously published recommendations as well as current clinical practices. For all the applications discussed in this paper (myocardial perfusion, viability, innervation, and function as acquired by single photon emission computed tomography and positron emission tomography or hybrid imaging), headings cover laboratory and patient demographics, clinical indication, tracer administration and image acquisition, findings, and conclusion of the report. The statement also discusses recommended terminology in nuclear cardiology, image display, and preliminary reports. It is hoped that this statement may lead to more attention to create well-written and standardized nuclear cardiology reports and eventually lead to improved clinical outcome. PMID:25618478

  15. Overall measurements of dose to patients in common interventional cardiology procedures.

    PubMed

    Wang, Weipeng; Zhang, Menglong; Zhang, Yi

    2013-12-01

    This study was designed to measure peak skin dose (PSD), dose-area product (DAP), cumulative dose (CD) and fluoroscopy time (FT) for interventional cardiology procedures and to evaluate whether patient doses were higher than that in other published data. Three cardiac procedure types, including coronary angiography (CAG), percutaneous transluminal coronary angioplasty (PTCA) and radio frequency (RF) ablation, were entered into the study. Data of four special metrics (PSD, DAP, CD and FT) for these procedures were collected and measured. A total of 238 patients who underwent interventional radiology procedures participated in this study. For every procedure, data about PSD were resulted from six TLD arrays and DAP, CD and FT were collected from the displayed monitor. The mean, standard deviation (SD), range and third quartile of the distribution of PSD, DAP, CD and FT recorded and measured on spot were calculated for all procedures. High-dose cases were specifically recorded. There was wide variation in the doses observed for different instances of the same procedure. PSD for PTCA and RF ablation ranged from 0.1 Gy to more than 3 Gy. Of 238 instances, there were 22 (9.2 %) with PSDs greater than 2 Gy and 4 (1.7 %) than 3 Gy. The third quartile of the distribution for PTCA had exceeded the DIMOND preliminary reference levels by 41.1 % in DAP and 25.0 % in FT. Mean DAP was in the range of reported values for CAG procedure, but higher than all data obtained in literatures for PTCA. Data from this study are in the range of most reported values for CAG and RF ablation procedure, while higher than that obtained in some literatures for PTCA. In case of a constant delivering of high doses to patient and physician himself, thorough training of interventionalists and staff is necessary, and the legislation has to be revised and set dose constrains especially for the interventional high-dose procedures. PMID:23770572

  16. Nuclear cardiology patient tracking using a palm-based device: methods and clinician satisfaction.

    PubMed

    Siddiqui, Khan M; Butcher, Richard J

    2002-01-01

    Handheld personal computers are popular, easy to use, inexpensive, portable, and can share data among different operating systems. In our institution, nuclear cardiology testing is performed in the nuclear medicine department and jointly reported by radiologists and cardiologists. The objective of this article is to describe a system for recording nuclear cardiology data and to assess clinician satisfaction using handheld computers with the Palm Operating System. We devised a Palm-based relational database/ using commercially available software (HanDBase) that requires minimal computer expertise to implement and maintain. Data are collected by the cardiologist and synchronized to a single central relational database compatible with Microsoft Access. We assessed cardiologists' satisfaction with this system. Cardiologists unanimously agreed that this system had a positive impact on patient management and cardiology fellow education. They were satisfied with ease of data input, sharing, retrieval, and clarity of data display. The cardiologist with the least experience in using the software took longer to input data and thought that it prolonged the nuclear cardiology rounds. The idea to develop this software was to ease data entry using shortcuts and lists, limiting data stored to that essential for patient management and also to transmit data easily between staff. The cardiologist with the most experience in using the software felt more comfortable and satisfied with it. This was perhaps due to his continuous involvement in the development of this system. Like any new system, there is a learning curve in using this software. The software was easy to customize, and support and tutorials were found on the manufacturer's Web site. The system of collecting data using handheld computers with the Palm Operating System is easy to use, relatively inexpensive, accurate, and secure. The user-friendly system provides prompt, complete, and accurate data, enhancing the education

  17. The current and future status of nuclear cardiology: a consensus report.

    PubMed

    Underwood, Stephen Richard; de Bondt, Pieter; Flotats, Albert; Marcasa, Claudio; Pinto, Fausto; Schaefer, Wolfgang; Verberne, Hein Jan

    2014-09-01

    Cardiac imaging now provides a range of anatomical and functional information with some overlap in the ability of individual techniques to guide diagnosis and management. This report summarizes the conclusions of a panel of cardiac imagers who assembled to discuss the current state of the field. It focuses principally on options for nuclear cardiology, the choice between individual techniques, and areas where further advances would benefit patient management. PMID:24819850

  18. Estimation of staff lens doses during interventional procedures. Comparing cardiology, neuroradiology and interventional radiology.

    PubMed

    Vano, E; Sanchez, R M; Fernandez, J M

    2015-07-01

    The purpose of this article is to estimate lens doses using over apron active personal dosemeters in interventional catheterisation laboratories (cardiology IC, neuroradiology IN and radiology IR) and to investigate correlations between occupational lens doses and patient doses. Active electronic personal dosemeters placed over the lead apron were used on a sample of 204 IC procedures, 274 IN and 220 IR (all performed at the same university hospital). Patient dose values (kerma area product) were also recorded to evaluate correlations with occupational doses. Operators used the ceiling-suspended screen in most cases. The median and third quartile values of equivalent dose Hp(10) per procedure measured over the apron for IC, IN and IR resulted, respectively, in 21/67, 19/44 and 24/54 µSv. Patient dose values (median/third quartile) were 75/128, 83/176 and 61/159 Gy cm(2), respectively. The median ratios for dosemeters worn over the apron by operators (protected by the ceiling-suspended screen) and patient doses were 0.36; 0.21 and 0.46 µSv Gy(-1) cm(-2), respectively. With the conservative approach used (lens doses estimated from the over apron chest dosemeter) we came to the conclusion that more than 800 procedures y(-1) and per operator were necessary to reach the new lens dose limit for the three interventional specialties. PMID:25848117

  19. Occupational radiation doses to the extremities and the eyes in interventional radiology and cardiology procedures

    PubMed Central

    Efstathopoulos, E P; Pantos, I; Andreou, M; Gkatzis, A; Carinou, E; Koukorava, C; Kelekis, N L; Brountzos, E

    2011-01-01

    Objectives The aim of this study was to determine occupational dose levels in interventional radiology and cardiology procedures. Methods The study covered a sample of 25 procedures and monitored occupational dose for all laboratory personnel. Each individual wore eight thermoluminescent dosemeters next to the eyes, wrists, fingers and legs during each procedure. Radiation protection shields used in each procedure were recorded. Results The highest doses per procedure were recorded for interventionists at the left wrist (average 485 μSv, maximum 5239 μSv) and left finger (average 324 μSv, maximum 2877 μSv), whereas lower doses were recorded for the legs (average 124 μSv, maximum 1959 μSv) and the eyes (average 64 μSv, maximum 1129 μSv). Doses to the assisting nurses during the intervention were considerably lower; the highest doses were recorded at the wrists (average 26 μSv, maximum 41 μSv) and legs (average 18 μSv, maximum 22 μSv), whereas doses to the eyes were minimal (average 4 μSv, maximum 16 μSv). Occupational doses normalised to kerma area product (KAP) ranged from 11.9 to 117.3 μSv/1000 cGy cm2 and KAP was poorly correlated to the interventionists' extremity doses. Conclusion Calculation of the dose burden for interventionists considering the actual number of procedures performed annually revealed that dose limits for the extremities and the lenses of the eyes were not exceeded. However, there are cases in which high doses have been recorded and this can lead to exceeding the dose limits when bad practices are followed and the radiation protection tools are not properly used. PMID:21172967

  20. Patient radiation doses in the most common interventional cardiology procedures in Croatia: first results.

    PubMed

    Brnić, Z; Krpan, T; Faj, D; Kubelka, D; Ramac, J Popić; Posedel, D; Steiner, R; Vidjak, V; Brnić, V; Visković, K; Baraban, V

    2010-02-01

    Apart from its benefits, the interventional cardiology (IC) is known to generate high radiation doses to patients and medical staff involved. The European Union Medical Exposures Directive 97/43/Euroatom strongly recommend patient dosimetry in interventional radiology, including IC. IC patient radiation doses in four representative IC rooms in Croatia were investigated. Setting reference levels for these procedures have difficulties due to the large difference in procedure complexity. Nevertheless, it is important that some guideline values are available as a benchmark to guide the operators during these potentially high-dose procedures. Local and national diagnostic reference levels (DRLs) were proposed as a guidance. A total of 138 diagnostic (coronary angiography, CA) and 151 therapeutic (PTCA, stenting) procedures were included. Patient irradiation was measured in terms of kerma-area product (KAP), fluoroscopy time (FT) and number of cine-frames (F). KAP was recorded using calibrated KAP-meters. DRLs of KAP, FT and F were calculated as third quartile values rounded up to the integer. Skin doses were assessed on a selected sample of high skin dose procedures, using radiochromic films, and peak skin doses (PSD) were presented. A relative large range of doses in IC was detected. National DRLs were proposed as follows: 32 Gy cm(2), 6.6 min and 610 frames for CA and 72 Gy cm(2), 19 min and 1270 frames for PTCA. PSD <1 Gy were measured in 72 % and PSD >2 Gy in 8 % of selected patients. Measuring the patient doses in radiological procedures is required by law, but rarely implemented in Croatia. The doses recorded in the study are acceptable when compared with the literature, but optimisation is possible. The preliminary DRL values proposed may be used as a guideline for local departments, and should be a basis for radiation reduction measures and quality assurance programmes in IC in Croatia. PMID:19880413

  1. Nuclear cardiology.

    PubMed

    Penkava, R R

    1985-05-01

    Radionuclide cardiac imaging is a safe, noninvasive alternative to cardiac catheterization for observation and evaluation of cardiac wall motion and calculation of ejection fraction. Nuclide imaging offers a greater degree of sensitivity and specificity in detecting myocardial ischemia and infarction than do conventional electrocardiographic and cardiac enzyme studies. It is especially useful in problem cases. Myocardial infarction can usually be evaluated with respect to size and relative age of infarction. PMID:2986439

  2. Low dose in nuclear cardiology: state of the art in the era of new cadmium-zinc-telluride cameras.

    PubMed

    Acampa, Wanda; Buechel, Ronny R; Gimelli, Alessia

    2016-06-01

    The use of myocardial perfusion imaging has seen a tremendous growth during the last decade and has become the most commonly used non-invasive imaging tool for risk stratification in patients with suspected and known coronary artery disease. Adherence to radiation safety best practices varied significantly between laboratories but the possibility to use the new cameras in nuclear cardiology can reduce dramatically the radiation dose without losing accuracy. Moreover, the physical characteristics of ultrafast technology could be able to open new doors for the evaluation of old parameters, changing the impact of nuclear cardiology in the diagnostic strategies. PMID:26985078

  3. Diagnostic radiology and nuclear cardiology. Their use in assessment of equine cardiovascular disease.

    PubMed

    Koblik, P D; Hornof, W J

    1985-08-01

    Survey thoracic radiography, although limited by physical considerations in the adult horse, can supply clinically useful information about changes in cardiac size and function. The radiographic features of cardiomegaly, altered pulmonary circulation, pulmonary edema, and pleural effusion as manifested in the horse are discussed. Nuclear cardiology can be performed in the standing horse. The initial transit of a radioactive tracer through the central circulation provides information about cardiac chamber size, efficiency of ventricular contraction, valvular competence, and presence of intracardiac or extracardiac shunts. Computer analysis of similar studies allows quantitation of several useful cardiac parameters including ventricular ejection fraction and shunt size (QP/QS). Gated blood pool nuclear studies are better suited to evaluate cardiac response to stress but are difficult to perform in the conscious horse with standard imaging equipment. PMID:2934115

  4. Noninvasive Identification of ATTRwt Cardiac Amyloid: The Re-emergence of Nuclear Cardiology.

    PubMed

    Maurer, Mathew S

    2015-12-01

    More than half of all subjects with chronic heart failure are older adults with preserved ejection fraction (HFpEF). Effective therapy for this condition is yet to be delineated by clinical trials, suggesting that a greater understanding of underlying biologic mechanisms is needed, especially for the purpose of clinical intervention and future clinical trials. Amyloid infiltration of the myocardium is an underappreciated contributing factor to HFpEF that is often caused by misfolded monomers or oligomers of the protein transthyretin. While previously called senile cardiac amyloidosis and traditionally requiring endomyocardial biopsy for diagnosis, advances in our pathophysiologic understanding of this condition, coupled with nuclear imaging techniques using bone isotopes that can diagnose this condition noninvasively and the development of potential therapies, have resulted in a renewed interest in this previously considered "rare" condition. This reviewer focuses on the re-emergence of nuclear cardiology using pyrophosphate agents that hold promise for early, noninvasive identification of affected individuals. PMID:26091765

  5. Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS)

    PubMed Central

    Einstein, Andrew J.; Pascual, Thomas N. B.; Mercuri, Mathew; Karthikeyan, Ganesan; Vitola, João V.; Mahmarian, John J.; Better, Nathan; Bouyoucef, Salah E.; Hee-Seung Bom, Henry; Lele, Vikram; Magboo, V. Peter C.; Alexánderson, Erick; Allam, Adel H.; Al-Mallah, Mouaz H.; Flotats, Albert; Jerome, Scott; Kaufmann, Philipp A.; Luxenburg, Osnat; Shaw, Leslee J.; Underwood, S. Richard; Rehani, Madan M.; Kashyap, Ravi; Paez, Diana; Dondi, Maurizio

    2015-01-01

    Aims To characterize patient radiation doses from nuclear myocardial perfusion imaging (MPI) and the use of radiation-optimizing ‘best practices’ worldwide, and to evaluate the relationship between laboratory use of best practices and patient radiation dose. Methods and results We conducted an observational cross-sectional study of protocols used for all 7911 MPI studies performed in 308 nuclear cardiology laboratories in 65 countries for a single week in March–April 2013. Eight ‘best practices’ relating to radiation exposure were identified a priori by an expert committee, and a radiation-related quality index (QI) devised indicating the number of best practices used by a laboratory. Patient radiation effective dose (ED) ranged between 0.8 and 35.6 mSv (median 10.0 mSv). Average laboratory ED ranged from 2.2 to 24.4 mSv (median 10.4 mSv); only 91 (30%) laboratories achieved the median ED ≤ 9 mSv recommended by guidelines. Laboratory QIs ranged from 2 to 8 (median 5). Both ED and QI differed significantly between laboratories, countries, and world regions. The lowest median ED (8.0 mSv), in Europe, coincided with high best-practice adherence (mean laboratory QI 6.2). The highest doses (median 12.1 mSv) and low QI (4.9) occurred in Latin America. In hierarchical regression modelling, patients undergoing MPI at laboratories following more ‘best practices’ had lower EDs. Conclusion Marked worldwide variation exists in radiation safety practices pertaining to MPI, with targeted EDs currently achieved in a minority of laboratories. The significant relationship between best-practice implementation and lower doses indicates numerous opportunities to reduce radiation exposure from MPI globally. PMID:25898845

  6. Comparison of procedural complications with versus without interventional cardiology fellows-in-training during contemporary percutaneous coronary intervention.

    PubMed

    Stolker, Joshua M; Allen, Drew S; Cohen, David J; Kennedy, Kevin F; Laster, Steven B; Frutkin, Andrew D; Mehta, Sameer K; O'Neal, Kelly R; Marso, Steven P

    2014-01-01

    Despite increasing complexity of contemporary procedures at tertiary care hospitals, the relationship between interventional cardiology fellows-in-training (ICFITs) and complications of percutaneous coronary intervention (PCI) has not been reported. We compiled logbooks of 6 ICFITs at an academic hospital and evaluated patient and procedural characteristics of PCIs performed with and without presence of an ICFIT. The primary end point was the composite of all in-hospital PCI complications defined by the American College of Cardiology's National Cardiovascular Data Registry: (1) catheterization laboratory events such as no-reflow and dissection/perforation, (2) general clinical events such as stroke or cardiogenic shock, (3) vascular and bleeding complications, and (4) miscellaneous complications such as peak troponin or creatinine levels. Logistic regression adjusted for differences in measured confounders between patients treated with and without presence of an ICFIT. All analyses were repeated after excluding PCI for ST-elevation myocardial infarction. Of 2,605 PCI procedures at the academic hospital between July 2007 and April 2010, an ICFIT was present for 1,638 procedures (63%). Despite having worse clinical and procedural characteristics, patients in the ICFIT group experienced similar rates of the composite end point (12.9% vs 14.5% without ICFIT, p = 0.27). Longer mean fluoroscopy times and greater number of stents were noted in the ICFIT group; however, hospital length of stay was shorter and no individual adverse events were increased in the ICFIT procedures. Presence of an ICFIT remained unrelated to the composite end point after multivariable adjustment (odds ratio 0.92, 95% confidence interval 0.71 to 1.20; p = 0.53), and findings were similar after excluding PCI for ST-elevation myocardial infarction. In conclusion, in contemporary practice at a large academic medical center, PCI complication rates were not adversely affected by the presence of an

  7. Cardiovascular imaging in the diagnosis and monitoring of cardiotoxicity: cardiovascular magnetic resonance and nuclear cardiology.

    PubMed

    Pepe, Alessia; Pizzino, Fausto; Gargiulo, Paola; Perrone-Filardi, Pasquale; Cadeddu, Christian; Mele, Donato; Monte, Ines; Novo, Giuseppina; Zito, Concetta; Di Bella, Gianluca

    2016-05-01

    Chemotherapy-induced cardiotoxicity (CTX) is a determining factor for the quality of life and mortality of patients administered potentially cardiotoxic drugs and in long-term cancer survivors. Therefore, prevention and early detection of CTX are highly desirable, as is the exploration of alternative therapeutic strategies and/or the proposal of potentially cardioprotective treatments. In recent years, cardiovascular imaging has acquired a pivotal role in this setting. Although echocardiography remains the diagnostic method most used to monitor cancer patients, the need for more reliable, reproducible and accurate detection of early chemotherapy-induced CTX has encouraged the introduction of second-line advanced imaging modalities, such as cardiac magnetic resonance (CMR) and nuclear techniques, into the clinical setting. This review of the Working Group on Drug Cardiotoxicity and Cardioprotection of the Italian Society of Cardiology aims to afford an overview of the most important findings from the literature about the role of CMR and nuclear techniques in the management of chemotherapy-treated patients, describe conventional and new parameters for detecting CTX from both diagnostic and prognostic perspectives and provide integrated insight into the role of CMR and nuclear techniques compared with other imaging tools and versus the positions of the most important international societies. PMID:27183525

  8. Changing from image intensifier to flat detector technology for interventional cardiology procedures: a practical point of view.

    PubMed

    Bokou, C; Schreiner-Karoussou, A; Breisch, R; Beissel, J

    2008-01-01

    A small-scale internal audit has been used to evaluate the impact of the use of a dynamic flat panel detector in the clinical routine in the National Interventional Cardiology Centre in Luxembourg. The parameters tested during commissioning and constancy control of an X-ray system, the introduction of new clinical protocols, the patient and the personal staff dosimetry were considered. The technical parameters tested by the hospital physicist stay the same as for the image intensifier. No innovative protocols have been adopted due to the existence of the flat panel detector. A reduction in dose was noted after the installation of a flat detector, due mostly to the continuing education of the interventional cardiologists as well as the initial calibration of the radiological system. The understanding of the X-ray system and its possibilities is vital for the optimisation of clinical procedures in patient and staff exposure. PMID:18448437

  9. Appropriate use criteria in clinical routine practice: implications in a nuclear cardiology lab.

    PubMed

    Gimelli, Alessia; Rovai, Ilaria; Liga, Riccardo; Pasanisi, Emilio Maria; Marzullo, Paolo

    2016-06-01

    The efforts for a broad application of the appropriate use criteria to reduce inappropriate nuclear stress testing have frequently been unsuccessful and the reported rates of inappropriateness have varied widely between studies. We sought to analyze the criteria of clinical appropriateness of a cohort of consecutive patients referred to our nuclear cardiology laboratory to perform stress myocardial perfusion imaging (MPI) and to assess the relationships between test appropriateness and the evaluation of ischaemia. A cohort of 251 consecutive patients, admitted to our Institute from January to March 2015, who underwent stress/rest MPI on a dedicated cardiac camera equipped with cadmium-zinc-telluride detectors, was selected. The level of clinical appropriateness of each MPI test was categorized in each patient according to the AUC criteria. According to the accepted criteria, the majority of the MPI stress-tests could be classified as clinically appropriate (218 of 251, 87 % of the tests), while only 16 (6 %) and 17 (7 %) resulted of uncertain appropriateness or clearly inappropriate, respectively. Of the 251 appropriate tests, 22 (10 %), 65 (30 %), and 131 (60 %) showed the presence of a mild (SDS < 4), moderate (4 ≥ SDS < 7), and severe (SDS ≥ 7) ischemic burden, respectively, while none of the inappropriate test showed moderate-to-severe ischaemia (P < 0.001 for comparisons). The rate of inappropriate MPI tests is considerably low in a high-volume laboratory. Appropriate and inappropriate studies identify patients at high and low probability of significant ischemia, respectively, providing insights on the effects of the level of appropriateness on stress-test results. PMID:26961179

  10. Review of Cardiovascular Imaging in the Journal of Nuclear Cardiology in 2015-Part 2 of 2: Myocardial perfusion imaging.

    PubMed

    Hage, Fadi G; AlJaroudi, Wael A

    2016-06-01

    In 2015, the Journal of Nuclear Cardiology (®) published many high-quality articles. In this series, we will summarize key articles that have appeared in the Journal last year to provide for the interested reader a quick review of the advancements that have recently occurred in the field. In the first article of this 2-part series, we concentrated on publications dealing with plaque imaging, cardiac positron emission tomography, computed tomography, and magnetic resonance. This review will focus on myocardial perfusion imaging summarizing advances in the field including in diagnosis, prognosis, and appropriate use. PMID:26892251

  11. Normal values for nuclear cardiology: Japanese databases for myocardial perfusion, fatty acid and sympathetic imaging and left ventricular function.

    PubMed

    Nakajima, Kenichi

    2010-04-01

    Myocardial normal databases for stress myocardial perfusion study have been created by the Japanese Society of Nuclear Medicine Working Group. The databases comprised gender-, camera rotation range- and radiopharmaceutical-specific data-sets from multiple institutions, and normal database files were created for installation in common nuclear cardiology software. Based on the electrocardiography-gated single-photon emission computed tomography (SPECT), left ventricular function, including ventricular volumes, systolic and diastolic functions and systolic wall thickening were also analyzed. Normal databases for fatty acid imaging using (123)I-beta-methyl-iodophenyl-pentadecanoic acid and sympathetic imaging using (123)I-meta-iodobenzylguanidine were also examined. This review provides lists and overviews of normal values for myocardial SPECT and ventricular function in a Japanese population. The population-specific approach is a key factor for proper diagnostic and prognostic evaluation. PMID:20108130

  12. Normal values for nuclear cardiology: Japanese databases for myocardial perfusion, fatty acid and sympathetic imaging and left ventricular function

    PubMed Central

    2010-01-01

    Myocardial normal databases for stress myocardial perfusion study have been created by the Japanese Society of Nuclear Medicine Working Group. The databases comprised gender-, camera rotation range- and radiopharmaceutical-specific data-sets from multiple institutions, and normal database files were created for installation in common nuclear cardiology software. Based on the electrocardiography-gated single-photon emission computed tomography (SPECT), left ventricular function, including ventricular volumes, systolic and diastolic functions and systolic wall thickening were also analyzed. Normal databases for fatty acid imaging using 123I-beta-methyl-iodophenyl-pentadecanoic acid and sympathetic imaging using 123I-meta-iodobenzylguanidine were also examined. This review provides lists and overviews of normal values for myocardial SPECT and ventricular function in a Japanese population. The population-specific approach is a key factor for proper diagnostic and prognostic evaluation. PMID:20108130

  13. Cardiology Mannequin

    NASA Technical Reports Server (NTRS)

    1979-01-01

    Education of medical students in cardiology requires access to patients having a variety of different forms of heart disease. But bringing together student, instructor and patient is a difficult and expensive process that does not benefit the patient. An alternate approach is substitution of a lifelike mannequin capable of simulating many conditions of heart disease. The mannequin pictured below, together with a related information display, is an advanced medical training system whose development benefited from NASA visual display technology and consultative input from NASA's Kennedy Space Center. The mannequin system represents more than 10 years of development effort by Dr. Michael S. Gordon, professor of cardiology at the University of Miami (Florida) School of Medicine.

  14. Tele-cardiology.

    PubMed

    Molefi, M; Fortuin, J; Wynchank, S

    2006-01-01

    After defining tele-medicine, we describe its situation in the public health service of South Africa and its application to cardiology. Methods of communication relevant to tele-cardiology are outlined, together with their bearing on primary healthcare. The range of tele-cardiological applications to electrocardiology, echocardiology, auscultation, imaging and pathology are indicated. Tele-cardiology's contributions to a range of cardiological problems and types of management are described briefly. Finally, a mention is made of the relevance of tele-medicine to education and the costs related to cardiology, with an indication of some future needs for tele-cardiology. PMID:16547558

  15. University cardiology clinic.

    PubMed

    Borozanov, V

    2013-01-01

    In distant 1972, within framework of the Internal Clinic, a cardiologic department was organized which was soon, on 29.XII.1974, transformed into the Cardiology Clinic, later the Institute for Heart Diseases, and in 2008 was renamed the University Cardiology Clinic. The greater part of its foundation was possible owing to Prof. Dimitar Arsov and Prof. Radovan Percinkovski, who was the clinic's first director in the period from 1974 to 1984. In 1985, the Clinic moved into its own new building, and in that way was physically detached from the Internal Clinics. Until its move to the new building, the Clinic functioned in the Internal Clinics building, organized as an outpatient polyclinic and inpatient infirmary department with clinical beds, a coronary intensive care unit and a haemodynamics laboratory equipped with the most modern equipment of that time. Today the Clinic functions through two integral divisions: an inpatient infirmary department which comprises an intensive coronary care unit and fourteen wards which altogether have 139 clinical beds, and the diagnostic centre which comprises an emergency clinic and day hospital, a communal and consultative outpatients' clinic functioning on a daily basis, through which some 300-350 patients pass every day, and diagnostic laboratories with a capacity of nearly 100 non-invasive and 20-30 invasive diagnostic procedures daily. The Clinic is a teaching base, and its doctors are educators of students at the Medical, Dental and Pharmacy Faculties, and also of students at the High School for Nurses and X-ray technicians, but also for those in Internal Medicine and especially Cardiology. The Clinic is also a base for scientific Masters' and post-doctoral studies, and such higher degrees are achieved not only by doctors who work here, but also by doctors from Medical Centres both in the country and abroad. Doctors working in this institution publish widely, not only a great number of books and monographs, but also original

  16. Assessing Competence in Pediatric Cardiology

    ERIC Educational Resources Information Center

    Johnson, Apul E.; And Others

    1976-01-01

    In response to the need to assure physician competence, a rating scale was developed at the University of Minnesota Medical School for use in evaluating clinical competence in pediatric cardiology. It was tested on first- and second-year specialists. Development and testing procedures are described. (JT)

  17. [Over diagnostic imaging in cardiology].

    PubMed

    Carpeggiani, Clara

    2014-03-01

    Medical imaging is one of the major cause of rising health care costs. Diagnostic imaging has increased more rapidly than any other component of medical care. About 5 billion imaging tests are performed worldwide each year. According to recent estimates, at least one-third of all examinations are partially or totally inappropriate. Two out of 3 imaging tests employ ionizing radiations with radiology or nuclear medicine. The medical use of radiation is the largest man-made source of radiation exposure. Medical X-rays and γ-rays are a proven human carcinogen. The attributable long-term extra-risk of cancer due to diagnostic testing is around 10% in industrialized countries. Cardiologists prescribe and/or directly perform >50% of all imaging examinations, accounting for about two-thirds of the total effective dose given to patients. The dose of common cardiological examinations may be significant: 500 chest X-rays= a stress scintigraphy with sestamibi, 750 chest X-rays= a Multislice Computed Tomography, 1,000 chest X-rays= a coronary angiography and stenting. Unfortunately, few doctors are aware of the level of radiation their patients are exposed to during radiological tests and more intensive use of ionizing testing was not associated with greater awareness. Also as a consequence of unawareness, the rate of inappropriate examinations is unacceptably high in cardiology, even for procedures with high radiation load. Higher exposure doses correspond to higher long-term risks; there are no safe doses, and all doses add up in determining the cumulative risks over a lifetime. Doctors should make every effort so that «each patient should get the right imaging exam, at the right time, with the right radiation dose», as suggested by US Food and Drug Administration in the 2010 initiative to reduce unnecessary radiation exposure from medical imaging. This is best obtained through a systematic implementation of the "3 A's strategy" proposed by the International Atomic Energy

  18. Safe sedation in modern cardiological practice.

    PubMed

    Furniss, Stephen S; Sneyd, J Robert

    2015-10-01

    Safe sedation is fundamental to many modern cardiological procedures, and following the publication of the report on safe sedation by the Academy of Medical Royal Colleges, this report discusses sedation specifically in cardiological practice. The major areas within cardiology that use sedation are cardioversion, catheter ablation particularly of atrial fibrillation, transoesophageal echocardiography, implantable device (cardiovascular implantable electronic device) procedures and other procedures such as transcatheter aortic valve replacement. There is increasing demand for cardiological sedation but there is wide geographical variation in its use and there are also growing data to support non-anaesthetists giving sedation. The use of benzodiazepines, particularly for short procedures, is common, but even here good record-keeping and audit together with an understanding of the continuum of sedation and having appropriately trained staff and the necessary facilities are vital. Nurse administration of propofol may be appropriate for some procedures in cardiology that require at least moderate sedation. Appropriate training is essential and the use of capnography and target controlled infusion pumps for propofol administration is recommended. PMID:26085525

  19. [Advances in geriatric cardiology].

    PubMed

    Gómez Sánchez, Miguel A; Bañuelos de Lucas, Camino; Ribera Casado, José M; Pérez Casar, Feliciano

    2006-01-01

    The continued aging of the population is an acknowledged fact. The proportion of individuals in the European Union aged over 65 years will reach 29.9% by 2050, almost double the present figure of 16.4%. Approximately one third of people in this age-group has clinically significant cardiovascular disease. Physicians dealing with cardiology in older patients have to be aware of the specific clinical and prognostic features of cardiovascular disease in the elderly, and with its treatment. Consequently, it is clear that continuing medical education in geriatric cardiology is essential, and that is one of the tasks of the Working Group on Geriatric Cardiology. This special issue provides a magnificent opportunity for presenting an update on important topics in geriatric cardiology, such as the aging of the cardiovascular system, heart failure, and atrial fibrillation. PMID:16540026

  20. [Radiation protection in interventional cardiology].

    PubMed

    Durán, Ariel

    2015-01-01

    INTERVENTIONAL: cardiology progress makes each year a greater number of procedures and increasing complexity with a very good success rate. The problem is that this progress brings greater dose of radiation not only for the patient but to occupationally exposed workers as well. Simple methods for reducing or minimizing occupational radiation dose include: minimizing fluoroscopy time and the number of acquired images; using available patient dose reduction technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using protective shielding; using imaging equipment whose performance is controlled through a quality assurance programme; and wearing personal dosimeters so that you know your dose. Effective use of these methods requires both appropriate education and training in radiation protection for all interventional cardiology personnel, and the availability and use of appropriate protective tools and equipment. Regular review and investigation of personnel monitoring results, accompanied as appropriate by changes in how procedures are performed and equipment used, will ensure continual improvement in the practice of radiation protection in the interventional suite. PMID:26169040

  1. 2014 update on interventional cardiology.

    PubMed

    Hernández Hernández, Felipe; de la Torre Hernández, José M; Rumoroso Cuevas, José R; García del Blanco, Bruno; Martínez-Sellés, Manuel; Trillo Nouche, Ramiro

    2015-04-01

    This article reviews the most relevant publications and studies in the field of interventional cardiology in 2014. In the area of coronary interventional procedures, integrated treatment of acute coronary syndrome continues to be the subject of numerous studies that evaluate different devices and pharmacological and mechanical strategies that can be used without increasing the risk of hemorrhage or the need for reintervention. Certain anatomical substrates continue to generate a considerable number of publications, both on the outcomes with different stents and on the use of specific techniques. Bioabsorbable drug-eluting stents are used in increasingly complex lesions with promising results. The development of interventional procedures for structural heart disease continues to advance, with new evidence on percutaneously placed aortic valve prostheses, the outcome of percutaneous mitral valve repair, and the safety and efficacy of left atrial appendage occlusion. Finally, renal denervation has generated one of the major debates of the year. PMID:25749393

  2. Radiation safety and nuclear medicine policies and procedures.

    PubMed

    Berman, C G

    1999-07-01

    There is a growing concern over possible adverse effects from medical applications of ionizing radiation. Hospital personnel must be educated in procedures to minimize exposure to themselves and their patients. Basic radiation safety procedures to protect personnel and patients are discussed. Examples of the nuclear medicine policies and procedures used for lymphatic mapping are provided. PMID:10448699

  3. Women in interventional cardiology: Is there a problem?

    PubMed

    Safian, Robert D

    2016-03-01

    In the United States, women account for 4% of interventional cardiologists and perform 3% of interventional procedures. Male and female cardiology fellows share concerns that dissuade them from careers in interventional cardiology; unique issues for women include professional isolation and childbearing. Interventional fellowships should enhance female mentorship and develop friendly policies regarding maternity leave; other issues require comprehensive solutions to medical school debt, duration of training, and balancing professional goals with lifestyle. PMID:26994976

  4. [Epistemology in cardiology].

    PubMed

    de Micheli, A

    1988-01-01

    The probabilistic character of several scientific laws, is emphasized. Some considerations are formulated about epistemology: the critical study of the principles, hypotheses and results of sciences. The evolution of medical epistemology and its implications in the field of cardiology is also described from the hippocratic treatises to the present. In former works the oldest use of the word hypothesis with the sense of supposition, is found. Finally remains to be established the relationship between the individual and general field i.e. between a patient, the isolated object of study, and the disease as an abstraction of the human mind. PMID:3063225

  5. Onco-cardiology: Present and future.

    PubMed

    Sueta, Daisuke; Hokimoto, Seiji

    2016-07-15

    "Onco-cardiology" is a term that indicates cardiotoxicity during treatment of malignant diseases. Many studies have demonstrated that chemotherapy agents induce cardiotoxicity in certain ratios. In clinical settings, active malignant diseases or a history thereof are often encountered in patients with cardiovascular disease (CVD); it is not uncommon for a patient to struggle with a prior treatment. We have previously demonstrated a close association between malignant diseases and coronary calcifications in coronary artery disease. The concurrence of arteriosclerotic diseases, including CVD, with malignant diseases should be carefully considered in clinical settings, particularly with regard to scheduled surgical procedures. Moreover, it is essential that all medical professionals associated with cancer care understand these associations. Our advocacy will provide new insight into onco-cardiology. PMID:27107544

  6. Procedures manual for the Evaluated Nuclear Structure Data File

    SciTech Connect

    Bhat, M.R.

    1987-10-01

    This manual is a collection of various notes, memoranda and instructions on procedures for the evaluation of data in the Evaluated Nuclear Structure Data File (ENSDF). They were distributed at different times over the past few years to the evaluators of nuclear structure data and some of them were not readily avaialble. Hence, they have been collected in this manual for ease of reference by the evaluators of the international Nuclear Structure and Decay Data (NSDD) network contribute mass-chains to the ENSDF. Some new articles were written specifically for this manual and others are reivsions of earlier versions.

  7. Automating Nuclear-Safety-Related SQA Procedures with Custom Applications

    SciTech Connect

    Freels, James D.

    2016-01-01

    Nuclear safety-related procedures are rigorous for good reason. Small design mistakes can quickly turn into unwanted failures. Researchers at Oak Ridge National Laboratory worked with COMSOL to define a simulation app that automates the software quality assurance (SQA) verification process and provides results in less than 24 hours.

  8. Computational Cardiology: The Heart of the Matter

    PubMed Central

    Trayanova, Natalia A.

    2012-01-01

    This paper reviews the newest developments in computational cardiology. It focuses on the contribution of cardiac modeling to the development of new therapies as well as the advancement of existing ones for cardiac arrhythmias and pump dysfunction. Reviewed are cardiac modeling efforts aimed at advancing and optimizing existent therapies for cardiac disease (defibrillation, ablation of ventricular tachycardia, and cardiac resynchronization therapy) and at suggesting novel treatments, including novel molecular targets, as well as efforts to use cardiac models in stratification of patients likely to benefit from a given therapy, and the use of models in diagnostic procedures. PMID:23213566

  9. Advances in clinical cardiology.

    PubMed

    McNeice, Andrew H; McAleavey, Neil M; Menown, Ian B A

    2014-08-01

    Multiple, potentially practice-changing cardiology trials have been presented or published over the past year. In this paper, we summarize and place in clinical context, new data regarding management of acute coronary syndrome and ST-elevation myocardial infarction (copeptin assessment, otamixaban, cangrelor, prasugrel, sodium nitrite, inclacumab, ranolazine, preventive coronary intervention of non-culprit lesions, immediate thrombolytic therapy versus transfer for primary intervention), new coronary intervention data (thrombectomy, radial access, pressure wire fractional flow reserve, antiplatelet therapy duration and gene-guidance, permanent and biodegradable polymers, coronary bifurcation and strategies), and coronary artery bypass data (off pump vs. on pump). Latest trials in trans-aortic valve implantation, heart failure (eplerenone, aliskiren, spironolactone, sildenafil, dopamine, nesiritide, omecamtiv mecarbil, the algisyl left ventricular augmentation device, and echo-guided cardiac resynchronization), atrial fibrillation (edoxaban, dabigatran, and ablation), cardiac arrest (hypothermia, LUCAS™ mechanical chest compression), and cardiovascular prevention (vitamins, renal denervation for resistant hypertension, renal artery stenting, saxagliptin, alogliptin, and gastric banding) are also discussed. PMID:25074280

  10. [First annual report of practitioners of interventional cardiology in private practice in Germany. Results of procedures of left heart catheterization and coronary interventions in the year 1996].

    PubMed

    Silber, S; Albrecht, A; Göhring, S; Kaltenbach, M; Kneissl, D; Kokott, N; Levenson, B; Mathey, D; Pöhler, E; Reifart, N; Sauer, G; Schofer, J; Schwarzbach, F

    1998-02-01

    The German Society for Cardiac Angiography and Interventions in Private Practice has started a registry of cardiac procedures since 1996 in order to establish a standard for performance. Although quality management for the cath lab makes sense and is also legally required, there is no generally recommended infrastructure for quality assurance existing in Germany at this time. Therefore, the German Society of Cardiologists in Private Practice (BNK) initiated a project in 1994 to develop a computer program for paperless documentation of diagnostic cardiac catheterizations and coronary interventions (PTCA) using a minimal data set. In 1996, 8 private associated groups participated in this project. The (anonymous) analysis of 10,316 diagnostic cardiac catheterizations and 2597 PTCA yielded the following results: In 95% of the patients, diagnostic cardiac catheterization was performed using the femoral and in 5% the brachial/radial approach. The mean volume of administered contrast medium was 164 +/- 138 ml/patient. The mean LV-EF was greater than 50% in 58.4% of the patients and between 30% and 50% in 10.1%. Coronary artery disease was diagnosed in 69.6% of the patients and valvular/congenital heart disease in 8.5%. In 18.4% of the patients undergoing diagnostic cardiac catheterizations no significant heart disease was identified. Mortality in the cath lab as well as the rate of cerebral insults was 0.05%. In 22.9% and 19% of the patients PTCA and cardiac surgery respectively was recommended. In patients undergoing PTCA, stable angina was present in 74.4% and unstable angina in 13.1%. Of the total number of PTCA procedures, 5.8% were performed in the setting of acute myocardial infarction. The PTCA lesion success rate was 96%, the mean diameter stenosis was 81% pre and 6% post-intervention. The mortality rate at 1 month post-PTCA was 0.4%, and myocardial infarction 1.0%. An acute occlusion occurred in 1.3% of the PTCA patients; 0.6% had to be transferred for emergency

  11. Supporting the future nuclear workforce with computer-based procedures

    DOE PAGESBeta

    Oxstrand, Johanna; Le Blanc, Katya

    2016-05-01

    Here we see that computer-based tools have dramatically increased ease and efficiency of everyday tasks. Gone are the days of paging through a paper catalog, transcribing product numbers, and calculating totals. Today, a consumer can find a product online with a simple search engine, and then purchase it in a matter of a few clicks. Paper catalogs have their place, but it is hard to imagine life without on-line shopping sites. All tasks conducted in a nuclear power plant are guided by procedures, which helps ensure safe and reliable operation of the plants. One prominent goal of the nuclear industrymore » is to minimize the risk of human errors. To achieve this goal one has to ensure tasks are correctly and consistently executed. This is partly achieved by training and by a structured approach to task execution, which is provided by procedures and work instructions. Procedures are used in the nuclear industry to direct workers' actions in a proper sequence. The governing idea is to minimize the reliance on memory and choices made in the field. However, the procedure document may not contain sufficient information to successfully complete the task. Therefore, the worker might have to carry additional documents such as turnover sheets, operation experience, drawings, and other procedures to the work site. The nuclear industry is operated with paper procedures like paper catalogs of the past. A field worker may carry a large stack of documents needed to complete a task to the field. Even though the paper process has helped keep the industry safe for decades, there are limitations to using paper. Paper procedures are static (i.e., the content does not change after the document is printed), difficult to search, and rely heavily on the field worker’s situational awareness and ability to consistently meet the high expectation of human performance excellence. With computer-based procedures (CBPs) that stack of papers may be reduced to the size of a small tablet or even

  12. Pediatric Cardiology Boot Camp: Description and Evaluation of a Novel Intensive Training Program for Pediatric Cardiology Trainees.

    PubMed

    Ceresnak, Scott R; Axelrod, David M; Motonaga, Kara S; Johnson, Emily R; Krawczeski, Catherine D

    2016-06-01

    The transition from residency to subspecialty fellowship in a procedurally driven field such as pediatric cardiology is challenging for trainees. We describe and assess the educational value of a pediatric cardiology "boot camp" educational tool designed to help prepare trainees for cardiology fellowship. A two-day intensive training program was provided for pediatric cardiology fellows in July 2015 at a large fellowship training program. Hands-on experiences and simulations were provided in: anatomy, auscultation, echocardiography, catheterization, cardiovascular intensive care (CVICU), electrophysiology (EP), heart failure, and cardiac surgery. Knowledge-based exams as well as surveys were completed by each participant pre-training and post-training. Pre- and post-exam results were compared via paired t tests, and survey results were compared via Wilcoxon rank sum. A total of eight participants were included. After boot camp, there was a significant improvement between pre- and post-exam scores (PRE 54 ± 9 % vs. POST 85 ± 8 %; p ≤ 0.001). On pre-training survey, the most common concerns about starting fellowship included: CVICU emergencies, technical aspects of the catheterization/EP labs, using temporary and permanent pacemakers/implantable cardiac defibrillators (ICDs), and ECG interpretation. Comparing pre- and post-surveys, there was a statistically significant improvement in the participants comfort level in 33 of 36 (92 %) areas of assessment. All participants (8/8, 100 %) strongly agreed that the boot camp was a valuable learning experience and helped to alleviate anxieties about the start of fellowship. A pediatric cardiology boot camp experience at the start of cardiology fellowship can provide a strong foundation and serve as an educational springboard for pediatric cardiology fellows. PMID:26961569

  13. [Cost analysis of twenty-nine nuclear medicine procedures].

    PubMed

    Kastanioti, Catherine K; Alphalbouharali, Gihand; Fotopoulos, Andreas

    2004-01-01

    The aim of this study was to compare actual cost estimates for diagnostic procedures as applied in the nuclear medicine department of our University Hospital, with cost estimates obtained through an analytical activity-based costing methodology. Activity data on the use of twenty-nine nuclear medicine procedures were collected. The actual hospital prices for the fiscal years of 2003-2004 were obtained from the Accounting Department of the Hospital. Cost estimates were calculated per patient. Activity-based data were compared with hospital prices and also with unit costs from the activity-based costing methodology. Our results showed a significant statistical difference between unit cost estimates per patient based on hospital prices, as compared with those based on unit costs. This study shows that in our university hospital, reliance on generic hospital prices for nuclear medicine procedures, considerable underestimates their real cost by a mean value of 40% as derived through the activity-based costing methodology and can lead to substantial financial hospital deficits. PMID:15841290

  14. Physician Requirements-1990. For Cardiology.

    ERIC Educational Resources Information Center

    Tracy, Octavious; Birchette-Pierce, Cheryl

    Professional requirements for physicians specializing in cardiology were estimated to assist policymakers in developing guidelines for graduate medical education. The determination of physician requirements was based on an adjusted needs rather than a demand or utilization model. For each illness, manpower requirements were modified by the…

  15. Mobile Apps in Cardiology: Review

    PubMed Central

    2013-01-01

    Background Cardiovascular diseases are the deadliest diseases worldwide, with 17.3 million deaths in 2008 alone. Among them, heart-related deaths are of the utmost relevance; a fact easily proven by the 7.25 million deaths caused by ischemic heart disease alone in that year. The latest advances in smartphones and mHealth have been used in the creation of thousands of medical apps related to cardiology, which can help to reduce these mortality rates. Objective The aim of this paper is to study the literature on mobile systems and applications currently available, as well as the existing apps related to cardiology from the leading app stores and to then classify the results to see what is available and what is missing, focusing particularly on commercial apps. Methods Two reviews have been developed. One is a literature review of mobile systems and applications, retrieved from several databases and systems such as Scopus, PubMed, IEEE Xplore, and Web of Knowledge. The other is a review of mobile apps in the leading app stores, Google play for Android and Apple’s App Store for iOS. Results Search queries up to May 2013 located 406 papers and 710 apps related to cardiology and heart disease. The most researched section in the literature associated with cardiology is related to mobile heart (and vital signs) monitoring systems and the methods involved in the classification of heart signs in order to detect abnormal functions. Other systems with a significant number of papers are mobile cardiac rehabilitation systems, blood pressure measurement, and systems for the detection of heart failure. The majority of apps for cardiology are heart monitors and medical calculators. Other categories with a high number of apps are those for ECG education and interpretation, cardiology news and journals, blood pressure tracking, heart rate monitoring using an external device, and CPR instruction. There are very few guides on cardiac rehabilitation and apps for the management of the

  16. History of German pediatric cardiology.

    PubMed

    Heintzen, P

    2002-01-01

    Due to the isolation of German medicine in World War II accompanied by the destruction of many hospitals, German pediatricians did not show any serious interest in the treatment of children with congenital heart diseases, nor did they take notice of the progress achieved by Helen Taussig, Alfred Blalock and other cardiologists and surgeons in the western world. This problem was even worse in East Germany. Only a few German internists and forward-looking surgeons were able and ready to take care of this group of principally operable children in places like Bonn/Düsseldorf, Marburg/Munich, Berlin, and Hamburg. However, in the early 1950s some directors of pediatrics at university hospitals--largely motivated by the cardiac surgeons--allowed or even encouraged younger colleagues to concentrate on pediatric cardiology and to begin application of heart catheterization and angiocardiography. In 1960 a group of colleagues interested in pediatric cardiology met for the first time in Frankfurt and became the nucleus of the future "working group" (1969) and finally the "German Society of Pediatric Cardiology" (1974). By 1972 pediatric cardiology had been approved as an independent (sub)specialty. Colleagues and friends from surrounding countries (Austria, Great Britain, Sweden, Switzerland, and the Netherlands) and also from the US and some eastern countries were either members or regular guests during or between the meetings. Pediatric cardiology is now represented in Germany by specialized practitioners, trainees and assistants who work in both community and university hospitals, and in specialized departments. Due to the foresightedness of the Chief of Pediatrics, Prof. G. Joppich, the first Chair of Pediatric Cardiology was founded in Göttingen in 1960 under the direction of A. Beuren. Another model of interdisciplinary cooperation between pediatric cardiologists, bioengineers, mathematicians and computer scientists was established in Kiel in 1966. In other places

  17. History of Cardiology in India

    PubMed Central

    Das, Mrinal Kanti; Kumar, Soumitra; Deb, Pradip Kumar; Mishra, Sundeep

    2015-01-01

    History as a science revolves around memories, travellers' tales, fables and chroniclers' stories, gossip and trans-telephonic conversations. Medicine itself as per the puritan's definition is a non-exact science because of the probability-predictability-sensitivity-specificity factors. Howsoever, the chronicles of Cardiology in India is quite interesting and intriguing. Heart and circulation was known to humankind from pre-Vedic era. Various therapeutics measures including the role of Yoga and transcendental meditation in curing cardiovascular diseases were known in India. Only recently there has been resurgence of the same globally. There have been very few innovations in Cardiology in India. The cause of this paucity possibly lie in the limited resources. This has a vicious effect on the research mentality of the population who are busy in meeting their daily requirements. This socio-scientific aspect needs a thorough study and is beyond the scope of the present documentation. Present is the future of past and so one must not forget the history which is essentially past that give the present generation the necessary fulcrum to stand in good stead. The present article essentially aims to pay tribute to all the workers and pioneers in the field of Cardiology in India, who in spite of limited resources ventured in an unchartered arena. PMID:26071301

  18. Routine Quality Control of Clinical Nuclear Medicine Instrumentation: A Brief Review*

    PubMed Central

    Zanzonico, Pat

    2009-01-01

    This article reviews routine quality-control (QC) procedures for current nuclear medicine instrumentation, including the survey meter, dose calibrator, well counter, intraoperative probe, organ (“thyroid”) uptake probe, γ-camera, SPECT and SPECT/CT scanner, and PET and PET/CT scanner. It should be particularly useful for residents, fellows, and other trainees in nuclear medicine, nuclear cardiology, and radiology. The procedures described and their respective frequencies are presented only as general guidelines. PMID:18587088

  19. Nobel prizes: contributions to cardiology.

    PubMed

    Mesquita, Evandro Tinoco; Marchese, Luana de Decco; Dias, Danielle Warol; Barbeito, Andressa Brasil; Gomes, Jonathan Costa; Muradas, Maria Clara Soares; Lanzieri, Pedro Gemal; Gismondi, Ronaldo Altenburg

    2015-08-01

    The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize's history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15%) studies were important for cardiovascular area. There were 33 (16%) laureates, and two (6%) were women. Fourteen (42%) were American, 15 (45%) Europeans and four (13%) were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male. PMID:25945466

  20. [Circulatory assist devices in cardiology].

    PubMed

    Ferrari, M; Figulla, H R

    2005-03-24

    One out of 13 patients with an acute myocardial infarction is endangered of cardiogenic shock. In addition, acute valvular leakage, shunt vitiae, and acute myocarditis can lead to acute myocardial failure. As a therapeutic option, mechanical assist devices offer cardiac support and hemodynamic stabilization under these circumstances. The following minimal-invasive devices are used in cardiology and intensive care medicine: intra-aortic balloon pulsation (IABP), intra-vascular axial screw pumps, extra-corporal centrifugal pumps with and without additional membrane oxygenator. The IABP improves left ventricular function by a systolic reduction of the after-load, and an increase of diastolic blood pressure dependent on myocardial function. In contrast, axial screw pumps and centrifugal pumps can provide circulatory support independently of myocardial function. Mechanical assist devices can prevent irreversible damage not only by offering a reduction of myocardial work load, but also by improving organ perfusion in cardiogenic shock situations. Another indication for mechanical circulatory support depicts high-risk coronary angioplasty if the left ventricular ejection fraction is severely reduced or the target vessel supplies more than 50 % of vital myocardium. In case of irreversible heart failure, turbine pumps or centrifugal pumps offer a stabilization for the patient's transfer to a cardiac surgery center. They can also be used for bridging to heart transplantation in acute situations. Technical improvements will enhance the use of mechanical assist devices in the near future. Especially the development of portable emergency devices will enrich therapeutic possibilities in cardiology and intensive care medicine. PMID:15776348

  1. Nobel Prizes: Contributions to Cardiology

    PubMed Central

    Mesquita, Evandro Tinoco; Marchese, Luana de Decco; Dias, Danielle Warol; Barbeito, Andressa Brasil; Gomes, Jonathan Costa; Muradas, Maria Clara Soares; Lanzieri, Pedro Gemal; Gismondi, Ronaldo Altenburg

    2015-01-01

    The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize’s history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15%) studies were important for cardiovascular area. There were 33 (16%) laureates, and two (6%) were women. Fourteen (42%) were American, 15 (45%) Europeans and four (13%) were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male. PMID:25945466

  2. 48 CFR 1850.403 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Special procedures for unusually hazardous or nuclear risks. 1850.403 Section 1850.403 Federal Acquisition Regulations System... Residual Powers 1850.403 Special procedures for unusually hazardous or nuclear risks....

  3. 48 CFR 1450.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Special procedures for unusually hazardous or nuclear risks. 1450.104-3 Section 1450.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 1450.104-3 Special procedures for unusually hazardous or nuclear risks. The...

  4. 48 CFR 1450.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Special procedures for unusually hazardous or nuclear risks. 1450.104-3 Section 1450.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 1450.104-3 Special procedures for unusually hazardous or nuclear risks. The...

  5. 48 CFR 1850.403 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Special procedures for unusually hazardous or nuclear risks. 1850.403 Section 1850.403 Federal Acquisition Regulations System... Residual Powers 1850.403 Special procedures for unusually hazardous or nuclear risks....

  6. 48 CFR 1450.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Special procedures for unusually hazardous or nuclear risks. 1450.104-3 Section 1450.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 1450.104-3 Special procedures for unusually hazardous or nuclear risks. The...

  7. 48 CFR 1450.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Special procedures for unusually hazardous or nuclear risks. 1450.104-3 Section 1450.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 1450.104-3 Special procedures for unusually hazardous or nuclear risks. The...

  8. 48 CFR 1450.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Special procedures for unusually hazardous or nuclear risks. 1450.104-3 Section 1450.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 1450.104-3 Special procedures for unusually hazardous or nuclear risks. The...

  9. 48 CFR 50.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... unusually hazardous or nuclear risks. 50.104-3 Section 50.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 50.104-3 Special procedures for unusually hazardous or nuclear risks. (a... nuclear risks should be submitted to the contracting officer and shall include the following...

  10. 48 CFR 50.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... unusually hazardous or nuclear risks. 50.104-3 Section 50.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 50.104-3 Special procedures for unusually hazardous or nuclear risks. (a... nuclear risks should be submitted to the contracting officer and shall include the following...

  11. 48 CFR 50.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... unusually hazardous or nuclear risks. 50.104-3 Section 50.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 50.104-3 Special procedures for unusually hazardous or nuclear risks. (a... nuclear risks should be submitted to the contracting officer and shall include the following...

  12. 48 CFR 50.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... unusually hazardous or nuclear risks. 50.104-3 Section 50.104-3 Federal Acquisition Regulations System... Extraordinary Contractual Actions 50.104-3 Special procedures for unusually hazardous or nuclear risks. (a... nuclear risks should be submitted to the contracting officer and shall include the following...

  13. Cardiology education using hypermedia and digital imagery.

    PubMed

    Klingler, J W; Andrews, L T; Leighton, R F

    1992-07-01

    A computer-based educational system for the study of cardiovascular imaging is described. This system, based on HyperCard * and a standard Macintosh II, integrates hypertext retrieval, computer graphics, sound, and medical images into a single interactive environment stored on a standard hard disk. This 'hypermedia' approach allows arbitrary complexity coupled with direct, immediate, easy traversal of the images and related text, which provides the opportunity for students to move at their own pace, choose their own direction through the material and repeat as often as desired. Storage on magnetic medium allows for easy updating with new studies and material in order to keep pace with advances in medical imaging technology. The system could be mastered onto CD-ROM for ease of distribution if so desired. The system includes a tutorial on the basics of digital image representation and example studies from cineangiography, nuclear medicine, echocardiography and magnetic resonance imaging of the heart. Quantitative techniques for evaluation of left ventricular function are explained using computer graphics overlays on the original medical images. Color encoded functional images are also included as an aid to visualization of ventricular performance data. The system has proven useful as a primer for digital imaging in cardiology prior to specific case study in a traditional mentor relationship. PMID:1458869

  14. Improving Performance in a Nuclear Cardiology Department

    ERIC Educational Resources Information Center

    LaFleur, Doug; Smalley, Karolyn; Austin, John

    2005-01-01

    Improving performance in the medical industry is an area that is ideally suited for the tools advocated by the International Society of Performance Improvement (ISPI). This paper describes an application of the tools that have been developed by Dale Brethower and Geary Rummler, two pillars of the performance improvement industry. It allows the…

  15. Nuclear cardiology: Myocardial perfusion and function

    SciTech Connect

    Seldin, D.W. )

    1991-08-01

    Myocardial perfusion studies continue to be a major focus of research, with new investigations of the relationship of exercise-redistribution thallium imaging to diagnosis, prognosis, and case management. The redistribution phenomenon, which seemed to be fairly well understood a few years ago, is now recognized to be much more complex than originally thought, and various strategies have been proposed to clarify the meaning of persistent defects. Pharmacologic intervention with dipyridamole and adenosine has become available as an alternative to exercise, and comparisons with exercise imaging and catheterization results have been described. Thallium itself is no longer the sole single-photon perfusion radiopharmaceutical; two new technetium agents are now widely available. In addition to perfusion studies, advances in the study of ventricular function have been made, including reports of studies performed in conjunction with technetium perfusion studies, new insights into cardiac physiology, and the prognostic and case-management information that function studies provide. Finally, work has continued with monoclonal antibodies for the identification of areas of myocyte necrosis. 41 references.

  16. Advances in interventional cardiology: beyond the balloon.

    PubMed

    Nickolaus, M J; Chambers, C E; Ettinger, S M; Gilchrist, I C; Kozak, M

    2000-12-01

    The world of interventional cardiology has changed dramatically since the advent of balloon angioplasty. New therapies have evolved over the past decade as knowledge of the pathophysiology of heart disease has increased. Nurses who have an understanding of this pathophysiology will be better equipped to manage and educate their patients, teaching them about current and future interventional therapies. This article reviews the pathophysiology of heart disease, current interventional therapies, and the future directions for interventional cardiology nursing practice. PMID:11072277

  17. The Paediatric Cardiology Hall of Fame – Donald Nixon Ross.

    PubMed

    Somerville, Jane

    2015-10-01

    Donald Nixon Ross, FRCS (4 October 1922 to 7 July 2014) was a South African-born British cardiothoracic surgeon, who developed the pulmonary autograft, known as the Ross procedure, for the treatment of aortic valve disease, and also performed the first heart transplant in the United Kingdom in 1968. This paper, written by Jane Somerville, Professor of Cardiology [Retired], Imperial College London, London, United Kingdom, provides the personal recollections about Donald Ross from Jane Somerville, and thus provides a unique snapshot of cardiac surgical history. PMID:26574617

  18. Eye lens dose in interventional cardiology.

    PubMed

    Principi, S; Delgado Soler, C; Ginjaume, M; Beltran Vilagrasa, M; Rovira Escutia, J J; Duch, M A

    2015-07-01

    The ICRP has recently recommended reducing the occupational exposure dose limit for the lens of the eye to 20 mSv y(-1), averaged over a period of 5 y, with no year exceeding 50 mSv, instead of the current 150 mSv y(-1). This reduction will have important implications for interventional cardiology and radiology (IC/IR) personnel. In this work, lens dose received by a staff working in IC is studied in order to determine whether eye lens dose monitoring or/and additional radiological protection measures are required. Eye lens dose exposure was monitored in 10 physicians and 6 nurses. The major IC procedures performed were coronary angiography and percutaneous transluminal coronary angioplasty. The personnel were provided with two thermoluminescent dosemeters (TLDs): one calibrated in terms of Hp(3) located close to the left ear of the operator and a whole-body dosemeter calibrated in terms of Hp(10) and Hp(0.07) positioned on the lead apron. The estimated annual eye lens dose for physicians ranged between 8 and 60 mSv, for a workload of 200 procedures y(-1). Lower doses were collected for nurses, with estimated annual Hp(3) between 2 and 4 mSv y(-1). It was observed that for nurses the Hp(0.07) measurement on the lead apron is a good estimate of eye lens dose. This is not the case for physicians, where the influence of both the position and use of protective devices such as the ceiling shield is very important and produces large differences among doses both at the eyes and on the thorax. For physicians, a good correlation between Hp(3) and dose area product is shown. PMID:25809107

  19. Echocardiography: frontier imaging in cardiology

    PubMed Central

    Steeds, R P

    2011-01-01

    This article reviews the recent developments in echocardiography that have maintained this technology at the forefront of day-to-day imaging in clinical cardiology. The primary reason for most requests for imaging in cardiovascular medicine is to assess left ventricular structure and function. As our understanding of left ventricular mechanics has become more intricate, tissue Doppler and speckle tracking modalities have been developed that deliver greater insights into diagnosis of cardiomyopathy and earlier warning of ventricular dysfunction. Increased accuracy has been achieved with the dissemination of real-time three-dimensional echocardiography, which has also acquired a central role in the pre-operative assessment of patients prior to reparative valvular surgery. The use of contrast has broadened the indications for transthoracic echocardiography and has increased the accuracy of stress echocardiography, while reducing the number of patients who cannot be scanned because of a limited acoustic window. Finally, echocardiography will be seen in the future not only as a diagnostic tool in those affected by cardiovascular disease but also as a method for prediction of risk and perhaps activation of targeted treatment. PMID:22723531

  20. Cardiology in a district hospital

    PubMed Central

    Joy, Michael; Huggett, Isabel

    1982-01-01

    During 1975-81 a non-invasive cardiac unit was established at St Peter's Hospital, Chertsey, a district hospital serving a population of 202 000. There was a progressive increase in outpatient referrals in cardiology, and in 1981 non-invasive investigations included 424 echocardiograms, 305 exercise electrocardiograms, 275 ambulatory electrocardiograms, and 147 thallium-201 studies. Between 1979 and 1981, 151 patients were admitted directly to major centres for further investigation; 74% of those with ischaemic heart disease and 68% of those with valvular heart disease subsequently underwent surgery, a ratio of investigation to surgery that is half the norm for the four metropolitan regions. Based on the 1981 figures, which were substantially above those for 1980, there is a need for a minimum of 270 open heart operations per million of the population including 180 vein bypass operations. This figure for bypass grafting is 230% higher than in the United Kingdom as a whole in 1978 and has substantial implications. PMID:6811004

  1. Paediatric cardiology programs in countries with limited resources: how to bridge the gap

    PubMed Central

    Sulafa, K.M. Ali

    2010-01-01

    Establishing paediatric cardiology service in a country with limited resources like Sudan is a challenging task. A paediatric cardiac team was formed then the services in different disciplines were gradually established. Echocardiography (echo) clinics were founded in tertiary and peripheral hospitals. Cardiac catheterization (cath) was established at the Sudan Heart Centre (SHC) in 2004 and over 400 procedures had been performed including interventional catheterization like pulmonary valve dilatation, patent ductus arteriosus and atrial septal defect device closure. Congenital heart surgery started in 2001, currently 200 cases are done each year including closed procedures as well as open heart procedures for patients weighing more than 8 kg. Cardiology-cardiac surgery as well as adult congenital heart disease meetings were held and contributed positively to the services. The cardiology-cardiac surgery scientific club meeting was founded as a forum for academic discussions. A fellowship program was established in 2004 and included seven candidates trained in paediatric cardiology and intensive care. Two training courses had been established: congenital heart disease echo and paediatric electrocardiogram interpretation. Links with regional and international cardiac centres had important roles in consolidating our program. Significant obstacles face our service due to the small number of trained personnel, high cost of procedures, the lack of regular supplies and lack of cardiac intensive care facilities for young infants. Bridging the huge gap needs extensive official as well as non-governmental efforts, training more staff, supporting families and collaboration with regional and international centres. PMID:23960607

  2. Paediatric cardiology programs in countries with limited resources: how to bridge the gap.

    PubMed

    Sulafa, K M Ali

    2010-07-01

    Establishing paediatric cardiology service in a country with limited resources like Sudan is a challenging task. A paediatric cardiac team was formed then the services in different disciplines were gradually established. Echocardiography (echo) clinics were founded in tertiary and peripheral hospitals. Cardiac catheterization (cath) was established at the Sudan Heart Centre (SHC) in 2004 and over 400 procedures had been performed including interventional catheterization like pulmonary valve dilatation, patent ductus arteriosus and atrial septal defect device closure. Congenital heart surgery started in 2001, currently 200 cases are done each year including closed procedures as well as open heart procedures for patients weighing more than 8 kg. Cardiology-cardiac surgery as well as adult congenital heart disease meetings were held and contributed positively to the services. The cardiology-cardiac surgery scientific club meeting was founded as a forum for academic discussions. A fellowship program was established in 2004 and included seven candidates trained in paediatric cardiology and intensive care. Two training courses had been established: congenital heart disease echo and paediatric electrocardiogram interpretation. Links with regional and international cardiac centres had important roles in consolidating our program. Significant obstacles face our service due to the small number of trained personnel, high cost of procedures, the lack of regular supplies and lack of cardiac intensive care facilities for young infants. Bridging the huge gap needs extensive official as well as non-governmental efforts, training more staff, supporting families and collaboration with regional and international centres. PMID:23960607

  3. 48 CFR 250.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Special procedures for unusually hazardous or nuclear risks. 250.104-3 Section 250.104-3 Federal Acquisition Regulations System... unusually hazardous or nuclear risks....

  4. 48 CFR 250.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Special procedures for unusually hazardous or nuclear risks. 250.104-3 Section 250.104-3 Federal Acquisition Regulations System... unusually hazardous or nuclear risks....

  5. 48 CFR 250.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Special procedures for unusually hazardous or nuclear risks. 250.104-3 Section 250.104-3 Federal Acquisition Regulations System... unusually hazardous or nuclear risks....

  6. 48 CFR 1850.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Special procedures for unusually hazardous or nuclear risks. 1850.104-3 Section 1850.104-3 Federal Acquisition Regulations System... nuclear risks. (a) Indemnification requests. (1) Contractor indemnification requests must be submitted...

  7. 48 CFR 1850.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Special procedures for unusually hazardous or nuclear risks. 1850.104-3 Section 1850.104-3 Federal Acquisition Regulations System... nuclear risks. (a) Indemnification requests. (1) Contractor indemnification requests must be submitted...

  8. 48 CFR 250.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Special procedures for unusually hazardous or nuclear risks. 250.104-3 Section 250.104-3 Federal Acquisition Regulations System... unusually hazardous or nuclear risks....

  9. 48 CFR 250.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 3 2013-10-01 2013-10-01 false Special procedures for unusually hazardous or nuclear risks. 250.104-3 Section 250.104-3 Federal Acquisition Regulations System... unusually hazardous or nuclear risks....

  10. Procedure for evaluating nuclear power plant relay seismic functionality

    SciTech Connect

    Betlack, J.; Carritte, R.; Schmidt, W. )

    1990-12-01

    This procedure has been prepared for use in evaluating relays as part of plant specific resolution of USI A-46. It is also expected to be generally applicable in other seismic evaluations, such as seismic margins determinations. 11 refs., 2 figs.

  11. Measures of Knowledge and Attitude Toward Preventive Cardiology.

    ERIC Educational Resources Information Center

    Allred, Charlene A.; And Others

    1985-01-01

    The development and validation of an inventory of preventive cardiology at the University of Virginia is described. The inventory contains two instruments designed to measure medical students' preinstructional and postinstructional knowledge of and attitude toward preventive cardiology. (Author/MLW)

  12. Computer-Based Procedures for Field Workers in Nuclear Power Plants: Development of a Model of Procedure Usage and Identification of Requirements

    SciTech Connect

    Katya Le Blanc; Johanna Oxstrand

    2012-04-01

    The nuclear industry is constantly trying to find ways to decrease the human error rate, especially the human errors associated with procedure use. As a step toward the goal of improving procedure use performance, researchers, together with the nuclear industry, have been looking at replacing the current paper-based procedures with computer-based procedure systems. The concept of computer-based procedures is not new by any means; however most research has focused on procedures used in the main control room. Procedures reviewed in these efforts are mainly emergency operating procedures and normal operating procedures. Based on lessons learned for these previous efforts we are now exploring a more unknown application for computer based procedures - field procedures, i.e. procedures used by nuclear equipment operators and maintenance technicians. The Idaho National Laboratory and participants from the U.S. commercial nuclear industry are collaborating in an applied research effort with the objective of developing requirements and specifications for a computer-based procedure system to be used by field workers. The goal is to identify the types of human errors that can be mitigated by using computer-based procedures and how to best design the computer-based procedures to do so. This paper describes the development of a Model of Procedure Use and the qualitative study on which the model is based. The study was conducted in collaboration with four nuclear utilities and five research institutes. During the qualitative study and the model development requirements and for computer-based procedures were identified.

  13. Update for 2014 on clinical cardiology, geriatric cardiology, and heart failure and transplantation.

    PubMed

    Barón-Esquivias, Gonzalo; Manito, Nicolás; López Díaz, Javier; Martín Santana, Antonio; García Pinilla, José Manuel; Gómez Doblas, Juan José; Gómez Bueno, Manuel; Barrios Alonso, Vivencio; Lambert, José Luis

    2015-04-01

    In the present article, we review publications from the previous year in the following 3 areas: clinical cardiology, geriatric cardiology, and heart failure and transplantation. Among the new developments in clinical cardiology are several contributions from Spanish groups on tricuspid and aortic regurgitation, developments in atrial fibrillation, syncope, and the clinical characteristics of heart disease, as well as various studies on familial heart disease and chronic ischemic heart disease. In geriatric cardiology, the most relevant studies published in 2014 involve heart failure, degenerative aortic stenosis, and data on atrial fibrillation in the geriatric population. In heart failure and transplantation, the most noteworthy developments concern the importance of multidisciplinary units and patients with preserved systolic function. Other notable publications were those related to iron deficiency, new drugs, and new devices and biomarkers. Finally, we review studies on acute heart failure and transplantation, such as inotropic drugs and ventricular assist devices. PMID:25758161

  14. An Evaluation of a Clerkship In Cardiology

    ERIC Educational Resources Information Center

    Edson, John N.; and others

    1969-01-01

    Evaluation of the clinical clerkship in Cardiology for general practitioners proves there is an urgent need for continuing post graduate medical education for general practitioners. Clerkship was offered jointly by the Long Island College Hospital and the State University of New York Downstate Medical Center, Brooklyn, New York. (IR)

  15. Evaluation of Cardiology Training and Manpower Requirements.

    ERIC Educational Resources Information Center

    Adams, Forrest H., Ed.; Mendenhall, Robert C., Ed.

    Begun in June, 1971 and completed in October 1973, the study had the following specific goals: to define the cardiologist's role; to determine cardiology training program objectives; to determine manpower needs for cardiologists; and to determine the educational needs of cardiologists. The major information was sought from all active cardiologists…

  16. Year in review 2010: Critical Care - cardiology

    PubMed Central

    2011-01-01

    We review key research papers in cardiology and intensive care published during 2010 in Critical Care and quote related studies published in other journals if appropriate. Papers were grouped into the following categories: cardiovascular therapies, biomarkers, hemodynamic monitoring, cardiovascular diseases, and microcirculation. PMID:22152086

  17. Business process re-engineering a cardiology department.

    PubMed

    Bakshi, Syed Murtuza Hussain

    2014-01-01

    The health care sector is the world's third largest industry and is facing several problems such as excessive waiting times for patients, lack of access to information, high costs of delivery and medical errors. Health care managers seek the help of process re-engineering methods to discover the best processes and to re-engineer existing processes to optimize productivity without compromising on quality. Business process re-engineering refers to the fundamental rethinking and radical redesign of business processes to achieve dramatic improvements in critical, contemporary measures of performance, such as cost, quality and speed. The present study is carried out at a tertiary care corporate hospital with 1000-plus-bed facility. A descriptive study and case study method is used with intensive, careful and complete observation of patient flow, delays, short comings in patient movement and workflow. Data is collected through observations, informal interviews and analyzed by matrix analysis. Flowcharts were drawn for the various work activities of the cardiology department including workflow of the admission process, workflow in the ward and ICCU, workflow of the patient for catheterization laboratory procedure, and in the billing and discharge process. The problems of the existing system were studied and necessary suggestions were recommended to cardiology department module with an illustrated flowchart. PMID:26502490

  18. Ionizing Radiation-Induced Cataract in Interventional Cardiology Staff

    PubMed Central

    Bitarafan Rajabi, Ahmad; Noohi, Feridoun; Hashemi, Hassan; Haghjoo, Majid; Miraftab, Mohammad; Yaghoobi, Nahid; Rastgou, Fereydon; Malek, Hadi; Faghihi, Hoshang; Firouzabadi, Hassan; Asgari, Soheila; Rezvan, Farhad; Khosravi, Hamidreza; Soroush, Sara; Khabazkhoob, Mehdi

    2015-01-01

    Background: The use of ionizing radiation has led to advances in medical diagnosis and treatment. Objectives: The purpose of this study was to determine the risk of radiation cataractogenesis in the interventionists and staff performing various procedures in different interventional laboratories. Patients and Methods: This cohort study included 81 interventional cardiology staff. According to the working site, they were classified into 5 groups. The control group comprised 14 professional nurses who did not work in the interventional sites. Participants were assigned for lens assessment by two independent trained ophthalmologists blinded to the study. Results: The electrophysiology laboratory staff received higher doses of ionizing radiation (17.2 ± 11.9 mSv; P < 0.001). There was a significant positive correlation between the years of working experience and effective dose in the lens (P < 0.001). In general, our findings showed that the incidence of lens opacity was 79% (95% CI, 69.9-88.1) in participants with exposure (the case group) and our findings showed that the incidence of lenses opacity was 7.1% (95% CI:2.3-22.6) with the relative risk (RR) of 11.06 (P < 0.001). Conclusions: We believe that the risk of radiation-induced cataract in cardiology interventionists and staff depends on their work site. As the radiation dose increases, the prevalence of posterior eye changes increases. PMID:25789258

  19. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A; Masoudi, Frederick A; Dehmer, Gregory J; Patel, Manesh R; Smith, Peter K; Chambers, Charles E; Ferguson, T Bruce; Garcia, Mario J; Grover, Frederick L; Holmes, David R; Klein, Lloyd W; Limacher, Marian C; Mack, Michael J; Malenka, David J; Park, Myung H; Ragosta, Michael; Ritchie, James L; Rose, Geoffrey A; Rosenberg, Alan B; Russo, Andrea M; Shemin, Richard J; Weintraub, William S; Wolk, Michael J; Bailey, Steven R; Douglas, Pamela S; Hendel, Robert C; Kramer, Christopher M; Min, James K; Patel, Manesh R; Shaw, Leslee; Stainback, Raymond F; Allen, Joseph M

    2012-04-01

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD

  20. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A

    2012-02-28

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD

  1. Radiation exposure and adverse health effects of interventional cardiology staff.

    PubMed

    Kesavachandran, Chandrasekharan Nair; Haamann, Frank; Nienhaus, Albert

    2013-01-01

    To the best of our knowledge, this chapter constitutes the first systematic review of radiation exposure to eyes, thyroid, and hands for Interventional Cardiology (IC) staff. We have concluded from our review that these anatomical locations are likely to be exposed to radiation as a result of the limited use of personal protective equipment (PPE) among IC staff as shown in Fig. 8. Our review also reveals that, with the exception of three eye exposure cases, the annual radiation dose to eyes, thyroid, and hands among IC staff was within recommended levels and limits. The As Low As Reasonably Achievable (ALARA) limit was not achieved in three cases for fingers/hands and four cases for eyes. However, an increased incidence of cataracts were reported for IC staff, and this gives rise to the concern that low-dose or unnoticed exposures may increase the risk of developing cataracts among cardiology staff. Clearly, the formation of cataracts among IC staff may be an issue and should be studied in more depth. Our review also disclosed that the two groups who receive excessive radiation doses (i.e., exceed the recommended limit) are physicians-in-training and junior staff physicians who work in cardiac catheterization laboratories. In particular, more attention should be given to assessing the effects of radiation exposure among IC staff who work in the Asia Pacific countries, because our review indicates that the number of IC procedures performed by IC staff in these countries is higher than for other continents. There is a huge demand for procedures conducted by IC staff in the Asia-Pacific area, for both treating patients and consulting with specialists. Our review also disclosed that recommended limits for per-procedure radiation doses are needed for IC staff. We recommend that such limits be established by the appropriate national and international agencies that are responsible for occupational radiation exposure. Although our review indicates that the current

  2. Diagnostic cardiology: Noninvasive imaging techniques

    SciTech Connect

    Come, P.C.

    1985-01-01

    This book contains 23 chapters. Some of the chapter titles are: The chest x-ray and cardiac series; Computed tomographic scanning of the heart, coronary arteries, and great vessels; Digital subtraction angiography in the assessment of cardiovascular disease; Magnetic resonance: technique and cardiac applications; Basics of radiation physics and instrumentation; and Nuclear imaging: the assessment of cardiac performance.

  3. Japanese consensus guidelines for pediatric nuclear medicine. Part 1: Pediatric radiopharmaceutical administered doses (JSNM pediatric dosage card). Part 2: Technical considerations for pediatric nuclear medicine imaging procedures.

    PubMed

    Koizumi, Kiyoshi; Masaki, Hidekazu; Matsuda, Hiroshi; Uchiyama, Mayuki; Okuno, Mitsuo; Oguma, Eiji; Onuma, Hiroshi; Kanegawa, Kimio; Kanaya, Shinichi; Kamiyama, Hiroshi; Karasawa, Kensuke; Kitamura, Masayuki; Kida, Tetsuo; Kono, Tatsuo; Kondo, Chisato; Sasaki, Masayuki; Terada, Hitoshi; Nakanishi, Atsushi; Hashimoto, Teisuke; Hataya, Hiroshi; Hamano, Shin-ichiro; Hirono, Keishi; Fujita, Yukihiko; Hoshino, Ken; Yano, Masayuki; Watanabe, Seiichi

    2014-06-01

    The Japanese Society of Nuclear Medicine has recently published the consensus guidelines for pediatric nuclear medicine. This article is the English version of the guidelines. Part 1 proposes the dose optimization in pediatric nuclear medicine studies. Part 2 comprehensively discusses imaging techniques for the appropriate conduct of pediatric nuclear medicine procedures, considering the characteristics of imaging in children. PMID:24647992

  4. A probabilistic seismic risk assessment procedure for nuclear power plants: (I) Methodology

    USGS Publications Warehouse

    Huang, Y.-N.; Whittaker, A.S.; Luco, N.

    2011-01-01

    A new procedure for probabilistic seismic risk assessment of nuclear power plants (NPPs) is proposed. This procedure modifies the current procedures using tools developed recently for performance-based earthquake engineering of buildings. The proposed procedure uses (a) response-based fragility curves to represent the capacity of structural and nonstructural components of NPPs, (b) nonlinear response-history analysis to characterize the demands on those components, and (c) Monte Carlo simulations to determine the damage state of the components. The use of response-rather than ground-motion-based fragility curves enables the curves to be independent of seismic hazard and closely related to component capacity. The use of Monte Carlo procedure enables the correlation in the responses of components to be directly included in the risk assessment. An example of the methodology is presented in a companion paper to demonstrate its use and provide the technical basis for aspects of the methodology. ?? 2011 Published by Elsevier B.V.

  5. 48 CFR 1850.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Special procedures for unusually hazardous or nuclear risks. 1850.104-3 Section 1850.104-3 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE ADMINISTRATION CONTRACT MANAGEMENT EXTRAORDINARY CONTRACTUAL ACTIONS AND THE SAFETY ACT Extraordinary...

  6. 48 CFR 50.104-3 - Special procedures for unusually hazardous or nuclear risks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Special procedures for unusually hazardous or nuclear risks. 50.104-3 Section 50.104-3 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT EXTRAORDINARY CONTRACTUAL ACTIONS AND THE SAFETY ACT Extraordinary Contractual Actions...

  7. Medico-legal issues in cardiology.

    PubMed

    Abbott, Ryan; Cohen, Michael

    2013-01-01

    The aim of this article is to educate physicians about the current litigation climate in cardiology and cardiac surgery, with a focus on the most frequently litigated areas of practice, including failure to diagnose and treat myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention, and the use of tissue plasminogen activator. Empirical research on cardiology malpractice is presented, along with a sampling of up-to-date cases designed to illustrate common issues and important themes. The principles for reducing legal liability are also discussed, including the informed consent process, spoliation of records, and the role of documentation. Finally, practical recommendations are provided for cardiologists and cardiac surgeons to limit their legal liability. PMID:23422021

  8. Use of smartphone technology in cardiology.

    PubMed

    Nguyen, Hoang H; Silva, Jennifer N A

    2016-05-01

    Smartphone-based technologies along with broadband connectivity are changing the way modern cardiology is practiced. The ever broadening connectivity and increasing capabilities of smartphone-based technologies can better monitor, diagnose, and prevent cardiovascular diseases. Researchers can leverage the ubiquitous use of smartphone-based technologies and their constant stream of biometric data to establish large community-based clinical research studies. Patient engagement is enhanced with constant and on-demand access to physicians, daily self-monitoring, and expanding social networks. On the other hand, the exponential growth of smartphone-based technologies invariably disrupts the traditional healthcare model and leaves a vacuum in the infrastructure, medico-legal apparatus, and reimbursement systems that need to be addressed. In this review, we present a comprehensive discussion of the various applications utilizing smartphone-based technologies in cardiology. PMID:26686266

  9. [Update on preventive cardiology and rehabilitation].

    PubMed

    Fernández de Bobadilla Osorio, Jaime; Fernández-Bobadilla, Esteban; García-Porrero, Esteban; Luengo-Fernández, Emilio; Casasnovas-Lenguas, José Antonio

    2012-01-01

    The aim of the Preventive Cardiology and Rehabilitation Section of the Spanish Society of Cardiology is to promote knowledge about and adoption of the lifestyle, therapy and rehabilitation program guidelines that are best able to improve cardiovascular health in the Spanish population. To achieve this aim, a number of working groups have carried out research into and provided education about the latest developments in cardiovascular prevention, and have provided information about these developments to all those affected, including physicians, healthcare workers, healthcare administrators and the general public. This year, the working group on smoking produced an key document that was presented to cardiologists in our Society; its intention was to provide a simple algorithm to help patients give up smoking that could be applied in only 3 minutes. The working group on cardiac rehabilitation gave a presentation on the true impact of rehabilitation on survival after percutaneous coronary intervention and heart failure. Also this year, the European Society of Cardiology published a major revision of guidelines on the treatment of dyslipidemia, which was welcomed by many but criticized by others. Our correspondent at the European Society reflects on the role and usefulness of these guidelines in practice. PMID:22269841

  10. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    PubMed

    Ronan, Grace; Wolk, Michael J; Bailey, Steven R; Doherty, John U; Douglas, Pamela S; Hendel, Robert C; Kramer, Christopher M; Min, James K; Patel, Manesh R; Rosenbaum, Lisa; Shaw, Leslee J; Stainback, Raymond F; Allen, Joseph M; Brindis, Ralph G; Kramer, Christopher M; Shaw, Leslee J; Cerqueira, Manuel D; Chen, Jersey; Dean, Larry S; Fazel, Reza; Hundley, W Gregory; Itchhaporia, Dipti; Kligfield, Paul; Lockwood, Richard; Marine, Joseph Edward; McCully, Robert Benjamin; Messer, Joseph V; O'Gara, Patrick T; Shemin, Richard J; Wann, L Samuel; Wong, John B; Patel, Manesh R; Kramer, Christopher M; Bailey, Steven R; Brown, Alan S; Doherty, John U; Douglas, Pamela S; Hendel, Robert C; Lindsay, Bruce D; Min, James K; Shaw, Leslee J; Stainback, Raymond F; Wann, L Samuel; Wolk, Michael J; Allen, Joseph M

    2014-02-01

    The American College of Cardiology Foundation along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical presentations for stable ischemic heart disease (SIHD) to consider use of stress testing and anatomic diagnostic procedures. This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging (RNI), stress echocardiography (Echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. A major innovation in this document is the rating of tests side by side for the same indication. The side-by-side rating removes any concerns about differences in indication or interpretation stemming from prior use of separate documents for each test. However, the ratings were explicitly not competitive rankings due to the limited availability of comparative evidence, patient variability, and range of capabilities available in any given local setting. The indications for this review are limited to the detection and risk assessment of SIHD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Eighty clinical scenarios were developed by a writing committee and scored by a separate rating panel on a scale of 1-9, to designate Appropriate, May Be Appropriate, or Rarely Appropriate use following a modified Delphi process following the recently updated AUC development methodology. The use of some modalities of testing in the initial evaluation of patients with symptoms representing ischemic equivalents, newly diagnosed heart failure, arrhythmias, and syncope was generally found to be Appropriate or May Be Appropriate, except in cases where low pre-test probability or low risk limited the benefit of most testing except exercise electrocardiogram (ECG

  11. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    PubMed

    Wolk, Michael J; Bailey, Steven R; Doherty, John U; Douglas, Pamela S; Hendel, Robert C; Kramer, Christopher M; Min, James K; Patel, Manesh R; Rosenbaum, Lisa; Shaw, Leslee J; Stainback, Raymond F; Allen, Joseph M

    2014-02-01

    The American College of Cardiology Foundation along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical presentations for stable ischemic heart disease (SIHD) to consider use of stress testing and anatomic diagnostic procedures. This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging (RNI), stress echocardiography (Echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. A major innovation in this document is the rating of tests side by side for the same indication. The side-by-side rating removes any concerns about differences in indication or interpretation stemming from prior use of separate documents for each test. However, the ratings were explicitly not competitive rankings due to the limited availability of comparative evidence, patient variability, and range of capabilities available in any given local setting. The indications for this review are limited to the detection and risk assessment of SIHD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Eighty clinical scenarios were developed by a writing committee and scored by a separate rating panel on a scale of 1 to 9, to designate Appropriate, May Be Appropriate, or Rarely Appropriate use following a modified Delphi process following the recently updated AUC development methodology. The use of some modalities of testing in the initial evaluation of patients with symptoms representing ischemic equivalents, newly diagnosed heart failure, arrhythmias, and syncope was generally found to be Appropriate or May Be Appropriate, except in cases where low pre-test probability or low risk limited the benefit of most testing except exercise electrocardiogram

  12. [Gastrointestinal bleeding in cardiological patients].

    PubMed

    Braun, G; Messmann, H

    2013-11-01

    Oral anticoagulation and antiplatelet therapy are risk factors for gastrointestinal (GI) bleeding. GI bleeding-especially lower GI bleeding-seems to be associated with a poorer outcome. With the introduction of dabigatrane and rivaroxaban, difficulties in the management of bleeding complications arose. Thus, the goal of the authors was to establish a standard operating procedure (SOP) for the treatment of severe GI bleeding associated with rivaroxaban, dabigatrane, and antiplatelet therapy. Bleeding complications during phenprocoumon treatment should be treated with prothrombin complex concentrates and vitamin K1. Dabigatrane elimination is highly dependent to the renal function. The measurement of drug concentrations of dabigatrane and rivaroxaban is useful to indicate an increased risk of bleeding complications. Severe bleeding associated with dabigatrane or rivaroxaban therapy should trigger prothrombin complex therapy, whereby in cases with severe bleeding associated with antiplatelet therapy platelet transfusion should be initiated. Low-dose aspirin should be continued after 24 h. PMID:24150711

  13. The interventionalism of medicine: interventional radiology, cardiology, and neuroradiology

    PubMed Central

    Lakhan, Shaheen E; Kaplan, Anna; Laird, Cyndi; Leiter, Yaacov

    2009-01-01

    Interventional medical practitioners are specialists who do minimally invasive procedures instead of surgery or other treatment. Most often, these procedures utilize various imaging and catheterization techniques in order to diagnose and treat vascular issues in the body. Interventionalist techniques, including injecting arteries with dye, visualizing these via x-ray, and opening up blockages, developed from early pioneers' bold and sometimes controversial experiments which aimed to find safer and better ways to treat coronary artery and other atherosclerotic vascular disease. Currently, the major interventional specialties are interventional (or vascular) radiology, interventional cardiology, and endovascular surgical (interventional) neuroradiology. All three are perfecting the use of stents and other procedures to keep diseased arteries open, while also evaluating the application these procedures. The rapid new development of imaging technologies, mechanical devices, and types of treatment, while certainly beneficial to the patient, can also lead to ambiguity regarding specific specialty claims on certain techniques and devices. While these practitioners can be in competition with each other, cooperation and communication are the most advantageous methods to deal with these "turf wars." All of the interventionalists are needed to deliver the best medical care to patients, now and in the future. PMID:19740425

  14. Computer–Based Procedures for Nuclear Power Plant Field Workers: Preliminary Results from Two Evaluation Studies

    SciTech Connect

    Katya L Le Blanc; Johanna H Oxstrand

    2013-10-01

    The Idaho National Laboratory and participants from the U.S. nuclear industry are collaborating on a research effort aimed to augment the existing guidance on computer-based procedure (CBP) design with specific guidance on how to design CBP user interfaces such that they support procedure execution in ways that exceed the capabilities of paper-based procedures (PBPs) without introducing new errors. Researchers are employing an iterative process where the human factors issues and interface design principles related to CBP usage are systematically addressed and evaluated in realistic settings. This paper describes the process of developing a CBP prototype and the two studies conducted to evaluate the prototype. The results indicate that CBPs may improve performance by reducing errors, but may increase the time it takes to complete procedural tasks.

  15. Comparison of Safety of Radial and Femoral Approaches for Coronary Catheterization in Interventional Cardiology

    PubMed Central

    Samul, Wojciech; Turowska, Anna; Kwasiborski, Przemysław Jerzy; Kowalczyk, Paweł; Cwetsch, Andrzej

    2015-01-01

    Background The femoral approach has been the preferably used access in interventional cardiology as well for coronary diagnostics as for percutaneous coronary intervention, being perceived as easy and facilitating quick access with relatively low risk. Due to the results of the latest studies, however, the radial approach has become increasingly popular. The aim of this study was a safety analysis of cardiological interventional procedures (i.e., coronarography and PCI) according to the vessel approach. Material/Methods The 204 coronary interventions done in our Department of Interventional Cardiology were retrospectively analyzed. All the procedures were classified according to femoral or radial access. The incidence of local complications (e.g., major bleedings and hematomas) was assessed as well as the volume of contrast agent administered during the procedure and the radiation dose. Results It has been shown that radial approach, which is obviously more comfortable for patients, reduces the risk of local complications (0 vs. 2.97% and 0 vs. 3.96%) and does not lead to increased radiation exposure (p=0.88). However, there could be a larger volume of contrast agent administered (p=0.029), which in some cases could increase the risk of contrast-induced nephropathy. Conclusions The radial approach should be recommended as a first choice because it is safer than the classical femoral approach, but one must be cautious in choosing radial approach patients with renal insufficiency. PMID:25996689

  16. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine.

    PubMed

    Hendel, Robert C; Berman, Daniel S; Di Carli, Marcelo F; Heidenreich, Paul A; Henkin, Robert E; Pellikka, Patricia A; Pohost, Gerald M; Williams, Kim A

    2009-06-01

    The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac radionuclide imaging (RNI) is frequently considered. This document is a revision of the original Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT MPI) Appropriateness Criteria, published 4 years earlier, written to reflect changes in test utilization and new clinical data, and to clarify RNI use where omissions or lack of clarity existed in the original criteria. This is in keeping with the commitment to revise and refine appropriate use criteria (AUC) on a frequent basis. The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Sixty-seven clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of cardiac RNI for diagnosis and risk assessment in intermediate- and high-risk patients with coronary artery disease (CAD) was viewed favorably, while testing in low-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Additionally, use for perioperative testing was found to be inappropriate except for high selected groups of patients. It is anticipated that these results will have a significant impact on physician decision making, test performance, and reimbursement policy, and will help guide future research. PMID:19451357

  17. Computer-based procedure for field activities: Results from three evaluations at nuclear power plants

    SciTech Connect

    Oxstrand, Johanna; bly, Aaron; LeBlanc, Katya

    2014-09-01

    Nearly all activities that involve human interaction with the systems of a nuclear power plant are guided by procedures. The paper-based procedures (PBPs) currently used by industry have a demonstrated history of ensuring safety; however, improving procedure use could yield tremendous savings in increased efficiency and safety. One potential way to improve procedure-based activities is through the use of computer-based procedures (CBPs). Computer-based procedures provide the opportunity to incorporate context driven job aids, such as drawings, photos, just-in-time training, etc into CBP system. One obvious advantage of this capability is reducing the time spent tracking down the applicable documentation. Additionally, human performance tools can be integrated in the CBP system in such way that helps the worker focus on the task rather than the tools. Some tools can be completely incorporated into the CBP system, such as pre-job briefs, placekeeping, correct component verification, and peer checks. Other tools can be partly integrated in a fashion that reduces the time and labor required, such as concurrent and independent verification. Another benefit of CBPs compared to PBPs is dynamic procedure presentation. PBPs are static documents which limits the degree to which the information presented can be tailored to the task and conditions when the procedure is executed. The CBP system could be configured to display only the relevant steps based on operating mode, plant status, and the task at hand. A dynamic presentation of the procedure (also known as context-sensitive procedures) will guide the user down the path of relevant steps based on the current conditions. This feature will reduce the user’s workload and inherently reduce the risk of incorrectly marking a step as not applicable and the risk of incorrectly performing a step that should be marked as not applicable. As part of the Department of Energy’s (DOE) Light Water Reactors Sustainability Program

  18. [German Society of Nuclear Medicine procedure guideline on beta-amyloid brain PET imaging].

    PubMed

    Barthel, Henryk; Meyer, Philipp T; Drzezga, Alexander; Bartenstein, Peter; Boecker, Henning; Brust, Peter; Buchert, Ralph; Coenen, Heinz H; la Fougère, Christian; Gründer, Gerhard; Grünwald, Frank; Krause, Bernd J; Kuwert, Torsten; Schreckenberger, Matthias; Tatsch, Klaus; Langen, Karl-Josef; Sabri, Osama

    2016-08-01

    Recently, a number of positron emission tomography (PET) radiotracers have been approved for clinical use. These tracers target cerebral beta-amyloid (Aβ) plaques, a hallmark of Alzheimer's disease. Increasing use of this method implies the need for respective standards. This German Society of Nuclear Medicine guideline describes adequate procedures for Aβ plaque PET imaging. It not only discusses the tracers used for that purpose, but also lists measures for correct patient preparation, image data generation, processing, analysis and interpretation. With that, this "S1" category (according to the German Association of the Scientific Medical Societies standard) guideline aims at contributing to quality assurance of nuclear imaging in Germany. PMID:27080914

  19. Sources and magnitude of occupational and public exposures from nuclear medicine procedures

    SciTech Connect

    1996-03-11

    This Report addresses the sources of exposures incurred in the practice of nuclear medicine and provides the necessary data to evaluate the magnitude of exposures to those directly associated with that practice and to those who provide nursing care to the patients containing radiopharmaceuticals. Exposure to members of the public are also addressed. The primary emphasis of this Report is on these individuals and not on the patient, since the patient receives the direct benefit from the nuclear medicine procedure. It is recognized that the patient also receives the bulk of any potential radiation decrement.

  20. Procedure for conducting a human-reliability analysis for nuclear power plants. Final report

    SciTech Connect

    Bell, B.J.; Swain, A.D.

    1983-05-01

    This document describes in detail a procedure to be followed in conducting a human reliability analysis as part of a probabilistic risk assessment when such an analysis is performed according to the methods described in NUREG/CR-1278, Handbook for Human Reliability Analysis with Emphasis on Nuclear Power Plant Applications. An overview of the procedure describing the major elements of a human reliability analysis is presented along with a detailed description of each element and an example of an actual analysis. An appendix consists of some sample human reliability analysis problems for further study.

  1. [Informed consent in cardiology. The Committee on Informed Consent of the Commission on Professional Matters of the Sociedad Española de Cardiología].

    PubMed

    de los Reyes López, M; Iñíguez Romo, A; Goicolea de Oro, A; Funes López, B; Castro Beiras, A

    1998-10-01

    In the last thirty years, the clinical relationship between physicians and patients has been rather modified. There are several factors that have contributed to this change: a) New ways to execute medical practises, specially referred to the development of new techniques; b) Cultural changes in our western society, mainly in the mediterranean area, where there has been progress in the recognition of patients' autonomy to decide about their own lives, health and their own bodies; c) The increasing number of lawsuits, complaints and judgements about the problems that clinical information involves, particularly the informed consent in clinical practise. We consider it necessary to make an extensive and deep discussion from all of the areas in Medicine and Law, to analyze the different ethical and legal parts of the informed consent. For that reason the Spanish Society of Cardiology offers their members a basic document in order to reflect about these facts, developing arguments, justifications and supports. This document has also considered models, conditions to their applicability according to Spanish law, and the experience we have had. Finally, there is a list of diagnostic procedures and interventional practises in cardiology that might be preceded by a written informed consent document. We considered them by the name of Spanish Society of Cardiology recommendations. PMID:9834627

  2. Using cost/risk procedures to establish recovery criteria following a nuclear reactor accident.

    PubMed

    Tawil, J J; Strenge, D L

    1987-02-01

    In the event of a major accidental release of radionuclides at a nuclear power plant, large populated areas could become seriously contaminated. Local officials would be responsible for establishing radiation recovery criteria that would permit the evacuated population to return safely to their jobs and homes. The range of acceptable criteria could imply variations in property losses in the billions of dollars. Given the likely public concern over the health consequences and the enormity of the potential property losses, a cost/risk analysis can provide important input to establishing the recovery criteria. This paper describes procedures for conducting a cost/risk analysis of a site radiologically contaminated by a nuclear power plant accident. The procedures are illustrated by analyzing a hypothetically contaminated site, using software developed for determining the property and health effects of major reactor accidents. PMID:3818283

  3. A case study of technology transfer: Cardiology

    NASA Technical Reports Server (NTRS)

    Schafer, G.

    1974-01-01

    Research advancements in cardiology instrumentation and techniques are summarized. Emphasis is placed upon the following techniques: (1) development of electrodes which show good skin compatibility and wearer comfort; (2) contourography - a real time display system for showing the results of EKGs; (3) detection of arteriosclerosis by digital computer processing of X-ray photos; (4) automated, noninvasive systems for blood pressure measurement; (5) ultrasonoscope - a noninvasive device for use in diagnosis of aortic, mitral, and tricuspid valve disease; and (6) rechargable cardiac pacemakers. The formation of a biomedical applications team which is an interdisciplinary team to bridge the gap between the developers and users of technology is described.

  4. Cardiological telemonitoring in rehabilitation and sports medicine.

    PubMed

    Vainoras, Alfonsas; Marozas, Vaidotas; Korsakas, Stasys; Gargasas, Liudas; Siupsinskas, Laimonas; Miskinis, Vytenis

    2004-01-01

    The paper presents the development results of teleconsultative cardiology systems and their application in rehabilitation and sport medicine. The first teleconsultative cardiology (TELECARD) system was developed for outpatient departments in the city of Kaunas, using Internet links. It was based on the CompCardioSignal terminal. One branch of the TELECARD system with a mobile CompCardioSignal terminal was used for functional state evaluation of Lithuanian sportsmen during the 2000 Sydney Olympic Games. The examined results have shown that every sportsman responded differently to acclimatization and the TELECARD system provided support to physicians and coaches for making optimal decisions regarding the sportsmen's adaptation and other situations. The final telemetry system was used for rower monitoring. It was based on the new CompCardioSignal terminal with three EASI ECG leads and synchronously recorded motion signals for evaluation of human reaction to physical load. The developed telemonitoring systems were a useful tool for evaluation of human reaction to physical load in rehabilitation and sports activities. PMID:15718601

  5. [The origins of the Czech Society of Cardiology and of Czech cardiology].

    PubMed

    Widimský, J

    2013-06-01

    The paper presents the origins of the Czech Society of Cardiology on the one hand, and the origins of Czech cardiology on the other. The Czech Society of Cardiology is the third oldest in the world (after the American and German Societies). It was founded in 1929 by Prof. Libenský. As early as in 1933, the Society organised the first international congress of cardiologists in Prague, which was attended by 200 doctors, out of which 50 were from abroad. The most participants came from France and Poland. Other participants came from England, Argentina, Belgium, the Netherlands, Italy, Romania, Spain and Switzerland. The worldwide importance of this congress is apparent from the fact that both the World Society of Cardiology and the European Society of Cardiology (EKS) were founded after World War II in the years 1950 and 1952, i.e. almost 20 years after the first international congress of cardiology in Prague. In 1964, the Fourth Congress of European Society of Cardiology was held in Prague with the participation of 1,500 specialists from 31 countries and chaired by Prof. Pavel Lukl, the later president of EKS (1964- 1968). The paper also presents the work of our specialists in WHO and the history of the international journal Cor et Vasa issued by the Avicenum publishing house in Prague in English and Russian in the years 1958- 1992. An important role in the development of our cardiology was played by certain departments and clinics. In 1951, the Institute for Cardiovascular Research (ÚCHOK) was founded in PrahaKrč, thanks to the initiative of MU Dr. František Kriegl, the Deputy Minister of Health. Its first director was Klement Weber, who published, as early as in 1929, a monograph on arrhythmias -  50 years earlier than arrhythmias started to be at the centre of attention of cardiologists. Klement Weber was one of the doctors of President T. G. Masaryk during his serious disease towards the end of his life. Jan Brod was the deputy of Klement Weber in the

  6. Current global and Korean issues in radiation safety of nuclear medicine procedures.

    PubMed

    Song, H C

    2016-06-01

    In recent years, the management of patient doses in medical imaging has evolved as concern about radiation exposure has increased. Efforts and techniques to reduce radiation doses are focussed not only on the basis of patient safety, but also on the fundamentals of justification and optimisation in cooperation with international organisations such as the International Commission on Radiological Protection, the International Atomic Energy Agency, and the World Health Organization. The Image Gently campaign in children and Image Wisely campaign in adults to lower radiation doses have been initiated in the USA. The European Association of Nuclear Medicine paediatric dosage card, North American consensus guidelines, and Nuclear Medicine Global Initiative have recommended the activities of radiopharmaceuticals that should be administered in children. Diagnostic reference levels (DRLs), developed predominantly in Europe, may be an important tool to manage patient doses. In Korea, overexposure to radiation, even from the use of medical imaging, has become a public issue, particularly since the accident at the Fukushima nuclear power plant. As a result, the Korean Nuclear Safety and Security Commission revised the technical standards for radiation safety management in medical fields. In parallel, DRLs for nuclear medicine procedures have been collected on a nationwide scale. Notice of total effective dose from positron emission tomography-computed tomography for cancer screening has been mandatory since mid-November 2014. PMID:26960820

  7. Final report on repair procedure of strong ground motion data from underground nuclear tests

    SciTech Connect

    Tunnell, T.W.

    1995-04-01

    Certain difficulties arise when recording close-in around motion from underground nuclear explosions. Data quality can be compromised by a variety of factors, including electromagnetic pulse, noise spikes, direct current effect, and gauge clipping and gauge tilt. From March 1988 through September 1994, EG&G Energy Measurements repaired strong round-motion data (acceleration data) from underground nuclear tests for the Los Alamos National Laboratory using, an automated repair procedure. The automated repair determined and implemented the required repairs based on user input and a consistent set of criteria. A log was kept of each repair so that the repair procedure could be duplicated. This relaxed the requirement to save the repaired data. Developed for the VAX system, the procedure allowed the user to stack up a large number of repairs, plot the repaired data, and obtain hard copies. The plotted data could then be reviewed for a given test to determine the consistency of repair for a given underground test. This feature released the user to perform other tasks while the data were being repaired.

  8. Collective effective dose in Europe from X-ray and nuclear medicine procedures.

    PubMed

    Bly, R; Jahnen, A; Järvinen, H; Olerud, H; Vassileva, J; Vogiatzi, S

    2015-07-01

    Population doses from radiodiagnostic (X-ray and nuclear medicine) procedures in Europe were estimated based on data collected from 36 European countries. For X-ray procedures in EU and EFTA countries (except Liechtenstein) the collective effective dose is 547,500 man Sv, resulting in a mean effective dose of 1.06 mSv per caput. For all European countries included in the survey the collective effective dose is 605,000 man Sv, resulting in a mean effective dose of 1.05 mSv per caput. For nuclear medicine procedures in EU countries and EFTA (except Liechtenstein) countries the collective effective dose is 30,700 man Sv, resulting in a mean effective dose of 0.06 mSv per caput. For all European countries included in the survey the collective effective dose is 31,100 man Sv, resulting in a mean effective dose of 0.05 mSv per caput. PMID:25848115

  9. REVIEW Of COMPUTERIZED PROCEDURE GUIDELINES FOR NUCLEAR POWER PLANT CONTROL ROOMS

    SciTech Connect

    David I Gertman; Katya Le Blanc; Ronald L Boring

    2011-09-01

    Computerized procedures (CPs) are recognized as an emerging alternative to paper-based procedures for supporting control room operators in nuclear power plants undergoing life extension and in the concept of operations for advanced reactor designs. CPs potentially reduce operator workload, yield increases in efficiency, and provide for greater resilience. Yet, CPs may also adversely impact human and plant performance if not designed and implemented properly. Therefore, it is important to ensure that existing guidance is sufficient to provide for proper implementation and monitoring of CPs. In this paper, human performance issues were identified based on a review of the behavioral science literature, research on computerized procedures in nuclear and other industries, and a review of industry experience with CPs. The review of human performance issues led to the identification of a number of technical gaps in available guidance sources. To address some of the gaps, we developed 13 supplemental guidelines to support design and safety. This paper presents these guidelines and the case for further research.

  10. Advances in cardiology: clinical trial update.

    PubMed

    Howe, Andrew J; Shand, James A; Menown, Ian B A

    2011-05-01

    Multiple key cardiology trials have been presented or published over recent months, several with the potential to change clinical practice. In this article, we summarize and place in clinical context new trial findings regarding anticoagulation in the cardiac catheterization laboratory (enoxaparin, fondaparinux and unfractionated heparin), the implications of genetic polymorphisms and functional testing for antiplatelet therapy (clopidogrel and ticagrelor), new oral anticoagulants for use in atrial fibrillation (apixiban and rivaroxaban), optimal pacing strategies and pharmacological agents in heart failure (ivabradine, eplerenone, cardiac resynchronization therapy, telemonitoring and intracoronary bone marrow stem cell infusion). Clinical trials in percutaneous structural intervention (transcatheter aortic valve implantation, MONARC™ mitral annular implant, STARFlex(®) patent foramen ovale device) and advanced percutaneous coronary intervention (everolimus-eluting stents, biodegradable polymer/polymer-free technologies and contemporary use of intravascular ultrasound) are also discussed. PMID:21627472

  11. [Cardiology in the Morgagni's anatomo pathological work].

    PubMed

    de Micheli, Alfredo; Iturralde, Pedro; Aranda Fraustro, Alberto

    2015-01-01

    In the XVIII century, under the influence of the "systematic spirit", characteristic of the Enlightenment age, pathological anatomy was systematized in the Morgagni's fundamental treatise De sedibus et causis morborum per anatomen indagatis, published as letters in 1761. Certain biographical data of the author are reported here as well as some his more important contributions to cardiology such as the Morgagni's, Adams', Stokes' syndrome. His points of view on sudden death and his observations on post-infarct myocardial rupture, are related also. In his global evaluation of these facts, the speculative approach always predominates. Indeed, in these anatomist's works, we find a good example of the application of epistemologic principles to the medical field. PMID:25862292

  12. Preliminary clinical experience in cardiology with sonazoid.

    PubMed

    Marelli, C

    2000-08-17

    Sonazoid (formerly NC100100) is a new ultrasound contrast agent for intravenous injection developed by Nycomed-Amersham. It consists of perfluorocarbon microbubbles that are stabilized with a surfactant and are within a well-defined size range (median diameter approximately 3 microm). Due to the low diffusibility and blood solubility of the gas, the controlled size distribution of the microbubbles, and the flexibility of the shell, Sonazoid is a free-flowing tracer capable of crossing the pulmonary capillary bed after peripheral intravenous injection. It is stable enough for the duration of the ultrasound examination and provides echo enhancement useful for clinical requirements. The preliminary clinical experience in cardiology indications, including its use in reducing the frequency of inadequate echocardiographic studies in patients with suboptimal echocardiograms, and its use as a myocardial perfusion agent in the setting of acute myocardial ischemia is briefly discussed. PMID:10997345

  13. 10 CFR 770.7 - What procedures are to be used to transfer real property at defense nuclear facilities for...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false What procedures are to be used to transfer real property at defense nuclear facilities for economic development? 770.7 Section 770.7 Energy DEPARTMENT OF ENERGY TRANSFER OF REAL PROPERTY AT DEFENSE NUCLEAR FACILITIES FOR ECONOMIC DEVELOPMENT § 770.7...

  14. ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    PubMed

    Patel, Manesh R; Bailey, Steven R; Bonow, Robert O; Chambers, Charles E; Chan, Paul S; Dehmer, Gregory J; Kirtane, Ajay J; Wann, L Samuel; Ward, R Parker

    2012-05-29

    The American College of Cardiology Foundation, in collaboration with the Society for Cardiovascular Angiography and Interventions and key specialty and subspecialty societies, conducted a review of common clinical scenarios where diagnostic catheterization is frequently considered. The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of noninvasive imaging appropriate use criteria. The 166 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9, to designate appropriate use (median 7 to 9), uncertain use (median 4 to 6), and inappropriate use (median 1 to 3). Diagnostic catheterization may include several different procedure components. The indications developed focused primarily on 2 aspects of diagnostic catheterization. Many indications focused on the performance of coronary angiography for the detection of coronary artery disease with other procedure components (e.g., hemodynamic measurements, ventriculography) at the discretion of the operator. The majority of the remaining indications focused on hemodynamic measurements to evaluate valvular heart disease, pulmonary hypertension, cardiomyopathy, and other conditions, with the use of coronary angiography at the discretion of the operator. Seventy-five indications were rated as appropriate, 49 were rated as uncertain, and 42 were rated as inappropriate. The appropriate use criteria for diagnostic catheterization have the potential to impact physician decision making, healthcare delivery, and reimbursement policy. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research. PMID:22578925

  15. OCCUPATIONAL DOSE ASSESSMENT IN INTERVENTIONAL CARDIOLOGY IN SERBIA.

    PubMed

    Kaljevic, J; Ciraj-Bjelac, O; Stankovic, J; Arandjic, D; Bozovic, P; Antic, V

    2016-09-01

    The objective of this work is to assess the occupational dose in interventional cardiology in a large hospital in Belgrade, Serbia. A double-dosimetry method was applied for the estimation of whole-body dose, using thermoluminescent dosemeters, calibrated in terms of the personal dose equivalent Hp(10). Besides the double-dosimetry method, eye dose was also estimated by means of measuring ambient dose equivalent, H*(10), and doses per procedure were reported. Doses were assessed for 13 physicians, 6 nurses and 10 radiographers, for 2 consequent years. The maximum annual effective dose assessed was 4.3, 2.1 and 1.3 mSv for physicians, nurses and radiographers, respectively. The maximum doses recorded by the dosemeter worn at the collar level (over the apron) were 16.8, 11.9 and 4.5 mSv, respectively. This value was used for the eye lens dose assessment. Estimated doses are in accordance with or higher than annual dose limits for the occupational exposure. PMID:26464526

  16. The development of protocols to cover clinical care in cardiology.

    PubMed

    Duwel, C M; Kruijssen, H A

    1995-01-01

    PROCAS (PRofiles Of CAre System) is one of the AIM projects whose objectives are to improve the quality and efficiency of medical treatment. These will be realised in establishing a methodology for defining and developing what are termed "Profiles of Care". These are sets of options for clinicians which are meant to create acceptable ways of managing patients with similar conditions and which represent good clinical practice. Moreover, a prototype system will be realised by the application of informatics and telematics, to enhance the provision of efficient and effective care in both hospitals and outpatient departments. Because of the retrospective nature of the ICD-9-CM system for the classification of cardiological patients, a draft for a Prospective Patient Data Model, which involves the assessment of somatic, psychosocial, environmental and demographic axes, is being presented. This multi-axial evaluation allows for the generation of the smallest unit of diagnostic-therapeutic procedures, based on the definition of the patient's health problem; that is: the patient-orientated diagnosis or the appropriate indication. PMID:10163708

  17. An unusual complication after interventional cardiology reveals and infrequent condition: Idiopathic CD4 deficiency.

    PubMed

    Fica, Alberto; Verdugo, Fernando; Landaeta, María V; Flores, Alfredo; Roessler, Ingmar

    2016-01-01

    Herpes zoster (HZ) is of rare occurrence after interventional procedures with few events reported until now. A 74 year-old man with a past medical history of idiopathic thrombocytopenic purpura, splenectomy, autoimmune hemolytic anemia, and polymyalgia rheumatica developed HZ on the right median nerve 7 days after he underwent a coronariography for managing an acute coronary syndrome. He evolved with cutaneous dissemination and required intravenous acyclovir therapy. Laboratory evaluation disclosed a previously unknown idiophatic CD4 lymphocytopenia. HZ should be added to the list of complications after interventional cardiology and associated immunosuppressive factors ruled out. PMID:26768667

  18. Processes and Procedures for Application of CFD to Nuclear Reactor Safety Analysis

    SciTech Connect

    Richard W. Johnson; Richard R. Schultz; Patrick J. Roache; Ismail B. Celik; William D. Pointer; Yassin A. Hassan

    2006-09-01

    Traditionally, nuclear reactor safety analysis has been performed using systems analysis codes such as RELAP5, which was developed at the INL. However, goals established by the Generation IV program, especially the desire to increase efficiency, has lead to an increase in operating temperatures for the reactors. This increase pushes reactor materials to operate towards their upper temperature limits relative to structural integrity. Because there will be some finite variation of the power density in the reactor core, there will be a potential for local hot spots to occur in the reactor vessel. Hence, it has become apparent that detailed analysis will be required to ensure that local ‘hot spots’ do not exceed safety limits. It is generally accepted that computational fluid dynamics (CFD) codes are intrinsically capable of simulating fluid dynamics and heat transport locally because they are based on ‘first principles.’ Indeed, CFD analysis has reached a fairly mature level of development, including the commercial level. However, CFD experts are aware that even though commercial codes are capable of simulating local fluid and thermal physics, great care must be taken in their application to avoid errors caused by such things as inappropriate grid meshing, low-order discretization schemes, lack of iterative convergence and inaccurate time-stepping. Just as important is the choice of a turbulence model for turbulent flow simulation. Turbulence models model the effects of turbulent transport of mass, momentum and energy, but are not necessarily applicable for wide ranges of flow types. Therefore, there is a well-recognized need to establish practices and procedures for the proper application of CFD to simulate flow physics accurately and establish the level of uncertainty of such computations. The present document represents contributions of CFD experts on what the basic practices, procedures and guidelines should be to aid CFD analysts to obtain accurate

  19. A probabilistic seismic risk assessment procedure for nuclear power plants: (II) Application

    USGS Publications Warehouse

    Huang, Y.-N.; Whittaker, A.S.; Luco, N.

    2011-01-01

    This paper presents the procedures and results of intensity- and time-based seismic risk assessments of a sample nuclear power plant (NPP) to demonstrate the risk-assessment methodology proposed in its companion paper. The intensity-based assessments include three sets of sensitivity studies to identify the impact of the following factors on the seismic vulnerability of the sample NPP, namely: (1) the description of fragility curves for primary and secondary components of NPPs, (2) the number of simulations of NPP response required for risk assessment, and (3) the correlation in responses between NPP components. The time-based assessment is performed as a series of intensity-based assessments. The studies illustrate the utility of the response-based fragility curves and the inclusion of the correlation in the responses of NPP components directly in the risk computation. ?? 2011 Published by Elsevier B.V.

  20. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D

    2010-11-23

    The American College of Cardiology Foundation, along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria. The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research. PMID:20975004

  1. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D; Kramer, Christopher M; Berman, Daniel; Brown, Alan; Chaudhry, Farooq A; Cury, Ricardo C; Desai, Milind Y; Einstein, Andrew J; Gomes, Antoinette S; Harrington, Robert; Hoffmann, Udo; Khare, Rahul; Lesser, John; McGann, Christopher; Rosenberg, Alan; Schwartz, Robert; Shelton, Marc; Smetana, Gerald W; Smith, Sidney C

    2010-11-23

    The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance (CMR) appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria (1). The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease (CAD) was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography (CT) for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research. PMID:21087721

  2. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.

    PubMed

    Taylor, Allen J; Cerqueira, Manuel; Hodgson, John McB; Mark, Daniel; Min, James; O'Gara, Patrick; Rubin, Geoffrey D

    2010-01-01

    The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac computed tomography (CCT) is frequently considered. The present document is an update to the original CCT/cardiac magnetic resonance (CMR) appropriateness criteria published in 2006, written to reflect changes in test utilization, to incorporate new clinical data, and to clarify CCT use where omissions or lack of clarity existed in the original criteria (1). The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Ninety-three clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of CCT angiography for diagnosis and risk assessment in patients with low or intermediate risk or pretest probability for coronary artery disease (CAD) was viewed favorably, whereas testing in high-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Use of noncontrast computed tomography (CT) for calcium scoring was rated as appropriate within intermediate- and selected low-risk patients. Appropriate applications of CCT are also within the category of cardiac structural and functional evaluation. It is anticipated that these results will have an impact on physician decision making, performance, and reimbursement policy, and that they will help guide future research. PMID:21232696

  3. Helio-geomagnetic influence in cardiological cases

    NASA Astrophysics Data System (ADS)

    Katsavrias, Ch.; Preka-Papadema, P.; Moussas, X.; Apostolou, Th.; Theodoropoulou, A.; Papadima, Th.

    2013-01-01

    The effects of the energetic phenomena of the Sun, flares and coronal mass ejections (CMEs) on the Earth's ionosphere-magnetosphere, through the solar wind, are the sources of the geomagnetic disturbances and storms collectively known as Space Weather. The research on the influence of Space Weather on biological and physiological systems is open. In this work we study the Space Weather impact on Acute Coronary Syndromes (ACS) distinguishing between ST-segment elevation acute coronary syndromes (STE-ACS) and non-ST-segment elevation acute coronary syndromes (NSTE-ACS) cases. We compare detailed patient records from the 2nd Cardiologic Department of the General Hospital of Nicaea (Piraeus, Greece) with characteristics of geomagnetic storms (DST), solar wind speed and statistics of flares and CMEs which cover the entire solar cycle 23 (1997-2007). Our results indicate a relationship of ACS to helio-geomagnetic activity as the maximum of the ACS cases follows closely the maximum of the solar cycle. Furthermore, within very active periods, the ratio NSTE-ACS to STE-ACS, which is almost constant during periods of low to medium activity, changes favouring the NSTE-ACS. Most of the ACS cases exhibit a high degree of association with the recovery phase of the geomagnetic storms; a smaller, yet significant, part was found associated with periods of fast solar wind without a storm.

  4. Toward a personal health society in cardiology.

    PubMed

    Fayn, Jocelyne; Rubel, Paul

    2010-03-01

    In this paper, we present a new generation of health services that has emerged due to the development of advanced information and communication technology (ICT) solutions, like the Enhanced Personal, Intelligent, and Mobile system for Early Detection and Interpretation of Cardiac Syndromes (EPI-MEDICS). It is a personal self-care system that allows any citizen to self-record high-quality ECGs on demand with a smart portable device, which is endowed with powerful ICT capabilities: self-adaptive embedded intelligence, mobile health record management support on SmartMedia card, embedded Web server, and wireless communication. The EPI-MEDICS solution design also provides ambient, intelligent, and pervasive computing services offering any citizen a ubiquitous, reliable, and efficient management of his/her own cardiac status. A multicentric evaluation performed in Europe with a series of device prototypes and the performance assessment of the original methods of signal synthesis that were designed to guarantee a high interoperability level of the recorded data within the clinical practice, as well as of the decision-support methodologies that were developed for an early detection of life-threatening myocardial ischemia and arrhythmia, at home or anywhere, demonstrate the pertinence of going toward a personal health society in cardiology, which still yields the highest mortality rate in industrialized countries. PMID:20007033

  5. The contributions of Carl Ludwig to cardiology.

    PubMed

    Zimmer, H G

    1999-03-01

    The basic instruments for measuring functional cardiovascular parameters and the most important discoveries made by Carl Ludwig and his disciples in cardiovascular physiology are described and put into perspective in regard to the further development of his methods and ideas. The most important apparatus was the kymograph, which, for the first time, made recording and documenting of functional parameters possible. This instrument was also used for the functional evaluation of the isolated perfused frog heart that was developed by Elias Cyon in Ludwig's Leipzig Physiological Institute. In the isolated frog heart, important phenomena were discovered such as the staircase ('Treppe'), the absolute refractory period and the all-or-none law of the heart. The isolated dog heart was used to determine the origin of the first heart sound, which was characterized as a muscle tone. To measure regional blood flow and eventually cardiac output, a flowmeter ('Stromuhr') was designed. Precise measurements of cardiac output became possible only when Adolf Fick had developed his principle, which served as the basis for the modern indicator methods. Cyon and Ludwig also discoverd the depressor nerve, which constitutes the basis of the baroreceptor reflex. Finally, the precise localization of the vasomotor centre in the ventrolateral medulla was achieved in Ludwig's Leipzig Physiological Institute. This was confirmed more than 100 years later with modern neuroanatomical methods making use of retrograde axonal transport. Thus, Ludwig and his scholars made major substantial contributions to cardiovascular knowledge that can be considered to constitute the basis of modern cardiology. PMID:10202196

  6. Development of the preliminary procedure for a national nuclear safety authority staff acting during the PWR NPP accident

    SciTech Connect

    Kostadinov, V.

    1997-12-01

    We present the development of the new preliminary procedure for a National Nuclear Safety Authority staff preparedness for action in the case of a Pressurized Water Reactor Nuclear Power Plant accident. The procedures are generic and equally applicable for advanced nuclear plants. The basic goal of the procedure is systematic determination of the responsibilities of the staff expert group(s) members for accident analysis and consequences prediction. Moreover, the procedure describes anticipated practices of an expert group acting during a plant accident. Different sources will define the state(s) of the plant as: the plant form for initial notification of an accident, the particular form for specific plant information, etc. By this procedure we propose three expert groups successively to work up to eight hours each, in the circumstances of an accident. We suppose the expert group to have mostly five members each. The members should have different tasks for resolution, defined by the procedure. The head of the group will coordinate group members work during an accident. Group members have to be qualified and acquainted with all adequate references. In the paper we present a newly devised agenda with presumed duties of each member of the group. Furthermore, we also composed a special form for information exchange between the utility and regulatory staff member during an accident. 8 refs., 1 fig.

  7. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: A Report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology: Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A

    2009-03-10

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an appropriateness review of common clinical scenarios in which coronary revascularization is frequently considered. The clinical scenarios were developed to mimic common situations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. Approximately 180 clinical scenarios were developed by a writing committee and scored by a separate technical panel on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization was considered appropriate and likely to improve health outcomes or survival. Scores of 1 to 3 indicate revascularization was considered inappropriate and unlikely to improve health outcomes or survival. The mid range (4 to 6) indicates a clinical scenario for which the likelihood that coronary revascularization would improve health outcomes or survival was considered uncertain. For the majority of the clinical scenarios, the panel only considered the appropriateness of revascularization irrespective of whether this was accomplished by percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). In a select subgroup of clinical scenarios in which revascularization is generally considered appropriate, the appropriateness of PCI and CABG individually as the primary mode of revascularization was considered. In general, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia was viewed favorably. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy were viewed less favorably. It is

  8. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization : a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology. Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A; Masoudi, Frederick A; Brindis, Ralph G; Beckman, Karen J; Chambers, Charles E; Ferguson, T Bruce; Garcia, Mario J; Grover, Frederick L; Holmes, David R; Klein, Lloyd W; Limacher, Marian; Mack, Michael J; Malenka, David J; Park, Myung H; Ragosta, Michael; Ritchie, James L; Rose, Geoffrey A; Rosenberg, Alan B; Shemin, Richard J; Weintraub, William S; Wolk, Michael J; Allen, Joseph M; Douglas, Pamela S; Hendel, Robert C; Peterson, Eric D

    2009-02-15

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an appropriateness review of common clinical scenarios in which coronary revascularization is frequently considered. The clinical scenarios were developed to mimic common situations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. Approximately 180 clinical scenarios were developed by a writing committee and scored by a separate technical panel on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization was considered appropriate and likely to improve health outcomes or survival. Scores of 1 to 3 indicate revascularization was considered inappropriate and unlikely to improve health outcomes or survival. The mid range (4 to 6) indicates a clinical scenario for which the likelihood that coronary revascularization would improve health outcomes or survival was considered uncertain. For the majority of the clinical scenarios, the panel only considered the appropriateness of revascularization irrespective of whether this was accomplished by percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). In a select subgroup of clinical scenarios in which revascularization is generally considered appropriate, the appropriateness of PCI and CABG individually as the primary mode of revascularization was considered. In general, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia was viewed favorably. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy were viewed less favorably. It is

  9. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: a report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A

    2009-02-10

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an appropriateness review of common clinical scenarios in which coronary revascularization is frequently considered. The clinical scenarios were developed to mimic common situations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. Approximately 180 clinical scenarios were developed by a writing committee and scored by a separate technical panel on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization was considered appropriate and likely to improve health outcomes or survival. Scores of 1 to 3 indicate revascularization was considered inappropriate and unlikely to improve health outcomes or survival. The mid range (4 to 6) indicates a clinical scenario for which the likelihood that coronary revascularization would improve health outcomes or survival was considered uncertain. For the majority of the clinical scenarios, the panel only considered the appropriateness of revascularization irrespective of whether this was accomplished by percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). In a select subgroup of clinical scenarios in which revascularization is generally considered appropriate, the appropriateness of PCI and CABG individually as the primary mode of revascularization was considered. In general, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia was viewed favorably. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy were viewed less favorably. It is

  10. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians.

    PubMed

    Douglas, Pamela S; Garcia, Mario J; Haines, David E; Lai, Wyman W; Manning, Warren J; Patel, Ayan R; Picard, Michael H; Polk, Donna M; Ragosta, Michael; Parker Ward, R; Weiner, Rory B

    2011-03-01

    The American College of Cardiology Foundation (ACCF), in partnership with the American Society of Echocardiography (ASE) and along with key specialty and subspecialty societies, conducted a review of common clinical scenarios where echocardiography is frequently considered. This document combines and updates the original transthoracic and transesophageal echocardiography appropriateness criteria published in 2007 (1) and the original stress echocardiography appropriateness criteria published in 2008 (2). This revision reflects new clinical data, reflects changes in test utilization patterns,and clarifies echocardiography use where omissions or lack of clarity existed in the original criteria.The indications (clinical scenarios)were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of the original appropriate use criteria (AUC).The 202 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9,to designate appropriate use(median 7 to 9), uncertain use(median 4 to 6), and inappropriate use (median 1 to 3). Ninety-seven indications were rated as appropriate, 34 were rated as uncertain, and 71 were rated as inappropriate. In general,the use of echocardiography for initial diagnosis when there is a change in clinical status or when the results of the echocardiogram are anticipated to change patient management were rated appropriate. Routine testing when there was no change in clinical status or when results of testing were unlikely to modify management were more likely to be inappropriate than appropriate/uncertain.The AUC for echocardiography have the potential to impact physician decision making,healthcare delivery, and reimbursement policy. Furthermore,recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research. PMID

  11. Measurements of eye lens doses in interventional cardiology using OSL and electronic dosemeters†.

    PubMed

    Sanchez, R M; Vano, E; Fernandez, J M; Ginjaume, M; Duch, M A

    2014-12-01

    The purpose of this paper is to test the appropriateness of OSL and electronic dosemeters to estimate eye lens doses at interventional cardiology environment. Using TLD as reference detectors, personal dose equivalent was measured in phantoms and during clinical procedures. For phantom measurements, OSL dose values resulted in an average difference of -15 % vs. TLD. Tests carried out with other electronic dosemeters revealed differences up to ±20 % versus TLD. With dosemeters positioned outside the goggles and when TLD doses were >20 μSv, the average difference OSL vs. TLD was -9 %. Eye lens doses of almost 700 μSv per procedure were measured in two cases out of a sample of 33 measurements in individual clinical procedures, thus showing the risk of high exposure to the lenses of the eye when protection rules are not followed. The differences found between OSL and TLD are acceptable for the purpose and range of doses measured in the survey. PMID:24464819

  12. Application of EPRI risk-based inservice inspection procedure to combustion engineering design of nuclear power plant

    SciTech Connect

    Lubin, B.T.; Fourgerousse, R.

    1996-12-01

    The EPRI developed risk-based inservice inspection procedure is used to select the elements for inservice inspection on a section of the high pressure safety injection system of the Entergy Operations ANO2 nuclear plant. This plant is the pilot plant in a six utility-eleven plant EPRI tailored collaboration program to apply the general EPRI procedures to Combustion Engineering NSSS designs. The procedure results in a reduction of candidate inspection locations from 14, based on current ASME Section XI rules for B-J welds to 3, based on the risk-based selection criteria.

  13. Radiation dose and image quality for paediatric interventional cardiology

    NASA Astrophysics Data System (ADS)

    Vano, E.; Ubeda, C.; Leyton, F.; Miranda, P.

    2008-08-01

    Radiation dose and image quality for paediatric protocols in a biplane x-ray system used for interventional cardiology have been evaluated. Entrance surface air kerma (ESAK) and image quality using a test object and polymethyl methacrylate (PMMA) phantoms have been measured for the typical paediatric patient thicknesses (4-20 cm of PMMA). Images from fluoroscopy (low, medium and high) and cine modes have been archived in digital imaging and communications in medicine (DICOM) format. Signal-to-noise ratio (SNR), figure of merit (FOM), contrast (CO), contrast-to-noise ratio (CNR) and high contrast spatial resolution (HCSR) have been computed from the images. Data on dose transferred to the DICOM header have been used to test the values of the dosimetric display at the interventional reference point. ESAK for fluoroscopy modes ranges from 0.15 to 36.60 µGy/frame when moving from 4 to 20 cm PMMA. For cine, these values range from 2.80 to 161.10 µGy/frame. SNR, FOM, CO, CNR and HCSR are improved for high fluoroscopy and cine modes and maintained roughly constant for the different thicknesses. Cumulative dose at the interventional reference point resulted 25-45% higher than the skin dose for the vertical C-arm (depending of the phantom thickness). ESAK and numerical image quality parameters allow the verification of the proper setting of the x-ray system. Knowing the increases in dose per frame when increasing phantom thicknesses together with the image quality parameters will help cardiologists in the good management of patient dose and allow them to select the best imaging acquisition mode during clinical procedures.

  14. Improving Access to Pediatric Cardiology in Cape Verde via a Collaborative International Telemedicine Service.

    PubMed

    Lapão, Luís Velez; Correia, Artur

    2015-01-01

    This paper addresses the role of international telemedicine services in supporting the evacuation procedures from Cape Verde to Portugal, enabling better quality and cost reductions in the management of the global health system. The Cape Verde, as other African countries, health system lacks many medical specialists, like pediatric cardiologists, neurosurgery, etc. In this study, tele-cardiology shows good results as diagnostic support to the evacuation decision. Telemedicine services show benefits while monitoring patients in post-evacuation, helping to address the lack of responsive care in some specialties whose actual use will help save resources both in provision and in management of the evacuation procedures. Additionally, with tele-cardiology collaborative service many evacuations can be avoided whereas many cases will be treated and followed locally in Cape Verde with remote technical support from Portugal. This international telemedicine service enabled more efficient evacuations, by reducing expenses in travel and housing, and therefore contributed to the health system's improvement. This study provides some evidence of how important telemedicine really is to cope with both the geography and the shortage of physicians. PMID:25980705

  15. Comparison of abomasal emptying in neonatal calves with a nuclear scintigraphic procedure.

    PubMed

    Nappert, G; Lattimer, J C

    2001-01-01

    The purpose of the present study was to demonstrate that nuclear medicine technology allows observation of the effect that milk clotting has on abomasal emptying in the living neonatal calf. Scintigraphic evaluation of abomasal emptying was carried out in 6 healthy male Holstein calves. The calves were fed 10% of their body weight daily as whole cow's milk that was divided equally and consumed as 2 feedings via a nipple bottle. One day before the nuclear scintigraphic procedure, the calves were randomly fed whole cow's milk, or an oral rehydration solution (ORS) containing bicarbonate and high levels of soluble fibre was fed for 3 consecutive feedings an hour before the portion of milk. For each calf, both feeding programs were repeated twice at a one-week interval. Immediately following administration of the 99mTC-sulfur-colloid-containing milk, the calves were imaged with the gamma camera positioned lateral and ventral to the abomasum. Additional right lateral and ventral views of the abomasum were collected at 15, 30, 45, 60, 90, 120, 150, 180, 210, and 240 min after administration of the radionuclide. Blood glucose determination were performed at one-hour intervals for 7 h after feeding milk to evaluate milk digestibility in both feeding programs. No significant differences in the results of the glucose absorption test or in the radionuclide counts of the abomasum were found between both feeding programs. Scintigraphic evaluation of abomasal emptying was found to be a useful technique for visualization of milk clotting and to test the effect of an ORS on milk digestibility. PMID:11227195

  16. 10 CFR 770.7 - What procedures are to be used to transfer real property at defense nuclear facilities for...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false What procedures are to be used to transfer real property... ENERGY TRANSFER OF REAL PROPERTY AT DEFENSE NUCLEAR FACILITIES FOR ECONOMIC DEVELOPMENT § 770.7 What... congressional defense committees through the Secretary of Energy. (d) Transfer. After the...

  17. 10 CFR 770.7 - What procedures are to be used to transfer real property at defense nuclear facilities for...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false What procedures are to be used to transfer real property... ENERGY TRANSFER OF REAL PROPERTY AT DEFENSE NUCLEAR FACILITIES FOR ECONOMIC DEVELOPMENT § 770.7 What... congressional defense committees through the Secretary of Energy. (d) Transfer. After the...

  18. 10 CFR 770.7 - What procedures are to be used to transfer real property at defense nuclear facilities for...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false What procedures are to be used to transfer real property... ENERGY TRANSFER OF REAL PROPERTY AT DEFENSE NUCLEAR FACILITIES FOR ECONOMIC DEVELOPMENT § 770.7 What... congressional defense committees through the Secretary of Energy. (d) Transfer. After the...

  19. 10 CFR 770.7 - What procedures are to be used to transfer real property at defense nuclear facilities for...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false What procedures are to be used to transfer real property... ENERGY TRANSFER OF REAL PROPERTY AT DEFENSE NUCLEAR FACILITIES FOR ECONOMIC DEVELOPMENT § 770.7 What... congressional defense committees through the Secretary of Energy. (d) Transfer. After the...

  20. What to Expect From the Evolving Field of Geriatric Cardiology.

    PubMed

    Bell, Susan P; Orr, Nicole M; Dodson, John A; Rich, Michael W; Wenger, Nanette K; Blum, Kay; Harold, John Gordon; Tinetti, Mary E; Maurer, Mathew S; Forman, Daniel E

    2015-09-15

    The population of older adults is expanding rapidly, and aging predisposes to cardiovascular disease. The principle of patient-centered care must respond to the preponderance of cardiac disease that now occurs in combination with the complexities of old age. Geriatric cardiology melds cardiovascular perspectives with multimorbidity, polypharmacy, frailty, cognitive decline, and other clinical, social, financial, and psychological dimensions of aging. Although some assume that a cardiologist may instinctively cultivate some of these skills over the course of a career, we assert that the volume and complexity of older cardiovascular patients in contemporary practice warrants a more direct approach to achieve suitable training and a more reliable process of care. We present a rationale and vision for geriatric cardiology as a melding of primary cardiovascular and geriatrics skills, thereby infusing cardiology practice with expanded proficiencies in diagnosis, risks, care coordination, communications, end-of-life, and other competences required to best manage older cardiovascular patients. PMID:26361161

  1. Potential Uses, Limitations, and Basic Procedures of Micronuclei and Nuclear Abnormalities in Buccal Cells

    PubMed Central

    Torres-Bugarín, Olivia; Zavala-Cerna, María Guadalupe; Nava, Arnulfo; Flores-García, Aurelio; Ramos-Ibarra, María Luisa

    2014-01-01

    The use of biomarkers as tools to evaluate genotoxicity is increasing recently. Methods that have been used previously to evaluate genomic instability are frequently expensive, complicated, and invasive. The micronuclei (MN) and nuclear abnormalities (NA) technique in buccal cells offers a great opportunity to evaluate in a clear and precise way the appearance of genetic damage whether it is present as a consequence of occupational or environmental risk. This technique is reliable, fast, relatively simple, cheap, and minimally invasive and causes no pain. So, it is well accepted by patients; it can also be used to assess the genotoxic effect derived from drug use or as a result of having a chronic disease. Furthermore the beneficial effects derived from changes in life style or taking additional supplements can also be evaluated. In the present paper, we aim to focus on the explanation of MN test and its usefulness as a biomarker; we further give details about procedures to perform and interpret the results of the test and review some factors that could have an influence on the results of the technique. PMID:24778463

  2. Simulation of beta radiator handling procedures in nuclear medicine by means of a movable hand phantom.

    PubMed

    Blunck, Ch; Becker, F; Urban, M

    2011-03-01

    In nuclear medicine therapies, people working with beta radiators such as (90)Y may be exposed to non-negligible partial body doses. For radiation protection, it is important to know the characteristics of the radiation field and possible dose exposures at relevant positions in the working area. Besides extensive measurements, simulations can provide these data. For this purpose, a movable hand phantom for Monte Carlo simulations was developed. Specific beta radiator handling scenarios can be modelled interactively with forward kinematics or automatically with an inverse kinematics procedure. As a first investigation, the dose distribution on a medical doctor's hand injecting a (90)Y solution was measured and simulated with the phantom. Modelling was done with the interactive method based on five consecutive frames from a video recorded during the injection. Owing to the use of only one camera, not each detail of the radiation scenario is visible in the video. In spite of systematic uncertainties, the measured and simulated dose values are in good agreement. PMID:21044994

  3. Evaluation criteria and procedure for nuclear power plant temporary loads/temporary conditions

    SciTech Connect

    Tang, H.T.; Minichiello, J.C.; Olson, D.E.

    1996-12-01

    Operating nuclear power plants frequently encounter temporary loads/temporary conditions in plant normal operation and maintenance (O and M). The most obvious examples are installation of temporary shielding and scaffolding, or removal of certain supports, to facilitate plant refueling and maintenance outage activities. Short-term operability calls such as those due to snubber failures or unanticipated transients also create temporary loads/temporary conditions. These temporary situations often generate loads that are outside the original plant design basis. Consequently, separate evaluations are needed to ensure that plant structures, systems and components (SSCs) maintain their integrity and functionality while these temporary loads are active. Also, the temporary structures and components need to be evaluated to ensure their integrity during the temporary duration of use. Three types of approaches are normally adopted either individually or in combination to perform needed evaluations: relax the design allowables, use a more refined analysis model but retain the design basis acceptance criteria, or offset temporary loads by eliminating or reducing part of the design basis loads based on short duration considerations. This paper reviews temporary loading/temporary condition issues and the current industry criteria and procedures proposed in dealing with these issues. Where appropriate, regulatory positions on temporary loads/temporary conditions are discussed.

  4. An overview of radioactive waste disposal procedures of a nuclear medicine department.

    PubMed

    Ravichandran, R; Binukumar, J P; Sreeram, Rajan; Arunkumar, L S

    2011-04-01

    Radioactive wastes from hospitals form one of the various types of urban wastes, which are managed in developed countries in a safe and organized way. In countries where growth of nuclear medicine services are envisaged, implementations of existing regulatory policies and guidelines in hospitals in terms of handling of radioactive materials used in the treatment of patients need a good model. To address this issue, a brief description of the methods is presented. A designed prototype waste storage trolley is found to be of great help in decaying the I-131 solid wastes from wards before releasing to waste treatment plant of the city. Two delay tanks with collection time of about 2 months and delay time of 2 months alternately result in 6 releases of urine toilet effluents to the sewage treatment plant (STP) of the hospital annually. Samples of effluents collected at releasing time documented radioactive releases of I-131 much below recommended levels of bi-monthly release. External counting of samples showed good statistical correlation with calculated values. An overview of safe procedures for radioactive waste disposal is presented. PMID:21731225

  5. Historical Patterns in the Types of Procedures Performed and Radiation Safety Practices Used in Nuclear Medicine From 1945-2009.

    PubMed

    Van Dyke, Miriam E; Drozdovitch, Vladimir; Doody, Michele M; Lim, Hyeyeun; Bolus, Norman E; Simon, Steven L; Alexander, Bruce H; Kitahara, Cari M

    2016-07-01

    The authors evaluated historical patterns in the types of procedures performed in diagnostic and therapeutic nuclear medicine and the associated radiation safety practices used from 1945-2009 in a sample of U.S. radiologic technologists. In 2013-2014, 4,406 participants from the U.S. Radiologic Technologists (USRT) Study who previously reported working with medical radionuclides completed a detailed survey inquiring about the performance of 23 diagnostic and therapeutic radionuclide procedures and the use of radiation safety practices when performing radionuclide procedure-related tasks during five time periods: 1945-1964, 1965-1979, 1980-1989, 1990-1999, and 2000-2009. An overall increase in the proportion of technologists who performed specific diagnostic or therapeutic procedures was observed across the five time periods. Between 1945-1964 and 2000-2009, the median frequency of diagnostic procedures performed substantially increased (from 5 wk to 30 wk), attributable mainly to an increasing frequency of cardiac and non-brain PET scans, while the median frequency of therapeutic procedures performed modestly decreased (from 4 mo to 3 mo). Also a notable increase was observed in the use of most radiation safety practices from 1945-1964 to 2000-2009 (e.g., use of lead-shielded vials during diagnostic radiopharmaceutical preparation increased from 56 to 96%), although lead apron use dramatically decreased (e.g., during diagnostic imaging procedures, from 81 to 7%). These data describe historical practices in nuclear medicine and can be used to support studies of health risks for nuclear medicine technologists. PMID:27218293

  6. [Fundamental bases of digital information processing in nuclear cardiology (III)].

    PubMed

    Cuarón, A; González, C; García Moreira, C

    1984-01-01

    This article describes the transformation of the gamma-camera images into digital form. The incidence of a gamma photon on the detector, produces two voltage pulses, which are proportional to the coordinates of the incidence points, and a digital pulse, indicative of the occurrence of the event. The coordinate pulses passes through a analog-digital converter, that is activated by the pulse. The result is the appearance of a digital number at the out-put of the converter, which is proportional to the voltage at its in-put. This number, is stored on the accumulation memory of the system, either on a list mode or on a matrix mode. Static images can be stored on a single matrix. Dynamic data can be stored on a series of matrixes, each representing a different period of acquisition. It is also possible to capture information on a series of matrixes syncronized with the electrocardiogram of the patient. In this instance, each matrix represents a distinct period of the cardiac cycle. Data stored on the memory, can be used to process and display images and quantitative histograms on a video screen. In order to do that, it is necessary to translate the digital data on the memory to voltage levels, and to transform these on light levels on the screen. This, is achieved through a digital analog converter. The reading of the digital memory must be syncronic with the electronic scanning of the video screen. PMID:6466002

  7. Automatic management system for dose parameters in interventional radiology and cardiology.

    PubMed

    Ten, J I; Fernandez, J M; Vaño, E

    2011-09-01

    The purpose of this work was to develop an automatic management system to archive and analyse the major study parameters and patient doses for fluoroscopy guided procedures performed in cardiology and interventional radiology systems. The X-ray systems used for this trial have the capability to export at the end of the procedure and via e-mail the technical parameters of the study and the patient dose values. An application was developed to query and retrieve from a mail server, all study reports sent by the imaging modality and store them on a Microsoft SQL Server data base. The results from 3538 interventional study reports generated by 7 interventional systems were processed. In the case of some technical parameters and patient doses, alarms were added to receive malfunction alerts so as to immediately take appropriate corrective actions. PMID:21831869

  8. Procedures for using expert judgment to estimate human-error probabilities in nuclear power plant operations. [PWR; BWR

    SciTech Connect

    Seaver, D.A.; Stillwell, W.G.

    1983-03-01

    This report describes and evaluates several procedures for using expert judgment to estimate human-error probabilities (HEPs) in nuclear power plant operations. These HEPs are currently needed for several purposes, particularly for probabilistic risk assessments. Data do not exist for estimating these HEPs, so expert judgment can provide these estimates in a timely manner. Five judgmental procedures are described here: paired comparisons, ranking and rating, direct numerical estimation, indirect numerical estimation and multiattribute utility measurement. These procedures are evaluated in terms of several criteria: quality of judgments, difficulty of data collection, empirical support, acceptability, theoretical justification, and data processing. Situational constraints such as the number of experts available, the number of HEPs to be estimated, the time available, the location of the experts, and the resources available are discussed in regard to their implications for selecting a procedure for use.

  9. [A federal project of Integrated Health Care in cardiology].

    PubMed

    Beyrle, B

    2006-01-01

    This paper reports in detail on a project of Integrated Health Care in cardiology at the federal level in Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data. PMID:16598581

  10. Weekly Interdisciplinary Colloquy on Cardiology: A Decade of Experiment.

    ERIC Educational Resources Information Center

    Wehrmacher, William H.; And Others

    1981-01-01

    An experimental, continuing, weekly interdisciplinary colloquy on cardiology is described. It is organized between the departments of medicine and physiology of Loyola University Medical Center to promote interaction between basic scientists and practicing physicians in the medical school. (Author/MLW)

  11. Comparison of Two Educational Strategies in Teaching Preventive Cardiology.

    ERIC Educational Resources Information Center

    Stroup-Benham, Christine A.; And Others

    This study assessed the impact of two educational strategies: text only versus text plus small group discussion, among two groups of third-year internal medicine clerkship students in a preventive cardiology course. The course was a required, 12-week Internal Medical clerkship at the University of Texas Medical Branch. The first group reviewed…

  12. Burnout, Perceived Stress, and Depression among Cardiology Residents in Argentina

    ERIC Educational Resources Information Center

    Waldman, Silvina V.; Diez, Juan Cruz Lopez; Arazi, Hernan Cohen; Linetzky, Bruno; Guinjoan, Salvador; Grancelli, Hugo

    2009-01-01

    Objective: Because medical residency is a stressful time for training physicians, placing residents at increased risk for psychological distress, the authors studied the prevalence of burnout, perceived stress, and depression in cardiology residents in Argentina and examined the association between sociodemographic characteristics and these…

  13. Light Water Reactor Sustainability Program: Computer-based procedure for field activities: results from three evaluations at nuclear power plants

    SciTech Connect

    Oxstrand, Johanna; Bly, Aaron; LeBlanc, Katya

    2014-09-01

    Nearly all activities that involve human interaction with the systems of a nuclear power plant are guided by procedures. The paper-based procedures (PBPs) currently used by industry have a demonstrated history of ensuring safety; however, improving procedure use could yield tremendous savings in increased efficiency and safety. One potential way to improve procedure-based activities is through the use of computer-based procedures (CBPs). Computer-based procedures provide the opportunity to incorporate context driven job aids, such as drawings, photos, just-in-time training, etc into CBP system. One obvious advantage of this capability is reducing the time spent tracking down the applicable documentation. Additionally, human performance tools can be integrated in the CBP system in such way that helps the worker focus on the task rather than the tools. Some tools can be completely incorporated into the CBP system, such as pre-job briefs, placekeeping, correct component verification, and peer checks. Other tools can be partly integrated in a fashion that reduces the time and labor required, such as concurrent and independent verification. Another benefit of CBPs compared to PBPs is dynamic procedure presentation. PBPs are static documents which limits the degree to which the information presented can be tailored to the task and conditions when the procedure is executed. The CBP system could be configured to display only the relevant steps based on operating mode, plant status, and the task at hand. A dynamic presentation of the procedure (also known as context-sensitive procedures) will guide the user down the path of relevant steps based on the current conditions. This feature will reduce the user’s workload and inherently reduce the risk of incorrectly marking a step as not applicable and the risk of incorrectly performing a step that should be marked as not applicable. As part of the Department of Energy’s (DOE) Light Water Reactors Sustainability Program

  14. Inverse sampled Bernoulli (ISB) procedure for estimating a population proportion, with nuclear material applications

    SciTech Connect

    Wright, T.

    1982-01-01

    A new sampling procedure is introduced for estimating a population proportion. The procedure combines the ideas of inverse binomial sampling and Bernoulli sampling. An unbiased estimator is given with its variance. The procedure can be viewed as a generalization of inverse binomial sampling.

  15. [The Sociedad Española de Cardiología on the Internet: current resources and future prospects. The Internet Committee of the Sociedad Española de Cardiología].

    PubMed

    Arribas, F; Elízaga, J; Bosch, X

    1998-10-01

    The Internet can help physicians to identify needed clinical information quickly providing continued medical education. Internet also improves medical information of the non-medical population. Researchers have quick access to library catalogs, Medline and other important databases from the most recognized research centers. Furthermore, it can put physicians in ready contact with other specialists for communication and consultation, facilitates administrative procedures of multicenter studies and accelerates editorial processes of biomedical journals. Since its creation, the website of the Spanish Society of Cardiology has evolved rapidly to the present model, providing different kinds of services to its members including faster communication, information from national and international societies and congresses, earlier access to the full content of Revista Española de Cardiología and to a variety of graphic resources and of continuing education. Nowadays, the website of the Spanish Society of Cardiology is consulted by one thousand visitors a week, even at weekends. The degree of activity increases from 3 h P.M. with a peak from 11 h P.M. to 1 h A.M. In the near future, our website will incorporate its own courses of continuing medical education with on-line evaluation and credit granting, will give support to multicenter studies and will initiate the publication and discussion of clinical cases of interest. PMID:9834626

  16. Update on heart failure, heart transplant, congenital heart disease, and clinical cardiology.

    PubMed

    Almenar, Luis; Zunzunegui, José Luis; Barón, Gonzalo; Carrasco, José Ignacio; Gómez-Doblas, Juan José; Comín, Josep; Barrios, Vivencio; Subirana, M Teresa; Díaz-Molina, Beatriz

    2013-04-01

    In the year 2012, 3 scientific sections-heart failure and transplant, congenital heart disease, and clinical cardiology-are presented together in the same article. The most relevant development in the area of heart failure and transplantation is the 2012 publication of the European guidelines for heart failure. These describe new possibilities for some drugs (eplerenone and ivabradine); expand the criteria for resynchronization, ventricular assist, and peritoneal dialysis; and cover possibilities of percutaneous repair of the mitral valve (MitraClip(®)). The survival of children with hypoplastic left heart syndrome in congenital heart diseases has improved significantly. Instructions for percutaneous techniques and devices have been revised and modified for the treatment of atrial septal defects, ostium secundum, and ventricular septal defects. Hybrid procedures for addressing structural congenital heart defects have become more widespread. In the area of clinical cardiology studies have demonstrated that percutaneous prosthesis implantation has lower mortality than surgical implantation. Use of the CHA2DS2-VASc criteria and of new anticoagulants (dabigatran, rivaroxaban and apixaban) is also recommended. In addition, the development of new sequencing techniques has enabled the analysis of multiple genes. PMID:24775619

  17. Study of on-line computerized procedures system of nuclear power plants

    SciTech Connect

    Liu Fei; Zhang Zhijian; Peng Minjun

    2006-07-01

    An on-line computerized procedures system (OCPS) for normal operation is developed. The system makes use of the advantages of computerized procedures system and provides the detailed and comprehensible procedures. The configuration is introduced. OCPS has been built on Embedded real-time operation system VxWorks using C language. Computerized procedures are described exampled with cold start-up in this paper, helping operators to know about the state of plants during the complex operating course. After adopting the computerized procedures, the labor intensity and mental pressure of operators will be reduced. (authors)

  18. Dose reduction through automation of nuclear weapons dismantlement and storage procedures at the Department of Energy`s Pantex Facility

    SciTech Connect

    Thompson, D.A.; Poston, J.W.

    1996-06-01

    With the end of the Cold War and the subsequent break up of the Soviet Union, the number of weapons in the nuclear stockpile now greatly exceeds any foreseeable future need. To compensate for this excess an estimated 20,000 nuclear warheads have been earmarked for dismantlement and storage at the Department of Energy`s Pantex Plant near Amarillo, Texas. It is anticipated that the majority of these warheads will arrive at the Pantex facility by the year 2000. At that time, it is estimated that current dismantlement and inventory procedures will not be adequate to control worker radiation exposure within administrative and federal dose limits. To control these exposures alternate approaches to dismantlement and inventory must be developed. One attractive approach is to automate as many activities as possible, thus reducing worker exposure. To facilitate automation of dismantlement and storage procedures, current procedures were investigated in terms of collective dose to workers, time to completion, ease of completion, and cost of automation for each task. A cost-benefit comparison was then performed in order to determine which procedures would be most cost-effective to automate.

  19. Staff lens doses in interventional urology. A comparison with interventional radiology, cardiology and vascular surgery values.

    PubMed

    Vano, E; Fernandez, J M; Resel, L E; Moreno, J; Sanchez, R M

    2016-03-01

    The purpose of this work is to evaluate radiation doses to the lens of urologists during interventional procedures and to compare them with values measured during interventional radiology, cardiology and vascular surgery. The measurements were carried out in a surgical theatre using a mobile C-arm system and electronic occupational dosimeters (worn over the lead apron). Patient and staff dose measurements were collected in a sample of 34 urology interventions (nephrolithotomies). The same dosimetry system was used in other medical specialties for comparison purposes. Median and 3rd quartile values for urology procedures were: patient doses 30 and 40 Gy cm(2); personal dose equivalent Hp(10) over the apron (μSv/procedure): 393 and 848 (for urologists); 21 and 39 (for nurses). Median values of over apron dose per procedure for urologists resulted 18.7 times higher than those measured for radiologists and cardiologists working with proper protection (using ceiling suspended screens) in catheterisation laboratories, and 4.2 times higher than the values measured for vascular surgeons at the same hospital. Comparison with passive dosimeters worn near the eyes suggests that dosimeters worn over the apron could be a reasonable conservative estimate for ocular doses for interventional urology. Authors recommend that at least the main surgeon uses protective eyewear during interventional urology procedures. PMID:26583458

  20. Estimation of initiating event distribution at nuclear power plants by Bayesian procedure

    SciTech Connect

    Chen Guangming; Chu, T.L.

    1995-12-31

    Initiating events at nuclear power plants such as human errors or components failures may lead to a nuclear accident. The study of the frequency of these events or the distribution of the failure rate is necessary in probabilistic risk assessment for nuclear power plants. This paper presents Bayesian modelling methods for the analysis of the distribution of the failure rate. The method can also be utilized in other related fields especially where the data is sparse. An application of the Bayesian modelling in the analysis of distribution of the time to recover Loss of Off-Site Power ( LOSP) is discussed in the paper.

  1. European Society of Cardiology (ESC) Congress Report from London 2015.

    PubMed

    Nishiguchi, Tsuyoshi; Akasaka, Takashi

    2015-01-01

    The Annual Congress of the European Society of Cardiology (ESC) was held in London from 29 August to 2 September 2015. It is the leading conference in cardiology in the world, with presentations on the latest scientific discoveries, innovations, technology, education, and clinical practices. More than 32,000 delegates and 5,000 exhibitors from 140 countries participated, sharing a number of scientific presentations, including 28 clinical hot lines, 18 clinical trial updates, 20 registry studies, 12 basic and translational science hot line studies, and 4,533 abstract studies. Japan had the highest number of accepted abstracts at the Congress, indicating the great contribution of Japanese scientists and the Japanese Circulation Society. PMID:26459395

  2. A framework for clinical reasoning in adult cardiology

    PubMed Central

    de la Calzada, Carlos S

    2015-01-01

    It is well known that an expert clinician formulates a diagnostic hypothesis with little clinical data. In comparison, students have difficulties in doing so. The mental mechanism of diagnostic reasoning is almost unconscious and therefore difficult to teach. The purpose of this essay (devoted to 2nd-year medical students) is to present an integrating framework to teach clinical reasoning in cardiology. By analyzing cardiology with a synthetic mind, it becomes apparent that although there are many diseases, the heart, as an organ, reacts to illness with only six basic responses. The clinical manifestations of heart diseases are the direct consequence of these cardiac responses. Considering the six cardiac responses framework, diagnostic reasoning is done in three overlapping steps. With the presented framework, the process of reasoning becomes more visual and needs less clinical data, resembling that of the expert clinician. PMID:26203294

  3. Requirements for Computer Based-Procedures for Nuclear Power Plant Field Operators Results from a Qualitative Study

    SciTech Connect

    Katya Le Blanc; Johanna Oxstrand

    2012-05-01

    Although computer-based procedures (CBPs) have been investigated as a way to enhance operator performance on procedural tasks in the nuclear industry for almost thirty years, they are not currently widely deployed at United States utilities. One of the barriers to the wide scale deployment of CBPs is the lack of operational experience with CBPs that could serve as a sound basis for justifying the use of CBPs for nuclear utilities. Utilities are hesitant to adopt CBPs because of concern over potential costs of implementation, and concern over regulatory approval. Regulators require a sound technical basis for the use of any procedure at the utilities; without operating experience to support the use CBPs, it is difficult to establish such a technical basis. In an effort to begin the process of developing a technical basis for CBPs, researchers at Idaho National Laboratory are partnering with industry to explore CBPs with the objective of defining requirements for CBPs and developing an industry-wide vision and path forward for the use of CBPs. This paper describes the results from a qualitative study aimed at defining requirements for CBPs to be used by field operators and maintenance technicians.

  4. Advanced Pipe Replacement Procedure for a Defective CRDM Housing Nozzle Enables Continued Normal Operation of a Nuclear Power Plant

    SciTech Connect

    Gilmore, Geoff; Becker, Andrew

    2006-07-01

    During the 2003 outage at the Ringhals Nuclear Plant in Sweden, a leak was found in the vicinity of a Control Rod Drive Mechanism (CRDM) housing nozzle at Unit 1. Based on the ALARA principle for radioactive contamination, a unique repair process was developed. The repair system includes utilization of custom, remotely controlled GTAW-robots, a CNC cutting and finishing machine, snake-arm robots and NDE equipment. The success of the repair solution was based on performing the machining and welding operations from the inside of the SCRAM pipe through the CRDM housing since accessibility from the outside was extremely limited. Before the actual pipe replacement procedure was performed, comprehensive training programs were conducted. Training was followed by certification of equipment, staff and procedures during qualification tests in a full scale mock-up of the housing nozzle. Due to the ingenuity of the overall repair solution and training programs, the actual pipe replacement procedure was completed in less than half the anticipated time. As a result of the successful pipe replacement, the nuclear power plant was returned to normal operation. (authors)

  5. The pediatric cardiology pharmacopeia: 2013 update.

    PubMed

    Severin, Paul Nicholas; Awad, Sawsan; Shields, Beth; Hoffman, Joan; Bonney, William; Cortez, Edmundo; Ganesan, Rani; Patel, Aloka; Barnes, Steve; Barnes, Sean; Al-Anani, Shada; Gupta, Umang; Cheddar, Yolandee Bell; Gonzalez, Ismael E; Mallula, Kiran; Ghawi, Hani; Kazmouz, Suhaib; Gendi, Salwa; Abdulla, Ra-id

    2013-01-01

    The use of medications plays a pivotal role in the management of children with heart diseases. Most children with increased pulmonary blood flow require chronic use of anticongestive heart failure medications until more definitive interventional or surgical procedures are performed. The use of such medications, particularly inotropic agents and diuretics, is even more amplified during the postoperative period. Currently, children are undergoing surgical intervention at an ever younger age with excellent results aided by advanced anesthetic and postoperative care. The most significant of these advanced measures includes invasive and noninvasive monitoring as well as a wide array of pharmacologic agents. This review update provides a medication guide for medical practitioners involved in care of children with heart diseases. PMID:23192622

  6. Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings

    PubMed Central

    Jena, Anupam B.; Prasad, Vinay; Goldman, Dana P.; Romley, John

    2014-01-01

    IMPORTANCE Thousands of physicians attend scientific meetings annually. Although hospital physician staffing and composition may be affected by meetings, patient outcomes and treatment patterns during meeting dates are unknown. OBJECTIVE To analyze mortality and treatment differences among patients admitted with acute cardiovascular conditions during dates of national cardiology meetings compared with nonmeeting dates. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of 30-day mortality among Medicare beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure, or cardiac arrest from 2002 through 2011 during dates of 2 national cardiology meetings compared with identical nonmeeting days in the 3 weeks before and after conferences (AMI, 8570 hospitalizations during 82 meeting days and 57 471 during 492 nonmeeting days; heart failure, 19 282 during meeting days and 11 4591 during nonmeeting days; cardiac arrest, 1564 during meeting days and 9580 during nonmeeting days). Multivariable analyses were conducted separately for major teaching hospitals and nonteaching hospitals and for low-and high-risk patients. Differences in treatment utilization were assessed. EXPOSURES Hospitalization during cardiology meeting dates. MAIN OUTCOMES AND MEASURES Thirty-day mortality, procedure rates, charges, length of stay. RESULTS Patient characteristics were similar between meeting and nonmeeting dates. In teaching hospitals, adjusted 30-day mortality was lower among high-risk patients with heart failure or cardiac arrest admitted during meeting vs nonmeeting dates (heart failure, 17.5% [95% CI, 13.7%–21.2%] vs 24.8% [95% CI, 22.9%–26.6%]; P < .001; cardiac arrest, 59.1% [95% CI, 51.4%–66.8%] vs 69.4% [95% CI, 66.2%–72.6%]; P = .01). Adjusted mortality for high-risk AMI in teaching hospitals was similar between meeting and nonmeeting dates (39.2% [95% CI, 31.8%–46.6%] vs 38.5% [95% CI, 35.0%–42.0%]; P = .86), although adjusted percutaneous

  7. A practical method for skin dose estimation in interventional cardiology based on fluorographic DICOM information.

    PubMed

    Matthews, Lucy; Dixon, Matthew; Rowles, Nick; Stevens, Greg

    2016-03-01

    A practical method for skin dose estimation for interventional cardiology patients has been developed to inform pre-procedure planning and post-procedure patient management. Absorbed dose to the patient skin for certain interventional radiology procedures can exceed thresholds for deterministic skin injury, requiring documentation within the patient notes and appropriate patient follow-up. The primary objective was to reduce uncertainty associated with current methods, particularly surrounding field overlap. This was achieved by considering rectangular field geometry incident on a spherical patient model in a polar coordinate system. The angular size of each field was quantified at surface of the sphere, i.e. the skin surface. Computer-assisted design software enabled the modelling of a sufficient dataset that was subsequently validated with radiochromic film. Modelled overlap was found to agree with overlap measured using film to within 2.2° ± 2.0°, showing that the overall error associated with the model was < 1 %. Mathematical comparison against exposure data extracted from procedural Digital Imaging and Communication in Medicine files was used to generate a graphical skin dose map, demonstrating the dose distribution over a sphere centred at the interventional reference point. Dosimetric accuracy of the software was measured as between 3.5 and 17 % for different variables. PMID:25994848

  8. Patient doses in interventional cardiology in Bosnia and Herzegovina: first results.

    PubMed

    Beganović, Adnan; Kulić, Mehmed; Spuzić, Muhamed; Gazdić-Santić, Maja; Skopljak-Beganović, Amra; Drljević, Advan; Dzanić, Suad; Basić, Begzada; Lincender, Lidija

    2010-01-01

    Cardiologists at the Cardiac Centre of the Clinical Centre of Sarajevo University performed invasive cardiology procedures in one room equipped with a Siemens Coroskop (Siemens Healthcare, Erlangen, Germany) unit with the possibility of digital cine imaging. The number of procedures performed with this unit is 1126 per year. The number of adults performing only diagnostic procedures is 816, therapeutic procedures 62 and both diagnostic and therapeutic 228. Twenty diagnostic examinations but no therapeutic procedure are performed on children per year. The workload is increasing year by year, with an average increase of 26 % per year. The X-ray system does not have a kerma area product (KAP) meter installed; therefore an external KAP meter was mounted on the X-ray tube. Gafchromic dosimetry films (International Specialty Products, Wayne, USA) were placed under the patient to record the skin dose distribution. The peak skin dose (PSD) was calculated from the maximum optical density of the dosimetry films. Dose measurements were performed on 51 patients undergoing therapeutic procedures (percutaneous transluminal coronary angioplasty and stent placement). Two patients received doses (KAP) larger than 100 Gycm(2). The PSD was higher than 1 Gy in 3 out of 16 evaluations, and one of these patients received a skin dose >2 Gy. No deterministic skin effects were recorded. The dosimetry results are similar to results reported in other countries. Invasive cardiac procedures deliver high doses to the skin that could cause deterministic effects (erythema). Physicians performing these procedures should be aware of these risks. More efforts should be put into the training of cardiologists in radiation protection. PMID:20223846

  9. C-arm rotation as a method for reducing peak skin dose in interventional cardiology

    PubMed Central

    Pasciak, Alexander S; Bourgeois, Austin C; Jones, A Kyle

    2014-01-01

    Purpose Prolonged interventional cardiology (IC) procedures may result in radiation-induced skin injury, a potentially preventable cause of patient morbidity. Rotating the C-arm during an IC procedure may reduce this risk, although the methods by which the technique can be practically applied remains unexplored. A previous study demonstrated that C-arm rotation often increases peak skin dose (PSD) in interventional radiology procedures. The purpose of this study was to determine whether C-arm rotation reduces the PSD in IC procedures and, if so, under what circumstances. Materials and methods Simulations were performed using a numerical ray-tracing algorithm to analyse the effect of C-arm rotation on PSD across a range of patient sizes, C-arm configurations and procedure types. Specific data from modern fluoroscopes and patient dimensions were used as inputs to the simulations. Results In many cases, modest C-arm rotation angles completely eliminated overlap between X-ray field sites on the skin. When overlap remained, PSD increases were generally small. One exception was craniocaudal rotation, which tended to increase PSD. C-arm rotation was most effective for large patients and small X-ray field sizes. Small patients may not benefit from C-arm rotation as a procedural modification. The use of a prophylactic method where the C-arm was rotated between small opposing oblique angles was effective in reducing PSD. Conclusions With the exception of rotation to steep craniocaudal angles, rotating the C-arm reduces PSD in IC procedures when used as either a procedural modification or a prophylactic strategy. Tight collimation increases the benefit of C-arm rotation. PMID:25568803

  10. Intraocular Lens-Shell Technique: Adjustment of the Surgical Procedure Leads to Greater Safety When Treating Dense Nuclear Cataracts

    PubMed Central

    Chen, Weirong; Qu, Bo; Zhang, Xinyu; Lin, Zhuoling; Chen, Jingjing; Liu, Yizhi

    2014-01-01

    Objective To compare the efficacy and safety of the intraocular lens (IOL)-shell procedure versus conventional phacoemulsification for the surgical treatment of dense cataracts. Methods Eighty eyes with dense nuclear cataracts were enrolled in a prospective, randomized controlled study. Patients were assigned to two groups. In Group I, the IOL was traditionally implanted after all nuclear fragments were completely removed, and in Group II, the IOL was innovatively implanted in the bag before the last residual nuclear fragment was removed. This novel adjusted surgical procedure, named the “IOL-shell technique”, features use of the IOL as a protective barrier rather than simply as a refractive alternative, and it is conceptually different from the traditional step-by-step procedure. Clinical examinations, including uncorrected visual acuity, central corneal thickness (CCT), temporal clear corneal incision thickness and corneal endothelial cell density, were carried out. Results The inter-group difference in temporal corneal thickness was found to be of no statistical significance at any of the visits. Compared to eyes in Group I, those in Group II were shown to have significantly less corneal endothelial cell loss on both the 7th and 30th day following surgery. At 7 days after surgery, the mean corneal endothelial cell loss in Group II was 10.29%, compared to 14.37% in Group I (P<0.05). The mean endothelial cell loss measured on postoperative day 30 was 16.88% in Group II compared to 23.32% in Group I (P<0.05). On the 1st day after surgery, the mean CCT of eyes in Group II was significantly smaller compared to Group I (Group I vs. Group II: 19.42% vs. 13.50%, P<0.05). Conclusions Compared to conventional phacoemulsification, the IOL-shell technique was shown to be a relatively safer procedure without compromised efficiency for dense cataracts, and it caused less corneal endothelial cell loss and milder postoperative corneal edema (Clinical Trials Identifier: NCT

  11. [Transradial approach in interventional cardiology: "quod licet femoralisti, non licet radialisti"].

    PubMed

    Lukenda, Josip

    2012-01-01

    Transradial approach has been used in invasive cardiology since 1989 and since 1995 for PCI. Croatia is late in using this technique for about one whole decade. The advantage of transradial approach over femoral approach are serious local complications of (2.6-2.8%), more frequent with modem therapy (7.4%), occasionally requiring surgical repair (2.4%). Major adverse cardiovascular events are significantly more occurring with femoral (3.8-6.55%) compared to transradial approach (2.5-3.7%), while in the MORTAL study total mortality is higher as well. Patients prefer transradial approach due to it being less painful and uncomfortable, and also because of greater mobility after the procedure. Time spent for patient care by nurses is shortened by half than what it used to be, and the final savings per patient is $290. An unfavorable aspect of transradial approach is clinically insignificant radial artery occlusion (0.6%-1.4%), as well as higher radiation exposure, for 12% in practice. Procedural time is similar, but it could take up to 3 minutes longer. Access site crossover is more often with transradial (4.7-7.6%), compared to femoral procedure (1.4-2.0%), but PCI failure is independent of approach. All unfavorable aspects are diminishing with experience of a cardiologist. Now, some of the Croatian centers, such as General Hospital Zadar, use transradial approach in 67% of catheterizations, 64% of PCI, and 38% of all primary PCIs. PMID:22930938

  12. Nuclear cardiograph and scintigraphy

    NASA Technical Reports Server (NTRS)

    Mclaughlin, P.

    1975-01-01

    Extensive advances in the technology of detectors, data analysis systems, and tracers used have resulted in greatly expanded applications of radioisotopes to the assessment of cardiac function and disease. The development of nuclear cardiology has proceeded along four lines: (1) radionuclide angiography, (2) myocardial perfusion imaging, (3) intracoronary microsphere imaging, and (4) regional myocardial blood flow determination using inert gases.

  13. [Criteria catalogue for Integrated Health Care in cardiology].

    PubMed

    Frantz, E

    2006-01-01

    This paper comprises criteria for projects of Integrated Health Care in cardiology. With these criteria, projects can be assessed for their congruence with essentials that have been assigned by the German Cardiac Society, the Association of German Hospital Cardiologists and the Association of German Practice Cardiologists. The main purpose is to ensure that evidence-based medicine is the basis for the contracts and that all valid guidelines have been observed when services have been agreed. Possibly this paper may be the basis to award an approval to projects that meet all the criteria. This paper is no model contract. PMID:16598573

  14. Hanford spent nuclear fuel cold vacuum drying proof of performance test procedure

    SciTech Connect

    McCracken, K.J.

    1998-06-10

    This document provides the test procedure for cold testing of the first article skids for the Cold Vacuum Drying (CVD) process at the Facility. The primary objective of this testing is to confirm design choices and provide data for the initial start-up parameters for the process. The current scope of testing in this document includes design verification, drying cycle determination equipment performance testing of the CVD process and MCC components, heat up and cool-down cycle determination, and thermal model validation.

  15. Impact of a Preventive Cardiology Curriculum on Knowledge and Attitudes of First-Year Medical Students.

    ERIC Educational Resources Information Center

    Veitia, Marie C.; And Others

    1993-01-01

    A study of 54 first-year Marshall University (West Virginia) medical students found that a preventive cardiology curriculum improved both knowledge of and attitudes about preventive cardiology in general and on all 4 subscales (epidemiological evidence, risk factor characteristics, pathophysiology, primary interventions). (Author/MSE)

  16. Nuclear transfer procedures in the ovine can induce early embryo fragmentation and compromise cloned embryo development.

    PubMed

    Xue, Lian; Cheng, Lei; Su, Guanghua; Kang, Feng; Wu, Xia; Bai, Chunling; Zhang, Li; Li, Guang-Peng

    2011-07-01

    Cytoplasmic fragmentations are frequently observed in early mammalian embryos, and especially in the human. In our research we have observed subtle clues that the occurrence of fragmentation was most likely a result of somatic cell nuclear transfer (NT) protocols, and in particular, the in vitro culture system. In this study we examined various putative factors that might induce early embryo fragmentation in the ovine. The results indicate that nuclear transfer protocols such as the fusion parameter, activation treatment, and especially the choice of culture medium affected embryo cleavage rates and resulted in a higher incidence of fragmented embryos. Upon using the same fusion parameter, activation parameters that were based upon amino acids containing synthetic oviduct fluids (SOFaa) culture system resulted in significantly lower fragmentation rates than when utilizing a Charles Rosenkrans 1 (CR1aa) culture system. Fragmented embryos typically exhibited irregular numbers of blastomeres with the majority of blastomeres devoid of chromatin. Factors such as fusion DC pulse, activation treatment and culture system led to higher fragmentation and also affected in vitro and in vivo embryo development. The SOFaa based culture system produced a higher number of quality NT embryos resulting in higher pregnancy rates and the birth of live lambs as compared to the CR1aa based system (P<0.05). We conclude that early embryo fragmentation in the ovine is caused by suboptimal cloning protocols, and NT embryo development is especially affected by the culture system used. PMID:21700405

  17. ENDF-102 DATA FORMATS AND PROCEDURES FOR THE EVALUATION NUCLEAR DATA FILE ENDF-6.

    SciTech Connect

    MCLANE,V.

    2001-05-15

    The Evaluated Nuclear Data File (ENDF) formats and libraries are decided by the Cross Section Evaluation Working Group (CSEWG), a cooperative effort of national laboratories, industry, and universities in the U.S. and Canada, and are maintained by the National Nuclear Data Center (NNDC). Earlier versions of the ENDF format provided representations for neutron cross sections and distributions, photon production from neutron reactions, a limited amount of charged-particle production from neutron reactions, photo-atomic interaction data, thermal neutron scattering data, and radionuclide production and decay data (including fission products). Version 6 (ENDF-6) allows higher incident energies, adds more complete descriptions of the distributions of emitted particles, and provides for incident charged particles and photonuclear data by partitioning the ENDF library into sub-libraries. Decay data, fission product yield data, thermal scattering data, and photo-atomic data have also been formally placed in sub-libraries. In addition, this rewrite represents an extensive update to the Version V manual.

  18. Analyzing astrophysical neutrino signals using realistic nuclear structure calculations and the convolution procedure

    NASA Astrophysics Data System (ADS)

    Tsakstara, V.; Kosmas, T. S.

    2011-12-01

    Convoluted differential and total cross sections of inelastic ν scattering on 128,130Te isotopes are computed from the original cross sections calculated previously using the quasiparticle random-phase approximation. We adopt various spectral distributions for the neutrino energy spectra such as the common two-parameter Fermi-Dirac and power-law distributions appropriate to explore nuclear detector responses to supernova neutrino spectra. We also concentrate on the use of low-energy β-beam neutrinos, originating from boosted β--radioactive 6He ions, to decompose original supernova (anti)neutrino spectra that are subsequently employed to simulate total cross sections of the reactions 130Te(ν˜,ν˜')130Te*. The concrete nuclear regimes selected, 128,130Te, are contents of the multipurpose CUORE and COBRA rare event detectors. Our present investigation may provide useful information about the efficiency of the Te detector medium of the above experiments in their potential use in supernova neutrino searches.

  19. Hypertrophic Cardiomyopathy: New Evidence Since the 2011 American Cardiology of Cardiology Foundation and American Heart Association Guideline.

    PubMed

    Fraiche, Ariane; Wang, Andrew

    2016-07-01

    Since publication of the 2011 American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) Guideline for the diagnosis and treatment of hypertrophic cardiomyopathy (HCM), more recent studies offer greater insights about this condition. With increased recognition of the role of sarcomere protein mutations and myocardial structural abnormalities in the pathophysiology of this disease, new evidence offers potential improvements for the management of patients with HCM. In this review of studies published since 2011, we highlight several studies that may impact diagnostic considerations, risk stratification, and treatment of symptoms in HCM. PMID:27294414

  20. [Diagnosis of thyroid diseases using imaging procedures with reference to nuclear magnetic resonance tomography].

    PubMed

    Held, P; Zilch, H G; Baumgartl, W; Maccio, A

    1986-01-01

    Results of MR imaging performed in 74 patients with diseases of the thyroid gland and in normal persons are compared with nuclear medicine (99mTc 04 and 131J scans) and sonography (5 and 7.5 MHz transducers, linear scans) results. The MR-signal intensity of hot nodules--Plummers' disease--is not specific. Therefore scintigraphy combined with sonography remain the methods of choice for the diagnosis of hyperfunctioning nodules. Morphologic alterations within the thyroid gland are detected by MRT as well as by ultrasound. But when lesions are not limited to the thyroid bed MRT will become the imaging examination of choice. Therefore MRT can be useful for scanning retrotracheal and superior mediastinal extent of thyroid lesions. Also clinically inapparent metastases to the cervical and mediastinal nodes may be detected. PMID:3554875

  1. Simulation based planning of surgical interventions in pediatric cardiology

    NASA Astrophysics Data System (ADS)

    Marsden, Alison L.

    2013-10-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting.

  2. European Society of Cardiology (ESC) Congress Report from Munich 2012.

    PubMed

    Ozaki, Yukio

    2012-01-01

    The Annual Congress of the European Society of Cardiology (ESC) was held in Munich from the 26(th) to 29(th) of August 2012. The daily attendance ranged from 26,600 to 27,407 up to the 28(th) and several important issues were presented and discussed, including antiplatelet therapy for acute coronary syndrome (TRILOGY ACS), transcatheter aortic valve implantation, renal denervation, novel oral anticoagulants for atrial fibrillation (AFib), AFib ablation, the impact of the Great East Japan Earthquake on cardiovascular disease, management of vasospastic angina, plaque rupture and erosion (ESC-JCS [Japanese Circulation Society] joint session), heart failure, and FFR-guided percutaneous coronary intervention outcome. Three ESC "GOLD MEDALS" were awarded, including one to Professor Ryozo Nagai, the first Asian to receive this award. The ESC meeting has become one of the most important for updating not only general cardiologists' education but also specialists' expertise. Japan topped the number of abstracts submitted to ESC 2012 (>1,200 abstracts), while the ESC would like to establish a strong collaboration with the Japanese Cardiology Society. Relations between ESC and JCS will become closer and more favorable year by year. PMID:23075818

  3. Optical fiber distributed temperature sensor in cardiological surgeries

    NASA Astrophysics Data System (ADS)

    Skapa, Jan; Látal, Jan; Penhaker, Marek; Koudelka, Petr; Hancek, František; Vasinek, Vladimír

    2010-04-01

    In those days a lot of cardiological surgeries is made every day. It is a matter of very significant importance keeping the temperature of the hearth low during the surgery because it decides whether the cells of the muscle will die or not. The hearth is cooled by the ice placed around the hearth muscle during the surgery and cooling liquid is injected into the hearth also. In these days the temperature is measured only in some points of the hearth using sensors based on the pH measurements. This article describes new method for measurement of temperature of the hearth muscle during the cardiological surgery. We use a multimode optical fiber and distributed temperature sensor (DTS) based on the stimulated Raman scattering in temperature measurements. This principle allows us to measure the temperature and to determine where the temperature changes during the surgery. Resolution in the temperature is about 0.1 degrees of Celsius. Resolution in length is about 1 meter. The resolution in length implies that the fiber must be wound to ensure the spatial resolution about 5 by 5 centimeters.

  4. Simulation-based planning of surgical interventions in pediatric cardiology

    NASA Astrophysics Data System (ADS)

    Marsden, Alison

    2012-11-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. This is particularly true in pediatric cardiology, due to the wide variation in anatomy observed in congenital heart disease patients. While medical imaging provides increasingly detailed anatomical information, clinicians currently have limited knowledge of important fluid mechanical parameters. Treatment decisions are therefore often made using anatomical information alone, despite the known links between fluid mechanics and disease progression. Patient-specific simulations now offer the means to provide this missing information, and, more importantly, to perform in-silico testing of new surgical designs at no risk to the patient. In this talk, we will outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We will then present new methodology for coupling optimization with simulation and uncertainty quantification to customize treatments for individual patients. Finally, we will present examples in pediatric cardiology that illustrate the potential impact of these tools in the clinical setting.

  5. Possible helio-geomagnetic activity influence on cardiological cases

    NASA Astrophysics Data System (ADS)

    Katsavrias, Christos

    Eruptive solar events as flares and coronal mass ejections (CMEs) occur during solar activ-ity periods. Energetic particles, fast solar wind plasma and electromagnetic radiation pass through interplanetary space, arrive on Earth's ionosphere-magnetosphere and produce various disturbances. It is well known the negative influence of geomagnetic substorms on the human technological applications on geospace. During the last 25 years, many studies concerning the possible influence on the human health are published. Increase of the Acute Coronary Syn-dromes and disorders of the Cardiac Rhythm, increase of accidents as well as neurological and psychological disorders (e.g. increase of suicides) during or near to the geomagnetic storms time interval are reported. In this study, we research the problem in Greece, focusing on patients with Acute Myocardial Infraction, hospitalized in the 2nd Cardiological Department of the General Hospital of Nikaea (Piraeus City), for the time interval 1997-2007 (23rd solar cycle) and also to the arrival of emergency cardiological cases to Emergency Department of two greek hospitals, the General Hospital of Lamia City and the General Hospital of Veria City during the selected months, with or without helio-geomagnetic activity, of the 23rd solar cycle. Increase of cases is recorded during the periods with increase helio-geomagnetic activity. The necessity of continuing the research for a longer period and with a bigger sample is high; so as to exact more secure conclusions.

  6. Simulation based planning of surgical interventions in pediatric cardiology

    PubMed Central

    Marsden, Alison L.

    2013-01-01

    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting. PMID:24255590

  7. Speeding up coeliac disease diagnosis in cardiological settings

    PubMed Central

    Chicco, Daniela; Taddio, Andrea; Sinagra, Gianfranc; Di Lenarda, Andrea; Ferrara, Fortunato; Moretti, Michele; Martelossi, Stefano; Di Toro, Nicola; Ventura, Alessandro

    2010-01-01

    Introduction High prevalence of coeliac disease (CD) has been reported among patients with idiopathic dilated cardiomyopathy (DCM). We evaluated the feasibility and diagnostic accuracy of screening for CD by rapid test of anti-transglutaminase antibodies in the cardiology outpatients’ clinic. Material and methods We screened the blood samples of 104 patients with DCM, 44 of their first-degree relatives, 63 diseased controls and 101 healthy controls for the presence of anti-transglutaminase antibodies in a drop of whole blood using a rapid assay. This test was compared to the enzyme-linked immunosorbent assay and the anti-endomysium antibody test. Results Our rapid test was positive in three (2.9%) DCM patients, in one (2%) relative and in one (1%) healthy control. These subjects were positive at both control assays. Two DCM patients had iron-deficient anaemia. The healthy relative was asymptomatic, while the healthy control experienced extreme asthenia. The relative refused intestinal biopsy, while the others showed histological evidence of CD. During the gluten-free diet, the patient with the worst left ventricular ejection fraction (LVEF) underwent heart transplant, and LVEF values improved in the other two. Anaemia and tiredness resolved in all patients. Conclusion Early detection of CD in a cardiological setting allows prompt treatment with a gluten-free diet of gluten-dependent complaints with potential benefits for the course of DCM. PMID:22419932

  8. Local patient dose diagnostic reference levels in pediatric interventional cardiology in Chile using age bands and patient weight values

    SciTech Connect

    Ubeda, Carlos; Miranda, Patricia; Vano, Eliseo

    2015-02-15

    Purpose: To present the results of a patient dose evaluation program in pediatric cardiology and propose local diagnostic reference levels (DRLs) for different types of procedure and age range, in addition to suggesting approaches to correlate patient dose values with patient weight. This study was the first conducted in Latin America for pediatric interventional cardiology under the auspices of the International Atomic Energy Agency. Methods: Over three years, the following data regarding demographic and patient dose values were collected: age, gender, weight, height, number of cine series, total number of cine frames, fluoroscopy time (FT), and two dosimetric quantities, dose-area product (DAP) and cumulative dose (CD), at the patient entrance reference point. The third quartile values for FT, DAP, CD, number of cine series, and the DAP/body weight ratio were proposed as the set of quantities to use as local DRLs. Results: Five hundred and seventeen patients were divided into four age groups. Sample sizes by age group were 120 for <1 yr; 213 for 1 to <5 yr; 82 for 5 to <10 yr; and 102 for 10 to <16 yr. The third quartile values obtained for DAP by diagnostic and therapeutic procedures and age range were 1.17 and 1.11 Gy cm{sup 2} for <1 yr; 1.74 and 1.90 Gy cm{sup 2} for 1 to <5 yr; 2.83 and 3.22 Gy cm{sup 2} for 5 to <10 yr; and 7.34 and 8.68 Gy cm{sup 2} for 10 to <16 yr, respectively. The third quartile value obtained for the DAP/body weight ratio for the full sample of procedures was 0.17 (Gy cm{sup 2}/kg) for diagnostic and therapeutic procedures. Conclusions: The data presented in this paper are an initial attempt at establishing local DRLs in pediatric interventional cardiology, from a large sample of procedures for the standard age bands used in Europe, complemented with the values of the ratio between DAP and patient weight. This permits a rough estimate of DRLs for different patient weights and the refining of these values for the age bands when there

  9. [The QuIK-Registry of the German Society of Cardiologists in private practice: countrywide and benchmarking quality assurance in invasive cardiology].

    PubMed

    Albrecht, A; Levenson, B; Göhring, S; Haerer, W; Reifart, N; Ringwald, G; Troger, B

    2009-10-01

    QuIK is the German acronym for QUality Assurance in Invasive Cardiology. It describes the continuous project of an electronic data collection in Cardiac catheterization laboratories all over Germany. Mainly members of the German Society of Cardiologists in Private Practice (BNK) participate in this computer based project. Since 1996 data of diagnostic and interventional procedures are collected and send to a registry-center where a regular benchmarking analysis of the results is performed. Part of the project is a yearly auditing process including an on-site visit to the cath lab to guarantee for the reliability of information collected. Since 1996 about one million procedures have been documented. PMID:19834845

  10. Nuclear medicine practices in the 1950s through the mid-1970s and occupational radiation doses to technologists from diagnostic radioisotope procedures.

    PubMed

    Drozdovitch, Vladimir; Brill, Aaron B; Mettler, Fred A; Beckner, William M; Goldsmith, Stanley J; Gross, Milton D; Hays, Marguerite T; Kirchner, Peter T; Langan, James K; Reba, Richard C; Smith, Gary T; Bouville, André; Linet, Martha S; Melo, Dunstana R; Lee, Choonsik; Simon, Steven L

    2014-10-01

    Data on occupational radiation exposure from nuclear medicine procedures for the time period of the 1950s through the 1970s is important for retrospective health risk studies of medical personnel who conducted those activities. However, limited information is available on occupational exposure received by physicians and technologists who performed nuclear medicine procedures during those years. To better understand and characterize historical radiation exposures to technologists, the authors collected information on nuclear medicine practices in the 1950s, 1960s, and 1970s. To collect historical data needed to reconstruct doses to technologists, a focus group interview was held with experts who began using radioisotopes in medicine in the 1950s and the 1960s. Typical protocols and descriptions of clinical practices of diagnostic radioisotope procedures were defined by the focus group and were used to estimate occupational doses received by personnel, per nuclear medicine procedure, conducted in the 1950s to 1960s using radiopharmaceuticals available at that time. The radionuclide activities in the organs of the reference patient were calculated using the biokinetic models described in ICRP Publication 53. Air kerma rates as a function of distance from a reference patient were calculated by Monte Carlo radiation transport calculations using a hybrid computational phantom. Estimates of occupational doses to nuclear medicine technologists per procedure were found to vary from less than 0.01 μSv (thyroid scan with 1.85 MBq of administered I-iodide) to 0.4 μSv (brain scan with 26 MBq of Hg-chlormerodin). Occupational doses for the same diagnostic procedures starting in the mid-1960s but using Tc were also estimated. The doses estimated in this study show that the introduction of Tc resulted in an increase in occupational doses per procedure. PMID:25162420

  11. NUCLEAR MEDICINE PRACTICES IN THE 1950s THROUGH THE mid-1970s AND OCCUPATIONAL RADIATION DOSES TO TECHNOLOGISTS FROM DIAGNOSTIC RADIOISOTOPE PROCEDURES

    PubMed Central

    Drozdovitch, Vladimir; Brill, Aaron B.; Mettler, Fred A.; Beckner, William M.; Goldsmith, Stanley J.; Gross, Milton D.; Hays, Marguerite T.; Kirchner, Peter T.; Langan, James K.; Reba, Richard C.; Smith, Gary T.; Bouville, André; Linet, Martha S.; Melo, Dunstana R.; Lee, Choonsik; Simon, Steven L.

    2014-01-01

    Data on occupational radiation exposure from nuclear medicine procedures for the time period of the 1950s through the 1970s is important for retrospective health risk studies of medical personnel who conducted those activities. However, limited information is available on occupational exposure received by physicians and technologists who performed nuclear medicine procedures during those years. To better understand and characterize historical radiation exposures to technologists, we collected information on nuclear medicine practices in the 1950s, 1960s, and 1970s. To collect historical data needed to reconstruct doses to technologists, a focus group interview was held with experts who began using radioisotopes in medicine in the 1950s and the 1960s. Typical protocols and descriptions of clinical practices of diagnostic radioisotope procedures were defined by the focus group and were used to estimate occupational doses received by personnel, per nuclear medicine procedure, conducted in the 1950s-1960s using radiopharmaceuticals available at that time. The radionuclide activities in the organs of the reference patient were calculated using the biokinetic models described in ICRP Publication 53. Air kerma rates as a function of distance from a reference patient were calculated by Monte Carlo radiation transport calculations using a hybrid computational phantom. Estimates of occupational doses to nuclear medicine technologists per procedure were found to vary from less than 0.01 μSv (thyroid scan with 1.85 MBq of administered 131I-iodide) to 0.4 μSv (brain scan with 26 MBq of 203Hg-chlormerodin). Occupational doses for the same diagnostic procedures starting in the mid-1960s but using 99mTc were also estimated. The doses estimated in this study show that the introduction of 99mTc resulted in an increase in occupational doses per procedure. PMID:25162420

  12. Patient radiation doses in interventional cardiology in the U.S.: Advisory data sets and possible initial values for U.S. reference levels

    SciTech Connect

    Miller, Donald L.; Hilohi, C. Michael; Spelic, David C.

    2012-10-15

    Purpose: To determine patient radiation doses from interventional cardiology procedures in the U.S and to suggest possible initial values for U.S. benchmarks for patient radiation dose from selected interventional cardiology procedures [fluoroscopically guided diagnostic cardiac catheterization and percutaneous coronary intervention (PCI)]. Methods: Patient radiation dose metrics were derived from analysis of data from the 2008 to 2009 Nationwide Evaluation of X-ray Trends (NEXT) survey of cardiac catheterization. This analysis used deidentified data and did not require review by an IRB. Data from 171 facilities in 30 states were analyzed. The distributions (percentiles) of radiation dose metrics were determined for diagnostic cardiac catheterizations, PCI, and combined diagnostic and PCI procedures. Confidence intervals for these dose distributions were determined using bootstrap resampling. Results: Percentile distributions (advisory data sets) and possible preliminary U.S. reference levels (based on the 75th percentile of the dose distributions) are provided for cumulative air kerma at the reference point (K{sub a,r}), cumulative air kerma-area product (P{sub KA}), fluoroscopy time, and number of cine runs. Dose distributions are sufficiently detailed to permit dose audits as described in National Council on Radiation Protection and Measurements Report No. 168. Fluoroscopy times are consistent with those observed in European studies, but P{sub KA} is higher in the U.S. Conclusions: Sufficient data exist to suggest possible initial benchmarks for patient radiation dose for certain interventional cardiology procedures in the U.S. Our data suggest that patient radiation dose in these procedures is not optimized in U.S. practice.

  13. Durability of Class I American College of Cardiology/American Heart Association Clinical Practice Guideline Recommendations

    PubMed Central

    Neuman, Mark D.; Goldstein, Jennifer N.; Cirullo, Michael A.; Schwartz, J. Sanford

    2015-01-01

    IMPORTANCE Little is known regarding the durability of clinical practice guideline recommendations over time. OBJECTIVE To characterize variations in the durability of class I (“procedure/treatment should be performed/administered”) American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations. DESIGN, SETTING, AND PARTICIPANTS Textual analysis by 4 independent reviewers of 11 guidelines published between 1998 and 2007 and revised between 2006 and 2013. MAIN OUTCOMES AND MEASURES We abstracted all class I recommendations from the first of the 2 most recent versions of each guideline and identified corresponding recommendations in the subsequent version. We classified recommendations replaced by less determinate or contrary recommendations as having been downgraded or reversed; we classified recommendations for which no corresponding item could be identified as having been omitted. We tested for differences in the durability of recommendations according to guideline topic and underlying level of evidence using bivariable hypothesis tests and conditional logistic regression. RESULTS Of 619 index recommendations, 495 (80.0%; 95%CI, 76.6%–83.1%) were retained in the subsequent guideline version, 57 (9.2%; 95%CI, 7.0%–11.8%) were downgraded or reversed, and 67 (10.8%; 95%CI, 8.4%–13.3%) were omitted. The percentage of recommendations retained varied across guidelines from 15.4%(95%CI, 1.9%–45.4%) to 94.1%(95%CI, 80.3%–99.3%; P < .001). Among recommendations with available information on level of evidence, 90.5%(95%CI, 83.2%–95.3%) of recommendations supported by multiple randomized studies were retained, vs 81.0% (95%CI, 74.8%–86.3%) of recommendations supported by 1 randomized trial or observational data and 73.7%(95% CI, 65.8%–80.5%) of recommendations supported by opinion (P = .001). After accounting for guideline-level factors, the probability of being downgraded, reversed, or omitted was greater for

  14. "Baby Heart Project": the Italian project for accreditation and quality management in pediatric cardiology and cardiac surgery.

    PubMed

    Albanese, Sonia B; Zannini, Lucio V; Perri, Gianluigi; Crupi, Giancarlo; Turinetto, Bruno; Pongiglione, Giacomo

    2014-10-01

    Optimization of the relationship between the supply and the demand for medical services should ideally be taken into consideration for the planning within each national Health System. Although government national health organizations embrace this policy specifically, the contribution of expert committees (under the scientific societies' guarantee in any specific medical field) should be advocated for their capability to collect and analyze the data reported by the various national institutions. In addition, these committees have the competence to analyze the need for the resources necessary to the operation of these centers. The field of pediatric cardiology and cardiac surgery may represent a model of clinical governance of particular interest with regard to programming and to a definition of the quality standards that may be extended to highly specialized institutions and ideally to the entire Health System. The "Baby Heart Project," which represents a model of governance and clinical quality in the field of pediatric cardiology and cardiac surgery, was born from the spontaneous aggregation of a committee of experts, supported by duly appointed Italian Scientific Societies and guided by a national agency for accreditation. The ultimate aim is to standardize both procedures and results for future planning within the national Health System. PMID:24880465

  15. Tracking patient radiation exposure: challenges to integrating nuclear medicine with other modalities.

    PubMed

    Mercuri, Mathew; Rehani, Madan M; Einstein, Andrew J

    2012-10-01

    The cumulative radiation exposure to the patient from multiple radiological procedures can place some individuals at significantly increased risk for stochastic effects and tissue reactions. Approaches, such as those in the International Atomic Energy Agency's Smart Card program, have been developed to track cumulative radiation exposures to individuals. These strategies often rely on the availability of structured dose reports, typically found in the DICOM header. Dosimetry information is currently readily available for many individual x-ray-based procedures. Nuclear medicine, of which nuclear cardiology constitutes the majority of the radiation burden in the US, currently lags behind x-ray-based procedures with respect to reporting of radiation dosimetric information. This article discusses qualitative differences between nuclear medicine and x-ray-based procedures, including differences in the radiation source and measurement of its strength, the impact of biokinetics on dosimetry, and the capability of current scanners to record dosimetry information. These differences create challenges in applying, monitoring, and reporting strategies used in x-ray-based procedures to nuclear medicine, and integrating dosimetry information across modalities. A concerted effort by the medical imaging community, dosimetry specialists, and manufacturers of imaging equipment is required to develop strategies to improve the reporting of radiation dosimetry data in nuclear medicine. Some ideas on how to address this issue are suggested. PMID:22695788

  16. Exploiting expert systems in cardiology: a comparative study.

    PubMed

    Economou, George-Peter K; Sourla, Efrosini; Stamatopoulou, Konstantina-Maria; Syrimpeis, Vasileios; Sioutas, Spyros; Tsakalidis, Athanasios; Tzimas, Giannis

    2015-01-01

    An improved Adaptive Neuro-Fuzzy Inference System (ANFIS) in the field of critical cardiovascular diseases is presented. The system stems from an earlier application based only on a Sugeno-type Fuzzy Expert System (FES) with the addition of an Artificial Neural Network (ANN) computational structure. Thus, inherent characteristics of ANNs, along with the human-like knowledge representation of fuzzy systems are integrated. The ANFIS has been utilized into building five different sub-systems, distinctly covering Coronary Disease, Hypertension, Atrial Fibrillation, Heart Failure, and Diabetes, hence aiding doctors of medicine (MDs), guide trainees, and encourage medical experts in their diagnoses centering a wide range of Cardiology. The Fuzzy Rules have been trimmed down and the ANNs have been optimized in order to focus into each particular disease and produce results ready-to-be applied to real-world patients. PMID:25417018

  17. Open source cardiology electronic health record development for DIGICARDIAC implementation

    NASA Astrophysics Data System (ADS)

    Dugarte, Nelson; Medina, Rubén.; Huiracocha, Lourdes; Rojas, Rubén.

    2015-12-01

    This article presents the development of a Cardiology Electronic Health Record (CEHR) system. Software consists of a structured algorithm designed under Health Level-7 (HL7) international standards. Novelty of the system is the integration of high resolution ECG (HRECG) signal acquisition and processing tools, patient information management tools and telecardiology tools. Acquisition tools are for management and control of the DIGICARDIAC electrocardiograph functions. Processing tools allow management of HRECG signal analysis searching for indicative patterns of cardiovascular pathologies. Telecardiology tools incorporation allows system communication with other health care centers decreasing access time to the patient information. CEHR system was completely developed using open source software. Preliminary results of process validation showed the system efficiency.

  18. On New Spain and Mexican medicinal botany in cardiology.

    PubMed

    de Micheli-Serra, Alfredo Alessandro; Izaguirre-Ávila, Raúl

    2014-01-01

    Towards the middle of the XVI century, the empirical physician Martín de la Cruz, in New Spain, compiled a catalogue of the local medicinal herbs and plants, which was translated into Latin by Juan Badiano, professor at the Franciscan college of Tlatelolco. On his side, Dr. Francisco Hernández, the royal physician (protomédico) from 1571 until 1577, performed a systematic study of the flora and fauna in this period. His notes and designs were not published at that time, but two epitomes of Hernández' works appeared, respectively, in 1615 in Mexico and in 1651 in Rome. During the XVIII century, two Spanish scientific expeditions arrived to these lands. They were led, respectively, by the Spanish naturalist Martín Sessé and the Italian seaman, Alessandro Malaspina di Mulazzo, dependent from the Spanish Government. These expeditions collected and carried rich scientific material to Spain. At the end of that century, the Franciscan friar Juan Navarro depicted and described several Mexican medicinal plants in the fifth volume of his botanic work. In the last years of the colonial period, the fundamental works of Humboldt and Bonpland on the geographic distribution of the American plants were published. In the modern age, the first research about the Mexican medicinal botany was performed in the laboratory of the Instituto Médico Nacional [National Medical Institute] under the leadership of Dr. Fernando Altamirano, who started pharmacological studies in this country. Later, trials of cardiovascular pharmacology were performed in the small laboratories of the cardiological unit at the General Hospital of Mexico City, on Dr. Ignacio Chávez' initiative. The Mexican botanical-pharmacological tradition persists alive and vigorous at the Instituto Nacional de Cardiología and other scientific institutions of the country. PMID:24960330

  19. Report of the American College of Cardiology (ACC) Scientific Sessions 2016, Chicago.

    PubMed

    Mano, Toshiaki; Yamamoto, Kazuhiro

    2016-05-25

    The 65(th)Annual Scientific Sessions of the American College of Cardiology (ACC) were held at McCormick Place, Chicago, from April 2-4, 2016. The ACC Scientific Sessions are one of the 2 major scientific cardiology meetings in the USA and one of the major scientific meetings of cardiology in the world. It had an attendance of 18,769 and over 2,000 oral and poster abstracts, including 8 late-breaking clinical trials. This report presents the key presentations and the highlights from the ACC Scientific Sessions 2016 in Chicago. (Circ J 2016; 80: 1308-1313). PMID:27151567

  20. Function Allocation in Complex Socio-Technical Systems: Procedure usage in nuclear power and the Context Analysis Method for Identifying Design Solutions (CAMIDS) Model

    NASA Astrophysics Data System (ADS)

    Schmitt, Kara Anne

    This research aims to prove that strict adherence to procedures and rigid compliance to process in the US Nuclear Industry may not prevent incidents or increase safety. According to the Institute of Nuclear Power Operations, the nuclear power industry has seen a recent rise in events, and this research claims that a contributing factor to this rise is organizational, cultural, and based on peoples overreliance on procedures and policy. Understanding the proper balance of function allocation, automation and human decision-making is imperative to creating a nuclear power plant that is safe, efficient, and reliable. This research claims that new generations of operators are less engaged and thinking because they have been instructed to follow procedures to a fault. According to operators, they were once to know the plant and its interrelations, but organizationally more importance is now put on following procedure and policy. Literature reviews were performed, experts were questioned, and a model for context analysis was developed. The Context Analysis Method for Identifying Design Solutions (CAMIDS) Model was created, verified and validated through both peer review and application in real world scenarios in active nuclear power plant simulators. These experiments supported the claim that strict adherence and rigid compliance to procedures may not increase safety by studying the industry's propensity for following incorrect procedures, and when it directly affects the outcome of safety or security of the plant. The findings of this research indicate that the younger generations of operators rely highly on procedures, and the organizational pressures of required compliance to procedures may lead to incidents within the plant because operators feel pressured into following the rules and policy above performing the correct actions in a timely manner. The findings support computer based procedures, efficient alarm systems, and skill of the craft matrices. The solution to

  1. Radiation exposure to nuclear medicine staffs during 18F-FDG PET/CT procedures at Ramathibodi Hospital

    NASA Astrophysics Data System (ADS)

    Donmoon, T.; Chamroonrat, W.; Tuntawiroon, M.

    2016-03-01

    The aim of this study is to estimate the whole body and finger radiation doses per study received by nuclear medicine staff involved in dispensing, administration of 18F-FDG and interacting with radioactive patients during PET/CT imaging procedures in a PET/CT facility. The whole-body doses received by radiopharmacists, technologists and nurses were measured by electronic dosimeter and the finger doses by ring dosimeter during a period of 4 months. In 70 PET/CT studies, the mean whole-body dose per study to radiopharmacist, technologist, and nurse were 1.07±0.09, 1.77±0.46, μSv, and not detectable respectively. The mean finger doses per study received by radiopharmacist, technologist, and nurse were 265.65±107.55, 4.84±1.08 and 19.22±2.59 μSv, respectively. The average time in contact with 18F-FDG was 5.88±0.03, 39.06±1.89 and 1.21±0.02 minutes per study for radiopharmacist, technologist and nurse respectively. Technologists received highest mean effective whole- body dose per study and radiopharmacist received the highest finger dose per study. When compared with the ICRP dose limit, each individual worker can work with many more 18F- FDG PET/CT studies for a whole year without exceeding the occupational dose limits. This study confirmed that low levels of radiation does are received by our medical personnel involved in 18F-FDG PET/CT procedures.

  2. A rapid dissolution procedure to aid initial nuclear forensics investigations of chemically refractory compounds and particles prior to gamma spectrometry.

    PubMed

    Reading, David G; Croudace, Ian W; Warwick, Phillip E; Britton, Richard

    2015-11-01

    A rapid and effective preparative procedure has been evaluated for the accurate determination of low-energy (40-200 keV) gamma-emitting radionuclides ((210)Pb, (234)Th, (226)Ra, (235)U) in uranium ores and uranium ore concentrates (UOCs) using high-resolution gamma ray spectrometry. The measurement of low-energy gamma photons is complicated in heterogeneous samples containing high-density mineral phases and in such situations activity concentrations will be underestimated. This is because attenuation corrections, calculated based on sample mean density, do not properly correct where dense grains are dispersed within a less dense matrix (analogous to a nugget effect). The current method overcomes these problems using a lithium tetraborate fusion that readily dissolves all components including high-density, self-attenuating minerals/compounds. This is the ideal method for dissolving complex, non-volatile components in soils, rocks, mineral concentrates, and other materials where density reduction is required. Lithium borate fusion avoids the need for theoretical efficiency corrections or measurement of matrix matched calibration standards. The resulting homogeneous quenched glass produced can be quickly dissolved in nitric acid producing low-density solutions that can be counted by gamma spectrometry. The effectiveness of the technique is demonstrated using uranium-bearing Certified Reference Materials and provides accurate activity concentration determinations compared to the underestimated activity concentrations derived from direct measurements of a bulk sample. The procedure offers an effective solution for initial nuclear forensic studies where complex refractory minerals or matrices exist. It is also significantly faster, safer and simpler than alternative approaches. PMID:26572834

  3. The foundation and launch of the Melbourne Interventional Group: a collaborative interventional cardiology project.

    PubMed

    Ajani, A E; Szto, G; Duffy, S J; Eccleston, D; Clark, D J; Lefkovits, J; Chew, D P; Warren, R; Black, A; New, G; Walton, A; Lew, R; Shaw, J; Horrigan, M; Sebastian, M; Yan, B P; Brennan, A; Meehan, A; Reid, C; Krum, H

    2006-02-01

    The Melbourne Interventional Group (MIG) is a voluntary collaborative venture of interventional cardiologists practicing at 12 major public and private hospitals in Victoria, designed to record data pertaining to percutaneous coronary interventions (PCI) and perform long-term follow-up. The potential advantages of collaboration involve large-scale analysis of current interventional strategies (e.g. drug-eluting stents, evaluation of new technologies and cost-effective analysis), provide a basis for multi-centred clinical trials and allow comparison of clinical outcomes with cardiac surgery. The established registry documents demographic, clinical and procedural characteristics of consecutive patients undergoing PCI and permits analysis of those characteristics at 30 days and 12 months. The registry is co-ordinated by the Centre of Clinical Research Excellence (CCRE), a research body within the Department of Epidemiology and Preventive Medicine (Monash University, Melbourne). The eventual goal of MIG is to provide a contemporary appraisal of Australian interventional cardiology practice, with opportunities to improve in-hospital and long-term outcomes of patients with coronary artery disease. PMID:16473790

  4. 3D-Printing in Congenital Cardiology: From Flatland to Spaceland

    PubMed Central

    Deferm, Sébastien; Meyns, Bart; Vlasselaers, Dirk; Budts, Werner

    2016-01-01

    Medical imaging has changed to a great extent over the past few decades. It has been revolutionized by three-dimensional (3D) imaging techniques. Despite much of modern medicine relying on 3D imaging, which can be obtained accurately, we keep on being limited by visualization of the 3D content on two-dimensional flat screens. 3D-printing of graspable models could become a feasible technique to overcome this gap. Therefore, we printed pre- and postoperative 3D-models of a complex congenital heart defect. With this example, we intend to illustrate that these models hold value in preoperative planning, postoperative evaluation of a complex procedure, communication with the patient, and education of trainees. At this moment, 3D printing only leaves a small footprint, but makes already a big impression in the domain of cardiology and cardiovascular surgery. Further studies including more patients and more validated applications are needed to streamline 3D printing in the clinical setting of daily practice. PMID:27195174

  5. 3D-Printing in Congenital Cardiology: From Flatland to Spaceland.

    PubMed

    Deferm, Sébastien; Meyns, Bart; Vlasselaers, Dirk; Budts, Werner

    2016-01-01

    Medical imaging has changed to a great extent over the past few decades. It has been revolutionized by three-dimensional (3D) imaging techniques. Despite much of modern medicine relying on 3D imaging, which can be obtained accurately, we keep on being limited by visualization of the 3D content on two-dimensional flat screens. 3D-printing of graspable models could become a feasible technique to overcome this gap. Therefore, we printed pre- and postoperative 3D-models of a complex congenital heart defect. With this example, we intend to illustrate that these models hold value in preoperative planning, postoperative evaluation of a complex procedure, communication with the patient, and education of trainees. At this moment, 3D printing only leaves a small footprint, but makes already a big impression in the domain of cardiology and cardiovascular surgery. Further studies including more patients and more validated applications are needed to streamline 3D printing in the clinical setting of daily practice. PMID:27195174

  6. A set of patient and staff dose data for validation of Monte Carlo calculations in interventional cardiology.

    PubMed

    Vano, E; Sanchez, R M; Fernandez, J M; Bartal, G; Canevaro, L; Lykawka, R; Melo, C

    2015-07-01

    The purpose of this paper is to report a set of experimental values of patient and staff doses in a cardiac catheterisation laboratory using the range of radiographic and geometric parameters from routine clinical practice. The data obtained will be available for validation of Monte Carlo calculations and for training purposes. They will also help optimise radiation protection for patients and staff. Experimental measurements were made with an anthropomorphic phantom, and a monoplane flat detector-based X-ray system was used for interventional cardiology procedures. Standard operational protocols used in clinical practice were applied. Around 1000 patient dose and 5000 staff dose values were measured for different operational conditions (angulations, distances, collimation and wedge filter, magnification, phantom thicknesses, using Copper absorber, etc.). Uncertainties were also estimated. Increase factors of 3-10 for patients and staff doses were measured for the different C-arm angulations. PMID:25802462

  7. Dutch guidelines for interventional cardiology: institutional and operator competence and requirements for training

    PubMed Central

    Aengevaeren, W.R.M.; Laarman, G.J.; Suttorp, M.J.; ten Berg, J.M.; van Boven, A.J.; de Boer, M.J.; Piek, J.J.; van Ommen, G.V.A.; Bronzwaer, J.G.F.; Smits, P.; Deckers, J.W.

    2005-01-01

    Interventional cardiology is an expanding field within cardiovascular medicine and today it is generally accepted that cardiologists require specific training, knowledge and skills. Hospitals where coronary interventions are performed must be properly equipped and able to provide specialised care. Percutaneous coronary interventions are frequently used for coronary revascularisation. The public should have confidence in the uniformity of high quality care. Therefore, such quality of care should be maintained by certification of the individual operators, general guidelines for institutional requirements and formal audits. The Netherlands Society of Cardiology (NVVC) will be implementing a new registration system for cardiologists with a subspecialisation that will include registration for interventional cardiology. The NVVC asked the Working Group of Interventional Cardiology (WIC) to update the 1994 Dutch guidelines on operator and institutional competence, and requirements for training in interventional cardiology in order to incorporate them into the official directives. The present guidelines represent the expert opinion of the Dutch interventional cardiology community and are in accordance with international regulations. After two rounds of discussion, the NVVC approved the guidelines in November 2004 during the autumn meeting. PMID:25696433

  8. An update on radiation absorbed dose to patients from diagnostic nuclear medicine procedures in Tehran: A study on four academic centers

    PubMed Central

    Motazedian, Motahareh; Tabeie, F; Vatankhah, P; Shafiei, B; Amoui, M; Atefi, M; Ansari, M; Asli, I Neshandar

    2016-01-01

    Purpose: Use of radiopharmaceuticals for diagnostic nuclear medicine procedures is one of the main sources of radiation exposure. We performed this study with respect to the rapid growth in nuclear medicine in Iran and lack of updated statistics. Materials and Methods: The data were obtained for all active Nuclear Medicine Centers affiliated to Shahid Beheshti University of Medical Sciences during 2009 and 2010. Results: The most frequently performed procedures were bone (30.16%), cardiac (28.96%), renal (17.97%), and thyroid (7.93%) scans. There was a significant decrease in the number of thyroid scintigraphies with 131I and 99mTc-sulfur colloid liver/spleen scans and tremendous increase in the frequencies of cardiac and bone scintigraphies compared to one decade ago. Conclusion: Compared to previous studies, there were striking changes in trends of diagnostic nuclear medicine procedures in Tehran. This field is still evolving in the country, and this trend will further change with the introduction of positron emission tomography scanners in future. PMID:27095860

  9. Epidemiological studies of CHD and the evolution of preventive cardiology.

    PubMed

    Wong, Nathan D

    2014-05-01

    Cardiovascular diseases (CVDs) cause nearly one-third of all deaths worldwide. Coronary heart disease (CHD) accounts for the greatest proportion of CVDs, and risk factors such as hypertension, cigarette smoking, diabetes mellitus or elevated glucose level, elevated cholesterol levels, and obesity or being overweight are the top six causes of death globally. Ecological and population-based longitudinal studies, conducted globally or within individual countries, have established the role of traditional and novel risk factors and measures of subclinical disease in the prediction of CHD. Risk assessment with short-term or long-term risk prediction algorithms can help to identify individuals who would benefit most from risk-factor interventions. Evaluation of novel risk factors and screening for subclinical atherosclerosis can also help to identify individuals at highest cardiovascular risk. Prevention of CHD focuses on identifying and managing risk factors at both the population and individual levels through primordial, primary, and secondary prevention. Epidemiological studies have provided the hypotheses for subsequent clinical trials that have documented the efficacy of risk-factor interventions, which are the basis of preventive cardiology. Future research efforts will determine the screening and intervention strategies that have the greatest effect on CHD prevention. PMID:24663092

  10. [About the origin, evolution and irradiation of Mexican cardiology].

    PubMed

    de Micheli, Alfredo

    2014-01-01

    The Mexican cardioangiology started in the nineteen century thanks to first endeavors of surgeons and physicians related to local academies and to School of Medicine, established in 1833 by Dr. Valentin Gómez Farías. Dr. Manuel Carpio, the future first head of department of physiology in this school, translated to Spanish language and published, in 1823, the article On pectoriloquo of the French physician Marat and later performed some experiments on the heart' motion. During the Secont Empire (1864-1867), the physician Samuel von Basch performed studies to define the arterial hypertension, called by him "latent atherosclerosis", i.e. the "essential hypertension". Once he had returned to his country, he invented in 1880, a sphygmomanometer of mercury column, that was the model for the instrument constructed by the Italian physician Scipione Riva-Rocci and presented in 1896. In our time, Dr. Demetrio Sodi Pallares systematized a metabolic therapy called "polarizing therapy", i.e. capable of repolarizing the heart's cells partly depolarized due to hypoxia or direct aggressions. These were the first steps in Mexico on the way to a promising medicine starting and the great adventure of Mexican cardiology. PMID:25260577

  11. Update: Innovation in cardiology (II). Telecardiology: past, present and future.

    PubMed

    Sørensen, Jacob Thorsted; Clemmensen, Peter; Sejersten, Maria

    2013-03-01

    Technological advances over the past decades have allowed improved diagnosis and monitoring of patients with acute coronary syndromes as well as patients with advanced heart failure. High-quality digital recordings transmitted wirelessly by cellular telephone networks have augmented the prehospital use of transportable electrocardiogram machines as well as implantable devices for arrhythmia monitoring and therapy. The impact of prehospital electrocardiogram recording and interpretation in patients suspected of acute myocardial infarction should not be underestimated. It enables a more widespread access to rapid reperfusion therapy, thereby reducing treatment delay, morbidity and mortality. Further, continuous electrocardiogram monitoring has improved arrhythmia diagnosis and dynamic ST-segment changes have been shown to provide important prognostic information in patients with acute ST-elevation myocardial infarction. Likewise, remote recording or monitoring of arrhythmias and vital signs seem to improve outcome and reduce the necessity of re-admissions or outpatient contacts in patients with heart failure or arrhythmias. In the future telemonitoring and diagnosis is expected to further impact the way we practice cardiology and provide better care for the patient with cardiovascular disease. PMID:24775456

  12. Milestones in pediatric cardiology: making possible the impossible.

    PubMed

    Mormile, Raffaella; Quadrini, Ilaria; Squarcia, Umberto

    2013-02-01

    Pediatric Cardiology as a discipline has been proposed to have been born on August 26, 1938, when Robert Gross at the age of 33 years, successfully ligated a patent ductus arteriosus of a 7 years girl at the Children's Hospital in Boston. In November 1944, Helen Taussig convinced Alfred Blalock to anastomose the left subclavian artery to the left pulmonary artery after Robert Gross had declined to cooperate with her. About the 1950s, at the University of Minneapolis, Clarence Walton Lillehei worked on a controlled "crossed circulation" in which the cardiopulmonary bypass machine was another human, generally one of the patient's parents. In 1966 Williams Rashkind introduced ballon septostomy as a palliative approach to complete transposition of the Great Arteries, followed later by Jean Kan's balloon valvuloplasty to open the pulmonary valve. During the 1960s Giancarlo Rastelli developed a new classification of the Atrio Ventricular Canal defect which allowed to have a strikingly better surgical results. Today, even the hypoplastic left heart syndrome (HLHS), at one time a fatal condition, is operable. The completion of the Human Genome Project has been an enormous help in the understanding the genetic causes of cardiac anomalies. However, there are very few approved application for stem cells, and stem cells will not likely replace organ transplantation any time soon. Recently, the protein survivin has been described as a novel player in cardioprotection against myocardial ischemia/reperfusion injury. The science needs to be made with love to warrant the humanity of Research. PMID:23280521

  13. I. Nuclear Production Reaction and Chemical Isolation Procedure for Americium-240 II. New Superheavy Element Isotopes: Plutonium-242(Calcium-48,5n)(285)114

    NASA Astrophysics Data System (ADS)

    Ellison, Paul Andrew

    2011-12-01

    Part I discusses the study of a new nuclear reaction and chemical separation procedure for the production of 240Am. Thin 242Pu, natTi, and natNi targets were coincidently activated with protons from the 88-Inch Cyclotron, producing 240Am, 48V, and 57Ni, respectively. The radioactive decay of these isotopes was monitored using high-purity Ge gamma ray detectors in the weeks following irradiation. The excitation function for the 242 Pu(p, 3n)240Am nuclear reaction was measured to be lower than theoretical predictions, but high enough to be the most viable nuclear reaction for the large-scale production of 240 Am. Details of the development of a chemical separation procedure for isolating 240Am from proton-irradiated 242Pu are discussed. The separation procedure, which includes two anion exchange columns and two extraction chromatography columns, was experimentally investi- gated using tracer-level 241Am, 239Pu, and model proton-induced fission products 95Zr, 95Nb, 125Sb, and 152Eu. The separation procedure was shown to have an Am/Pu separation factor of >2x10 7 and an Am yield of ˜70%. The separation procedure was found to purify the Am sample from >99.9% of Eu, Zr, Nb, and Sb. The procedure is well suited for the processing of ˜1 gram of proton-irradiated 242Pu to produce a neutron-induced fission target consisting of tens of nanograms of 240Am. Part II describes the use of the Berkeley Gas-filled Separator at the Lawrence Berkeley National Laboratory 88-Inch Cyclotron for the study of the 242Pu(48Ca,5n)285114 nuclear re- action. The new, neutron-deficient, superheavy element isotope 285114 was produced in 48Ca irradiations of 242Pu targets at a center-of-target beam energy of 256 MeV ( E* = 50 MeV). The alpha decay of 285114 was followed by the sequential alpha decay of four daughter nuclides, 281Cn, 277Ds, 273Hs, and 269 Sg. 265Rf was observed to decay by spontaneous fission. The measured alpha-decay Q-values were compared with those from a macroscopic

  14. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision.

    PubMed

    Verberne, Hein J; Acampa, Wanda; Anagnostopoulos, Constantinos; Ballinger, Jim; Bengel, Frank; De Bondt, Pieter; Buechel, Ronny R; Cuocolo, Alberto; van Eck-Smit, Berthe L F; Flotats, Albert; Hacker, Marcus; Hindorf, Cecilia; Kaufmann, Philip A; Lindner, Oliver; Ljungberg, Michael; Lonsdale, Markus; Manrique, Alain; Minarik, David; Scholte, Arthur J H A; Slart, Riemer H J A; Trägårdh, Elin; de Wit, Tim C; Hesse, Birger

    2015-11-01

    Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated 2015 procedural guidelines are highlighted, focusing on the important changes related to new instrumentation with improved image information and the possibility to reduce radiation exposure, which is further discussed in relation to the recent developments of new International Commission on Radiological Protection (ICRP) models. Introduction of the selective coronary vasodilator regadenoson and the use of coronary CT-contrast agents for hybrid imaging with SPECT/CT angiography are other important areas for nuclear cardiology that were not included in the previous guidelines. A large number of minor changes have been described in more detail in the fully revised version available at the EANM home page: http://eanm.org/publications/guidelines/2015_07_EANM_FINAL_myocardial_perfusion_guideline.pdf . PMID:26290421

  15. Role Of The Bureau Of Radiological Health In Assessment Of Risks From Clinical Nuclear Magnetic Resonance (NMR) Procedures

    NASA Astrophysics Data System (ADS)

    Anderson, Mary P.; Athey, T. W.; Phillips, Robert A.

    1982-12-01

    The 1976 Medical Device Amendments to the Federal Food, Drug, and Cosmetic Act provide for the classification of a medical device intended for human use into one of three regulatory classes based on the extent of control necessary to ensure safety and effectiveness: Class I, General Controls; Class II, Performance Standards; Class III, Premarket Approval. Class III devices are those for which there is insufficient information available to ensure safety and effectiveness through General Controls and Performance Standards alone. New devices such as Nuclear Magnetic Resonance Imaging systems fall under Class III because they were developed after the date of the law's enactment (28 May 1976). Investigational studies involving human subjects undertaken to develop safety and effectiveness data for a post-enactment Class III device come under the Investigational Device Exemption (IDE) Regulation (21 CFR 812). This regulation distinguishes between investigations of devices that pose a significant risk to the human subject and those that do not. A significant risk investigation "presents a potential for serious risk to the health, safety, or welfare of a subject." Procedures for obtaining an IDE differ if the device does or does not pose a significant risk. The sponsor of a clinical trial, and ultimately the Institutional Review Board (IRB), have the primary responsibility to determine whether a certain clinical use of the investigational device represents a significant risk to the subject of the investigation. A finding of significant risk does not mean that a device is too hazardous for clinical studies, but it does mean that a formal application for an IDE must be made to and approved by the Food and Drug Administration (FDA) before a clinical trial can begin. If the device is deemed not to pose a significant risk, unless otherwise notified by FDA, the sponsor is not required to submit an IDE application to FDA. Instead, the sponsor and investigators must satisfy only

  16. A review on the Avicenna's contribution to the field of cardiology.

    PubMed

    Zarshenas, Mohammad M; Zargaran, Arman

    2015-03-01

    The cardiology and field of cardiovascular approaches are often mentioned as of the earliest concerns throughout the history of mankind civilization. During the golden ages of Islamic era, 9th to 12th centuries A.D., medical knowledge from various fields including cardiology was flourished by prominent Persian physicians and scholars. Among those outstanding physicians and scientists of the Islamic golden era, Avicenna is known as a famous and pioneer character. To outline the cardiovascular knowledge and contribution of Avicenna, current review compiled all his evidence-based concepts of cardiovascular findings from current medical literatures as well as those mentioned in his important medical encyclopedia, the Canon of Medicine. In this review, Avicenna's findings on cardiovascular anatomy such as his description of Willis circle, capillary circulation and arterial and ventricular contractions in the cardiovascular system have been mentioned. Also, his books and manuscripts on cardiology as well as findings and theories on cardiovascular and allied diseases were discussed. These findings are included in his descriptions on cardiac tamponade, stroke, palpitation, atherosclerosis, hypertension, association of the cardiovascular complications with erection and ejaculation, interaction between the heart and emotions as well as some of his mentioned drugs for cardiological disorders and the early concepts of drug targeting. These results can show Avicenna's great contribution to improve the sciences of cardiology in early medieval era. PMID:25577770

  17. Patient-centered imaging: shared decision making for cardiac imaging procedures with exposure to ionizing radiation.

    PubMed

    Einstein, Andrew J; Berman, Daniel S; Min, James K; Hendel, Robert C; Gerber, Thomas C; Carr, J Jeffrey; Cerqueira, Manuel D; Cullom, S James; DeKemp, Robert; Dickert, Neal W; Dorbala, Sharmila; Fazel, Reza; Garcia, Ernest V; Gibbons, Raymond J; Halliburton, Sandra S; Hausleiter, Jörg; Heller, Gary V; Jerome, Scott; Lesser, John R; Raff, Gilbert L; Tilkemeier, Peter; Williams, Kim A; Shaw, Leslee J

    2014-04-22

    The current paper details the recommendations arising from an NIH-NHLBI/NCI-sponsored symposium held in November 2012, aiming to identify key components of a radiation accountability framework fostering patient-centered imaging and shared decision-making in cardiac imaging. Symposium participants, working in 3 tracks, identified key components of a framework to target critical radiation safety issues for the patient, the laboratory, and the larger population of patients with known or suspected cardiovascular disease. The use of ionizing radiation during an imaging procedure should be disclosed to all patients by the ordering provider at the time of ordering, and reinforced by the performing provider team. An imaging protocol with effective dose ≤3 mSv is considered very low risk, not warranting extensive discussion or written informed consent. However, a protocol effective dose >20 mSv was proposed as a level requiring particular attention in terms of shared decision-making and either formal discussion or written informed consent. Laboratory reporting of radiation dosimetry is a critical component of creating a quality laboratory fostering a patient-centered environment with transparent procedural methodology. Efforts should be directed to avoiding testing involving radiation, in patients with inappropriate indications. Standardized reporting and diagnostic reference levels for computed tomography and nuclear cardiology are important for the goal of public reporting of laboratory radiation dose levels in conjunction with diagnostic performance. The development of cardiac imaging technologies revolutionized cardiology practice by allowing routine, noninvasive assessment of myocardial perfusion and anatomy. It is now incumbent upon the imaging community to create an accountability framework to safely drive appropriate imaging utilization. PMID:24530677

  18. HEARTVIEW-A Knowledge Base to Support Clinical Research in Cardiology

    PubMed Central

    Leão, Beatriz de F.; Timmers, Teun; van der Lei, Johan; van Mulligen, Erik M.

    1990-01-01

    This paper presents HEARTVIEW - a knowledge base (KB) that offers aid for clinical research in cardiology. This KB is an essential component of the medical workstation MW2000, now under development at the department of Medical Informatics at the Erasmus University. HEARTVIEW integrates different types of knowledge: a conceptual model of the medical record in cardiology and knowledge on how to perform data analysis, according to the cardiological sub-domain. The design of HEARTVIEW is based on the assumption of a general structure in the medical record. The KB can be consulted by other modules in the MW2000 and by users through a medically-oriented graphical interface. The prototype is implemented on a Xerox 1100-series workstation. After evaluation, it will be transferred to the Unix environment, where the MW2000 is under development [1,2].

  19. Cardiac ablation procedures

    MedlinePlus

    ... food tips Heart attack - discharge Heart disease - risk factors Heart failure ... Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed ...

  20. A report from the European Society of Cardiology Congress 2014 (August 30-September 3 - Barcelona, Spain).

    PubMed

    Dulsat, C

    2014-09-01

    The European Society of Cardiology (ESC) Annual Congress is the largest cardiology conference in the world and this year ran in Barcelona from August 30 to September 3. During the meeting, more than 30,000 cardiologists from over 100 countries met to share their knowledge in all cardiovascular fields, from basic science to management and prevention of cardiovascular diseases. Apart from more than 4,500 interesting abstracts presented in posters and oral sessions, five new ESC Clinical Practice Guidelines were presented among the latest clinical trial results, updates and registries. PMID:25313372

  1. Report of the American College of Cardiology (ACC) Scientific Sessions 2015, San Diego.

    PubMed

    Murohara, Toyoaki

    2015-01-01

    The 64th Annual Scientific Sessions and Exposition of the American College of Cardiology (ACC) were held at the San Diego Convention Center from March 14-16, 2015. The ACC Scientific Sessions are 1 of 2 major scientific cardiology meetings in the United States, with nearly 20,000 attendees, including 15,000 cardiovascular professionals. There were over 2,100 oral and poster abstracts, and more than 15 late-breaking clinical trials (LBCTs) abstructs. This report presents the highlights and several key presentations, especially the LBCTs, from the ACC Scientific Sessions 2015. I hope this review will help cardiologists update to the latest information. PMID:25959559

  2. Radiation exposure benefit of a lead cap in invasive cardiology

    PubMed Central

    Kuon, E; Birkel, J; Schmitt, M; Dahm, J B

    2003-01-01

    Background: Occupational head exposure to radiation in cardiologists may cause radiation induced cataracts and an increased risk of brain cancer. Objective: To determine the effectiveness of 0.5 mm lead equivalent caps, not previously used in invasive cardiology, in comparison with a 1.0 mm lead equivalent ceiling mounted lead glass screen. Design: An anthropomorphic Alderson-Rando phantom was used to represent the patient. Scatter entrance skin air kerma to the operator position (S-ESAK-O) was measured during fluoroscopy for all standard angulations and the S-ESAK-O per dose–area product (DAP) calculated, as applied to the phantom. Results: Measured mean (SD) left/right anterior oblique angulation ratios of S-ESAK-O without lead devices were 23.1 (10.1), and varied as a function of tube angulation, body height, and angle of incidence. S-ESAK-O/DAP decreased with incremental operator body height by 10 (3)% per 10 cm. A 1.0 mm lead glass shield reduced mean S-ESAK-O/DAP originating from coronary angiography from 1089 (764) to 54 (29) nSv/Gy × cm2. A 0.5 mm lead cap was effective in lowering measured levels to 1.8 (1.1) nSv/Gy × cm2. Both devices together enabled attenuation to 0.5 (0.1) nSv/Gy × cm2. The most advantageous line of vision for protection of the operator’s eyes was ⩾ 60° rightward. Conclusions: Use of 0.5 mm lead caps proved highly effective, attenuating S-ESAK-O to 2.7 (2.0) × 10−3 of baseline, and to 1.2 (1.4) × 10−3 of baseline where there was an additional 1.0 mm lead glass shield. These results could vary according to the x ray systems used, catheterisation protocols, and correct use of radiation protection devices. PMID:12975420

  3. Applications of CdTe to nuclear medicine. Final report

    SciTech Connect

    Entine, G.

    1985-05-07

    Uses of cadmium telluride (CdTe) nuclear detectors in medicine are briefly described. They include surgical probes and a system for measuring cerebral blood flow in the intensive care unit. Other uses include nuclear dentistry, x-ray exposure control, cardiology, diabetes, and the testing of new pharmaceuticals. (ACR)

  4. The Adult Congenital and Pediatric Cardiology Section: increasing the opportunities for the congenital heart disease community within the American College of Cardiology.

    PubMed

    Martin, Gerard R; Mitchell, Stephanie; Beekman, Robert H; Feinstein, Jeffrey A; Jenkins, Kathy J; Landzberg, Michael; Webb, Gary

    2012-01-01

    The Adult Congenital and Pediatric Cardiology (AC/PC) Section was established to develop a clear voice within the American College of Cardiology and address the myriad issues facing the congenital heart disease profession. The Section is governed by the AC/PC Council, which includes pediatric cardiologists, adult congenital cardiologists, a cardiac care associate, and a fellow-in-training member. The Council is responsible for bidirectional communication between the College's Board of Trustees and the AC/PC Section members. Since its founding in 2004, Section objectives have been defined by the College's mission: to advocate for quality cardiovascular care through education, research promotion, and the development and application of standards and guidelines and to influence health care policy. The pillars of the College-advocacy, quality, education, and member engagement-serve as the defining template for the Section's strategy. The Section has developed work groups in advocacy, clinical practice, education and training, quality, and publications. A separate leadership group has been developed for adult congenital heart disease. Work groups are open to all Section members. Recognition of the importance of lifelong care in congenital heart disease led Section leaders to incorporate pediatric cardiology and adult congenital heart disease content into each of the work groups. There are more than 1,200 Section members, with nearly 400 members actively contributing to Section activities. This article outlines Section efforts to date and highlights significant successes to date. PMID:22192673

  5. Test of a Cardiology Patient Simulator with Students in Fourth-Year Electives.

    ERIC Educational Resources Information Center

    Ewy, Gordon A.; And Others

    1987-01-01

    Students at five medical schools participated in an evaluation of a cardiology patient simulator (CPS), a life-size mannequin capable of simulating a wide variety of cardiovascular conditions. The CPS enhances learning both the knowledge and the skills necessary to perform a bedside cardiovascular evaluation. (Author/MLW)

  6. Use of a reusable shielded marker to enhance the accuracy, safety, and efficacy of nuclear medicine procedures.

    PubMed

    Hayes, M; Altes, T; Teates, C D; Parekh, J

    2000-05-01

    Three cases illustrate the use of a reusable, shielded marker to identify anatomic structures and mark pathologic lesions. No other nuclear medicine marker is available with a shutter mechanism designed to interrupt radiation, thus protecting the patient and technologist from unnecessary radiation and minimizing image artifacts. PMID:10795694

  7. ENDF-102 data formats and procedures for the evaluated nuclear data file ENDF-6. Revision November 1995

    SciTech Connect

    McLane, V.; Dunford, C.L.; Rose, P.F.

    1995-11-01

    The ENDF formats and libraries are decided by the Cross Section Evaluation Working Group (CSEWG), a cooperative effort of national laboratories, industry, and universities in the US and Canada, and are maintained by the National Nuclear Data Center (NNDC). Earlier versions of the ENDF format provided representations for neutron cross sections and distributions, photon production from neutron reactions, a limited amount of charged-particle production from neutron reactions, photo-atomic interaction data, thermal neutron scattering data, and radionuclide production and decay data (including fission products). Version 6 (ENDF-6) allows higher incident energies, adds more complete descriptions of the distributions of emitted particles, and provides for incident charged particles and photo-nuclear data by partitioning the ENDF library into sublibraries. Decay data, fission product yield data, thermal scattering data, and photo-atomic data have also been formally placed in sublibraries. In addition, this rewrite represents an extensive update to the Version V manual.

  8. The Next Step in Deployment of Computer Based Procedures For Field Workers: Insights And Results From Field Evaluations at Nuclear Power Plants

    SciTech Connect

    Oxstrand, Johanna; Le Blanc, Katya L.; Bly, Aaron

    2015-02-01

    The paper-based procedures currently used for nearly all activities in the commercial nuclear power industry have a long history of ensuring safe operation of the plants. However, there is potential to greatly increase efficiency and safety by improving how the human operator interacts with the procedures. One way to achieve these improvements is through the use of computer-based procedures (CBPs). A CBP system offers a vast variety of improvements, such as context driven job aids, integrated human performance tools (e.g., placekeeping, correct component verification, etc.), and dynamic step presentation. The latter means that the CBP system could only display relevant steps based on operating mode, plant status, and the task at hand. A dynamic presentation of the procedure (also known as context-sensitive procedures) will guide the operator down the path of relevant steps based on the current conditions. This feature will reduce the operator’s workload and inherently reduce the risk of incorrectly marking a step as not applicable and the risk of incorrectly performing a step that should be marked as not applicable. The research team at the Idaho National Laboratory has developed a prototype CBP system for field workers, which has been evaluated from a human factors and usability perspective in four laboratory studies. Based on the results from each study revisions were made to the CBP system. However, a crucial step to get the end users' (e.g., auxiliary operators, maintenance technicians, etc.) acceptance is to put the system in their hands and let them use it as a part of their everyday work activities. In the spring 2014 the first field evaluation of the INL CBP system was conducted at a nuclear power plant. Auxiliary operators conduct a functional test of one out of three backup air compressors each week. During the field evaluation activity, one auxiliary operator conducted the test with the paper-based procedure while a second auxiliary operator followed

  9. Gallocyanin chromalum as a nuclear stain in cytology. I. A cytophotometric comparison of the Husain-Watts Gallocyanin chromalum staining protocol with the Feulgen procedure.

    PubMed

    Schulte, E K; Lyon, H; Prento, P

    1991-05-01

    In the present study, the staining characteristics of the Gallocyanin chromalum technique devised by Husain and Watts are compared with the Feulgen reaction. Liver imprints, blood smears, and cervical smears were fixed in ethanol and stained with either the Husain and Watts Gallocyanin chromalum reagent or the Feulgen-Schiff reagent. The slides were then post-treated with 70% ethanol-HCl pH 1.0, or with phosphotungstic acid for 0.5-30 min. The integrated optical density of cell nuclei was measured with a VIDAS image analyzer. In the material stained with the Husain and Watts procedure, some Gallocyanin chromalum was removed from the nuclei in the early phase (5 min) of all the post-treatment steps, followed by a plateau phase where the integrated optical density remained constant for 30 min. In this phase, the nuclear absorbance was highly reproducible and of the same size regardless of the post-treatment. Both the Husain and Watts procedure and the Feulgen-reaction gave quantitative staining of DNA. The Gallocyanin chromalum stain after Husain and Watts is a quick staining procedure for quantitative evaluation of DNA in cytological material. Proper rinsing of the slides is necessary for a good reproducibility of results. PMID:1723725

  10. The history of the German Cardiac Society and the American College of Cardiology and their two founders.

    PubMed

    Lüderitz, Berndt; Holmes, David R; Harold, John

    2013-02-26

    The German Cardiac Society is the oldest national cardiac society in Europe, founded on June 3, 1927, in Bad Nauheim by Dr. Bruno Kisch and Professor Arthur Weber. They were actively supported by Dr. Franz Groedel, who together with Kisch became co-founders of the American College of Cardiology in 1949. Both Groedel and Kisch would be proud to see the fulfillment of their visions and dreams, which was commemorated at the joint session of the two societies held during the 78th annual meeting of the German Cardiac Society in Mannheim, Germany. "It is ironic that their dreadful years in Germany and their loss to German Cardiology helped to contribute to advances in American and international Cardiology," said Dr. Simon Dack, American College of Cardiology president in 1956 and 1957. The legacy of Groedel might be reflected by his own words: "We will meet the future not merely by dreams but by concerned action and inextinguishable enthusiasm". PMID:23428213

  11. A Procedure for Determination of Degradation Acceptance Criteria for Structures and Passive Components in Nuclear Power Plants

    SciTech Connect

    Nie, J.; Braverman, J.; Hofmayer, C.; Choun, Y-S.; Hahm, D.; Choi, I-K.

    2012-01-30

    The Korea Atomic Energy Research Institute (KAERI) has been collaborating with Brookhaven National Laboratory since 2007 to develop a realistic seismic risk evaluation system which includes the consideration of aging of structures and components in nuclear power plants (NPPs). This collaboration program aims at providing technical support to a five-year KAERI research project, which includes three specific areas that are essential to seismic probabilistic risk assessment: (1) probabilistic seismic hazard analysis, (2) seismic fragility analysis including the effects of aging, and (3) a plant seismic risk analysis. The understanding and assessment of age-related degradations of structures, systems, and components and their impact on plant safety is the major goal of this KAERI-BNL collaboration. Four annual reports have been published before this report as a result of the collaboration research.

  12. [The beginning of Mexican cardiology in the springtime of the Mexican National Academy of Medicine].

    PubMed

    de Micheli, Alfredo

    2016-01-01

    The National Academy of Medicine was founded 141 years ago during the French intervention. Under the sponsorship of this brand-new medical association, Mexican cardioangiology took its first steps in the medical and surgical field as well. After the falling of the second empire, the medical and surgical advances of this discipline continued. The corresponding publications appeared in different volumes of the "Gaceta Médica de México"; at present journal of the Academy still published in our time. These steps permitted the development of the true cardiologic speciality during 40s of the twentieth century, due to the vision of Professor Ignacio Chávez, father of Mexican cardiology. Some examples of application are the epistemologic criteria in cardiologycal domains such as the conception of Riva-Rocci's sphygmomanometer in Italy in the nineteenth century and the so-called cardiac metabolic therapy in Mexico of our time, are included. PMID:26549154

  13. Neuropsychological Testing in Interventional Cardiology Staff after Long-Term Exposure to Ionizing Radiation.

    PubMed

    Marazziti, Donatella; Tomaiuolo, Francesco; Dell'Osso, Liliana; Demi, Virginia; Campana, Serena; Piccaluga, Emanuela; Guagliumi, Giulio; Conversano, Ciro; Baroni, Stefano; Andreassi, Maria Grazia; Picano, Eugenio

    2015-10-01

    This study aimed at comparing neuropsychological test scores in 83 cardiologists and nurses (exposed group, EG) working in the cardiac catheterization laboratory, and 83 control participants (non exposed group, nEG), to explore possible cognitive impairments. The neuropsychological assessment was carried out by means of a battery called "Esame Neuropsicologico Breve." EG participants showed significantly lower scores on the delayed recall, visual short-term memory, and semantic lexical access ability than the nEG ones. No dose response could be detected. EG participants showed lower memory and verbal fluency performances, as compared with nEG. These reduced skills suggest alterations of some left hemisphere structures that are more exposed to IR in interventional cardiology staff. On the basis of these findings, therefore, head protection would be a mandatory good practice to reduce effects of head exposure to ionizing radiation among invasive cardiology personnel (and among other exposed professionals). PMID:26400563

  14. Exploring the impact of an Aboriginal Health Worker on hospitalised Aboriginal experiences: lessons from cardiology.

    PubMed

    Taylor, Kate P; Thompson, Sandra C; Smith, Julie S; Dimer, Lyn; Ali, Mohammed; Wood, Marianne M

    2009-11-01

    To enhance Aboriginal inpatient care and improve outpatient cardiac rehabilitation utilisation, a tertiary hospital in Western Australia recruited an Aboriginal Health Worker (AHW). Interviews were undertaken with the cardiology AHW, other hospital staff including another AHW, and recent Aboriginal cardiac patients to assess the impact of this position. The impact of the AHW included facilitating culturally appropriate care, bridging communication divides, reducing discharges against medical advice, providing cultural education, increasing inpatient contact time, improving follow-up practices and enhancing patient referral linkages. Challenges included poor job role definition, clinical restrictions and limitations in AHW training for hospital settings. This study demonstrates that AHWs can have significant impacts on Aboriginal cardiac inpatient experiences and outpatient care. Although this study was undertaken in cardiology, the lessons are transferable across the hospital setting. PMID:20166903

  15. International project on individual monitoring and radiation exposure levels in interventional cardiology.

    PubMed

    Padovani, R; Le Heron, J; Cruz-Suarez, R; Duran, A; Lefaure, C; Miller, D L; Sim, H K; Vano, E; Rehani, M; Czarwinski, R

    2011-03-01

    Within the Information System on Occupational Exposure in Medicine, Industry and Research (ISEMIR), a new International Atomic Energy Agency initiative, a Working Group on interventional cardiology, aims to assess staff radiation protection (RP) levels and to propose an international database of occupational exposures. A survey of regulatory bodies (RBs) has provided information at the country level on RP practice in interventional cardiology (IC). Concerning requirements for wearing personal dosemeters, only 57 % of the RB specifies the number and position of dosemeters for staff monitoring. Less than 40 % of the RBs could provide occupational doses. Reported annual median effective dose values (often <0.5 mSv) were lower than expected considering validated data from facility-specific studies, indicating that compliance with continuous individual monitoring is often not achieved in IC. A true assessment of annual personnel doses in IC will never be realised unless a knowledge of monitoring compliance is incorporated into the analysis. PMID:21051431

  16. [Identification of psychologically impaired patients in cardiologic rehabilitation].

    PubMed

    Kittel, J; Karoff, M

    1998-05-01

    As psychological factors have a substantial influence on the further medical, psychological and occupational career of a patient with somatic disease, early identification of patients with psychological disturbances is of special importance in medical rehabilitation. The share of psychologically disturbed patients in a cardiac rehabilitation clinic has been screened. Different methods for identification of anxious and depressive patients (by medical and psychological staff as well as a screening instrument) are compared. Concluding, the benefit of introducing a screening instrument as a routine procedure is discussed under the aspect of effectivity. PMID:9653795

  17. Assessment of radiation dose in nuclear cardiovascular imaging using realistic computational models

    SciTech Connect

    Xie, Tianwu; Lee, Choonsik; Bolch, Wesley E.; Zaidi, Habib

    2015-06-15

    Purpose: Nuclear cardiology plays an important role in clinical assessment and has enormous impact on the management of a variety of cardiovascular diseases. Pediatric patients at different age groups are exposed to a spectrum of radiation dose levels and associated cancer risks different from those of adults in diagnostic nuclear medicine procedures. Therefore, comprehensive radiation dosimetry evaluations for commonly used myocardial perfusion imaging (MPI) and viability radiotracers in target population (children and adults) at different age groups are highly desired. Methods: Using Monte Carlo calculations and biological effects of ionizing radiation VII model, we calculate the S-values for a number of radionuclides (Tl-201, Tc-99m, I-123, C-11, N-13, O-15, F-18, and Rb-82) and estimate the absorbed dose and effective dose for 12 MPI radiotracers in computational models including the newborn, 1-, 5-, 10-, 15-yr-old, and adult male and female computational phantoms. Results: For most organs, {sup 201}Tl produces the highest absorbed dose whereas {sup 82}Rb and {sup 15}O-water produce the lowest absorbed dose. For the newborn baby and adult patient, the effective dose of {sup 82}Rb is 48% and 77% lower than that of {sup 99m}Tc-tetrofosmin (rest), respectively. Conclusions: {sup 82}Rb results in lower effective dose in adults compared to {sup 99m}Tc-labeled tracers. However, this advantage is less apparent in children. The produced dosimetric databases for various radiotracers used in cardiovascular imaging, using new generation of computational models, can be used for risk-benefit assessment of a spectrum of patient population in clinical nuclear cardiology practice.

  18. A study of role expansion: a new GP role in cardiology care

    PubMed Central

    2014-01-01

    Background The National Health Service is reconfiguring health care services in order to meet the increasing challenge of providing care for people with long-term conditions and to reduce the demand on specialised outpatient hospital services by enhancing primary care. A review of cardiology referrals to specialised care and the literature on referral management inspired the development of a new GP role in Cardiology. This new extended role was developed to enable GPs to diagnose and manage patients with mild to moderate heart failure or atrial fibrillation and to use a range of diagnostics effectively in primary care. This entailed GPs participating in a four-session short course with on-going clinical supervision. The new role was piloted in a small number of GP practices in one county in England for four months. This study explores the impact of piloting the Extended Cardiology role on the GP’s role, patients’ experience, service delivery and quality. Methods A mixed methods approach was employed including semi-structured interviews with GPs, a patient experience survey, a quality review of case notes, and analysis on activity and referral data. Results The participating GPs perceived the extended GP role as a professional development opportunity that had the potential to reduce healthcare utilisation and costs, through a reduction in referrals, whilst meeting the patient’s wishes for the provision of care closer to home. Patient experience of the new GP service was positive. The standard of clinical practice was judged acceptable. There was a fall in referrals during the study period. Conclusion This new role in cardiology was broadly welcomed as a model of care by the participating GPs and by patients, because of the potential to improve the quality of care for patients in primary care and reduce costs. As this was a pilot study further development and continuing evaluation of the model is recommended. PMID:24885826

  19. [Devices for visualizing biosignals for the comprehensive equipping of cardiology institutions].

    PubMed

    Kats, B M; Olifer, B M

    1981-01-01

    Purposeful activity of the Scientific-Production Association of Radioelectronic Medical Equipment in the creation, serial tissue and practical mastering of to-day's aids of biosignal visualization allows, in optimal way, realizing complete instrumentation of major links in cardiological service. Further perfection of these facilities is directed to more efficient diagnostic value of visible information, to acceleration of diagnostic process and its simplicity. PMID:7207090

  20. [Provision of apparatus to resuscitation and intensive therapy departments of the cardiology service].

    PubMed

    Smerdov, A A

    1980-01-01

    The article describes monitoring systems for following critically-ill patients, and cardio-resuscitation complex, apparatus for defibrillation, and short-term anaesthesy, cardiostimulators. All these units have been elaborated and serially produced by the Radioelectronic Medical Equipment Association. Their importance and place in providing the patients treatment and diagnosis in resuscitation and intensive care departments of the cardiological service are shown. PMID:7442501

  1. Impact of cardiology referral: clinical outcomes and factors associated with physicians' adherence to recommendations

    PubMed Central

    Marques, André C; Calderaro, Daniela; Yu, Pai C; Gualandro, Danielle M; Carmo, Gabriel A L; Azevedo, Fernanda R; Pastana, Adriana F; Lima, Eneas M O; Monachini, Maristela; Caramelli, Bruno

    2014-01-01

    OBJECTIVES: Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations. METHODS: We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected. RESULTS: Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99). CONCLUSIONS: Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations. PMID:25518017

  2. Population radiation dose from diagnostic nuclear medicine procedures in the Tehran population in 1999-2003: striking changes in only one decade.

    PubMed

    Tabeie, Faraj; Mohammadi, Hooshang; Asli, Isa Neshandar

    2013-02-01

    Use of unsealed radiopharmaceuticals in Iran's nuclear medicine centers has expanded rapidly in the last decade. As part of a nationwide survey, this study was undertaken to estimate the radiation risk due to the diagnostic nuclear medicine procedures performed in Tehran in 1999-2003. During the five years of the study, the data of 101,540 yearly examinations of diagnostic nuclear medicine were obtained for 34 (out of 40) active nuclear medicine centers in Tehran. The patients studied were aged 1 y, 5 y, 10 y, 15 y, and adults (>15 y). Compared to an earlier investigation in 1989 (which was published in 1995), striking changes were found to be occurring in the trends of nuclear medicine in Tehran in a matter of a decade. The frequency of cardiac examinations increased from less than 1% in 1989 to 43.2% (mean of 5 y) in 2003; thyroid examinations, with the relative frequency of higher than 80% in 1989, decreased to 26.7% in the current investigation (averaged for 2001); and the number of overall examinations per 1,000 population of Tehran increased from 1.9 in 1989 to 8.8 in this study (about fourfold). The decrease in relative frequency of thyroid examinations could be attributed to the lower referral policy (mainly by specialists), decreased incidence of goiter due to implementation of programs for iodine enrichment diets, introduction of fine needle aspiration (FNA), and sonography techniques for diagnosis of thyroid disease. The large increase in relative frequency of cardiac examinations could be due to the increase in the number of single photon emission computerized tomography (SPECT) systems in recent years as compared to 1989 in Tehran. The collective effective dose increased from 400 (person-Sv) in 1999 to 529 (person-Sv) in 2003, and the effective dose per capita increased from 34.80 μSv in 1999 to 44.06 μSv in 2003 (average, 35.60 μSv). PMID:23274814

  3. Sports cardiology: lessons from the past and perspectives for the future.

    PubMed

    Leischik, Roman

    2015-01-01

    The possibility of myocardial damage as a result of endurance sport has been known about since ancient times. According to a leg-end, a soldier named Pheidippides (more likely Philippides) dropped dead after run-ning from war-torn Marathon to Athens with the news of victory. Millennia later, we do not know whether he was a soldier or a courier, or whether he really ran the entire 240 km from Athens to Sparta and then back from Marathon to Athens. What is clear however, is that his death went down in history as the first documented exercise-related death and provides a tangible starting-point for the discipline of sport cardiology. Sports cardiology today covers a broad range of areas; from patients with cardiomyopathies, coronary disease and metabolic syndrome through to fitness fans, high-performance athletes and those with physically demanding professions. The following editorial introduces the primary topics for discussion to be included in the F1000Research channel Sports cardiology with the hope that this will evoke open, controversial and broad discourse in the form of reviews and original research papers in this important field. PMID:26097692

  4. Assessment and Utility of Frailty Measures in Critical Illness, Cardiology, and Cardiac Surgery.

    PubMed

    Rajabali, Naheed; Rolfson, Darryl; Bagshaw, Sean M

    2016-09-01

    Frailty is a clearly emerging theme in acute care medicine, with obvious prognostic and health resource implications. "Frailty" is a term used to describe a multidimensional syndrome of loss of homeostatic reserves that gives rise to a vulnerability to adverse outcomes after relatively minor stressor events. This is conceptually simple, yet there has been little consensus on the operational definition. The gold standard method to diagnose frailty remains a comprehensive geriatric assessment; however, a variety of validated physical performance measures, judgement-based tools, and multidimensional scales are being applied in critical care, cardiology, and cardiac surgery settings, including open cardiac surgery and transcatheter aortic value replacement. Frailty is common among patients admitted to the intensive care unit and correlates with an increased risk for adverse events, increased resource use, and less favourable patient-centred outcomes. Analogous findings have been described across selected acute cardiology and cardiac surgical settings, in particular those that commonly intersect with critical care services. The optimal methods for screening and diagnosing frailty across these settings remains an active area of investigation. Routine assessment for frailty conceivably has numerous purported benefits for patients, families, health care providers, and health administrators through better informed decision-making regarding treatments or goals of care, prognosis for survival, expectations for recovery, risk of complications, and expected resource use. In this review, we discuss the measurement of frailty and its utility in patients with critical illness and in cardiology and cardiac surgery settings. PMID:27476983

  5. Preliminary Study of Pet Owner Adherence in Behaviour, Cardiology, Urology, and Oncology Fields

    PubMed Central

    Talamonti, Zita; Cassis, Chiara; Brambilla, Paola G.; Scarpa, Paola; Stefanello, Damiano; Cannas, Simona; Minero, Michela; Palestrini, Clara

    2015-01-01

    Successful veterinary treatment of animals requires owner adherence with a prescribed treatment plan. The aim of our study was to evaluate and compare the level of adherence of the owners of patients presented for behavioural, cardiological, urological, and oncological problems. At the end of the first examination, each owner completed a questionnaire. Then, the owners were called four times to fill out another questionnaire over the phone. With regard to the first questionnaire, statistically significant data concern behavioral medicine and cardiology. In the first area the owner's worry decreases during the follow-up and the number of owners who would give away the animal increases. In cardiology, owners who think that the pathology harms their animal's quality of life decreased significantly over time. With regard to the 9 additional follow-up questions, in behavioural medicine and urology the owner's discomfort resulting from the animal's pathology significantly decreases over time. Assessment of adherence appears to be an optimal instrument in identifying the positive factors and the difficulties encountered by owners during the application of a treatment protocol. PMID:26185708

  6. Preliminary Study of Pet Owner Adherence in Behaviour, Cardiology, Urology, and Oncology Fields.

    PubMed

    Talamonti, Zita; Cassis, Chiara; Brambilla, Paola G; Scarpa, Paola; Stefanello, Damiano; Cannas, Simona; Minero, Michela; Palestrini, Clara

    2015-01-01

    Successful veterinary treatment of animals requires owner adherence with a prescribed treatment plan. The aim of our study was to evaluate and compare the level of adherence of the owners of patients presented for behavioural, cardiological, urological, and oncological problems. At the end of the first examination, each owner completed a questionnaire. Then, the owners were called four times to fill out another questionnaire over the phone. With regard to the first questionnaire, statistically significant data concern behavioral medicine and cardiology. In the first area the owner's worry decreases during the follow-up and the number of owners who would give away the animal increases. In cardiology, owners who think that the pathology harms their animal's quality of life decreased significantly over time. With regard to the 9 additional follow-up questions, in behavioural medicine and urology the owner's discomfort resulting from the animal's pathology significantly decreases over time. Assessment of adherence appears to be an optimal instrument in identifying the positive factors and the difficulties encountered by owners during the application of a treatment protocol. PMID:26185708

  7. 2013 update on congenital heart disease, clinical cardiology, heart failure, and heart transplant.

    PubMed

    Subirana, M Teresa; Barón-Esquivias, Gonzalo; Manito, Nicolás; Oliver, José M; Ripoll, Tomás; Lambert, Jose Luis; Zunzunegui, José L; Bover, Ramon; García-Pinilla, José Manuel

    2014-03-01

    This article presents the most relevant developments in 2013 in 3 key areas of cardiology: congenital heart disease, clinical cardiology, and heart failure and transplant. Within the area of congenital heart disease, we reviewed contributions related to sudden death in adult congenital heart disease, the importance of specific echocardiographic parameters in assessing the systemic right ventricle, problems in patients with repaired tetralogy of Fallot and indication for pulmonary valve replacement, and confirmation of the role of specific factors in the selection of candidates for Fontan surgery. The most recent publications in clinical cardiology include a study by a European working group on correct diagnostic work-up in cardiomyopathies, studies on the cost-effectiveness of percutaneous aortic valve implantation, a consensus document on the management of type B aortic dissection, and guidelines on aortic valve and ascending aortic disease. The most noteworthy developments in heart failure and transplantation include new American guidelines on heart failure, therapeutic advances in acute heart failure (serelaxin), the management of comorbidities such as iron deficiency, risk assessment using new biomarkers, and advances in ventricular assist devices. PMID:24774396

  8. Radiation safety in nuclear medicine: a practical guide. Final report

    SciTech Connect

    Sodd, V.J.

    1981-11-01

    This publication brings together, in concise form, information regarding the many recommendations and requirements for safe operation of a nuclear medicine laboratory. The need for such a compendium was perceived by the staff of the Nuclear Medicine Laboratory. This need arises from several sources. Many individuals enter the field with little training in the handling of radioactive materials; for example, a physician trained in cardiology, oncology, or neurology. The increasing development of portable instrumentation has allowed movement of radiopharmaceuticals from the confines of the nuclear medicine lab to coronary and intensive care facilities where personnel may lack adequate knowledge of safe handling procedures. A health physicist, trained to account for all radioactive material placed under his control, may have difficulty adapting to the accepted practice of releasing a patient who has been administered millicurie quantities of radioactivity, with little or no control over subsequent disposal of excreta. Further differences exist between handling practices for radioactive materials in the scientific laboratory and in the medical facility. This guide tries where possible to clarify some of these issues.

  9. A suggested procedure for resolving an anomaly in least-squares data analysis known as ``Peelle`s Pertinent Puzzle`` and the general implications for nuclear data evaluation

    SciTech Connect

    Chiba, Satoshi |; Smith, D.L.

    1991-09-01

    Modern nuclear-data evaluation methodology is based largely on statistical inference, with the least-squares technique being chosen most often to generate best estimates for physical quantities and their uncertainties. It has been observed that those least-squares evaluations which employ covariance matrices based on absolute errors that are derived directly from the reported experimental data often tend to produce results which appear to be too low. This anomaly is discussed briefly in this report, and a procedure for resolving it is suggested. The method involves employing data uncertainties which are derived from errors expressed in percent. These percent errors are used, in conjunction with reasonable a priori estimates for the quantities to be evaluated, to derive the covariance matrices which are required for applications of the least-squares procedure. This approach appears to lead to more rational weighting of the experimental data and, thus, to more realistic evaluated results than are obtained when the errors are based on the actual data. The procedure is very straightforward when only one parameter must be estimated. However, for those evaluation exercises involving more than one parameter, this technique demands that a priori estimates be provided at the outset for all of the parameters in question. Then, the least-squares method is applied iteratively to produce a sequence of sets of estimated values which are anticipated to convergence toward a particular set of parameters which one then designates as the ``best`` evaluated results from the exercise. It is found that convergence usually occurs very rapidly when the a priori estimates approximate the final solution reasonably well.

  10. Managing uncertainty in complex interventional fluoroscopic procedures.

    PubMed

    Leuenberger, Ronald; Meade, Jason A

    2014-11-01

    There was a concern for potential patient skin burns indicated by air kerma as recorded by fluoroscopy equipment during two interventional fluoroscopic procedures. Two sentinel events as defined by The Joint Commission were indicated. Dose reconstruction based on measurements of machine output showed the air kerma readings were high by approximately a factor of four and no patient injury or sentinel event occurred. The radiation safety program in effect at the time of the incidents allowed discovery of equipment problems before a serious patient injury occurred, but additional controls have been implemented as a result, including quality control checks performed by cardiology, additional training, a database for tracking equipment maintenance, and mandatory entry of patient dose into electronic health records with follow-up orders automatically generated by the electronic health records. Most unexpected injuries are a result of multiple failures, but there are also multiple opportunities to prevent the injury. This paper provides a comprehensive look at patient safety concerns during two interventional cardiology fluoroscopic procedures and offers ways to further reduce risks to patients. It focuses on lessons learned and a systems-based approach to improving and promoting radiation safety during complex interventional fluoroscopic procedures. PMID:25272028

  11. [Cardiology online: impact and pitfalls of Internet medical news].

    PubMed

    Wood, Shelley M; Topol, Eric J

    2012-01-01

    Twenty years ago, the main sources for physicians seeking information on new procedures, drugs, or devices were meetings and medical journals. The dawn of the Internet radically transformed how news and information is delivered and absorbed, beginning with the launch of online journals back in the mid-1990s. A decade and a half later, physicians can learn about new innovations the moment they are made public, and they can get that news from their phones and tablets, their Twitter or Facebook accounts, or via their favorite blog or medical news web site. Along with the clear advantages of accessing new medical information any time of day comes the need for physicians to be aware of the pitfalls of online medical content and to have a heightened sense of responsibility when it comes to integrating information gleaned online into their medical practices. PMID:22322467

  12. Interventional cardiology in perspective: impact on cardiac rehabilitation.

    PubMed

    Maier, W; Meier, B

    1998-11-01

    Exponential evolution of percutaneous, catheter-based revascularization has modified traditional premises of cardiac rehabilitation. With increasing numbers of percutaneous transluminal angioplasty (PTCA) procedures relative to coronary artery bypass grafting interventions, the need for in-patient rehabilitation is declining; on the other hand, the need for life-style counselling within the framework of out-patient rehabilitation is increasing. Risk factor interventions are important to minimize and to retard the progression of the disease. Rehabilitation programmes offer exercise training, stress modification and life style counselling to reduce cardiovascular risk factors and to increase exercise capability. Since costs of out-patient rehabilitation seem to be lower than those of in-patient rehabilitation, a case may be made in favour of directing limited funds to additional interventions and to saving money by replacing in-patient rehabilitation with outpatient programmes after PTCA. The budget-holder has to make the choice. PMID:9857946

  13. Mitral valve disease: a cardiologic-surgical interaction.

    PubMed

    Barlow, J B

    1996-10-01

    The respective roles of cardiologist and cardiac surgeon in the operative management of any specific case of mitral valve disease are variable. The range from the prevalent complete predominance of the surgeon through meaningful interaction between the two, concerning the timing and type of surgery, to predominance of the cardiologist when the surgeon accepts a role of technician. There are a number of scenarios in mitral valve surgery in which a reduced risk of postoperative hospital mortality and morbidity, by performing the simplest and shortest procedure, have to be balanced against enhanced peri-operative problems when other aspects are addressed that improve, sometimes markedly, the long-term prognosis. It is argued that a mildly stenotic aortic valve should often be replaced at the time of mitral valve surgery; that despite technical difficulties and a variable long-term postoperative course, surgeons should continue to repair rather than replace the mitral valves of young patients with severe mitral regurgitation despite the invariable presence of active rheumatic carditis; and that excess leaflet tissue and lax chordae in cases of degenerative mitral regurgitation are casually related to multifocal and potentially fatal ventricular ectopy. The crucial but neglected role of an organically abnormal tricuspid anulus in allowing dilatation and hence tricuspid regurgitation in patients with rheumatic mitral valve disease is considered in some detail. Such dilatation may occur late after mitral valve surgery for rheumatic disease, has generally and incorrectly been regarded as "functional" tricuspid regurgitation, contributes importantly to the postoperative "restriction-dilatation syndrome" and can be effectively prevented, or when once established then surgically managed, by a modified De Vega anuloplasty. Finally it is believed that, unlike mitral balloon valvuloplasty in selected instances, successful tricuspid balloon valvuloplasty can never be accomplished

  14. NMR clinical imaging and spectroscopy: Its impact on nuclear medicine

    SciTech Connect

    Not Available

    1990-02-02

    This is a collection of four papers describing aspects of past and future use of nuclear magnetic resonance as a clinical diagnostic tool. The four papers are entitled (1) What Does NMR Offer that Nuclear Medicine Does Not by Jerry W. Froelich, (2) Oncological Imaging: Now, Future and Impact Jerry W. Froelich, (3) Magnetic Resonance Spectroscopy/Spectroscopic Imaging and Nuclear Medicine: Past, Present and Future by H. Cecil Charles, and (4) MR Cardiology: Now, Future and Impact by Robert J. Herfkens.

  15. NMR clinical imaging and spectroscopy: Its impact on nuclear medicine

    SciTech Connect

    Not Available

    1990-02-02

    This is a collection of four papers describing aspects of past and future use of nuclear magnetic resonance as a clinical diagnostic tool. The four papers are entitled (1) What Does NMR Offer that Nuclear Medicine Does Not? by Jerry W. Froelich, (2) Oncological Imaging: Now, Future and Impact Jerry W. Froelich, (3) Magnetic Resonance Spectroscopy/Spectroscopic Imaging and Nuclear Medicine: Past, Present and Future by H. Cecil Charles, and (4) MR Cardiology: Now, Future and Impact by Robert J. Herfkens.

  16. A large-scale multicentre study in Belgium of dose area product values and effective doses in interventional cardiology using contemporary X-ray equipment.

    PubMed

    Bogaert, E; Bacher, K; Thierens, H

    2008-01-01

    In this paper, a large-scale multicentre patient dose study performed in eight Belgian interventional cardiology departments is presented. Effective dose (E) was calculated based on a detailed dose-area product (DAP)-registration during each procedure and by using conversion coefficients generated by the Monte Carlo-based computer program PCXMC. Conversion coefficients were found to be 0.177 mSv Gycm(-2) for systems that do not use any additional copper filtration in cineradiography and 0.207 mSv Gycm(-2) for systems that use additional copper filtration in cineradiography. Mean E values of 9.6 and 15.3 mSv for diagnostic and therapeutic procedures, respectively, were obtained. DAP distributions were investigated in order to derive dose reference levels: 71 and 106 Gycm2 for diagnostic and therapeutic procedures, respectively, are proposed. Significant differences were observed in DAP distributions taking into account whether additional copper filtration was used in the cineradiography mode. Apart from the skin, the organs most at risk are lungs and heart. The probability of fatal cancer for the studied population amounted to 1.1x10(-4) and 2.1x10(-4) for diagnostic and therapeutic procedures, respectively, for the age distribution of the patients considered in this multicentre study. PMID:17681964

  17. The development of iodine-123-methyl-branched fatty acids and their applications in nuclear cardiology

    SciTech Connect

    Knapp, F.F. Jr.; Ambrose, K.R.; Kropp, J.; Biersack, H.J.; Goodman, M.M.; Franken, P.; Reske, S.N.; Som, P.; Sloof, G.W.; Visser, F.C.

    1993-06-01

    Continued Interest in the use of iodine-1 23-labeled fatty acids for myocardial Imaging results from observations from a variety of studies that in many types of cardiac disease, regional fatty acid myocardial uptake patterns are often different than regional distribution of flow tracers. These differences may reflect alterations in important parameters of metabolism which can be useful for patient management or therapeutic strategy decision making. In addition, use of iodine-I 23-labeled fatty acid distribution may represent a unique metabolic probe to relate some aspects of the metabolism of these substrates with the regional viability of cardiac tissue. The use of such viability markers could provide important prognostic information on myocardial salvage, helping to identify patients for revascularization or angioplasty. Clinical studies are currently in progress with the iodine-123-labeled 1 5-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) fatty acid analogue at several institutions. The goals of this paper are to discuss development of the concept of metabolic trapping of fatty acids, to briefly review development and evaluation of various radioiodinated methyl-branched fatty acids and to discuss recent patient studies with iodine-123 (BMIPP) using single photon emission computerized tomography (SPECT).

  18. The development of iodine-123-methyl-branched fatty acids and their applications in nuclear cardiology

    SciTech Connect

    Knapp, F.F. Jr.; Ambrose, K.R. ); Kropp, J.; Biersack, H.J. . Inst. fuer Klinische und Experimentelle Nuklearmedizin); Goodman, M.M. . Dept. of Radiology); Franken, P. . Nuclear Medicine Dept.); Reske, S.N. (Ulm Univ. (Germany

    1993-01-01

    Continued Interest in the use of iodine-1 23-labeled fatty acids for myocardial Imaging results from observations from a variety of studies that in many types of cardiac disease, regional fatty acid myocardial uptake patterns are often different than regional distribution of flow tracers. These differences may reflect alterations in important parameters of metabolism which can be useful for patient management or therapeutic strategy decision making. In addition, use of iodine-I 23-labeled fatty acid distribution may represent a unique metabolic probe to relate some aspects of the metabolism of these substrates with the regional viability of cardiac tissue. The use of such viability markers could provide important prognostic information on myocardial salvage, helping to identify patients for revascularization or angioplasty. Clinical studies are currently in progress with the iodine-123-labeled 1 5-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) fatty acid analogue at several institutions. The goals of this paper are to discuss development of the concept of metabolic trapping of fatty acids, to briefly review development and evaluation of various radioiodinated methyl-branched fatty acids and to discuss recent patient studies with iodine-123 (BMIPP) using single photon emission computerized tomography (SPECT).

  19. SPECT attenuation correction: an essential tool to realize nuclear cardiology's manifest destiny.

    PubMed

    Garcia, Ernest V

    2007-01-01

    Single photon emission computed tomography (SPECT) myocardial perfusion imaging has attained widespread clinical acceptance as a standard of care for cardiac patients. Yet, physical phenomena degrade the accuracy of how our cardiac images are visually interpreted or quantitatively analyzed. This degradation results in cardiac images in which brightness or counts are not necessarily linear with tracer uptake or myocardial perfusion. Attenuation correction (AC) is a methodology that has evolved over the last 30 years to compensate for this degradation. Numerous AC clinical trials over the last 10 years have shown increased diagnostic accuracy over non-AC SPECT for detecting and localizing coronary artery disease, particularly for significantly increasing specificity and normalcy rate. This overwhelming evidence has prompted our professional societies to issue a joint position statement in 2004 recommending the use of AC to maximize SPECT diagnostic accuracy and clinical usefulness. Phantom and animal studies have convincingly shown how SPECT AC recovers the true regional myocardial activity concentration, while non-AC SPECT does not. Thus, AC is also an essential tool for extracting quantitative parameters from all types of cardiac radionuclide distributions, and plays an important role in establishing cardiac SPECT for flow, metabolic, innervation, and molecular imaging, our manifest destiny. PMID:17276302

  20. Performance evaluation of D-SPECT: a novel SPECT system for nuclear cardiology

    NASA Astrophysics Data System (ADS)

    Erlandsson, Kjell; Kacperski, Krzysztof; van Gramberg, Dean; Hutton, Brian F.

    2009-05-01

    D-SPECT (Spectrum Dynamics, Israel) is a novel SPECT system for cardiac perfusion studies. Based on CZT detectors, region-centric scanning, high-sensitivity collimators and resolution recovery, it offers potential advantages over conventional systems. A series of measurements were made on a β-version D-SPECT system in order to evaluate its performance in terms of energy resolution, scatter fraction, sensitivity, count rate capability and resolution. Corresponding measurements were also done on a conventional SPECT system (CS) for comparison. The energy resolution of the D-SPECT system at 140 keV was 5.5% (CS: 9.25%), the scatter fraction 30% (CS: 34%), the planar sensitivity 398 s-1 MBq-1 per head (99mTc, 10 cm) (CS: 72 s-1 MBq-1), and the tomographic sensitivity in the heart region was in the range 647-1107 s-1 MBq-1 (CS: 141 s-1 MBq-1). The count rate increased linearly with increasing activity up to 1.44 M s-1. The intrinsic resolution was equal to the pixel size, 2.46 mm (CS: 3.8 mm). The average reconstructed resolution using the standard clinical filter was 12.5 mm (CS: 13.7 mm). The D-SPECT has superior sensitivity to that of a conventional system with similar spatial resolution. It also has excellent energy resolution and count rate characteristics, which should prove useful in dynamic and dual radionuclide studies.

  1. Handbook of radiologic procedures

    SciTech Connect

    Hedgcock, M.

    1986-01-01

    This book is organized around radiologic procedures with each discussed from the points of view of: indications, contraindications, materials, method of procedures and complications. Covered in this book are: emergency radiology chest radiology, bone radiology, gastrointestinal radiology, GU radiology, pediatric radiology, computerized tomography, neuroradiology, visceral and peripheral angiography, cardiovascular radiology, nuclear medicine, lymphangiography, and mammography.

  2. Progress in interventional cardiology: challenges for the future.

    PubMed

    Simsekyilmaz, Sakine; Liehn, Elisa A; Militaru, Constantin; Vogt, Felix

    2015-03-01

    Cardiovascular disease is the leading cause of death in the western and developing countries. Percutaneous transluminal coronary interventions have become the most prevalent treatment option for coronary artery disease; however, due to serious complications, such as stent thrombosis and in-stent restenosis (ISR), the efficacy and safety of the procedure remain important issues to address. Strategies to overcome these aspects are under extensive investigation. In this review, we summarise relevant milestones during the time to overcome these limitations of coronary stents, such as the development of polymer-free drug-eluting stents (DES) to avoid pro-inflammatory response due to the polymer coating or the developement of stents with cell-directing drugs to, simultaneously, improve re-endothelialisation and inhibit ISR amongst other techniques most recently developed, which have not fully entered the clinical stage. Also the novel concept of fully biodegradable DES featured by the lack of a permanent foreign body promises to be a beneficial and applicable tool to restore a natural vessel with maintained vasomotion and to enable optional subsequent surgical revascularisation. PMID:25608683

  3. Current research in nuclear medicine and molecular imaging in Italy: highlights of the 10th National Congress of the Italian Association of Nuclear Medicine and Molecular Imaging.

    PubMed

    Cuocolo, A

    2011-06-01

    The 10th National Congress of the Italian Association of Nuclear Medicine and Molecular Imaging (AIMN) took place in Rimini on March 18-21, 2011 under the chairmanship of Professor Stefano Fanti. The program was of excellent quality and put a further step for the settlement of the standardized AIMN congress structure. A large industrial exhibition demonstrated the latest technological innovations and developments within the field. The congress was a great success with more than 1100 total participants and more than 360 abstracts received. Of these, 40 abstracts were accepted for oral and 285 for poster presentations. The original investigations presented were related to different areas of nuclear medicine and molecular imaging, with particular focus on advances in instrumentation and data processing, progress in radiochemistry and pharmacy, novel diagnostics and therapeutics, and new insights in well established areas of clinical application, such as oncology, cardiology, neurology, psychiatry, endocrinology, paediatrics, and infection and inflammation. Noteworthy, several presentations at this congress, focusing on quantitative interpretation of the imaging data and on pragmatic endpoints, such as adverse outcomes, identified when nuclear medicine procedures achieved clinical effectiveness for patient care and patient management and further demonstrated that nuclear medicine plays a crucial role in the contemporary medical scenario. This highlights lecture is only a brief summary of the large amount of data presented and discussed, which can be found in much greater detail in the congress abstract book, published as volume 55, supplement 1 of the Q J Nucl Med Mol Imaging in April 2011. PMID:21532541

  4. Improved cardiovascular diagnostic accuracy by pocket size imaging device in non-cardiologic outpatients: the NaUSiCa (Naples Ultrasound Stethoscope in Cardiology) study

    PubMed Central

    2010-01-01

    Miniaturization has evolved in the creation of a pocket-size imaging device which can be utilized as an ultrasound stethoscope. This study assessed the additional diagnostic power of pocket size device by both experts operators and trainees in comparison with physical examination and its appropriateness of use in comparison with standard echo machine in a non-cardiologic population. Three hundred four consecutive non cardiologic outpatients underwent a sequential assessment including physical examination, pocket size imaging device and standard Doppler-echo exam. Pocket size device was used by both expert operators and trainees (who received specific training before the beginning of the study). All the operators were requested to give only visual, qualitative insights on specific issues. All standard Doppler-echo exams were performed by expert operators. One hundred two pocket size device exams were performed by experts and two hundred two by trainees. The time duration of the pocket size device exam was 304 ± 117 sec. Diagnosis of cardiac abnormalities was made in 38.2% of cases by physical examination and in 69.7% of cases by physical examination + pocket size device (additional diagnostic power = 31.5%, p < 0.0001). The overall K between pocket size device and standard Doppler-echo was 0.67 in the pooled population (0.84 by experts and 0.58 by trainees). K was suboptimal for trainees in the eyeball evaluation of ejection fraction, left atrial dilation and right ventricular dilation. Overall sensitivity was 91% and specificity 76%. Sensitivity and specificity were lower in trainees than in experts. In conclusion, pocket size device showed a relevant additional diagnostic value in comparison with physical examination. Sensitivity and specificity were good in experts and suboptimal in trainees. Specificity was particularly influenced by the level of experience. Training programs are needed for pocket size device users. PMID:21110840

  5. Provision of services for the diagnosis and treatment of heart disease. Fourth report of a Joint Cardiology Committee of the Royal College of Physicians of London and the Royal College of Surgeons of England.

    PubMed Central

    1992-01-01

    The principal conclusions of the fourth report of the Joint Cardiology Committee are: 1 Cardiovascular disease remains a major cause of death and morbidity in the population and of utilisation of medical services. 2 Reduction in the risk of cardiovascular disease is feasible, and better co-ordination is required of strategies most likely to be effective. 3 Pre-hospital care of cardiac emergencies, in particular the provision of facilities for defibrillation, should continue to be developed. 4 There remains a large shortfall in provision of cardiological services with almost one in five district hospitals in England and Wales having no physician with the appropriate training. Few of the larger districts have two cardiologists to meet the recommendation for populations of over 250,000. One hundred and fifty extra consultant posts (in both district and regional centres) together with adequate supporting staff and facilities are urgently needed to provide modest cover for existing requirements. 5 The provision of coronary bypass grafting has expanded since 1985, but few regions have fulfilled the unambitious objectives stated in the Third Joint Cardiology Report. 6 The development of coronary angioplasty has been slow and haphazard. All regional centres should have at least two cardiologists trained in coronary angioplasty and there should be a designated budget. Surgical cover is still required for most procedures and is best provided on site. 7 Advances in the management of arrhythmias, including the use of specialised pacemakers, implantable defibrillators, and percutaneous or surgical ablation of parts of the cardiac conducting system have resulted in great benefit to patients. Planned development of the emerging sub-specialty of arrhythmology is required. 8 Strategies must be developed to limit the increased exposure of cardiologists to ionising radiation which will result from the expansion and increasing complexity of interventional procedures. 9 Supra

  6. Percutaneous interventions in cardiology in Poland in the year 2014. Summary report of the Association of Cardiovascular Interventions of the Polish Cardiac Society AISN PTK

    PubMed Central

    Siudak, Zbigniew; Legutko, Jacek; Parma, Radosław; Chmielak, Zbigniew; Bartuś, Stanisław; Dobrzycki, Sławomir; Grygier, Marek; Moszura, Tomasz; Pawłowski, Tomasz; Dudek, Dariusz

    2015-01-01

    Introduction The Board of the Association of Cardiovascular Interventions of the Polish Cardiac Society (AISN PTK) publishes annual data from the National PCI Registry (ORPKI) operated by the Jagiellonian University Medical College in Krakow. Aim For the first time the AISN PTK report is based on the new electronic database implemented in Poland on January 1st, 2014. Material and methods In 2014, there were 155 invasive cardiology centers registered in the ORPKI database (an increase by 1 center in comparison to 2013) and 92% of them had 24/7 percutaneous (PCI) duty. For the first time the number of catheterization laboratories (cath labs) in Poland remained stable, and even though there was an increase by 1 in absolute numbers, 2 cath labs ceased to admit patients in 2014. This means that the number of active cath labs per 1 million inhabitants is similar to last year and equals 4. Results In comparison to 2013, there was a significant increase in the total number of coronary angiographies. There were 226 713 angiographies in 2014. The total number of PCI procedures was 126 241, which is 5.1% more than in 2013. Conclusions There was a significant increase in the overall number of coronary angiographies and PCIs in Poland in 2014. The use of attributes of modern interventional cardiology such as drug-eluting stents and bioabsorbable vascular stents is growing as well as more frequent choice of a radial access site by PCI operators even in ST-elevation myocardial infarction patients. One should also note a significant rise in the use of additional imaging or diagnostic tools such as fractional flow reserve, intravascular ultrasound and optical coherent tomography. PMID:26677356

  7. The lebanese society of cardiology: plans and perspectives, navigating against contrary winds and progressing against all odds.

    PubMed

    Kossaify, Antoine; Moussallem, Nicolas

    2014-01-01

    Scientific societies in medicine theoretically aim to improve a medical field as a science; however, this role is expanding nowadays to seeking also the improved practice of a certain medical field. In this regard, the current Lebanese Society of Cardiology (2013-2015) has laid many plans and considered many perspectives. These concern mainly, but not exclusively, the increase of public awareness regarding prevention, investment in research, implementation of guidelines, support of continuous medical education, organization of cardiology symposia and congresses, and achievement of national registries regarding main cardiac conditions, as well as the society's main objective of decreasing the burden of cardiovascular diseases in Lebanon. Nonetheless, the implementation of such plans and perspectives is facing contrary winds related to a multifaceted phenomenon: the dominance of private medicine with a subsequent lack of teamwork, the dominance of private media, the social and political unrest in Lebanon, significant discrepancies in the scientific background of cardiologists, and the absence of a standardized national cardiology licensing exam. Importantly, the implementation of such plans and perspectives requires individual commitment, along with the cooperation of the Order of Physicians, the Syndicate of Hospitals in Lebanon (representing private hospitals) and the Ministry of Health. Moreover, industry must be more committed to medical scientific societies; the support of cardiology events organized without the auspices of the Lebanese Society of Cardiology is not encouraged because of the presence of significant conflict of interest. PMID:25452697

  8. The Lebanese Society of Cardiology: Plans and Perspectives, Navigating Against Contrary Winds and Progressing Against All Odds

    PubMed Central

    Kossaify, Antoine; Moussallem, Nicolas

    2014-01-01

    Scientific societies in medicine theoretically aim to improve a medical field as a science; however, this role is expanding nowadays to seeking also the improved practice of a certain medical field. In this regard, the current Lebanese Society of Cardiology (2013–2015) has laid many plans and considered many perspectives. These concern mainly, but not exclusively, the increase of public awareness regarding prevention, investment in research, implementation of guidelines, support of continuous medical education, organization of cardiology symposia and congresses, and achievement of national registries regarding main cardiac conditions, as well as the society’s main objective of decreasing the burden of cardiovascular diseases in Lebanon. Nonetheless, the implementation of such plans and perspectives is facing contrary winds related to a multifaceted phenomenon: the dominance of private medicine with a subsequent lack of teamwork, the dominance of private media, the social and political unrest in Lebanon, significant discrepancies in the scientific background of cardiologists, and the absence of a standardized national cardiology licensing exam. Importantly, the implementation of such plans and perspectives requires individual commitment, along with the cooperation of the Order of Physicians, the Syndicate of Hospitals in Lebanon (representing private hospitals) and the Ministry of Health. Moreover, industry must be more committed to medical scientific societies; the support of cardiology events organized without the auspices of the Lebanese Society of Cardiology is not encouraged because of the presence of significant conflict of interest. PMID:25452697

  9. Endocrinological and Cardiological Late Effects Among Survivors of Childhood Acute Lymphoblastic Leukemia

    PubMed Central

    Karakaya, Pakize; Yılmaz, Şebnem; Tüfekçi, Özlem; Kır, Mustafa; Böber, Ece; İrken, Gülersu; Ören, Hale

    2013-01-01

    Objective: Survival rates for childhood acute lymphoblastic leukemia (ALL) have significantly improved and late effects of therapy have been important in the follow-up of survivors. The objective of this study is to identify the endocrinological and cardiological late effects of ALL patients treated in our pediatric hematology unit. Materials and Methods: Patients treated for ALL with BFM protocols after at least 5 years of diagnosis and not relapsed were included in the study. Endocrinological late effects (growth failure, obesity, insulin resistance, dyslipidemia, thyroid gland disorders, osteopenia/osteoporosis, and pubertal disorders) and cardiological late effects were evaluated. The study group was evaluated with anthropometric measurements, body mass index, and laboratory testing of fasting glucose, insulin, serum lipids, thyroid functions, and bone mineral densities. Echocardiography and pulsed wave Doppler imaging were performed for analysis of cardiac functions. Results: Of the 38 ALL survivors, at least 1 adverse event occurred in 23 (60%), with 8 of them (21%) having multiple problems. Six (16%) of the survivors were obese and 8 (21%) of them were overweight. Subjects who were overweight or obese at the time of diagnosis were more likely to be overweight or obese at last follow-up. Obesity was more frequently determined in patients who were younger than 6 years of age at the time of diagnosis. Insulin resistance was observed in 8 (21%) subjects. Insulin resistance was more frequently seen in subjects who had family history of type 2 diabetes mellitus. Hyperlipidemia was detected in 8 (21%) patients. Hypothyroidism or premature thelarche were detected in 2 children. Two survivors had osteopenia. Cardiovascular abnormalities occurred in one of the subjects with hypertension and cardiac diastolic dysfunction. Conclusion: We point out the necessity of follow-up of these patients for endocrinological and cardiological late effects, since at least one adverse

  10. Improving VTE risk assessment at point of admission to a tertiary centre cardiology ward.

    PubMed

    Wilson, Rachel

    2015-01-01

    Cardiology wards are generally high turnover units, which may receive primary PCI, high-risk NSTEMI patients, and other general cardiac admissions from a large geographical area. Many centres also provide national specialist services for rarer cardiac conditions for which admissions may be lengthy. Cardiac patients have significant risk factors for venous thromboembolism (VTE) as immobility may be due to systolic dysfunction, attachment to continuous monitoring and predisposition to chest pain, or cardiac syncope. It is recommended by NICE that an initial VTE risk assessment is undertaken at the time of patient admission, with reassessment within 24 hours. For this purpose a risk assessment tool is featured on the front of many Trust drug charts. It is noted that this risk assessment is electronic in other trusts. We undertook an audit into the drug chart documentation of VTE risk assessment on the cardiology ward and the Coronary Care Unit (CCU) at The Royal Free Hospital. It was evident that documentation of VTE risk assessment was poor. The audit interventions were; a teaching presentation to the cardiology department, an educational poster, several update emails to the department and the identification of a 'VTE risk assessment champion' to audit ongoing compliance. Following these measures the second audit round demonstrated that documentation of initial risk assessment was slightly improved, but significant improvement was seen in documentation of risk assessment at 24 hours post admission. Results from a third audit cycle indicated that the improvement in initial VTE risk assessment was sustained, and that there was a significant sustained improvement in risk assessment at 24 hours (p <0.05). Recommendations for sustained improvement included: redesigning the drug chart so that the VTE risk assessment tool was linked to the VTE prophylaxis prescription box, and designating the responsibility of the initial VTE risk assessment to the on call junior doctor who

  11. Improving VTE risk assessment at point of admission to a tertiary centre cardiology ward

    PubMed Central

    Wilson, Rachel

    2015-01-01

    Cardiology wards are generally high turnover units, which may receive primary PCI, high-risk NSTEMI patients, and other general cardiac admissions from a large geographical area. Many centres also provide national specialist services for rarer cardiac conditions for which admissions may be lengthy. Cardiac patients have significant risk factors for venous thromboembolism (VTE) as immobility may be due to systolic dysfunction, attachment to continuous monitoring and predisposition to chest pain, or cardiac syncope. It is recommended by NICE that an initial VTE risk assessment is undertaken at the time of patient admission, with reassessment within 24 hours. For this purpose a risk assessment tool is featured on the front of many Trust drug charts. It is noted that this risk assessment is electronic in other trusts. We undertook an audit into the drug chart documentation of VTE risk assessment on the cardiology ward and the Coronary Care Unit (CCU) at The Royal Free Hospital. It was evident that documentation of VTE risk assessment was poor. The audit interventions were; a teaching presentation to the cardiology department, an educational poster, several update emails to the department and the identification of a ‘VTE risk assessment champion’ to audit ongoing compliance. Following these measures the second audit round demonstrated that documentation of initial risk assessment was slightly improved, but significant improvement was seen in documentation of risk assessment at 24 hours post admission. Results from a third audit cycle indicated that the improvement in initial VTE risk assessment was sustained, and that there was a significant sustained improvement in risk assessment at 24 hours (p <0.05). Recommendations for sustained improvement included: redesigning the drug chart so that the VTE risk assessment tool was linked to the VTE prophylaxis prescription box, and designating the responsibility of the initial VTE risk assessment to the on call junior doctor

  12. Early cardiology assessment and intervention reduces mortality following myocardial injury after non-cardiac surgery (MINS)

    PubMed Central

    Hua, Alina; Pattenden, Holly; Leung, Maria; Davies, Simon; George, David A.; Raubenheimer, Hilgardt; Niwaz, Zakiyah

    2016-01-01

    Background Myocardial injury after non-cardiac surgery (MINS) is defined as troponin elevation of ≥0.03 ng/mL associated with 3.87-fold increase in early mortality. We sought to determine the impact of cardiology intervention on mortality in patients who developed MINS after general thoracic surgery. Methods A retrospective review was performed in patients over 5 years. Troponin was routinely measured and levels ≥0.04 ng/mL classified as positive. Data acquisition and mortality status was obtained via medical records and NHS tracing systems. Thirty-day mortality was compared on MINS cohort using Fisher’s exact square testing and logistic regression analysis. Results Troponin levels were measured in 491 (96%) of 511 patients. Eighty (16%) patients fulfilled the MINS criteria. Sixty-one (76%) received early cardiology consult and “myocardial infarction” stated in four (5%) patients. Risk assessment (for AMI) was undertaken; 20 (25%) patients were commenced on aspirin, four (5%) on β-blockers and one (1%) underwent percutaneous coronary intervention. Forty-nine (61%) patients received primary risk factor modifications and 26 (33%) had outpatient follow-up. There were no significant differences in the proportion of patients who died within 30 days post-operatively in the MINS group of 2.6% compared to the non-MINS group of 1.6% (P=0.625). The odds ratio for 30-day mortality in the MINS group was 1.69 (95% CI: 0.34 to 8.57, P=0.522). Conclusions MINS is common after general thoracic surgery. Early cardiology intervention reduced the expected hazard ratio of early death from 3.87 to an odds ratio of 1.69 with no significant difference in 30-day mortality for patients who developed MINS. PMID:27162667

  13. Is reversal of endothelial dysfunction still an attractive target in modern cardiology?

    PubMed Central

    Mordi, Ify; Tzemos, Nikolaos

    2014-01-01

    Although the endothelium has a number of important functions, the term endothelial dysfunction is commonly used to describe impairment in its vasodilatory capacity. There have been numerous studies evaluating the relationship between endothelial dysfunction and cardiovascular disease, however assessment of endothelial function is perhaps still primarily thought of as a research tool and has not reached widespread clinical acceptance. In this review we explore the relationship between endothelial dysfunction and cardiovascular disease, its prognostic significance, methods of pharmacological reversal of endothelial dysfunction, and ask the question, is reversal of endothelial dysfunction still an attractive target in modern cardiology? PMID:25228961

  14. [Pay for performance approach and its possible future influence on revenues in German interventional cardiology units].

    PubMed

    Miljak, Tomislav; Rupp, Wolfgang

    2016-01-01

    Pay-for-performance in German health care system is still uncommon but--in view of scheduled legislative projects--could gain more influence in future. Beside others, risc adjusted in-hospital mortality and the door-to-ballon-time inpatients with ST-elevation myocardial infarction could become quality- and performance indicators in interventional cardiology units. As a result, process optimization based on these indicators could have an impact on both patient value (as already today) and revenues (from 2017 onwards). PMID:26800075

  15. Biomarkers in Cardiology - Part 2: In Coronary Heart Disease, Valve Disease and Special Situations

    PubMed Central

    2015-01-01

    Cardiovascular diseases are the main causes of mortality and morbidity in Brazil. Their primary and secondary preventions are a priority for the health system and require multiple approaches for increased effectiveness. Biomarkers are tools used to identify with greater accuracy high-risk individuals, establish a faster diagnosis, guide treatment, and determine prognosis. This review aims to highlight the importance of biomarkers in clinical cardiology practice and raise relevant points regarding their application and perspectives for the next few years. This document was divided into two parts. This second part addresses the application of biomarkers in coronary heart disease, valvular diseases, cardio-oncology, pulmonary embolism, and cardiorenal syndrome. PMID:26083777

  16. Biomarkers in Cardiology – Part 1 – In Heart Failure and Specific Cardiomyopathies

    PubMed Central

    2014-01-01

    Cardiovascular diseases are the leading causes of mortality and morbidity in Brazil. The primary and secondary preventions of those diseases are a priority for the health system and require multiple approaches to increase their effectiveness. Biomarkers are tools used to more accurately identify high-risk individuals, to speed the diagnosis, and to aid in treatment and prognosis determination. This review aims to highlight the importance of biomarkers in clinical cardiology practice, and to raise relevant points of their use and the promises for the coming years. This document was divided into two parts, and this first one discusses the use of biomarkers in specific cardiomyopathies and heart failure. PMID:25590924

  17. The Genesis, Maturation, and Future of Critical Care Cardiology.

    PubMed

    Katz, Jason N; Minder, Michael; Olenchock, Benjamin; Price, Susanna; Goldfarb, Michael; Washam, Jeffrey B; Barnett, Christopher F; Newby, L Kristin; van Diepen, Sean

    2016-07-01

    The cardiac intensive care unit (CICU) has changed considerably over time and now serves a unique patient population with a high burden of cardiovascular and noncardiovascular critical illness. Patient complexity and technological evolutions in the CICU have catalyzed the development of critical care cardiology, a fledgling discipline that combines specialization in cardiovascular diseases with knowledge and experience in critical care medicine. Numerous uncertainties and challenges threaten to stymie the growth of this field. A multidisciplinary dialogue focused on the best care design for the CICU patient is needed as we consider alternative approaches to clinical training, staffing, and investigation in this rapidly evolving arena. PMID:27364053

  18. [Medical and social medicine correlates of serum cholesterol value during and after inpatient cardiologic rehabilitation--a prospective study].

    PubMed

    Keck, M; Budde, H G

    1999-08-01

    The connection between changes in the serum cholesterol value during and after in-patient cardiological rehabilitation on the one hand and medical and sociomedical variables on the other is investigated. In 162 male and female patients up to 60 years of age undergoing inpatient cardiological rehabilitation under the pension insurance scheme for workers, a significant decrease of serum cholesterol values could be observed between the beginning and the end of cardiological rehabilitation of 24.5 mg% (10.6%), with a subsequent increase of 12.5 mg% (6%) seven months later. Independent of a possible medical antilipemic therapy the group of patients with a positive occupational perspective was found to have better controlled serum cholesterol values than pensioners or those patients with a negative occupational perspective such as unemployment or dismissal. It can be assumed that those patients having a positive occupational perspective are more likely to follow dietetic and/or medical therapeutic regimes. PMID:10507094

  19. Nuclear Stress Test

    MedlinePlus

    ... Scan Diagnostic Tests and Procedures Echocardiography Electrocardiogram Electrophysiology Studies Exercise Stress Test Holter Monitoring Intravascular Ultrasound Nuclear Ventriculography Optical ...

  20. The worldwide environment of cardiovascular disease: prevalence, diagnosis, therapy, and policy issues: a report from the American College of Cardiology.

    PubMed

    Laslett, Lawrence J; Alagona, Peter; Clark, Bernard A; Drozda, Joseph P; Saldivar, Frances; Wilson, Sean R; Poe, Chris; Hart, Menolly

    2012-12-25

    The environment in which the field of cardiology finds itself has been rapidly changing. This supplement, an expansion of a report created for the Board of Trustees, is intended to provide a timely snapshot of the socio-economic, political, and scientific aspects of this environment as it applies to practice both in the United States and internationally. This publication should assist healthcare professionals looking for the most recent statistics on cardiovascular disease and the risk factors that contribute to it, drug and device trends affecting the industry, and how the practice of cardiology is changing in the United States. PMID:23257320

  1. Pulse waveform analysis as a bridge between pulse examination in Chinese medicine and cardiology.

    PubMed

    de Sá Ferreira, Arthur; Lopes, Agnaldo José

    2013-04-01

    Pulse examination was probably the earliest attempt to distinguish between health and illnesses. Starting at the pre-Hippocratic era, Chinese medicine practitioners developed techniques for pulse examination and defined pulse images based on their perceptions of pulse waveforms at the radial artery. Pulse images were described using basic variables (frequency, rhythm, wideness, length, deepness, and qualities) developed under philosophical trends such as Taoism and Confucianism. Recent advances in biomedical instrumentation applied to cardiology opened possibilities to research on pulse examination based on ancient Chinese medical theories: the pulse wave analysis. Although strongly influenced by philosophy, some characteristics used to describe a pulse image are interpretable as parameters obtained by pulse waveform analysis such as pulse wave velocity and augmentation index. Those clinical parameters reflect concepts unique to Chinese medicine - such as yinyang - while are based on wave reflection and resonance theories of fluids mechanics. Major limitations for integration of Chinese and Western pulse examination are related to quantitative description of pulse images and pattern differentiation based on pulse examination. Recent evidence suggests that wave reflection and resonance phenomena may bridge Chinese medicine and cardiology to provide a more evidence-based medical practice. PMID:23546634

  2. Paediatric interventional cardiology: flat detector versus image intensifier using a test object

    NASA Astrophysics Data System (ADS)

    Vano, E.; Ubeda, C.; Martinez, L. C.; Leyton, F.; Miranda, P.

    2010-12-01

    Entrance surface air kerma (ESAK) values and image quality parameters were measured and compared for two biplane angiography x-ray systems dedicated to paediatric interventional cardiology, one equipped with image intensifiers (II) and the other one with dynamic flat detectors (FDs). Polymethyl methacrylate phantoms of different thicknesses, ranging from 8 to 16 cm, and a Leeds TOR 18-FG test object were used. The parameters of the image quality evaluated were noise, signal-difference-to-noise ratio (SdNR), high contrast spatial resolution (HCSR) and three figures of merit combining entrance doses and signal-to-noise ratios or HCSR. The comparisons showed a better behaviour of the II-based system in the low contrast region over the whole interval of thicknesses. The FD-based system showed a better performance in HCSR. The FD system evaluated would need around two times more dose than the II system evaluated to reach a given value of SdNR; moreover, a better spatial resolution was measured (and perceived in conventional monitors) for the system equipped with flat detectors. According to the results of this paper, the use of dynamic FD systems does not lead to an automatic reduction in ESAK or to an automatic improvement in image quality by comparison with II systems. Any improvement also depends on the setting of the x-ray systems and it should still be possible to refine these settings for some of the dynamic FDs used in paediatric cardiology.

  3. The dawn of a new era in onco-cardiology: The Kumamoto Classification.

    PubMed

    Sueta, Daisuke; Tabata, Noriaki; Akasaka, Tomonori; Yamashita, Takayoshi; Ikemoto, Tomokazu; Hokimoto, Seiji

    2016-10-01

    The term "onco-cardiology" has been used in reference to cardiotoxicity in the treatment of malignant disease. In actual clinical situations, however, cardiovascular disease (CVD) associated with malignant disease and the concurrence of atherosclerotic disease with malignant disease are commonly observed, complicating the course of treatment. Patients with malignant disease associated with coronary artery disease often die from the cardiovascular disease, so it is essential to classify these disease states. Additionally, the prevalence of these classifications makes it easy to manage patients with malignant disease and coronary artery disease. We divided the broad field of onco-cardiology into 4 classifications based on clinical scenarios (CSs): CS1 represents the so-called paraneoplastic syndrome. CS2 represents cardiotoxicity during treatment of malignant diseases. CS3 represents the concurrence of atherosclerotic disease with malignant disease, and CS4 represents cardiovascular disease with benign tumors. This classification facilitates the management of patients with malignant disease and coronary artery disease by promoting not only the primary but also the secondary prevention of CVD. PMID:27394984

  4. Accidental nuclear war: Modifications to superpower arsenals and to procedures for handling them could substantially reduce the risk of unintended Armageddon

    SciTech Connect

    Blair, B.G.; Kendall, H.W.

    1990-12-01

    If nuclear war breaks out in the coming decade or two, it will probably be by accident. The threat of a cold-blooded, calculated first strike is vanishing, but beneath the calm surface of constructive diplomacy among the traditional nuclear rivals lurks the danger of unpremeditated use of nuclear weapons. The accidental, unauthorized or inadvertent use of these weapons has become the most plausible path to nuclear war. Both superpowers, as well as France, Great Britain and China - long-standing members of the nuclear club - are potential sources of accidental missile launch. The emergence of fledgling nuclear powers such as India, Pakistan and Israel - some armed with ballistic missiles - pushes nuclear safeguards even closer to the top of the international security agenda. The chances of unwanted nuclear war would be reduced significantly if tamper proof, coded locks were installed on all nuclear weapons and if methods were put in place to disarm nuclear forces even after launch. In addition, the US and the Soviet Union should reduce their reliance on the dangerous policy of launch on warning and reduce the launch readiness of their nuclear forces. The social and political upheavals in the Soviet Union underscore fears of unintended nuclear war. Civil turmoil raises the possibility that rebellious ethnic groups or splinter organizations could capture nuclear weapons. Other, deeper fault lines run through the whole of Soviet society and may be capable of cracking the foundations of its nuclear command system. Although the US faces no such civil unrest, the country's system of nuclear command carries some risk that nuclear weapons might be used contrary to the intentions of legitimate authorities.

  5. Costing imaging procedures.

    PubMed

    Bretland, P M

    1988-01-01

    The existing National Health Service financial system makes comprehensive costing of any service very difficult. A method of costing using modern commercial methods has been devised, classifying costs into variable, semi-variable and fixed and using the principle of overhead absorption for expenditure not readily allocated to individual procedures. It proved possible to establish a cost spectrum over the financial year 1984-85. The cheapest examinations were plain radiographs outside normal working hours, followed by plain radiographs, ultrasound, special procedures, fluoroscopy, nuclear medicine, angiography and angiographic interventional procedures in normal working hours. This differs from some published figures, particularly those in the Körner report. There was some overlap between fluoroscopic interventional and the cheaper nuclear medicine procedures, and between some of the more expensive nuclear medicine procedures and the cheaper angiographic ones. Only angiographic and the few more expensive nuclear medicine procedures exceed the cost of the inpatient day. The total cost of the imaging service to the district was about 4% of total hospital expenditure. It is shown that where more procedures are undertaken, the semi-variable and fixed (including capital) elements of the cost decrease (and vice versa) so that careful study is required to assess the value of proposed economies. The method is initially time-consuming and requires a computer system with 512 Kb of memory, but once the basic costing system is established in a department, detailed financial monitoring should become practicable. The necessity for a standard comprehensive costing procedure of this nature, based on sound cost accounting principles, appears inescapable, particularly in view of its potential application to management budgeting. PMID:3349241

  6. Evaluation of neurological and cardiological findings in carbonmonoxide poisoning in children

    PubMed Central

    Boztepe, Hatice; Yalaki, Zahide; Bilge, Yıldız Dallar

    2014-01-01

    Aim: The aim of our study was to investigate the relation of blood carboxyhemoglobin level with presentation finding and clinical properties and to demonstrate neurological and cardiological findings which are indicators of tissue hypoxia in patients followed up because of carbonmonoxide (CO) poisoning. Material and Methods: Three hundred and twenty-five patients who were followed up because of carbonmonoxide poisoning between 2011 and 2013 in our pediatric emergency department were evaluated prospectively. Ethics committee approval was obtained for the study on 10.19.2011 (number: 0437). The carbonmonoxide levels, source of intoxication, neurological and cardiological findings and treatment methods were recorded. Blood gases and cardiac enzymes were studied and electrocardiography (ECG) was performed. The data were analysed using SPSS for windows 16.0 package program. Results: One hundred and sixty-eight (51.7%) of the patients were female and the median age was 9 years (11 days–17 years). Two hundred and twenty-eight (70.2%) of the patients were poisoned while using heater and 78.1% presented during winter months. The median carbonmonoxide level of the patients was found to be 24.8%. Cardiac enzymes were found to be increased in 10.5% of the patients, first degree A-V block was found in 0.6% and negative T wave was found in 0.3%. Glasgow coma score was found to be below 14 in 4.6% of the patients. A significant correlation was found between the carboxyhemoglobin levels and neurological findings, cardiological findings and lactate (p<0.05). Normobaric oxygen treatment was given to 76.3% of the patients and hyperbaric oxygen treatment was given to 23.7%. Conclusions: We think that neurological disorders and cardiac findings may be closely related, since systemic involvement may be easier in carbonmonoxide poisoning in children, Glasgow coma score should be assessed in the follow-up of the patients and cardiac enzymes and serum lactate levels should be monitored

  7. The changing interface between district hospital cardiology and the major cardiac centres

    PubMed Central

    1997-01-01

    The national priority for reducing mortality and morbidity from cardiovascular disease, the resulting expansion in the number of consultant cardiologists, and the reforms of the National Health Service have produced significant changes in delivery of care for cardiac patients and in the relations between district general hospitals (DGH) and the old regional cardiac centres. 1.2 The British Cardiac Society, the Medical Royal Colleges of Physicians of London and Edinburgh, and the Royal College of Physicians and Surgeons of Glasgow established a working group to make recommendations on the most appropriate evolution of these changes to secure high quality care in a cost-effective and professionally rewarding environment. The principal conclusions of the working group were: i) The establishment of new cardiac catheterisation laboratories in DGHs remote from a major cardiac centre should be encouraged provided the workload is adequate to ensure efficient use of the facility. ii) Cardiologists working in districts close to a major centre should be encouraged to catheterise their patients at the centre. iii) Close liaison of the district cardiologist with a cardiac surgeon and interventionist is vitally important. iv) The centres will be required to provide tertiary care for emergency and urgent cases from their traditional catchment area, specialised expertise for the management of rare and difficult cases, and angioplasty. Some centres will also offer complex electrophysiology, and ablation techniques. v) The centres must also provide routine cardiology services for their local district, facilities for cardiac catheterisation for DGH cardiologists, and training for doctors, nurses, technicians, and radiographers. vi) Some centres will be linked with paediatric cardiology and paediatric cardiac surgical units. vii) District cardiac centres will be required to provide a full non-invasive diagnostic service and emergency care for patients referred by general practitioners

  8. Complementary and alternative medicine: a survey of its use in pediatric cardiology

    PubMed Central

    Adams, Denise; Whidden, Ashley; Honkanen, Meeri; Dagenais, Simon; Clifford, Tammy; Baydala, Lola; King, W. James

    2014-01-01

    Background The use of complementary and alternative medicine is high among children and youth with chronic illnesses, including patients with cardiac conditions. Our goal was to assess the prevalence and patterns of such use among patients presenting to academic pediatric cardiology clinics in Canada. Methods A survey instrument was developed to inquire about current or previous use of complementary and alternative medicine products and practices, including indications, beliefs, sources of information and whether this use was discussed with physicians. Between February and July 2007, the survey was administered to patients (or their parents/guardians) presenting to 2 hospital-based cardiology clinics: the Stollery Children’s Hospital in Edmonton, Alberta, and the Children’s Hospital of Eastern Ontario in Ottawa, Ontario. Results At the Stollery Children’s Hospital, 64.1% of the 145 respondents had used complementary and alternative medicine compared with 35.5% of the 31 respondents at the Children’s Hospital of Eastern Ontario (p = 0.003). Overall, the most common products in current use were multivitamins (70.6%), vitamin C (22.1%), calcium (13.2%), unspecified “cold remedies” (11.8%) and fish oil or omega-3 fatty acids (11.8%). The most common practices in current use were massage (37.5%), faith healing (25.0%), chiropractic (20.0%), aromatherapy (15.0%) and Aboriginal healing (7.5%). Many patients (44.9%) used complementary and alternative medicine products at the same time as conventional prescription drugs. Concurrent use was discussed with physicians or pharmacists by 64.3% and 31.3% of respondents, respectively. Interpretation Use of complementary and alternative medicine products and practices was high among patients seen in the pediatric cardiology clinics in our study. Most respondents believed that the use of these products and practices was helpful; few reported harms and many did not discuss this use with their physicians, increasing the

  9. The radiology informed consent form: recommendations from the European Society of Cardiology position paper.

    PubMed

    Carpeggiani, Clara; Picano, Eugenio

    2016-06-01

    Every radiological and nuclear medicine examination confers a definite long-term risk of cancer, but most patients undergoing such examinations receive no or inaccurate information about radiation dose and corresponding risk related to the dose received. Informed consent is a procedure to support (not substitute) the physician/patient dialogue and relationship, facilitating a free, informed and aware expression of the patient's will in the principle of patient autonomy. Physicians are responsible for providing patients with all the information on risks, benefits and alternatives useful to the patient to make the decision. In current radiological practice the information on the radiation dose and long-term cancer risks is difficult to find and not easy to understand. The form using plain language should spell-out the type of examination, the effective dose (mSv), the effective dose expressed in number of chest radiographs and the risk of cancer. The current practice clashes against the guidelines and the law. PMID:27269736

  10. In-Hospital Cardiology Consultation and Evidence-Based Care for Nursing Home Residents with Heart Failure

    PubMed Central

    Aronow, Wilbert S.; Rich, Michael W.; Goodlin, Sarah J.; Birkner, Thomas; Zhang, Yan; Feller, Margaret A.; Aban, Inmaculada B.; Jones, Linda G.; Bearden, Donna M.; Allman, Richard M.; Ahmed, Ali

    2013-01-01

    Objectives To determine the association between cardiology consultation and evidence-based care for nursing home (NH) residents with heart failure (HF). Participants Hospitalized NH residents (n= 646) discharged from 106 Alabama hospitals with a primary discharge diagnosis of HF during 1998–2001. Design Observational. Measurements of Evidence-Based Care Pre-admission estimation of left ventricular ejection fraction (LVEF) for patients with known HF (n=494), in-hospital LVEF estimation for HF patients without known LVEF (n=452), and discharge prescriptions of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs-or-ARBs) to systolic HF (LVEF <45%) patients discharged alive who were eligible to receive those drugs (n=83). Eligibility for ACEIs-or-ARBs was defined as lack of prior allergy or adverse effect, serum creatinine <2.5 mg/dL, serum potassium <5.5 mEq/L, and systolic blood pressure >100 mm Hg. Results Pre-admission LVEF was estimated in 38% and 12% of patients receiving and not receiving cardiology consultation, respectively (adjusted odds ratio {AOR}, 3.49; 95% CI, 2.16–5.66; p <0.001). In-hospital LVEF was estimated in 71% and 28% of patients receiving and not receiving cardiology consultation, respectively (AOR, 6.01; 95% CI, 3.69–9.79; p <0.001). ACEIs-or-ARBs were prescribed to 62% and 82% of patients receiving and not receiving cardiology consultation, respectively (AOR, 0.24; 95% CI, 0.07–0.81; p=0.022). Conclusion In-hospital cardiology consultation was associated with significantly higher odds of LVEF estimation among NH residents with HF. However, it did not translate into higher odds of discharge prescriptions for ACEIs-or-ARBs to NH resident with systolic HF who were eligible for the receipt of these drugs. PMID:21982687

  11. Taking the perfect nuclear image: quality control, acquisition, and processing techniques for cardiac SPECT, PET, and hybrid imaging.

    PubMed

    Case, James A; Bateman, Timothy M

    2013-10-01

    Nuclear Cardiology for the past 40 years has distinguished itself in its ability to non-invasively assess regional myocardial blood flow and identify obstructive coronary disease. This has led to advances in managing the diagnosis, risk stratification, and prognostic assessment of cardiac patients. These advances have all been predicated on the collection of high quality nuclear image data. National and international professional societies have established guidelines for nuclear laboratories to maintain high quality nuclear cardiology services. In addition, laboratory accreditation has further advanced the goal of the establishing high quality standards for the provision of nuclear cardiology services. This article summarizes the principles of nuclear cardiology single photon emission computed tomography (SPECT) and positron emission tomography (PET) imaging and techniques for maintaining quality: from the calibration of imaging equipment to post processing techniques. It also will explore the quality considerations of newer technologies such as cadmium zinc telleride (CZT)-based SPECT systems and absolute blood flow measurement techniques using PET. PMID:23868070

  12. Dissemination, standardization and user-flexibility in implementing TOMRs for cardiology.

    PubMed Central

    Pinciroli, F.; Combi, C.; Pozzi, G.; Rossi, R.

    1991-01-01

    A great many clinics are interested in using software programs in daily practice. We report on the construction of a time oriented medical record unit (TOMRU). It runs on MS-DOS personal computers. TOMRU handles the follow-up data of ambulatory patients. Of the possible database customizations allowed by TOMRU, the cardiology patient database (TOMRU/C) and hypertensive patient database (TOMRU/H) were developed and are described here. Customizing TOMRU should in any case be left to an expert user, in charge of database management. The clinical information to be included in the customizations was obtained by discussing the needs of and obtaining the consensus of clinical practitioners. TOMRU/C was handed over to some hundreds of clinical centres during the computerized itinerant courses held to train users. PMID:1807630

  13. [Hygiene and motivation factors of nursing work in a cardiology ward].

    PubMed

    Somense, Carolina Bueno; Duran, Erika Christiane Marocco

    2014-09-01

    The present study aimed to identify hygienic and motivational factors in the nursing work according to the Two-Factor Theory, as well as their relation with professional satisfaction/dissatisfaction. This exploratory-descriptive study involved nine nurses from the cardiology ward of a hospital in the interior of the State of São Paulo, between August and September 2013. A self-applied questionnaire was used, including open and closed questions. The data were categorized as hygienic and motivational. Results show the nurses' satisfaction with autonomy, work itself and teamwork, duties, content and responsibilities of the job. Dissatisfaction is related to career growth possibilities; work, political and administrative conditions at the institution, supervision and lack of institutional support. Satisfaction and dissatisfaction factors include relationships, acknowledgements and remuneration. Nurses' satisfaction is determined by multiple and often controversial factors. PMID:25474845

  14. Tools for assessing quality of life in cardiology and cardiac surgery.

    PubMed

    Gierlaszyńska, Karolina; Pudlo, Robert; Jaworska, Izabela; Byrczek-Godula, Kamila; Gąsior, Mariusz

    2016-03-01

    The holistic concept of health, popularization of knowledge, as well as social and economic factors have contributed to the growing interest in research concerning quality of life in cardiovascular diseases. The value of direct measurements of the patient's well-being and the extent of their functioning in everyday life (i.e., health-related quality of life; HRQoL) has gained appreciation. Questionnaires are the most popular method of measuring quality of life. On the basis of the literature, we can conclude that the Short-Form Health Survey (SF-36) questionnaire is one of the most widely used tools measuring the quality of life of patients undergoing cardiological treatment and cardiac surgery. PMID:27212988

  15. Practicing whole-patient cardiology: An interview with Mimi Guarneri, MD. Interview by Sheldon Lewis.

    PubMed

    Guarneri, Mimi

    2008-01-01

    Mimi Guarneri, MD, is medical director and co-founder of Scripps Center for Integrative Medicine in San Diego, California. She received her medical degree from SUNY Medical Center in New York and served an internship and residency at Cornell Medical Center, where she later became chief medical resident. Dr Guarneri and Rauni King, RN, in 1997 founded the Scripps Center for Integrative Medicine to address the emotional and spiritual needs of patients as well as their physical needs. Dr Guarneri is a member of the American College of Cardiology, Alpha Omega Alpha, and the American Medical Women's Association. She is a diplomate of the American Holistic Medical Association and has keynoted numerous integrative medicine conferences, authored the best-selling book The Heart Speaks, and appeared on NBC's Today show. Dr Guarneri was interviewed earlier this year by Sheldon Lewis, former editor in chief of Advances. PMID:20664142

  16. 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. PMID:26778592

  17. Tools for assessing quality of life in cardiology and cardiac surgery

    PubMed Central

    Pudlo, Robert; Jaworska, Izabela; Byrczek-Godula, Kamila; Gąsior, Mariusz

    2016-01-01

    The holistic concept of health, popularization of knowledge, as well as social and economic factors have contributed to the growing interest in research concerning quality of life in cardiovascular diseases. The value of direct measurements of the patient's well-being and the extent of their functioning in everyday life (i.e., health-related quality of life; HRQoL) has gained appreciation. Questionnaires are the most popular method of measuring quality of life. On the basis of the literature, we can conclude that the Short-Form Health Survey (SF-36) questionnaire is one of the most widely used tools measuring the quality of life of patients undergoing cardiological treatment and cardiac surgery. PMID:27212988

  18. A telemedicine network for remote paediatric cardiology services in north-east Brazil

    PubMed Central

    Hazin, Sheila Maria Vieira; Regis, Cláudio Teixeira; Soares de Araújo, Juliana Sousa; Albuquerque, Fernanda Cruz de Lira; Moser, Lúcia Roberta Didier Nunes; Hatem, Thamine de Paula; Gomes de Freitas, Carolina Paim; Mourato, Felipe Alves; Tavares, Thiago Ribeiro; Gomes, Renata Grigório Silva; Severi, Rossana; Santos, Cícera Rocha; Ferreira da Silva, Jailson; Rezende, Juliana Landim; Vieira, Paulo Coelho; Filho, José Luiz de Lima

    2015-01-01

    Abstract Problem Providing health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries. Approach In October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart defects. Echocardiograms were performed by physicians under direct online supervision of a cardiologist; alternatively, a video recording of the examination was subsequently reviewed by a cardiologist. Cardiovascular surgeons came to a paediatric hospital in the state capital once a week to perform heart surgeries. Local setting Until 2011, the State of Paraíba had no structured programme to care for children with heart disease. This often resulted in missed or late diagnosis, with adverse health consequences for the children. Relevant changes From 2012 to 2014, 73 751 babies were screened for heart defects and 857 abnormalities were identified. Detection of congenital heart diseases increased from 4.09 to 11.62 per 1000 live births (P < 0.001). Over 6000 consultations and echocardiograms were supervised via the Internet. Time to diagnosis, transfers and hospital stays were greatly reduced. A total of 330 operations were carried out with 6.7% (22/330) mortality. Lessons learnt Access to an echocardiography machine with remote supervision by a cardiologist improves the detection of congenital heart disease by neonatologists; virtual outpatient clinics facilitate clinical management; the use of Internet technology with simple screening techniques allows resources to be allocated more efficiently. PMID:26668441

  19. Faxing ECGs from peripheral hospitals to Tertiary Paediatric Cardiology Units- Is it Safe and Sustainable?

    PubMed Central

    McGrath, Sam; Skinner, Greg; Morgan, Gareth J

    2014-01-01

    Intoduction Recent local involvement with the United Kingdom“Safe and Sustainable review of paediatric cardiology services” has highlighted the need for development of clinical networks and improvement of the communication infrastructure within and between teams. One common communication between peripheral and tertiary hospitals is facsimile transfer of electrocardiograms. The quality of fax transmission can be variable, raising concerns regarding the quality of the received image, accuracy of the diagnosis and appropriateness of the resultant advice. Methods We performed a systematic quality evaluation of faxed ECGs to determine whether they should be replaced on the basis of patient safety and information governance. A sample of 50 ECGs was selected from over 300 which had been faxed to our tertiary department. These were scored according to a structured system leading to a 10 point Likert scale, assessing technical quality and the ability to make a clinically relevant assessment of the information. Results Only 1 from 50 faxed ECGs fulfilled all 9 objective criteria set. Heart rate and quadrant of the QRS axis were only identifiable in 10%. Comparing the faxed ECGs with the rating given to an original ECG confirmed a significant difference in the interpretability of faxed and original ECGs (p<0.05). Conclusion Our study suggests that faxed ECGs do not provide consistent, accurate diagnostic information. It suggests that this currently widespread practice should be considered as a potential patient safety issue within developing paediatric cardiology networks. We would recommend that faxing of ECGs be replaced with scanning of ECGs, transmitted via secure email. PMID:24757263

  20. Trends in pediatric cardiology referrals, testing, and satisfaction at a Canadian tertiary centre.

    PubMed

    Caddell, Andrew J; Wong, Kenny K; Barker, Andrew P; Warren, Andrew E

    2015-01-01

    Anecdotal and European evidence suggests that outpatient pediatric referrals and their diagnostic testing burden are increasing. We sought to characterize new pediatric cardiology referrals, testing performed, outcomes, and patient satisfaction in a Canadian academic hospital and how these had changed over time. Clinical data were extracted from new outpatient consultations to the IWK Children's Heart Centre between August 1, 2011 and August 17, 2012 and compared with similar local data collected in July-February 2002 using χ(2) testing. Predictors of significant differences were sought using regression analysis. Satisfaction data were collected from a validated patient questionnaire, and 620 new outpatients were evaluated. Organic disease was more likely in younger patients (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.8-4.0) or in patients referred by pediatricians (OR, 2.3; 95% CI, 1.6-3.3). Odds of echocardiography being performed were significantly increased if patients were younger than 1 year (OR, 2.0; 95% CI, 1.3-3.0), were seen at outreach clinics (OR, 1.7; 95% CI, 1.2-2.3), or were referred by pediatricians (OR, 3.7; 95% CI, 2.6-5.3). Cardiologists differed significantly in ordering echocardiograms for referred patients (P = 0.002). The patients referred in the current era have significantly less organic disease than did those in 2002 (27% vs 37%; P = 0.007), but they underwent significantly more echocardiography (58% vs 38%; P < 0.001) and Holter monitoring (12% vs 4%; P = 0.001). Satisfaction results were high and unrelated to diagnostic testing. Pediatric cardiology referrals in Maritime Canada have increased in volume, consistent with changes seen at other centres. This, coupled with changing cardiac investigations, has increased testing burden. Individual cardiologists affected the odds of echocardiography being ordered. Satisfaction with services was high, with no predictors identified. PMID:25547558

  1. End-of-life care in a cardiology department: have we improved?

    PubMed Central

    Ruiz-Garcia, Juan; Diez-Villanueva, Pablo; Ayesta, Ana; Bruña, Vanessa; Figueiras-Graillet, Lourdes M; Gallego-Parra, Laura; Fernández-Avilés, Francisco; Martínez-Sellés, Manuel

    2016-01-01

    Background End-of-life care is not usually a priority in cardiology departments. We sought to evaluate the changes in end-of-life care after the introduction of a do-not-resuscitate (DNR) order protocol. Methods & Results Retrospective analysis of all deaths in a cardiology department in two periods, before and after the introduction of the protocol. Comparison of demographic characteristics, use of DNR orders, and end-of-life care issues between both periods, according to the presence in the second period of the new DNR sheet (Group A), a conventional DNR order (Group B) or the absence of any DNR order (Group C). The number of deaths was similar in both periods (n = 198 vs. n = 197). The rate of patients dying with a DNR order increased significantly (57.1% vs. 68.5%; P = 0.02). Only 4% of patients in both periods were aware of the decision taken about cardiopulmonary resuscitation. Patients in Group A received the DNR order one day earlier, and 24.5% received it within the first 24 h of admission (vs. 2.6% in the first period; P < 0.001). All patients in Group A with an implantable cardioverter defibrillator (ICD) had shock therapies deactivated (vs. 25.0% in the first period; P = 0.02). Conclusions The introduction of a DNR order protocol may improve end-of-life care in cardiac patients by increasing the use and shortening the time of registration of DNR orders. It may also contribute to increase ICD deactivation in patients with these orders in place. However, the introduction of the sheet in late stages of the disease failed to improve patient participation. PMID:27605939

  2. Class attendance and cardiology examination performance: a study in problem-based medical curriculum

    PubMed Central

    Bamuhair, Samira S; Al Farhan, Ali I; Althubaiti, Alaa; ur Rahman, Saeed; Al-Kadri, Hanan M

    2016-01-01

    Background and aims Information on the effect of students’ class attendance on examination performance in a problem-based learning medical curriculum is limited. This study investigates the impact of different educational activities on students’ academic performance in a problem-based learning curriculum. Methods This is a retrospective cohort study conducted on the cardiology block at the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. All students who undertook the cardiology block during the academic year 2011–2012 were included. The students’ attendance was measured using their overall attendance percentage. This percentage is a product of their attendance of many activities throughout the block. The students’ performance was assessed by the final mark obtained, which is a product of many assessment elements. Statistical correlation between students’ attendance and performance was established. Results A total of 127 students were included. The average lecture attendance rate for the medical students in this study was found to be 86%. A significant positive correlation was noted between the overall attendance and the accumulated students’ block mark (r=0.52; P<0.001). Students’ attendance to different education activities was correlated to their final mark. Lecture attendance was the most significant predictor (P<0.001), that is, 1.0% increase in lecture attendance has predicted a 0.27 increase in students’ final block mark. Conclusion Class attendance has a positive effect on students’ academic performance with stronger effect for lecture attendance compared to attendance in other teaching modalities. This suggests that lecture attendance is critical for learning even when a problem-based learning medical curriculum is applied. PMID:26929658

  3. Provision of Transition Education and Referral Patterns from Pediatric Cardiology to Adult Cardiac Care.

    PubMed

    Harbison, Anna L; Grady, Stafford; Chi, Kevin; Fernandes, Susan M

    2016-02-01

    ACC/AHA guidelines recommend a structured preparation for and transfer to adult-oriented cardiac care for adult survivors of pediatric onset heart disease (POHD). Given this, we sought to describe the transition and transfer practices for a cohort of young adults with POHD and to determine factors associated with successful transfer to adult-oriented cardiac care. We performed a single-center, retrospective chart review on patients ≥18 years of age, with POHD likely to require lifelong cardiac care, who were seen in outpatient pediatric cardiology (PC) between 2008 and 2011. Successful transfer was defined as the subsequent attendance at adult cardiology (AC) within 2 years of PC visit. We identified 118 patients who met study criteria. Mean age 22.4 ± 2.0 years, 59 % male, 64 % white and 40 % Hispanic. Mean transition education topics noted was 3.3 ± 1.8 out of 20 and covered the underlying cardiac disease (89 %), follow-up and current medications (56 %) and exercise limitations (34 %). Recommendations for follow-up were AC (57 %) and PC (33 %). Of those told to transfer to AC, 79 % successfully transferred. Characteristics of successful transfer included: prior cardiac surgery (p = 0.008), cardiac medication use (p = 0.006) and frequency of follow-up ≤1 year (p = 0.037). One-quarter of all subjects did not follow-up within at least 2 years. Despite published guidelines, transition education appears lacking and the approach to transfer to adult cardiac care is not consistent. Given the increased risk of morbidity and mortality in this patient population, standardization of transition education and transfer processes appear warranted. PMID:26385471

  4. Heterogeneity in statin indications within the 2013 american college of cardiology/american heart association guidelines.

    PubMed

    Shah, Ravi V; Rubenfire, Melvyn; Brook, Robert D; Lima, João A C; Nallamothu, Brahmajee; Murthy, Venkatesh L

    2015-01-01

    A standard ("core") implementation of American College of Cardiology/American Heart Association 2013 lipid guidelines (based on 10-year risk) dramatically increases the statin-eligible population in older Americans, raising controversy in the cardiovascular community. The guidelines also endorse a more "comprehensive" risk approach based in part on lifetime risk. The impact of this broader approach on statin eligibility remains unclear. We studied the impact of 2 different implementations of the new guidelines ("core" and "comprehensive") using the National Health and Nutrition Examination Survey. Although "core" guidelines led to 72.0 million subjects qualifying for statin therapy, the broader "comprehensive" application led to nearly a twofold greater estimate for statin-eligible subjects (121.2 million), with the greatest impact among those aged 21 to 45 years. Subjects indicated for statin therapy under comprehensive guidelines had a greater burden of cardiovascular risk factors and a higher lifetime risk of cardiovascular disease than those not indicated for statins. In particular, men aged 21 to 45 years had a 3.13-fold increased odds of being eligible for statin therapy only under the "comprehensive" guidelines (vs standard "core" guidelines; 95% confidence interval 2.82 to 3.47, p <0.0001). There were no racial differences. In conclusion, the "comprehensive" approach to statin eligibility espoused by the American College of Cardiology/American Heart Association 2013 guidelines would increase the statin-eligible population to over 120 million Americans, particularly targeting younger men with high-risk factor burden. PMID:25456869

  5. Preschooler test or procedure preparation

    MedlinePlus

    ... procedure or other situation to ensure your child's safety. Restraints may be used to keep your child safe when staff temporarily have to leave the room during x-ray and nuclear studies. They may also be used when a ...

  6. Adherence of heart failure patients to exercise: barriers and possible solutions: a position statement of the Study Group on Exercise Training in Heart Failure of the Heart Failure Association of the European Society of Cardiology.

    PubMed

    Conraads, Viviane M; Deaton, Christi; Piotrowicz, Ewa; Santaularia, Nuria; Tierney, Stephanie; Piepoli, Massimo F; Pieske, Burkert; Schmid, Jean-Paul; Dickstein, Kenneth; Ponikowski, Piotr P; Jaarsma, Tiny

    2012-05-01

    The practical management of heart failure remains a challenge. Not only are heart failure patients expected to adhere to a complicated pharmacological regimen, they are also asked to follow salt and fluid restriction, and to cope with various procedures and devices. Furthermore, physical training, whose benefits have been demonstrated, is highly recommended by the recent guidelines issued by the European Society of Cardiology, but it is still severely underutilized in this particular patient population. This position paper addresses the problem of non-adherence, currently recognized as a main obstacle to a wide implementation of physical training. Since the management of chronic heart failure and, even more, of training programmes is a multidisciplinary effort, the current manuscript intends to reach cardiologists, nurses, physiotherapists, as well as psychologists working in the field. PMID:22499542

  7. 10 CFR 820.63 - Procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Procedures. 820.63 Section 820.63 Energy DEPARTMENT OF ENERGY PROCEDURAL RULES FOR DOE NUCLEAR ACTIVITIES Exemption Relief § 820.63 Procedures. The Secretarial Officer shall utilize any procedures deemed necessary and appropriate to comply with his...

  8. 10 CFR 820.63 - Procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Procedures. 820.63 Section 820.63 Energy DEPARTMENT OF ENERGY PROCEDURAL RULES FOR DOE NUCLEAR ACTIVITIES Exemption Relief § 820.63 Procedures. The Secretarial Officer shall utilize any procedures deemed necessary and appropriate to comply with his...

  9. 10 CFR 820.63 - Procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Procedures. 820.63 Section 820.63 Energy DEPARTMENT OF ENERGY PROCEDURAL RULES FOR DOE NUCLEAR ACTIVITIES Exemption Relief § 820.63 Procedures. The Secretarial Officer shall utilize any procedures deemed necessary and appropriate to comply with his...

  10. 10 CFR 820.63 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Procedures. 820.63 Section 820.63 Energy DEPARTMENT OF ENERGY PROCEDURAL RULES FOR DOE NUCLEAR ACTIVITIES Exemption Relief § 820.63 Procedures. The Secretarial Officer shall utilize any procedures deemed necessary and appropriate to comply with his...

  11. Giovanni Battista Morgagni in the murals of Diego Rivera at the National Institute of Cardiology of Mexico City.

    PubMed

    Estañol, Bruno; Delgado, Guillermo R

    2014-07-01

    The Italian physician Giovanni Battista Morgagni was the founder of the clinico-anatomical method. His masterpiece De sedibus, et causis morborum per anatomen indagatis represented a major breakthrough in the history of medicine. In the murals of Diego Rivera at the National Institute of Cardiology, Morgagni appears at the center of the fresco. With his left index finger points to the chest of a dying patient with a bulging pulsating aortic aneurysm below the left clavicle, and with his right hand, that holds a scalpel, shows the aneurysm found at the autopsy table. With this striking image the clinico-anatomical method is succinctly depicted. Professor Ignacio Chávez, the founder of the National Institute of Cardiology, gave the artist the elements to draw Morgagni, but the disposition and the importance of Morgagni in the fresco were due to the talent of Rivera. PMID:23493179

  12. How changes to the Medicare Benefits Schedule could improve the practice of cardiology and save taxpayer money.

    PubMed

    Harper, Richard W; Nasis, Arthur; Sundararajan, Vijaya

    2015-09-21

    Rising health care costs above inflation are placing serious strains on the sustainability of the Australian Medicare system in its current structure. The Medicare Benefits Schedule (MBS), which lists rebates payable to patients for private medical services provided on a fee-for-service basis, is the cornerstone of the Australian health care system. Introduced in the 1980s, the MBS has changed little despite major advances in the evidence base for the practice of cardiology. We outline how we believe sensible changes to the MBS listings for four cardiac services--invasive coronary angiography, computed tomography coronary angiography, stress testing and percutaneous coronary intervention--would improve the clinical practice of cardiology and save substantial amounts of taxpayer money. PMID:26377292

  13. [Examination procedures].

    PubMed

    Vassault, A; Arnaud, J; Szymanovicz, A

    2010-12-01

    Examination procedures have to be written for each examination according to the standard requirements. Using CE marked devices, technical inserts can be used, but because of their lack of homogeneity, it could be easier to document their use as a standard procedure. Document control policy applies for those procedures, the content of which could be as provided in this document. Electronic manuals can be used as well. PMID:21613016

  14. Bridging the Gap, Facing the Challenge-the 26(th) Great Wall International Congress of Cardiology (GW-ICC).

    PubMed

    Zhang, Yingmei; Ren, Jun

    2016-02-01

    The joint venue of the 26(th) Great Wall International Congress of Cardiology (GW-ICC) & Asia Pacific Heart Congress 2015 (APHC 2015) & International Congress Cardiovascular Prevention and Rehabilitation 2015 (ICCPR 2015) were held from October 29 to November 01, 2015 at the China National Convention Center (CNCC), Beijing, China. This year's conference focused on cardiovascular disease prevention, health promotion, education and training, as well as disease management and rehabilitation. PMID:26885499

  15. Bridging the Gap, Facing the Challenge—the 26th Great Wall International Congress of Cardiology (GW-ICC)

    PubMed Central

    Zhang, Yingmei

    2016-01-01

    The joint venue of the 26th Great Wall International Congress of Cardiology (GW-ICC) & Asia Pacific Heart Congress 2015 (APHC 2015) & International Congress Cardiovascular Prevention and Rehabilitation 2015 (ICCPR 2015) were held from October 29 to November 01, 2015 at the China National Convention Center (CNCC), Beijing, China. This year’s conference focused on cardiovascular disease prevention, health promotion, education and training, as well as disease management and rehabilitation. PMID:26885499

  16. Position paper on the importance of psychosocial factors in cardiology: Update 2013

    PubMed Central

    Ladwig, Karl-Heinz; Lederbogen, Florian; Albus, Christian; Angermann, Christiane; Borggrefe, Martin; Fischer, Denise; Fritzsche, Kurt; Haass, Markus; Jordan, Jochen; Jünger, Jana; Kindermann, Ingrid; Köllner, Volker; Kuhn, Bernhard; Scherer, Martin; Seyfarth, Melchior; Völler, Heinz; Waller, Christiane; Herrmann-Lingen, Christoph

    2014-01-01

    Background: The rapid progress of psychosomatic research in cardiology and also the increasing impact of psychosocial issues in the clinical daily routine have prompted the Clinical Commission of the German Heart Society (DGK) to agree to an update of the first state of the art paper on this issue which was originally released in 2008. Methods: The circle of experts was increased, general aspects were implemented and the state of the art was updated. Particular emphasis was dedicated to coronary heart diseases (CHD), heart rhythm diseases and heart failure because to date the evidence-based clinical knowledge is most advanced in these particular areas. Differences between men and women and over the life span were considered in the recommendations as were influences of cognitive capability and the interactive and synergistic impact of classical somatic risk factors on the affective comorbidity in heart disease patients. Results: A IA recommendation (recommendation grade I and evidence grade A) was given for the need to consider psychosocial risk factors in the estimation of coronary risks as etiological and prognostic risk factors. Furthermore, for the recommendation to routinely integrate psychosocial patient management into the care of heart surgery patients because in these patients, comorbid affective disorders (e.g. depression, anxiety and post-traumatic stress disorder) are highly prevalent and often have a malignant prognosis. A IB recommendation was given for the treatment of psychosocial risk factors aiming to prevent the onset of CHD, particularly if the psychosocial risk factor is harmful in itself (e.g. depression) or constrains the treatment of the somatic risk factors. Patients with acute and chronic CHD should be offered anti-depressive medication if these patients suffer from medium to severe states of depression and in this case medication with selective reuptake inhibitors should be given. In the long-term course of treatment with implanted

  17. Challenging the holy grail of hospital accreditation: A cross sectional study of inpatient satisfaction in the field of cardiology

    PubMed Central

    2010-01-01

    Background Subjective parameters such as quality of life or patient satisfaction gain importance as outcome parameters and benchmarks in health care. In many countries hospitals are now undergoing accreditation as mandatory or voluntary measures. It is believed but unproven that accreditations positively influence quality of care and patient satisfaction. The present study aims to assess in a defined specialty (cardiology) the relationship between patient satisfaction (as measured by the recommendation rate) and accreditation status. Methods Consecutive patients discharged from 25 cardiology units received a validated patient satisfaction questionnaire. Data from 3,037 patients (response rate > 55%) became available for analysis. Recommendation rate was used as primary endpoint. Different control variables such as staffing level were considered. Results The 15 accredited units did not differ significantly from the 10 non-accredited units regarding main hospital (i.e. staffing levels, no. of beds) and patient (age, gender) characteristics. The primary endpoint "recommendation rate of a given hospital" for accredited hospitals (65.6%, 95% Confidence Interval (CI) 63.4 - 67.8%) and hospitals without accreditation (65.8%, 95% CI 63.1 - 68.5%) was not significantly different. Conclusion Our results support the notion that - at least in the field of cardiology - successful accreditation is not linked with measurable better quality of care as perceived by the patient and reflected by the recommendation rate of a given institution. Hospital accreditation may represent a step towards quality management, but does not seem to improve overall patient satisfaction. PMID:20459873

  18. A new experimental procedure for determination of photoelectric efficiency of a NaI(Tl) detector used for nuclear medicine liquid waste monitoring with traceability to a reference standard radionuclide calibrator.

    PubMed

    Ceccatelli, A; Campanella, F; Ciofetta, G; Marracino, F M; Cannatà, V

    2010-02-01

    To determine photopeak efficiency for (99m)Tc of the NaI(Tl) detector used for liquid waste monitoring at the Nuclear Medicine Unit of IRCCS Paediatric Hospital Bambino Gesù in Rome, a specific experimental procedure, with traceability to primary standards, was developed. Working with the Italian National Institute for Occupational Prevention and Safety, two different calibration source geometries were employed and the detector response dependence on geometry was investigated. The large percentage difference (almost 40%) between the two efficiency values obtained showed that geometrical effects cannot be neglected. PMID:19914080

  19. The impact of various protective tools on the dose reduction in the eye lens in an interventional cardiology-clinical study.

    PubMed

    Domienik, J; Bissinger, A; Grabowicz, W; Jankowski, Ł; Kręcki, R; Makowski, M; Masiarek, K; Plewka, M; Lubiński, A; Peruga, J Z

    2016-06-01

    The aim of the study was to check, in clinical practice, the potential for the dose reduction of lead eyewear and a ceiling-suspended shield used to protect the eye lens of physicians working in interventional cardiology. To this end, for the lead eyewear, the dose reduction factors were derived to correct the readings from a dosimeter used routinely outside the glasses. Four types of lead eyewear with attached loose thermoluminescent dosimeters and EYE-D dosimeters were worn by physicians in two clinical centres, for two-month periods, during coronary angiography (CA), percutaneous coronary intervention (PCI), and pacemaker procedures. In order to analyse, separately, how a ceiling-suspended lead screen absorbs the scattered radiation, a series of measurements was carried out during single CA/PCI procedures performed with and without the protection. The lead eyewear may reduce the doses to the eye closest to the x-ray tube by a factor between 1.1 and 3.4, depending on its model and the physician's position. The effectiveness of the eyewear may, however, vary-even for the same model and physician-almost twofold between different working periods. The ceiling-suspended shield decreases the doses in clinical practice by a factor of 2.3. The annual eye lens doses without the eyewear estimated from routine measurements are high-above or close to the new eye lens dose limit established by the recent EU Basic Safety Standards, even though the ceiling-suspended shield was used. Therefore, to comply with the new dose limit that is set in the Directive, protection of the eyes of physicians with high workloads might require the use of both the eyewear and the ceiling-suspended shield. PMID:27183002

  20. Impact of a Virtual Clinic in a Paediatric Cardiology Network on Northeast Brazil.

    PubMed

    de Araújo, Juliana Sousa Soares; Dias Filho, Adalberto Vieira; Silva Gomes, Renata Grigório; Regis, Cláudio Teixeira; Rodrigues, Klecida Nunes; Siqueira, Nicoly Negreiros; Albuquerque, Fernanda Cruz de Lira; Mourato, Felipe Alves; Mattos, Sandra da Silva

    2015-01-01

    Introduction. Congenital heart diseases (CHD) affect approximately 1% of live births and is an important cause of neonatal morbidity and mortality. Despite that, there is a shortage of paediatric cardiologists in Brazil, mainly in the northern and northeastern regions. In this context, the implementation of virtual outpatient clinics with the aid of different telemedicine resources may help in the care of children with heart defects. Methods. Patients under 18 years of age treated in virtual outpatient clinics between January 2013 and May 2014 were selected. They were divided into 2 groups: those who had and those who had not undergone a screening process for CHD in the neonatal period. Clinical and demographic characteristics were collected for further statistical analysis. Results. A total of 653 children and teenagers were treated in the virtual outpatient clinics. From these, 229 had undergone a neonatal screening process. Fewer abnormalities were observed on the physical examination of the screened patients. Conclusion. The implementation of pediatric cardiology virtual outpatient clinics can have a positive impact in the care provided to people in areas with lack of skilled professionals. PMID:26265913

  1. Impact of a Virtual Clinic in a Paediatric Cardiology Network on Northeast Brazil

    PubMed Central

    de Araújo, Juliana Sousa Soares; Dias Filho, Adalberto Vieira; Silva Gomes, Renata Grigório; Regis, Cláudio Teixeira; Rodrigues, Klecida Nunes; Siqueira, Nicoly Negreiros; Albuquerque, Fernanda Cruz de Lira; Mourato, Felipe Alves; Mattos, Sandra da Silva

    2015-01-01

    Introduction. Congenital heart diseases (CHD) affect approximately 1% of live births and is an important cause of neonatal morbidity and mortality. Despite that, there is a shortage of paediatric cardiologists in Brazil, mainly in the northern and northeastern regions. In this context, the implementation of virtual outpatient clinics with the aid of different telemedicine resources may help in the care of children with heart defects. Methods. Patients under 18 years of age treated in virtual outpatient clinics between January 2013 and May 2014 were selected. They were divided into 2 groups: those who had and those who had not undergone a screening process for CHD in the neonatal period. Clinical and demographic characteristics were collected for further statistical analysis. Results. A total of 653 children and teenagers were treated in the virtual outpatient clinics. From these, 229 had undergone a neonatal screening process. Fewer abnormalities were observed on the physical examination of the screened patients. Conclusion. The implementation of pediatric cardiology virtual outpatient clinics can have a positive impact in the care provided to people in areas with lack of skilled professionals. PMID:26265913

  2. Himage PACS: a new approach to storage, integration, and distribution of cardiologic images

    NASA Astrophysics Data System (ADS)

    Costa, Carlos M.; Silva, Augusto; Oliveira, Jose L.; Ribeiro, Vasco G.; Ribeiro, Jose

    2004-04-01

    This paper presents a Cardiology oriented information system that provides permanent availability of all clinical history, including alphanumeric and image data, with time and cost-effective transmission (reduced download time), without loss of image diagnosis quality and based on a Web Multimedia Integrated Access Interface. This implies the integration of HIS and PACS in a unique access interface, providing on-line and fast access to authorized healthcare professionals. The benefits obtained from the HIS-PACS integration and from the availability of all historical patient data are unquestionable to practitioners but also to the patients. Moreover, the system includes a telematic platform capable of establishing cooperative telemedicine sessions where our most impressive utilization is a transcontinental work platform for cardiovascular ultrasound. The key point of our approach starts with the construction of a DICOM private transfer syntax that is prepared to support any video encoder installed on a Windows-based station. With this structure it is possible to select the best encoder to a specific modality and work scenario. Good trade-off between compression ratio and diagnostic quality, low network traffic load, backup facilities and data portability are other achievements of this system.

  3. Transition from image intensifier to flat panel detector in interventional cardiology: Impact of radiation dose

    PubMed Central

    Livingstone, Roshan S.; Chase, David; Varghese, Anna; George, Paul V.; George, Oommen K.

    2015-01-01

    Flat panel detector (FPD) technology in interventional cardiology is on the increase due to its varied advantages compared to the conventional image intensifier (II) systems. It is not clear whether FPD imparts lower radiation doses compared to II systems though a few studies support this finding. This study intends to compare radiation doses from II and FPD systems for coronaryangiography (CAG) and Percutaneous Transluminal Coronary Angioplasty (PTCA) performed in a tertiary referral center. Radiation doses were measured using dose area product (DAP) meter from patients who underwent CAG (n = 222) and PTCA (n = 75) performed using FPD angiography system. The DAP values from FPD were compared with earlier reported data using II systems from the same referral center where the study was conducted. The mean DAP values from FPD system for CAG and PTCA were 24.35 and 63.64 Gycm2 and those from II system were 27.71 and 65.44 Gycm2. Transition from II to FPD system requires stringent dose optimization strategies right from the initial period of installation. PMID:26150684

  4. [The cardiology community and health reform. Some reflections to open a debate].

    PubMed

    Schweiger, C

    2000-01-01

    A recently introduced health care reform in Italy will modify substantially the scenario in which all physicians and also the cardiac specialists working in and out of the hospitals will operate. Therefore it is important that the cardiological community, who manages a large proportion of human and financial resources of the Italian National Health Service, knows the reform and interacts with the national and local authorities for the best implementation of the basic principles on which the reform has been founded. These principles are the following: the Italian health service will guarantee all citizens the so-called "essential levels of care" identified in accordance with four distinctive features. They must: 1) safeguard real needs of care (i.e. cosmetic surgery is not considered), 2) be evidence based, 3) be appropriate for individual patients, 4) be cost-effective. In a context of scarce resources and rapidly increasing demand of care this basic strategy seems to be the only one suitable for a National Health Service, but the application of this principle in the real world of care seems a very difficult task, and the role of medical associations is obviously crucial for a good outcome. This report illustrates some articles of the law that deal with the medical profession: guidelines and appropriateness of the criteria; accreditation, clinical competence and quality control; continuing medical education. PMID:10832116

  5. Dante and cardiology: Physiopathology and clinical features of cardiovascular diseases in the Middle Ages.

    PubMed

    Riva, M A; Cambioli, L; Castagna, F; Cianci, N; Varrenti, M; Giannattasio, C; Cesana, G

    2015-02-15

    Ancient non-medical texts can unexpectedly provide useful information on the development of knowledge about the heart and its diseases throughout history. The 750th anniversary of the birth of the Italian poet Dante Alighieri (1265-1321) provides a timely opportunity to analyze medical references in his works, in particular, focusing on literary descriptions that may be attributed to cardiovascular disorders. Dante's high level of medical knowledge, probably derived from his academic studies, is testified by his affiliation to the Florentine Guild of physicians and pharmacists. In all his works, the poet shows a deep interest for the heart. However, his anatomical and physiological knowledge of the circulatory system appears to be poor, probably due to it being based on theories and concepts brought forth by Aristotle and Galen, which were taught in medieval universities. Despite this, accurate descriptions of some symptoms (emotional syncope, orthopnea, dyspnea on exertion) and signs (ascites, paleness), which may be attributed to cardiovascular disorders, can be easily found in Dante's works, particularly in his masterpiece, the Divine Comedy. The literary and historical analysis of cardiovascular signs and symptoms allows us to assume that clinical features due to alterations of heart function were probably known by medieval physicians, but their etiology and pathophysiological mechanisms were not completely understood in that period. Historians of cardiology and clinicians should consider analysis of non-medical texts (including poetry) as an opportunity to better investigate the evolution of their discipline throughout the ages. PMID:25544198

  6. Management of stable angina: A commentary on the European Society of Cardiology guidelines.

    PubMed

    Ambrosio, Giuseppe; Komajda, Michel; Mugelli, Alessandro; Lopez-Sendón, José; Tamargo, Juan; Camm, John

    2016-09-01

    In 2013 the European Society of Cardiology (ESC) released new guidelines on the management of stable coronary artery disease. These guidelines update and replace the previous ESC guidelines on the management of stable angina pectoris, issued in 2006. There are several new aspects in the 2013 ESC guidelines compared with the 2006 version. This opinion paper provides an in-depth interpretation of the ESC guidelines with regard to these issues, to help physicians in making evidence-based therapeutic choices in their routine clinical practice. The first new element is the definition of stable coronary artery disease itself, which has now broadened from a 'simple' symptom, angina pectoris, to a more complex disease that can even be asymptomatic. In the first-line setting, the major changes in the new guidelines are the upgrading of calcium channel blockers, the distinction between dihydropyridines and non-dihydropyridine calcium channel blockers, and the presence of important statements regarding the combination of calcium channel blockers with beta-blockers. In the second-line setting, the 2013 ESC guidelines recommend the addition of long-acting nitrates, ivabradine, nicorandil or ranolazine to first-line agents. Trimetazidine may also be considered. However, no clear distinction is made among different second-line drugs, despite different quality of evidence in favour of these agents. For example, the use of ranolazine is supported by strong and recent evidence, while data supporting the use of the traditional agents appear relatively scanty. PMID:27222385

  7. Overcoming a perfect storm: an academic cardiology section's story of survival.

    PubMed

    Calvin, James E

    2007-03-01

    Increasingly, academic institutions are grappling with financial pressures that threaten the academic mission. The author presents an actual case history in which a section of cardiology in an academic health center was confronted with huge projected deficits that had to be eliminated within the fiscal year. The section used eight principles to shift from deficit to profitability (i.e., having revenue exceed costs). These principles included confronting the brutal facts, managing costs and revenue cycles, setting expectations for faculty, and quality improvement. The section accomplished deficit reduction through reducing faculty salaries (nearly $2 million) and nonfaculty salaries ($1.3 million) and reducing operational costs while maintaining revenues by increasing individual faculty productivity and reducing accounts receivable. In the face of these reductions, clinical revenues were maintained, but research revenue and productivity fell (but research is being fostered now that clinical services are profitable again). These principles can be used to stabilize the financial position of clinical practices in academic settings that are facing financial challenges. PMID:17327712

  8. Heart Failure Association of the European Society of Cardiology heart failure nurse curriculum.

    PubMed

    Riley, Jillian P; Astin, Felicity; Crespo-Leiro, Marisa G; Deaton, Christi M; Kienhorst, Jens; Lambrinou, Ekaterini; McDonagh, Theresa A; Rushton, Claire A; Stromberg, Anna; Filippatos, Gerasimos; Anker, Stefan D

    2016-07-01

    Recent advances in care and management of heart failure have improved outcome, largely as a result of the developing evidence basis for medications, implantable devices and the organization of heart failure follow-up. Such developments have also increased the complexity of delivering and coordinating care. This has led to a change to the way in which heart failure services are organized and to the traditional role of the heart failure nurse. Nurses in many countries now provide a range of services that include providing care for patients with acute and with chronic heart failure, working in and across different sectors of care (inpatient, outpatient, community care, the home and remotely), organising care services around the face-to-face and the remote collection of patient data, and liaising with a wide variety of health-care providers and professionals. To support such advances the nurse requires a skill set that goes beyond that of their initial education and training. The range of nurses' roles across Europe is varied. So too is the nature of their educational preparation. This heart failure nurse curriculum aims to provide a framework for use in countries of the European Society of Cardiology. Its modular approach enables the key knowledge, skills, and behaviours for the nurse working in different care settings to be outlined and so facilitate nursing staff to play a fuller role within the heart failure team. PMID:27220672

  9. [Cardiology writings in New Spain and in the first century of the Independent period].

    PubMed

    de Micheli, Alfredo

    2015-01-01

    The first writings on cardioangiology found in public and private libraries of New Spain from the xvi century to the first century of the Independent period in Mexico are mentioned. These go from the truly incunabular ones, books printed until the year 1500, to the physiology treatises published by European authors in the xvii and xviii centuries, as well as the cardiology texts from French authors of the first half of the xix century. The writings were depicted in the catalogs of the University library, founded in 1762, as well as in the library of a master builder of the Metropolitan Cathedral of the xvii century and that of a physician of the xviii century, Dr. José Ignacio Bartolache. The latter, in turn, edited for a brief period, from October 1772 to February 1773, a scientific-medical journal, «Mercurio Volante», which was the first scientific-hebdomadary publication in the Americas. Likewise, in the libraries of New Spain, several European scientific journals could be found, such as the one edited by the abbot Rozier, in which the initial writings of Lavoisier appeared. The exchange of ideas and knowledge, pointed out herein, attests to the always enthused interest of given individuals from New Spain on the boundless and passionate domains of cardioangiology. PMID:25260578

  10. [Personalized therapy in cardiology. Biomarkers, pharmacogenetics and therapy of monogenic diseases].

    PubMed

    Eschenhagen, T; Blankenberg, S

    2013-02-01

    Improved therapy and prophylaxis of cardiovascular diseases have contributed to an increase in life expectancy like no other field of medicine. However, many cardiological diseases remain untreatable and standard therapies often work only in a minority of patients or cause more harm than benefit. Personalized approaches appear to be a promising solution. Monogenic heart diseases are paradigmatic for this approach and can in rare cases be treated mutation specifically. Overall, however, success remains limited. Next generation sequencing will facilitate the identification of mutations causing diseases. Cell culture models based on induced pluripotent stem cells open the perspective of individualized testing of disease severity and pharmacological or genetic therapy. In contrast to monogenic diseases genetic testing plays no practical role yet in the management of multifactorial cardiovascular diseases. Biomarkers can identify individuals with increased cardiovascular risk. Furthermore, biomarker-guided therapy represents an attractive option with troponin-guided therapy of acute coronary syndromes as a successful example. Individual responses to drugs vary and are partly determined by genes. Simple genetic analyses can improve response prediction and minimize side effects in cases such as warfarin and high doses of simvastatin. Taken together personalized approaches will gain importance in the cardiovascular field but this requires the development of better methods and research that quantifies the true value of the new knowledge. PMID:23371262

  11. Combined cardiological and neurological abnormalities due to filamin A gene mutation

    PubMed Central

    de Wit, Marie Claire Y.; de Coo, Irenaeus F. M.; Lequin, Maarten H.; Halley, Dicky J. J.; Roos-Hesselink, Jolien W.

    2010-01-01

    Background Cardiac defects can be the presenting symptom in patients with mutations in the X-linked gene FLNA. Dysfunction of this gene is associated with cardiac abnormalities, especially in the left ventricular outflow tract, but can also cause a congenital malformation of the cerebral cortex. We noticed that some patients diagnosed at the neurogenetics clinic had first presented to a cardiologist, suggesting that earlier recognition may be possible if the diagnosis is suspected. Methods and results From the Erasmus MC cerebral malformations database 24 patients were identified with cerebral bilateral periventricular nodular heterotopia (PNH) without other cerebral cortical malformations. In six of these patients, a pathogenic mutation in FLNA was present. In five a cardiac defect was also found in the outflow tract. Four had presented to a cardiologist before the cerebral abnormalities were diagnosed. Conclusions The cardiological phenotype typically consists of aortic or mitral regurgitation, coarctation of the aorta or other left-sided cardiac malformations. Most patients in this category will not have a FLNA mutation, but the presence of neurological complaints, hyperlaxity of the skin or joints and/or a family history with similar cardiac or neurological problems in a possibly X-linked pattern may alert the clinician to the possibility of a FLNA mutation. PMID:20730588

  12. Length of Hospital Stay Prediction at the Admission Stage for Cardiology Patients Using Artificial Neural Network.

    PubMed

    Tsai, Pei-Fang Jennifer; Chen, Po-Chia; Chen, Yen-You; Song, Hao-Yuan; Lin, Hsiu-Mei; Lin, Fu-Man; Huang, Qiou-Pieng

    2016-01-01

    For hospitals' admission management, the ability to predict length of stay (LOS) as early as in the preadmission stage might be helpful to monitor the quality of inpatient care. This study is to develop artificial neural network (ANN) models to predict LOS for inpatients with one of the three primary diagnoses: coronary atherosclerosis (CAS), heart failure (HF), and acute myocardial infarction (AMI) in a cardiovascular unit in a Christian hospital in Taipei, Taiwan. A total of 2,377 cardiology patients discharged between October 1, 2010, and December 31, 2011, were analyzed. Using ANN or linear regression model was able to predict correctly for 88.07% to 89.95% CAS patients at the predischarge stage and for 88.31% to 91.53% at the preadmission stage. For AMI or HF patients, the accuracy ranged from 64.12% to 66.78% at the predischarge stage and 63.69% to 67.47% at the preadmission stage when a tolerance of 2 days was allowed. PMID:27195660

  13. Occupational exposure doses in interventional procedures in Bosnia and Herzegovina.

    PubMed

    Bašić, B; Beganović, A; Skopljak-Beganović, A; Samek, D

    2011-03-01

    Monitoring of occupationally exposed workers in Bosnia and Herzegovina started in 1960s and it was interrupted in 1992. Dosimetry service resumed in 1999 when the International Atomic Energy Agency provided Radiation Protection Centre with Harshaw 4500 Thermoluminescence dosemeter (TLD)-reader and the first set of TLDs. The highest doses are received by professionals working in interventional procedures (radiology, cardiology, gastroenterohepatology etc.). Number of these procedures is increasing each year (just in cardiology this increase is 24 % per year). Results from two TLDs are used to estimate effective dose. One is worn under the apron (chest level), and the other above (neck level). Calculation is performed using Niklason's methodology. Total number of occupationally exposed persons in interventional radiology is 90. The collective dose they receive is 67 person mSv, while the mean dose is 0.77 mSv (based on 12-month period). Highest doses are received by physicians (3.7 mSv), while radiographers and nurses receive 2.1 and 1.9 mSv respectively. This occurs due to the fact that physicians stand closer to the source (patient). The lead apron is proven to be the most efficient radiation protection equipment, but, also, lead thyroid shield and glasses can significantly lower doses received by professionals. The use of this equipment is highly recommended. PMID:21138927

  14. What Is Nuclear Medicine?

    MedlinePlus

    ... known as cosmic radiation, is in the upper atmosphere due to solar and galactic emissions. A typical ... used in medical procedures. 4 Cosmic Radiation Sun - - + - Atmosphere - + +- + + Earth How many nuclear medicine procedures are performed ...

  15. Highlights of the Annual Congress of the European Association of Nuclear Medicine, Istanbul, 2005: The incremental value of nuclear medicine for patient management and care.

    PubMed

    Cuocolo, Alberto; Acampa, Wanda; Varrone, Andrea; Salvatore, Marco

    2006-03-01

    The 2005 Annual Congress of the European Association of Nuclear Medicine (EANM) took place in Istanbul on October 15-19, under the chairmanship of Professor Hatice Durak. The programme was of excellent quality and represented a further step towards the achievement of a standardized EANM congress structure. A large industrial exhibition demonstrated the latest technological innovations and developments within the field. The congress was a great success: there were more than 4,000 participants, and 1,670 abstracts were received. Of these, 1,399 were accepted for oral or poster presentations, with a rejection rate of 16.2%. The original investigations presented were related to different areas of nuclear medicine, and addressed particularly advances in instrumentation and data processing, progress in radiochemistry and pharmacy, novel diagnostics and therapeutics, and new insights in well-established areas of clinical application, such as oncology, cardiology, neurology, psychiatry, endocrinology, paediatrics, nephrology, and infection and inflammation. It is noteworthy that a number of studies presented at this congress focussed on the quantitative interpretation of the imaging data and on pragmatic endpoints, such as adverse outcomes, and identified when nuclear medicine procedures achieved clinical effectiveness for patient care and management. These and many other studies presented at the congress demonstrate once more the crucial role that nuclear medicine has to play in contemporary medicine. This highlights lecture is only a brief summary of the large amount of data presented and discussed, which can be found in much greater detail in the congress proceedings book, published as volume 32, supplement 1 of the Eur J Nucl Med Mol Imaging in September 2005. PMID:16538466

  16. Expert consensus (SBC/SBHCI) on the use of drug-eluting stents: recommendations of the Brazilian society of interventional cardiology/ Brazilian society of cardiology for the Brazilian public single healthcare system.

    PubMed

    Lima, Valter C; Mattos, Luiz Alberto P; Caramori, Paulo R A; Perin, Marco A; Mangione, José A; Machado, Bruno M; Coelho, Wilson M C; Bueno, Ronaldo R L

    2006-10-01

    The authors review percutaneous coronary intervention (PCI) evolution and its growing application in myocardial revascularization for patients with coronary heart disease in Brazil and worldwide. PCI was introduced in 1977 using only the catheter balloon. Limitations of this method (acute occlusion and coronary restenosis) led to the adoption of coronary stents and more recently the advent of drug-eluting stents2, which were developed to drastically reduce restenosis rates. These developments allowed the exponential growth of percutaneous coronary intervention (PCI) procedures in Brazil which have replaced many bypass surgery procedures and have become the gold standard for the majority of symptomatic patients suffering from coronary artery disease. The preference for this procedure gained new dimensions in 2000 when the Brazilian Public Healthcare System (SUS) began reimbursing for stent procedures. This measure exemplified the importance of the Public Healthcare System's participation in incorporating medical advances and offering a high standard of cardiovascular treatment to a large portion of the Brazilian population. It is emphasized that prevention of in-stent restenosis is complex due to its unpredictable and ubiquitous occurrence. Control of this condition improves quality of life and reduces the recurrence of angina pectoris, the need to perform new revascularization procedures and hospital readmissions. The overall success of the drug-eluting stents has proven to be reliable and consistent in overcoming restenosis and has some beneficial impact for all clinical and angiographic conditions. This paper discusses the adoption and criteria for the use of drug-eluting stents in other countries as well as the recommendations established by the Brazilian Society of Interventional Cardiology for their reimbursement by SUS. The incorporation of new healthcare technology involves two distinct stages. During the first stage, the product is registered with the

  17. The introduction of automated dispensing and injection during PET procedures: a step in the optimisation of extremity doses and whole-body doses of nuclear medicine staff.

    PubMed

    Covens, P; Berus, D; Vanhavere, F; Caveliers, V

    2010-08-01

    Significant staff exposure is generally expected during PET-and PET/CT applications. Whole-body doses as well as extremity doses are usually higher per procedure compared with SPECT applications. Dispensing individual patient doses and manual injection involves high extremity doses even when heavy weighted syringe shields are used. In some cases the external radiation causes an exposure to the fingertips of more than 500 mSv y(-1), which is the yearly limit. Whole-body doses per procedure are relatively lower compared with extremity doses and are generally spread over the entire procedure (Guillet, B., Quentin, P., Waultier, S., Bourrelly, M., Pisano, P. and Mundler, O. Technologist radiation exposure in routine clinical practice with 18F-FDG PET. J. Nucl. Med. Technol. 33, 175-179 (2005). Optimisation of the individual workload is often used to restrict staff doses, but many PET centres face the need for further optimisation to reduce the staff doses to an acceptable level. During this study the effect of the use of an automated dispensing and injection system for (18)FDG on whole-body doses and extremity doses was evaluated. Detailed dosimetric studies using thermoluminescent and direct ion storage dosimetry were carried out before and after the introduction of this system. The results show that the extremity doses can be reduced by more than 95 % up to a mean level of 10 muSv per handled GBq. At the same time, whole-body doses can be halved during injection of the tracer. This results in a dose reduction of 20 % during the entire procedure of injection, escorting and positioning. In this way, the study shows that with the use of automated dispensing and injection a considerable staff dose reduction can be obtained. PMID:20335185

  18. Writer's Guide for technical procedures

    SciTech Connect

    Not Available

    1991-09-01

    A primary objective throughout the Department of Energy (DOE) complex is that operations be conducted in a deliberate and controlled manner with emphasis upon recognition and maintenance of the facility-specific safety envelope. One critical element of maintaining the safety envelope is procedures. DOE is providing guidance through this and other writer's guides to assist procedure writers across the DOE complex in producing accurate, complete, and usable procedures that promote safe and efficient operations in keeping with such DOE Orders as 5480.19, Conduct of Operations for DOE Facilities'', 5480.5, Safety of Nuclear facilities'', and 5480.6, Safety of Department of Energy-Owned Nuclear Reactors''. This Writer's Guide addresses the content, format, and style of technical procedures (procedures that prescribe production, operation of equipment and facilities, and maintenance activities) and is intended to be applied in a manner appropriate to the individual facility, 15 refs.

  19. [Commentary by the German Society for Thoracic and Cardiovascular Surgery on the positions statement by the German Cardiology Society on quality criteria for transcatheter aortic valve implantation (TAVI)].

    PubMed

    Cremer, Jochen; Heinemann, Markus K; Mohr, Friedrich Wilhelm; Diegeler, Anno; Beyersdorf, Friedhelm; Niehaus, Heidi; Ensminger, Stephan; Schlensak, Christian; Reichenspurner, Hermann; Rastan, Ardawan; Trummer, Georg; Walther, Thomas; Lange, Rüdiger; Falk, Volkmar; Beckmann, Andreas; Welz, Armin

    2014-12-01

    Surgical aortic valve replacement is still considered the first-line treatment for patients suffering from severe aortic valve stenosis. In recent years, transcatheter aortic valve implantation (TAVI) has emerged as an alternative for selected high-risk patients. According to the latest results of the German external quality assurance program, mandatory by law, the initially very high mortality and procedural morbidity have now decreased to approximately 6 and 12%, respectively. Especially in Germany, the number of patients treated by TAVI has increased exponentially. In 2013, a total of 10.602 TAVI procedures were performed. TAVI is claimed to be minimally invasive. This is true concerning the access, but it does not describe the genuine complexity of the procedure, defined by the close neighborhood of the aortic valve to delicate intracardiac structures. Hence, significant numbers of life-threatening complications may occur and have been reported. Owing to the complexity of TAVI, there is a unanimous concordance between cardiologists and cardiac surgeons in the Western world demanding a close heart team approach for patient selection, intervention, handling of complications, and pre- as well as postprocedural care, respectively. The prerequisite is that TAVI should not be performed in centers with no cardiac surgery on site. This is emphasized in all international joint guidelines and expert consensus statements. Today, a small number of patients undergo TAVI procedures in German hospitals without a department of cardiac surgery on site. To be noted, most of these hospitals perform less than 20 cases per year. Recently, the German Cardiac Society (DGK) published a position paper supporting this practice pattern. Contrary to this statement and concerned about the safety of patients treated this way, the German Society for Thoracic and Cardiovascular Surgery (DGTHG) still fully endorses the European (ESC/EACTS) and other actual international guidelines and

  20. Update on Nonsurgical Lung Volume Reduction Procedures

    PubMed Central

    Neder, J. Alberto; O'Donnell, Denis E.

    2016-01-01

    There has been a surge of interest in endoscopic lung volume reduction (ELVR) strategies for advanced COPD. Valve implants, coil implants, biological LVR (BioLVR), bronchial thermal vapour ablation, and airway stents are used to induce lung deflation with the ultimate goal of improving respiratory mechanics and chronic dyspnea. Patients presenting with severe air trapping (e.g., inspiratory capacity/total lung capacity (TLC) < 25%, residual volume > 225% predicted) and thoracic hyperinflation (TLC > 150% predicted) have the greatest potential to derive benefit from ELVR procedures. Pre-LVRS or ELVR assessment should ideally include cardiological evaluation, high resolution CT scan, ventilation and perfusion scintigraphy, full pulmonary function tests, and cardiopulmonary exercise testing. ELVR procedures are currently available in selected Canadian research centers as part of ethically approved clinical trials. If a decision is made to offer an ELVR procedure, one-way valves are the first option in the presence of complete lobar exclusion and no significant collateral ventilation. When the fissure is not complete, when collateral ventilation is evident in heterogeneous emphysema or when emphysema is homogeneous, coil implants or BioLVR (in that order) are the next logical alternatives. PMID:27445557

  1. Update on Nonsurgical Lung Volume Reduction Procedures.

    PubMed

    Neder, J Alberto; O'Donnell, Denis E

    2016-01-01

    There has been a surge of interest in endoscopic lung volume reduction (ELVR) strategies for advanced COPD. Valve implants, coil implants, biological LVR (BioLVR), bronchial thermal vapour ablation, and airway stents are used to induce lung deflation with the ultimate goal of improving respiratory mechanics and chronic dyspnea. Patients presenting with severe air trapping (e.g., inspiratory capacity/total lung capacity (TLC) < 25%, residual volume > 225% predicted) and thoracic hyperinflation (TLC > 150% predicted) have the greatest potential to derive benefit from ELVR procedures. Pre-LVRS or ELVR assessment should ideally include cardiological evaluation, high resolution CT scan, ventilation and perfusion scintigraphy, full pulmonary function tests, and cardiopulmonary exercise testing. ELVR procedures are currently available in selected Canadian research centers as part of ethically approved clinical trials. If a decision is made to offer an ELVR procedure, one-way valves are the first option in the presence of complete lobar exclusion and no significant collateral ventilation. When the fissure is not complete, when collateral ventilation is evident in heterogeneous emphysema or when emphysema is homogeneous, coil implants or BioLVR (in that order) are the next logical alternatives. PMID:27445557

  2. How electricity was discovered and how it is related to cardiology.

    PubMed

    de Micheli-Serra, Alfredo; Iturralde-Torres, Pedro; Izaguirre-Ávila, Raúl

    2012-01-01

    We relate the fundamental stages of the long road leading to the discovery of electricity and its uses in cardiology. The first observations on the electromagnetic phenomena were registered in ancient texts; many Greek and Roman writers referred to them, although they provided no explanations. The first extant treatise dates back to the XIII century and was written by Pierre de Maricourt during the siege of Lucera, Italy, by the army of Charles of Anjou, French king of Naples. There were no significant advances in the field of magnetism between the appearance of this treatise and the publication of the study De magnete magneticisque corporibus (1600) by the English physician William Gilbert. Scientists became increasingly interested in electromagnetic phenomena occurring in certain fish, i.e., the so-called electric ray that lived in the South American seas and the Torpedo fish that roamed the Mediterranean Sea. This interest increased in the 18th century, when condenser devices such as the Leyden jar were explored. It was subsequently demonstrated that the discharges produced by "electric fish" were of the same nature as those produced in this device. The famous "controversy" relating to animal electricity or electricity inherent to an animal's body also arose in the second half of the 18th century. The school of thought of the physicist Volta sustained the principle of a single electrical action generated by metallic contact. This led Volta to invent his electric pile, considered as the first wet cell battery. Toward the middle of the XIX century, the disciples of the physiologist Galvani were able to demonstrate the existence of animal electricity through experiments exploring the so-called current of injury. On the path of Volta's approach, many characteristics of electricity were detailed, which ultimately led to their usage in the industrial field. The route followed by Galvani-Nobili-Matteucci led to the successes of Waller, Einthoven, etcetera, enabling the

  3. Development of a tele-stethoscope and its application in pediatric cardiology.

    PubMed

    Hedayioglu, F L; Mattos, S S; Moser, L; de Lima, M E

    2007-01-01

    Over the years, many attempts have been made to develop special stethoscopes for the teaching of auscultation. The objective of this article is to report on the experience with the development and implementation of an electronic stethoscope and a virtual library of cardiac sounds. There were four stages to this project: (1) the building of the prototype to acquire, filter and amplify the cardiac sounds, (2) the development of a software program to record, reproduce and visualize them, (3) the testing of the prototype in a clinical scenario, and (4) the development of an internet site, to store and display the sounds collected. The first two stages are now complete. The prototype underwent an initial evaluation in a clinical scenario within the Unit and during virtual out-patient clinical sessions. One hundred auscultations were recorded during these tests. They were reviewed and discussed on-line by a panel of experience cardiologists during the sessions. Although the sounds were considered "satisfactory" for diagnostic purposes by the cardiology team, they identified some qualitative differences in the electronic recorded auscultations, such as a higher pitch of the recorded sounds. Prospective clinical studies are now being conducted to further evaluate the interference of the electronic device in the physicians' capability to diagnose different cardiac conditions. An internet site (www.caduceusvirtual.com.br/ auscultaped) was developed to host these cardiac auscultations. It is set as a library of cardiac sounds, catalogued by pathologies and already contains examples from auscultations of the majority of common congenital heart lesions, such as septal defects and valvar lesions. PMID:17249332

  4. Imaging skills for transthoracic echocardiography in cardiology fellows: The value of motion metrics

    PubMed Central

    Montealegre-Gallegos, Mario; Mahmood, Feroze; Kim, Han; Bergman, Remco; Mitchell, John D.; Bose, Ruma; Hawthorne, Katie M.; O’Halloran, T. David; Wong, Vanessa; Hess, Philip E.; Matyal, Robina

    2016-01-01

    Background: Proficiency in transthoracic echocardiography (TTE) requires an integration of cognitive knowledge and psychomotor skills. Whereas cognitive knowledge can be quantified, psychomotor skills are implied after repetitive task performance. We applied motion analyses to evaluate psychomotor skill acquisition during simulator-based TTE training. Methods and Results: During the first month of their fellowship training, 16 cardiology fellows underwent a multimodal TTE training program for 4 weeks (8 sessions). The program consisted of online and live didactics as well as simulator training. Kinematic metrics (path length, time, probe accelerations) were obtained at the start and end of the course for 8 standard TTE views using a simulator. At the end of the course TTE image acquisition skills were tested on human models. After completion of the training program the trainees reported improved self-perceived comfort with TTE imaging. There was also an increase of 8.7% in post-test knowledge scores. There was a reduction in the number of probe accelerations [median decrease 49.5, 95% CI = 29-73, adjusted P < 0.01], total time [median decrease 10.6 s, 95% CI = 6.6-15.5, adjusted P < 0.01] and path length [median decrease 8.8 cm, 95% CI = 2.2-17.7, adjusted P < 0.01] from the start to the end of the course. During evaluation on human models, the trainees were able to obtain all the required TTE views without instructor assistance. Conclusion: Simulator-derived motion analyses can be used to objectively quantify acquisition of psychomotor skills during TTE training. Such an approach could be used to assess readiness for clinical practice of TTE. PMID:27052064

  5. Introduction and summary of principal conclusions of the Second European Workshop in Aviation Cardiology.

    PubMed

    Joy, M

    1999-04-01

    Aviation is the only system of mass transportation regulated by international statute. The responsible agency is the International Civil Aviation Organization (ICAO), a safety directorate of the United Nations Organization. In 1995 almost 1-3 billion passengers were carried by the airlines of the world, the previous decade having seen a 50% growth in the number of passengers and the amount of freight carried. The total complement of professional pilots world-wide is approximately 455,000, although a significantly greater number of licence holders are involved in private or recreational flying. Approximately 11,500 large commercial transport aircraft are in service. All nations are signatories to the Chicago Convention of 1944, which, with its Annexes, forms the legal basis for an international agreement on aviation safety. Chapter six of Annex I contains the 'International Standards and Recommended Practices' (ISARPs) for the medical licensing of personnel which have been adopted and revised from time to time by the ICAO. The standards are interpreted by the relevant chapter in the Manual of Civil Aviation Medicine, first published in 1974 and last revised 18 years ago. Its status is only advisory, and it is currently being rewritten. As a part of the European harmonization process, the Joint Airworthiness Authorities directorate (now the Joint Aviation Authorities (JAA)) was set up as a supranational European body to agree explicit standards for the 29 signatory nations, and to regulate all aspects of certification. The new medical standard, which is complementary to that of the ICAO, is due to be promulgated in July 1999 whilst the cardiological standard, which has already undergone comprehensive revision, has yet to be agreed. Hafner has reviewed the JAA process in this supplement. PMID:11543488

  6. Fetal cardiology: changing the definition of critical heart disease in the newborn.

    PubMed

    Słodki, M; Respondek-Liberska, M; Pruetz, J D; Donofrio, M T

    2016-08-01

    Infants born with congenital heart disease (CHD) may require emergent treatment in the newborn period. These infants are likely to benefit the most from a prenatal diagnosis, which allows for optimal perinatal planning. Several cardiac centers have created guidelines for the management of these high-risk patients with CHD. This paper will review and compare several prenatal CHD classification systems with a particular focus on the most critical forms of CHD in the fetus and newborn. A contemporary definition of critical CHD is one which requires urgent intervention in the first 24 h of life to prevent death. Such cardiac interventions may be not only life saving for the infant but also decrease subsequent morbidity. Critical CHD cases may require delivery at specialized centers that can provide perinatal, obstetric, cardiology and cardiothoracic surgery care. Fetuses diagnosed in mid-gestation require detailed fetal diagnostics and serial monitoring during the prenatal period, in order to assess for ongoing changes and identify progression to a more severe cardiac status. Critical CHD may progress in utero and there is still much to be learned about how to best predict those who will require urgent neonatal interventions. Despite improved therapeutic capabilities, newborns with critical CHD continue to have significant morbidity and mortality due to compromise that begins in the delivery room. Fetal echocardiography is the best way to predict the need for specialized care at birth to improve outcome. Once the diagnosis is made of critical CHD, delivery at the proper time and in appropriate institution with specific care protocols should be initiated. More work needs to be done to better delineate the risk factors for progression of critical CHD and to determine which newborns will require specialized care. The most frequently described forms of critical CHD requiring immediate intervention include hypoplastic left heart syndrome with intact or severely restricted

  7. The conceptual basis of mathematics in cardiology: (I) algebra, functions and graphs.

    PubMed

    Bates, Jason H T; Sobel, Burton E

    2003-02-01

    This is the first in a series of four articles developed for the readers of. Without language ideas cannot be articulated. What may not be so immediately obvious is that they cannot be formulated either. One of the essential languages of cardiology is mathematics. Unfortunately, medical education does not emphasize, and in fact, often neglects empowering physicians to think mathematically. Reference to statistics, conditional probability, multicompartmental modeling, algebra, calculus and transforms is common but often without provision of genuine conceptual understanding. At the University of Vermont College of Medicine, Professor Bates developed a course designed to address these deficiencies. The course covered mathematical principles pertinent to clinical cardiovascular and pulmonary medicine and research. It focused on fundamental concepts to facilitate formulation and grasp of ideas. This series of four articles was developed to make the material available for a wider audience. The articles will be published sequentially in Coronary Artery Disease. Beginning with fundamental axioms and basic algebraic manipulations they address algebra, function and graph theory, real and complex numbers, calculus and differential equations, mathematical modeling, linear system theory and integral transforms and statistical theory. The principles and concepts they address provide the foundation needed for in-depth study of any of these topics. Perhaps of even more importance, they should empower cardiologists and cardiovascular researchers to utilize the language of mathematics in assessing the phenomena of immediate pertinence to diagnosis, pathophysiology and therapeutics. The presentations are interposed with queries (by Coronary Artery Disease, abbreviated as CAD) simulating the nature of interactions that occurred during the course itself. Each article concludes with one or more examples illustrating application of the concepts covered to cardiovascular medicine and

  8. The conceptual basis of mathematics in cardiology IV: statistics and model fitting.

    PubMed

    Bates, Jason H T; Sobel, Burton E

    2003-06-01

    This is the fourth in a series of four articles developed for the readers of Coronary Artery Disease. Without language ideas cannot be articulated. What may not be so immediately obvious is that they cannot be formulated either. One of the essential languages of cardiology is mathematics. Unfortunately, medical education does not emphasize, and in fact, often neglects empowering physicians to think mathematically. Reference to statistics, conditional probability, multicompartmental modeling, algebra, calculus and transforms is common but often without provision of genuine conceptual understanding. At the University of Vermont College of Medicine, Professor Bates developed a course designed to address these deficiencies. The course covered mathematical principles pertinent to clinical cardiovascular and pulmonary medicine and research. It focused on fundamental concepts to facilitate formulation and grasp of ideas. This series of four articles was developed to make the material available for a wider audience. The articles will be published sequentially in Coronary Artery Disease. Beginning with fundamental axioms and basic algebraic manipulations they address algebra, function and graph theory, real and complex numbers, calculus and differential equations, mathematical modeling, linear system theory and integral transforms and statistical theory. The principles and concepts they address provide the foundation needed for in-depth study of any of these topics. Perhaps of even more importance, they should empower cardiologists and cardiovascular researchers to utilize the language of mathematics in assessing the phenomena of immediate pertinence to diagnosis, pathophysiology and therapeutics. The presentations are interposed with queries (by Coronary Artery Disease abbreviated as CAD) simulating the nature of interactions that occurred during the course itself. Each article concludes with one or more examples illustrating application of the concepts covered to

  9. The conceptual basis of mathematics in cardiology: (II). Calculus and differential equations.

    PubMed

    Bates, Jason H T; Sobel, Burton E

    2003-04-01

    This is the second in a series of four articles developed for the readers of Coronary Artery Disease. Without language ideas cannot be articulated. What may not be so immediately obvious is that they cannot be formulated either. One of the essential languages of cardiology is mathematics. Unfortunately, medical education does not emphasize, and in fact, often neglects empowering physicians to think mathematically. Reference to statistics, conditional probability, multicompartmental modeling, algebra, calculus and transforms is common but often without provision of genuine conceptual understanding. At the University of Vermont College of Medicine, Professor Bates developed a course designed to address these deficiencies. The course covered mathematical principles pertinent to clinical cardiovascular and pulmonary medicine and research. It focused on fundamental concepts to facilitate formulation and grasp of ideas. This series of four articles was developed to make the material available for a wider audience. The articles will be published sequentially in Coronary Artery Disease. Beginning with fundamental axioms and basic algebraic manipulations they address algebra, function and graph theory, real and complex numbers, calculus and differential equations, mathematical modeling, linear system theory and integral transforms and statistical theory. The principles and concepts they address provide the foundation needed for in-depth study of any of these topics. Perhaps of even more importance, they should empower cardiologists and cardiovascular researchers to utilize the language of mathematics in assessing the phenomena of immediate pertinence to diagnosis, pathophysiology and therapeutics. The presentations are interposed with queries (by Coronary Artery Disease abbreviated as CAD) simulating the nature of interactions that occurred during the course itself. Each article concludes with one or more examples illustrating application of the concepts covered to

  10. The conceptual basis of mathematics in cardiology III: linear systems theory and integral transforms.

    PubMed

    Bates, Jason H T; Sobel, Burton E

    2003-05-01

    This is the third in a series of four articles developed for the readers of Coronary Artery Disease. Without language ideas cannot be articulated. What may not be so immediately obvious is that they cannot be formulated either. One of the essential languages of cardiology is mathematics. Unfortunately, medical education does not emphasize, and in fact, often neglects empowering physicians to think mathematically. Reference to statistics, conditional probability, multicompartmental modeling, algebra, calculus and transforms is common but often without provision of genuine conceptual understanding. At the University of Vermont College of Medicine, Professor Bates developed a course designed to address these deficiencies. The course covered mathematical principles pertinent to clinical cardiovascular and pulmonary medicine and research. It focused on fundamental concepts to facilitate formulation and grasp of ideas.This series of four articles was developed to make the material available for a wider audience. The articles will be published sequentially in Coronary Artery Disease. Beginning with fundamental axioms and basic algebraic manipulations they address algebra, function and graph theory, real and complex numbers, calculus and differential equations, mathematical modeling, linear system theory and integral transforms and statistical theory. The principles and concepts they address provide the foundation needed for in-depth study of any of these topics. Perhaps of even more importance, they should empower cardiologists and cardiovascular researchers to utilize the language of mathematics in assessing the phenomena of immediate pertinence to diagnosis, pathophysiology and therapeutics. The presentations are interposed with queries (by Coronary Artery Disease abbreviated as CAD) simulating the nature of interactions that occurred during the course itself. Each article concludes with one or more examples illustrating application of the concepts covered to

  11. Annual impact of scribes on physician productivity and revenue in a cardiology clinic

    PubMed Central

    Bank, Alan J; Gage, Ryan M

    2015-01-01

    Objective Scribes are increasingly being used in clinics to assist physicians with documentation during patient care. The annual effect of scribes in a real-world clinic on physician productivity and revenue has not been evaluated. Methods We performed a retrospective study comparing the productivity during routine clinic visits of ten cardiologists using scribes vs 15 cardiologists without scribes. We tracked patients per hour and patients per year seen per physician. Average direct revenue (clinic visit) and downstream revenue (cardiovascular revenue in the 2 months following a clinic visit) were measured in 486 patients and used to calculate annual revenue generated as a result of increased productivity. Results Physicians with scribes saw 955 new and 4,830 follow-up patients vs 1,318 new and 7,150 follow-up patients seen by physicians without scribes. Physicians with scribes saw 9.6% more patients per hour (2.50±0.27 vs 2.28±0.15, P<0.001). This improved productivity resulted in 84 additional new and 423 additional follow-up patients seen, 3,029 additional work relative value units (wRVUs) generated, and an increased cardiovascular revenue of $1,348,437. Physicians with scribes also generated an additional revenue of $24,257 by producing clinic notes that were coded at a higher level. Total additional revenue generated was $1,372,694 at a cost of $98,588 for the scribes. Conclusion Physician productivity in a cardiology clinic was ∼10% higher for physicians using scribes. This improved productivity resulted in 84 additional new and 423 additional follow-up patients seen in 1 year. The use of scribes resulted in the generation of 3,029 additional wRVUs and an additional annual revenue of $1,372,694 at a cost of $98,588. PMID:26457055

  12. Spatial and temporal overview of research in pediatric and congenital cardiology: trends and global challenges.

    PubMed

    Bräutigam, Martina; Kempny, Aleksander; Radke, Robert; Baumgartner, Helmut; Diller, Gerhard-Paul

    2014-08-01

    Available information on the global distribution of research output in pediatric cardiology (PC) is sparse. This study took a bibliometric approach to characterize research output, assess the level of competition, describe the geographic distribution of the leading research centers in the field, and investigate determinants of research output. In addition, the study characterized the journals publishing PC research and identified temporal trends in research interest over time. Publications presenting original research in PC between 1995 and 2011 were identified. A total of 9,410 relevant articles were identified based on a PubMed search followed by subsequent electronic filtering and manual review. A dramatic increase in PC publications was seen during the study period (from 309 in 1995 to 1,075 in 2011). This was accompanied by an increase in impact factors and an overproportional rise in PC contributions relative to the general PubMed trend. Research in PC was shown to be highly competitive and becoming increasingly so (Herfindahl-Hirschman index of 1.64%). Research output correlated with gross domestic product, national levels of corruption, education, urbanization, geography, and presence of national centers of excellence. The data presented in this report allow benchmarking of different cities and countries and provide insights into the potential determinants of high-quality publications and the spectrum of publishing journals. The report also highlights the central role of subspecialty journals and shows that PC research output is related to national wealth, surrogates of appropriate use of resources, an adequate workforce, and education. Additionally, it emphasizes the potential beneficial effects of establishing centers of excellence in the field. PMID:24584212

  13. The PhysioNet/Computing in Cardiology Challenge 2015: Reducing False Arrhythmia Alarms in the ICU

    PubMed Central

    Clifford, Gari D; Silva, Ikaro; Moody, Benjamin; Li, Qiao; Kella, Danesh; Shahin, Abdullah; Kooistra, Tristan; Perry, Diane; Mark, Roger G.

    2016-01-01

    High false alarm rates in the ICU decrease quality of care by slowing staff response times while increasing patient delirium through noise pollution. The 2015 Physio-Net/Computing in Cardiology Challenge provides a set of 1,250 multi-parameter ICU data segments associated with critical arrhythmia alarms, and challenges the general research community to address the issue of false alarm suppression using all available signals. Each data segment was 5 minutes long (for real time analysis), ending at the time of the alarm. For retrospective analysis, we provided a further 30 seconds of data after the alarm was triggered. A collection of 750 data segments was made available for training and a set of 500 was held back for testing. Each alarm was reviewed by expert annotators, at least two of whom agreed that the alarm was either true or false. Challenge participants were invited to submit a complete, working algorithm to distinguish true from false alarms, and received a score based on their program’s performance on the hidden test set. This score was based on the percentage of alarms correct, but with a penalty that weights the suppression of true alarms five times more heavily than acceptance of false alarms. We provided three example entries based on well-known, open source signal processing algorithms, to serve as a basis for comparison and as a starting point for participants to develop their own code. A total of 38 teams submitted a total of 215 entries in this year’s Challenge. PMID:27331073

  14. Human-based approaches to pharmacology and cardiology: an interdisciplinary and intersectorial workshop

    PubMed Central

    Rodriguez, Blanca; Carusi, Annamaria; Abi-Gerges, Najah; Ariga, Rina; Britton, Oliver; Bub, Gil; Bueno-Orovio, Alfonso; Burton, Rebecca A.B.; Carapella, Valentina; Cardone-Noott, Louie; Daniels, Matthew J.; Davies, Mark R.; Dutta, Sara; Ghetti, Andre; Grau, Vicente; Harmer, Stephen; Kopljar, Ivan; Lambiase, Pier; Lu, Hua Rong; Lyon, Aurore; Minchole, Ana; Muszkiewicz, Anna; Oster, Julien; Paci, Michelangelo; Passini, Elisa; Severi, Stefano; Taggart, Peter; Tinker, Andy; Valentin, Jean-Pierre; Varro, Andras; Wallman, Mikael; Zhou, Xin

    2016-01-01

    Both biomedical research and clinical practice rely on complex datasets for the physiological and genetic characterization of human hearts in health and disease. Given the complexity and variety of approaches and recordings, there is now growing recognition of the need to embed computational methods in cardiovascular medicine and science for analysis, integration and prediction. This paper describes a Workshop on Computational Cardiovascular Science that created an international, interdisciplinary and inter-sectorial forum to define the next steps for a human-based approach to disease supported by computational methodologies. The main ideas highlighted were (i) a shift towards human-based methodologies, spurred by advances in new in silico, in vivo, in vitro, and ex vivo techniques and the increasing acknowledgement of the limitations of animal models. (ii) Computational approaches complement, expand, bridge, and integrate in vitro, in vivo, and ex vivo experimental and clinical data and methods, and as such they are an integral part of human-based methodologies in pharmacology and medicine. (iii) The effective implementation of multi- and interdisciplinary approaches, teams, and training combining and integrating computational methods with experimental and clinical approaches across academia, industry, and healthcare settings is a priority. (iv) The human-based cross-disciplinary approach requires experts in specific methodologies and domains, who also have the capacity to communicate and collaborate across disciplines and cross-sector environments. (v) This new translational domain for human-based cardiology and pharmacology requires new partnerships supported financially and institutionally across sectors. Institutional, organizational, and social barriers must be identified, understood and overcome in each specific setting. PMID:26622055

  15. Use and role of monoclonal antibodies and other biologics in preventive cardiology.

    PubMed

    Gencer, Baris; Laaksonen, Reijo; Buhayer, Aliki; Mach, François

    2015-01-01

    Biotechnological advances now enable the design of fully human antibodies to target specific antigens in a growing number of diseases. Monoclonal antibodies (mAbs) differ from traditional small chemical molecules in several ways: (1) biological production ‒ they are grown in and extracted from cell cultures; (2) specificity ‒ they demonstrate high target specificity, with a low risk of drug-drug interactions; (3) administration ‒ they are delivered parenterally (intravenously or subcutaneously); (4) dosage interval ‒ their extended half-lives generally allow for spaced dosing (from weekly to monthly). In cardiology, fully human mAbs directed against proprotein convertase subtilisin / kexin type 9 (PCSK9) have shown to be effective in reducing low-density lipoprotein cholesterol (LDL-C) in phase II clinical trials among patients with familial hypercholesterolaemia (FH). PCSK9 inhibitors have just received approval for the treatment of FH and clinical atherosclerotic disease, and patients not at target under maximally tolerated statin therapy or intolerant to statins. Large-scale phase III trials are currently assessing the role of PCSK9 inhibitors in the secondary prevention setting for patients with acute coronary syndromes (ACS) and poorly controlled LDL-C under evidence-based therapies. Another area currently under investigation for fully human mAbs in secondary prevention is their potential ability to inhibit inflammatory pathways. In this context, canakinumab, a specific mAb inhibiting interleukin-1β (IL-1β), has already received approval for the treatment of systemic juvenile idiopathic arthritis. The canakinumab anti-inflammatory thrombosis outcomes trial (CANTOS) is an ongoing trial assessing whether inhibition of IL-1β could reduce the occurrence of cardiovascular adverse events in 17,200 patients with ACS and with defined persisting inflammation. PMID:26524671

  16. 2014 Guidelines of Taiwan Society of Cardiology (TSOC) for the Management of Pulmonary Arterial Hypertension

    PubMed Central

    Hsu, Chih-Hsin; Ho, Wan-Jing; Huang, Wei-Chun; Chiu, Yu-Wei; Hsu, Tsu-Shiu; Kuo, Ping-Hung; Hsu, Hsao-Hsun; Chang, Jia-Kan; Cheng, Chin-Chang; Lai, Chao-Lun; Liang, Kae-Woei; Lin, Shoa-Lin; Sung, Hsao-Hsun; Tsai, Wei-Chuan; Weng, Ken-Pen; Hsieh, Kai-Sheng; Yin, Wei-Hsian; Lin, Shing-Jong; Wang, Kuo-Yang

    2014-01-01

    Pulmonary hypertension (PH) is a hemodynamic and pathophysiologic condition, defined as a mean pulmonary arterial pressure exceeding 25 mmHg at rest. According to the recent classifications, it is grouped into pulmonary arterial hypertension (PAH), heart-related, lung-related, thromboembolic, and miscellaneous PH. In the past two decades, tremendous advances have occurred in the field of PH. These include (1) development of clinical diagnostic algorithm and a monitoring strategy dedicated to PAH, (2) defining strong rationales for screening at-risk populations, (3) advent of pulmonary specific drugs which makes PAH manageable, (4) recognition of needs of having proper strategy of combining existing pulmonary specific drugs, and/or potential novel drugs, (5) pursuit of clinical trials with optimal surrogate endpoints and study durations, (6) recognition of critical roles of PH/right ventricular function, as well as interdependence of ventricles in different conditions, especially those with various phenotypes of heart failure, and (7) for rare diseases, putting equal importance on carefully designed observation studies, various registries, etc., besides double blind randomized studies. In addition, ongoing basic and clinical research has led to further understanding of relevant physiology, pathophysiology, epidemiology and genetics of PH/PAH. This guidelines from the working group of Pulmonary Hypertension of the Taiwan Society of Cardiology is to provide updated guidelines based on the most recent international guidelines as well as Taiwan’s domestic research on PH. The guidelines are mainly for the management of PAH (Group 1) ; however the majority of content can be helpful for managing other types of PH. PMID:27122817

  17. Dental Procedures.

    PubMed

    Ramponi, Denise R

    2016-01-01

    Dental problems are a common complaint in emergency departments in the United States. There are a wide variety of dental issues addressed in emergency department visits such as dental caries, loose teeth, dental trauma, gingival infections, and dry socket syndrome. Review of the most common dental blocks and dental procedures will allow the practitioner the opportunity to make the patient more comfortable and reduce the amount of analgesia the patient will need upon discharge. Familiarity with the dental equipment, tooth, and mouth anatomy will help prepare the practitioner for to perform these dental procedures. PMID:27482994

  18. Cardiac troponins-Translational biomarkers in cardiology: Theory and practice of cardiac troponin high-sensitivity assays.

    PubMed

    Adamcova, Michaela; Popelova-Lencova, Olga; Jirkovsky, Eduard; Simko, Fedor; Gersl, Vladimir; Sterba, Martin

    2016-01-01

    Tn is a unique translational biomarker in cardiology whose potential has not been diminished in the new era of high sensitive assays. cTns can be valuable markers in cardiac diseases as well as in infectious diseases and respiratory diseases. Furthermore, the role of cTns is growing in the routine evaluation of cardioxicity and in determining the efficacy/safety ratio of novel cardioprotective strategies in clinical settings. cTns can detect myocardial injury not only in a wide spectrum of laboratory animals in experimental studies in vivo, but also in isolated heart models or cardiomyocytes in vitro. The crucial issue regarding the cross-species usage of cardiac troponin investigation remains the choice of cardiac troponin testing. This review summarizes the recent proteomic data on aminoacid sequences of cTnT and cTnI in various species, as well as selected analytical characteristics of human cardiac troponin high-sensitivity assays. Due to the highly phylogenetically conserved structure of troponins, the same bioindicator can be investigated using the same method in both clinical and experimental cardiology, thus contributing to a better understanding of the pathogenesis of cardiac diseases as well as to increased effectiveness of troponin use in clinical practice. Measuring cardiac troponins using commercially available human high-sensitivity cardiac troponin tests with convenient antibodies selected on the basis of adequate proteomic knowledge can solve many issues which would otherwise be difficult to address in clinical settings for various ethical and practical reasons. Our survey could help elaborate the practical guidelines for optimizing the choice of cTns assay in cardiology. © 2016 BioFactors, 42(2):133-148, 2016. PMID:26876101

  19. Poor adherence to anticoagulation guidelines in patients with non-valvular atrial fibrillation treated in a tertiary cardiology unit

    PubMed Central

    Kew, Guan Sen; Tan, Mabel; Lim, Toon Wei

    2015-01-01

    Introduction Atrial fibrillation (AF) is a well-known cause of strokes and all major society guidelines recommend oral anticoagulants (OAC) such as vitamin K antagonists (VKA) for patients with concomitant risk factors to prevent them. However, compliance with these guidelines is historically poor. This study aims to evaluate the adherence to CHADS2 (congestive heart failure, hypertension,age ≥75 years, diabetes mellitus and prior stroke or transient ischaemic attack) guidelines, explore reasons and evaluate outcomes for non-adherence in a tertiary cardiology unit. Materials and methods A retrospective study of patients admitted into a tertiary cardiology unit from January to March 2010. Results Of 1826 unique cardiac patients screened, 163 (8.9%) of them had non-valvular AF or atrial flutter. Their mean age was 69.8 years and 58.9% were men. Of the 54 patients on warfarin with documented international normalised ratio (INR), only 22 (40.7%) of them had an INR within the therapeutic range (INR less than two in 22 (40.7%) and greater than three in 10 (18.5%)). Of the 119 patients with CHADS2 greater than or equal to two, only 46 (38.7%) were discharged with warfarin. Among the remaining 73 (61.3%) patients, the most common reasons for not prescribing warfarin include history of bleeding (n=24, 32.9%), no reason documented (n=17, 23.3%) and patient preference (n=12, 19.2%). On follow-up, patients on warfarin were found to have better survival outcomes (mean 1522±41 days) as compared with (mean 1255±63 days) in patients not on OAC (p value=0.001). Conclusions Few patients who require anticoagulation receive it in accordance with the guidelines even in a tertiary cardiology unit. There are many impediments to the effective use of VKA for stroke prevention among patients with AF. PMID:27326208

  20. EXIT procedure: a report of the first three Mississippi cases.

    PubMed

    Brewer, Justin; Liechty, Kenneth W; Bofill, James A

    2012-04-01

    The University of Mississippi Medical Center has initiated a state-of-the-art fetal center. This project involves collaboration between multiple disciplines including anesthesiology, pediatric surgery, maternal-fetal medicine, radiology, neonatology, genetics, pediatric cardiology and other pediatric subspecialties, nursing, and social work. Complicated fetal patients from throughout the southeastern U.S.A. may be referred to this center and benefit from new and innovative interventions that have not been available to this region in the past. The first three EXIT (ex-utero intrapartum treatment) procedures were recently performed at Batson Children's Hospital at the University of Mississippi Medical Center. Our objective is to share our recent experiences with this novel procedure and to detail some of the basics of an EXIT delivery. PMID:22803277

  1. [Distance methods of cardiologic monitoring in diagnostics of high loading effects on organism of sportsman and cosmonaut].

    PubMed

    Kuznetsov, V I; Ryzhakov, N I; Tarakanov, S A; Nikitenko, A N; Rassadina, A A; Kozlenok, A V; Moroshkin, V S

    2012-01-01

    Increase of cardiovascular tension is a common thing for professional athletic training. Cardiovascular pathologies can be prevented by permanent physiological monitoring using, among others, the methods of cardiologic monitoring so far available in stationary diagnostic centers. On-line remote diagnostics during training is potent to enhance effectiveness and efficiency of sporting people's health management. In addition, RD will also enable extensive investigations of the bodily responses of individually determined training loads. The paper gives an overview of the current RM technologies. PMID:23457962

  2. 10 CFR 26.127 - Procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Procedures. 26.127 Section 26.127 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Licensee Testing Facilities § 26.127 Procedures. (a) Licensee testing facilities shall develop, implement, and maintain clear and well-documented procedures...

  3. 10 CFR 26.127 - Procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Procedures. 26.127 Section 26.127 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Licensee Testing Facilities § 26.127 Procedures. (a) Licensee testing facilities shall develop, implement, and maintain clear and well-documented procedures...

  4. 10 CFR 26.127 - Procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Procedures. 26.127 Section 26.127 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Licensee Testing Facilities § 26.127 Procedures. (a) Licensee testing facilities shall develop, implement, and maintain clear and well-documented procedures...

  5. 10 CFR 26.127 - Procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Procedures. 26.127 Section 26.127 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Licensee Testing Facilities § 26.127 Procedures. (a) Licensee testing facilities shall develop, implement, and maintain clear and well-documented procedures...

  6. 10 CFR 4.336 - Compliance procedure.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Compliance procedure. 4.336 Section 4.336 Energy NUCLEAR... FINANCIAL ASSISTANCE FROM THE COMMISSION Regulations Implementing the Age Discrimination Act of 1975, as Amended Investigation, Conciliation, and Enforcement Procedures § 4.336 Compliance procedure. (a) NRC...

  7. 10 CFR 4.336 - Compliance procedure.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Compliance procedure. 4.336 Section 4.336 Energy NUCLEAR... FINANCIAL ASSISTANCE FROM THE COMMISSION Regulations Implementing the Age Discrimination Act of 1975, as Amended Investigation, Conciliation, and Enforcement Procedures § 4.336 Compliance procedure. (a) NRC...

  8. 10 CFR 4.336 - Compliance procedure.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Compliance procedure. 4.336 Section 4.336 Energy NUCLEAR... FINANCIAL ASSISTANCE FROM THE COMMISSION Regulations Implementing the Age Discrimination Act of 1975, as Amended Investigation, Conciliation, and Enforcement Procedures § 4.336 Compliance procedure. (a) NRC...

  9. 10 CFR 4.336 - Compliance procedure.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Compliance procedure. 4.336 Section 4.336 Energy NUCLEAR... FINANCIAL ASSISTANCE FROM THE COMMISSION Regulations Implementing the Age Discrimination Act of 1975, as Amended Investigation, Conciliation, and Enforcement Procedures § 4.336 Compliance procedure. (a) NRC...

  10. 10 CFR 26.157 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Procedures. 26.157 Section 26.157 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Laboratories Certified by the Department of Health and Human Services § 26.157 Procedures. (a) HHS-certified laboratories shall develop, implement, and maintain clear and well-documented procedures for...

  11. 10 CFR 26.127 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Procedures. 26.127 Section 26.127 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Licensee Testing Facilities § 26.127 Procedures. (a) Licensee testing facilities shall develop, implement, and maintain clear and well-documented procedures for accession, shipment, and testing of...

  12. ENDF-6 Formats Manual Data Formats and Procedures for the Evaluated Nuclear Data File ENDF/B-VI and ENDF/B-VII

    SciTech Connect

    Herman, M.; Members of the Cross Sections Evaluation Working Group

    2009-06-01

    In December 2006, the Cross Section Evaluation Working Group (CSEWG) of the United States released the new ENDF/B-VII.0 library. This represented considerable achievement as it was the 1st major release since 1990 when ENDF/B-VI has been made publicly available. The two libraries have been released in the same format, ENDF-6, which has been originally developed for the ENDF/B-VI library. In the early stage of work on the VII-th generation of the library CSEWG made important decision to use the same formats. This decision was adopted even though it was argued that it would be timely to modernize the formats and several interesting ideas were proposed. After careful deliberation CSEWG concluded that actual implementation would require considerable resources needed to modify processing codes and to guarantee high quality of the files processed by these codes. In view of this the idea of format modernization has been postponed and ENDF-6 format was adopted for the new ENDF/B-VII library. In several other areas related to ENDF we made our best to move beyond established tradition and achieve maximum modernization. Thus, the 'Big Paper' on ENDF/B-VII.0 has been published, also in December 2006, as the Special Issue of Nuclear Data Sheets 107 (1996) 2931-3060. The new web retrieval and plotting system for ENDF-6 formatted data, Sigma, was developed by the NNDC and released in 2007. Extensive paper has been published on the advanced tool for nuclear reaction data evaluation, EMPIRE, in 2007. This effort was complemented with release of updated set of ENDF checking codes in 2009. As the final item on this list, major revision of ENDF-6 Formats Manual was made. This work started in 2006 and came to fruition in 2009 as documented in the present report.

  13. New Exercise-Dipyridamole Combined Test for Nuclear Cardiology in Insufficient Effort: Appropriate Diagnostic Sensitivity Keeping Exercise Prognosis

    PubMed Central

    Cortinas, Inés Vidal; Beretta, Mario; Alonso, Omar; Mut, Fernando

    2015-01-01

    Background Myocardial perfusion scintigraphy (MPS) in patients not reaching 85% of the maximum predicted heart rate (MPHR) has reduced sensitivity. Objectives In an attempt to maintain diagnostic sensitivity without losing functional exercise data, a new exercise and dipyridamole combined protocol (EDCP) was developed. Our aim was to evaluate the feasibility and safety of this protocol and to compare its diagnostic sensitivity against standard exercise and dipyridamole protocols. Methods In patients not reaching a sufficient exercise (SE) test and with no contraindications, 0.56 mg/kg of dipyridamole were IV administered over 1 minute simultaneously with exercise, followed by 99mTc-MIBI injection. Results Of 155 patients, 41 had MPS with EDCP, 47 had a SE test (≥ 85% MPHR) and 67 underwent the dipyridamole alone test (DIP). They all underwent coronary angiography within 3 months. The three stress methods for diagnosis of coronary lesions had their sensitivity compared. For stenosis ≥ 70%, EDCP yielded 97% sensitivity, SE 90% and DIP 95% (p = 0.43). For lesions ≥ 50%, the sensitivities were 94%, 88% and 95%, respectively (p = 0.35). Side effects of EDCP were present in only 12% of the patients, significantly less than with DIP (p < 0.001). Conclusions The proposed combined protocol is a valid and safe method that yields adequate diagnostic sensitivity, keeping exercise prognostic information in patients unable to reach target heart rate, with fewer side effects than the DIP. PMID:26039661

  14. Influence of cardiac and respiratory motion on tomographic reconstructions of the heart: implications for quantitative nuclear cardiology

    SciTech Connect

    Ter-Pogossian, M.M.; Bergmann, S.R.; Sobel, B.E.

    1982-12-01

    The potential influence of physiological, periodic motions of the heart due to the cardiac cycle, the respiratory cycle, or both on quantitative image reconstruction by positron emission tomography (PET) has been largely neglected. To define their quantitative impact, cardiac PET was performed in 6 dogs after injection of /sup 11/C-palmitate under disparate conditions including: normal cardiac and respiration cycles and cardiac arrest with and without respiration. Although in vitro assay of myocardial samples demonstrated that palmitate uptake was homogeneous (coefficient of variation . 10.1%), analysis of the reconstructed images demonstrated significant heterogeneity of apparent cardiac distribution of radioactivity due to both intrinsic cardiac and respiratory motion. Image degradation due to respiratory motion was demonstrated in a healthy human volunteer as well, in whom cardiac tomography was performed with Super PETT I during breath-holding and during normal breathing. The results indicate that quantitatively significant degradation of reconstructions of true tracer distribution occurs in cardiac PET due to both intrinsic cardiac and respiratory induced motion of the heart. They suggest that avoidance of or minimization of these influences can be accomplished by gating with respect to both the cardiac cycle and respiration or by employing brief scan times during breath-holding.

  15. Interventional cardiology, where real life and science do not necessarily meet.

    PubMed

    Meier, Bernhard

    2016-07-01

    Evidence-based diagnosis, decision-making, and therapy appear a must these days. Generating and publishing evidence is a tedious job according to ever new and tightened research practice regulations. Rules will never prevent the typical human behaviour from showing the new thing to be shinier and the old thing dustier than they really are. The medical community is solicited to concoct a meal that is gullible for patients, authorities, and third-party payers out of the available evidence (after applying some conversion factors correcting the common bias of the researchers), anticipation of what will be the evidence tomorrow, common sense, and digested experience. Examples of misguidance by poorly produced or misinterpreted evidence are plentiful in interventional cardiology as they are in other disciplines. Coronary stents, for instance, were first underestimated due to the fact that they were generally used in bailout situations where the outcome remained rather dismal in spite of the salvaging potential of stents. Then they were overused quite uncritically rather to the detriment of the patient. Now with the high quality of the modern drug-eluting stents (DESs), the overuse persists but is no longer a concern. However, the enhanced potential of DESs compared with bare-metal stents was poorly exploited for >10 years because of reports that slipped through the meshes of good review and publication practice to convey the untenable message that bare-metal stents were preferable in many situations. As other examples, use of the fractional flow reserve (FFR) for decision-making has to be questioned despite prominently published reports recommending it. Fixing a lesion is today easier and hardly more complication prone than assessing it with the FFR. Closure of the patent foramen ovale may never be properly applied, because the collection of the understandably requested evidence takes decades, a follow-up duration that makes research unattractive to physicians and

  16. Procedural simulation.

    PubMed

    Patel, Aalpen A; Glaiberman, Craig; Gould, Derek A

    2007-06-01

    In the past few decades, medicine has started to look at the potential use of simulators in medical education. Procedural medicine lends itself well to the use of simulators. Efforts are under way to establish national agendas to change the way medical education is approached and thereby improve patient safety. Universities, credentialing organizations, and hospitals are investing large sums of money to build and use simulation centers for undergraduate and graduate medical education. PMID:17574195

  17. Comparison of RIMPUFF, HYSPLIT, ADMS atmospheric dispersion model outputs, using emergency response procedures, with (85)Kr measurements made in the vicinity of nuclear reprocessing plant.

    PubMed

    Connan, Olivier; Smith, Kilian; Organo, Catherine; Solier, Luc; Maro, Denis; Hébert, Didier

    2013-10-01

    The Institut de Radioprotection et de Sureté Nucléaire (IRSN) performed a series of (85)Kr air sampling campaigns at mesoscale distances (18-50 km) from the AREVA NC La Hague nuclear reprocessing plant (North West France) between 2007 and 2009. The samples were collected in order to test and optimise a technique to measure low krypton-85 ((85)Kr) air concentrations and to investigate the performance of three atmospheric dispersion models (RIMPUFF, HYSPLIT, and ADMS), This paper presents the (85)Kr air concentrations measured at three sampling locations which varied from 2 to 8000 Bq m(-3), along with the (85)Kr air concentrations output by the dispersion models. The dispersion models made reasonable estimates of the mean concentrations of (85)Kr field measurements during steady wind conditions. In contrast, the models failed to accurately predict peaks in (85)Kr air concentration during periods of rapid and large changes in wind speed and/or wind direction. At distances where we made the comparisons (18-50 km), in all cases, the models underestimated the air concentration activities. PMID:23850583

  18. Procedure of calculation of the spatial distribution of temperatures and heat fluxes in the steam generator of a nuclear power installation with an RBEC fast-neutron reactor

    NASA Astrophysics Data System (ADS)

    Frolov, A. A.; Sedov, A. A.

    2016-08-01

    A method for combined 3D/1D-modeling of thermohydraulics of a once-through steam generator (SG) based on the joint analysis of three-dimensional thermo- and hydrodynamics of a single-phase heating coolant in the intertube space and one-dimensional thermohydraulics of steam-generating channels (tubes) with the use of well-known friction and heat-transfer correlations under various boiling conditions is discussed. This method allows one to determine the spatial distribution of temperatures and heat fluxes of heat-exchange surfaces of SGs with a single-phase heating coolant in the intertube space and with steam generation within tubes. The method was applied in the analytical investigation of typical operation of a once-through SG of a nuclear power installation with an RBEC fast-neutron heavy-metal reactor that is being designed by Kurchatov Institute in collaboration with OKB GIDROPRESS and Leipunsky Institute of Physics and Power Engineering. Flow pattern and temperature fields were obtained for the heavy-metal heating coolant in the intertube space. Nonuniformities of heating of the steam-water coolant in different heat-exchange tubes and nonuniformities in the distribution of heat fluxes at SG heat-exchange surfaces were revealed.

  19. 20th-Century “medical Marco Polos” in the origins of preventive cardiology and cardiovascular disease epidemiology.

    PubMed

    Blackburn, Henry

    2012-03-01

    In mid-20th century, several streams of knowledge converged to create the new academic discipline of cardiovascular disease epidemiology and the new practice of preventive cardiology. One stream was modern cardiology, with the ability to diagnose myocardial infarction, to characterize and count its victims, and to report vital statistics on cardiovascular causes of death. Another stream came from burgeoning clinical and laboratory research and greater understanding of the underlying processes of atherosclerosis and hypertension. A third stream came from the observations of intellectually curious "medical Marco Polos," who brought back from travels their tales of unusual population frequencies of heart attacks, along with ideas about sociocultural causes. This led to more formal research about cardiovascular disease risk and causes among populations and about mechanisms in the clinic and laboratory. The broad river of investigation thus formed produced a risk paradigm of the multiple biologic, behavioral, and societal factors in causal pathways to the common cardiovascular diseases. An evidence base was built for sound clinical and public health approaches to prevention. Here, the author tells brief stories about 5 early and particularly observant world travelers and their influence on knowledge and thinking about prevention. PMID:22470931

  20. Telemedicine for cardiovascular disease continuum: A position paper from the Italian Society of Cardiology Working Group on Telecardiology and Informatics.

    PubMed

    Brunetti, Natale Daniele; Scalvini, Simonetta; Acquistapace, Flavio; Parati, Gianfranco; Volterrani, Maurizio; Fedele, Francesco; Molinari, Giuseppe

    2015-04-01

    Telemedicine is the provision of health care services, through the use of information and communication technology, in situations where the health care professional and the patient, or 2 health care professionals, are not in the same location. It involves the secure transmission of medical data and information, through text, sound, images, or other forms needed for the prevention, diagnosis, treatment, and follow-up of a patient. First data on implementation of telemedicine for the diagnosis and treatment of acute myocardial infarction date from more than 10 years ago. Telemedicine has a potential broad application to the cardiovascular disease continuum and in many branches of cardiology, at least including heart failure, ischemic heart disease and arrhythmias. Telemedicine might have an important role as part of a strategy for the delivery of effective health care for patients with cardiovascular disease. In this document the Working Group on Telecardiology and Informatics of the Italian Society of Cardiology intends to remark some key-points regarding potential benefit achievable with the implementation of telemedicine support in the continuum of cardiovascular disease. PMID:25755064

  1. Evolving interpretation of the athlete's electrocardiogram: from European Society of Cardiology and Stanford criteria, to Seattle criteria and beyond.

    PubMed

    Zorzi, Alessandro; ElMaghawry, Mohamed; Corrado, Domenico

    2015-01-01

    Electrocardiographic (ECG) pre-participation screening can prevent sudden cardiac death in the athletes by early diagnosis and disqualification of affected individuals. Interpretation of the athlete's ECG should be based on specific criteria, because ECG changes that would be considered abnormal in the untrained population may develop in trained athletes as a physiologic and benign consequence of the heart's adaptation to exercise. In 2010, a stem document from the Section of Sports Cardiology of the European Society of Cardiology (ESC) proposed to classify the athlete's ECG changes according to the prevalence, relation to exercise training, association with an increased risk of cardiovascular disease and need for further investigations into two groups: "common and training-related" (Group 1) and "uncommon and training-unrelated" (Group 2). Over the last years, several efforts have been made to refine the ESC criteria for interpretation of the athlete's ECG in order to improve specificity maintaining good sensitivity, especially among elite and Afro-Caribbean athletes, which show the highest rate of false positives Group 2 ECG abnormalities. However, the balance between improvement in specificity and loss of sensitivity should be evaluated keeping in mind that the primary aim of the screening program is to save the athlete's lives rather than money. PMID:25724348

  2. Collected radiochemical and geochemical procedures

    SciTech Connect

    Kleinberg, J

    1990-05-01

    This revision of LA-1721, 4th Ed., Collected Radiochemical Procedures, reflects the activities of two groups in the Isotope and Nuclear Chemistry Division of the Los Alamos National Laboratory: INC-11, Nuclear and radiochemistry; and INC-7, Isotope Geochemistry. The procedures fall into five categories: I. Separation of Radionuclides from Uranium, Fission-Product Solutions, and Nuclear Debris; II. Separation of Products from Irradiated Targets; III. Preparation of Samples for Mass Spectrometric Analysis; IV. Dissolution Procedures; and V. Geochemical Procedures. With one exception, the first category of procedures is ordered by the positions of the elements in the Periodic Table, with separate parts on the Representative Elements (the A groups); the d-Transition Elements (the B groups and the Transition Triads); and the Lanthanides (Rare Earths) and Actinides (the 4f- and 5f-Transition Elements). The members of Group IIIB-- scandium, yttrium, and lanthanum--are included with the lanthanides, elements they resemble closely in chemistry and with which they occur in nature. The procedures dealing with the isolation of products from irradiated targets are arranged by target element.

  3. Methodological approach for the assessment of ultrasound reproducibility of cardiac structure and function: a proposal of the study group of Echocardiography of the Italian Society of Cardiology (Ultra Cardia SIC) Part I

    PubMed Central

    2011-01-01

    When applying echo-Doppler imaging for either clinical or research purposes it is very important to select the most adequate modality/technology and choose the most reliable and reproducible measurements. Quality control is a mainstay to reduce variability among institutions and operators and must be obtained by using appropriate procedures for data acquisition, storage and interpretation of echo-Doppler data. This goal can be achieved by employing an echo core laboratory (ECL), with the responsibility for standardizing image acquisition processes (performed at the peripheral echo-labs) and analysis (by monitoring and optimizing the internal intra- and inter-reader variability of measurements). Accordingly, the Working Group of Echocardiography of the Italian Society of Cardiology decided to design standardized procedures for imaging acquisition in peripheral laboratories and reading procedures and to propose a methodological approach to assess the reproducibility of echo-Doppler parameters of cardiac structure and function by using both standard and advanced technologies. A number of cardiologists experienced in cardiac ultrasound was involved to set up an ECL available for future studies involving complex imaging or including echo-Doppler measures as primary or secondary efficacy or safety end-points. The present manuscript describes the methodology of the procedures (imaging acquisition and measurement reading) and provides the documentation of the work done so far to test the reproducibility of the different echo-Doppler modalities (standard and advanced). These procedures can be suggested for utilization also in non referall echocardiographic laboratories as an "inside" quality check, with the aim at optimizing clinical consistency of echo-Doppler data. PMID:21943283

  4. Nuclear imaging in pediatrics

    SciTech Connect

    Siddiqui, A.R.

    1985-01-01

    The author's intent is to familiarize practicing radiologists with the technical aspects and interpretation of nuclear medicine procedures in children and to illustrate the indications for nuclear medicine procedures in pediatric problems. Pediatric doses, dosimetry, sedation, and injection techniques, organ systems, oncology and infection, testicular scanning and nuclear crystography, pediatric endocrine and skeletal systems, ventilation and perfusion imaging of both congenital and acquired pediatric disorders, cardiovascular problems, gastrointestinal, hepatobiliary, reticuloendothelial studies, and central nervous system are all topics which are included and discussed.

  5. [Anaemia and iron deficiency in clinical practice:from cardiology to gastroenterology and beyond].

    PubMed

    Češka, Richard

    2014-12-01

    . Gastorenterology is a common field for the use of Fe administration. The losses in the GIT are frequent as well as malabsorption of Fe in several gastrointestinal diseases. A typical example may be inflammatory bowel disease, especially Crohn´s disease. Not only case reports demonstrate the positive effect of ferric carboxymaltose in Crohn´s disease.Parenteral administration of Fe in cardiology. Recently published work (multicentric randomized controlled double-blinde trial) CONFIRM HF have proved that administration of ferric carboxymaltose in heart failure patients have improved their functional ability, NYHA stratification and quality of life. The pilot studies performed before resulted positively and CONFIRM HF only confirmed their conclusions.Quality of life - neglected parameter. Conclusions of CONFIRM HF introduce the improved quality of life as one of the main result. Unfortunately, it is a parameter (subjective, difficult to objectify) which doesn´t have such importance as endpoint - indicator of intervention trials. It is shown that treatment of anaemia is important in chronic fatigue (especially women) and affects quality of life. Improvement in symptoms of fatigue has been demonstrated after administration of 1000 mg of ferric carboxymaltose. Fe treatment improves quality of life in anaemic oncology patients as well. PMID:25692829

  6. Procedural knowledge

    NASA Technical Reports Server (NTRS)

    Georgeff, Michael P.; Lansky, Amy L.

    1986-01-01

    Much of commonsense knowledge about the real world is in the form of procedures or sequences of actions for achieving particular goals. In this paper, a formalism is presented for representing such knowledge using the notion of process. A declarative semantics for the representation is given, which allows a user to state facts about the effects of doing things in the problem domain of interest. An operational semantics is also provided, which shows how this knowledge can be used to achieve particular goals or to form intentions regarding their achievement. Given both semantics, the formalism additionally serves as an executable specification language suitable for constructing complex systems. A system based on this formalism is described, and examples involving control of an autonomous robot and fault diagnosis for NASA's Space Shuttle are provided.

  7. Implementation of reperfusion therapy in acute myocardial infarction. A policy statement from the European Society of Cardiology.

    PubMed

    Bassand, Jean-Pierre; Danchin, Nicolas; Filippatos, Gerasimos; Gitt, Anselm; Hamm, Christian; Silber, Sigmund; Tubaro, Marco; Weidinger, Franz

    2005-12-01

    Reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) is the most important component of treatment, as it strongly influences short- and long-term patient outcome. The main objective of healthcare providers should be to achieve at least 75% of reperfusion therapy applied to patients suffering from STEMI in a timely manner, and preferably within the first 3 h after onset of symptoms. Establishing networks of reperfusion at regional and national level, implying close collaboration between all the actors involved in reperfusion therapy, namely hospitals, departments of cardiology, PCI centres, emergency medical systems (EMS), (para)medically staffed ambulances, private cardiologists, primary care physicians, etc., is a key issue. All forms of reperfusion, depending on local facilities, need to be available to patients. Protocols must be written and agreed for the strategy of reperfusion to be applied within a network. Early diagnosis of STEMI is essential and is best achieved by rapid ECG recording and interpretation at first medical contact, wherever this contact takes place (hospital or ambulance). Tele-transmission of ECG for immediate interpretation by experienced cardiologists is an alternative. Primary PCI is the preferred reperfusion option if it can be performed by experienced staff within 90 min after first medical contact. Thrombolytic treatment, administered if possible in the pre-hospital setting, is a valid option if PCI cannot be performed in a timely manner, particularly within the first 3 h following onset of symptoms. Thrombolysis is not the end of the reperfusion therapy. Rescue PCI must be performed in the case of thrombolysis failure. Next-day PCI after successful thrombolysis has been proven efficacious. Quality control is important for monitoring the efficacy of networks of reperfusion. All elements that influence time to reperfusion must be taken into account, particularly transfer delays, in-hospital delays, and door

  8. 48 CFR 2015.606 - Agency procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... proposal into the unsolicited proposal tracking system. ... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Agency procedures. 2015.606 Section 2015.606 Federal Acquisition Regulations System NUCLEAR REGULATORY COMMISSION...

  9. 48 CFR 2015.606 - Agency procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... proposal into the unsolicited proposal tracking system. ... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Agency procedures. 2015.606 Section 2015.606 Federal Acquisition Regulations System NUCLEAR REGULATORY COMMISSION...

  10. 48 CFR 2015.606 - Agency procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... proposal into the unsolicited proposal tracking system. ... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Agency procedures. 2015.606 Section 2015.606 Federal Acquisition Regulations System NUCLEAR REGULATORY COMMISSION...

  11. 48 CFR 2015.606 - Agency procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... proposal into the unsolicited proposal tracking system. ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Agency procedures. 2015.606 Section 2015.606 Federal Acquisition Regulations System NUCLEAR REGULATORY COMMISSION CONTRACTING...

  12. Clinical trials update from the European Society of Cardiology Heart Failure meeting: COMET, COMPANION, Tezosentan and SHAPE.

    PubMed

    Coletta, Alison P; Clark, Andrew L; Seymour, Anne Marie L; Cleland, John G F

    2003-08-01

    This article continues a series of reports on recent research developments in the field of heart failure. Key presentations made at the European Society of Cardiology Heart Failure Update meeting, held in Strasbourg, France are described. The COMET study showed a 17% relative risk reduction in all-cause mortality with carvedilol compared with metoprolol tartrate. The COMPANION study, as previously reported, showed encouraging results for the use of cardiac resynchronisation and implantable defibrillator therapy in patients with heart failure, but further evidence is awaited. The results of a study on tezosentan suggest that lower doses of this endothelin antagonist may be clinically more effective with fewer adverse effects compared with higher doses. The SHAPE survey of heart failure awareness in Europe identified a need for further heart failure education amongst the public, patients, their carers and primary care physicians. PMID:12921817

  13. 500(th) anniversary of the birth of the precursor of modern cardiology: Josephus Struthius Polonus (1510-1568).

    PubMed

    Grzybowski, Andrzej; Sak, Jarosław; Pawlikowski, Jakub

    2011-01-01

    In this article, the authors take a closer look at the figure of Josephus Struthius Polonus (1510- -1568), one of the most famous physicians of the European Renaissance, on the 500(th) anniversary of his birth. Struthius became famous for his critical analysis of Galen's works and his own research into the circulatory system. The analysis of Struthius's scientific achievements leads to a conclusion that he was one of the pioneers of modern cardiology. He was a precursor of William Harvey (1578-1657) in studying the cardiovascular system, and the first person in the history of European medicine to present the pulse in a graphic form. He also presented similar ideas to those proposed in the 19(th) century by the inventor of the sphygmograph Karl von Vierodt (1818-1884), and the inventor of the polygraph Sir James Mackenzie (1853-1925). PMID:21948000

  14. Personnel, equipment, and facilities for electrophysiological and catheter ablation procedures in Europe: results of the European Heart Rhythm Association Survey.

    PubMed

    Estner, Heidi L; Chen, Jian; Potpara, Tatjana; Proclemer, Alessandro; Todd, Derick; Blomström-Lundqvist, Carina

    2014-07-01

    Clinical electrophysiology (EP) and catheter ablation of arrhythmias are rapidly evolving in recent years. More than 50 000 catheter ablations are performed every year in Europe. Emerging indications, an increasing number of procedures, and an expected high quality require national and international standards as well as trained specialists. The purpose of this European Heart Rhythm Association (EHRA) survey was to assess the practice of requirements for EP personnel, equipment, and facilities in Europe. Responses to the questionnaire were received from 52 members of the EHRA research network. The survey involved high-, medium-, and low-volume EP centres, performing >400, 100-399, and under 100 implants per year, respectively. The following topics were explored: (i) EP personnel issues including balance between female and male operators, responsibilities within the EP department, age profiles, role and training of fellows, and EP nurses, (ii) the equipments available in the EP laboratories, (iii) source of patient referrals, and (iv) techniques used for ablation for different procedures including sedation, and peri-procedural use of anticoagulation and antibiotics. The survey reflects the current EP personnel situation characterized by a high training requirement and specialization. Arrhythmia sections are still most often part of cardiology departments and the head of cardiology is seldom a heart rhythm specialist. Currently, the vast majority of EP physicians are men, although in the subgroup of physicians younger than 40 years, the proportion of women is increasing. Uncertainty exists regarding peri-procedural anticoagulation, antibiotic prophylaxis, and the need for sedation during specific procedures. PMID:24966009

  15. 77 FR 51943 - Procedures for Safety Investigations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-28

    ... Investigations, which published July 27, 2012 in the Federal Register, 77 FR 44174. The comment period expires... SAFETY BOARD 10 CFR Part 1708 Procedures for Safety Investigations AGENCY: Defense Nuclear Facilities Safety Board. ACTION: Proposed rule; extension of comment period. SUMMARY: The Defense Nuclear...

  16. 32 CFR 223.6 - Procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 2 2011-07-01 2011-07-01 false Procedures. 223.6 Section 223.6 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS DEPARTMENT OF DEFENSE UNCLASSIFIED CONTROLLED NUCLEAR INFORMATION (DOD UCNI) § 223.6 Procedures. Appendix A to this...

  17. 10 CFR 4.570 - Compliance procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... procedures established by the Equal Employment Opportunity Commission in 29 CFR part 1613 pursuant to section... 10 Energy 1 2010-01-01 2010-01-01 false Compliance procedures. 4.570 Section 4.570 Energy NUCLEAR... FINANCIAL ASSISTANCE FROM THE COMMISSION Enforcement of Nondiscrimination on the Basis of Handicap...

  18. 10 CFR 4.570 - Compliance procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... procedures established by the Equal Employment Opportunity Commission in 29 CFR part 1613 pursuant to section... 10 Energy 1 2013-01-01 2013-01-01 false Compliance procedures. 4.570 Section 4.570 Energy NUCLEAR... FINANCIAL ASSISTANCE FROM THE COMMISSION Enforcement of Nondiscrimination on the Basis of Disability...

  19. 10 CFR 4.570 - Compliance procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... procedures established by the Equal Employment Opportunity Commission in 29 CFR part 1613 pursuant to section... 10 Energy 1 2012-01-01 2012-01-01 false Compliance procedures. 4.570 Section 4.570 Energy NUCLEAR... FINANCIAL ASSISTANCE FROM THE COMMISSION Enforcement of Nondiscrimination on the Basis of Handicap...

  20. 10 CFR 4.570 - Compliance procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... procedures established by the Equal Employment Opportunity Commission in 29 CFR part 1613 pursuant to section... 10 Energy 1 2014-01-01 2014-01-01 false Compliance procedures. 4.570 Section 4.570 Energy NUCLEAR... FINANCIAL ASSISTANCE FROM THE COMMISSION Enforcement of Nondiscrimination on the Basis of Disability...

  1. 10 CFR 76.33 - Application procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 2 2013-01-01 2013-01-01 false Application procedures. 76.33 Section 76.33 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Application § 76.33 Application procedures. (a) Filing requirements. (1) An application for a certificate of compliance must be tendered...

  2. 10 CFR 76.33 - Application procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 2 2012-01-01 2012-01-01 false Application procedures. 76.33 Section 76.33 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Application § 76.33 Application procedures. (a) Filing requirements. (1) An application for a certificate of compliance must be tendered...

  3. 10 CFR 76.33 - Application procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 2 2014-01-01 2014-01-01 false Application procedures. 76.33 Section 76.33 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Application § 76.33 Application procedures. (a) Filing requirements. (1) An application for a certificate of compliance must be tendered...

  4. 10 CFR 76.33 - Application procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Application procedures. 76.33 Section 76.33 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Application § 76.33 Application procedures. (a) Filing requirements. (1) An application for a certificate of compliance must be tendered...

  5. 10 CFR 76.33 - Application procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 2 2011-01-01 2011-01-01 false Application procedures. 76.33 Section 76.33 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS Application § 76.33 Application procedures. (a) Filing requirements. (1) An application for a certificate of compliance must be tendered...

  6. Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology.

    PubMed

    Lyon, Alexander R; Bossone, Eduardo; Schneider, Birke; Sechtem, Udo; Citro, Rodolfo; Underwood, S Richard; Sheppard, Mary N; Figtree, Gemma A; Parodi, Guido; Akashi, Yoshihiro J; Ruschitzka, Frank; Filippatos, Gerasimos; Mebazaa, Alexandre; Omerovic, Elmir

    2016-01-01

    Takotsubo syndrome is an acute reversible heart failure syndrome that is increasingly recognized in modern cardiology practice. This Position Statement from the European Society of Cardiology Heart Failure Association provides a comprehensive review of the various clinical and pathophysiological facets of Takotsubo syndrome, including nomenclature, definition, and diagnosis, primary and secondary clinical subtypes, anatomical variants, triggers, epidemiology, pathophysiology, clinical presentation, complications, prognosis, clinical investigations, and treatment approaches. Novel structured approaches to diagnosis, risk stratification, and management are presented, with new algorithms to aid decision-making by practising clinicians. These also cover more complex areas (e.g. uncertain diagnosis and delayed presentation) and the management of complex cases with ongoing symptoms after recovery, recurrent episodes, or spontaneous presentation. The unmet needs and future directions for research in this syndrome are also discussed. PMID:26548803

  7. Designing Flight Deck Procedures

    NASA Technical Reports Server (NTRS)

    Degani, Asaf; Wiener, Earl

    2005-01-01

    Three reports address the design of flight-deck procedures and various aspects of human interaction with cockpit systems that have direct impact on flight safety. One report, On the Typography of Flight- Deck Documentation, discusses basic research about typography and the kind of information needed by designers of flight deck documentation. Flight crews reading poorly designed documentation may easily overlook a crucial item on the checklist. The report surveys and summarizes the available literature regarding the design and typographical aspects of printed material. It focuses on typographical factors such as proper typefaces, character height, use of lower- and upper-case characters, line length, and spacing. Graphical aspects such as layout, color coding, fonts, and character contrast are discussed; and several cockpit conditions such as lighting levels and glare are addressed, as well as usage factors such as angular alignment, paper quality, and colors. Most of the insights and recommendations discussed in this report are transferable to paperless cockpit systems of the future and computer-based procedure displays (e.g., "electronic flight bag") in aerospace systems and similar systems that are used in other industries such as medical, nuclear systems, maritime operations, and military systems.

  8. Pilot program on patient dosimetry in pediatric interventional cardiology in Chile

    SciTech Connect

    Ubeda, Carlos; Vano, Eliseo; Miranda, Patricia; Leyton, Fernando

    2012-05-15

    Purpose: The aim of this study was to present the results of a pilot program on patient dosimetry carried out in Chile during the last 5 yr, using a biplane x-ray angiography system settled for pediatrics. This research was conducted in Latin America under the auspices of the International Atomic Energy Agency (IAEA) supporting programs on radiological protection (RP) of patients. Methods: Patient age, gender, weight, height, number of cine series, total number of cine frames, fluoroscopy time, and two dosimetric quantities [air kerma-area product (P{sub ka}) and cumulative dose (CD) at the patient entrance reference point] were recorded for each procedure. Results: The study includes 544 patients grouped into four age groups. The distributions by age group were 150 for <1 yr; 203 for 1 to <5 yr; 97 for 5 to <10 yr; and 94 for 10 to <16 yr. Median values of P{sub ka} and CD for the four age groups were 0.94, 1.46, 2.13, and 5.03 Gy cm{sup 2} and 23.9, 26.8, 33.5, and 51.6 mGy, respectively. No significant statistical differences were found between diagnostic and therapeutic procedures. A moderate correlation (r = 0.64) was seen between P{sub ka} and patient weight. Conclusions: The dose values reported in this paper were lower than those published in the previous work for the same age groups as a result of the optimization actions carried out by cardiologists and medical physicists with the support of the IAEA. Methodology and results will be used as a starting point for a wider survey in Chile and Latin America with the goal to obtain regional diagnostic reference levels as recently recommended by the International Commission on Radiological Protection for interventional procedures.

  9. [Cardiovascular diseases and the subspecialties cardiology and angiology in "Schlichtungs"- Proceedings].

    PubMed

    Scheppokat, K D; Held, K

    2003-10-01

    A: The Schlichtungsstelle (expert panel for alternative dispute resolution) of Northern Germany, in 2001, decided on 2620 malpractice claims; 233 of these were related to the treatment of cardiovascular disorders, coronary and venous diseases being the most common. The physicians involved in these disputes represented 18 (sub-)specialities. Complaints related to procedures were the ones most frequently submitted by the patients, followed by those concerning diagnostics. Negligence was found to be present in 37% of the cases, the highest proportion being due to mistakes of diagnosis, followed by organisational and system-related mistakes. Medical negligence as the cause of injury was assumed in 46/233 (20%) of the cases, the injuries being serious in 18 and fatal in 6 of the 46 patients. Negligent and non-negligent iatrogenic injuries combined, amounted to 132/233 (57%) of the "cardiovascular" panel cases. B: From 1992 to 2001, we collected 165 panel cases involving cardiologists and 3 involving angiologists. In most of these the underlying disease was coronary, but in 14 cases the underlying disorder was psychosomatic. 35% of the complaints submittted by the patients were about invasive procedures. 12% of the instances of negligence determined in the panel proceedings were due to procedural mistakes, whereas 47% were due to mistakes related to indication and to the monitoring of the patients after procedures. Negligent iatrogenic injury was assumed in 27%, non-negligent iatrogenic injury in another 53% of the cases, so that the total of iatrogenic injuries amounted to 80% of the "cardio-angiologists" panel cases. 19/168 (11%) patients died from iatrogenic injuries. Organization and coordination among medical persons and institutions treating patients need improvement. A considerable number of disputes and claims seems to be initiated and caused by deficits in doctor-patient-communication. Attempts at reducing negligence and adverse events should center around those

  10. Automated volume of interest delineation and rendering of cone beam CT images in interventional cardiology

    NASA Astrophysics Data System (ADS)

    Lorenz, Cristian; Schäfer, Dirk; Eshuis, Peter; Carroll, John; Grass, Michael

    2012-02-01

    Interventional C-arm systems allow the efficient acquisition of 3D cone beam CT images. They can be used for intervention planning, navigation, and outcome assessment. We present a fast and completely automated volume of interest (VOI) delineation for cardiac interventions, covering the whole visceral cavity including mediastinum and lungs but leaving out rib-cage and spine. The problem is addressed in a model based approach. The procedure has been evaluated on 22 patient cases and achieves an average surface error below 2mm. The method is able to cope with varying image intensities, varying truncations due to the limited reconstruction volume, and partially with heavy metal and motion artifacts.

  11. [The Health Department of Sicily "Regional recommendations for hospital discharge and communication with patients after admission due to a cardiologic event" decree].

    PubMed

    Abrignani, Maurizio Giuseppe; De Luca, Giovanni; Gabriele, Michele; Tourkmani, Nidal

    2014-06-01

    Mortality and rehospitalizations still remain high after discharge for an acute cardiologic event. In this context, hospital discharge represents a potential pitfall for heart disease patients. In the setting of care transitions, the discharge letter is the main instrument of communication between hospital and primary care. Communication, besides, is an integral part of high-quality, patient-centered interventions aimed at improving the discharge process. Inadequate information at discharge significantly affects the quality of treatment compliance and the adoption of lifestyle modifications for an effective secondary prevention. The Health Department of Sicily, in 2013, established a task force with the aim to elaborate "Regional recommendations for hospital discharge and communication with patients after admission due to a cardiologic event", inviting to participate GICR-IACPR and many other scientific societies of cardiology and primary care, as discharge letter and communication are fundamental junctions of care transitions in cardiology. These recommendations have been published as a specific decree and contain: a structured model of discharge letter, which includes all of the parameters characterizing patients at high clinical risk, high thrombotic risk and low risk according to the Consensus document ANMCO/GICR-IACPR/GISE; is thus possible to identify these patients, choosing consequently the most appropriate follow-up pathways. A particular attention has been given to the "Medication Reconciliation" and to the identification of therapeutic targets; an educational Kit, with different forms on cardiac diseases, risk factors, drugs and lifestyle; a check-list about information given to the patient and caregivers. The "Recommendations" represent, in conclusion, the practical realization of the fruitful cooperation between scientific societies and political-administrative institutions that has been realized in Sicily in the last years. PMID:25845093

  12. HUMAN RELIABILITY ANALYSIS FOR COMPUTERIZED PROCEDURES

    SciTech Connect

    Ronald L. Boring; David I. Gertman; Katya Le Blanc

    2011-09-01

    This paper provides a characterization of human reliability analysis (HRA) issues for computerized procedures in nuclear power plant control rooms. It is beyond the scope of this paper to propose a new HRA approach or to recommend specific methods or refinements to those methods. Rather, this paper provides a review of HRA as applied to traditional paper-based procedures, followed by a discussion of what specific factors should additionally be considered in HRAs for computerized procedures. Performance shaping factors and failure modes unique to computerized procedures are highlighted. Since there is no definitive guide to HRA for paper-based procedures, this paper also serves to clarify the existing guidance on paper-based procedures before delving into the unique aspects of computerized procedures.

  13. Writer`s guide for technical procedures

    SciTech Connect

    1998-12-01

    A primary objective of operations conducted in the US Department of Energy (DOE) complex is safety. Procedures are a critical element of maintaining a safety envelope to ensure safe facility operation. This DOE Writer`s Guide for Technical Procedures addresses the content, format, and style of technical procedures that prescribe production, operation of equipment and facilities, and maintenance activities. The DOE Writer`s Guide for Management Control Procedures and DOE Writer`s Guide for Emergency and Alarm Response Procedures are being developed to assist writers in developing nontechnical procedures. DOE is providing this guide to assist writers across the DOE complex in producing accurate, complete, and usable procedures that promote safe and efficient operations that comply with DOE orders, including DOE Order 5480.19, Conduct of Operations for DOE Facilities, and 5480.6, Safety of Department of Energy-Owned Nuclear Reactors.

  14. Nuclear disarmament verification

    SciTech Connect

    DeVolpi, A.

    1993-12-31

    Arms control treaties, unilateral actions, and cooperative activities -- reflecting the defusing of East-West tensions -- are causing nuclear weapons to be disarmed and dismantled worldwide. In order to provide for future reductions and to build confidence in the permanency of this disarmament, verification procedures and technologies would play an important role. This paper outlines arms-control objectives, treaty organization, and actions that could be undertaken. For the purposes of this Workshop on Verification, nuclear disarmament has been divided into five topical subareas: Converting nuclear-weapons production complexes, Eliminating and monitoring nuclear-weapons delivery systems, Disabling and destroying nuclear warheads, Demilitarizing or non-military utilization of special nuclear materials, and Inhibiting nuclear arms in non-nuclear-weapons states. This paper concludes with an overview of potential methods for verification.

  15. European Society of Cardiology Guideline-Adherent Antithrombotic Treatment and Risk of Mortality in Asian Patients with Atrial Fibrillation.

    PubMed

    Li, Cheng-Hung; Liu, Chia-Jen; Chou, Annie Y; Chao, Tze-Fan; Tuan, Ta-Chuan; Chen, Su-Jung; Wang, Kang-Ling; Lin, Yenn-Jiang; Chang, Shih-Lin; Lo, Li-Wei; Hu, Yu-Feng; Chung, Fa-Po; Liao, Jo-Nan; Chen, Tzeng-Ji; Wu, Tsu-Juey; Chen, Shih-Ann

    2016-01-01

    This study compared the risk of mortality in atrial fibrillation (AF) patients treated adherent to the 2012 European Society of Cardiology (ESC) guidelines for stroke prevention and those who were not treated according to guideline recommendations. This study used the Taiwan National Health Insurance Research Database. From 1996 to 2011, 354,649 newly diagnosed AF patients were identified as the study population. Among the study cohort, 45,595 and 309,054 patients were defined as Guideline-Adherent and Non-Adherent groups, respectively. During the follow up of 1,480,280 person-years, 133,552 (37.7%) patients experienced mortality. The risk of mortality was lower among AF patients whose treatment was adherent to the guideline recommendation for stroke prevention than those whose treatment was not (annual risk of mortality = 4.3% versus 10.0%) with an adjusted hazard ratio of 0.62 (95% confidence interval = 0.61-0.64, p value < 0.001) after adjusting for age, gender, CHA2DS2-VASc score and antiplatelet therapy. The findings were consistently observed after propensity matching analysis. In conclusion, the risk of mortality was lower for AF patients who were treated according to the antithrombotic recommendations of the 2012 ESC guidelines, guided by the CHA2DS2-VASc score. Better efforts to implement guidelines would lead to improved outcomes for patients with AF. PMID:27498702

  16. Prevalence and profile of congenital heart disease and pulmonary hypertension in Down syndrome in a pediatric cardiology service

    PubMed Central

    Mourato, Felipe Alves; Villachan, Lúcia Roberta R.; Mattos, Sandra da Silva

    2014-01-01

    OBJECTIVE: To determine the frequence and profile of congenital heart defects in Down syndrome patients referred to a pediatric cardiologic center, considering the age of referral, gender, type of heart disease diagnosed by transthoracic echocardiography and its association with pulmonary hypertension at the initial diagnosis. METHODS: Cross-sectional study with retrospective data collection of 138 patients with Down syndrome from a total of 17,873 records. Descriptive analysis of the data was performed, using Epi-Info version 7. RESULTS: Among the 138 patients with Down syndrome, females prevailed (56.1%) and 112 (81.2%) were diagnosed with congenital heart disease. The most common lesion was ostium secundum atrial septal defect, present in 51.8%, followed by atrioventricular septal defect, in 46.4%. Ventricular septal defects were present in 27.7%, while tetralogy of Fallot represented 6.3% of the cases. Other cardiac malformations corresponded to 12.5%. Pulmonary hypertension was associated with 37.5% of the heart diseases. Only 35.5% of the patients were referred before six months of age. CONCLUSIONS: The low percentage of referral until six months of age highlights the need for a better tracking of patients with Down syndrome in the context of congenital heart disease, due to the high frequency and progression of pulmonary hypertension. PMID:25119745

  17. Analysis of the discrepancies identified during medication reconciliation on patient admission in cardiology units: a descriptive study

    PubMed Central

    Lombardi, Natália Fracaro; Mendes, Antonio Eduardo Matoso; Lucchetta, Rosa Camila; Reis, Wálleri Christini Torelli; Fávero, Maria Luiza Drechsel; Correr, Cassyano Januário

    2016-01-01

    ABSTRACT Objectives: this observational study aimed to describe the discrepancies identified during medication reconciliation on patient admission to cardiology units in a large hospital. Methods: the medication history of patients was collected within 48 hours after admission, and intentional and unintentional discrepancies were classified as omission, duplication, dose, frequency, timing, and route of drug administration. Results: most of the patients evaluated were women (58.0%) with a mean age of 59 years, and 75.5% of the patients had a Charlson comorbidity index score between 1 and 3. Of the 117 discrepancies found, 50.4% were unintentional. Of these, 61.0% involved omission, 18.6% involved dosage, 18.6% involved timing, and 1.7% involved the route of drug administration. Conclusion: this study revealed a high prevalence of discrepancies, most of which were related to omissions, and 50% were unintentional. These results reveal the number of drugs that are not reincorporated into the treatment of patients, which can have important clinical consequences. PMID:27533269

  18. Insights from the early experience of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.

    PubMed

    Rumsfeld, John S; Holmes, David R; Stough, Wendy Gattis; Edwards, Fred H; Jacques, Louis B; Mack, Michael J

    2015-03-01

    The current system for postmarket surveillance of medical devices in the United States is limited. To help change this paradigm for transcatheter valve therapies (TVTs), starting with transcatheter aortic valve replacement, the Society of Thoracic Surgeons and the American College of Cardiology partnered to form the TVT Registry program in close collaboration with the U.S. Food and Drug Administration and the Center for Medicare and Medicaid Services. The goal of the TVT Registry is to measure and improve quality of care and patient outcomes in clinical practice and to have a pivotal role in the scientific evidence and surveillance for medical devices. Challenges were faced in the early experience of the registry included developing multistakeholder partnerships, data collection requirements, and the use of the registry for pre- and post-market device evaluations. In addressing these challenges, the TVT Registry demonstrates that it is feasible for professional societies to assume a pivotal role in pre- and/or post-market studies, leveraging a clinical registry infrastructure. Sharing the TVT Registry experience may help other professional societies and stakeholders better anticipate and plan for these challenges. PMID:25703888

  19. European Society of Cardiology Guideline-Adherent Antithrombotic Treatment and Risk of Mortality in Asian Patients with Atrial Fibrillation

    PubMed Central

    Li, Cheng-Hung; Liu, Chia-Jen; Chou, Annie Y.; Chao, Tze-Fan; Tuan, Ta-Chuan; Chen, Su-Jung; Wang, Kang-Ling; Lin, Yenn-Jiang; Chang, Shih-Lin; Lo, Li-Wei; Hu, Yu-Feng; Chung, Fa-Po; Liao, Jo-Nan; Chen, Tzeng-Ji; Wu, Tsu-Juey; Chen, Shih-Ann

    2016-01-01

    This study compared the risk of mortality in atrial fibrillation (AF) patients treated adherent to the 2012 European Society of Cardiology (ESC) guidelines for stroke prevention and those who were not treated according to guideline recommendations. This study used the Taiwan National Health Insurance Research Database. From 1996 to 2011, 354,649 newly diagnosed AF patients were identified as the study population. Among the study cohort, 45,595 and 309,054 patients were defined as Guideline-Adherent and Non-Adherent groups, respectively. During the follow up of 1,480,280 person-years, 133,552 (37.7%) patients experienced mortality. The risk of mortality was lower among AF patients whose treatment was adherent to the guideline recommendation for stroke prevention than those whose treatment was not (annual risk of mortality = 4.3% versus 10.0%) with an adjusted hazard ratio of 0.62 (95% confidence interval = 0.61–0.64, p value < 0.001) after adjusting for age, gender, CHA2DS2-VASc score and antiplatelet therapy. The findings were consistently observed after propensity matching analysis. In conclusion, the risk of mortality was lower for AF patients who were treated according to the antithrombotic recommendations of the 2012 ESC guidelines, guided by the CHA2DS2-VASc score. Better efforts to implement guidelines would lead to improved outcomes for patients with AF. PMID:27498702

  20. Occupational and patient exposure in coronary angiography procedures

    NASA Astrophysics Data System (ADS)

    Sulieman, A.; Alzimami, K.; Gafar, R.; Babikir, E.; Alsafi, K.; Suliman, I. I.

    2014-11-01

    Cardiac catheterization is the gold standard in the diagnosis and management of coronary artery diseases. The objectives of this study were to evaluate the radiation dose of patients and staff during cardiology procedures. Staff was monitored using thermoluminescence dosimeter (TLD) chips for 86 procedures. The mean patient dose was 2813.6 μGy m2 and the mean fluoroscopic time was 4.8 min. The mean radiation doses for cardiologists were 0.9 mGy for the forehead, 0.92 mGy for the thyroid, 1.38 mGy for the chest, 1.28 mGy for the waist and 1.41 mGy for the hand. The mean radiation doses for assistants were 0.72 mGy for the chest, 0.82 mGy for the hand. High patient and staff exposure is due to lack of experience and protective equipment, exacerbated by a high workload. Interventional procedures remain operator dependent; therefore, continuous training is crucial.

  1. Multimodality Imaging for Guiding EP Ablation Procedures.

    PubMed

    Njeim, Mario; Desjardins, Benoit; Bogun, Frank

    2016-07-01

    Recent advances in 3-dimensional electroanatomical mapping have been met by continuous improvements in the field of cardiac imaging and image integration during ablation procedures. Echocardiography, computed tomography, cardiac magnetic resonance, and nuclear imaging provide information about cardiac anatomy and ultrastructure of the heart that may be crucial for a successful ablation procedure. Techniques and value of pre-procedural, intraprocedural, and post-procedural imaging and image integration are discussed in this review article. Pre-procedural imaging provides key anatomic information that can be complemented by intraprocedural imaging to minimize procedural complications. Furthermore, the presence and extent of structural heart disease can be assessed pre-procedurally and can be displayed intraprocedurally to limit and focus the mapping and ablation procedure to the area of interest. Pre-procedural imaging combined with imaging obtained during the ablation procedure further enhances procedural safety, reduces exposure to ionizing radiation from fluoroscopy, reduces procedure time, and may improve outcomes. PMID:27388666

  2. Molecular Signaling Pathways Behind the Biological Effects of Salvia Species Diterpenes in Neuropharmacology and Cardiology.

    PubMed

    Akaberi, M; Iranshahi, M; Mehri, S

    2016-06-01

    The genus Salvia, from the Lamiaceae family, has diverse biological properties that are primarily attributable to their diterpene contents. There is no comprehensive review on the molecular signaling pathways of these active components. In this review, we investigated the molecular targets of bioactive Salvia diterpenes responsible for the treatment of nervous and cardiovascular diseases. The effects on different pathways, including apoptosis signaling, oxidative stress phenomena, the accumulation of amyloid beta plaques, and tau phosphorylation, have all been considered to be mechanisms of the anti-Alzheimer properties of Salvia diterpenes. Additionally, effects on the benzodiazepine and kappa opioid receptors and neuroprotective effects are noted as neuropharmacological properties of Salvia diterpenes, including tanshinone IIA, salvinorin A, cryptotanshinone, and miltirone. Tanshinone IIA, as the primary diterpene of Salvia miltiorrhiza, has beneficial activities in heart diseases because of its ability to scavenge free radicals and its effects on transcription factors, such as nuclear transcription factor-kappa B (NF-κB) and the mitogen-activated protein kinases (MAPKs). Additionally, tanshinone IIA has also been proposed to have cardioprotective properties including antiarrhythmic activities and effects on myocardial infarction. With respect to the potential therapeutic effects of Salvia diterpenes, comprehensive clinical trials are warranted to evaluate these valuable molecules as lead compounds. Copyright © 2016 John Wiley & Sons, Ltd. PMID:26988179

  3. Handbooks in radiology: Nuclear medicine

    SciTech Connect

    Datz, F.L.

    1988-01-01

    This series of handbooks covers the basic facts, major concepts and highlights in seven radiological subspecialties. ''Nuclear Medicine'' is a review of the principles, procedures and clinical applications that every radiology resident and practicing general radiologist should know about nuclear medicine. Presented in an outline format it covers all of the organ systems that are imaged by nuclear medicine.

  4. Nuclear material operations manual

    SciTech Connect

    Tyler, R.P.

    1981-02-01

    This manual provides a concise and comprehensive documentation of the operating procedures currently practiced at Sandia National Laboratories with regard to the management, control, and accountability of nuclear materials. The manual is divided into chapters which are devoted to the separate functions performed in nuclear material operations-management, control, accountability, and safeguards, and the final two chapters comprise a document which is also issued separately to provide a summary of the information and operating procedures relevant to custodians and users of radioactive and nuclear materials. The manual also contains samples of the forms utilized in carrying out nuclear material activities. To enhance the clarity of presentation, operating procedures are presented in the form of playscripts in which the responsible organizations and necessary actions are clearly delineated in a chronological fashion from the initiation of a transaction to its completion.

  5. 10 CFR 35.2610 - Records of safety procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Records of safety procedures. 35.2610 Section 35.2610 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Records § 35.2610 Records of safety procedures. A licensee shall retain a copy of the procedures required by §§ 35.610(a)(4) and...

  6. 10 CFR 2.310 - Selection of hearing procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Selection of hearing procedures. 2.310 Section 2.310 Energy NUCLEAR REGULATORY COMMISSION AGENCY RULES OF PRACTICE AND PROCEDURE Rules of General Applicability: Hearing Requests, Petitions To Intervene, Availability of Documents, Selection of Specific Hearing Procedures, Presiding Officer Powers,...

  7. 10 CFR 35.2610 - Records of safety procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Records of safety procedures. 35.2610 Section 35.2610 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Records § 35.2610 Records of safety procedures. A licensee shall retain a copy of the procedures required by §§ 35.610(a)(4) and...

  8. 10 CFR 35.2610 - Records of safety procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Records of safety procedures. 35.2610 Section 35.2610 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Records § 35.2610 Records of safety procedures. A licensee shall retain a copy of the procedures required by §§ 35.610(a)(4) and...

  9. 10 CFR 36.53 - Operating and emergency procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Operating and emergency procedures. 36.53 Section 36.53 Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR IRRADIATORS Operation of Irradiators § 36.53 Operating and emergency procedures. (a) The licensee shall have and follow written operating procedures for— (1)...

  10. [First definition of minimal care model: the role of nurses, physiotherapists, dietitians and psychologists in preventive and rehabilitative cardiology].

    PubMed

    Bettinardi, Ornella; da Vico, Letizia; Pierobon, Antonia; Iannucci, Manuela; Maffezzoni, Barbara; Borghi, Silvana; Ferrari, Marina; Brazzo, Silvia; Mazza, Antonio; Sommaruga, Marinella; Angelino, Elisabetta; Biffi, Barbara; Agostini, Susanna; Masini, Maria Luisa; Ambrosetti, Marco; Faggiano, Pompilio; Griffo, Raffaele

    2014-09-01

    Rehabilitative and preventive cardiology (CRP) is configured as intervention prevention to "gain health" through a process of multifactorial care that reduces disability and the risk of subsequent cardiovascular events. It makes use of an interdisciplinary team in which every professional needs to have multiple intervention paths because of the different levels of clinical and functional complexity of cardiac patients who currently have access to the rehabilitation. The document refers to the use of interventions by nurses, physiotherapists, dietitians and psychologists that are part of the rehabilitation team of CRP. Interventions of which have been documented, on scientific bases and clinical practice, empirical effectiveness and organizational efficiency. The methodological approach of this paper is a first attempt to define, through the model of consensus, the minimum standards for a CRP evidence based characterized by clearly defined criteria that can be used by operators of CRP. The document describes the activities to be carried out in each of the phases included in the pathways of care by nurses, physiotherapists, dietitians and psychologists. The routes identified were divided, according to the type of patients who have access to the CRP and to the phases of care, including the initial assessment, intervention, evaluation and final reporting, in high medium and low complexity. Examples of models of reporting, used by the operators of the team according to the principles of good clinical practice, are provided. This is made to allow traceability of operations, encourage communication inside the working group and within the patient and the caregiver. Also to give any possible indication for the post-rehabilitation. PMID:26058266

  11. Procedure preparation for ISO 9000 certification

    SciTech Connect

    Klement, R.E.

    1995-11-01

    The Kansas City Division (KCD) produces nonnuclear components for nuclear weapons. The company has operated the plant for the US Department of Energy since 1949. Throughout the history of the plant, procedures were written to reflect the nuclear weapons industry best practices, and the facility built a reputation for producing high quality products. In 1991 a critical process team was asked to use Just In Time principles to determine a better way to administrate procedures. By 1992 the team was successful in implementing a full-time centralized procedure group to handle the creation, coordination, review, resolution, and publication of plant-wide administrative and operating procedures. In 1993 AlliedSignal was commissioned by its President and CEO Larry Bossidy to register all of the world-wide sites under the ISO 9000 quality standard. This presented a formidable challenge for the Kansas City Division. Though the independent third-party auditors conceded during a preassessment that the company did in fact build high quality products, the procedures and procedure system did not accurately reflect the current business practices. The purpose of this paper is to share information about the successful implementation of centralized procedure administration and the re-engineering of the procedure system, leading to successful ISO 9001 certification at AlliedSignal Inc., Kansas City Division.

  12. Authentication Procedures - The Procedures and Integration Working Group

    SciTech Connect

    Kouzes, Richard T.; Bratcher, Leigh; Gosnell, Tom; Langner, Diana; MacArthur, D.; Mihalczo, John T.; Pura, Carolyn; Riedy, Alex; Rexroth, Paul; Scott, Mary; Springarn, Jay

    2001-05-31

    Authentication is how we establish trust in monitoring systems and measurements to verify compliance with, for example, the storage of nuclear weapons material. Authentication helps assure the monitoring party that accurate and reliable information is provided by any measurement system and that any irregularities are detected. The U.S. is developing its point of view on the procedures for authentication of monitoring systems now planned or contemplated for arms reduction and control applications. The authentication of a system utilizes a set of approaches, including: functional testing using trusted calibration sources, evaluation of documentation, evaluation of software, evaluation of hardware, random selection of hardware and software, tamper-indicating devices, and operational procedures. Authentication of measurement systems should occur throughout their lifecycles, starting with the elements of design, and moving to off-site authentication, on-siste authentication, and continuing with authentication following repair. The most important of these is the initial design of systems. Hardware and software design criteria and procurement decisions can make future authentication relatively straightforward or conversely very difficult. Facility decisions can likewise ease the procedures for authentication since reliable and effective monitoring systems and tampering indicating devices can help provide the assurance needed in the integrity of such items as measurement systems, spare equipment, and reference sources. This paper will summarize the results of the U.S. Authentication Task Force discussion on the role of procedures in authentication.

  13. December 2014 HeartWeek issue of cardiology in the young: highlights of HeartWeek 2014: diseases of the cardiac valves from the foetus to the adult.

    PubMed

    Jacobs, Jeffrey P

    2014-12-01

    This December Issue of Cardiology in the Young represents the 12th annual publication generated from the two meetings that compose "HeartWeek in Florida". "HeartWeek in Florida", the joint collaborative project sponsored by the Cardiac Center at the Children's Hospital of Philadelphia, Pennsylvania, together with Johns Hopkins All Children's Heart Institute of Saint Petersburg, Florida, averages over 1000 attendees every year and is now recognised as one of the major planks of continuing medical and nursing education for those working in the fields of diagnosis and treatment of cardiac disease in the foetus, neonate, infant, child, and adult. "HeartWeek in Florida" combines the International Symposium on Congenital Heart Disease, organised by All Children's Hospital and Johns Hopkins Medicine and entering its 15th year, with the Annual Postgraduate Course in Pediatric Cardiovascular Disease, organised by The Children's Hospital of Philadelphia and entering its 18th year. This December, 2014 Issue of Cardiology in the Young features highlights of Johns Hopkins All Children's Heart Institute's 14th Annual International Symposium on Congenital Heart Disease, which was held at the Renaissance Vinoy Resort & Golf Club, Saint Petersburg, Florida, from 15-18 February, 2014. This Symposium was co-sponsored by The American Association for Thoracic Surgery (AATS) and had as its special focus " Diseases of the Cardiac Valves from the Fetus to the Adult ". We acknowledge the tremendous contributions made to paediatric and congenital cardiac care by Duke Cameron and Joel Brenner, and therefore we dedicate this December, 2014 HeartWeek Issue of Cardiology in the Young to them. Duke Cameron is Professor of Surgery at Johns Hopkins University and Cardiac Surgeon-in-Charge at The Johns Hopkins Hospital. Joel Brenner is Professor of Pediatrics at Johns Hopkins University and Director of the Taussig Heart Center at Bloomberg Children's Center, The Johns Hopkins Hospital. Together

  14. A dataset to assess providers׳ knowledge and attitudes towards the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline.

    PubMed

    Pokharel, Yashashwi; Steinberg, Lynne; Chan, Winston; Akeroyd, Julia M; Jones, Peter H; Nambi, Vijay; Nasir, Khurram; Petersen, Laura; Ballantyne, Christie M; Virani, Salim S

    2016-06-01

    We previously examined provider׳s understanding of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol management guideline (DOI: http://dx.doi.org/10.1016/j.jacl.2015.11.002)(Virani et al., 2013) [1], and also assessed whether a case-based educational intervention could improve providers׳ knowledge gaps and attitudes towards the guideline (DOI: 10.1016/j.atherosclerosis.2015.12.044) (Pokharel, et al., 2016) [2]. Here we describe the dataset that we used to examine our objectives. PMID:27054163

  15. The 2013 American College of Cardiology/American Heart Association guidelines on treating blood cholesterol and assessing cardiovascular risk: a busy practitioner's guide.

    PubMed

    Gupta, Arpeta; Smith, Donald A

    2014-12-01

    The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults and Guideline on the Assessment of Cardiovascular Risk were released in mid-November 2013. This article explains the guidelines, the risk equations, and their derivations, and addresses criticisms so that practicing physicians may be more comfortable in using the guidelines and the risk equations to inform patients of their atherosclerotic cardiovascular risk and choices to reduce that risk. The article also addresses patient concerns about statin safety if lifestyle changes have been insufficient to reduce their risk. PMID:25432387

  16. A dataset to assess providers׳ knowledge and attitudes towards the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline

    PubMed Central

    Pokharel, Yashashwi; Steinberg, Lynne; Chan, Winston; Akeroyd, Julia M.; Jones, Peter H.; Nambi, Vijay; Nasir, Khurram; Petersen, Laura; Ballantyne, Christie M.; Virani, Salim S.

    2016-01-01

    We previously examined provider׳s understanding of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol management guideline (DOI: http://dx.doi.org/10.1016/j.jacl.2015.11.002)(Virani et al., 2013) [1], and also assessed whether a case-based educational intervention could improve providers׳ knowledge gaps and attitudes towards the guideline (DOI: 10.1016/j.atherosclerosis.2015.12.044) (Pokharel, et al., 2016) [2]. Here we describe the dataset that we used to examine our objectives. PMID:27054163

  17. Nuclear Medicine

    MedlinePlus

    ... Parents/Teachers Resource Links for Students Glossary Nuclear Medicine What is nuclear medicine? What are radioactive tracers? ... funded researchers advancing nuclear medicine? What is nuclear medicine? Nuclear medicine is a medical specialty that uses ...

  18. Computerized procedures system

    DOEpatents

    Lipner, Melvin H.; Mundy, Roger A.; Franusich, Michael D.

    2010-10-12

    An online data driven computerized procedures system that guides an operator through a complex process facility's operating procedures. The system monitors plant data, processes the data and then, based upon this processing, presents the status of the current procedure step and/or substep to the operator. The system supports multiple users and a single procedure definition supports several interface formats that can be tailored to the individual user. Layered security controls access privileges and revisions are version controlled. The procedures run on a server that is platform independent of the user workstations that the server interfaces with and the user interface supports diverse procedural views.

  19. Pediatric nuclear medicine

    SciTech Connect

    Not Available

    1986-01-01

    This symposium presented the latest techniques and approaches to the proper medical application of radionuclides in pediatrics. An expert faculty, comprised of specialists in the field of pediatric nuclear medicine, discussed the major indications as well as the advantages and potential hazards of nuclear medicine procedures compared to other diagnostic modalities. In recent years, newer radiopharmaceuticals labeled with technetium-99m and other short-lived radionuclides with relatively favorable radiation characteristics have permitted a variety of diagnostic studies that are very useful clinically and carry a substantially lower radiation burden then many comparable X-ray studies. This new battery of nuclear medicine procedures is now widely available for diagnosis and management of pediatric patients. Many recent research studies in children have yielded data concerning the effacacy of these procedures, and current recommendations will be presented by those involved in conducting such studies. Individual papers are processed separately for the Energy Data Base.

  20. Second-generation real-time three-dimensional echocardiography. Finally on its way into clinical cardiology?

    PubMed

    von Bardeleben, R S; Kühl, H P; Mohr-Kahaly, S; Franke, A

    2004-01-01

    Three-dimensional (3D) echocardiographic imaging has been introduced as a tool to improve the assessment of both morphologic and functional parameters of the cardiovascular system. In the past, data acquisition was limited due to time-consuming sequential acquisition of multiple triggered 2D image planes from 10-60 heart cycles using transesophageal rotational, transthoracic rotational or transthoracic freehand approaches. Recent improvements in the size of matrix array probes and in computing power of modern ultrasound equipment have significantly increased both spatial and temporal resolution of "second-generation" real-time 3D scanners. Although the superiority of 3D echocardiography in the determination of ventricular volume, ventricular mass or valvular orifice area had already been demonstrated in the late 1990s, widespread use in clinical cardiology was limited on account of difficulties in acquisition and post-processing. Clinical use of modern 3D echocardiography is boosted by the marked reduction in acquisition time and the unique possibility of on-line rendering on the ultrasound system. The ability to visualize a virtual 3D surface in real time-although limited to a sector size of about 30 degrees-offers new insights into cardiac pathomorpholgy even in patients with arrhythmias and may in realtime 3D-contrast flow analysis. Analysis of wide-angle 3D datasets (90 by 90 degree pyramidal shape) is possible by combining the 3D information of several [4-7] consecutive heart cycles. 3D datasets including the complete left ventricle provide comprehensive information on ventricular and mitral valve morphology and function. Qualitative and quantitative analyses of regional wall motion at rest and during stress become possible. Combination with 3D color Doppler data allows additional assessment of valvular function as well as determination of flow in the left ventricular outflow tract and across septal defects. The integration and future quantification of these

  1. 32 CFR 291.6 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... PROGRAM DEFENSE NUCLEAR AGENCY (DNA) FREEDOM OF INFORMATION ACT PROGRAM § 291.6 Procedures. (a) If HQ, DNA... handcarry the request to PAO. TDNM and AFRRI personnel will forward all FOIA requests to HQ, DNA, Attn: PAO. FCDNA will adhere to paragraph 6d and FCDNA Supplement to DNA Instruction 5400.7C. 2 2 Copies can...

  2. 32 CFR 291.6 - Procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... PROGRAM DEFENSE NUCLEAR AGENCY (DNA) FREEDOM OF INFORMATION ACT PROGRAM § 291.6 Procedures. (a) If HQ, DNA... handcarry the request to PAO. TDNM and AFRRI personnel will forward all FOIA requests to HQ, DNA, Attn: PAO. FCDNA will adhere to paragraph 6d and FCDNA Supplement to DNA Instruction 5400.7C. 2 2 Copies can...

  3. 48 CFR 2009.407-3 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Inspector General prior to consulting with the Inspector General. (b) Decision-making process. If, after... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Procedures. 2009.407-3 Section 2009.407-3 Federal Acquisition Regulations System NUCLEAR REGULATORY COMMISSION COMPETITION...

  4. 48 CFR 2009.406-3 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... General prior to consulting with the Inspector General. (b) Decision-making process. If, after reviewing... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Procedures. 2009.406-3 Section 2009.406-3 Federal Acquisition Regulations System NUCLEAR REGULATORY COMMISSION COMPETITION...

  5. 10 CFR 4.570 - Compliance procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Compliance procedures. 4.570 Section 4.570 Energy NUCLEAR REGULATORY COMMISSION NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE FROM THE COMMISSION Enforcement of Nondiscrimination on the Basis of Handicap in Programs or Activities Conducted by the...

  6. 10 CFR 4.336 - Compliance procedure.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Compliance procedure. 4.336 Section 4.336 Energy NUCLEAR REGULATORY COMMISSION NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE FROM THE COMMISSION Regulations Implementing the Age Discrimination Act of 1975, as Amended Investigation, Conciliation,...

  7. 32 CFR 291.6 - Procedures.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... PROGRAM DEFENSE NUCLEAR AGENCY (DNA) FREEDOM OF INFORMATION ACT PROGRAM § 291.6 Procedures. (a) If HQ, DNA... handcarry the request to PAO. TDNM and AFRRI personnel will forward all FOIA requests to HQ, DNA, Attn: PAO. FCDNA will adhere to paragraph 6d and FCDNA Supplement to DNA Instruction 5400.7C. 2 2 Copies can...

  8. 32 CFR 291.6 - Procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... PROGRAM DEFENSE NUCLEAR AGENCY (DNA) FREEDOM OF INFORMATION ACT PROGRAM § 291.6 Procedures. (a) If HQ, DNA... handcarry the request to PAO. TDNM and AFRRI personnel will forward all FOIA requests to HQ, DNA, Attn: PAO. FCDNA will adhere to paragraph 6d and FCDNA Supplement to DNA Instruction 5400.7C. 2 2 Copies can...

  9. 32 CFR 291.6 - Procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... PROGRAM DEFENSE NUCLEAR AGENCY (DNA) FREEDOM OF INFORMATION ACT PROGRAM § 291.6 Procedures. (a) If HQ, DNA... handcarry the request to PAO. TDNM and AFRRI personnel will forward all FOIA requests to HQ, DNA, Attn: PAO. FCDNA will adhere to paragraph 6d and FCDNA Supplement to DNA Instruction 5400.7C. 2 2 Copies can...

  10. Turner's syndrome: cardiologic profile according to the different chromosomal patterns and long-term clinical follow-Up of 136 nonpreselected patients.

    PubMed

    Prandstraller, D; Mazzanti, L; Picchio, F M; Magnani, C; Bergamaschi, R; Perri, A; Tsingos, E; Cacciari, E

    1999-01-01

    The preferential association between Turner's syndrome and congenital heart defects (CHD) have been well known since the first description by Morgagni. There are few studies about the different cardiologic problems stemming from different chromosomal patterns of X monosomies. We reviewed a large series of 136 patients with Turner syndrome without cardiologic preselection, 29 of whom had some kind of CHD (21.5%). Partial anomalous pulmonary venous drainage (PAPVD; 2.9%), aortic valve disease (stenosis and/or incompetence) (AoVD; 5. 1%), aortic coarctation (AoCo; 4.4%), and bicuspid aortic valve (BicAo; 14.7%) are much more frequent in Turner's syndrome than in the normal population, with the difference being statistically highly significant. In our cases, only the 45, X subjects showed severe CHD and multiple lesions, whereas the X-ring pattern was associated with an elevated prevalence of BicAo. Patients with X-deletion showed no signs of congenital heart malformations. Eleven patients, all with 45, X pattern, and significant CHD, underwent cardiac surgery at a mean age of 7.7 +/- 5.3 years (range 7 days-18 years) without complications. At follow-up of 3-18 years (8.6 +/- 5. 2), we were unable to observe any type of evolution of the remaining untreated cardiovascular anomalies. PMID:9986886

  11. Diagnosis and management of Transposition of great arteries within a pediatric cardiology network with the aid of telemedicine: A case report from Brazil.

    PubMed

    Galdino, Millena M; Hazin, Sheila Mv; de Araújo, Juliana Ss; Regis, Cláudio T; Rodrigues, Klecida N; Mourato, Felipe A; Mattos, Sandra da Silva

    2016-04-01

    We present a case of a newborn from a remote, underserved area in the inland of Paraíba, a state from Northeast Brazil. She presented with clinical cyanosis at birth. With the aid of telemedicine, a neonatologist under online cardiology supervision performed a screening echocardiogram. The session established the diagnosis of simple transposition of the great vessels in the baby's first few hours of life. During the same telemedicine session, the necessary arrangements for transferal to a larger maternity center took place. The baby was maintained stable on prostaglandins and was subsequently transferred to a tertiary cardiac center in the neighboring State, Pernambuco. She underwent anatomical correction at day 10, presented no surgical or postoperative complications, and was discharged home at the age of 21 days. She is now over three years old and continues her follow-up care mostly at her hometown, with local pediatricians under online supervision by a cardiologist in a virtual outpatient clinic. The establishment of a Pediatric Cardiology Network, with the aid of telemedicine, can produce a major impact on the access to specialized health care for poor regions of developing countries. PMID:26159438

  12. [Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology position statement on dyslipidemia management. Differences between the European and American guidelines].

    PubMed

    Lobos Bejarano, José María; Galve, Enrique; Royo-Bordonada, Miguel Ángel; Alegría Ezquerra, Eduardo; Armario, Pedro; Brotons Cuixart, Carlos; Camafort Babkowski, Miguel; Cordero Fort, Alberto; Maiques Galán, Antonio; Mantilla Morató, Teresa; Pérez Pérez, Antonio; Pedro-Botet, Juan; Villar Álvarez, Fernando; González-Juanatey, José Ramón

    2015-01-01

    The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention. Full English text available from:www.revespcardiol.org/en. PMID:25444651

  13. [Spanish interdisciplinary committee for cardiovascular disease prevention and the spanish society of cardiology position statement on dyslipidemia management. Differences between the European and american guidelines].

    PubMed

    Lobos Bejarano, José María; Galve, Enrique; Royo-Bordonada, Miguel Ángel; Alegría Ezquerra, Eduardo; Armario, Pedro; Brotons Cuixart, Carlos; Camafort Babkowski, Miguel; Cordero Fort, Alberto; Maiques Galán, Antonio; Mantilla Morató, Teresa; Pérez Pérez, Antonio; Pedro-Botet, Juan; Villar Álvarez, Fernando; González-Juanatey, José Ramón

    2015-04-01

    The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention. PMID:25450438

  14. [Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology Position Statement on Dyslipidemia Management. Differences Between the European and American Guidelines].

    PubMed

    Lobos Bejarano, José María; Galve, Enrique; Royo-Bordonada, Miguel Ángel; Alegría Ezquerra, Eduardo; Armario, Pedro; Brotons Cuixart, Carlos; Camafort Babkowski, Miguel; Cordero Fort, Alberto; Maiques Galán, Antonio; Mantilla Morató, Teresa; Pérez Pérez, Antonio; Pedro-Botet, Juan; Villar Álvarez, Fernando; González-Juanatey, José Ramón

    2015-01-01

    The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention. PMID:26179969

  15. Public Sector Impasse Procedures.

    ERIC Educational Resources Information Center

    Vadakin, James C.

    The subject of collective bargaining negotiation impasse procedures in the public sector, which includes public school systems, is a broad one. In this speech, the author introduces the various procedures, explains how they are used, and lists their advantages and disadvantages. Procedures discussed are mediation, fact-finding, arbitration,…

  16. 2015 guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the management of hypertension.

    PubMed

    Chiang, Chern-En; Wang, Tzung-Dau; Ueng, Kwo-Chang; Lin, Tsung-Hsien; Yeh, Hung-I; Chen, Chung-Yin; Wu, Yih-Jer; Tsai, Wei-Chuan; Chao, Ting-Hsing; Chen, Chen-Huan; Chu, Pao-Hsien; Chao, Chia-Lun; Liu, Ping-Yen; Sung, Shih-Hsien; Cheng, Hao-Min; Wang, Kang-Ling; Li, Yi-Heng; Chiang, Fu-Tien; Chen, Jyh-Hong; Chen, Wen-Jone; Yeh, San-Jou; Lin, Shing-Jong

    2015-01-01

    It has been almost 5 years since the publication of the 2010 hypertension guidelines of the Taiwan Society of Cardiology (TSOC). There is new evidence regarding the management of hypertension, including randomized controlled trials, non-randomized trials, post-hoc analyses, subgroup analyses, retrospective studies, cohort studies, and registries. More recently, the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) published joint hypertension guidelines in 2013. The panel members who were appointed to the Eighth Joint National Committee (JNC) also published the 2014 JNC report. Blood pressure (BP) targets have been changed; in particular, such targets have been loosened in high risk patients. The Executive Board members of TSOC and the Taiwan Hypertension Society (THS) aimed to review updated information about the management of hypertension to publish an updated hypertension guideline in Taiwan. We recognized that hypertension is the most important risk factor for global disease burden. Management of hypertension is especially important in Asia where the prevalence rate grows faster than other parts of the world. In most countries in East Asia, stroke surpassed coronary heart disease (CHD) in causing premature death. A diagnostic algorithm was proposed, emphasizing the importance of home BP monitoring and ambulatory BP monitoring for better detection of night time hypertension, early morning hypertension, white-coat hypertension, and masked hypertension. We disagreed with the ESH/ESH joint hypertension guidelines suggestion to loosen BP targets to <140/90 mmHg for all patients. We strongly disagree with the suggestion by the 2014 JNC report to raise the BP target to <150/90 mmHg for patients between 60-80 years of age. For patients with diabetes, CHD, chronic kidney disease who have proteinuria, and those who are receiving antithrombotic therapy for stroke prevention, we propose BP targets of <130/80 mmHg in our guidelines. BP

  17. Crew procedures development techniques

    NASA Technical Reports Server (NTRS)

    Arbet, J. D.; Benbow, R. L.; Hawk, M. L.; Mangiaracina, A. A.; Mcgavern, J. L.; Spangler, M. C.

    1975-01-01

    The study developed requirements, designed, developed, checked out and demonstrated the Procedures Generation Program (PGP). The PGP is a digital computer program which provides a computerized means of developing flight crew procedures based on crew action in the shuttle procedures simulator. In addition, it provides a real time display of procedures, difference procedures, performance data and performance evaluation data. Reconstruction of displays is possible post-run. Data may be copied, stored on magnetic tape and transferred to the document processor for editing and documentation distribution.

  18. Nonlinear Dynamics in Cardiology

    PubMed Central

    Krogh-Madsen, Trine; Christini, David J.

    2013-01-01

    The dynamics of many cardiac arrhythmias, as well as the nature of transitions between different heart rhythms, have long been considered evidence of nonlinear phenomena playing a direct role in cardiac arrhythmogenesis. In most types of cardiac disease, the pathology develops slowly and gradually, often over many years. In contrast, arrhythmias often occur suddenly. In nonlinear systems, sudden changes in qualitative dynamics can, counter-intuitively, result from a gradual change in a system parameter –this is known as a bifurcation. Here, we review how nonlinearities in cardiac electrophysiology influence normal and abnormal rhythms and how bifurcations change the dynamics. In particular, we focus on the many recent developments in computational modeling at the cellular level focused on intracellular calcium dynamics. We discuss two areas where recent experimental and modeling work have suggested the importance of nonlinearities in calcium dynamics: repolarization alternans and pacemaker cell automaticity. PMID:22524390

  19. Computers in Cardiology.

    ERIC Educational Resources Information Center

    Feldman, Charles L.

    The utilization of computers in the interpretation of electrocardiograms (EKG's) and vectorcardiograms is the subject of this report. A basic introduction into the operations of the electrocardiograms and vectorcardiograms is provided via an illustrated text. A historical development of the EKG starts with the 1950's with the first attempts to use…

  20. Computerised cardiological case notes.

    PubMed Central

    Williams, K N; Brooksby, I A; Morrice, J; Houseago, S; Webb-Peploe, M M

    1982-01-01

    Optical Mark Reader forms have been used by the Cardiac Department at St Thomas's Hospital for six years to store clinical and haemodynamic data by computer. Forms are completed by clinical staff in outpatients and also for those patients undergoing cardiac catheterisation. Three documents are used to record the symptoms and signs at the clinical consultation, the results of relevant investigations, and the important findings at cardiac catheterisation. These documents are fed into a computer and data from them, together with a limited quantity of types information, are used to produce full clinical reports for our colleagues and the case notes. There reports have saved much secretarial and medical time. A variety of analyses is available for research and management purposes. PMID:7093086

  1. Nanotechnology in interventional cardiology

    PubMed Central

    Cyrus, Tillmann; Wickline, Samuel A; Lanza, Gregory M

    2013-01-01

    High-grade atherosclerotic stenoses are reduced to zero or minimal residual stenosis grades by a single or a series of balloon angioplasties. Currently, stents are implanted to prevent immediate vascular recoil and elution of an anti-mitotic drug from the stent struts minimizes restenosis. An unwanted side-effect of this drug-elution is delayed re-endothelialization which requires the treatment with two anti-platelet drugs in many cases for a minimum of one year to prevent acute in-stent thrombosis. Advances in stent-design and drug-elution technology, now in its fourth generation, have not abated this issue. Nanotechnology-based local drug delivery has the potential to achieve restenosis prevention while not impeding endothelial healing. Molecularly targeted drugs can be aimed to specifically bind to epitopes in the injured media and adventitia. Thus, endothelial healing may progress unhindered. To prevent restenosis, this technology may be used with bare metal or biodegradable stents. In this article novel nanoparticulate agents will be compared regarding their potential to deliver drugs to molecular targets within the vascular wall. Potential molecular targets, targeting mechanisms, drug-delivery propensities, and biocompatibility will be reviewed. PMID:21748858

  2. [Futility in Cardiology].

    PubMed

    Romanò, Massimo

    2016-01-01

    Medical futility refers to interventions that are unlikely to produce any significant benefit for the patient. Medical and technological resources allow many patients affected by advanced cardiovascular diseases to receive more aggressive and expensive treatments than ever before. This wide range of available options can frequently lead to the delay of complex end-of-life decisions, such as starting palliative care programs. Medical futility is a daily problem, with significant ethical implications and concerns about the respect of the main ethics points: non maleficence, patient's autonomy, and justice. This paper examines some considerations and applications of the concept of medical futility, particularly about the various definitions of futility, the complexities of management when care is considered futile and the ethical and clinical criteria to withdrawing or withholding aggressive treatments. The patient-centered care, based on physician-patient communication, seems to be the best approach to this problem, even with a patient with advanced heart disease. Finally, the increasing power of technology and its relationship with the current cultural values of the developed societies are outlined, particularly when end-of-life decisions are addressed. PMID:26901253

  3. Integrated Performance Testing Workshop - Supplemental Materials (Scripts and Procedures)

    SciTech Connect

    Baum, Gregory A.

    2014-02-01

    A variety of performance tests are described relating to: Material Transfers; Emergency Evacuation; Alarm Response Assessment; and an Enhanced Limited Scope Performance Test (ELSPT). Procedures are given for: nuclear material physical inventory and discrepancy; material transfers; and emergency evacuation.

  4. Evaluation and processing of nuclear data

    SciTech Connect

    Pearlstein, S.

    1980-01-01

    The role a nuclear data evaluator plays in obtaining evaluated nuclear data, needed for applications, from measured nuclear data is surveyed. Specific evaluation objectives, problems, and procedures are discussed. The use of nuclear systematics to complement nuclear experiment and theory is described. With the Evaluated Nuclear Data File (ENDF) as an example, the formatting, checking, and processing of nuclear data are discussed as well as the testing of evaluated nuclear data in the calculation of integral benchmark experiments. Other important topics such as the Probability Table Method and interrelation between differential and integral data are also discussed. 25 figures.

  5. The presence of family members during cardiopulmonary resuscitation: European federation of Critical Care Nursing associations, European Society of Paediatric and Neonatal Intensive Care and European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions Joint Position Statement.

    PubMed

    Fulbrook, Paul; Latour, Jos; Albarran, John; de Graaf, Wouter; Lynch, Fiona; Devictor, Denis; Norekvål, Tone

    2007-12-01

    This paper presents the European federation of Critical Care Nursing associations, the European Society of Paediatric and Neonatal Intensive Care, and the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions Joint Position Statement on The Presence of Family Members During Cardiopulmonary Resuscitation. PMID:17919981

  6. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association task force on practice guidelines

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The goals of the American College of Cardiology (ACC) and the American Heart Association (AHA) are to prevent cardiovascular (CV) diseases, improve the management of people who have these diseases through professional education and research, and develop guidelines, standards and policies that promot...

  7. [Patterns of information and informed consent procedures. Study of the Ethical Commission of the ANMCO].

    PubMed

    Zuppiroli, Alfredo; Bobbio, Marco; Geraci, Enrico; Martelloni, Massimo; Spinsanti, Sandro; Vergassola, Rossano; Violini, Roberto

    2002-01-01

    A survey on patterns of information and informed consent procedures during daily clinical practice has been performed by the Ethical Commission of ANMCO. A structured questionnaire (38 questions) was sent to the 653 cardiological units of the National Health Service in Italy. Four hundred and eighty (73.5%) were received. The following variables were considered to evaluate differences in the answers from the various cardiological units: geographical site, presence or absence of an in-patient department, a cath-lab, and of cardiac surgery facilities. Independent predictors of returning questionnaires were: geographical site (Northern Italy vs Central and Southern) and the presence of a cath-lab. Informed consent forms were provided in 53% of instances, while in 40% a free comment about the topic of informed consent was sent. Statistically significant differences in the answers were found about physicians' and nurses' role, ways of information, qualitative and quantitative risk estimates, other persons' role, models of consent forms and procedures of obtaining consent. Free comments and informed consent forms did not allow a statistical analysis. However, they still provided sufficient material to identify specific patterns of how cardiologists deal with the informed consent process. The distinction between the two phases of information and consent was rarely clear. Information or educational material was often mixed with consent forms. While some still showed a paternalistic approach, or else considered informed consent as a formal act, others demonstrated a deep understanding of the significance of the concept of informed consent. A widespread need of guidelines and standard patterns resulted. PMID:11899574

  8. [The ANMCO (National Association of Hospital Cardiologists) in a changing health care system. Consensus development of the Organizing Symposium of the XXXI National Congress of Cardiology--ANMCO; Florence, May 21, 2000].

    PubMed

    2000-12-01

    imperfect health-market, how to first inform the patient and then guarantee true freedom of choice, how to respect the values of the patient, transcending ideological limits and proposing organizational solutions and a return to ethical guidelines. In order to be able to approach topics of this importance and complexity with some probability of success it is fundamental that a proper consensus is reached among the cardiological community which formulates and attempts to carry out any proposed strategy. Working hypotheses designed by a minority of the Society, even if authoritative, and "imposed" on the majority are destined to have a difficult and short life. These premises gave rise to the innovative method characterizing this Symposium: each of the four topics, once identified, was assigned to an expert member who produced a preliminary draft including some proposals. These drafts were circulated to all members of the Association some months prior to the conference, in order to allow for any new comments, proposals and criticisms. This interaction with the members allowed us to collect grass-root opinions which were then organized into their respective topics by one discussant for each topic, who acted as spokesman at the conference. During the Symposium the expert member for each topic summarized his proposals and initial thoughts (already known to all members) while the discussant represented the opinions of the members; finally each topic was open to debate. The last step of this complex procedure was a meeting of the symposium panel made up of the chairmen, speakers and discussants who drafted a consensus document representative of all the opinions discussed at the Symposium. What follows is the consensus document on the four chosen topics for the general information of all the members and for proposal to the Board of the Society who will take the executive decisions. Chapter 1. The speed with which technology is improving and medical knowledge increasing is creating

  9. Procedure improvement enterprises

    SciTech Connect

    Davis, P.L.

    1992-01-01

    At Allied-Signal's Kansas City Division (KCD), we recognize the importance of clear, concise and timely procedures for sharing information, promoting consistency and documenting the way we do business. For these reasons, the KCD has gathered a team of employees to analyze the process we currently use to publish procedures, identify the procedure needs of KCD employees, and design a system that meets or exceeds the requirements and expectations of DOE. The name of our group is the Procedure Improvement Enterprise Critical Process Team, or PIE CPT. The mission statement of Procedure Improvement Enterprise is to develop and implement within the Kansas City Division an effective nd flexible procedure system that will establish a model of excellence, will emphasize team work and open communication, and will ensure compliance with corporate/government requirements.

  10. Procedure improvement enterprises

    SciTech Connect

    Davis, P.L.

    1992-01-01

    At Allied-Signal`s Kansas City Division (KCD), we recognize the importance of clear, concise and timely procedures for sharing information, promoting consistency and documenting the way we do business. For these reasons, the KCD has gathered a team of employees to analyze the process we currently use to publish procedures, identify the procedure needs of KCD employees, and design a system that meets or exceeds the requirements and expectations of DOE. The name of our group is the Procedure Improvement Enterprise Critical Process Team, or PIE CPT. The mission statement of Procedure Improvement Enterprise is to develop and implement within the Kansas City Division an effective nd flexible procedure system that will establish a model of excellence, will emphasize team work and open communication, and will ensure compliance with corporate/government requirements.

  11. Nuclear power and nuclear weapons

    SciTech Connect

    Vaughen, V.C.A.

    1983-01-01

    The proliferation of nuclear weapons and the expanded use of nuclear energy for the production of electricity and other peaceful uses are compared. The difference in technologies associated with nuclear weapons and nuclear power plants are described.

  12. Pyroshock prediction procedures

    NASA Astrophysics Data System (ADS)

    Piersol, Allan G.

    2002-05-01

    Given sufficient effort, pyroshock loads can be predicted by direct analytical procedures using Hydrocodes that analytically model the details of the pyrotechnic explosion and its interaction with adjacent structures, including nonlinear effects. However, it is more common to predict pyroshock environments using empirical procedures based upon extensive studies of past pyroshock data. Various empirical pyroshock prediction procedures are discussed, including those developed by the Jet Propulsion Laboratory, Lockheed-Martin, and Boeing.

  13. Candidate CDTI procedures study

    NASA Technical Reports Server (NTRS)

    Ace, R. E.

    1981-01-01

    A concept with potential for increasing airspace capacity by involving the pilot in the separation control loop is discussed. Some candidate options are presented. Both enroute and terminal area procedures are considered and, in many cases, a technologically advanced Air Traffic Control structure is assumed. Minimum display characteristics recommended for each of the described procedures are presented. Recommended sequencing of the operational testing of each of the candidate procedures is presented.

  14. Model Action Plan for Nuclear Forensics and Nuclear Attribution

    SciTech Connect

    Dudder, G B; Niemeyer, S; Smith, D K; Kristo, M J

    2004-03-01

    Nuclear forensics and nuclear attribution have become increasingly important tools in the fight against illegal trafficking in nuclear and radiological materials. This technical report documents the field of nuclear forensics and nuclear attribution in a comprehensive manner, summarizing tools and procedures that have heretofore been described independently in the scientific literature. This report also provides national policy-makers, decision-makers, and technical managers with guidance for responding to incidents involving the interdiction of nuclear and radiological materials. However, due to the significant capital costs of the equipment and the specialized expertise of the personnel, work in the field of nuclear forensics has been restricted so far to a handful of national and international laboratories. In fact, there are a limited number of specialists who have experience working with interdicted nuclear materials and affiliated evidence. Most of the laboratories that have the requisite equipment, personnel, and experience to perform nuclear forensic analysis are participants in the Nuclear Smuggling International Technical Working Group or ITWG (see Section 1.8). Consequently, there is a need to disseminate information on an appropriate response to incidents of nuclear smuggling, including a comprehensive approach to gathering evidence that meets appropriate legal standards and to developing insights into the source and routes of nuclear and radiological contraband. Appendix A presents a ''Menu of Options'' for other Member States to request assistance from the ITWG Nuclear Forensics Laboratories (INFL) on nuclear forensic cases.

  15. 10 CFR 39.63 - Operating and emergency procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Operating and emergency procedures. 39.63 Section 39.63 Energy NUCLEAR REGULATORY COMMISSION LICENSES AND RADIATION SAFETY REQUIREMENTS FOR WELL LOGGING Radiation Safety Requirements § 39.63 Operating and emergency procedures. Each licensee shall develop and follow written operating and emergency...

  16. 10 CFR 26.403 - Written policy and procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Written policy and procedures. 26.403 Section 26.403 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS FFD Program for Construction § 26.403 Written policy and procedures. (a) Licensees and other entities who implement an FFD program under...

  17. 10 CFR 26.403 - Written policy and procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Written policy and procedures. 26.403 Section 26.403 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS FFD Program for Construction § 26.403 Written policy and procedures. (a) Licensees and other entities who implement an FFD program under...

  18. 10 CFR 26.403 - Written policy and procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Written policy and procedures. 26.403 Section 26.403 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS FFD Program for Construction § 26.403 Written policy and procedures. (a) Licensees and other entities who implement an FFD program under...

  19. 10 CFR 26.403 - Written policy and procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Written policy and procedures. 26.403 Section 26.403 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS FFD Program for Construction § 26.403 Written policy and procedures. (a) Licensees and other entities who implement an FFD program under...

  20. 10 CFR 26.403 - Written policy and procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Written policy and procedures. 26.403 Section 26.403 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS FFD Program for Construction § 26.403 Written policy and procedures. (a) Licensees and other entities who implement an FFD program under...