Lancet
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Letter Comparative Study
Out-of-hours consultant cover and case-mix-adjusted mortality in intensive care.
UK national recommendations include 24 h non-resident availability of consultants with a sessional commitment to intensive care (intensivists). We tested whether continual availability of such specialists improved standardised mortality ratios compared with non-specialist cover by anaesthetists who also cover other hospital departments. The case-mix-adjusted hospital mortality of intensive-care patients improved significantly in the intensivist group compared with the non-specialist group (standardised mortality ratios 0.81 vs 1.11 ratio 0.73 [95% CI 0.55-0.97]). Introduction of 24 h intensivist cover, therefore, seems to improve outcomes in intensive-care units.
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Cardiogenic shock remains the major cause of death among patients with all types of acute coronary syndromes. Thus, there is a growing interest in the identification of patients who are at risk for developing cardiogenic shock, in the exploration of different therapeutic approaches to preventing its development, and in the improvement of outcome when it occurs. ⋯ Algorithms are presented that predict its occurrence in both ST-segment-elevation myocardial infarction and unstable angina or non-ST-elevation myocardial infarction, and that predict its mortality in patients with ST-segment-elevation acute myocardial infarction. Such new areas as metabolic therapy and glycoprotein IIb/IIIa inhibitors are discussed, as are the economic implications of shock.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of vasopeptidase inhibitor, omapatrilat, and lisinopril on exercise tolerance and morbidity in patients with heart failure: IMPRESS randomised trial.
We aimed to assess in patients with congestive heart failure whether dual inhibition of neutral endopeptidase and angiotensin-converting enzyme (ACE) with the vasopeptidase inhibitor omapatrilat is better than ACE inhibition alone with lisinopril on functional capacity and clinical outcome. ⋯ Our findings suggest that omapatrilat could have some advantages over lisinopril in the treatment of patients with congestive heart failure. Thus use of vasopeptidase inhibitors could constitute a potentially important treatment for further improving the prognosis and well being of patients with this disorder.