The Canadian journal of cardiology
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To determine the adequacy of the discharge summary in reporting important investigative results and future management plans in patients hospitalized and discharged with a diagnosis of heart failure. ⋯ Substantial inadequacies exist in communicating to the community physician, at the time of discharge from an acute care teaching hospital, valuable patient management information of patients with heart failure. This may have implications for continuity of care and subsequent clinical outcomes.
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Quality indicators are measurement tools for assessing the structure, processes and outcomes of care. Although quality indicators have been developed in other countries, Canadian cardiovascular disease indicators do not exist. ⋯ A set of Canadian quality indicators for CHF care encompassing organizational attributes, pharmacotherapy, investigations, counselling, continuity of care and disease outcomes has been developed. These quality indicators will serve as a foundation for future studies evaluating the quality of CHF care in Canada.
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To determine whether pulsatile perfusion is clinically beneficial for adult cardiac operations. ⋯ Pulsatile flow does not appear to offer any clinical benefit over nonpulsatile flow for cardiac surgery patients.
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Access to new therapies in hospitals depends upon both clinical trial evidence and local Pharmacy and Therapeutics (P&T) committee approval. The process of formulary evaluation by P&T committees is not well-understood. ⋯ There is wide variability in the time taken for Canadian institutions to adopt new cardiovascular therapies, which is not explained by regional, hospital or P&T committee characteristics. Standardization of the formulary application and evaluation processes, including sharing of information amongst institutions, would lead to broader understanding of the applicable issues, more objectivity and improved efficiency.
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Case Reports
Rescue therapy with methylene blue in systemic inflammatory response syndrome after cardiac surgery.
Severe unresponsive vasoplegia syndrome following cardiopulmonary bypass is rare. The authors report a case of severe vasoplegia, unresponsive to conventional treatment three days following cardiopulmonary bypass. A single intravenous bolus (2 mg/kg) of methylene blue was administered with normalization of the peripheral resistance. The use of methylene blue as rescue therapy in severe vasoplegia syndrome is discussed.