Latest Articles
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The prevalence of smoking remains stubbornly high in the UK despite comprehensive tobacco control measures. A national quality improvement (QI) approach to enhance the treatment of an estimated 1,000,000 annual hospital admissions of tobacco smokers could provide a new opportunity to improve population health and reduce healthcare demand. Barriers to QI include knowledge, costs and competing demands. This study aimed to evaluate the feasibility and effectiveness of a national QI programme hosted by the British Thoracic Society, focused on improving NHS tobacco dependency treatment in acute hospitals. ⋯ This novel, national, online QI programme supported participating multidisciplinary teams in acute trusts across the UK to deliver tobacco dependency treatment pathway improvements using QI tools and methodology. This programme demonstrated the feasibility and effectiveness of delivering a national QI programme, at low cost using a microsystems approach applied to an important area of clinical medicine.
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Background: Data on the involvement of hospital palliative care teams (HPCT) in the management of patients with hematologic malignancies (HM) are limited. Objectives: To describe characteristics, symptom burden according to the German Hospice and Palliative Care Evaluation assessment tool, and course of inpatients with HM who were referred to a HPCT, and compare them with their counterparts with solid tumors (ST). Design: Retrospective analysis. ⋯ The time between the first contact with the HPCT and death was shorter for patients with HM (p < 0.001). Patients with HM also had a shorter overall time of care by the HPCT (p < 0.001). Conclusions: As compared with their counterparts with ST, inpatients with HM were closer to death at referral to the HPCT, experienced a comparable overall symptom burden, and were admitted to the ICU more frequently after HPCT involvement.
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J. Thorac. Cardiovasc. Surg. · Jan 2025
Rare Coronary Artery Variants are Associated with Increased Mortality and Reinterventions Following the Arterial Switch Operation.
To determine the influence of coronary anatomy on long-term outcomes of the arterial switch operation (ASO). ⋯ Rare coronary artery variants-particularly intramural-are associated with increased mortality and coronary reinterventions after ASO. A low threshold for unroofing intramurals is likely associated with declining mortality and improved outcomes. Additional investigations are needed to determine the long-term fate of the coronary arteries after ASO.
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Observational Study
Bystander Cardiopulmonary Resuscitation and Outcomes of Mass Cardiac Arrests Caused by A Crowd Crush.
A crowd crush can lead to respiratory arrest and result in multiple mass cardiac arrests (MCAs), which are often classified as Black Tag in disaster triage. Recently, many laypersons have been commonly trained in compression-only cardiopulmonary resuscitation (CPR) without ventilation support in various communities. This study aims to describe the characteristics of bystander CPR administered and the outcomes of MCAs during the Itaewon crowd crush incident. ⋯ Most MCAs were pronounced deceased, likely due to their classification as Black Tag or delayed response times. Only a small percentage (4.8%) of bystander CPR cases included rescue breathing. An optimized resuscitation protocol for MCAs in crowd crush scenarios should be developed.
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Central retinal artery occlusion (CRAO) is an ophthalmic emergency characterized by sudden loss of vision with a low chance of spontaneous recovery. This case report presents a 49-year-old female with sudden right eye visual loss, diagnosed as non-arteritic CRAO. Fundoscopic examination revealed retinal pallor, and optical coherence tomography demonstrated edema of the inner retinal layer, consistent with CRAO. ⋯ It also emphasizes the importance of considering cardiac comorbidities, particularly PFO, in younger CRAO patients, and underscores the need for a multidisciplinary approach and comprehensive stroke-etiology workups in CRAO management. This report contributes to the limited evidence on CRAO treatment in Japan, particularly in the context of lower tPA dosing and associated cardiac abnormalities. It underscores the importance of early diagnosis, treatment, and thorough etiological investigation in improving outcomes for CRAO patients.