Medicine
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Disparities in quality of care have always been a major challenge in health care. Providing information to patients may help to narrow such disparities. However, the relationship between level of patient information and outcomes remains to be explored. ⋯ Medical personnel did have a significantly better survival outcome and a shorter length of stay following definitive surgery than nonmedical personnel patients. The outcome disparities can be partially explained by characteristics of their treatment providers. The findings may serve as an important reference for better understanding how information may narrow gaps in quality of care through better choice of providers.
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This report describes an endovascular repair of a residual type A dissection using a medical device that is not marked by european conformity (CE) or Food and Drug Administration (FDA). The patient underwent ascending aortic surgery for acute type A dissection. The 2-year angio-computed tomography demonstrated patency of the residual false lumen with evolution into a 6 cm aneurysm, the extension of the dissection from the aortic arch to the aortic bifurcation with thrombosis of the right common iliac artery. ⋯ We used the Najuta thoracic stent graft and successfully handled the pathology in a multiple-phase treatment. Technology is evolving with specific grafts for the ascending and fenestrated grafts for the aortic arch. In this single case the Najuta endograft, in spite of the periprocedural problems, was a valid therapeutic option.
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Portal vein (PV) occlusion after liver transplant is an uncommon clinical situation, and percutaneous interventional treatment for this condition has not been widely described. The aim of this study was to evaluate the long-term treatment effect of interventional treatment for PV occlusion after liver transplantation (LT). Follow-up data of 13 patients who received interventional treatment for PV occlusion after LT between July 2007 and April 2013 were analyzed. ⋯ No portal hypertension-related symptoms reoccurred during follow-up. In conclusion, interventional treatment for PV occlusion after LT showed a high success rate and good long-term results. Comprehensive interventional treatment should be used for extensive PV occlusion.
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Review Meta Analysis
Obstructive sleep apnea and serious adverse outcomes in patients with cardiovascular or cerebrovascular disease: a PRISMA-compliant systematic review and meta-analysis.
Obstructive sleep apnea (OSA) is seen in approximately 60% to 70% of patients with stroke or ischemic heart disease (IHD). The relationship between OSA and recurrent vascular events and all-cause mortality remains inconclusive. We aimed to systematically evaluate the associations between OSA and serious adverse outcomes following stroke or IHD by a meta-analysis of prospective cohort studies. ⋯ The results did not materially change in the sensitivity analyses for the outcomes of stroke and all-cause mortality. OSA may be a significant predictor of serious adverse outcomes following stroke or IHD. More high-quality studies are needed to determine if better treatment of OSA leads to fewer recurrent vascular events, especially a large-scale, multicenter randomized-controlled trial.
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Review Meta Analysis
Clinical- and cost-effectiveness of telemedicine in type 2 diabetes mellitus: a systematic review and meta-analysis.
Emerging telemedicine programs offer potential low-cost solutions to the management of chronic disease. We sought to evaluate the clinical effectiveness and cost effectiveness of telemedicine approaches on glycemic control in patients with type 2 diabetes mellitus. Using terms related to type 2 diabetes and telemedicine, MEDLINE, Cochrane, EMBASE, and CINAHL Plus were searched to identify relevant studies published through February 28, 2014. ⋯ These studies were disparate, both in terms of overall expense and relative cost-effectiveness. Optimization of telemedicine approaches could potentially allow for more effective self-management of disease in type 2 diabetes patients, though evidence to-date is unconvincing. Furthermore, significant publication bias was detected, suggesting that the literature should be interpreted cautiously.