The Canadian journal of cardiology
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The aim of the study was to set up and validate a predictive scoring system for nonpsychiatrists to facilitate screening of postoperative delirium in cardiac surgery patients. ⋯ The DESCARD tool might be effective in screening of patients at risk of postoperative delirium and can be easily used by all nonpsychiatrists involved in the care of cardiac surgery patients.
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We describe the case of a 29-year-old woman with peripartum cardiomyopathy (PPCM) complicated by multiple cerebral infarcts. Current treatment of PPCM is reviewed with a focus on the role of anticoagulation in PPCM.
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There is a paucity of data regarding the type of anaesthesia used and the perception toward anaesthesia among cardiologists, anaesthesiologists, and nurses. Our objective was to describe the use of sedation during nonsurgical cardiac procedures. ⋯ Anaesthesia and especially sedation is frequently used during percutaneous cardiac procedures. The rate of use and perceptions regarding sedation differs among professionals and might be influenced by culture, training, and geography. There is a lack of adequate formal training in the use of sedation and analgesia for nonanaesthesia professionals.
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Herein, updated evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in Canadian adults are detailed. For 2014, 3 existing recommendations were modified and 2 new recommendations were added. The following recommendations were modified: (1) the recommended sodium intake threshold was changed from ≤ 1500 mg (3.75 g of salt) to approximately 2000 mg (5 g of salt) per day; (2) a pharmacotherapy treatment initiation systolic blood pressure threshold of ≥ 160 mm Hg was added in very elderly (age ≥ 80 years) patients who do not have diabetes or target organ damage (systolic blood pressure target in this population remains at < 150 mm Hg); and (3) the target population recommended to receive low-dose acetylsalicylic acid therapy for primary prevention was narrowed from all patients with controlled hypertension to only those ≥ 50 years of age. ⋯ The rationale for these recommendation changes is discussed. In addition, emerging data on blood pressure targets in stroke patients are discussed; these data did not lead to recommendation changes at this time. The Canadian Hypertension Education Program recommendations will continue to be updated annually.
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The past decade has seen hypertension improving in the United States where control is approximately 50%. Kaiser Permanente has mirrored and exceeded these national advances in control. Integrated models of care such as Kaiser Permanente and the Veterans Administration health systems have demonstrated the greatest hypertension outcomes. ⋯ The KPSC hypertension program is continually evolving in these areas. With these high control rates and established infrastructure, they are positioned to take on different innovations and study models. Such potential projects are drafting strategies on resistant hypertension or addressing the concerns about overtreatment of hypertension.