The Canadian journal of cardiology
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Guidelines for the provision of echocardiography in Canada were jointly developed and published by the Canadian Cardiovascular Society and the Canadian Society of Echocardiography in 2005. Since their publication, recognition of the importance of echocardiography to patient care has increased, along with the use of focused, point-of-care echocardiography by physicians of diverse clinical backgrounds and variable training. New guidelines for physician training and maintenance of competence in adult echocardiography were required to ensure that physicians providing either focused, point-of-care echocardiography or comprehensive echocardiography are appropriately trained and proficient in their use of echocardiography. ⋯ These guidelines provide a blueprint for physician training despite different clinical backgrounds and help standardize physician training and training programs across the country. Adherence to the guidelines will ensure that physicians providing echocardiography have acquired sufficient expertise required for their specific practice. The document will also provide a framework for other national societies to standardize their training programs in echocardiography and will provide a benchmark by which competency in adult echocardiography may be measured.
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Therapeutic hypothermia preserves neurologic function in post-cardiac arrest patients. Several studies suggest that hypothermia may preserve myocardial function in patients with acute myocardial infarction (AMI). We carried out a systematic review to evaluate the efficacy of therapeutic hypothermia at reducing infarct size and decreasing major adverse cardiac events (MACEs) and all-cause mortality in AMI patients. ⋯ Subgroup analyses suggested that hypothermia may reduce infarct size in patients with anterior wall infarction. Our review suggests that therapeutic hypothermia is safe and feasible. However, more evidence is needed to determine whether therapeutic hypothermia is associated with improved infarct size, MACEs, or all-cause mortality in RCTs of AMI patients.
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Little is known regarding potential differences in antihypertensive prescribing practices at a Canadian provincial level. Our objective was to determine provincial differences in the use of antihypertensive drug therapy in Canada. ⋯ Large increases in antihypertensive prescriptions occurred in all provinces of Canada, but the provinces varied substantially in the increase in total and drug-specific classes of antihypertensive drugs. The basis for provincial differences in antihypertensive prescriptions remains unknown and is likely multifactorial but may relate in part to initial provincial variations in diagnosis, treatment, and control of hypertension, as well as individual provincial drug policies.
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Acute heart failure (AHF) affects nearly every Canadian with heart failure (HF) at least once. Despite several attempts, no medical therapies have been shown to improve the natural history of AHF. In addition, the place of diagnosis of AHF is increasingly made in the outpatient setting. ⋯ This report reviews the recent literature regarding the presentation, diagnosis, management, and prognosis of AHF. Areas of future research priority are indicated and guidelines for improving treatment are provided. AHF is an important clinical area that has not been as intensively studied as chronic HF; it presents both important needs and exciting opportunities for research and innovation.