The Canadian journal of cardiology
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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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The relationship between isovolumic left ventricular (LV) relaxation and LV filling pressures remains incompletely explored. If there is a relationship between the rate of early diastolic LV relaxation and LV end-diastolic pressure, this would have important implications concerning both our understanding and, potentially, our treatment of LV diastolic dysfunction. ⋯ These observations suggest that the rate of LV isovolumic relaxation is a predictor of LV end-diastolic pressure.
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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.