American heart journal
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American heart journal · Jan 1999
Trends in the use of pharmacotherapies for acute myocardial infarction among physicians who design and/or implement randomized trials versus physicians in routine clinical practice: the MILIS-TIMI experience. Multicenter Investigation on Limitation of Infarct Size. Thrombolysis in Myocardial Infarction.
Although studies have documented that randomized, controlled trials (RCTs) have a measurable influence on clinical practice, investigators have uncovered important deficiencies in the application of RCT findings to the management of acute myocardial infarction (AMI). Little is known about the extent to which physicians who design and/or implement clinical trials differ from physicians in routine practice in their translation of the literature. ⋯ Physicians who design and/or implement RCTs translate the results of the medical literature more promptly and to a greater extent than physicians in routine clinical practice. Differences between different physician classes need to be studied further amid efforts to reconfigure health care delivery that currently favor more dominant roles for primary care physicians.
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American heart journal · Jan 1999
Influence of time to treatment on early infarct-related artery patency after different thrombolytic regimens. ALKK-Study Group.
In an in vitro model, recombinant tissue-type plasminogen activator was significantly more effective than streptokinase in dissolving 24-hour-old human blood clots. Therefore there might be a difference in the effect of time to treatment on the efficacy of these fibrinolytics with different fibrin specificity in patients with acute myocardial infarction. ⋯ We conclude from our data that the thrombolytic efficacy of recombinant tissue-type plasminogen activator and reteplase does not decrease with the increasing interval between symptom onset and initiation of therapy. In contrast, after anisoylated plasminogen streptokinase activator complex, streptokinase, and urokinase treatment, a decrease in patency, especially TIMI-3 patency in patients treated after >3 hours after symptom onset, was observed. These results may influence the choice of the thrombolytic agent in patients who are seen >3 hours after symptom onset.
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American heart journal · Jan 1999
ReviewCardiopulmonary resuscitation: historical perspective to recent investigations.
There are at least 300,000 cardiac arrests annually in the United States. Cardiopulmonary resuscitation (CPR) effectively restores hemodynamic stability, return of spontaneous circulation (ROSC), in 40% to 60% of arrests. Prolonged survival is significantly lower because of underlying illness and the postresuscitation syndrome, specifically central nervous system injury and left ventricular stunning after resuscitation. ⋯ Active compression-decompression and interposed abdominal compressions improved ROSC in prospective randomized trials; abdominal compressions have also been shown to increase survival to hospital discharge. Despite 30 years of research, CPR is now performed much as it was initially. Further research into the mechanisms of cardiac arrest, development of predictive models, and improved means to improve cardiac output and survival are needed.
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American heart journal · Jan 1999
Randomized Controlled Trial Multicenter Study Clinical TrialA randomized, multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease. Antithrombotic Therapy Consortium Investigators.
Therapy with intravenous unfractionated heparin improves clinical outcome in patients with active thromboembolic disease, but achieving and maintaining a therapeutic level of anticoagulation remains a major challenge for clinicians. ⋯ Weight-adjusted heparin dosing according to a standardized titration nomogram combined with point-of-care coagulation monitoring using the BMC Coaguchek Plus System represents an effective and widely generalizable strategy for managing patients with thromboembolic disease that fosters the rapid achievement of a desired range of anticoagulation. Additional work is needed, however, to improve on existing patient-specific strategies that can more effectively sustain a therapeutic state of anticoagulation.
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American heart journal · Jan 1999
Comparative StudyParaplane analysis from precordial three-dimensional echocardiographic data sets for rapid and accurate quantification of left ventricular volume and function: a comparison with magnetic resonance imaging.
Three-dimensional echocardiography (3DE) calculates left ventricular volumes (LVV) and ejection fraction (EF) without geometric assumptions, but prolonged analysis time limits its routine use. This study was designed to validate a modified 3DE method for rapid and accurate LVV and EF calculation compared with magnetic resonance imaging (MRI). ⋯ The 3DE-A and 3DE-B methods have excellent correlation and close limits of agreement with MRI for calculating LVV and EF in both normal subjects and cardiac patients. The 3DE-B method by paraplane analysis with 8 equidistant short-axis slices has observer variability similar to MRI and reduces the 3DE analysis time to 10 minutes, therefore offering a rapid, reproducible, and accurate method for LVV and EF calculation.