Progress in cardiovascular diseases
-
Prog Cardiovasc Dis · Jul 2013
Review Historical ArticleDeep hypothermic circulatory arrest: real-life suspended animation.
Deep hypothermic circulatory arrest (DHCA) is a cerebral protection technique that was developed in the 1950s and popularized in the 1970s. It has become one of the three most common cerebral protection techniques currently used in aortic arch surgeries, with the other two being antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP). ⋯ Other institutions, however, prefer ACP or RCP to DHCA. Each technique has its own set of pros and cons, and the question regarding which technique is the superior method for cerebral protection is hotly debated.
-
An increasing number of academic senior physicians are approaching their potential retirement in good health with accumulated clinical and research experience that can be a valuable asset to an academic institution. Considering the need to let the next generation ascend to leadership roles, when and how should a medical career be brought to a close? We explore the roles for academic medical faculty as they move into their senior years and approach various retirement options. ⋯ In the United States there is no fixed age for retirement as there is in Europe, but European physicians are initiating changes. What is certain is that careful planning, innovative thinking, and the incorporation of new patterns of medical practice are all part of this complex transition and timing of senior academic physicians into retirement.
-
Prog Cardiovasc Dis · Jan 2013
ReviewSyncope management unit: evolution of the concept and practice implementation.
Syncope, a clinical syndrome, has many potential causes. The prognosis of a patient experiencing syncope varies from benign outcome to increased risk of mortality or sudden death, determined by the etiology of syncope and the presence of underlying disease. Because a definitive diagnosis often cannot be established immediately, hospital admission is frequently recommended as the "default" approach to ensure patient's safety and an expedited evaluation. ⋯ Similarities and differences of these syncope units are compared. Outcomes and endpoints from these studies are summarized. Developing a syncope unit with a standardized protocol applicable to most practice settings would be an ultimate goal for clinicians and investigators who have interest, expertise, and commitment to improve care for this large patient population.
-
Prog Cardiovasc Dis · Jan 2013
ReviewSyncope risk assessment in the emergency department and clinic.
The initial assessment of patients who present with presumed syncope is challenging. Syncope has many possible causes ranging from relatively benign to potentially life-threatening, and sorting through the possibilities may not be feasible given time limitations in an urgent care setting. Therefore, the physician almost always must determine whether the affected individual needs in-hospital evaluation or can be safely referred to an outpatient syncope evaluation clinic. ⋯ In those cases in which the diagnosis is uncertain, risk stratification schemes such as those summarized in this communication become more essential. However, at present no single risk assessment protocol appears to be satisfactory for universal application. The development of a consensus recommendation is an essential next step.
-
We discuss ethical issues of organ transplantation including the stewardship tension between physicians' duty to do everything possible for their patients and their duty to serve society by encouraging organ donation. We emphasize consideration of the role of the principles of justice, utility and equity in the just distribution of transplantable organ as scarce resources. ⋯ We need uniformity in standards of death determination, agreement on the duration of asystole before death is declared, and consensus on the allowable circulatory interventions on the newly declared organ donor that are intended to improve organ function. We discuss the importance of maintaining the dead donor rule, despite the argument of some scholars to abandon it.