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Goodwin Covington posted an update 6 months, 4 weeks ago
001), percutaneous coronary intervention (1.7% vs. 38.5%; p<0.001), and coronary artery bypass grafting (0.4% vs. 7.8%; p<0.001) were lower among type 2 MI patients. Patients with type 2 MI had lower risk of in-hospital mortality (adjusted odds ratio 0.57 ) and 30-day MI readmission (adjusted odds ratio 0.46 ). There was no difference in risk of 30-day all-cause or heart failure readmission.
Patients with type 2 MI have a unique cardiovascular phenotype when compared with type 1 MI, and are managed in a heterogenous manner. Validated management strategies for type 2 MI are needed.
Patients with type 2 MI have a unique cardiovascular phenotype when compared with type 1 MI, and are managed in a heterogenous manner. Validated management strategies for type 2 MI are needed.
The presence of a contralateral carotid occlusion (CCO) is an established high-risk feature for patients undergoing carotid endarterectomy (CEA) and is traditionally an indication for carotid artery stenting (CAS). Recent observational data have called into question whether CCO remains a high-risk feature for CEA.
The purpose of this study was to determine the clinical impact of CCO among patients undergoing CEA and CAS in a contemporary nationwide registry.
All patients undergoing CEA or CAS from 2007 to 2019 in the NCDR CARE (National Cardiovascular Data Registry Carotid Artery Revascularization and Endarterectomy) and PVI (Peripheral Vascular Intervention) registries were included. The primary exposure was the presence of CCO. The outcome was a composite of in-hospital death, stroke, and myocardial infarction. Multivariable logistic regression and inverse-probability of treatment weighting were used to compare outcomes.
Among 58,423 patients who underwent carotid revascularization, 4,624 (7.9%) hadrgoing CEA, but not CAS.The subjective recognition by those involved in care, of people with psychiatric disorders, is not self-evident. Caregivers, in the general sense of the term, often find it difficult to recognise the personal freedom and dignity of psychiatric patients. Care is, however, inseparable from the relationship of trust and the mobilisation of the patient’s ability to freely express choices and to participate in decisions concerning him; a central ability in the caregiver-patient relationship. Although the objectives of access to care and protection of the patient’s rights are clearly stated, the question of the mental patient’s freedom of choice, as well as his inner moral freedom, remains open to question, as does the questioning of these same freedoms among care providers.In the psychological care of separation disorders in child psychiatry, hospitalisation intervenes as a last resort, when care in an out-of-hospital structure but also in environments close to the child is no longer sufficient to contain his anxiety. A clinical example illustrates how nurses are led to position themselves and to think about care. It shows to what extent our containing functions can be an adapted response to the needs of the child in hospital.The home visit is a nursing practice more particularly developed within the framework of the medico-psychological centre. Going to the patient’s home to ensure continuity of care is not an easy task. Although approached in a nursing training institute, it cannot be learned. Clinical situations are sometimes explosive or disconcerting, undermining the helpless and inadequately prepared nurse. Supervision of nursing practices can be life-saving and allow everyone to make sense of clinical situations. Feedback from experience.The young psychiatric nurse has to adapt his posture in order to identify the challenges of his profession. The relationship with the subject and the desire to understand the issues must be at the heart of his professional life. What skills should be required to build up oneself? If this work is essentially relational, how can the right professional distance be apprehended? This is based on a commitment, an assumption of responsibility centred on analysis, an understanding of the patient and the ability to motivate him. In this context, the contributions of Carl Rogers, the characteristics of the clinical interview and the techniques favouring communication are valuable tools.Within the caregiver-patient relationship, the emotional burden and internal psychological tensions are central. If the desire to care leads to an encounter with the patient, a whole professional “growth” is to be built in order to learn how to relate to emotions and affects that accompany care situations. This “step sideways” allows for caring thinking. The avoidance of this acceptance can lead the caregiver to a psychic economy, to an overly framed posture, at the risk of not welcoming the patient’s suffering. Finally, the managerial ideology, if present in the hospital today, represents a brake on the capacity to think the clinic.The COVID-19 pandemic raises questions about the current state of our health care system. This particular context has highlighted hospital malaise, questioning the place of everyone, particularly in psychiatry. Being a caregiver raises the notion of commitment, the true foundation of the function of a psychiatric nurse. Clofarabine This term is discussed here, between commitment in politics and commitment in the clinic, inseparable forms which complement each other and grow together. Commitment to bring thought to life and to extend the caregiver’s existence in the name of the caregiver-patient relationship.In this viewpoint paper, the authors are tackling criticism to the limits of invasive imaging modalities for identification and treatment of vulnerable plaques. They believe in the clinical usefulness of invasive imaging modalities for identification of vulnerable plaques, and are suggesting an explanation for the suboptimal results of past studies, that failed to demonstrate a correlation between interventional treatment of vulnerable plaques, and reduction of hard clinical endpoints. Vulnerability studies have been based, so far, on the detection and measurement of plaques lipid content, because of its ease. However, the search for lipid “lakes” as a single common causal feature of acute coronary syndromes does not seem sufficient to identify patients at risk of adverse events. New imaging studies provided the rationale for improving clinical outcomes, adopting a more comprehensive assessment of target plaque morphology. There is little rationale in pursuing a functional assessment of coronary lesions to predict myocardial infarction.
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