The left ventricle (LV) ejection fraction (EF) alone is no longer sufficient to define LV function in aortic stenosis. New echocardiografic parameters such as Global Longitudinal Strain (GLS) and Myocardial Work (MW) can provide informations on early LV dysfunction compared to EF in patients wiht severe aortic stenosis. MW is the GLS with included afertload, using cuff blood pressure as a surrogate for LV systolic pressure (LVSP) which do not represent the real intraventricular pressure in this setting. The study aims how MW varies when to LV systolic pressure is added the mean aortic transvalvular gradient in patients with true severe aortic stenonsis and severe paradoxical aortic stenosis, having the same EF and GLS. 54 patients with true severe aortic stenosis were compared to 24 patients with severe paradoxical aortic stenosis. In addition to LVEF and GLS, the 4 parameters of the MW were calculated and compared between the two groups: Global Work Index (GWI), Global Constructive Work (GCW), Global Waste Work (GWW) and global work efficiency (GWE). Then to the MW parameters, mean transaortic gradient has been added, determining new 4 parameters: GWIMGAo, GCWMGAo, GWWMGAo, GWEMGAo. True severe aortic stenosis and severe paradoxical aortic stenosis have normal LVEF (61,26 ± 1,38% vs 59,09 ± 1,93%, p=ns, respectively), reduced GLS (-15,6 ± 0,48% vs -15,21 ± 0,70%, p=ns), aortic area index (AVAi 0,38 ± 0,01cm2/m2 vs 0,45 ± 0,01cm2/m2, p=0.001). GWIMGAo and GCWMGAo are worst in patients with true severe aortic stenosis (2388,66 ± 103,07mmHg% vs 1999,87 ± 137,25mmHg%, p=0,030; 3010,54 ± 104,55mmHg% vs 2496,75 ± 146,23mmHg%, p=0.006). The two groups have same LVEF and same reduced GLS, but from the MW point of view, true severe aortic demonstrate higher MW. MW variables could be and additional tool for the startification of severe aortic stenosis in terms of patient outcome.
Echocardiography is a useful tool for evaluation of organ damage and ejection fraction (EF) is the parameter for the evaluation of cardiac function. New parameters such as Global Longitudinal Strain (GLS) and Myocardial Work (MW) seem to be more sensitive in left ventricular (LV) dysfunction detection. The study investigates whether parameters of LV function such as GLS and MW are more sensitive in detecting LV impairment in patients with hypertension compared with healthy controls, than traditional parameters. Clinical and a comprehensive echocardiographic data of 40 patients with hypertension were analyzed in comparison with 10 normal subjects. In addition to LVEF and S’ on TDI, GLS and MW (Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW) and Global Work Efficiency (GWE), were determined and compared with healthy controls after adjustment for confounders. Hypertensives and controls have normal LVEF(61,9% ± 0,77% vs 62,7% ± 0,15% respectively) and S' on TDI (9,4 cm/s ± 3,21 cm/s vs 10,5 cm/s ± 2,1 cm/s respectively),normal LV mass index. GLS and LV MW GWE in hypertensive patients were reduced (-18,5% ± 0,4% vs -20,8% ± 0,7% respectively with p<0,000; 91,4 mmHg% ± 0,6 mmHg% vs 96,2 mmHg% ± 1,2 mmHg% respectively with p<0,000), while LV MW GWW (221,4 mmHg% ± 22,3 mmHg% vs 80 mmHg% ± 43,4 mmHg% respectively with p<0,000, GCW (2557,6 mmHg% ± 75,5 mmHg% vs 2361,5 mmHg% ± 147,2 mmHg% respectively with p<0,000 and GWI (2018,6 mmHg% ± 56,6 mmHg% vs 1977 mmHg% ± 110,3 mmHg% respectively with p<0,000) increased in comparison to controls. Despite a normal ejection fraction, novel echocardiographic parameters such as LV GLS and LV MW GWE are early reduced in hypertensive patients, while LV MW GWW, GCW and GWI early increased compared to healthy controls.
Mobile Applications (Apps) are becoming crucial for the management of the health status of the population, especially at home. Mobile Apps are also revolutionizing the way nursing care are delivered. Through these technologies, nurses can provide distance education, monitor the health status of patients, promote their self-care and ensure timely and effective care. The purpose of this manuscript is to describe Health Service, an eHealth platform that aims to promote and support healthy lifestyles and manage diseases with a high social impact. The implications for nursing practice, patient health literacy and equity of access to care will also be debated.
This study tries to describe the managerial competence of school principals, to describe the quality of teachers, then to analyze the managerial competencies of principals to improve teacher quality both partially and simultaneously in Karawang, Wadas. Qualitative methods, namely through observation, interviews and documentation. The results of this study indicate that the principal's managerial competence to improve the overall quality of teachers is going well, the principal makes every effort to carry out his duties as a leader or manager. Syllabus and curriculum programs that have gone well as planned since the founding of the school. Then the concept of the principal leads to the vision mission of the school, and applies open managerial concepts in management. The principal always works together, coordinates with all related elements and always provides motivation to teachers and students. Constantly monitoring, evaluating and evaluating and controlling school equipment.
The purpose of this study is to describe the management of character education strengthening programs in elementary schools. The type of research used is case study research using a qualitative approach. Data collection techniques used in the form of observation, interviews, and documentation. The stages of data analysis use three steps, namely: data condensation, presenting data, and drawing conclusions. The conclusions of this research show: (1) the planning of the character education strengthening program has several stages, namely observation, coordination meetings, compiling work programs, program implementation, monitoring, and evaluation, (2) the school principal is assisted by the school development team and school coordinator, ( 3) implementation of the program through four stages of activity, namely integration, acculturation, exemplary, and collaboration with parents.
