Providence St. Patrick Hospital, is a health care facility in Missoula, Montana.Providence St..
To determine the relationship between intraoperative lowest measured temperature (LMT) during cardiac surgery using cardiopulmonary bypass (CPB) and the risk for postoperative stroke. Secondarily, to determine the association between LMT and risk for 30-day mortality and other adverse outcomes. The effectiveness of deliberate hypothermia during CPB for the prevention of cardiac surgery-associated stroke and adverse outcomes remains uncertain. This cohort study from the Society of Thoracic Surgeons Adult Cardiac Surgery DatabaseTM included 1,847,808 patients who underwent coronary artery bypass graft surgery (CABG), valve surgery, and combined CABG-valve procedures between July 1, 2011, to March 1, 2022. Using propensity score-weighted regression analysis, we analyzed the effect of LMT on the incidence of postoperative stroke and other adverse outcomes. Since the relationship between LMT and the examined outcomes was non-linear, LMT was treated as a continuous variable. In risk adjusted analyses, no association was observed between the LMT and the primary outcome of postoperative stroke (P=0.316). For the secondary outcomes, encephalopathy or coma (P=0.649), or 30-day mortality (P=0.691) were also not associated with lower LMT. Acute kidney injury (P<0.001) was less common with lower and more common with higher LMTs. Pneumonia (P=0.002) was less common, yet reoperation for bleeding (P<0.001) was more common with higher LMTs. Hypothermia during CPB did not alter the risk of postoperative stroke. Secondary outcomes varied in their directionality of association with temperature, indicating that certain cardiac surgery patients may benefit, but others could be harmed by routine therapeutic hypothermia during CPB.
Zoonotic diseases, transmitted from animals to humans, are a growing health challenge in Africa. The rise in zoonotic diseases in Africa, driven by extensive demand for animal meat, the significance of animal husbandry in the economy, and swift population growth enhancing animal-human interactions, is alarming, as it facilitates disease spread. This article aims to discuss obstacles and approaches to closing the gap between research, policy, and implementation in the fight against zoonotic diseases in Africa. Addressing zoonotic diseases in Africa requires multidisciplinary and multi-sectorial research, policy-making, and implementation. Despite this, there is often a disconnection between research, policy, and action, which hinders the effective management of these diseases. This paper identifies key challenges that hinder bridging the research-policy-action gap. Misaligned priorities, with researchers focusing on global issues over local needs, coupled with poor communication among researchers, policymakers, and communities, exacerbate the gap. Additionally, Africa's under-resourced health systems and weak governance further complicate the implementation of research findings. To address these issues, the paper proposes strategies such as co-producing evidence with a multidisciplinary approach, strengthening health systems, and establishing networks and coordinating bodies to enhance collaboration. These steps are essential for effectively managing zoonotic diseases in Africa, ensuring a coordinated response that protects public health and contributes to global health security.
Journal of Child and Adolescent PsychopharmacologyVol. 29, No. 10 Letters to the EditorProbable Galactorrhea Associated with Sequential Trials of Escitalopram and Duloxetine in an Adolescent FemaleIan R. McGrane, Corle M. Morefield, and Kary L. AytesIan R. McGraneAddress correspondence to: Ian R. McGrane, PharmD, Skaggs School of Pharmacy, College of Health Professions and Biomedical Sciences, The University of Montana, 32 Campus Drive, Missoula, MT 59812 E-mail Address: ian.mcgrane@umontana.eduCollege of Health Professions and Biomedical Sciences, Skaggs School of Pharmacy, The University of Montana, Missoula, Montana.Search for more papers by this author, Corle M. MorefieldCollege of Health Professions and Biomedical Sciences, Skaggs School of Pharmacy, The University of Montana, Missoula, Montana.Search for more papers by this author, and Kary L. AytesDepartment of Psychiatry, Providence St. Patrick Hospital, Missoula, Montana.Search for more papers by this authorPublished Online:2 Dec 2019https://doi.org/10.1089/cap.2019.0099AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Probable Galactorrhea Associated with Sequential Trials of Escitalopram and Duloxetine in an Adolescent Female." Journal of Child and Adolescent Psychopharmacology, 29(10), pp. 788–789FiguresReferencesRelatedDetailsCited byDepression and Anxiety Disorders17 December 2021 Volume 29Issue 10Dec 2019 InformationCopyright 2019, Mary Ann Liebert, Inc., publishersTo cite this article:Ian R. McGrane, Corle M. Morefield, and Kary L. Aytes.Probable Galactorrhea Associated with Sequential Trials of Escitalopram and Duloxetine in an Adolescent Female.Journal of Child and Adolescent Psychopharmacology.Dec 2019.788-789.http://doi.org/10.1089/cap.2019.0099Published in Volume: 29 Issue 10: December 2, 2019Online Ahead of Print:July 24, 2019PDF download
Background: According to current European Society of Cardiology guidelines for the diagnosis and treatment of heart failure (HF), cardiac resynchronisation therapy (CRT) is indicated in patients suffering from HF with reduced ejection fraction (EF) with significantly widened QRS complexes. The presence of vital myocardium proven by dobutamine stress echocardiography (DSE) is considered as a good prognostic factor for responsiveness to this treatment. Chronotropic incompetence is, on the other hand, a known factor of unfavourable outcome in HF. Aim: The aim of this study was to analyse the relationship between heart rate (HR) response during DSE and resultant changes in echocardiographic parameters determined prior to CRT and six weeks post-implantation of the CRT system. Methods: The study included 72 men and 25 women with chronic HF and markedly deteriorated left ventricular (LV) systolic function (EF < 35%). Low-dose DSE was performed prior to the CRT system implantation. Baseline echocardiographic parameters determined before CRT were compared to those measured six weeks after implantation. Results: Implantation of the CRT system resulted in an improvement of LV systolic function. DSE showed a significant increase in HR, by 16.3 bpm on average. Patients with the least prominent increase in HR during DSE (< 7 bpm) presented with significantly greater end-diastolic LV dimension and volume, as well as with significantly lower EF than the subjects with the most evident increase in HR (> 24 bpm). Improvement in EF at six weeks was associated with lower baseline HR and its greater absolute and relative increase during DSE. Greater absolute increase in HR during DSE was also associated with more prominent decrease in systolic/diastolic LV volumes. Conclusions: Patients with better chronotropic response during DSE show significant improvement in LV parameters determined by echocardiography within six weeks of CRT. Chronotropic response to pharmacologic stress test may serve as a predictive factor in patients qualified for CRT.
BACKGROUND:The United States (US) is reforming primary care delivery systems, including the implementation of 'patient-centered medical homes.' Alignment of provider incentives with desired outcomes will likely be important to the success of these delivery system reforms.METHODS:This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create 'prisoner's dilemmas' that have stalled past reform efforts. It then uses this framework to illustrate, hypothetically, how advantages from different models could be blended together to encourage cooperation and improve the quality of primary care services delivered, thus providing an escape from current prisoner's dilemmas faced by providers.FINDINGS:Improvements in primary care delivery will largely hinge on blended payment mechanisms that can effectively combine the advantageous elements of fee-for-service, capitation, and incentive payments into a balanced equation that enables providers to escape the perverse financial incentives of current payment mechanisms and overcome collective action problems.CONCLUSIONS:If balanced appropriately, a blend of guaranteed payment and selective incentives designed to encourage primary care providers to deliver high quality care, efficient and equitable care and to eliminate incentives towards over-servicing could reach outcomes leading to shared benefits for everyone involved.
