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Poster PresentationsEVOLUTION AND OUTCOMES OF A RAPID RESPONSE TEAM
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Abstract
PURPOSE: In 2000, Christiana Care Health Services (CCHS) developed the Stabilization, Telemetry, Administration, Teaching (STAT) Nurse program to provide a critical care nurse as a resource to the nursing units. This program was implemented to support the growth of flexible telemetry capability to every hospital bed. In 2005, that program was expanded to the Rapid Response Team (RRT) by the addition of a respiratory therapist and a senior medical resident. The goal of the program was twofold:
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Therapeutic potential of natural flavonoids in pulmonary arterial hypertension: A review
2024, PhytomedicinePulmonary arterial hypertension (PAH) is a fatal disease caused by pulmonary vascular remodeling, with a high incidence and mortality. At present, many clinical drugs for treating PAH mainly exert effects by relaxing the pulmonary artery, with limited therapeutic effects, so the search for viable therapeutic agents continues uninterrupted. In recent years, natural flavonoids have shown promising potential in the treatment of cardiovascular diseases. It is necessary to comprehensively elucidate the potential of natural flavonoids to combat PAH.
To evaluate the potential of natural flavonoids to hinder or slow down the occurrence and development of PAH, and to identify promising drug discovery candidates.
Literature was collected from PubMed, Science Direct, Web of science, CNKI databases and Google scholar. The search terms used included “pulmonary arterial hypertension”, “pulmonary hypertension”, “natural products”, “natural flavonoids”, “traditional chinese medicine”, etc., and several combinations of these keywords.
The resources, structural characteristics, mechanisms, potential and prospect strategies of natural flavonoids for treating PAH were summarized. Natural flavonoids offer different solutions as possible treatments for PAH. These mechanisms may involve various pathways and molecular targets related to the pathogenesis of PAH, such as inflammation, oxidative stress, vascular remodeling, genetic, ion channels, cell proliferation and autophagy. In addition, prospect strategies of natural flavonoids for anti-PAH including structural modification and nanomaterial delivery systems have been explored. This review suggests that the potential of natural flavonoids as alternative therapeutic agents in the prevention and treatment of PAH holds promise for future research and clinical applications.
Despite displaying the enormous potential of flavonoids in PAH, some limitations need to be further explored. Firstly, using advanced drug discovery tools, including computer-aided design and high-throughput screening, to further investigate the safety, biological activity, and precise mechanism of action of flavonoids. Secondly, exploring the structural modifications of these compounds is expected to optimize their efficacy. Lastly, it is necessary to conduct well controlled clinical trials and a comprehensive evaluation of potential side effects to determine their effectiveness and safety.
Use of Oral Anticoagulant Drugs in Patients with Pulmonary Hypertension
2023, Heart Failure ClinicsBotulinum toxin in the management of primary and secondary Raynaud's phenomenon
2021, Best Practice and Research: Clinical RheumatologyRaynaud's phenomenon (RP) is common in rheumatic diseases. In the setting of systemic sclerosis (SSc), it can be complicated by digital ischemia that includes ulceration and gangrene. Systemic adverse effects may preclude the use of oral or topical vasodilators for the treatment of RP and its complications. In this article, we review effectiveness/efficacy of botulinum toxin injection in primary and secondary RP. We discuss botulinum toxin formulations, dosage, sites of administration, and adverse effects. The evidence for botulinum toxin in the treatment of primary and SSc-associated RP is promising. Consistency across patient populations, treatment options (botulinum serotype, dose, and injection site), and outcome measures will be essential for further research.
Increased levels of platelet-derived microparticles in pulmonary hypertension
2020, Thrombosis ResearchThrombosis and coagulation abnormalities are thought to be involved in disease progression of pulmonary hypertension. Platelet-derived microparticles (PDMP) are released from platelets following stimulation and have recently been demonstrated to play an important role in pathogenesis of various diseases. This study aimed to evaluate PDMP levels in patients with pulmonary hypertension.
Our cross-sectional study enrolled a total of 113 participants including 73 patients with pulmonary hypertension and 40 participants to serve as a control group. PDMP levels were measured using a PDMP ELISA kit, which detects glycoproteins CD42a and CD42b. Clinical parameters, including exercise capacity and hemodynamic parameters, were collected, and the relationship to PDMP levels were evaluated.
PDMP levels were significantly higher in patients than in participants in the control group (23.2 ± 39.4 U/mL and 7.8 ± 3.6 U/mL, respectively, P < 0.05). PDMP levels in patients with chronic thromboembolic pulmonary hypertension were correlated with right atrial pressure and cardiac index. PDMP levels were higher in male patients with idiopathic pulmonary arterial hypertension. Furthermore, patients administered a higher dose of epoprostenol had a tendency for lower PDMP levels.
The data suggest that PDMP levels are increased in patients with pulmonary hypertension. Further study is needed to understand the mechanism and impact of PDMP on disease progression.
Canadian Cardiovascular Society/Canadian Thoracic Society Position Statement on Pulmonary Hypertension
2020, Canadian Journal of CardiologyThe landscape of pulmonary hypertension (PH) has changed significantly since the last Canadian Cardiovascular Society/Canadian Thoracic Society position statement in 2005. Since then, advances in our understanding of the pathophysiology of PH and improvements in diagnostic and therapeutic options have transformed the care of patients with PH. Globally, PH has an estimated prevalence of 1%, increasing to 10% in those aged 65 years and older, most commonly due to left heart or lung disease. Although pulmonary arterial hypertension (PAH) is less common, the morbidity and mortality is significant and early diagnosis and treatment are essential. This document is targeted at clinicians and describes a framework for screening and diagnosis of PH, with recommendations for performance and interpretation of echocardiography, cardiac magnetic resonance imaging, and right heart catheterization. In addition, the current approach to PAH management in Canada including risk stratification and pharmacologic therapy aimed at achieving a low-risk profile is discussed. The rationale to avoid specific PAH therapy in patients with left heart disease and lung disease-related PH is emphasized, along with special considerations for the diagnosis and management of chronic thromboembolic PH. Future advancements in the identification of novel pathways and therapies, personalized approaches to direct therapy, as well as interventional approaches such as balloon pulmonary angioplasty for chronic thromboembolic PH promise to continue the rapid evolution of this field.
Le paysage de l’hypertension pulmonaire (HP) a beaucoup changé depuis que la Société canadienne de cardiologie et la Société canadienne de thoracologie ont émis leur dernier énoncé de position à ce sujet en 2005. L’évolution des connaissances de la physiopathologie de l’HP et les améliorations des options diagnostiques et thérapeutiques ont transformé les soins prodigués aux patients atteints d’HP. Selon les estimations, l’HP a une prévalence de 1 % dans le monde, prévalence qui atteint 10 % chez les personnes de 65 ans ou plus, et elle est le plus souvent attribuable à une cardiopathie gauche ou à une atteinte pulmonaire. Bien que l’hypertension artérielle pulmonaire (HAP) soit plus rare, la morbidité et la mortalité qui y sont associées demeurent importantes, et un diagnostic et un traitement précoces sont cruciaux. Les auteurs de cet article décrivent, à l’intention des cliniciens, un cadre pour le dépistage et le diagnostic de l’HP et formulent des recommandations pour l’exécution et l’interprétation des examens d’échocardiographie, d’imagerie cardiaque par résonance magnétique et de cathétérisme du cœur droit. Ils traitent également de l’approche actuelle en matière de prise en charge de l’HAP au Canada, qui comprend une stratification des risques et une pharmacothérapie visant l’atteinte d’un profil à faible risque. Les arguments justifiant qu’un traitement ciblant spécifiquement l’HAP soit évité chez les patients atteints d’une HP liée à une cardiopathie gauche ou à une atteinte pulmonaire sont présentés, ainsi que les considérations particulières relatives au diagnostic et à la prise en charge de l’HP thromboembolique chronique. Les percées à venir en matière de stratégies et de traitements novateurs, d’approches thérapeutiques directes personnalisées et d’approches interventionnelles, comme l’angioplastie pulmonaire par ballonnet dans les cas d’HP thromboembolique chronique, permettent de croire que ce domaine continuera d’évoluer rapidement.
Indications and potential pitfalls of anticoagulants in pulmonary hypertension: Would DOACs become a better option than VKAs?
2019, Blood ReviewsPulmonary hypertension (PH) comprises a cluster of severe conditions characterized by elevated mean pulmonary arterial pressure. While targeted therapies have been approved over the last twenty years for pulmonary arterial hypertension (PAH) and chronic-thrombo-embolic PH (CTEPH), the possible role of anticoagulant therapy as a supportive treatment PAH is still debated. In PAH, anticoagulant use remains frequent, although evidence appear to be poor (recommendation class IIb-C in international guidelines). In CTEPH treatment, anticoagulants are highly recommended, because it often involves thrombosis (recommendation class I—C in international guidelines). Historically, PH patients have been treated with vitamin K antagonists (VKA), which are the only available oral anticoagulants. In this context, risk/benefit ratio of VKA is affected by the risk of major bleeding events. This drawback could be mitigated with direct oral anticoagulants (DOACs): in addition to being less constraining for patients, DOACs have shown a lower risk of major bleeding events in their already approved indications (venous thromboembolism, atrial fibrillation). However, DOACs have never been specifically assessed in PAH and CTEPH patients. Bioaccumulation risk should be considered if DOACs are prescribed in PAH and CTEPH patients, especially the risk of drug-drug interaction mediated by P-glycoprotein and cytochrome 3A4 with targeted therapies.