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Improving Pulmonary Hypertension Care

Improving Pulmonary Hypertension Care

The success of treatment for pulmonary hypertension (PH), including pulmonary arterial hypertension (PAH), is dependent on early detection and an accurate diagnosis. “PH treatments are typically directed toward the underlying cause, but there can be overlap between various patient groups,” says Mardi Gomberg-Maitland, MD, MSc. “This overlap can complicate diagnostic approaches, therapeutic choices, and anticipated outcomes.” Patients are often referred to PH centers with incomplete evaluations. “PH centers offer important benefits to patients because they have clinicians and nurse teams who are dedicated and trained in caring for these patients,” says Dr. Gomberg-Maitland. “Unfortunately, patients are often referred late in the course of illness. Some are given PAH-specific medications without appropriate testing or indications.” Furthermore, PAH medications are expensive and difficult to manage. Data on Pulmonary Hypertension Diagnosis & Referral In JAMA Internal Medicine, Dr. Gomberg-Maitland, Cherylanne Glassner-Kolmin, BS, and colleagues had a study published that assessed PH diagnosis accuracy in patients referred to PH centers. “We also wanted to look at the appropriateness of use of PAH-specific medications based on current guidelines,” says Glassner-Kolmin. According to findings, 68% of patients were referred by cardiologists or pulmonologists to PH centers and 61% had late-stage disease. One-third of patients who received a definitive PAH diagnosis before their referral received a misdiagnosis. “We also found that many patients were treated contradictorily to published recommendations, either having not undergone a heart catheterization, having been inappropriately prescribed medications, or both,” says Glassner-Kolmin. Dr. Gomberg-Maitland says major efforts have been made to educate medical professionals about PH, but misdiagnoses and inappropriate treatment are still occurring. “Inexperienced clinicians should be cautious of giving patients a...

Improving Cardiac Catheterization

More than 1 million cardiac catheterizations are per­formed in the United States annually, and most of these procedures are performed via the femoral arter­ies through the groin. With transfemoral catheterization, patients must lie flat for 4 to 6 hours after the procedure. This is necessary to ensure the puncture site reaches hemostasis and to prevent bleeding complications. Transfemoral cath­eterization can be painful for patients once the procedure is completed because there is a need to compress the artery for 20 minutes manually. The decreased mobility after the proce­dure can also lead to other problems during hospitalization. An alternative approach that is being used by more and more clinicians nationwide is transradial catheterization. In these procedures, the coronary arteries are accessed via the wrist, enabling patients to become mobile almost immediately after the procedure. After the surgery, patients can walk, sit upright, use the bathroom, and eat and drink more quickly than with the transfemoral approach. The transradial approach has also been associated with lower complication rates and increased patient comfort. The complication rate for the transfemoral approach varies but can be as high as 3% to 5%. For transra­dial approaches, the rate drops to less than 1%. In addition, the bleeding associated with transfemoral approaches can be more dangerous than for that of transradial procedures. History of Transradial Catheterization The first transradial diagnostic catheterization was per­formed in the late 1980s in Europe. In 1993, a research team in Amsterdam began using the technique for interventional procedures. In recent years, the methods for catheterization have become increasingly enhanced. Some interventional cardiologists view transradial catheterization as the optimal choice for a...

Managing Catheter-Associated Urinary Tract Infections

Catheter-associated bacteriuria, the most common healthcare-associated infection, results from the widespread use of urinary catheterization. Oftentimes, the use of urinary catheters is inappropriate in hospitals and long-term care facilities. “Considerable personnel time and other costs are expended by healthcare institutions throughout the world to reduce the rate of catheter-associated infections, especially those that occur in patients with urinary tract symptoms,” says Thomas M. Hooton, MD. Strategies to reduce the use of catheterization have been shown to be effective in published literature. The data demonstrate that use of such strategies is likely to have a significant impact on the incidence of catheter-associated urinary tract infections (CA-UTI). An expert panel of the Infectious Diseases Society of America (IDSA) released new guidelines that address CA-UTI in adults aged 18 and older. Published in the March 1, 2010 issue of Clinical Infectious Diseases, the guidelines are aimed at assisting physicians in all specialties who perform direct patient care, especially of patients in hospitals or long-term care facilities. “These evidence-based IDSA guidelines provide diagnostic criteria and strategies to reduce the risk of CA-UTIs,” explains Dr. Hooton, who was the lead author of the guidelines. “They also provide strategies that have not been found to reduce the incidence of urinary infections. Management strategies are presented to assist clinicians who treat patients with catheter-associated asymptomatic bacteriuria or symptomatic urinary tract infection. Implementing the strategies outlined in the guidelines should be a priority for all healthcare facilities.” Reducing the Incidence According to the guidelines, the most effective way to reduce the incidence of CA-UTI is to reduce the use of urinary catheterization (Table 1). This requires restricting...
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