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Transradial Angiography: Coming to a Consensus

Transradial Angiography: Coming to a Consensus

Research indicates that the adoption of transradial angiography increased 10-fold between 2007 and 2011 in the United States. Randomized and observational studies have suggested that radial access reduces bleeding and vascular complication risks. Other studies have shown the approach reduces costs, increases patient satisfaction, and reduces mortality in some high-risk patients. 3 Major Recommendations To provide a guide to operators who are early in their adoption of radial procedures or are contemplating adoption, the Society for Cardiovascular Angiography and Intervention (SCAI) published a consensus statement in Catheterization and Cardiovascular Interventions. The document issued three major recommendations: 1. Preserve the radial artery and utilize practices that preserve radial artery patency. 2. Minimize patient and operator radiation exposure during radial procedures. 3. Transradial primary PCI for patients with STEMI should be performed only after sufficient experience is achieved in elective cases. “To monitor for and reduce the risk of radial artery occlusion, we recommend using adequate anticoagulation, the smallest profile equipment possible to minimize trauma to the radial artery and still obtain high-quality images, and non-occlusive hemostasis at the end of the procedure,” says Sunil V. Rao, MD, FSCAI, who served as lead author of the SCAI consensus statement (Table 1). “It’s important to keep enough pressure on the radial artery to obtain hemostasis but not so much that the antegrade flow is prevented.” The consensus statement also recommends that operators monitor for radial artery occlusions immediately after a radial procedure and during follow-up. SCAI recommends using ultrasound Doppler measurements or the reverse Barbeau test to accomplish this task. Radiation: Operator Considerations SCAI has published much information on reducing patient and...
2014 ASH Annual Scientific Meeting

2014 ASH Annual Scientific Meeting

New research is being presented at the 2014 annual scientific meeting of the American Society of Hypertension, or ASH, from May 16 to 20 in New York. Meeting Highlights Hypertension Program Improves BP Control  Comparing Approaches to Nutrition Care for BP Control Antihypertensive Pill Burden & Patient Adherence   News From the Meeting NY County Improves BP Control With Community-Based Initiative Hyperkalemia Evident with Spironolactone in Resistant Hypertension Haves and Have-Nots: Gaps Widen in Control of BP Among Insured and Uninsured Racial Disparity Found for Masked Hypertension Stroke Rounds: Variable BP Tied to CVD, Death Risks BP Advice from Dr YouTube: One-Third of Videos ‘Misleading Nighttime Hypertension—Not Daytime or Clinic—Predicts MI and Stroke in Meta-Analysis BP Guidelines: No Simple Answers Specialized Clinic Gets Results in Resistant Hypertension HTN Meeting Spotlights Renal Denervation   More From the Meeting Registration Hotel Reservations Program ASH/Preventive Cardiovascular Nurses Association Joint Program on Emerging Developments in Hypertension Exhibitor Prospectus 2014 ASH Annual Scientific Meeting Promotional PowerPoint...

The Ongoing Decline of Resident Education

A paper from Johns Hopkins looked at traditional, every fourth night calls compared to reduced-hours interns working staggered shifts of an every fifth night call or “night float.” “Night float” means working a shift that begins in the evening and ends in the morning, typically 8:00 PM to 8:00 AM. The study found that although interns working on the “night float” or every fifth night shifts got significantly more sleep than the control group of interns working longer shifts every fourth night, “both the every fifth night and night float models increased hand-offs, decreased availability for teaching conferences, and reduced intern presence during daytime work hours. Residents and nurses in both experimental models perceived reduced quality of care, so much so with night float that it was terminated early.” [Emphasis added] A JAMA Surgery paper received far less attention but had a similar theme. It surveyed 213 surgical interns from 11 university hospitals in July 2011 and May 2012 (the first academic year that the new 16-hour limit was in force). Although 82% of the interns reported a neutral or good quality of life, more than one-quarter had symptoms of emotional exhaustion and depersonalization, and 32% said their work-life balance was poor. Two-thirds said they thought about their satisfaction with being a surgeon daily or weekly, and 14% said they considered dropping out of surgery training at least weekly. More than half of the residents said that the work-hour changes had decreased their time spent in the operating room. At the end of their intern year, 44% said they did not believe that the work-hour limits led to reduced...
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