Raj Parikh

COPD exacerbation care bundle improves standard of care, length of stay, and readmission rates

Introduction COPD is the third leading cause of death in the world. Utilizing care bundles during acute COPD exacerbations results in fewer complications and lower costs. Our aim was to construct a COPD exacerbation care bundle and evaluate the effects on patient care. Methods We conducted a prospective analysis of 44 patients admitted with a COPD exacerbation to a single tertiary care facility. Primary outcomes included length of stay, readmission rates, and hospital costs. Secondary outcomes included patient education, pulmonologist follow-up, and timeliness of medication administration. Two cohorts were analyzed: those treated with an electronic COPD care bundle (cases; N=22) versus those treated without the care bundle (controls; N=22). Results Mean length of stay (51.2 vs 101.1 hours in controls; P-value =0.001), 30-day readmission rates (9.1% vs 54.4% in controls; P-value =0.001), and 60-day readmission rates (22.7% vs 77% in controls; P-value =0.0003) decreased in the care bundle group. Ninety-day hospital costs had a significant difference in the care bundle group (US

A Short Review: Complementary and Alternative Medicine in Lung Cancer

7,652 vs US

A review of current therapies used in the treatment of congestive heart failure.

19,954 in controls; P-value =0.044). Secondary outcomes included a 100% rate of COPD inhaler teaching (vs 27.3% in controls; P-value <0.001), 59.1% rate of pulmonologist follow-up after discharge (vs 18.2% in controls; P-value =0.005), and a mean reduction in time to steroid administration (7.0 hours; P-value =0.015) seen in the care bundle cases. Conclusion Our significant findings coupled with the recent success of standardized algorithms in managing COPD exacerbations stress the importance of enforcing clinical guidelines that can enhance patient care. We demonstrated improved care for COPD exacerbation patients during hospitalizations, thereby decreasing morbidity and the financial burden hospitals face in regard to this increasingly prevalent disease.

Angina pectoris: current therapy and future treatment options.

Complementary and alternative medicine (CAM) is a growing field that has started to integrate itself into the management of many diseases and disorders, including cancer. As more patients continue to incorporate the use of CAM into their treatment plans, it is important to understand the mechanism and clinical effectiveness of CAM. This review focuses on the role of CAM in lung cancer, including the available research trials that have focused on evaluating symptom control, quality of life, and survival rates in lung cancer patients. We have also reviewed the potential risks and benefits of several CAM medications as well as the future direction of this field.

Increased mortality from complications of pulmonary hypertension in patients undergoing transcatheter aortic valve replacement

Congestive heart failure is the leading cause of hospitalizations for patients older than 65 years. There are almost 700,000 new cases of heart failure annually and re-hospitalization rates are as high as 50% within the first few months of initial discharge. These statistics translate to healthcare costs that nearly reached US

In Acute Right Ventricular Failure, What are the Effects of Preload and Afterload?

40 billion in 2010. Understanding the therapeutic agents that can not only help decrease mortality and morbidity but also decrease the rate of re-hospitalizations is vital in the management of congestive heart failure. Here, the authors highlight the various classes of drugs used in the treatment of heart failure. They then provide a focused review examining the multiple clinical trials that have emphasized the evaluation of mortality, morbidity and hospitalization rates in heart failure patients who are receiving the different types of therapeutic agents.

THAWING THE SYSTEM: FROSTBITE TREATED WITH EPOPROSTENOL

Angina pectoris is the consequence of an inequality between the demand and supply of blood to the heart. Angina manifests itself as chest pain or discomfort and is a common complaint of patients in the hospital and in the clinic. There are, in fact, roughly half a million new cases of angina per year. Chest pain, while having many etiologies, is generally considered to be most lethal when related to a cardiac cause. In this review, the authors outline the current medical and surgical therapies that are used in the management of angina. Highlights of the various clinical trials that have assisted in the investigation of these therapies are summarized also. Then, the authors provide a focused review of the novel therapy options for angina that are currently being explored. From new medical treatments to revised surgical techniques to the discovery of stem cell therapy, many innovative options are being investigated for the treatment of angina.

Enhanced Mortality Associated With Pulmonary Hypertension in Patients Undergoing Transcatheter Aortic Valve Replacement

Aortic stenosis (AS) leads to pulmonary hypertension (PH) and right ventricle (RV) failure. Our goal was to describe mortality related to postoperative complications in PH patients undergoing transcatheter aortic valve replacement (TAVR). Ninety-three TAVR patients were analyzed (controls, sPAP < 50 mmHg; cases, sPAP ≥ 50 mmHg). Significant findings in cases included increased mortality (365 days), post-TAVR atrioventricular block (AVB) and acute kidney injury (AKI), and increased mean length of stay (LOS). This novel study highlights complications of PH as independent risk factors for death and significant morbidity post TAVR. Optimization of preoperative volume status and RV afterload reduction, while addressing AVB and AKI, may play a vital role in reducing mortality and LOS.

Angina pectoris: current therapy and future treatment

The right ventricle (RV) differs from the left ventricle teleologically, in its wall structure, and its function as a low-pressure pump connected to a high-capacitance pulmonary system. Acute RV failure presents differently from left ventricular failure and thus management strategies must also differ. It is well known that preload helps in acute RV failure; however, RV failure can occur from an ischemic RV or from increased RV afterload. We attempt to describe 3 different clinical scenarios leading to RV failure, RV ischemia, acute pulmonary embolism, and pulmonary hypertension, with regard to the effect of preload and afterload in all 3 situations.