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Geographic Variation in Implantable Cardioverter Defibrillator Utilization 5.13.10
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Leonard Davis Institute of Health Economics
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LDI Poster Template
Leonard Davis Institute of Health Economics
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In this lecture on circulatory shock, Dr. Faiza, an Assistant Professor of Physiology, delves into the profound implications of inadequate blood flow throughout the body, leading to tissue damage. The session begins by defining circulatory shock and elucidating its physiological causes, including decreased cardiac output, diminished blood volume, decreased vascular tone, obstruction to blood flow, excess metabolic rate, and abnormal perfusion patterns. Dr. Faiza categorizes shock into various types, such as cardiogenic shock, hypovolemic shock, neurogenic shock, obstructive shock, anaphylactic shock, and septic shock, and explores the pathophysiological basis of each. Furthermore, the lecture examines the stages of shock, from the non-progressive phase where compensatory mechanisms aim for full recovery to the progressive phase where shock worsens steadily without intervention, potentially leading to irreversible damage. Dr. Faiza discusses therapeutic interventions for shock, including replacement therapy, blood and plasma transfusion, sympathomimetic drugs, and other adjunctive treatments like head-down positioning, oxygen therapy, and glucocorticoids.
Circulatory Shock, types and stages, compensatory mechanisms
Circulatory Shock, types and stages, compensatory mechanisms
MedicoseAcademics
Dr. Faiza delivers an insightful lecture on the distinguishing characteristics of skeletal, smooth, and cardiac muscles, offering a comprehensive understanding of their histology, physiological anatomy, electrophysiological properties, and contractile mechanisms. Through meticulous tabulation and comparison, she aims to equip learners with a detailed comprehension of the unique features and functionalities of each muscle type. Beginning with a detailed exploration of histological differences, Dr. Faiza outlines key distinctions such as multinucleation in skeletal muscle, mononucleation in smooth and cardiac muscles, and the presence of striations in skeletal and cardiac muscles. She meticulously elucidates the structural arrangement of each muscle type, highlighting their cellular morphology and organization within tissues. Transitioning to physiological anatomy, Dr. Faiza navigates through various aspects including innervation, level of control, initiation of contraction, and modification by hormones. By delineating the role of the somatic nervous system in skeletal muscle control, and contrasting it with the autonomic nervous system's influence on smooth and cardiac muscles, she offers a nuanced understanding of neural regulation in muscle physiology. Furthermore, Dr. Faiza delves into electrophysiological properties, elucidating the mechanisms underlying action potential generation, duration, and ionic basis in each muscle type. Through insightful analysis, she reveals how differences in action potential characteristics contribute to variations in muscle contraction speed, duration, and resistance to fatigue. Finally, Dr. Faiza meticulously examines the contractile mechanisms of skeletal, smooth, and cardiac muscles, shedding light on the sliding filament theory, mechanisms of calcium action, and speed of contraction. By comprehensively comparing these mechanisms, she provides learners with a deep understanding of the intricate processes governing muscle contraction and function. Through engaging presentation and meticulous analysis, Dr. Faiza's lecture serves as a valuable resource for students seeking a thorough understanding of the fundamental differences between skeletal, smooth, and cardiac muscles.
Difference Between Skeletal Smooth and Cardiac Muscles
Difference Between Skeletal Smooth and Cardiac Muscles
MedicoseAcademics
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ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
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Circulatory Shock, types and stages, compensatory mechanisms
Circulatory Shock, types and stages, compensatory mechanisms
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Difference Between Skeletal Smooth and Cardiac Muscles
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Geographic Variation in Implantable Cardioverter Defibrillator Utilization 5.13.10
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![Geographic Variation in Implantable Cardioverter-Defibrillator Utilization and Heart Failure Survival: Is Low ICD Use Costing Lives? Peter W. Groeneveld, MD, MS · Andrew J. Epstein, PhD, MPP · Lin Yang, MS · Feifei Yang, MS · Daniel Polsky, PhD Philadelphia VA Medical Center; Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine; Division of Health Policy and Administration, Yale School of Public Health Results (continued) Conclusions Implications Results Methods (continued) Patients in Study* * Projected deaths were ICD rate at the level of the highest HRR quintile ICD ADOPTION RATES BY LOCALITY (HRR) QUINTILE OF Δ %ICD ICD USE AND MORTALITY BY LOCALITY (HRR), 2002-2006 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Background Objectives Methods ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],* Number (%) unless otherwise indicated. Percentages may not sum to 100 due to rounding. ,[object Object],[object Object],[object Object],[object Object],[object Object],* Data are n(%) unless otherwise indicated SURVIVAL MODEL MULTIVARIABLE REGRESSION RESULTS Base Survival Model Measure(s) of ICD use %ICD_Locality Hazard Ratio (95% CI) ICD_Patient Hazard Ratio (95% CI) Locality-level only 0.67 (0.52–0.85) n/a Patient-level only n/a 0.65 (0.64–0.66) Both levels 0.95 (0.75–1.21) 0.65 (0.64–0.66) Survival Model with ICD Recipients Removed from Cohort Measure(s) of ICD use %ICD_Locality Hazard Ratio (95% CI) ICD_Patient Hazard Ratio (95% CI) Locality-level only 0.87 (0.64–1.20) n/a POTENTIAL EXCESS HEART FAILURE MORTALITY DUE TO ICD UNDERUSE 1-Year Mortality HRR quintile (by Δ %ICD) Actual deaths, n Projected deaths*, n (95% CI) Difference, n (95% CI) Highest 15,121 15,121 (n/a) 0 2nd 19,623 19,456 (19,352-19,560) 167 (63–271) 3rd 18,622 18,390 (18,247-18,535) 232 (87–375) 4 th 14,900 14,669 (14,527-14,813) 231 (87–373) Lowest 11,805 11,562 (11,413-11,713) 243 (92–392) TOTAL 80,071 79,198 (78,927-79,469) 873 (602–1,144) 2-Year Mortality HRR quintile (by Δ %ICD) Actual deaths, n Projected deaths*, n (95% CI) Difference, n (95% CI) Highest 21,420 21,420 (n/a) 0 2nd 27,702 27,466 (27,319-27,613) 236 (89–383) 3rd 26,518 26,188 (25,984-26,393) 330 (125–534) 4 th 21,111 20,784 (20,582-20,987) 327 (124–529) Lowest 16,864 16,517 (16,304-16,733) 347 (131–560) TOTAL 113,615 112,375 (111,988-112,762) 1,240 (853–1,627) Variables Low Quintile Δ% ICD (n=135,670) Quintile 2, Δ% ICD (n=246,060) Quintile 3, Δ% ICD (n=275,040) Quintile 4 Δ% ICD (n=305,195) High Quintile Δ% ICD (n=230,780) P-value Patient-level Age, years (std) 81 (8) 80 (8) 81 (8) 80 (8) 80 (8) <.001 Female 104,251 (59) 129,948 (59) 163,625 (59) 171,402 (59) 131,859 (58) <.001 Non-white 15,779 (9) 31,600 (14) 43,564 (16) 40,356 (14) 41,055 (18) <.001 DxCG Riskscore, mean (std) 1.29 (1.05) 1.31 (1.08) 1.34 (1.12) 1.32 (1.11) 1.31 (1.13) <.001 Arrhythmia 78,343 (44) 94,579 (43) 116,176 (42) 122,843 (42) 93,986 (41) <.001 Valvular disease 1,202 (1) 1,376 (1) 1,822 (1) 2,043 (1) 1,623 (1) .001 Peripheral vascular disease 13,629 (8) 16,522 (7) 21,948 (8) 23,156 (8) 16,646 (7) <.001 Pulmonary disease 59,550 (34) 74,302 (34) 91,160 (33) 98,639 (34) 73,694 (32) <.001 Diabetes, uncmpl. 46,078 (26) 57,485 (26) 72,236 (26) 76,917 (26) 59,811 (26) .002 Diabetes with complications 9,454 (5) 11,846 (5) 15,791 (6) 15,578 (5) 11,685 (5) <.001 Renal disease 25,539 (14) 33,038 (15) 41,793 (15) 43,643 (15) 31,700 (14) <.001 Liver disease 1,448 (1) 1,896 (1) 2,500 (1) 2,628 (1) 2,115 (1) .001 Cancer, no mets. 8,280 (5) 10,576 (5) 13,390 (5) 13,651 (5) 10,617 (5) .02 Locality (HRR)-level Population, mean 729,117 919,014 1,179,765 1,087,331 954,702 .03 Population density, pop/sqml 262 345 691 891 959 .01 Black population, % 6 9 11 12 13 <.001 Per capita income, $ 19,750 20,626 20,291 20,376 20,185 .95 Academic hospitals per HRR, mean n 0.7 0.8 1.4 1.1 1.1 .19 ICD/CRT hospitals per HRR, mean n 3.6 4.7 6.9 5.9 5.6 .01 Acute hospital beds, n/1,000 pop 2.4 2.5 2.6 2.5 2.6 .39 Cardiologists, n/100,000 pop 5.5 5.6 5.7 6.2 6.0 .14](https://image.slidesharecdn.com/groeneveldpete-geographicvariationinimplantablecardioverterdefibrillatorutilization-5-13-10-100818152214-phpapp02/85/Geographic-Variation-in-Implantable-Cardioverter-Defibrillator-Utilization-5-13-10-1-320.jpg)
