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http://www.secardiologia.es/directos/actualizacionFA.html
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Complejo Hospitalario Universitario de Santiago de Compostela. Presidente SEC
Twitter: @JoseJuanatey
ICN Victoria presents Dr Dashiell Gantner, research fellow at the Monash University in Melbourne. Here he talks about translating ICU research into clinical practice.
> Why HEOR?
> Costs, Consequences and Perspectives
> Key Stakeholders in HEOR
> What is Health Economics and Pharmaco-economic Research?
> Economic Evaluations
> Incremental Cost Effectiveness Ratio (ICER)
> Concept of HRQoL
> Comparative Effectiveness Research (CER)
> Pragmatic Clinical Trials
> Observational Studies
> Systematic Reviews and Meta-Analysis
> Application of CER
> Health Technology Assessment (HTA)
> Real World Evidence (RWE)
> Patient Reported Outcomes (PROs)
> Patient Focused Drug Development (PFDD)
> Application of Health Economic Evaluations
> Challenges and Barriers
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Actualización en Fibrilación Auricular: de la evidencia a la práctica clínica.
10 de Junio de 2014, 16:30h
http://www.secardiologia.es/directos/actualizacionFA.html
Introducción: de la investigación a la práctica. ¿Qué cambia en la vida real?
Dr. José Ramón González-Juanatey
Complejo Hospitalario Universitario de Santiago de Compostela. Presidente SEC
Twitter: @JoseJuanatey
ICN Victoria presents Dr Dashiell Gantner, research fellow at the Monash University in Melbourne. Here he talks about translating ICU research into clinical practice.
> Why HEOR?
> Costs, Consequences and Perspectives
> Key Stakeholders in HEOR
> What is Health Economics and Pharmaco-economic Research?
> Economic Evaluations
> Incremental Cost Effectiveness Ratio (ICER)
> Concept of HRQoL
> Comparative Effectiveness Research (CER)
> Pragmatic Clinical Trials
> Observational Studies
> Systematic Reviews and Meta-Analysis
> Application of CER
> Health Technology Assessment (HTA)
> Real World Evidence (RWE)
> Patient Reported Outcomes (PROs)
> Patient Focused Drug Development (PFDD)
> Application of Health Economic Evaluations
> Challenges and Barriers
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Review by a Multidisciplinary Team (MDT) has been shown to lead to increased rates of surgical resection, radiotherapy, chemotherapy and timeliness of care. Most recently, the Victorian lung cancer patterns of care study have found that MDT review is an independent predictor of lung cancer survival.
Introduction of the NZ Health IT Plan enables better gout management - Reflections of an early adopter. Presented by Peter Gow, Counties Manukau DHB, at HINZ 2014, 12 November 2014, 11.37am, Plenary Room
Health outcomes research is seen as a cost-effective investment in measuring and defining value of new innovations in health care. We provide an overview of field and its applications
Defining and assessing a delineation uncertainty margin for modern radiotherapyCancer Institute NSW
The implementation of image-guided technology and progressively conformal techniques in modern radiotherapy for the treatment of cancer, ensure the planned distribution of dose is well matched to the clinician-defined target volume. However, this precision relies on the target volume including all malignant tissue, with delineation uncertainty resulting in potential normal tissue toxicities and insufficient dose to the cancer. Methods need to be implemented to minimise delineation uncertainty, and subsequently improve local control and patient outcomes.
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Age ≥75 years is an independent predictor of 30-day mortality in STEMI.
Although this higher mortality risk generally would dictate more aggressive treatments, recent data have shown, for example, that <1/2 of patients aged ≥80 years with STEMIs are treated with any reperfusion therapies at all.
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Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
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A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
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Pci vs tlt 2
1. JOURNAL CLUB
Two-year follow-up data from the STEPP-AMI
study: A prospective, observational, multicenter
study comparing tenecteplase-facilitated PCI versus
primary PCI in Indian patients with STEMI
i n d i a n h e a r t j o u r n a l 6 8 ( 2 0 1 6 ) 1 6 9 – 1 7 3
DR MALLESWARA RAO
4. • STEMI is a life threatening manifestation of CAD requiring timely
reperfusion
• incidence of STEMI is higher in the Indian population when compared
to developed countries
• Current recommendations maintain PCI as the treatment of choice ,
contingent upon rapid initiation of treatment at centers with a skilled
PCI laboratory within suggested timelines
• unavailability of primary PCI capable hospitals across India and
delays in transport -<10% of patients with STEMI-PCI in India
5. • patients who do reach the hospital early still have to deal with other issues, such
as arranging for finances, as most Indian patients pay out-of
pocket
• introduction of fibrin-specific lytic agents like tenecteplase (TNK) has improved
the IRA patency rates significantly.
• Rapid fibrinolytic treatment improved the outcomes in patients treated within
an hour of symptom onset, with tapering benefits after 3 hrs
• fibrinolysis -high rates of reocclusion of IRA
• initial bolus lysis followed by early CAG within 3–24 h
of fibrinolysis, with an appropriate PCI ='pharmacoinvasive strategy-good
alternative especially in a developing country such as India.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17. Comparison of primary angioplasty and pre-
hospital fibrinolysis in acute myocardial
infarction (CAPTIM) trial: a 5-year follow-up
• primary angioplasty (n = 421)VS pre-hospital fibrinolysis (rt-PA) with
immediate transfer to a centre with interventional facilities (n = 419)
all-cause mortality at 5 years
• 9.7% in the pre-hospital fibrinolysis group
• 12.6% in PPCI [ P = 0.18].
patients included within 2 h, 5 year mortality
• 5.8% in the pre-hospital fibrinolysis group
• 11.1% in PPCI [HR 0.50 ( P = 0.04],
Patients included after 2 h, 5 year mortality
• 14.5 vs 14.4% [ P = 0.92].
18. PRESENT STUDY
• prospective, observational, multicenter pilot study,
• between August 2011 and May 2013
• Study sites, which were capable of performing 24/7 primary
PCI, were selected from Tamilnadu,Karnataka , and Kerala
• 200 patients
• observational study, the treatment options were chosen entirely by
the patient and the attendants
• some patients who presented outside the recommended timelines
for thrombolysis have received lytic therapy .
19. AIM
• assess the safety, efficacy, and
feasibility of a pharmacoinvasive strategy in comparison to
primary PCI in STEMI
20. • primary endpoint
• set at 30 days
• composite of death, cardiogenic shock, reinfarction, repeat
revascularization, and congestive heart failure, and extended to 2
years
• Safety end points are bleeding assessed using the
TIMI classification at 30 day
21. • Baseline characteristics were no different between both groups,
except more patients in arm B were in killip's class I.
• 6.7% (n = 3) patients in arm A had insignificant disease; hence no
intervention was performed for them
• 100% of patients in arm B required angioplasty and stent
implantation.
pharmacoinvasive arm
(arm 'A') -
45 patients
PPCI arm (arm 'B') 155 patients
22.
23.
24.
25. • Patients in arm A also had better TIMI flow at CAG (TIMI 3 flow in
27.9%), higher radial procedures (76.7%), more IRA patency
(82.2%), and less thrombus burden.
• In arm 'A', 12.1% -failed thrombolysis.
26. bleeding outcomes
• 2.2% vs. 2.6%, 'p' not significant).
• efficacy end points are studied at 30 days, 3 months, 6 months, 1 year, and 2
years-no difference
• There is trend of benefit for arm B in the initial few months
• Primary endpoint at 30 days -trend toward benefit in the primary PCI group
(11.1% vs.3.9%, p = 0.07, RR = 2.8).
• At the end of 2-year follow-up, the initial benefit from PPCI seems to be
narrowed as more events have occurred in PPCI group (A-17.8% vs. B-13.6%, p =
0.47, RR = 1.31;).
• The additions of events in the primary endpoint of PPCI group are mainly due to
death and repeat revascularization
27. • This may be partly due to the fact that 6.7%of patients in arm A did
not require a stent placement due to insignificant disease at the
angiogram, which means they are at no risk of stent thrombosis or
restenosis.
• non-urgent basis on which the angioplasty was performed in arm A
may also have influenced the primary endpoint over a period of
time, but this fact needs further large studies to provide
comprehensive evidence.
•
28. CONCLUSION
• fibrinolysis followed by an early coronary angiogram within 3–24 h
with PCI, if appropriate, resulted in similar outcomes when
compared to primary PCI in patients with STEMI at 2-year
follow-up.
• These findings lend further support to the adoption
of a pharmacoinvasive strategy where patient and system related
delays are inherent