Evidence-based treatment of carotid artery stenosis

2011 ◽  
Vol 30 (6) ◽  
pp. E2 ◽  
Author(s):  
Kate C. Young ◽  
Anunaya Jain ◽  
Minal Jain ◽  
Robert E. Replogle ◽  
Curtis G. Benesch ◽  
...  
Keyword(s):  
Medical Management ◽  
Stroke Risk ◽  
Population Based ◽  
Current Evidence ◽  
Stent Insertion ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Design Considerations ◽  
Symptom Status ◽  
Symptomatic Stenosis

Carotid atheromatous disease is an important cause of stroke. Carotid endarterectomy (CEA) is a well-established option for reducing the risk of subsequent stroke due to symptomatic stenosis (> 50%). With adequately low perioperative risk (< 3%) and sufficient life expectancy, CEA may be used for asymptomatic stenosis (> 60%). Recently, carotid angioplasty and stent placement (CAS) has emerged as an alternative revascularization technique. Trial design considerations are discussed in relation to trial results to provide an understanding of why some trials were considered positive whereas others were not. This review then addresses both the original randomized studies showing that CEA is superior to best medical management and the newer studies comparing the procedure to stent insertion in both symptomatic and asymptomatic populations. Additionally, recent population-based studies show that improvements in best medical management may be lowering the stroke risk for asymptomatic stenosis. Finally, the choice of revascularization technique is discussed with respect to symptom status. Based on current evidence, CAS should remain limited to specific indications.

Acute myocarditis

2014 ◽  
Author(s):  
Demosthenes G. Katritsis ◽  
Bernard J. Gersh ◽  
A. John Camm
Keyword(s):  
Acute Myocarditis ◽  
Current Evidence ◽  
Evidence Based ◽  
Evidence Based Treatment

Classification, diagnosis, and current evidence-based treatment of myocarditis are presented.

scholarly journals Development and performance of a population-based risk stratification model for COVID-19

2021 ◽  
Author(s):  
Emili Vela ◽  
Gerard Carot-Sans ◽  
Montse Clèries ◽  
David Monterde ◽  
Xènia Acebes ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Hospital Admissions ◽  
Population Based ◽  
Current Evidence ◽  
Individual Risk ◽  
Severe Illness ◽  
Evidence Based ◽  
Operating Characteristics ◽  
Healthcare Resources ◽  
North East

Abstract The shortage of recently approved vaccines against the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has highlighted the need for evidence-based tools to prioritize healthcare resources for people at higher risk of severe coronavirus disease 2019 (COVID-19). Current evidence indicates that age is far from accurate in identifying the risk of severe illness; furthermore, the count of individual risk factors has limited applicability to population-based “stratify-and-shield” strategies. We developed a COVID-19 risk stratification system that allows allocating people into four mutually-exclusive risk categories based on multivariate models for hospital admissions, transfer to intensive care unit (ICU), and mortality among the general population. The model was developed using clinical, hospital, and epidemiological data from the entire population of Catalonia (North-East Spain; 7.5 million people) and validated using an independent dataset of 218,329 individuals with PCR-confirmed COVID-19, who were infected after developing the model. This showed high discrimination capacity, with an area under the curve of the receiving operating characteristics of 0.85 (95% CI 0.85–0.85) for hospital admissions, 0.86 (0.86–0.97) for ICU transfers, and 0.96 (0.96–0.96) for deaths. Our results provide clinicians and policymakers with an evidence-based tool for prioritizing COVID-19 healthcare resources other population groups aside from those with higher exposure to SARS-CoV-2 and frontline workers.

EARLY EJACULATION

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Emilia Claudia Todoruti
Keyword(s):  
Serotonin Reuptake ◽  
American Psychiatric Association ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Premature Ejaculation ◽  
Current Evidence ◽  
Evidence Based ◽  
Treatment Interventions ◽  
Pharmacological Agents ◽  
Evidence Based Treatment ◽  
Topical Anesthetics

Information on the epidemiology, etiology and treatment of premature ejaculation is reviewed. Evidence of the prevalence of premature ejaculation indicates that subjective concern about rapid ejaculation is a common concern worldwide. The hypotheses regarding the pathogenesis of premature ejaculation include: 1.) that it is a learned model of ejaculation maintained by interpersonal anxiety and 2.) that it is a dysfunctional result of the central or peripheral mechanisms that regulate ejaculatory thresholds and 3.) that it is a normal variant in latency ejaculation. Current evidence-based treatment interventions include behavioral psychotherapy and the use of pharmacological agents, including topical anesthetics and selective serotonin reuptake inhibitors. The purpose of this paper is to review the existing knowledge base on the definition, prevalence, etiology and treatment of premature ejaculation. American Psychiatric Association (2013).

scholarly journals Cardiac Sarcoidosis: When and How to Treat Inflammation

2021 ◽  
Vol 7 ◽  
Author(s):  
Gerard T Giblin ◽  
Laura Murphy ◽  
Garrick C Stewart ◽  
Akshay S Desai ◽  
Marcelo F Di Carli ◽  
...  
Keyword(s):  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Multidisciplinary Treatment ◽  
Current Evidence ◽  
Myocardial Inflammation ◽  
Evidence Based ◽  
Future Directions ◽  
Evidence Based Treatment ◽  
Inflammatory Phase ◽  
Treatment Indications

Sarcoidosis is a complex, multisystem inflammatory disease with a heterogeneous clinical spectrum. Approximately 25% of patients with systemic sarcoidosis will have cardiac involvement that portends a poorer outcome. The diagnosis, particularly of isolated cardiac sarcoidosis, can be challenging. A paucity of randomised data exist on who, when and how to treat myocardial inflammation in cardiac sarcoidosis. Despite this, corticosteroids continue to be the mainstay of therapy for the inflammatory phase, with an evolving role for steroid-sparing and biological agents. This review explores the immunopathogenesis of inflammation in sarcoidosis, current evidence-based treatment indications and commonly used immunosuppression agents. It explores a multidisciplinary treatment and monitoring approach to myocardial inflammation and outlines current gaps in our understanding of this condition, emerging research and future directions in this field.

scholarly journals Development and performance of a population-based risk stratification model for COVID-19

2021 ◽  
Author(s):  
Emili Vela ◽  
Gerard Carot-Sans ◽  
Montse Clèries ◽  
David Monterde ◽  
Xènia Acebes ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Hospital Admissions ◽  
Population Based ◽  
Current Evidence ◽  
Individual Risk ◽  
Severe Illness ◽  
Evidence Based ◽  
Operating Characteristics ◽  
Healthcare Resources ◽  
North East

The shortage of recently approved vaccines against the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has highlighted the need for evidence-based tools to prioritize healthcare resources for people at higher risk of severe coronavirus disease 2019 (COVID-19). Current evidence indicates that age is far from accurate in identifying the risk of severe illness; furthermore, the count of individual risk factors has limited applicability to population-based "stratify-and-shield" strategies. We developed a COVID-19 risk stratification system that allows allocating people into four mutually-exclusive risk categories based on multivariate models for hospital admissions, transfer to intensive care unit (ICU), and mortality among the general population. The model was developed using clinical, hospital, and epidemiological data from the entire population of Catalonia (North-East Spain; 7.5 million people) and validated using an independent dataset of 218,329 individuals with PCR-confirmed COVID-19, who were infected after developing the model. This showed high discrimination capacity, with an area under the curve of the receiving operating characteristics of 0.85 (95% CI 0.85 - 0.85) for hospital admissions, 0.86 (0.86 - 0.97) for ICU transfers, and 0.96 (0.96 - 0.96) for deaths. Our results provide clinicians and policymakers with an evidence-based tool for prioritizing COVID-19 healthcare resources other population groups aside from those with higher exposure to SARS-CoV-2 and frontline workers.

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