Narrative History of the Swan-Ganz Catheter: Development, Education, Controversies, and Clinician Acumen

2020 ◽  
Vol 31 (1) ◽  
pp. 25-33
Author(s):  
Jan M. Headley ◽  
Thomas Ahrens
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Hemodynamic Monitoring ◽  
50Th Anniversary ◽  
Evidence Base ◽  
Lessons Learned ◽  
Clinical Use ◽  
Development Education ◽  
Narrative History ◽  
History Of

The year 2020 marks the 50th anniversary of the landmark publication on the bedside clinical use of a flow-directed catheter. The catheter, now known as the Swan-Ganz catheter, truly revolutionized practice and care of the critically ill. Use of the catheter proliferated nearly without rigorous validation or evidence base until a moratorium was called in regard to its use. This article describes the history of the development of the Swan-Ganz catheter, its uses, and its near downfall. The authors, both involved in educating clinicians in the use of the pulmonary artery catheter, hope that telling this story shares tribal knowledge and lessons learned with newer generations of nurses who did not experience the explosion of development and knowledge in the area of hemodynamic monitoring. Partly because of advances in technology, and the catheter’s application for heart failure in particular, use of the pulmonary catheter is being resurrected.

scholarly journals 30 YEARS OF THE MINERALOCORTICOID RECEPTOR: Mineralocorticoid receptor antagonists: 60 years of research and development

2017 ◽  
Vol 234 (1) ◽  
pp. T125-T140 ◽  
Author(s):  
Peter Kolkhof ◽  
Lars Bärfacker
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Clinical Trials ◽  
Kidney Disease ◽  
Research And Development ◽  
Mineralocorticoid Receptor ◽  
Clinical Use ◽  
Patients With Heart Failure ◽  
History Of

The cDNA of the mineralocorticoid receptor (MR) was cloned 30 years ago, in 1987. At that time, spirolactone, the first generation of synthetic steroid-based MR antagonists (MRAs), which was identified in preclinical in vivo models, had already been in clinical use for 30 years. Subsequent decades of research and development by Searle & Co., Ciba-Geigy, Roussel Uclaf and Schering AG toward identifying a second generation of much more specific steroidal MRAs were all based on the initial 17-spirolactone construct. The salient example is eplerenone, first described in 1987, coincidentally with the cloning of MR cDNA. Its launch on the market in 2003 paralleled intensive drug discovery programs for a new generation of non-steroidal MRAs. Now, 30 years after the cDNA cloning of MR and 60 years of clinical use of steroidal MRAs, novel non-steroidal MRAs such as apararenone, esaxerenone and finerenone are in late-stage clinical trials in patients with heart failure, chronic kidney disease (CKD), hypertension and liver disease. Finerenone has already been studied in over 2000 patients with heart failure plus chronic kidney disease and/or diabetes, and in patients with diabetic kidney disease, in five phase II clinical trials. Here, we reflect on the history of the various generations of MRAs and review characteristics of the most important steroidal and non-steroidal MRAs.

scholarly journals Heart Failure Dashboard Design and Validation to Improve Care of Veterans

2020 ◽  
Vol 11 (01) ◽  
pp. 153-159
Author(s):  
Marva Foster ◽  
Catherine Albanese ◽  
Qiang Chen ◽  
Kristen A. Sethares ◽  
Stewart Evans ◽  
...  
Keyword(s):  
Heart Failure ◽  
Language Processing ◽  
Relevant Information ◽  
Lessons Learned ◽  
Data Validation ◽  
International Classification Of Disease ◽  
Care Assessment ◽  
History Of ◽  
Data Points ◽  
Icd Codes

Abstract Background Early electronic identification of patients at the highest risk for heart failure (HF) readmission presents a challenge. Data needed to identify HF patients are in a variety of areas in the electronic medical record (EMR) and in different formats. Objective The purpose of this paper is to describe the development and data validation of a HF dashboard that monitors the overall metrics of outcomes and treatments of the veteran patient population with HF and enhancing the use of guideline-directed pharmacologic therapies. Methods We constructed a dashboard that included several data points: care assessment need score; ejection fraction (EF); medication concordance; laboratory tests; history of HF; and specified comorbidities based on International Classification of Disease (ICD), ninth and tenth codes. Data validation testing with user test scripts was utilized to ensure output accuracy of the dashboard. Nine providers and key senior management participated in data validation. Results A total of 43 medical records were reviewed and 66 HF dashboard data discrepancies were identified during development. Discrepancies identified included: generation of multiple EF values on a few patients, missing or incorrect ICD codes, laboratory omission, incorrect medication issue dates, patients incorrectly noted as nonconcordant for medications, and incorrect dates of last cardiology appointments. Continuous integration and builds identified defects—an important process of the verification and validation of biomedical software. Data validation and technical limitations are some challenges that were encountered during dashboard development. Evaluations by testers and their focused feedback contributed to the lessons learned from the challenges. Conclusion Continuous refinement with input from multiple levels of stakeholders is crucial to development of clinically useful dashboards. Extraction of all relevant information from EMRs, including the use of natural language processing, is crucial to development of dashboards that will help improve care of individual patients and populations.

Next Lives Here: Forging Academia–Industry Partnerships in Analytics at the University of Cincinnati

2020 ◽  
Vol 50 (3) ◽  
pp. 166-175
Author(s):  
Michael J. Fry ◽  
Jeffrey D. Camm ◽  
Glenn Wegryn
Keyword(s):  
50Th Anniversary ◽  
Lessons Learned ◽  
Business Leaders ◽  
Business Analytics ◽  
Track Record ◽  
Industry Collaboration ◽  
History Of ◽  
University Of Cincinnati ◽  
College Of Business ◽  
The University

In 2018, the Department of Operations, Business Analytics, and Information Systems (OBAIS) in the Carl H. Lindner College of Business at the University of Cincinnati (UC) celebrated its 50th anniversary, and in 2019 the OBAIS department won the INFORMS UPS George D. Smith Prize. The OBAIS department has a long history of excellence in fostering academia-industry collaboration in the area of analytics as well as a track record of continued innovation. In this article, we summarize some of the history of the OBAIS department and describe many of the department’s innovations that enabled the department to win the 2019 Smith Prize. We provide an overview of the department’s curriculum of analytics-focused degree programs, and we explain how the UC Center for Business Analytics serves as the culmination of the department’s efforts to provide a supportive ecosystem in analytics for students, faculty, business leaders, and practitioners. We conclude with some lessons learned along our journey.

scholarly journals REAL WORLD ANALYSIS OF OUTCOMES OF REMOTE PULMONARY ARTERY HEMODYNAMIC MONITORING IN HEART FAILURE PATIENTS OF DIFFERENT AGE GROUPS

2021 ◽  
Vol 77 (18) ◽  
pp. 681
Author(s):  
Mansi Oberoi ◽  
Muhammad Hamza Saad Shaukat ◽  
Smitha Narayana Gowda ◽  
Adam Stys ◽  
Tomasz Stys ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Hemodynamic Monitoring ◽  
Real World ◽  
Age Groups ◽  
Heart Failure Patients

scholarly journals EARLY PULMONARY ARTERY PRESSURES PREDICT REDUCTION OF HEART FAILURE HOSPITALIZATIONS DURING AMBULATORY HEMODYNAMIC MONITORING

2020 ◽  
Vol 75 (11) ◽  
pp. 994
Author(s):  
Sandip Zalawadiya ◽  
Nirav Y. Raval ◽  
J. Heywood ◽  
Marie-Elena Brett ◽  
John Henderson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Hemodynamic Monitoring
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