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1.
Sci Rep ; 8(1): 10326, 2018 07 09.
Article in English | MEDLINE | ID: mdl-29985433

ABSTRACT

Antithrombotic management of STEMI patients with apical dysfunction, but without demonstrable thrombus, is controversial. Triple antithrombotic therapy (TATT, defined as the addition of oral anticoagulation to dual antiplatelet therapy, or DAPT) may be associated with increased bleeding, while DAPT alone may not adequately protect against cardio-embolic events. We undertook a dual-center study of anterior STEMI patients treated with primary PCI (pPCI) from 2013 to 2015 and presenting presumed new apical dysfunction. The Centre hospitalier de l'Université de Montréal (CHUM) uses a strategy of selective TATT, whereas the Centre hospitalier universitaire de Sherbrooke (CHUS) has favored ticagrelor-based DAPT for all patients since 2013. The primary composite outcome consisted of death, MI, stroke, revascularization, and BARC 3 to 5 bleeding up to 4-months follow-up. We identified 177 cases (69 CHUM; 108 CHUS). Baseline characteristics were similar and procedural success was high (97%). There was no difference in post-procedure LVEF (39 ± 9% vs 37 ± 9%) or the extent of apical dysfunction. The primary composite outcome occurred in 27% with the selective TATT strategy compared to 19% with ticagrelor-DAPT (p = 0.342). Thus, this retrospective dual-center analysis does not support a strategy of conventional TATT over ticagrelor-based DAPT for patients with apical dysfunction following anterior STEMI treated with pPCI. A pragmatic randomized trial is needed to provide a definitive answer to this clinical conundrum.


Subject(s)
Anticoagulants/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , ST Elevation Myocardial Infarction/drug therapy , Ticagrelor/therapeutic use , Ventricular Dysfunction, Left/etiology , Administration, Oral , Adult , Aged , Aged, 80 and over , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/pathology , Treatment Outcome , Young Adult
3.
Can J Public Health ; 107(3): e319-e325, 2016 Oct 20.
Article in English | MEDLINE | ID: mdl-27763849

ABSTRACT

OBJECTIVES: To invite and support managers of child care centres to measure radon concentrations in their buildings. Their ability to carry out a measurement protocol and communication plan was also evaluated as well as the intention of parents and educators to test for radon at home. PARTICIPANTS: Managers, parents and educators of child care centres. SETTING: 36 child care centres located in two priority investigation areas in Québec. INTERVENTION: A kit containing radon detectors with installation and recovery instructions was shipped by mail in addition to factsheets intended for parents and educators. Site visits and phone calls were also conducted with a sample of child care centres and participants. OUTCOMES: The instructions related to detector installation were generally well respected. Afterward, more than half (18) of the 34 parents and educators interviewed said that they had been directly informed of this radon testing by managers or other educators, and not by the factsheet provided. This radon measurement intervention was considered very relevant by 91% of them and a quarter (26%) expressed their intention to test for radon at home, while 6% had already done so. Two child care centres (5.5%) had at least one measurement above the Canadian guideline level of 200 Bq/m3. CONCLUSION: This intervention has demonstrated the ability of child care centre managers to carry out this type of autonomous procedure, which can be centralized to minimize costs. This type of intervention may influence parents to become more familiar with this contaminant and measure their family's exposure at home.


Subject(s)
Air Pollutants, Radioactive/analysis , Air Pollution, Indoor/analysis , Child Day Care Centers/organization & administration , Radiation Monitoring , Radon/analysis , Adult , Child , Communication , Female , Housing , Humans , Intention , Male , Middle Aged , Parents/psychology , Qualitative Research , Quebec
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