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1.
G Ital Cardiol (Rome) ; 9(12): 844-52, 2008 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-19119694

RESUMO

BACKGROUND: The value of echocardiography in the diagnosis and follow-up of most cardiovascular diseases is well established, even though the ever-increasing demand for the use of this technique is not always justifiable. The "Appropriatezza ECO Milano" project was developed among hospitals in Milan (Italy) to foster a rational use of echocardiography. The aim of this study was to evaluate and improve appropriateness of requests for two-dimensional color Doppler echocardiography, considering indications, prescription behaviors and clinical utility in both the outpatient and inpatient settings. METHODS: Following several meetings, a consensus was reached whereby a multicenter, observational study would be undertaken. We assessed the value of each request in agreement with the 2003 American College of Cardiology/American Heart Association/American Society of Echocardiography guidelines. An ad hoc Microsoft Access database was developed to collect study data, which refer to May 2007. Eleven hospitals participated in the study. RESULTS: 4130 echocardiographic examinations were considered (2300 performed in men and 1830 performed in women; mean age 64 +/- 16 years); 1701 examinations were performed in hospitalized patients and 2429 in outpatients. The incidence of pathological findings was higher in hospitalized patients (73%) than in outpatients (53%) (Pearson chi2 = 29, p<0.001). A higher additional clinical value was found in hospitalized vs non-hospitalized patients (48 vs. 35%, Pearson chi2 = 99; p <0.001). In both settings, the majority of echocardiographic examinations were requested by cardiologists (inpatients 36%, outpatients 54%). The most appropriate examinations were performed more frequently in class I or class IIA hospitalized patients (73%) than in outpatients (52%) (Pearson chi2 = 277, p<0.001). Furthermore, the least accurate the indication, the less the clinical utility found in examinations requested from hospitals and outpatient clinics (64 vs 61% in class I patients, Pearson chi2 = 413, p<0.001; 5 vs 11% in class III patients, Pearson chi2 = 584, p<0.001). Conclusions. Our data confirm an inadequate level of appropriateness of requests for two-dimensional color Doppler examinations in either inpatients or outpatients. After over 10 years of passively observing and recording this trend, a timely resolution of these issues is topical in order to improve the implementation of criteria and to guarantee cost-effective and high-quality cardiovascular care.


Assuntos
Cardiologia/normas , Doenças Cardiovasculares/diagnóstico por imagem , Ecocardiografia Doppler/normas , Pacientes Internados/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiologia/estatística & dados numéricos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Criança , Pré-Escolar , Ecocardiografia Doppler/estatística & dados numéricos , Estudos de Avaliação como Assunto , Feminino , Humanos , Incidência , Lactente , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Projetos de Pesquisa/normas
2.
Ital Heart J Suppl ; 4(7): 594-7, 2003 Jul.
Artigo em Italiano | MEDLINE | ID: mdl-14558288

RESUMO

We describe the case of bioprosthetic stentless aortic valve endocarditis due to Staphylococcus epidermidis in a female patient, who previously underwent mitral and aortic valve replacement: she presented left main coronary artery occlusion due to septic embolus with subsequent myocardial infarction complicated by cardiogenic shock. We discuss the therapeutic strategies, both medical and interventional, and the surgical options.


Assuntos
Valva Aórtica , Bioprótese , Vasos Coronários , Embolia/complicações , Endocardite Bacteriana/complicações , Próteses Valvulares Cardíacas , Valva Mitral , Infarto do Miocárdio/etiologia , Infecções Estafilocócicas/complicações , Staphylococcus epidermidis , Antibacterianos/uso terapêutico , Angiografia Coronária , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Radiografia Torácica , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus epidermidis/isolamento & purificação
3.
Ital Heart J Suppl ; 3(10): 1003-10, 2002 Oct.
Artigo em Italiano | MEDLINE | ID: mdl-12478826

RESUMO

The characteristics of patients admitted to cardiac rehabilitation units have progressively changed and are now represented by older age and clinical instability, with a higher percentage of females than in the past. Moreover, the demand of admission to cardiac rehabilitation departments has increased as a consequence of the extension of cardiac surgical procedures to older patients with frequent comorbidity. At the same time, the need of a shorter hospitalization in the acute hospital units has contributed to more frequent requests for cardiac rehabilitation admission. Cost factors and problems of organization have also contributed to the typology of the patients now admitted for cardiac rehabilitation. The data of patients admitted to the Cardiac Rehabilitation Unit of the Don Gnocchi Hospital in Milan are reported too: these data confirm the actual change in the typology of patients with respect to the past; the possible explanations and reasons, as well as the increased average age of the population and the increased number of surgical interventions in the elderly and females are also evaluated. Moreover, the programs and the rehabilitative aims have been consequently changed. Finally, even the use of non-invasive alternatives to ergometric tests is here discussed.


Assuntos
Procedimentos Cirúrgicos Cardíacos/reabilitação , Cardiopatias/reabilitação , Unidades Hospitalares , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Unidades de Cuidados Coronarianos , Feminino , Unidades Hospitalares/organização & administração , Humanos , Masculino , Complicações Pós-Operatórias/reabilitação , Fatores Sexuais
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