Stakeholders' views about cardiac report cards: a qualitative study.

CONTEXT: Health care report cards provide stakeholders with information on health care outcomes and other measures of care. Report cards are most well developed in cardiac care. A necessary first step to ground the development of cardiac report cards in actual experience is to understand the views of those most closely involved. To date, there has been no systematic description of stakeholders' views. OBJECTIVE: To describe stakeholders' views about cardiac report cards. DESIGN: The present study involved qualitative person-to-person interviews with 58 stakeholders from seven Canadian cities with major cardiac programs: Vancouver, Calgary, London, Toronto, Ottawa, Montreal and Halifax. PARTICIPANTS: A total of 58 participants from six stakeholder groups in cardiac care consisting of 15 administrators, 13 nurses, 12 cardiologists, seven outcomes researchers, six cardiac surgeons and five members of the media who report on health care. OUTCOME MEASURES: Participants' views and expectations of cardiac report cards were analyzed and organized into themes. RESULTS: The views of stakeholders on cardiac report cards were organized according to four themes: PURPOSE: Participants identified two purposes--accountability for quality care as well as public education and informed decision-making; DEVELOPMENT: Participants thought that the development of report cards should involve multistakeholder collaboration; CONTENT: Participants discussed three concepts--context, level of reporting and data; and Dissemination: Mechanisms discussed include the Internet, media and directly to health care providers. CONCLUSIONS: The views of stakeholders regarding cardiac report cards can be the basis of an evidence-based conceptual framework that can guide in the development, implementation and delivery of cardiac report cards. In the present study, the views of cardiologists, cardiac surgeons, cardiac nurses, administrators, outcomes researchers and members of media are described. A next step is to explore the views of cardiac patients.

Endothelin-1 produces no renal vasoconstriction in conscious newborn lambs.

Experiments were carried out to investigate the effects of endothelin-1 (ET-1) on renal vascular tone during development under physiological conditions in conscious lambs. Renal blood flow (RBF), renal vascular resistance (RVR), mean arterial pressure (MAP), and heart rate (HR) were measured in conscious, chronically instrumented lambs aged approximately 1 week and 6 weeks before and after intra-arterial (i.a.) injection of 0, 100, 200, and 400 ng/kg body weight of ET-1. In addition, plasma levels of ET-1 were measured in 39 sheep aged 5-85 days. In 6-week-old lambs, i.a. injection of ET-1 was associated with a rapid dose-dependent decrease in RBF that resulted from a dose-dependent increase in RVR. In 1-week-old lambs, there was no renal vasoconstriction observed after ET-1 administration, even at the highest dose tested. In response to i.a. injection of ET-1 to 1-week-old and 6-week-old lambs, MAP increased and there was a concomitant decrease in HR; these effects were dose dependent but not age dependent. Plasma levels of ET-1 were 10.7+/-4.2 pg/ml at 5-10 days, and remained constant throughout the first 3 months of life in conscious sheep. We conclude that ET-1 is not a renal vasoconstrictor agent in the immediate newborn period, and that the effects of ET-1 on renal vascular tone appear to be developmentally regulated.