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1.
J Cardiovasc Med (Hagerstown) ; 24(Suppl 2): e128-e133, 2023 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-37186563

RESUMEN

Sudden cardiac arrest is a leading cause of death in Europe. High-quality cardiopulmonary resuscitation (CPR) and guidelines compliance of rescuers have been associated with better outcomes after cardiac arrest. However, wide variability in attempting bystander CPR manoeuvres has been reported. Educational programmes for teaching CPR to medical students and fellows are highly advisable in this context. However, there is no homogeneity regarding the CPR education offered by academic institutions. We surveyed 208 Italian medical students and 162 fellows in cardiology regarding the educational offer and needs in CPR. Among the 11 medical schools surveyed, 8 (73%) offer basic (BLS) courses but only 3 (38%) with formal certification of 'BLS provider', while none offers advanced (ACLS/ALS) courses. Among the 30 specialization schools in cardiology surveyed, 10 (33%) offer a BLS course (6 with formal certification of 'BLS provider'), and 8 (27%) offer an ACLS/ALS course (5 with formal certification). Only a minority of students and fellows perceive themselves as highly proficient either in BLS or ACLS/ALS, although most of the fellows were involved at least once in rescuing a cardiac arrest. The present position paper analyses and suggests the strategies that should be adopted by Italian medical and specialization schools to spread the CPR culture and increase the long-standing retention of CPR-related technical and nontechnical skills.


Asunto(s)
Esclerosis Amiotrófica Lateral , Cardiología , Reanimación Cardiopulmonar , Paro Cardíaco , Estudiantes de Medicina , Humanos , Reanimación Cardiopulmonar/educación , Urgencias Médicas , Paro Cardíaco/terapia , Italia
2.
G Ital Cardiol (Rome) ; 21(9): 687-738, 2020 Sep.
Artículo en Italiano | MEDLINE | ID: mdl-33094745

RESUMEN

Venous thromboembolism (VTE), including pulmonary embolism and deep venous thrombosis, either symptomatic or incidental, is a common complication in the history of cancer disease. The risk of VTE is 4-7-fold higher in oncology patients, and it represents the second leading cause of death, after cancer itself. In cancer patients, compared with the general population, VTE therapy is associated with higher rates of recurrent thrombosis and/or major bleeding. The need for treatment of VTE in patients with cancer is a challenge for the clinician because of the multiplicity of types of cancer, the disease stage and the imbricated cancer treatment. Historically, in cancer patients, low molecular weight heparins have been preferred for treatment of VTE. More recently, in large randomized clinical trials, direct oral anticoagulants (DOACs) demonstrated to reduce the risk of VTE. However, in the "real life", uncertainties remain on the use of DOACs, especially for the bleeding risk in patients with gastrointestinal cancers and the potential drug-to-drug interactions with specific anticancer therapies.In cancer patients, atrial fibrillation can arise as a perioperative complication or for the side effect of some chemotherapy agents, as well as a consequence of some associated risk factors, including cancer itself. The current clinical scores for predicting thrombotic events (CHA2DS2-VASc) or for predicting bleeding (HAS-BLED), used to guide antithrombotic therapy in the general population, have not yet been validated in cancer patients. Encouraging data for DOAC prescription in patients with atrial fibrillation and cancer are emerging: recent post-hoc analysis showed safety and efficacy of DOACs for the prevention of embolic events compared to warfarin in cancer patients. Currently, anticoagulant therapy of cancer patients should be individualized with multidisciplinary follow-up and frequent reassessment. This consensus document represents an advanced state of the art on the subject and provides useful notes on clinical practice.


Asunto(s)
Anticoagulantes/administración & dosificación , Fibrilación Atrial/complicaciones , Cardiología , Consenso , Neoplasias/complicaciones , Sociedades Médicas , Tromboembolia Venosa/prevención & control , Administración Oral , Anticoagulantes/efectos adversos , Antitrombinas/administración & dosificación , Antitrombinas/efectos adversos , Femenino , Hemorragia/inducido químicamente , Heparina de Bajo-Peso-Molecular/administración & dosificación , Heparina de Bajo-Peso-Molecular/efectos adversos , Humanos , Masculino , Embolia Pulmonar/prevención & control , Factores de Riesgo
3.
Am Heart J ; 152(4): 685.e1-7, 2006 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-16996835

RESUMEN

BACKGROUND: Out-of-hospital cardiac arrest occurs at home in 65-80% of cases and is often witnessed. We designed a study to explore the feasibility of a home defibrillation program (a) evaluating the retention of cardiopulmonary resuscitation and automated external defibrillators (AED) use skills (BLSD) (b) assessing the impact on anxiety, depression, and quality of life and (c) recording the critical issues emerging from program implementation. METHODS: Thirty-three post-myocardial infarction patients and their 56 relatives received BLSD training and an AED. Assessment of BLSD skills, levels of anxiety, and depression and quality of life were scheduled every 3 months for 1 year or until a common stopping date. RESULTS: Overall BLSD score was 26 +/- 3 at baseline vs. 22 +/- 5 at 3 months (P < .0001), 21 +/- 6 at 6 months (P < .0001), 22 +/- 4 at 9 months (P < .0001) and 23 +/- 5 at 12 months (P = .001). Conversely, the BLSD component AED use" remained stable throughout the study. Quality of life, anxiety, and depression scores remained constant. Compliance to BLSD retraining sessions and AEDs checks decreased over time and was influenced by a concomitant clinical appointment. CONCLUSIONS: BLSD performance of families of post-myocardial infarction patients decreases over time, even though the ability to operate AEDs appears to be the least affected component. Compliance with retraining sessions and AED checks declines over time and is improved if they are combined with clinical appointments. The implementation of a home defibrillation program does not affect anxiety, depression, or the quality of life.


Asunto(s)
Muerte Súbita Cardíaca/prevención & control , Cardioversión Eléctrica , Familia , Atención Domiciliaria de Salud , Infarto del Miocardio , Sobrevivientes , Anciano , Ansiedad/etiología , Depresión/etiología , Familia/psicología , Estudios de Factibilidad , Femenino , Atención Domiciliaria de Salud/educación , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/psicología , Estudios Prospectivos , Calidad de Vida
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