Integrated coronary physiology in percutaneous intervention: a new paradigm in interventional cardiology.

Coronary angiography has provided an unrivalled appreciation of coronary anatomy fostering a far greater appreciation of the extent of atherosclerotic disease. However, the subjectivity of coronary angiography at determining the extent of plaque has been exposed with IVUS. Indices of coronary physiology have provided valuable adjunctive information as to the physiological importance of specific lesions. Fractional flow reserve is an established method for evaluating the significance of epicardial stenoses. Fractional flow reserve guided percutaneous coronary intervention is associated with improved outcomes when compared to a conventional angiographic guided strategy, particularly in intermediate lesions. The use of coronary physiology in the cath lab represents a new avenue to guide appropriate patient specific revascularisation strategies. This review examines the theory and evidence for fractional flow reserve and its use in percutaneous coronary intervention.

Intracoronal bleaching: concerns and considerations.

The history of intracoronal bleaching and the development of the walking bleach technique are reviewed. External cervical resorption associated with intracoronal bleaching is a serious sequela that has been reported in the literature. One explanation given for this phenomenon is that it results from an inflammatory process initiated by the presence of bleaching agents in the attachment apparatus. The basis for this conclusion is discussed. A review of published case reports on external cervical resorption associated with intracoronal bleaching revealed that: 100 per cent of the affected teeth had no intermediate dental base placed, 84 per cent were treated with a thermocatalytic technique, 80 per cent were bleached after the root canal sealer was fully set and 72 per cent had a history of trauma before bleaching. Based on these observations, it should be possible to safely bleach teeth intracoronally provided specific concerns and considerations are taken into account. These are: 1) the use of heat should be avoided; 2) an intermediate dental base should be placed with due respect to the attachment level; and 3) a base should be selected with due respect to its effectiveness in sealing tooth structure.

Nursing's approach to the care of the elderly.

This article describes the role and challenges nursing has assumed in the care of elderly patients in an Adult Day Health Care Program (ADHC). It describes the application of the standards of nursing practice from gerontological and rehabilitative nursing settings along with the standards (for Adult Day Care) proposed by the National Institute on Adult Day Care in an interdisciplinary, community based practice setting.

A challenge--fall risk management without restraints.

This report is a position paper based on anecdotal data and actual observations. The paper's intent is to describe an effective collaborative and viable approach to fall risk management in an elderly population. The use of restraints is discouraged. The setting is an Adult Day Health Care Program at the Veterans Administration Medical Center in Buffalo, New York. The program was established as a medical model Adult Day Health Care Program in April 1987 as an alternative for long-term care for elderly veteran patients. The author of this paper was the Co-Coordinator and Nurse Practitioner for the program while the data and observations presented in the paper were collected and made.