After ICH, antiplatelets safe for some
The use of antiplatelets (such as aspirin or clopidogrel) after intracerebral hemorrhage (ICH) doesn't increase the risk of recurrence, a recent study suggests. The study's 207 patients were treated at Massachusetts General Hospital between 1994 and 2004. Researchers interviewed these patients at regular intervals following their initial ICH treatments. Forty-six patients began using antiplatelets during the follow-up period. Though ICH recurred in 39 patients, antiplatelet use wasn't considered a significant factor in these outcomes. Researchers acknowledge that results may have been affected by the study's limited size and provider reluctance to prescribe antiplatelets to patients thought to have an especially high risk of recurrence. Nevertheless, these findings support the safety of antiplatelets for low-risk patients.
Source: Reuters Health. Aspirin use may be safe for some after intracerebral hemorrhage. Available at: http://www.reutershealth.com/archive/2006/01/23/professional/links/20060223clin0. Accessed August 20, 2006.
Chlorhexidine gluconate washcloths reduce VRE
Cleansing ICU patients with a chlorhexidine gluconate-saturated washcloth has been shown to control vancomycin-resistant enterococci (VRE) and other drug-resistant microorganisms. A trial conducted between October 2002 and December 2003 monitored the daily cleansing of 1,787 patients in three sequential study periods. Patients were given soap and water baths during period 1, cleansed with cloths saturated with 2% chlorhexidine gluconate during period 2, and cleansed with nonmedicated cloths during period 3. The use of chlorhexidine gluconate-saturated cloths resulted in less colonies of VRE than soap and water or nonmedicated cloth use, and the incidence of VRE decreased from 26 cases per 1,000 days to 9 per 1,000. Cleansing with chlorhexidine also decreased contamination of environmental surfaces and healthcare workers' hands. Chlorhexidine gluconate is a useful tool in stopping pathogen contamination and transmission.
Source: Barclay L, et al. Chlorhexidine gluconate cleansing may help control vancomycin-resistant enterococci. Medscape. Available at: http://www.medscape.com/viewarticle/523608?sssdmh=dm.1.181750&src=nldne. Accessed August 20, 2006.
Adult congenital heart disease patients need better care
Many children and infants born with heart abnormalities now enjoy longer life expectancy because of improved early treatment with medication or surgery. In Europe, adults living with congenital heart disease aren't receiving adequate care, according to a recent study by the Euro Heart Survey on Adult Congenital Heart Disease. Researchers observed data from 71 European care centers, concluding that many are understaffed and ill-equipped to support the increasing numbers of adult congenital heart disease patients across the continent. They suggest that all specialist centers have on staff at least one nurse specialist and one cardiologist trained in adult congenital heart disease. It's also advised that care-center surgeons perform a minimum of 50 congenital heart operations each year. Healthcare providers are encouraged to improve standards of continuous care for adult congenital heart disease patients in order to optimize the effects of treatment given in childhood and infancy.
Source: Moons P, et al. Delivery of care for adult patients with adult congenital heart disease in Europe: results from the Euro Heart Survey. Available at: http://eurheartj.oxfordjournals.org/cgi/content/abstract/ehi858v1. Accessed August 1, 2006.
Expand surveillance of implanted heart devices
A recent proposal by the Heart Rhythm Society states that implanted heart devices, such as implanted cardioverter defibrillators (ICDs) and pacemakers, should be better monitored for performance and potential problems.
Manufacturers are advised to take advantage of new technologies that allow daily monitoring of implants through wireless and remote devices. The society also encourages examination and study by independent experts, and the use of simpler language when explaining malfunctions to consumers. The term "recall" is best avoided, as doctors and patients often assume that a device that has been recalled should be automatically removed, which isn't necessarily the case. In the event that a malfunctioning device is removed, it should be returned to the manufacturer for study.
Source: Heart Rhythm Society. Draft recommendations report by the Heart Rhythm Society Task Force on Device Policies and Guidelines.
Cognitive function improved by carotid stents
Researchers exploring the neurocognitive effects of carotid artery stenting using an embolic protection device were stunned to find patients' cognitive function improving over time. Though the study hasn't yet reached its target survey group of 100 patients, results from the 51 currently enrolled patients have been positive overall. The neuroprotective device, a filter intended to prevent plaque fragments from causing trauma if they reach the brain, was deployed before the stent and removed after the stent was deployed. After stent placement, researchers monitored 39 of the enrolled patients for 3 months, and 30 for 6 months. Investigators originally believed that carotid artery stenting with filter protection would protect the brain. They expected to prove it by showing that brain function didn't worsen after stenting. However, their findings demonstrated that both symptomatic and asymptomatic patients both had statistically significant improvement in brain function.
Source: Smith M. SIR: carotid stents improve thinking. Medpage Today. Available at: http://medpagetoday.com/Radiology/2005SIRMeeting/tb/2968. Accessed August 1, 2006.
Thrombolytic therapy safe for strokes during pregnancy
Certain thrombolytic therapy treatments can be safely performed on pregnant women, if all risks to the woman and fetus are taken into consideration, according to a recent study at the Mount Sinai School of Medicine in New York. The study followed eight pregnant women between the ages of 21 and 43, all of whom suffered acute ischemic strokes. Nearly all of these strokes occurred during the first trimester of pregnancy. Half of the women were treated with rt-PA administered intravenously, usually within 3 hours of stroke, and half received urokinase locally, within 6 hours to 2 weeks after stroke. One woman died of arterial dissection complicating angiography. Seven of the women experienced some complications, such as hematomas and other bleeding complications. Three pregnancies ended in therapeutic abortions, two in miscarriages, and two in healthy deliveries. Healthcare providers should weigh all risks and benefits before administering thrombolytic treatment to pregnant women.
Source: Murugappan A, et al. Thrombolytic therapy of acute ischemic stroke during pregnancy. Neurology. 2006;66:768-770.
Stroke, SDB increase mortality risk
Stroke patients with sleep-disordered breathing (SDB) may be at an increased risk of death, a recent study suggests. One hundred fifty-two patients participated. At 3 days post-stroke, 17% of patients suffered from sleep apnea or related breathing problems. These issues subsided in 40% of patients over time. Older patients, male patients, and those with diabetes and high blood pressure were more likely to have SDB. A number of these patients required long-term continuous positive airway pressure therapy treatment. The death rate was higher for patients with SDB (22%). Those without SDB had an 8% death rate.
Source: Bassetti CL, Milanova M, Gugger M. Sleep-disordered breathing and acute ischemic stroke. Stroke. 2006;37:967-972.
Exercise affects heart failure patient outcomes
California researchers studying the effects of exercise on advanced heart failure patients found that these patients may benefit from a home-based exercise program. Participants, 99 in all, were divided into two groups. One group was assigned a low-level, home-based exercise program, taking several walks each week to increase their heart rates. These patients added mild resistance training later in the study. The second group served as a control for comparison purposes. After 6 months, researchers observed an average weight loss of 14 pounds among the group assigned to an exercise program and about half of a pound among those in the control group. The exercise group had fewer hospital admissions than the controls. Patients who exercised also showed lower incidence of depression and hostility. These findings demonstrate the beneficial effects of a low-level, home-based walking program on weight loss in overweight and obese patients with heart failure.
Source: Evangelista LA, et al. Usefulness of a home-based exercise program for overweight and obese patients with advanced heart failure. Am J Cardiol. 2006;97(6):886-890.
Blood pressure affected by sleep deprivation
Lack of sleep may increase the risk of developing high blood pressure. Analyzers observed data from 4,810 patients taking part in the first National Health and Nutrition Examination Survey. During the 10-year follow-up period, 647 patients developed hypertension. A clear association between sleep deprivation and the hypertension diagnosis was present. Patients sleeping 5 hours or less each night were twice as likely to develop hypertension. Though the connection between sleeping habits and high blood pressure isn't fully understood, these findings suggest that improving a patient's quality of sleep may function as an effective preventive measure for hypertension.
Source: Gangwisch JE, et al. Short sleep duration as a risk factor for hypertension. Hypertension. 2006;47:833-839.