المؤلفون: Alison Calver, Paul Cook, Rohit Sirohi, Chun Shing Kwok, James Wilkinson, John Rawlins, Zoe Nicholas, Nick Curzen, Rick Allan, Iain A. Simpson, Mark Mariathas, Lavinia Gabara, Sanjay Ramamoorthy, Jonathan Hinton, Mamas A. Mamas, Michael Mahmoudi, Simon Corbett, Glen P. Martin

المصدر: The American Journal of Cardiology. 158:124-131

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Kaplan-Meier Estimate, Internal medicine, medicine, Humans, Blood test, Hospital patients, Aged, Proportional Hazards Models, Aged, 80 and over, medicine.diagnostic_test, business.industry, Proportional hazards model, Troponin I, Middle Aged, Confidence interval, Hospitalization, Survival Rate, Cardiovascular Diseases, High sensitivity troponin, Cohort, Cardiology, Female, Observational study, Cardiology and Cardiovascular Medicine, 1 year mortality, business, Biomarkers

الوصف: This was an observational study of the 1-year outcomes of the 20,000 patients included in the original CHARIOT study. The aim of the study was to assess the association between high sensitivity troponin I (hs-cTnI) concentration and 1 year mortality in this cohort. The original CHARIOT study included a consecutive cohort of in- and out-patients undergoing blood tests for any reason. Hs-cTnI concentrations were measured regardless of whether the clinician requested them. These results were nested and not revealed to the team unless requested for clinical reasons. One year mortality data was obtained from NHS Digital as originally planned. Overall, 1782 (8.9%) patients had died at 1 year. Multivariable Cox regression analysis showed that a hs-cTnI concentration above the upper limit of normal was independently associated with the hazard of mortality (HR 2.23; 95% confidence intervals 1.97 to 2.52). Furthermore, the log (10) hs-cTnI concentration was independently associated with the hazard of 1 year mortality (HR 1.77; 95% confidence intervals 1.64 to 1.91). In conclusion, in a large, unselected hospital population of both in- and out-patients, in 18,282 (91.4%) of whom there was no clinical indication for testing, hs-cTnI concentration was associated with 1 year mortality.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::89fefed3f5264cd58a6fe0c4e9510592Test
https://doi.org/10.1016/j.amjcard.2021.07.050Test

المؤلفون: Jonathan Hinton, Mark Mariathas, Lavinia Gabara, Rick Allan, Zoe Nicholas, Chun Shing Kwok, Sanjay Ramamoorthy, Alison Calver, Simon Corbett, John Rawlins, Iain Simpson, James Wilkinson, Rohit Sirohi, Michael Mahmoudi, Glen Martin, Paul Cook, Mamas Mamas, Nick Curzen

المصدر: Stable IHD/Prevention/Hypertension/Lipids.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::663203441b594333cd3d09e8454ae69cTest
https://doi.org/10.1136/heartjnl-2022-bcs.169Test

المؤلفون: Jonathan Hinton, Andre Briosa e Gala, Rohit Sirohi

المصدر: The American Journal of Emergency Medicine

مصطلحات موضوعية: medicine.medical_specialty, Mitral regurgitation, Coronavirus disease 2019 (COVID-19), Ischemic mitral regurgitation, business.industry, Cardiogenic shock, 030208 emergency & critical care medicine, General Medicine, Emergency department, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Internal medicine, Mitral valve, Emergency Medicine, medicine, Cardiology, cardiovascular diseases, Myocardial infarction, Complication, business

الوصف: The reduction in patients presenting with ST-elevation myocardial infarction (STEMI) during the COVID19 crisis could have resulted from fears about developing COVID-19 infection in hospital. Patients who delay presenting with STEMI are more likely to develop mechanical complications, including acute ischemic mitral regurgitation (MR). We present a 69-year-old women with an inferior STEMI and cardiogenic shock due to acute ischemic MR who delayed presenting to hospital due to the fear of COVID-19. Early identification of this mechanical complication using transthoracic echocardiography in the Emergency Department enabled the team to target her optimisation. Ultimately these patients require urgent surgery to repair the mitral valve and revascularize the myocardium but they are often too unwell to undergo surgery and even when it is feasible the outcomes are poor.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d2a418ad55d602d31cdbfd6e25c2b4cbTest
https://doi.org/10.1016/j.ajem.2020.10.028Test

المؤلفون: Amerjeet Banning, Rohit Sirohi, Anthony H. Gershlick

المصدر: The Interventional Cardiology Training Manual ISBN: 9783319716336

مصطلحات موضوعية: business.industry, media_common.quotation_subject, medicine.medical_treatment, Best practice, Percutaneous coronary intervention, Audit, medicine.disease, Mentorship, Summative assessment, Intervention (counseling), Conventional PCI, medicine, Quality (business), Medical emergency, business, media_common

الوصف: Chronic total occlusion (CTO) intervention remains a challenge in terms of percutaneous coronary intervention (PCI). Traditionally average success rates (60–70% British Cardiovascular Interventional Society—BCIS data), procedure duration, degree of radiation exposure, percieved and real procedural complications and need for specialized operator training and maintenance of procedure volume have led to negative perceptions on the value of CTO PCI. Absence of robust data proving hard end point clinical benefit also raise questions over cost efficacy when traditional markers such an incremental cost-effectiveness ratio (ICER) are used. However in the right patients with real-life debilitating symptoms despite medical therapy, CTO PCI can transform a patient’s quality of life—they being able to walk and exercise with friends and family without having to stop because of angina can be life changing. We know there are a significant number of patients who have life-limiting angina despite medication and who can languish with poor quality of life for many years. CTO PCI done properly so as to get good results can change that. Recent advances in techniques including the retrograde approach as well as newer generation stents have yielded better results and renewed interest in CTO treatment. Therefore, it is beholden to the trainee/new consultant or other interventionist becoming interested in CTO PCI to ensure the following: Learn the technique in a structured formal progressive manner, preferably under the mentorship of another more experienced CTO operator. Do cases in conjunction with experienced colleagues. Become totally familiar with antegrade techniques first. Audit their data including success rates. Look to proctorship when they consider techniques/kit they are not familiar with. Attend live interactive courses as part of their summative experiential learning curve. Understand the principles behind the various techniques and are aware of the complications associated with this sometimes technically demanding procedure. Are fully aware of the issues around contrast-induced nephropathy and especially around radiation protection. This chapter will detail ways of ensuring best practice with most likely chance of success for PCI-CTO. It will provide the evidence base where available and include tips and tricks for best clinical practice.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::f4d925de7b12f156266f1ea61b624b40Test
https://doi.org/10.1007/978-3-319-71635-0_28Test

المؤلفون: Rohit, Sirohi, Chitkara, Kamal

المصدر: Complications of Percutaneous Coronary Intervention ; page 99-106 ; ISBN 9781447149583 9781447149590

الإتاحة: https://doi.org/10.1007/978-1-4471-4959-0_12Test

المؤلفون: David A. Gorard, Jamal O. Hayat, Rohit Sirohi

المصدر: European Journal of Gastroenterology & Hepatology. 20:648-652

مصطلحات موضوعية: medicine.medical_specialty, Adolescent, Referral, Gastrointestinal Diseases, Sedation, Child Health Services, Conscious Sedation, Workload, Anesthesia, General, Organic disease, Endoscopy, Gastrointestinal, Age Distribution, Interquartile range, medicine, Humans, General anaesthesia, Child, Referral and Consultation, Retrospective Studies, Hepatology, medicine.diagnostic_test, business.industry, General surgery, Gastroenterology, Retrospective cohort study, Hospitals, District, Endoscopy, Surgery, England, El Niño, Child, Preschool, Clinical Competence, Health Services Research, medicine.symptom, business

الوصف: Background Children often travel from district hospitals to teaching centres for endoscopic procedures by paediatric gastroenterologists. A 10-year district hospital experience of 'adult-service' gastroenterologists endoscoping children is reported with the aim of quantifying the workload, indications, sedation/anaesthesia practices, findings and safety of paediatric endoscopy performed by adult-service gastroenterologists. Methods Data on endoscopic procedures in patients younger than 16 years of age between 1997 and 2006 were obtained from hospital case-notes and computerized endoscopy/histology databases and were analysed. Results A total of 174 procedures (118 gastroscopies, 41 colonoscopies and 15 flexible sigmoidoscopies) were performed in 162 children. The median (interquartile range) age was 11.5 (5-14) years. Sixty-nine percent of patients were referred by paediatricians and 31% by general practitioners /other adult specialties. Children referred as outpatients waited a total of 50 (23.5-95) days from referral to procedure. Inpatient children waited 3 (1-4) days for their procedure. General anaesthesia was used in 89% (63 of 71) endoscopic procedures in children aged below 11 years and 100% of 47 procedures in children aged below 6 years. In contrast, 96% (99 of 103) procedures in children aged 11 years or older were done in the endoscopy unit with intravenous or no sedation. Organic disease was identified from 90 (52%) procedures. The most common diagnoses were coeliac disease (41), inflammatory bowel disease (26), gastro-oesophageal reflux (six) and foreign body removal (seven). No endoscopic complications occurred. Conclusion General gastroenterologists supported by paediatricians can provide endoscopic services for children safely and promptly in their local hospital. This is appropriate for the management of common gastrointestinal problems affecting children.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b5f34f668867614ddb15e22d087709c0Test
https://doi.org/10.1097/meg.0b013e3282f5e9b6Test