Mis ppt on hospital

Because every child is unique RASHTRIYE BAL SWASTHYA KARYAKRAM Accredited Hospitals Meeting New treatment order on 26 AUGUST, 2016 National Health Mission,

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Post MI Heart Failure with Left Ventricular Dysfunction Management

(26.7) 0.87 (0.79–0.95) 0.002 hospitalization for cardiovascular events Secondary endpoints (No.) Hospitalization for cardiovascular events 1004 876 0.87 0.03 Acute MI 269 268 0.99 0.96 Heart failure 618 477 0.77 /and Survival Study - SUMMARY - In patients with acute myocardial infarction (MI) complicated by left ventricular dysfunction and heart failure, eplerenone: Reduced all-cause mortality, and reduced death or hospitalization due to cardiovascular events Had no effect on the incidence of gynecomastia /

Hyperglycemia Management in the Hospital Tools to Make the Journey Safer & More Comfortable Bruce W. Bode, MD, FACE Atlanta Diabetes Associates Member.

of Diabetes Hogan P, et al. Diabetes Care. 2003;26:917 – 932. Per Capita Healthcare Expenditures (2002) DiabetesWithout diabetes Benefits of Improved Glucose Control in the Hospital l Aggressive insulin treatment improves –ICU outcomes –Outcomes post-MI –Cardiac surgery outcomes Mortality of DM Patients Undergoing CABG Furnary et al J Thorac Cardiovasc Surg 2003;123:1007-21 Costs of Hyperglycemia in the/

Charles V. Pollack Jr, MA, MD, FACEP, FAAEM Program Chairman Chairman, Department of Emergency Medicine Pennsylvania Hospital Professor of Emergency Medicine.

Presenters James Ferguson III, MD, FACC Associate Director, Cardiology Research Texas Heart Institute at St. Lukes Episcopal Hospital Episcopal Hospital Associate Professor Baylor College of Medicine Clinical Assistant Professor University of Texas Health Science Center at Houston at Houston /Staessen JA. Lancet, 1997;350: 757-764. Isolated Systolic Hypertension (Reported in 1000 patient years) Cardiovascular (HF, MI) Cardiovascular (HF, MI) l 20.5 placebo, 15.1 Tx (p=0.03) CVA CVA l 18 placebo, vs 11.8 Tx/

Coronary Artery Disease

most common first event followed by angina. Sudden cardiac death is not uncommon Acute myocardial infarction (AMI) One of the most common diagnosis in hospitalized patients in industrialized nations Mortality of acute MI is 30% and one-half of these deaths occur before hospitalization Mortality after admission has decreased by 30% in last 2 decades 1 in 25 pts (4%) who survive till/

Presented by: Fahim H. Jafary, M.D., F.A.C.C. Associate Professor of Medicine Aga Khan University Hospital, Karachi March 14, 2008 Primary Percutaneous.

90 minutes after Thrombolysis Am J Cardiol 2000;85:1409-1413 Jafary / Aga Khan University Hospital Thrombolytic Therapy Limitations Benefits not clear cut in some subsets CABG Cardiogenic Shock Elderly > 75 Jafary / Aga Khan University Hospital Thrombolytic Therapy Limitations Less effective in some “high risk” subsets Anterior Wall MI Lundergan et al; GUSTO I Angiographic Investigators; JACC 1998; 32: 648 Jafary / Aga Khan/

Epidemiology of traumatic and ischemic brain injuries G. Citerio Rianimazione – H San Gerardo – Monza (Mi) G. Citerio Rianimazione – H San Gerardo – Monza.

: a physiologically based classification system. Crit Care Med 1981; 9:591-597 71 % 19 % 7 %7 % 3 %3 % NL MI 97-98 G. Citerio, MD Chronic health evaluation A.Prior good health; B. Mild to moderate limitation of activity; C. Serious but not/that describe TBI-related disability in 1996-1997, CDC estimates the following: –Each year more than 80,000 Americans survive a hospitalization for traumatic brain injury but are discharged with TBI-related disabilities. –5.3 million Americans are living today with a TBI/

Aggressive Lipid Lowering Treatment Richard CESKA Centre of Preventive Cardiology University Hospital, Prague, Czech Republic International Atherosclerosis.

0.07 Presented at AHA 2005 % * Major coronary event defined as coronary death, hospitalization for non-fatal acute MI or resuscitated cardiac arrest. IDEAL Trial: Secondary Endpoints Major cardiovascular events, defined as any/−27  −26  −47  ARBITER 2: Secondary Efficacy Endpoint—Clinical Events Composite clinical event endpoint –Unstable angina/MI hospitalization –Stroke –Sudden cardiac death –Percutaneous coronary revascularization, CABG, or peripheral revascularization Patients with Event (%) P =.20 9/

Supported by a grant from Novartis Pharmaceuticals

cause mortality and the trial was designed to be event driven. Other important end points were CV death, hospitalization for heart failure and recurrent MI. Safety and tolerability were assessed and compared. The median duration of follow-up in VALIANT was 24./is as effective as a proven dose of captopril in reducing the risk of: Death, CV death, or nonfatal MI, or hospital admission for heart failure. Combining valsartan with a proven dose of captopril produced no further reductions in mortality and /


and regulators www.birlamedisoft.com Features of Quanta Wow!! Great features!! Powerful inbuilt Business Intelligence engine Graphical MIS, using dashboards and graphs Finest quality GUI by DevExpress Multi-location connectivity branches ready Portability on SQL-server, Oracle database www.birlamedisoft.com PharmacyTelemedicine Diagnostic Centre Clinic Hospital Regulator Supplier / Company Clinical Research Centre Staff Management Physician Public Desktop Laptop Mobile Kiosk Internet Inter/

Management of Coronary Artery Disease: Saravanan Kuppuswamy MD Division of Cardiology Department of Internal Medicine University of Missouri Hospital.

< 70 mg/dL Assess fasting lipid profile in all patients, and within 24 hours of hospitalization for those with an acute event. For patients hospitalized, initiate lipid-lowering medication as recommended below prior to discharge according to the following schedule: /001 +24 h+48 h+72 h 4.3% Death/MI Death/MI Boersma E, et al. Circulation. 1999;100:2045-2048. Early Use of GP IIb/IIIa Inhibition Improves PCI: CAPTURE, PURSUIT, PRISM-PLUS In-hospital Mortality is Lower With Early GP IIb/IIIa Inhibitor Use (/

Introduction to MIS Chapter 1 Introduction Jerry Post Technology Toolbox: Search Engines Technology Toolbox: Searching Cases: Fast Food.

History: Farmer Laborer Management YearFarmMfgMgtService 192029%44%22%6% 19402338308 19609364312 19803325213 20001166617 20101116820 MIS Organization Business Operations Tactical Management Strategic Mgt. EIS ES DSS Transaction Process Control ERP Operations/ Baxter/Strategy Supply storeroom Supply Closets Hospital Warehouse American Hospital Supply Supplier Typical Supply Relationship Supplier Baxter/Strategy Supply Closets Hospital Warehouse American Hospital Supply Supplier Baxter Supplier AHS/Baxter /

1 We’ve Come A Long Way-Prevention of Cardiovascular Disease in Women Ned Ferguson, M.D. University of Wisconsin Hospital and Clinics Section of Cardiovascular.

fewer diagnostic tests, fewer cardiology consultations, less percutaneous interventions and fewer beneficial discharge medications. 13 Women younger than 50 years of age have twice the MI hospital mortality than comparably aged men. Women are more likely to have MI complications of shock, heart failure, recurrent chest pain, cardiac rupture, and stroke. Antiplatlet therapy, thrombolysis, acute angioplasty, and CABG. All entail greater bleeding risk/

Experiences of a medical statistician working in a SARS- designated hospital in Singapore Arul Earnest MSc, DLSHTM, C.Stat School of Public Health, University.

predictors for mortality in a designated national SARS ICU in Singapore. T ai DY, Lew TW, Loo S, Earnest A, Chen MI; Tan Tock Seng Hospital SARS ICU Group. Ann Acad Med Singapore. 2003 Sep;32(5 Suppl):S34-6. This time, the study examined the factors/ predictors for mortality in a designated national SARS ICU in Singapore. T ai DY, Lew TW, Loo S, Earnest A, Chen MI; Tan Tock Seng Hospital SARS ICU Group. Ann Acad Med Singapore. 2003 Sep;32(5 Suppl):S34-6. Methods: Starting from the most significant, variables/

1 Riesgo Cardiovascular en Paciente VIH Esteban Martínez Servicio de Infecciones Hospital Clínic Universidad de Barcelona España I Congreso GESIDA Conferencia.

2009 * Recent exposure means current exposure or stopped in the previous 6 months DAD and French Hospital Database Studies: discrepancies among results Increase in the risk of MI by individual antiretroviral drugs and families % adjusted difference using ”ABC (no ddI)” versus using ”/ Bedimo R et al. IAS 2009. MOAB202 The association between ABC and MI may be biased by chronic kidney disease Veterans Cohort Study Datos del Hospital Clínic, Barcelona 2008 NRTI use different over time; patients treated with /

Children’s Hospital of Pittsburgh’s Clinical Services Building Pittsburgh, PA Final Thesis Presentation Gloria Brashear Construction Management Option.

Research 2: Virtual Modeling Breadth 1: Mechanical Breadth 2: Structural Acknowledgements Comments & Questions - Research of Virtual Modeling - Interview with MIS Project Leader with P.J. Dick, Inc. - Software Review - Research of BIM Consultants Vico vs. Autodesk Constructor vs. Revit Architecture Children’s Hospital of Pittsburgh Clinical Services Building Gloria S. Brashear Construction Management Option Department of Architectural Engineering The Pennsylvania State University/

Michigan’s Smoke-free Hospital Campuses: Steps to Implementation Michigan’s Smoke-free Hospital Campuses: Steps to Implementation Linda A. Thomas, MS Tobacco.

implemented smoke- free environment (SFE) at time project began First step was to survey 166 MI hospitals First step was to survey 166 MI hospitals 95% return rate 95% return rate Project Personnel Jodie Faber, BS – United Memorial Hospital, Greenville Therese Green, MHS – Northern Michigan Hospital, Petoskey Mishelle Bakewell, MA – Holland Hospital Lisa Roberts – University of Michigan Health System, Ann Arbor Thomas Peterson, MD – Michigan Medical PC/

MICHELANGELO: OASIS 5 Women’s Substudy Dr. Eva Swahn Department of Cardiology, Heart Centre, University Hospital, Linköping Sweden Disclosure Funded by.

randomization or selective invasive strategy (coronary angiography only in case of symptoms i.e. severe ischemia during index hospital admission or on a stress test). Study Objectives To evaluate whether, among women with NSTACS, an early /selective invasive strategy in terms of Death/MI/Stroke over a duration of 2 year follow-up All patients were concurrently managed with intense anti-ischemic and antithrombotic medication during index hospitalization. Indications for revascularization in the selective /

Breastfeeding Education for Home Visiting Programs Toolkit Copyright © Ann & Robert H. Lurie Children’s Hospital of Chicago. All rights reserved.

additional breastfeeding support in the community to help mothers continue breastfeeding once they have been discharged from the hospital. Community breastfeeding support is an important piece of the fight against childhood obesity. Home visiting programs represent/ Interviewing Tip Sheet for Home Visitors Adapted from: http://www.motivationalinterview.org/Documents/Skills%20Tip%20Sheet.pdf MI Procedure and Stages of Change Use the Stages of Change to help move your participants through the change/

12 Lead EKG 101 A Basic Overview of How to Interpret 12 Lead EKGs and Treat a Cardiac Patient Region IV Pre-Hospital Systems Coordination Committee.

, BBB is considered a complication of anterior septal infarcts. When BBB is the result of MI, the incidence of pump failure is 65-70% and the in-hospital mortality rate is 40%-60%. The BBB itself is not dangerous, but the high mortality / of blood supply for SA & AV nodes from the RCA Hypotension – treated with fluids, consider right side involvement Inferior Wall MI Lateral Wall MI Lateral Wall MI: results from occlusion of the Left Circumflex Artery At least 1 mm ST segment elevation in leads I, aVL, V5 & /

 Transfusion Medicine  Anticoagulation  Therapeutics  Perioperative Medicine  Critical Care  Choosing Wisely Update in Hospital Medicine 2013.

2:1), retrospective study, 1,212 hip fx patient cohort, median age 85  169 with MI (14%), 92% in <48 hr post-op, 75% “silent”  Mortality MI vs no-MI- › In hospital 14.5% vs 1.2% › 30 day 17.4% vs 4.2% › 1 /  Decreased odds - high volume ED, admissions to monitored transitional care  Conclusion – Respiratory conditions, MI and Sepsis should be triaged objectively out of the ED Update in Hospital Medicine 2013  Medical specialty societies were asked to “choose wisely” and identify five tests or procedures/

Optimal Strategies for DVT Prophylaxis: Translating Evidence into Practice Samuel Z. Goldhaber, MD Cardiovascular Division Brigham and Women’s Hospital.

Care (ensure prophylaxis from admission to discharge, to SNF, and at home) DVT/ PE are rampant but often preventable. ► Hospitalized patients are at risk, but prophylactic measures are often omitted. ► Behavior Modification and Quality Improvement strategies: - Electronic, Human alerts /DVTs in EU in 2004. Thromb Haemostas 2007; 98: 756 ►The high death rate from PE (exceeding acute MI!) and the high frequency of undiagnosed PE causing “sudden cardiac death” emphasize the need for improved preventive efforts./

INTRODUCTION TO OPERATIONS MANAGEMENT Chapter 1 MIS 373: Basic Operations Management.

? Q3: What actions could a manager take to better match supply and demand? Supply & Demand – VA HospitalSupply & Demand – VA Hospital (CNN AC360, 2:14 to 3:00) DISCUSSIONS Prompt questions: Q1: What are the implications of these differences between goods and services /Veterans languish and die on a VA hospitals secret list “Were making our appointments within 10 days, within the 14-day frame, when in reality it had been six, nine, in some cases 21 months” MIS 373: Basic Operations Management27 US CARBON /

Introduction I. Introduction:Marketing in the Hospitality Industry 1)Customer orientation. The purpose of a Business is to create and maintain profitable.

and the marketing research process. Information analysts process information to make it more useful. Finally, the MIS distributes information managers in the right form and at the right time to help in marketing planning, / complex distribution systems involving four or more channel members. V.Marketing Intermediaries. Marketing intermediaries available to the hospitality industry and travel industry include travel agents, tour operators. tour wholesalers, specialists, hotel sales representatives, incentive/

Cardiovascular A&P and Patho-physiology Irene Mueller, EdD, RHIA Montana Hospital Association May 26, 2010.

Hospital Association May 26, 2010 Objectives – First Hour Functions of Circulatory System Heart & Vessels –Anatomy –Normal physiology Congenital  –VSD –PDA –Coarctation of Aorta –ASD –Tetralogy of Fallot –Transposition of Great Arteries  Pathologies –HTN Objectives - 2 nd hour  Pathologies –CAD –MIs/.edu/dck3/heart/listen.htmlhttp://filer.case.edu/dck3/heart/listen.html Cincinnati Childrens Hospital Medical Center. Cardiac Anomalies / Congenital Heart Defects –http://www.cincinnatichildrens.org/health//

Diabetes Mellitus Chun-Jen Lin, MD Taipei Veterans General Hospital - BS control and stroke.

(N=175) Mean Change in Average CIMT CHICAGO TRIAL: A Study Evaluating Carotid Intima-Media Thickness in Atherosclerosis comparing Pioglitazone versus Glimepiride Risk of MI, IHD or a composite of major Macrovascular Events from Meta-analyses of Trials with Rosiglitazone or Pioglitazone versus Comparators Schernthaner G & Chilton R./ cancer. Thank you for your attention! Chun-Jen Lin, MD zenlin1981@hotmail.com Taipei Veterans General Hospital Chun-Jen Lin, MD zenlin1981@hotmail.com Taipei Veterans General/

Update in Hospital Medicine: Turning Evidence into Practice Joseph Li, MD Director, Hospital Medicine Beth Israel Deaconess Assistant Professor of Medicine.

Which of the following is correct about use of enoxaparin in non-ST elevation MI (NSTEMI)? D. Pt may have a higher risk of in-hospital mortality because of enoxaparin. Update in Hospital Medicine Case Presentation The dose of the enoxaparin is adjusted later that day and/. J Am Coll Cardiol. 2007;49:1763-9. High-risk ≥ 3 of: age > 70, angina, prior MI, CHF, DM, CKD, hx stroke Update in Hospital Medicine Results: DECREASE-V Medical treatment in 52 pts Revascularization in 49 pts PCI in 32 pts, CABG in 17 pts/

Dr Akhil Kapur London Chest Hospital, Barts and the London NHS Trust, London, UK On behalf of the CARDia Investigators Friday 30th January 2009.

(248) PCI (254) p valueHR and 95% CI Death 3.2 % 0.970.98 (0.37,2.61) Non fatal MI (Periprocedural MI) 5.7% (4.4%) 9.8% (4.7%) 0.088 (0.819) 1.77 (0.92,3.40) Non /5 years to increase power CARDia Participating Centres CentreLocal investigatorPatients Recruited Hammersmith Hospital, LondonKevin Beatt, Punit Ramrakha84 St Mary’s Hospital, LondonIqbal Malik62 London Chest HospitalMartin Rothman, Akhil Kapur52 St James Hospital, DublinPeter Crean42 Royal Sussex County, BrightonSteve Holmberg, Adam de Belder/

Cooling in MI. Myocardial Protection and Preservation "Cell protection is the new challenge for patient management in coronary care units, the catheterization.

, MD, FACC * JACC 2002; 40: 1928-34 Clinical Sites St Vincent’s HospitalMelbourne, Australia William Beaumont Hospital Royal Oak, MI Rush-Presbyterian-St.Luke’s Medical CenterChicago, IL Alton-Oschner Medical CenterNew Orleans, LA Beth Israel Medical CenterNew York/* 180 0306090120150180210240 TIME (Mins) AosAodHR * JACC 2002; 40: 1928-34 In-hospital Adverse Events* Cooling (n=21)Control (n=21) Death Recurrent MI Repeat PCI CABG MACE Stroke/TIA Cardiogenic shock Pulmonary edema VT/VF Bradycardia Hematoma >/

Peut-on aller encore plus loin avec les antagonistes de l’Angiotensine II ? Antoine Sarkis, MD Associate Professor of Cardiology Hotel Dieu de France Hospital.

362:772-777 012 3 Years 50 HR 0.77 p=0.0004 0 40 30 20 10 Candesartan Placebo CV Death of Hospitalization for HF 2,028 patients with symptomatic HF, LVSD (EF <40%), and intolerance to ACE-I randomized to candesartan (32 /, or diabetes + end-organ damage Results anticipated in 2007 Ramipril 10 mg + telmisartan 80 mg Primary end point: CV death, MI, stroke, hosp for HF Secondary end point: Newly diagnosed diabetes ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial Diabetic /

Sir Run Run Shaw Hospital Prof. Cheng Unit 5. Dermatomyositis , Scleroderma – Etiology, Clinical features, Diagnosis and Treatment. 1.5 hr Subacute cutaneous.

erythematosus Discoid lupus erythematosus - Etiology, Clinical features, Diagnosis and Treatment. 0.5 hr Sir Run Run Shaw Hospital Prof. Cheng Connective Tissue Diseases(CTD) -concept Autoimmune diseases –Autoimmune diseases – diseases associated with specific autoantibodies diseases/SRP Abs); 3,Abs to Mi-2, a nuclear helicase. 3,Abs to Mi-2, a nuclear helicase. * other myositis-specific autoantibodies * other myositis-specific autoantibodies Sir Run Run Shaw Hospital Prof. Cheng Autoantibodies in /

Incidence of Acute Coronary Syndromes (ACS): Statistics From Various Studies 1.4 million hospitalizations each year for ACS 944,000 hospitalizations for.

Weeks12 Weeks30 Days40 Days45 DaysF/U = Ischemic Heart Disease: Time-Dependent Mortality Risk 0 5 10 15 20 25 0123456 Deaths/100 Pts/Month Months After Hospital Admission Acute MI Unstable Angina Stable Angina Clinical Practice Guidelines. AHCPR publication No. 94-0602. Determinants of Plaque Vulnerability Downstream embolization DETERMINANTS OF THROMBOSIS - Local factors - Systemic factors UNSTABLE CORONARY ARTERY DISEASE ARTERY /

NEJM, 337: , August, 1997 The Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-wave Coronary Events (Unstable angina and non-Q-wave MI) The.

or more) :Definite evidence of underlying CAD (1 or more) : – Ischemic ECG changes on presentation – Previous MI, PTCA, or CABG – Previous angiography with > 50% vessel stenosis NEJM, 337:447-452, August, 1997 ESSENCE:/T-wave inversions in at least 2 contiguous leads Angina prompting revascularizationAngina prompting revascularization Angina prompting re-hospitalizationAngina prompting re-hospitalization NEJM, 337:447-452, August, 1997 Endpoint Definition (cont’d) Myocardial Infarction (at least one of the /

Marketing Information Systems and Marketing Research Chapter 5 Kotler, Bowen and Makens Marketing for Hospitality and Tourism.

Research Plan Presenting the Research Plan Designing the Sample Gathering Secondary Information Determining Specific Information Needs Marketing for Hospitality and Tourism, 6e Kotler, Bowen and Makens © 2014 by Pearson Higher Education, Inc Upper Saddle / company records, marketing intelligence activities, and the marketing research process. MIS (cont.) Information analysts process information to make it more useful. Finally, the MIS distributes information to managers in the right form and at the right/

Annual Patient Admissions for Acute Coronary Syndromes 1.4 MM Non-ST elevation ACS 0.6 MM ST-elevation MI ~ 2.0 MM patients admitted to CCU or telemetry.

5.5% 12.8%  (P=0.0001) Patients with MI within 72 hours (n=593) Patients without MI within 72 hours (n=8,868) Days following randomization % cumulative mortality Cumulative Mortality in Patients Experiencing MI During Hospitalization for Non-ST Elevation ACS Fintel DJ et al. J Am/ al. Circulation. 1999; Suppl 1:1-629. CK-MB levels during hospitalization Normal  1-2 *  2-3 *  3-5 *  5-10 *  10 * CK-MB levels during hospitalization Incidence of MI Prior to PCI in Patients with Non-ST Elevation ACS 8.9% 2/

Myocardial infarction Taras V. Chendey MD, PhD, Chair of Hospital Therapy

Myocardial infarction Taras V. Chendey MD, PhD, Chair of Hospital Therapy http://www.uzhnu.edu.ua/uk/infocentre/3984 Definition  Myocardial infarction is an ischemic necrosis of the myocardium, caused by occlusion of coronary artery and prolonged myocardial ischemia.  MI is an extreme consequence of acute coronary syndromes – the spectrum of clinical states caused by instability of coronary artery lumen due to plaque/

Health Care &Hospital Administration Dept. COB-Rabigh Health Management Information Systems All Chapters …

Administration Community Reception Community Medical Accounting Community Healthcare professional Staff Clinical laboratory technologist Radiological technologist Physician Nurse Hospital administrator Clinical Laboratory Community Radiological Community Pharmaceutical Community Pharmacist Structure of the Hospital Community Medical Service Patient Management Information System Clinical Information System MIS CIS GMIS Geographical Management Information System Development steps of HIS The information in/

Statins in risk reduction Vasil Velchev MD, PhD St.Anna University Hospital, Sofia.

CV events) compared with standard therapy. MIRACL Worsening Angina With New Objective Evidence of Ischemia and Emergency Re-hospitalization Relative risk = 0.74 P=0.018 Atorvastatin Placebo Time Since Randomization (Weeks) Cumulative Incidence (%) 15 10/Death from any cause Death from CHD Death from other causes MI Death or MI Death from CHD or MI Revascularization MI, revascularization or death from CHD Unstable angina requiring hospitalization Stroke Hazard ratio (95% CI) High-dose atorvastatin better /

Hyperglycemia Management in the Hospital Tools to Make the Journey Safer & More Comfortable Bruce W. Bode, MD, FACE Atlanta Diabetes Associates Member.

Healthcare Expenditures (2002) DiabetesWithout diabetes Benefits of Improved Glucose Control in the Hospital l Aggressive insulin treatment improves –ICU outcomes –Outcomes post-MI –Cardiac surgery outcomes Hospital Target Blood Glucose (mg/dL) l 80 – 110 in ICU patients/we have to control glucose only most powerful Methods For Managing Hospitalized Persons with Diabetes l Continuous Variable Rate IV Insulin Drip Major Surgery, NPO, Unstable, MI, DKA, Hyperglycemia, Steroids, Gastroparesis, Delivery, etc l /

Selección lógica de antiplaquetarios en SCA-ICP

dose, then 90 mg bid maintenance; (additional 90 mg pre-PCI) 6–12-month exposure Primary endpoint: CV death + MI + Stroke Primary safety endpint: Total major bleeding PCI = percutaneous coronary intervention; ASA = acetylsalicylic acid; CV = cardiovascular; TIA/Individualized therapy Does one size fit all?? Individualized therapy NO riesgo alto de sangrado Riesgo alto de sangrado Hospital Universitario de Bellvitge: Indicaciones de Antiagregación Oral en SCA IAMCEST IAM extenso* ECG: Anterior (≥4 /

Optimal Timing of PCI in ACS Patrick Hildbrand. Trends and Prognosis in ACS Furman MI, JACC 2001, 37:1571-1580 Hospital 1 year.

min of first medical contact as a systems goal. Primary PCI versus Fibrinolysis Primary PCI versus fibrinolysis for MI Meta analysis of 23 trials Keeley EC. Lancet 2003;361:13-20 P<0.0001 Defeated CAPTIM: Mortality at different time points Mortality Pre- hospital* fibrinolysis Primary PCI p- value Patients419421 At 30 days3.8%4.8%0.29 At 1 year5.4/

Effect of Early revascularization versus delayed revascularization versus medical therapy on inpatient mortality in patients with non ST elevation MI in.

-Is early revascularization better than delayed revascularization or Medical therapy alone in reducing in hospital mortality in Patients with non ST elevation MI in a community care setting? Secondary endpoint What is the relative mortality of NSTEMI patients/actually underwent intervention (PCI or CABG)? Methods Retrospective Data Analysis of patients at Mercy Hospital who have documented non ST elevation MI from June 2008 to June 2009 Institutional Review Board approval through the Catholic Health System /

Pediatric Minimally Invasive Surgery

with Tiny Incisions Lap Hirschsprung’s pull through 8 weeks post-op pull through Joseph A. Iocono, M.D. Assistant Professor Division of Pediatric Surgery University of Kentucky Children’s Hospital MIS-Advantages * Cosmesis * Analgesia * Adhesions * Decreased Ileus open operations often leave large, unsightly incisions with some laparoscopic instruments smaller than 2mm in size, it is often difficult to see incisions postoperatively/

TCT, October 14 th, 2008 Nico H.J.Pijls, MD, PhD Catharina Hospital, Eindhoven The Netherlands, The Netherlands, on behalf of the FAME investigators FRACTIONAL.

Gerald Werner) Bristol Royal Infirmary (A.Baumbach) Staedt. Krankenhaus, Bogenhausen (G.Riess) Glasgow Western Infirmary (Keith Oldroyd) Royal Victoria Hospital, Belfast (Ganesh Manoharan) FAME study Steering Committee: Nico H.J. Pijls, Eindhoven, Netherlands (PI) William F. Fearon, /, % 73750.30 Diabetes, % 25240.65 Hypertension, % 66610.10 Current smoker, % 32270.12 Hyperlipidemia, % 74720.62 Previous MI, % 36370.84 Unstable angina, % 36290.11 Previous PCI, % 26290.34 LVEF, mean±SD 57±1257±110.92 LVEF /

ANTIPLATELETS IN STROKE Prof. Ovidiu Bajenaru MD, PhD University of Medicine and Pharmacy “Carol Davila” Bucharest University Hospital of Emergency Bucharest.

bleeding was seen In patients with established atherothrombotic disease (CAD, cerebrovascular disease, or PAD) long-term clopidogrel plus ASA therapy resulted in a significant reduction in atherothrombotic events (MI/Stroke/CV Death/ hospitalization for vascular events) with no significant increase in severe bleeding compared to ASA alone Bhatt DL. Oral presentation at ACC 2006. Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS/

Rimodellamento Ventricolare e Conversione del Rimodellamento: soni processi confrontabili nei due sessi? Marisa Di Donato IRCCS San Donato Hospital University.

(SHAPE) ● Mitral valve incompetence (SIZE AND SHAPE) IRCCS Policlinico San Donato Sex Differeces after MI 0.02 0.001 0.05 496 pts (89 women) San Donato Hospital (unpublished) Pattern of LV Remodeling after Myocardial Infarction In Women % Concentric Eccentric Dilatation 496 pts / at the border of the lesion if VA present San Donato Hospital, Milano Italy Menicanti 2002 San Donato Hospital Series Pts submitted to SVR (2001-2009) O496 Patients with previous MI: 89 Women (age 68+/-10 yrs)** 407 Men (age /

Stents Are Not Enough: Recent Clopidogrel Data Rob Henderson Nottingham City Hospital Rob Henderson Nottingham City Hospital.

Stents Are Not Enough: Recent Clopidogrel Data Rob Henderson Nottingham City Hospital Rob Henderson Nottingham City Hospital Stent thrombosis - ‘Thrombus Horribilis’ In early 1990’s stent thrombosis occurred in ~4% of elective cases within 2d to 4 weeks Associated with high risk of MI (60-90%) and death (12-17%) In early 1990’s stent thrombosis occurred in ~4% of elective cases within 2d/

Myocardial Infarction  MI = heart attack  Defined as necrosis of heart muscle resulting from ischemia.  A very significant cause of death worldwide.

weeks  Healed myocardial infarct consisting of a dense collagenous scar. Microscopic features of myocardial infarction and its repair. Consequences and Complications of MI  1- Death: Unfortunately, 50% of the deaths associated with acute MI occur in individuals who never reach the hospital (within 1 hour of symptom onset-usually as a result of arrhythmias)  Extraordinary progress has been made in patient outcomes subsequent/

COURAGE. 15 US VA 19 US Non-VA Hospitals 1,355 patients 16 Canadian Hospitals 932 patients 50 Hospitals 2,287 patients enrolled between 6/99-1/04 A North.

Ratio (95% Cl)Number of EventsP Value PCI+OMTOMT Death and nonfatal MI2112021.05 (0.87-1.27)0.62 Death6874 Periprocedural MI359 MI108119 Death, MI, and stroke2222131.05 (0.87-1.27)0.62 Hospitalization for ACS1351251.07 (0.84-1.37)0.56 Death85950.87 (0.65-1.16)0.38 Total nonfatal MI1431281.13 (0.89-1.43)0/

Myocardial Infarction  MI = heart attack  Defined as necrosis of heart muscle resulting from ischemia.  A very significant cause of death worldwide.

weeks  Healed myocardial infarct consisting of a dense collagenous scar Microscopic features of myocardial infarction and its repair. Consequences and Complications of MI  1- Death: Unfortunately, 50% of the deaths associated with acute MI occur in individuals who never reach the hospital (within 1 hour of symptom onset-usually as a result of arrhythmias)  Extraordinary progress has been made in patient outcomes subsequent/

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