A team of researchers from UCLA and the University of Michigan has developed a material that could help prevent blood clots associated with catheters, heart valves, vascular grafts and other implanted biomedical devices.
Blood clots at or near implanted devices are thought to occur when the flow of nitric oxide, a naturally occurring clot-preventing agent generated in the blood vessels, is cut off. When this occurs, the devices can fail.
Some researchers have sought to solve this problem with implantable devices that gradually release nitric oxide, but their supply of the agent is necessarily limited. Instead, the UCLA

A new angiographic analysis of the CHAMPION PHOENIX trial examined the incidence and impact of stent thrombosis (ST) in patients undergoing percutaneous coronary intervention (PCI).

CHAMPION PHOENIX was a prospective, double-blind, active-controlled trial which randomised 11,145 patients to receive intravenous cangrelor or oral clopidogrel administered at the time of PCI. In a previous analysis presented at TCT 2013 and published in the Journal of the American College of Cardiology, cangrelor significantly reduced periprocedural and 30-day ischemic events in patients undergoing PCI.

In this new analysis, an independent core laboratory (CRF) blinded to the treatment performed the angiographic analysis of 10,939 of the randomised patients. Stent thrombosis was defined as the occurrence of either intraprocedural ST (IPST) or ARC defined ST (definite or probable). Adverse events were adjudicated by an independent clinical events committee.

ST occurred in 120 patients (1.1 percent) at 48 hours and in 175 patients (1.6 percent) at 30 days. The occurrence of ST at 48 hours and 30 days was associated with a marked increase in 30-day mortality (OR [95%CI] = 15.3 [8.6, 27.2], p<0.001; and 55.2 [36.6, 83.3] p<0.001, respectively). IPST, ARC acute ST (=24 hrs), and ARC subacute ST (1-30 days) occurred in 89 (0.8 percent), 32 (0.3 percent), and 60 (0.5 percent) patients respectively. Each type of ST was also associated with an increase in 30-day mortality (IPST: 17.4 [8.4, 36.1], p<0.001, ARC acute ST: 43.3 [18.1, 103.5], p<0.001, ARC sub-acute ST: 189.1, [107.9, 331.4], p<0.001). 'Regardless of the exact type of stent thrombosis, it remains associated with a high rate of death,' stated Deepak L. Bhatt, MD, MPH, Executive Director of Interventional Cardiovascular Programs at Brigham and Women

Scripps Whittier study shows potential for improving glycemic control in Latinos

As the effectiveness of anaesthesia, pain management and rehabilitation continues to improve, more orthopaedic procedures are being done on an outpatient basis. In a new research study same-day total joint replacement (TJR) patient outcomes were comparable to those of patients admitted to the hospital and staying at least one night following surgery. However, readmission rates, although statistically ‘non-significant,’ were higher for outpatient procedures. In a related study, a very low complication rate (.23 percent) was found in a review of more than 28,737 hand and upper extremity surgeries at an outpatient speciality clinic.
‘Our study supports the view that outpatient surgery can offer patients and physicians options for safe, cost-effective surgical care, offering improved patient comfort, increased efficiency and low complication rates.’
Many surgeons are now performing TJR as a same day procedure, with patients discharged within 24 hours of surgery. Outpatient TJR has ‘the potential benefit to cut costs and improve patient satisfaction,’ however, concerns for patient recovery, as well as increased Medicare scrutiny and financial penalties for unplanned hospital re-admissions within 30 days of surgery, is deterring some doctors and hospitals from routinely performing outpatient surgeries, said David N. Vegari, MD, a Philadelphia orthopaedic surgeon and lead author of the study, ‘Implications of Outpatient vs. Inpatient Total Joint Arthroplasty on Hospital Readmission Rates.’
In the study, researchers reviewed outcomes for 235 patients who underwent either outpatient (137 patients) or inpatient (98 patients) total knee or total hip replacement surgery between September 2010 and May 2011. Patients receiving outpatient surgery had a body mass index (BMI) =40 kg/m

Surgical decision making for sick, elderly patients should be orchestrated by a multidisciplinary team, including the patient, his or her family, the surgeon, primary care physician, nurses and non-clinicians, such as social workers, advocates Laurent G. Glance, M.D., in a perspective piece published.
For this group of patients, surgery can be very risky. Glance, professor and vice-chair for research in the Department of Anesthesiology at the University of Rochester School of Medicine and Dentistry believes a more patient-centred, team-based treatment approach would lead to higher quality care that matches the values and preferences of the sickest patients.
Usually, patients undergo a one-on-one consultation with their surgeon, who is frequently solely responsible for most of the decision making and management surrounding a possible surgical procedure. However, this traditional approach has potential pitfalls. For example, patients may not always be presented the full range of treatment options, such as medical treatment, less invasive surgical options, or watchful waiting.
‘Evaluating treatment options, formulating recommendations and articulating the benefits and risks to patients comprehensively require more than a well-informed or experienced surgeon,’ noted Glance, who is also a professor of Public Health Sciences and a cardiac anaesthesiologist at UR Medicine