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Physician-pharmacist collaboration versus usual care for treatment-resistant hypertension.
Smith, SM, Carris, NW, Dietrich, E, Gums, JG, Uribe, L, Coffey, CS, Gums, TH, Carter, BL
Journal of the American Society of Hypertension : JASH. 2016;(4):307-17
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Abstract
Team-based care has been recommended for patients with treatment-resistant hypertension (TRH), but its efficacy in this setting is unknown. We compared a physician-pharmacist collaborative model (PPCM) to usual care in patients with TRH participating in the Collaboration Among Pharmacists and Physicians To Improve Outcomes Now study. At baseline, 169 patients (27% of Collaboration Among Pharmacists and Physicians To Improve Outcomes Now patients) had TRH: 111 received the PPCM intervention and 58 received usual care. Baseline characteristics were similar between treatment arms. After 9 months, adjusted mean systolic blood pressure was reduced by 7 mm Hg more with PPCM intervention than usual care (P = .036). Blood pressure control was 34.2% with PPCM versus 25.9% with usual care (adjusted odds ratio, 1.92; 95% confidence interval, 0.33-11.2). These findings suggest that team-based care in the primary care setting may be effective for TRH. Additional research is needed regarding the long-term impact of these models and to identify patients most likely to benefit from team-based interventions.
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Role of physiological state 'normothermia' in internal thoracic artery spasm after harvesting.
Tarhan, A, Kehlibar, T, Yapici, F, Yilmaz, M, Arslan, Y, Yapici, N, Ozler, A
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2006;(5):749-52
Abstract
OBJECTIVE Vasospasm is often faced after the operative preparation of internal thoracic artery. Different vasodilating pharmacological agents are being used to eliminate this problem. During the preparation of internal thoracic artery, normal, local, and systemic temperatures are lost. We aimed to find out the effect of this decrease in temperature on the free flow of internal thoracic artery. METHODS We investigated the effects of normal saline solution at 20 degrees C (group I), papaverine at 20 degrees C (group II) and normal saline solution at 37 degrees C (group III). Each group contained 20 patients undergoing coronary bypass. Free flow of the left internal thoracic artery was measured after mobilization. After approximately 18 min the graft had been sprayed with one of the agents, and the second free flow was measured (t-interval was 18.2+/-2.1 for group I, 18.3+/-1.8 for group II, and 17.5+/-1.9 for group III). RESULTS Normal saline solution at 20 degrees C did not cause a significant change. Topical papaverine at 20 degrees C increased the flow from 42.1+/-10.7 ml/min to 77.5+/-17.9 ml/min (p < 0.0001). A significant increase also occurred with normal saline solution at 37 degrees C from 41+/-11.9 ml/min to 75.3+/-18.9 ml/min (p < 0.0001). CONCLUSIONS After harvesting the graft, regaining physiological normothermic state is enough for vasodilatation. Even using one of the most potent vasodilating agent papaverine at 20 degrees C is not superior to normothermia.