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Lainscak M.,University Clinic of Respiratory and Allergic Diseases Golnik | Lainscak M.,Applied Cachexia Research | Coletta A.P.,University of Hull | Sherwi N.,University of Hull | Cleland J.G.F.,University of Hull
European Journal of Heart Failure | Year: 2010

This article presents findings and a commentary on late-breaking trials presented during the meeting of the Heart Failure Society of America in September 2009. Unpublished reports should be considered as preliminary, since analyses may change in the final publication. The FAST trial showed somewhat better performance of intrathoracic impedance for prediction of deterioration in patients with heart failure (HF) when compared with daily weighing. The IMPROVE-HF study reported the benefits of education on the management of patients with systolic HF. Galectin-3 appeared a useful method for improving risk stratification of patients with chronic HF in a substudy of the COACH trial. A nuclear substudy of the HF-ACTION trial failed to demonstrate that resting myocardial perfusion imaging, a measure of myocardial scar and viability, was clinically useful. A small randomized controlled trial (DAD-HF) suggested that the use of low-dose dopamine in patients with acutely decompensated HF was associated with less deterioration in renal function and less hypokalaemia. The MARVEL-1 trial raises further concerns about the safety of myoblast transplantation in ischaemic HF. Source

Rozman A.,University Clinic of Respiratory and Allergic Diseases Golnik | Rozman A.,University Clinic of Respiratory and Allergic Diseases | Camlek L.,University Clinic of Respiratory and Allergic Diseases | Marc-Malovrh M.,University Clinic of Respiratory and Allergic Diseases | And 2 more authors.
Respirology | Year: 2013

Background and objective Thoracoscopy with a semi-rigid instrument is a recent technique successfully used for diagnosing pleural diseases. However, there are concerns about the diagnostic adequacy of biopsy samples obtained by semi-rigid procedures when compared with rigid thoracoscopy. The purpose of this study was to compare the size, quality and diagnostic adequacy of biopsy specimens obtained at semi-rigid and rigid thoracoscopy in a prospective, randomized fashion. Methods Patients with pleural effusion of unknown origin and/or pleural irregularities suspicious for pleural malignancy were included after less invasive means of diagnosis had failed. All procedures were performed under local anaesthesia with intravenous sedation/analgesia with a single point of entry. Patients were randomly assigned to a rigid instrument procedure (Olympus EndoEYE WA50120A, forceps) or semi-rigid instrument procedure (Olympus LTF-160, FB-55CR-1 forceps). Results Eighty-four patients were randomized. Five of them were excluded because of lack of pleural space. Thirty-eight patients were assigned to a rigid and 41 to a semi-rigid procedure, with mean follow up 24.1 (±8.1) months after the procedure. The average size of the sample obtained by rigid thoracoscopy was 24.7 mm2 (±12.9), and 11.7 mm2 (±7.6) by semi-rigid thoracoscopy. There were no differences in the quality and interpretability of the specimens assessed by the pathologist. The diagnostic accuracy was 100% for the rigid procedure and 97.6% for the semi-rigid procedure. Conclusions The samples obtained by semi-rigid thoracoscopy were smaller, but of adequate quality. The diagnostic accuracy was comparable with that of rigid thoracoscopy in the evaluation of pleural disease. © 2013 Asian Pacific Society of Respirology. Source

Lainscak M.,University Clinic of Respiratory and Allergic Diseases Golnik | Lainscak M.,Applied Cachexia Research | Podbregar M.,University of Ljubljana | Kovacic D.,General Hospital Celje | And 3 more authors.
Respiratory Medicine | Year: 2011

Chronic obstructive pulmonary disease (COPD) frequently coexists in patients with chronic heart failure (CHF) and is a key factor for beta blocker underprescription and underdosing. This study compared effects of bisoprolol and carvedilol in patients with both conditions. This was a randomized open-label study, of bisoprolol and carvedilol during initiation and uptitration to target of maximal tolerated dose. Pulmonary function testing, 12-lead electrocardiogram, and N-terminal pro brain natriuretic peptide were measured at baseline and follow-up. We randomized 63 elderly patients (73±9 years, 81 men, left ventricular ejection fraction 33±7) with mild to moderate CHF (54 New York Heart Assocation class II) and moderate to severe COPD (76 Global initiative for chronic Obstructive Lung Disease stage 2). Target dose was tolerated by 31 (49) patients and 19 (30) patients experienced adverse events during follow-up (19 bisoprolol, 42 carvedilol, p = 0.045). Study medication had to be withdrawn in 8 (13) patients (bisoprolol: 2 due to hypotension, 1 due to bradycardia; carvedilol: 2 due to hypotension and 1 due to wheezing, dyspnoea, and oedema, respectively). Forced expiratory volume in 1 st second significantly increased in bisoprolol (1561±414ml to 1698±519ml, p = 0.046) but not carvedilol (1704±484 to 1734±548, p = 0.44) group. Both agents reduced heart rate (bisoprolol: 75±14 to 68±10, p = 0.007; carvedilol 78±14 to 72±12, p = 0.016) and had no effect on N-terminal pro brain natriuretic peptide. Beta blockers frequently caused adverse events, and thus 49 of patients could tolerate the target dose. Bisoprolol induced demonstrable improvement in pulmonary function and caused less adverse events. © 2011 Elsevier Ltd. All rights reserved. Source

Farkas J.,University of Ljubljana | von Haehling S.,Applied Cachexia Research | Kalantar-Zadeh K.,University of California at Irvine | Morley J.E.,Saint Louis University | And 4 more authors.
Journal of Cachexia, Sarcopenia and Muscle | Year: 2013

Perception of healthy body size and composition differs considerably across the globe, ethnic groups, cultures, and even inside medical community. Although the concept of ideal body weight has evolved over the past decades, the observation that weight loss can have more deleterious effects within a short-term period than weight gain has remained rather consistent. Weight loss, as a prelude to cachexia, occurs frequently in a variety of disease states and meets the requirements of a global public health problem. Consequently, interventions to prevent and control chronic diseases require a comprehensive approach that targets a population as a whole and includes both prevention and treatment strategies. Around the globe, cachexia awareness campaigns and expanding the current public health priorities to highlight the cachexia magnitude and areas of interventions is necessary. Simultaneously, scientific efforts should provide us with more reliable estimates of body wasting and cachexia as well as pathophysiology of cachexia-associated death. As certain proportion of patients will, irrespective of preventive measures, eventually develop cachexia, a quest for effective remedy remains vital. © 2013 Springer-Verlag Berlin Heidelberg. Source

Knez L.,University Clinic of Respiratory and Allergic Diseases Golnik | Suskovic S.,University Clinic of Respiratory and Allergic Diseases Golnik | Rezonja R.,University of Ljubljana | Laaksonen R.,University of Helsinki | Mrhar A.,University of Ljubljana
Respiratory Medicine | Year: 2011

Poor communication of drug therapy at care interface often results in medication errors and adverse drug events. Medication reconciliation has been introduced as a measure to improve continuity of patient care. The aim of this cross-sectional observational study was to evaluate the need for medication reconciliation. Comprehensive information on pre-admission therapy was obtained by a research pharmacist for adult medical patients, admitted to a teaching hospital, specialised in pulmonary and allergic diseases, in Slovenia. This information was compared with the in-patient and discharge therapies to identify unintentional discrepancies (medication errors) whose clinical significance was determined by an expert panel reaching consensus. Most of the included 101 patients were elderly (median age: 73 years) who had multiple medications. Among their in-patient drugs (880), few discrepancies were a medication error (54/654), half of which were judged to be clinically important. A higher rate was observed in the discharge drug therapy (747): 369 of the identified discrepancies (566) were a medication error, over half of which were judged as clinically important. A greater number of pre-admission drugs, poorly taken medication histories and a greater number of medication errors in in-patient therapy predisposed patients to clinically important medication errors in discharge therapy. This study provided evidence in a small sample of patients on the discontinuity of drug therapy at patient discharge in a hospital in Slovenia and its implications for patient care. To ensure continuity and safety of patient care, medication reconciliation should be implemented throughout a patient's hospital stay. © 2011 Elsevier Ltd. All rights reserved. Source

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