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Revascularization for Isolated Proximal LAD Disease: PCI is Easiest, but is it Best?
Among patients with obstructive coronary disease requiring revascularization, guidelines would suggest a clear preference for coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) only in certain defined subsets, including those with left main disease and in diabetics with multi-vessel disease. Patients with isolated proximal LAD disease represent a unique high-risk subset of those with single-vessel disease, in that the size of the affected territory and associated ischemic risk makes CABG a viable option. In fact, U.S. guidelines currently assign a slight advantage to CABG with a left internal mammary graft to the left anterior descending (LAD) for such patients, rating this as a IIa indication vs a IIb recommendation for PCI. This is despite a relative paucity of data on this subset of patients, at least using contemporary treatments. In fact, of the nine randomized, controlled trials forming the basis for 17 published studies examining this question, most are quite small, and all but one were performed using bare-metal stents; the single small RCT incorporating drug-eluting stents (DES) used first-generation devices that are no longer part of the treatment landscape.
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Progress lags on needlestick prevention
Needlestick injuries remain stubbornly common, despite a long-standing federal law and worker safety regulations requiring an annual review of safety devices. Forging a path to improvement requires collaboration with hospital purchasing and quality improvement, says the coordinator of the nation’s most comprehensive needlestick surveillance system.
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New model significantly reduces boarding of psychiatric patients
No problem has proven more vexing to ED leaders in recent years than the issue of boarding related to patients with mental health concerns. It is not unusual for these patients to be held in the ED for hours, if not days, before a psychiatric bed is found. This has the effect of running up the healthcare tab while bogging down throughput, and it leaves virtually no one satisfied.
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Actively engage patients following these simple tips
Evidence-based health coaching (EBHC), a novel approach to engaging patients, combined with motivational interviewing can produce lasting change because it delves into the reasons behind patients’ resistance, one expert says.
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Examples of EBHC And MI in practice
The traditional provider-patient exchange can result in misunderstanding and a patient’s incomplete knowledge of what he or she needs to do to maintain better health, one expert says.
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Patient Engagement is Goal for Case Managers
Case managers can help patients with health behavior changes by combining evidence-based health coaching and motivational interviewing.
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Case Management, Advocacy and the Affordable Care Act
With the surge in the number of newly insured under the Affordable Care Act, case managers increasingly need to serve as patient advocates.
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