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Prasugrel, a novel third-generation oral thienopyridine (following ticlopidine and clopidogrel), has recently been shown to provide clinically important platelet inhibition in acute coronary syndromes (ACS), with decreased ischemic events compared to clopidogrel in the TRITON-TIMI 38 trial of almost 14,000 ACS patients undergoing PCI.
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Coronary artery stenoses involving the proximal left anterior descending coronary artery (LAD) have caused significant concern for clinicians over the years. If these lesions give rise to a myocardial infarction, this is often termed the "widow maker" because of the large area of myocardium subtended by the LAD and the high mortality associated with proximal LAD occlusion.
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Unfractionated Heparin (UFH) is the standard bridging therapy for patients with mechanical heart valves who need to temporarily stop oral anticoagulants. Small case series have suggested that low molecular weight heparin (LMWH) may be useful for this purpose.
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5-α reductase inhibitors and hip fracture in men; the effects of drug-reimbursement policy on outcomes; new guidelines for type 2 diabetes; beta-blocker-associated brady-cardia is linked to CVD events; FDA Updates.
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"Throughout our health care system, VA patients and staff face difficult and potentially life-altering decisions every day whether it be in clinics, in cubicles, or in council meetings. In the day-to-day business of health care, uncertainty or conflicts about values that is, ethical concerns inevitably arise." IntegratedEthics: Improving Ethics Quality in Health Care (U.S. Department of Veterans Affairs monograph)
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The IntegratedEthics program developed by the Department of Veterans Affairs (VA) for its facilities, which comprise the largest health care system in the United States, has drawn interest and attention both domestically and internationally.
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Even with the driven culture of modern medicine, one study published recently in the Journal of Medical Ethics found that 73% of 338 respondents said that they usually discuss their mistakes with their colleagues.
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"Increasingly, physicians and managed care organizations are being held accountable for quality of care based on the processes and outcomes of medical care and patient satisfaction. Yet high-quality care delivery involves more than good technical quality and acceptable customer service it also means upholding high ethical standards."
